Drive-by burials and FaceTime farewells: Grief in the Covid era will weigh on the American psyche for years to come

The rituals of grief and mourning are as old as time: the swift Jewish burial and seven days of sitting shiva to honor the dead; the Muslim washing and three-sheeted shrouding of a body; the solemn Mass of Christian Burial with Holy Communion and the promise of an afterlife. All these — and other rites of faith and community across the globe — have been brutally curtailed by the Covid-19 pandemic, with effects on the mental and physical health of those left behind that have yet to be grasped.

It’s become commonplace to measure the virus’ death toll in terms of the casualties of war: In the United States alone, the fatalities already amount to five Vietnams, more than 40 Iraqs and Afghanistans and upward of 95 9/11s. Americans could mark all those past losses together, with hugs and handholding, collective tears and tender mercies, candlelight vigils and choruses of “God Bless America.” By contrast, in bedside farewells via FaceTime, drive-by burials as under-attended as Jay Gatsby’s, and digital funerals on Zoom, we’ve been forced to mourn the victims of the novel coronavirus in a numbing new way: more or less alone.

“If circumstances are such that you have to grieve alone … you can’t get the support that you may really need,” said M. Katherine Shear, founder and director of the Center for Complicated Grief at Columbia University, and an expert on the study and treatment of what’s come to be known as “prolonged grief disorder.” “There are so many scenarios that people are experiencing right now that they in a sense don’t have the capacity to take the time,” added Shear, an internist and psychiatrist who noted that the negative health effects of unresolved grief on the human cardiovascular and immune systems are well-established, along with heightened risks for conditions such as anxiety, depression, substance use, and post-traumatic stress disorder.

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Lack of contact and comfort from other people can slow the process of acceptance of the reality and meaning of a loss, and keep the intensity of grief “profound and at center stage,” Shear said. At the same time, she said, most people have long been forced to integrate grieving into the conflicting demands of daily life — going to work, caring for children, keeping on keeping on. “It’s one of the ways that people have probably grieved from time immemorial, because you can’t always have the people around you you need, and you can’t always have the time and space.”

Indeed, unexpected circumstances require adaptation, as the Harvard historian Drew Gilpin Faust observed in her acclaimed 2008 book, “This Republic of Suffering: Death and the American Civil War.” The conflict, which killed 2% of the country’s population — the equivalent of 6 million people today — reshaped the prevailing treatment of death, including by prompting the rapid spread of embalming, so that families could safely transport their loved ones home from distant battlefields. As Faust noted in the Washington Post last spring, the current pandemic has once again “made death’s customary rituals impossible, overturning the forms and observances that counter the rupture of bereavement with the affirmation of community and continuity.” In her view, the challenge now is to learn “how to reaffirm our humanity and community as we come to terms with the mortality that defines, unites and ultimately engulfs us all.”

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Red Smith, 59, a veteran tech executive and entrepreneur in the San Francisco Bay Area, experienced these dislocations profoundly last summer after his healthy 83-year-old father, Warren, visited from his home in Southern California for a small Father’s Day gathering, then contracted Covid-19, took to a hospital upon returning home, and died there after three weeks spent alone.

“I was very, very close to my dad, so not being able to be with him was very, very hard,” Smith, a family friend, told me recently by phone. Eventually, his father’s nurses disconnected the elder Smith’s oxygen just long enough for him to be propped up near a window, where he could see the family standing on a small knoll outside the hospital, holding signs saying, “We Love You,” and “Fight As Hard as You Can.” He died two days later.

But that only “transitioned to the next pain,” Smith explained: a two-week wait for cremation at an overburdened mortuary. “It was very unsettling to me to think of him on some slab in a refrigerator somewhere.” By the time that wait was over, Covid was raging throughout the Los Angeles area and the Smiths held only a small, socially distanced graveside service, with none of his father’s octogenarian friends present. They eventually planned a memorial mass for the Monday after Thanksgiving but were forced to cancel it with Covid cases once again surging.

“I don’t think I’ve been able to complete — complete’s the wrong word but — but I don’t think I’ve been able to fully process his death,” Smith said. “It’s on television every day — every day is Covid, whether it’s reports on how the government mismanaged it, or the latest infection rate or the death rate or even the hero first responders. There’s no escape from this death. It’s glaring and fully frontal for me, and I can’t stand it but I can’t change it.”

More than 50 years ago, the Swiss-American psychiatrist Elisabeth Kübler-Ross posited a five-stage continuum of grief, summed up in sequential phases of denial, anger, bargaining, depression, and acceptance. Many experts today regard the process as less determinative and more dynamic, but there is near-universal agreement that grief is a process, not a one-time, overnight phenomenon. And that process has long depended importantly on collective gatherings, from the ancient Jewish ritual of covering mirrors and opening one’s home to friends — sometimes sitting on low stools, so as to be literally “brought low” by grief — to the boisterous catharsis of an old-fashioned wake. In the case of the sudden or traumatic deaths of people in their prime, such gatherings have often been quite large indeed, and even oddly jolly.

“They were a sociable people but they didn’t get much chance for sociability,” the novelist Edwin O’Connor wrote of an early 20th century Boston Irish wake in “The Last Hurrah.” “They were poor, they worked hard, and they didn’t have much in the way of diversion. Actually, the only place people got together was at the wake. Everybody knew everybody else; when somebody died, the others went to pay their respects and also to see and talk to each other. It was all part of the pattern.”

It is a paradox of Covid that in the very midst of a crisis in which mourners might most crave solidarity and shared company, the virus’ infectiousness has forced grieving families into virtual isolation. A survey by the World Health Organization found that the coronavirus had disrupted access to mental health services in more than 90% of countries.

Similarly, a survey by the Kaiser Family Foundation in midsummer revealed that more than half of American adults reported that their mental health had been negatively affected by the pandemic, up from 32% in March, while more than 10% noted an increase in alcohol use or substance use and a like amount reported a worsening of preexisting chronic health conditions.

Guidelines from the Centers for Disease Control and Prevention note that the pandemic can cause fear and worry about one’s health and economic security, prompt difficulties in sleep and concentration, and anxiety about the loss of routine support services people normally rely on, including child care.

The exigencies of Covid funerals have not been without some unexpected compensations. Mark Eden Horowitz, a longtime music specialist at the Library of Congress in Washington, where he oversees the care of the manuscripts of Irving Berlin, the Gershwin brothers, and others, lost his 87-year-old father, Terry, a retired architect and writer, to the virus in September. (His mother, Judy, was hospitalized with the virus at the same time, but recovered). Though he had worried about the technology involved, a Zoom funeral came as a kind of relief, in part because it absolved him and his family of the brisk burial that Jewish tradition would normally have required.

“It turned out we had almost a week to make the arrangements,” he said, “because with Covid, the cemetery was heavily booked. That gave me time to figure out who to contact and get email addresses and figure out who would speak. It would have been much more difficult had we only had the typical two days. … About 75 households ended up ‘attending’ and about 10 of us spoke. The funeral home arranged for a rabbi and a family friend is a cantor who actually insisted on being at the graveside along with the rabbi.”

Horowitz added, “I suppose it would have been nice to have seen a few people in person. But I’m not sure. I certainly wouldn’t have been more comforted.” It was, he said, “in many ways the best of the funerals I’ve attended.”

Indeed, all around the country, people have devised new ways of sharing their grief. The Dinner Party, a nonprofit founded a decade ago to help bereaved 20- and 30-somethings reflect on their grief over shared meals, has now gone virtual on Zoom and other platforms, drawing digital mourners from more than 100 cities in the United States, Canada, England, and Australia to “join the club nobody wants to join.”

Already, some experts have said they expect prolonged grief syndrome to “become a major public health concern” because of the pandemic. Columbia’s Shear said she has yet to see detailed clinical studies of the effects of Covid on grieving, and says that more time will be needed to gauge the ultimate impacts. In fact, it will likely take decades before the full burden of the pandemic can be measured.

Just as doctors have already identified cases of Covid “long haulers,” whose symptoms and attendant physical and cognitive complications linger long after the virus has left their systems, so there are bound to painful lingering effects on the collective psyche, long after the pandemic subsides.

Nancy Bristow, a historian at the University of Puget Sound, in her 2012 book, “American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic,” explored how a crisis that killed some 675,000 Americans — roughly equivalent to the death toll in the Civil War — managed to become virtually forgotten in the American consciousness within just decades, as the public focused instead on the optimism of the era, particularly when it came to the development of modern medicine.

That response, Bristow wrote, “was meaningless or worse for some of those who suffered most deeply,” including the novelists Katherine Anne Porter, who survived a devastating bout with the flu, and Thomas Wolfe, who lost a beloved brother to it. For them, Bristow wrote, “memories of the pandemic experience remained both painful and persistent.” Indeed, Bristow noted, in the aftermath of the epidemic, “some Americans felt only grief, and lived quietly for decades to come with a profound sense of loss.”

At a moment when it seems almost inconceivable that Covid will fade from the headlines soon, it is a sobering reminder of the depth and duration of heartache being felt in our own time.

Source: STAT