The Coming Pandemic

The aftermath of the COVID-19 pandemic will be a pandemic of complicated grief.

Posted Jun 23, 2020

As we cope with the current COVID-19 pandemic, there are questions of whether we will face a second wave of infection now that rules about quarantines are being relaxed, stores are slowly re-opening, and gatherings—albeit somewhat limited—are once again being permitted.

Since I am not an epidemiologist or medical doctor, I have to confess that I have no evidenced-based opinion on a second wave. I do, however, predict another pandemic emerging in the aftermath of COVID-19—a pandemic of complicated grief.

The unfortunate truth is that the very nature of the COVID-19 pandemic is that it encompasses many factors that are likely to complicate grief—including both deaths from the new virus as well as deaths from other causes that are occurring during the pandemic.

First is sheer numbers. As I write this in June 2020, the Centers for Disease Control and Prevention has identified over 2 million COVID-19 cases in the United States with over 100,000 deaths. What's more, the coronavirus also creates a sense of underlying anxiety as we are now forced to cope with a new disease that has unpredictable effects. The disease seems very random in its effects—some seem asymptomatic, others experience symptoms much like a cold or flu, and still others die.

One of the most difficult aspects of the pandemic is that those who are dying in hospitals or nursing homes are often dying alone—the very antithesis of our image of a good death. Not only does the company of others ease dying but it also facilitates the subsequent grief of survivors. It offers family and friends the opportunity to say goodbye, finish business, and share memories. For dying persons, the presence of these significant others validates their life, allows them to say final words, and offers the comfort and care that family and friends offer.

Moreover, quarantines, travel restrictions, and limits on gatherings impair the rituals surrounding dying and death. Chaplains and other clergy may be unable to be present to offer deathbed rituals such as prayers or last rites—again complicating images of a good death. We may not be able to have the funeral rituals we desired and feel the comfort of the presence of family and friends. And even if we seek out support from counselors or support groups, it is likely to be offered online—missing, to some degree, that critical human connection.

Then too, survivors may be coping with concurrent crises—a factor that further complicates grief. Because of the disruption of life caused by the pandemic, grieving individuals may be coping with multiple losses—of others they know, of jobs or income, or any other loss created by the pandemic.

For those who have died of the COVID-19 virus, there are other factors that complicate loss. As stated earlier, the disease itself is both sudden and unpredictable. Some may die with little warning. Family members may struggle with spiritual issues—wondering why this disease emerged and why it killed someone they loved.

There may be survivor guilt—raising the question of how one died while the mourner survived—especially if both were infected. There can also be death causation guilt arising from the thought or suspicion that the mourner was the source of infection.

For non-COVID-19 deaths, there may be anger that the emergence of the disease affected both the death and funeral of a loved one. Mourners may feel disenfranchised—perceiving that those who died of the virus receive acknowledgment and support while their losses are neglected.

The nature of the pandemic, then, is likely to leave a host of psychological issues ranging from hypochondrias, anxiety, and all the varied forms of complicated grief. Perhaps it is unrealistic to expect scientists and physicians to have forecast the emergence of this new pandemic. Yet, as therapists, we ought to expect and prepare for the next pandemic—a pandemic of problematic grief that will likely follow.