How the grief of one million COVID-19 deaths in the United States hurts us all

The United States recently reached 1 million deaths from COVID-19, which was incomprehensible at the start of the pandemic. People have lost parents, children, friends and other loved ones, and the pandemic has turned into a perpetual dark cloud under which we all have to live.

And living with it, said Stanford Medicine psychiatrist David Spiegel, MD, means living with prolonged grief that is felt not only by people whose loved ones have died, but also by the collective community.

To take a step back, I asked Spiegel to talk about community bereavement, the impact it has on the health of individuals and communities, what we can do to care for ourselves and others, and how we resume our normal activities even if we accept that COVID-19 will still be with us for a while. The following questions and answers are edited and condensed from my conversation with Spiegel, who is the director of the Stanford Medicine Center on Stress and Health.

Unfortunately, the pandemic is a disaster that everyone experiences every day, in one form or another, unlike other common causes of grief and death like gun violence, cancer and other illnesses. These deaths don’t have the commonalities that COVID-19 has.

Another factor is the sheer scale of deaths caused by the virus: for every person who dies, there are likely five to 20 people who were close to them and are suffering a terrible and unexpected loss.

It’s one thing if you have terminal cancer; it’s a terrible thing, but you know you have time to decide how you want to spend the time you have left, to settle your affairs, and to prepare your loved ones for your death.

Deaths from COVID-19 can happen suddenly and many people have died without being able to see, hold, speak or say goodbye to those closest to them. For their loved ones, this lack of closure complicates grief, adding further fear and uncertainty to the already collective fear about COVID-19.

What is the impact of prolonged mourning on individuals and communities?

It gets demoralizing after a while, kind of feeling unavoidable. During grief, there is usually a period of intense longing, loss, and sadness, and then you re-enter the world and eventually move past the intense period.

Now it feels like this endless drumbeat of the threat of illness and loss, one after the other.

We have had to endure many disruptions, including in our ability to do what our grandmothers told us to do to stay healthy: eat well, sleep well, exercise a lot. During lockdown, many of us have been underexposed to sunlight, which helps regulate your circadian rhythms by signaling our bodies when to be active (during the day) and when to sleep (at night).

The pandemic has also disrupted some of the fundamental mechanisms for maintaining health and responding to stress: the dysregulation of circadian rhythms and stress hormones like cortisol – which is important for regulating glucose metabolism – has real adverse effects on health. It can increase the risk of diabetes, obesity and heart disease

Our research found that women with advanced breast cancer who lacked a normal cortisol circadian rhythm, which should be high in the morning and low in the evening, died of breast cancer earlier.

Who do you think is most affected by prolonged grief?

Some of the people who have suffered the most in our studies and in others are, curiously, young people – the people who, from a mortality point of view, are the least at risk. But they suffer more because in your late teens and twenties there is a crucial life transition where you move beyond your family of origin and build your own family. And it’s very difficult to do now; people are just more isolated and there is also a new danger to navigate.

It has also interfered with social engagement which is important for young people, adding more pain and disruption for them. Childhood and early adulthood should be fun, and being constantly surrounded by danger and loss puts a brake on the expansion of this stage.

How can we, as a collective community, come together to support each other?

Masks and vaccines have a real psychological benefit – they not only help protect you, but also make you feel like you’re doing something to reduce the risk of this terrible pandemic.

The uncontrollable loss of COVID-19 makes you feel helpless. But taking steps to prevent yourself from getting sick is in your control. And it protects you and your family, and your community. You are engaged in a common task to make the world as safe as possible and to strengthen your commitment to your community.

These security measures also make it possible and pleasant to resume cautious social activity. We are social creatures, so let’s make the most of our opportunities to reconnect.

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