When the CDC issued “Practical Covid-19 Guidance for Funeral Directors” in late February,
2020, it was apparent that the world had reached an inflection point. Seemingly overnight, “business as usual” became “how we do business today and maybe tomorrow.”
Dr. David Berendes of the CDC said that the purpose of the protocols was to “encourage alternative options to gatherings.” Contact with the deceased loved one was restricted, gatherings at the funeral home were limited to immediate family and friends (national standard was ten people), and strict sanitation measures were enforced– elbow bumps replaced hugs, and Purell became the coin of the realm.
It was predicted that by the time June 2020 summer winds were blowing, the pandemic would have disappeared. It was also hoped that the inconvenience of the CDC funeral standards would ease. These hopes, unfortunately, turned out to be naïve. Fourteen months have now passed and the virus variants are entrenched.
Measuring the socioeconomic consequences of the virus will likely take decades to determine.
“Much like the terrorist attacks of September 11, 2001, the Covid-19 pandemic is likely to produce some changes that will be felt for years to come and will change the way we live, work, and govern,” a report from the National Intelligence Council recently stated.
The study suggested that the pandemic could potentially “erode faith” in societal order: polarization and lack of civic cohesion could make for a volatile, chaotic global environment.
Historians have long established that plagues can indelibly modify human behavior on a monumental scale. Economic systems have been reordered, political power obstructed — even Napoleon’s military advances were waylaid by disease.
Aside from alterations in actual funeral services, Covid-19 has reframed deathcare in two powerful ways: cremations have risen at record rates and the process of mourning has been seriously interrupted.
Prior to the onset of the virus, cremations had already been on a 20-year growth spurt in North America. 2015 was a landmark year — that was the point when cremations first surpassed traditional burial services. Although the final numbers for 2020 have not been announced, it is anticipated cremations may have jumped another 5 percent.
Obviously, given the restrictions on gatherings and travel bans, traditional funerals were bound to decline; whether the public will return to these practices when the pandemic ebbs
is an open question.
The disruption the virus has caused in grief recovery is a very disturbing development, especially because social scientists now know much more about bereavement than they did in the past. On Death and Dying, which Dr. Elisabeth Kübler-Ross published in 1969, was a landmark work: the five stages of grief which she posited (denial, anger, bargaining, depression and acceptance) gained wide popular currency. But those stages were based on anecdotal accounts, not really suited for a universal model.
Today, we realize that not everyone experiences grief in the same stages. It’s a natural reaction to a loss that proceeds in fits and starts; one pattern does not represent all. Generally speaking, people move from an acute phase of grief to an abiding acceptance of death.
Dr. Katherine Shear, a psychiatrist and Columbia professor, has written and spoken extensively about how the pandemic can “derail” people as they come to terms with a loss.
“Covid-19-related social distancing has a major impact on the grieving process in a number of ways,” Shear told Psychiatry Advisor. “People often cannot be present with their loved ones during the dying process. This raises a host of potential reactions.”
Among these reactions is acute “survivors guilt…the sense of discomfort or distress about having been spared the adversity the deceased endured,” Shear said. “Additionally, knowing that the deceased person has suffered, may have died alone…can increase feelings of personal guilt.”
Shear observed, “The bereaved person may not have had the opportunity to say good-bye to the loved one, leaving many things unsaid and resulting in a lack of closure. And not being with the person…can increase the sense of disbelief and make it more difficult to accept that the death actually occurred.”
After the passing, physical distancing policies shape final disposition rituals — not just the funeral itself, but religious observances, family gatherings, community support, and other healing opportunities.
According to Shear, the pandemic could produce an increase in patients who present Prolonged Grief Disorder — “a disturbance that causes clinically significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.”
How large a problem is this? It is estimated that each of the over half million Covid-19 deaths in this country are associated with at least nine loved ones. All potential victims of the upheaval of the pandemic.
Epidemiologist Michael Osterholm summarized the entire situation well: “This isn’t a pandemic of just a virus. This is a pandemic of emotion…this is not just a public health journey. This is really a personal journey for all of us.”