Four years on, the COVID-19 pandemic has a long tail of grief

March 11 marks the fourth anniversary of the World Health Organization’s declaration that the COVID-19 outbreak was a pandemic. COVID-19 hasn’t gone away, but there have been plenty of actions that suggest otherwise.

In May 2023, WHO announced COVID-19 was no longer a public health emergency (SN: 5/5/23). The United States shortly followed suit, which meant testing and treatments were no longer free (SN: 5/4/23). And on March 1 of this year, the U.S. Centers for Disease Control and Prevention loosened their isolation guidelines for people with COVID-19. Now the CDC says infected people can be around others as soon as a day after a fever subsides and symptoms are improving, even though someone is contagious during an infection for six to eight days, on average (SN: 7/25/22).

These outward signs of leaving the pandemic chapter behind neglect to acknowledge how many people cannot (SN: 10/27/21). Nearly 1.2 million people have died in the United States from COVID-19. Close to 9 million adults have long COVID. Nearly 300,000 children have lost one or both parents.

There has been little official recognition in the United States of the profound grief people have experienced and continue to experience. There is no federal monument to honor the dead — mourners have constructed their own memorials. A resolution to commemorate the first Monday of March as “COVID-19 Victims Memorial Day” awaits action by the U.S. Congress.

Many people are coping not just with the deaths of family and friends from COVID-19, but with how the pandemic robbed them of the chance to say goodbye to loved ones and grieve with their family and community. Researchers are studying the extent to which these losses rippled out into society and how the pandemic interrupted the grieving process.

Emily Smith-Greenaway, a demographer at the University of Southern California in Los Angeles, was part of team that estimated that for every one COVID-19 death, there are nine bereaved family members (SN: 4/4/22). Sarah Wagner, a social anthropologist at George Washington University in Washington, D.C., leads a project called Rituals in the Making, which is examining how the pandemic disrupted rituals and the experience of mourning through interviews with mourners and death care workers, among other research methods. Science News spoke with Smith-Greenaway and Wagner about their work. The interviews have been edited for length and clarity.

SN: Why is it important to estimate the number of close family members affected by COVID-19 deaths?

Smith-Greenaway: We typically quantify mortality events in terms of numbers of casualties. By shedding light explicitly on the concentric circles of people surviving each of the deaths, we offer a much more experiential perspective — the burden that a large-scale mortality event imposes on those who are still alive. It also allows us to kind of rescale the true sense of the magnitude of the crisis.

[With the number of deaths today,] our model demonstrates that about 10.5 million people have lost a close relative to COVID, [which includes] grandparents, parents, siblings, spouses and children. We’re not even capturing cousins, aunts, uncles. Think about how many children lost teachers or how many neighbors or friends or coworkers [died]. This is an underestimate when we’re thinking about the many people who are affected by each single death.

SN: What motivated the Rituals in the Making project?

Wagner: We began in May of 2020, and this was this period of heightened pandemic restriction and confinement. We posed what we saw as a fundamental question: How do we mourn when we cannot gather? Particularly in that first year, we were focused on the rituals around funeral, burial and commemorative practice and how they would be impacted and changed by the pandemic. In the last two years, [the project] has included the ways in which misinformation also compounds individual grief and more collective mourning.

A throughline in the research is that this mourning was interrupted and constrained by the conditions of the pandemic itself, but also troubled by politicization of the deaths. And then [there’s] this expectation that we move on, we push past the pandemic, and yet we have not acknowledged the enormity of the tragedy.

SN: Why are rituals and memorials important to grieving?

Wagner: We think about rituals as providing a means to respond to rupture. We are able to come together, gathering to stand before a coffin to say goodbye, or to have a wake, to sit down and have a meal with the bereaved. They are about providing an opportunity to remember and honor that loved one. But they are also about the living — a way of supporting the surviving family members, a way of helping them out of the chasm of that grief.

Memorials [such as a day of remembrance or a monument] are a nation saying, we recognize these lives and we anoint them with a particular meaning. We think about memorials as forms of acknowledgement and a way of making sense of major tragedies or major sacrifices.

In the context of the pandemic, the rituals that are broken and [the lack of] memorials at that national level help us see that the mourners have been left in many ways to take memory matters into their own hands. The responsibility has been pushed onto them at these acute moments of their own grief.

SN: How has the pandemic impacted survivors and the grieving process?

Smith-Greenaway: Societies have demographic memory. There is a generational effect any time we have a mortality crisis. A war or any large-scale mortality event lingers in the population, in the lives and memories of those who survived it.

This pandemic will stay with us for a very long time. [There are] young people who remember losing their grandma, but they couldn’t go see her in the hospital, or remember losing a parent in this sudden way because they brought COVID-19 home from school. So many lives were imprinted at such an early stage of life.

Wagner: Whether we are talking to the bereaved, members of the clergy, health care workers or staff from funeral homes, people describe the isolation. It is incredibly painful for families because they weren’t able to be with their loved one, to be able to touch someone, to hold their hand, to caress a cheek. People were left to wonder, “was my loved one aware? Were they confused? Were they in pain?” [After the death], not being able to have people into one’s home, not being able to go out. That sort of joy of having other people around you in your depths of grief — that was gone.

As the study progressed, [we learned about] the impact political divisiveness had on people’s grief. [Families were asked,] did the person have underlying health issues? What was the person’s vaccination status? It was as if the blame was getting shifted onto the deceased. Then to be confronted with, “this is all just a hoax,” or “[COVID-19 is] nothing worse than a bad cold.” To be a family member, and to struggle for recognition in the face of these conversations that their loved ones’ death and memory is not just dismissed, but in a way feels denied.

SN: How can society better support the need to grieve?

Smith-Greenaway: Bereavement policies are not very generous, as we would expect in America. Sometimes it’s one, two or three days. They’re also very restrictive, where it has to be a particular relation.

Think about kids. I’m a professor at a university. There’s this callous joke that college students just tell you their grandmother died because they don’t want to turn something in. This reflects how we treat bereavement as a society, especially for young people. Kids’ grief can often be misunderstood. It’s perceived to be bad behavior, that they’re acting out. I think we need comprehensive school policies that take better care to recognize how many kids are suffering losses in their lives.

Wagner: We’re enveloped in this silence around pandemic death. I think there’s a willingness to talk about the pandemic losses in other realms, the economic losses or the loss of social connection. Why is there this silence around 1.2 million deaths — the enormity of the tragedy?

If you know someone who has lost a loved one to COVID-19, talk to them about it. Ask them about that loved one. Just being an active part of conversations around memory can be a beautiful act. It can be a restorative act.