Managing bereavement during the COVID-19 pandemic

Mai-Britt Guldin is a clinical psychology expert and senior researcher at Aarhus University hospital, Aarhus, Denmark, and a member of the steering committee of The European Association for Palliative Care (EAPC) Bereavement Care Task Force. Together with members of the task force, she describes how COVID-19 is likely to affect bereavement and offers some useful tips and resources.

Mai-Britt Guldin.

As the coronavirus unfolds, our communities may be faced with the tragic deaths of loved ones under difficult circumstances. Demand for bereavement support is likely to increase while support is challenged by physical distancing and changes in service delivery. Restrictions on gathering and travel can mean that traditional ways of saying goodbye are disrupted and so are mourning and funeral rites. Palliative care and bereavement services need to be aware of this. They have an important role to play in helping with information and support.

What is grief?

Grief is a natural reaction to the loss of a loved one. Common feelings are disbelief, distress, sadness and being tearful. Yearning or longing for the deceased feels excruciating. In the early days and weeks of bereavement, the body reacts with a state of shock and tension making it hard to relax, sleep and eat. Normal routines can be difficult and the cognitive impact impairs concentration and decision-making. Over the following weeks and months, the bereaved person may struggle to adapt to everyday life from which the deceased is missing. People cope differently and based on cultural traditions. In many European countries there is a long tradition of coming together when there is serious illness and in the days after a death. Families take the time for rituals such as funerals, burials or cremations and arrange farewell rituals, social gatherings, sharing meals, paying tribute to the person who died by sharing stories and memories. In the longer run, bereaved persons may share their grief in different group and counselling activities. These rituals and activities often provide comfort and support as well as a familiar framework to manage the impact of the loss.

Changes in mourning behaviour during COVID-19 pandemic

The COVID-19 pandemic is changing our traditional ways to mark our losses and voice our grief. Physical distancing means that existing practices of saying goodbye are disrupted, and rituals and traditions that offer people an opportunity to share thoughts and feelings are changed. This is likely to affect the grief responses. Bereaved persons may have to deal with increased trauma surrounding the deaths and at the same time they are cut off from their usual support system. Feelings of loneliness and grief can be intensified, natural tensions and resentment might be difficult to manage, the lack of distractions and worries about society, economy or work can magnify the impact of bereavement. Persons who are already struggling with bereavement will also be affected – especially if their bereavement care is delayed. Moreover, many deaths and national crisis may exacerbate a feeling of lack of empathy or that some losses are less worthy of sympathy. Bereaved persons may even feel that their losses are less worthy of attention and they may hesitate to ask for support when they learn that people in their network are preoccupied with their own worries and reactions.

How to help yourself

• It is normal to react to loss. Be kind and tolerant to yourself. Allow yourself to feel and react in ways that feel natural to you.
• In the days after the loss, your body might react. Take good care of yourself. Try to use helpful strategies to restore sleep and be able to relax etc. Remember to keep hydrated and uphold regular and healthy mealtimes to restore your body.
• Try to normalize your daily activities and keep routines. Regular bedtimes and getting-up times can be of help, as well as exercise or going out in the garden or for a walk if possible.
• Be mindful not to become emotionally isolated. Even if people cannot visit or the funeral or memorial service was different than expected, allow others to offer their condolences and show support in different ways. Phone calls are still possible and emails, letters and messages through social media.
• Stay in contact with the people closest to you. Even though you cannot be physically near, reach out to them and keep conversations going through the telephone or other media. A regular flow of communication can remind you that you are not alone and that people are thinking of you and are there for you.
• If you or your network cannot attend a funeral or memorial service, it is still possible to feel part of the event by setting up video recordings, a livestream and participation by online platforms. Be mindful of setting time aside for a private goodbye, look at pictures, light a candle, create a digital slideshow or sing and play music together online. Arrange a private memorial service for later when it is possible.
• Remember it is ok to ask for help! Even though many people are struggling, your own feelings are valid. Be mindful that you ask for the care and attention you need. Sharing your thoughts and feelings and listening to the experience of others can be helpful.
• Limit distress. For instance minimize how much news and social media you consume about COVID-19 that causes you to feel anxious or worried to avoid additional stress. Try to seek information only from trusted sources and take steps to protect yourself and your loved ones.

Adapting bereavement care

Physical distancing means that services have to be delivered in a different way during the outbreak. As bereaved persons move forward in their grief processes, the organisation and funding of services might also be challenged. Palliative care services are encouraged to be as prepared as possible and to plan ahead to manage some of the impacts that we can expect. Alternative services could be, for example, online resources, social media information, updating written information, setting up phone or web-based services, or referring persons to available resources.

Additional help and information

• National Bereavement Alliance.
• Cruse Bereavement Care (Resources for coronavirus: dealing with bereavement and grief).
• Gute Trauer (in German language).
• What’s your grief? (Includes 10 Meaningful Ideas for Funerals or Memorials  in Isolation.
• The Irish Hospice Foundation (Care & Inform section of the website offers resources for health professionals, including support and advice on grief and loss in the time of Covid-19).
• Find out more about the EAPC Bereavement Task Force here.
• Coronavirus and the palliative care response: EAPC web page to source and share information, with many links to publications and resources including national guidelines videos, scientific journal collections. Please email us if you have new or updated resources to share.
• Latest news and first hand information will continue to be shared on the EAPC Twitter, Facebook and LinkedIn. Join the conversation at #pallicovid

Read more posts on ‘Coronavirus and palliative care’ on the EAPC blog. Next week, we’ll be hearing about ‘Palliative sedation in the context of COVID-19: Expert opinions from the Palliative Sedation project’.

Editorial note: This post is among the Top Ten most-viewed posts on the EAPC blog in the first six months of 2020.