Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

When a Loved One Dies from COVID-19questions.
Death of a loved one is a painful
As we move through the pain of grief,
When a loved one dies, we areexperience. However, death due
foreverchanged. As we move throughto COVID-19 is likely to be more
it is important to remember thatthe pain of grief, it is important todifficult for several reasons: the deathmany people find new strengths andremember that many people find newis unanticipated and families arecapabilities
anddevelop
enduring
strengths and capabilities and develop
separated from their hospitalized
enduring relationships with others.
loved one due to potential contagion.
relationships with others.
This Fact Sheet provides helpful
Families may be unable to grieve andinformation to families (or thosememorialize their loss in ways that arereligiously and culturally familiar. It is likely that family and caring for them) to help cope with their loss.
close friends will be distressed, confused, and have many
Circumstances Surrounding the Loss
Deaths due to COVID-19 occur in several types ofenvironments. Most will die in hospitals, some will die athome, and many will die in nursing homes and assisted
living facilities. Many die without their loved ones present,
unable to hold their hand, or grieve at their bedside. It
is expected that family members will want to know thecircumstances surrounding the death.
When the News Comes
As much as one might be prepared for the death ofa loved one, we are never ready to receive such news.
Notification of a COVID-19 death is likely to come as aphone call from someone representing the place where thedeath occurred. That person may or may not be known
to the family and might only have a few details about thedeath (e.g., time of death, who was with the patient at thetime of death, and any final message from the deceased totheir family). Additionally, family members are likely to be
distressed and unable to pose questions to the notifier, often
requiring additional contact after the initial notification.
In addition, the deceased’s remains and personal
belongings may not be quickly available, further distressing
the family. For families whose religion or culture prescribes
rituals for the management of the body, the absence of thebody can be an additional loss.
Adult family members should properly explain thecircumstances of the death to children using simple andclear language that is developmentally appropriate foreach child. The nature of a child’s relationship to thedeceased and age will likely determine the intensity of

their responses. Older children and teenagers may havemore questions, and family members need to be prepared
to share information in a calm and clear manner. Families
may want to seek professional help to understand how best
to inform and support children when someone close tothem dies. Given the current climate, this could be either
face-to-face or virtual.
Initial Reactions
Grief is a normal and expected reaction to the lossof a loved one. There are many ways to grieve, including
emotional reactions ranging from stunned disbelief, togreat sadness or rage. There is no “right” way to express
grief, especially immediately after notification when thenews is fresh and feelings are raw. Because of the physicaland emotional separation that is a part of the COVID-19
experience, family members may have been out of contact
with the deceased, so the death may feel less “real”. When
grief goes unacknowledged, people may experiencedisenfranchised grief, or that their grieving is unvalued,resulting in feelings of helplessness and powerlessness.
Grief impacts us in nearly all aspects of our lives:■ Cognitive — Problems remembering, concentrating,prioritizing■ Emotional — Strong feelings of sadness, anger, guilt,
loneliness, and even joy in remembering■ Behavioral — Increased/decreased activity■ Spiritual — Questioning faith or increased religious
activities

Continued

■ Social — Craving being alone or with others■ Physical — Fatigue, sleep difficulties, appetite changes■ Secondary loss — financial insecurity or loss

Collective Grief
How people express grief is influenced by culture.
Cultures vary in acceptance of intense displays of emotion
and sharing of feelings and difficulties. It is most helpful
to offer support, respect, and recognition of culturalrituals for grieving families. It is important for people togrieve together, even when they are unable to be together
physically. Family members can receive support from eachother, as well as friends and mental health professionals(e.g., grief counselors or chaplains). Support can beprovided “virtually” through phone calls, texts, emails, andvideo chat, and all these modalities should be encouraged.
Families are encouraged to consider options formemorials and burials at a time when family members
can be together. It may be necessary to modify traditional
memorialization practices. Importantly, memorializationoffers comforting ways to be together and mourn loved
ones.

Grief Adaptation
Grief can be a prolonged process that is neither linear
nor predictable. Acute grief is raw, disorganizing, andhighly emotional, however, intensity of grief usuallydiminishes over the first year after the death. Althoughgrief never really “ends”, with time it usually becomes aless central and dominating part of one’s life. However, incertain circumstances (e.g., sudden or violent deaths) theintensity of acute grief can continue unabated, at times
requiring intervention.
Those bereaved by COVID-19 are encouraged toreach out to others to both receive and offer support.
Being open and honest will encourage others to do thesame, creating important connections. Practicing goodself-care (e.g., eating properly, exercising, maintaining
good sleep hygiene) supports health, well-being, andresilience. Bereaved persons are encouraged to seek help
when required, including formal help from trusted healthcare providers or mental health professionals, such as theDisaster Distress Helpline (1-800-985-5990).

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University
4301 Jones Bridge Road, Bethesda, MD 20814-4799
www.CSTSonline.org