‘The grief has also been the epidemic’
Millions of Americans still struggle to grieve those lost during the COVID-19 pandemic
On June 18, the day before Father’s Day, Lily Kendall will finally be able to throw her father the wake that he always wanted. And when she does, it will be a year and a half since Ted Szoch, a lifelong Pittsburgher, fitness fanatic and devoted volunteer, died of COVID-19 at age 84.
Mr. Szoch is one of an estimated 1 million American victims of the COVID-19 pandemic.And Ms. Kendall is one of many millions more still grappling with how to mourn those lost to a disease that robbed Americans not just of their loved ones but also of their traditional ways to grieve.
“The grief has also been the epidemic,” said the Rev. Patricia D. Brown, a hospice bereavement manager and founder of Spirit works, a Wilkinsburg-based nonprofit. “It’s not just those who are grieving from those who have been lost to COVID but those who lost loved ones during COVID,” she said. “It’s hard to comprehend.” Grief’s ripples
A 2020 study co-authored by researchers at Penn State determined that with every COVID-19 death, approximately nine surviving Americans have lost a grandparent, parent, spouse, sibling or child. That number, called a “bereavement multiplier,” puts the number of those directly affected by COVID-19 loss at 9 million Americans and counting. The study notes that the scale of those bereaved by COVID-19 might create a “second wave of population health challenges tied to bereavement at the loss of social and economic support,” referencing the potential for lower educational attainment among youth, disrupted marriages and poorer physical and mental health.
Mr. Szoch was not your typical 84-yearold, keeping up a fitness regimen in his apartment building and biking all over the North Side, where he lived. He volunteered for Meals on Wheels, not wanting other senior citizens to go hungry during the pandemic, and kept up with family, sometimes dropping by to see the Kendall family in Squirrel Hill for visits with a mask on through their storm door.
“Well, I think I’ve done it this time,” he said to Ms. Kendall in a voicemail in December 2020, letting her know that he had symptoms of COVID-19.
From the time of his first symptom, it was only about three weeks until he died, going into the hospital the day before Christmas and passing away the day after New Year’s. At the time he was hospitalized, vaccines were available only to health care workers and treatment options were limited. For those hospitalized with COVID-19, visitors were not permitted.
When Ms. Kendall’s mother died in 2014, there were about 15 members of her family crowded into her hospital room. They sang to her and prayed for her, and Ms. Kendall held her mother’s hand as she took her last breath.
For her father, the stringent COVID19 precautions in place at the time meant that they never saw him in person again. At first they coordinated regular Zoom calls with the nurses, who could enter the room only every so often because they needed to suit up in full protective gear.
When Mr. Szoch entered hospice, the family began a 40-hour Zoom call, where hospital staff just let the camera run. Ms. Kendall’s wife, Karen, who runs a technology consulting business, scrambled to set up access for Mr. Szoch’s elderly brothers and sisters.
The moment that he actually died wasn’t noticeable on the Zoom call — the family found out when a nurse entered the room to let them know that his vitals had stopped.
“It was really hard after he passed away and the screen went blank,” said Ms. Kendall. “It was hard to convert that into reality.”
Without a script
When Ms. Kendall’s mother died, she thought of the grieving process as a “package” — first the hospital, then going with her dad to the funeral home to organize the service, then the service, then the wake.
When her father died, there was no script, despite his best intentions. “He wanted to have a really big wake,” she said. “He wanted a party with music and great food and friends and everyone coming together and planning our next family reunion. That’s what he envisioned, and we were not able to do that.”
The best they could do was a small, roughly 20-person service of close family, masked and spread out in a church that could hold hundreds. They put the service and graveside ceremony on Facebook Live. In deference to her grandfather’s wishes, Ms. Kendall’s daughter, Avery, now 11, wore a pink party dress.
As for Ms. Kendall, she is continuing to plan for her father the wake that he really wanted. Mr. Szoch was generous and gregarious, and couldn’t walk down the street on the North Side without stopping to talk to someone he knew. But for the wake, to be held in North Park a year and a half after his death, Ms. Kendall isn’t sure whether 30 peopleor 300 people will show up.
Many people depend on rituals around death to process grief, receive support and to provide a guide for how to function in the immediate aftermath of a death, said Janet Arida, outreach and education coordinator for the Highmark Caring Place in Marshall, which provides grief support to children and families who have experienced a death.
“All of the things that we have built into our culture in terms of grief were taken away,” she said. “All of those things disappeared for a period of time and people suffered as a result. It added another layer onto their grief.”
Isolation, magnified
That loss extended to those whose loved ones died not necessarily because of COVID-19, but died of another cause during the COVID-19 pandemic and were not able to have traditional funerals or gather together as they might have.
At UPMC Western Psychiatric Hospital, Kelly Monk runs support groups for those who have lost friends and relatives to suicide. She has seen the toll of isolation, and the loss of rituals, on those grieving deaths even unrelated to COVID-19.
“When people are grieving, they may be feeling very isolated and alone,” she said. “It was magnified many times by the COVID shutdown. People are feeling isolated because of COVID, because of their grief. People really kind of avoid you if they don’t know what to say,and because of the COVID restrictions people could pretendthat it didn’t happen.”
Ms. Monk believes that the effects of isolation on grief will have long-term effects on people in their healing process. Anecdotally, Rev. Brown has heard more reports of people whose grief has turned into a true depression as they mourn loved ones during the pandemic.
“I think for many it would have been a normal grief, but families couldn’t gather, people couldn’t come to their side or to their aid,” she said.
For those whose relatives did die from COVID-19, there are circumstances that are particularly difficult to manage.
The study by researchers at Penn State noted unique trauma for those whose relatives died of COVID-19 because the deaths are generally sudden and unanticipated, making it more difficult to feel closure. The study also noted, as was the case with Ms. Kendall, that when family members are physically separated and unable to provide care and comfort, intense grief is more likely.
Those whose relatives died from COVID-19 also find themselves in the midst of a pandemic where the cause of death is both inescapable
and increasingly controversial.
“Just turning on the TV andhearing ‘COVID, COVID, COVID’ all the time, for some of us it’s annoying and might cause panic or fear, but for people who have had a death, it’s as if something reminds you constantly of the cause of your loved one’s death,” said Ms.Arida.
As the response to COVID-19 has become more polarized, those who are grieving have also sometimes been subject to uncomfortable comments and questions about their loved one’s death, such as asking whether they were vaccinated or wore a mask.
Ms. Kendall’s daughter, Avery, remembers getting upset at school hearing a classmate say that she didn’t care if she got COVID-19. She would see people at school not wearing masks even when they were required, or making jokes about the coronavirus. “It’s not so funny after you’ve lost somebody,” she said. “Youtake it more seriously.”
Grieving together
With counts from the Centers for Disease Control and Prevention and other places that track public health data showing the United States near the milestone of 1 million COVID-19 deaths, people who are struggling to grieve those with COVID-19 also struggle to process news of so many other deaths at the sametime.
Rev. Brown is planning a remembrance service this summer for those who died of COVID-19 to give people an opportunity to grieve together with others in similar circumstances. The service will take place at 3 p.m. June 21 at Penn Forest Natural Burial Park in Verona, with music and speakers including Allegheny County Executive Rich Fitzgerald, health care workers and bereavement counselors. Other cities have held simi-lar memorials,she said.
“Icall it a double grief,” said Rev. Brown. “You’re grieving not only your own grief but everytime you turn on the TV orradio, it’s a collective grief.”