Though it first emerged and made headlines at the end of last year in China, COVID-19 has been formally impacting our way of life in the United States for well over two months. Current statistics according to Worldometer indicate that over one million Americans have been infected with the virus, and it has been responsible for over 64,000 deaths. While most of these deaths are happening in intensive-care environments among the elderly and immunocompromised, many cases have been reported documenting the virus' attack and destruction of formerly healthy, young individuals. The unknown risk that COVID-19 poses to all of our individual states of health has created a chronic level of anxiety across America, and the increase in deaths due to the virus has been painful and palpable. Additionally, Americans continue to die as a result of old age, chronic and terminal illnesses, and suddenly, unaffected by COVID. What makes these deaths remarkable, however, is that COVID's impact on healthcare and social distancing have created a unique, increasingly isolated environment of death and grief. Patients on hospice may no longer be allowed visits by their loved ones in their final days. Funeral attendance may be drastically limited. For the dying and those grieving the loss of loved ones, death during COVID feels especially cruel and painful. So, what can we do to face and alleviate the extra burden of the virus on our hearts and minds during the grief process? 

It is first important to recognize and appreciate the loss of normalcy happening during these unprecedented times. COVID has impacted our expectations of how to face death and dying in our society, and created a feeling of loss of control of our internal and external worlds. Our belief that we may have some control over how we live, die, and cope, has been disrupted, and this creates heightened distress and confusion. As we struggle with this painful "new normal", it is important to remember those areas in which we still have control, and be sure to maintain normalcy in our everyday routines as much as possible. If you are no longer able to visit a dying loved one in person, schedule a regular daily checkin via Facetime or phone call that occurs at the same time, and lasts the same amount of time. Make an agenda of predictable topics to connect with your loved one about. If your loved one is actively dying and not responsive, create a playlist of music, home movies, or other memories that may bring that person comfort even if they appear unconscious. Talk to them and assume they can hear you. If professional caregivers are present, ask them to place a phone or computer next to your loved one's ears if unconscious, or in front of them if they can participate, so that a connection is maintained. Send blankets and other comfort items to your dying loved one so that they can wrap themselves in a feeling of warmth or stroke stuffed toys as they hear your voice or see you online. For yourself, consider a weighted blanket or clothing your loved one once wore that bring you comfort. Activate your senses: create a world at a distance where you can still smell and touch parts of your dying loved one even if you are not physically present with them. Make a favorite recipe, and enjoy it as you chat. COVID cannot remove the power of our relationships and connections with our loved ones, even if we cannot be physically close to them. Drawing on consistent memories can help create a sense of safety, security, and comfort when the world feels out of control. 

As you cope with the painful aspects of grief and loss, practice mindfulness. This means allowing yourself to observe, but not judge, any frightening or anxiety-provoking thoughts that come across your mind during this time. This is a very challenging practice, but it is important to tell yourself, "don't believe everything you think!". One way to achieve a mindful state is to practice grounding exercises: instead of allowing anxiety about death, your own risk of infection, or loss of control to carry away, redirect yourself to the present. This can be done by focusing on your senses in the moment: name 5 vivid colors in the room in front of you. Take a usually mindless task, like doing the dishes, and focus as carefully as possible on every aspect of the activity: the feeling of soap bubbles on your hands, the sting of too-hot water, the feel of plunging your hands into the sink. Speak aloud to yourself, in the present tense: "I am washing the dishes for 60 seconds: 1, 2, 3...". "The water feels hot and soapy". Look out your window and describe what you see, or write it down: sounds of engines idling as items are delivered across the street; the chirping of baby birds in the nest unaware of COVID at all. Find a physical anchor: do you have a special item, such as a charm, totem, or statue, that you can handle when you feel anxious? Is there a certain essential oil or candle you might light to bring you to focus on this present situation? You can also re-orient yourself in your body by practicing bi-lateral stimulation, which is thought to aid in the processing of painful memories according to proponents of Eye Movement Desensitization and Reprocessing (EMDR) therapists. Proponents believe that bi-lateral stimulation encourages integration of different parts of your brain to work toward a feeling of connectedness, creating a soothing and healing experience. One simple exercise you can do at home consists of crossing your arms over your chest and taking turns rubbing on a diagonal, from your shoulder blade, across your chest, to your waist, with firm pressure, with your opposite hand. So, I might place my right hand firmly on my left shoulder, and rub downward across my body, and then do the same motion with my left. I might also wrap both arms around myself and give myself a hug. Using both sides of your body can help orient you into the present moment while also helping address distressing symptoms that are creating anxiety. Another similar exercise is butterfly hug tapping

As you plan for a funeral, prepare for the impact of social distancing. Usually, a funerals are an important ritual to practice as families and friends come together to honor the life of the deceased and share memories. They may engage in group prayer, memory sharing, eulogizing, and physical acts of burial. During COVID, this may no longer be possible. Anticipate other ways to bring the family together, creating virtual slideshows, an online guestbook, a Zoom call for Eulogizing, inviting religious clergy into your home for an informal, smaller service, and creating a meaningful memorial in your house or garden. Such memorials may include prayer altars, planting a tree or creating a meditative spot in our outside of your house. Be sure to check in with other grievers who may have come together for a funeral but are now unable to do so. This means extending funerary rituals, such as creating a journal where grievers can continue to share memories of the person who has died that might not have come up the "day" of the funeral or were not prepared in time. You can also consider creating a memorial group on social media as a place to gather and share art, poetry, and memories. Make plans with loved ones for a time in the future to have a "second funeral" when you all can be together, once social distancing has ended. Don't commit to a firm date, as nobody is sure when this can happen, but create a loose schedule and divide up responsibilities such as cooking, funeral program, order of services, etc. 

The above are just a few suggestions to get you started. If you are feeling increasingly isolated, depressed, and overwhelmed, know that while your grief may feel more intense during this time of isolation, it is very important to reach out to others. You can do this through peer support: finding groups online of grievers who are also struggling, or reading articles posted on sites like Modern Loss or What's Your Grief that are currently addressing the specific challenges of death and dying during COVID. If you find you need additional support, most psychotherapy services are now being offered via telehealth. At the Center for Growth, we have switched over to a virtual counseling model to maintain accessibility and support for our clients struggling with both pre-existing mental health challenges as well as new ones that have arisen as a result of the pandemic. You can make an appointment with a provider right now via Therapy Portal. If you think you may need professional help as you grieve, don't hesitate. We are trained to help you walk through these unusual and often frightening times to help you feel better soon. 

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