'Tsunami of Grief' to Hit as More Loved Ones Die

Jennifer Clopton

April 13, 2020

Editor's note: Find the latest COVID-19 news and guidance in Medscape's  Coronavirus Resource Center.

When John Pijanowski learned his father was to be taken off a ventilator at a New York hospital, he sat down at his kitchen counter in Fayetteville, AR, and wrote a Twitter tribute to his father he figured only family and close friends would read.

"My dad was a great man. There are no buildings named after him, he left behind no fortune, and there are no books that tell his story. He was not great in the way we often try to define the term — he was great in that he was such a *good* man — good to his core, unfailingly good."

Moments after he finished and closed his computer, John got the phone call that 87-year-old Don Pijanowski had died from COVID-19. And with that call, John became another of the mass of people in this world who began to grieve the loss of a loved one from the coronavirus pandemic.

On Twitter, John shared how his father, the youngest of 10 children who was born during the Great Depression, had a way of telling the harsh stories of his childhood with "a warm sense of nostalgia and a twinkle in his eye." He explained that rather than a suit-and-tie man, his Dad was a blue-collar resident of Buffalo, NY, a "green bar of lava soap guy" who worked in steel manufacturing and then built industrial turbo compressors. He shared stories his father told him, explained how he always viewed his dad as the "coolest in the room," and closed by saying his dad's defining feature was "how much he cared about people."

It was a while before the grieving son went online again. But when he did, he discovered something surprising: His thread about his dad had gone viral, tapping into an enormous sense of collective grief. It has since been read and shared tens of thousands of times across the world, and Pijanowski says Twitter metrics show it's been viewed more than 4 million times.

"There are some people from my old neighborhood that weighed in, but mostly it's people from all over the country and the world," he says. "Most didn't know my dad at all, but they do know a guy like him who told great stories, loved sports, cared about people, and had that same kind of dirty wash basin in the basement that can never get clean again because so many greasy, oily hands washed in it. They know that guy. That guy was a great guy, and a lot of people are hurting because they are losing 'that guy.' "



The COVID-19 Grief Tsunami

Death tolls from COVID-19 are being charted, tracked, and graphed every day, but the co-author of a new study published in a special COVID-19 issue of Applied Demography says we, as a country, haven't yet paid attention to the "tsunami of grief" that is just beginning as a result of these deaths.

"As we are all fixated on what this pandemic will mean in terms of the total lives lost, it is important to keep in mind that this number will feel far more pervasive because each life will leave multiple grieving," explains study co-author Emily Smith-Greenaway, PhD, an associate professor of sociology at the University of Southern California. "The U.S. epidemic has the potential to translate into such a high number of people losing a parent or grandparent — not to mention other relations, friends, or neighbors."

Seeking to quantify the impact from the mounting death toll, Smith-Greenaway and lead author Ashton Verdery, PhD, of Penn State University, assessed preliminary data from China and Italy showing the risk of death for older people who contract the virus. They combined that with demographic information about family structures and came up with models to estimate the number of Americans who could see a parent or grandparent die of COVID-19.

·       In a severe scenario of their modeling, if 40% are eventually confirmed infected, an estimated 4.7 million would have at least one parental death to COVID-19, and 9.1 million would lose at least one grandparent to the virus.

·       If confirmed infections reach just 10% of white and black Americans, that would mean roughly more than half a million (537,000) white and black Americans would die. Because these individuals are the grandparent or parent of multiple others, this would lead to an estimated 1.2 million white and black Americans losing a parent and an estimated 2.4 million losing at least one grandparent. These are just models; current estimates from public health officials put the anticipated numbers of deaths around 100,000,

No matter where the final numbers actually fall, researchers say there's no question the mounting death toll will bring untold amounts of grief that we as a country need to anticipate. They also warn that some families and communities will be especially hard hit by a "clustering of deaths," given the contagious nature of the coronavirus.

"A second wave public health concern is this tsunami of grief, and there is no comparison to this in recent history. Americans have not experienced a mortality shock like this," Smith-Greenaway says. "On top of that, these deaths are so traumatizing. They are sudden, and people have to grieve them alone. We need to brace ourselves for the collateral health damage that will come from this."

The Physical and Emotional Impacts of Grief

While grief is a very personal and unique thing, it takes a well-documented physical and mental toll that can be extreme. Johns Hopkins Medicine says physical symptoms of grief can include fatigue, headaches, and an upset stomach, and mental symptoms range from anxiety and depression to anger, irritability, and distraction. Studies also show bereavement can increase the risk of a heart attack and death.

"The mental health problems caused by this pandemic are real, life-threatening, and will grow over time. They must be taken and treated seriously. They will not miraculously go away on their own if we do nothing," explains Paul Gionfriddo, president and CEO of Mental Health America.

David Kessler agrees. He is one of the world's most well-known grief experts. He co-wrote one of the defining books on the subject: On Grief and Grieving: Finding the Meaning of Grief through the Five Stage of Loss with Elisabeth Kübler-Ross, shortly before her death in 2004. This year, Kessler was more than halfway through a 30-city tour for his new book, Finding Meaning: The Sixth Stage of Grief," when it was cut short because of the pandemic. That book, with the approval of the Kübler-Ross family, added a sixth stage of grief (meaning) to the five the duo had previously laid out: denial, anger, bargaining, depression, and acceptance.

"Without knowing this pandemic was coming, I wrote in the new book how one of my concerns in recent years has been that increasingly, I was seeing more and more people have a hard time in grief, and often that happened when people weren't able to hold or attend a memorial service or funeral for their loved one. Those rituals are part of what helps us process our loss and continue on, and nobody is able to engage in them right now," Kessler explains.

John Pijanowski and his family are among those who have put off a funeral, and the Arkansas man admits it does make the grieving process harder. He and his brothers are self-isolating across the country. Because their dad had COVID-19, nobody was allowed to go into the hospital and say goodbye to him. Now they can't gather to honor his life. Instead, they are mourning with each other via text and video chat several times a day.

He says the sudden nature of his family's loss also makes it feel more profound. His father was literally fine and talking on the phone with his children one day, and then so fatigued from the sudden onset of COVID-19 symptoms 3 days later that family found him lying on the floor, unable to move. He was rushed to the hospital and died just 3 days after that.

"This is so different. It came out of nowhere," Pijanowski says. My dad deteriorated so fast that we couldn't go to be with him as he was suffering, and none of us even got to talk to him one last time on the phone before he died."

How to Grieve While Social Distancing

Kessler says grief is always isolating, but with people being forced to stay at home during this pandemic, they are now getting hit with a double dose of isolation when they lose a loved one. He says that makes finding ways to express your grief — and connect with others who share it — especially important. So he's urging anyone who's had to delay or postpone a funeral or memorial service to find new ways to come together in the short term to work through their loss. 

"A life and a death needs to be marked, and now we have people being robbed of that chance. You can postpone a funeral, but you can't postpone grief, so please, find a way to come together virtually and remember the person you loved now," he says.

The grief expert says these moments can be small and personal but need to involve connecting with others, even if that happens in new and different ways. He suggests you can:

·       Work with a funeral home to see if you can livestream the casket for family.

·       Hold a memorial service over video chat so people have a way to gather and tell stories.

·       Invite a clergy person to speak and offer words of comfort over the phone or video chat — and even consider asking someone if they can sing as they would at an in-person memorial service. 

·       Show photos or edit a little video with home movies and photos that you share over video chat with others who are grieving your loved one's death too. 

"One of the most primal things about grief is that it must be witnessed. There is even science on this. We need our tears to be reflected and our grief to be seen and shared by another human being, because that tells us our loved one's life and their loss matters. We need that to heal," Kessler explains. "We aren't meant to be islands of grief. There is danger in that. That's when you become stuck and unable to move forward in life and live in a way that honors those who have died." 

He says meaning in the death of a loved one comes when you figure out how to honor the person you've lost. He says many people figure out how to do that through grief support groups. Since those often meet in person, Kessler created one on Facebook. Nearly 5,000 people joined Grief.com in about 3 weeks — and many of them were grieving people who've died from the virus. 

"Grief doesn't end, and it doesn't necessarily get smaller. We must become bigger. But in time, you learn to grieve with more love than pain. That comes from defining their loved ones by their life, not their death," Kessler explains. 

Pijanowski, who has a doctorate, and whose own academic research touches on self-care in educational settings, says he's looking for ways each day to feel less unmoored. For him, that means focusing on things he can control, like making healthy meals, sticking with a sleep schedule, regularly exercising, and being deliberate about making connections with others. Besides texting and talking with family on the phone and video chat, Pijanowski says the only other way he can really do that is to continue to read his way through the thousands of comments people left in response to his Twitter thread. 

"Just connecting on social media and being willing to listen and read stories about who others have lost feels like one of the only real gifts we can give people who are grieving right now. People are really pouring their stories out online, and sadly, I think it's just beginning. By the time this is over, I think everyone will know someone impacted by this pandemic in a grave way."


Paul Gionfriddo, president and CEO, Mental Health America, Alexandria, VA.

David Kessler, speaker, writer, and expert on grieving.

John Pijanowski, PhD, Fayetteville, AR.

Emily Smith-Greenaway, associate professor of sociology, University of Southern California, Los Angeles.

Applied Demography: "COVID-19 and Family Bereavement in the United States."

CNN: "Tracking Covid-19 cases in the U.S."

Johns Hopkins University & Medicine, Coronavirus Resource Center.

Johns Hopkins Medicine: "Grief and Loss."

Harvard School of Public Health: "Recent bereavement greatly increases heart attack risk."


Psychosomatic Medicine: "Mortality After Bereavement: The Role of Cardiovascular Disease and Depression."

USA Today: "US coronavirus map: Tracking the outbreak."

CDC: "Coronavirus 2019 — US Cases."

Wikipedia: "Casualties of the September 11 Attacks."