The pandemic has disrupted how we grieve. The effects could be long-lasting.

About 650,000 people have died worldwide from the coronavirus, and behind each of those deaths is a collection of grieving family and friends.

But the nature of the coronavirus itself presents an unusual problem for people facing the death of a loved one. To prevent further spread of the disease, many rituals of the mourning process have been interrupted: Hospitals limit the number of people who can visit a dying person’s bedside, for example. Funerals and other commemorations are delayed — or canceled altogether.

These disruptions can have serious, long-term impacts on the way people process grief, says Dr. Harvey Chochinov, a distinguished professor of psychiatry at the University of Manitoba in Winnipeg, Canada.

“During the course of COVID-19…family members aren’t available to follow what I call a ‘path of least regret.’ That is, they have questions that will linger, because they haven’t been at the bedside, such as: Were they in pain? Were they frightened? Were they alone at the time they died?” Chochinov said.

“When you change the course of dying and distort the course of dying, you can expect there are going to be distortions in the course of how people go on to grieve,” he continued.

Those distortions may include mental health impacts on those who are left behind.

“We can really expect that there is going to be a tsunami of suffering.”

“We can really expect that there is going to be a tsunami of suffering,” Chochinov said. 

The inability to grieve properly because of COVID-19 restrictions affects people whose loved ones are dying of any cause, whether the coronavirus or not. In the aftermath of the pandemic, Chochinov warns, there may be an uptick in persistent complex bereavement disorder, a debilitating form of grief that can be accompanied by anxiety or PTSD, sleep disorders and depression. 

Related: Mourning in the midst of a pandemic

“The studies I’m aware of suggest complicated bereavement takes place [in] anywhere from 7-10% of individuals who are bereft,” he said. “I think, given the distortions we’re seeing in the dying process and unavailability of community rituals of mourning, that, if anything, we can expect the prevalence of complex, persistent bereavement disorder could go up.”

Chochinov is a member of an organization called the Canadian Grief Alliance, which in May called on the Candian government to form a “national grief strategy” in response to the pandemic.

“We know that resources are scarce and that even within the resources that are currently available, the system is stretched,” Chochinov said. “We also know there are some particularly vulnerable populations: so, people living in rural and remote areas, Indigenous people, immigrants, refugees, children, youth, Francophones. The availability of culturally sensitive grief supports simply is not there,” he added.

“We have called upon the government to make monies available to bolster currently existing services and to create expanded services for those in need, as well as to try to answer some of the questions regarding what will grief look like as a result of the pandemic,” he said.