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Covid’s hidden toll

Like many people, 46-year-old Sandhya has been feeling guilty lately. She and her husband (49), decided to prioritize safety over socialization during first wave of the pandemic. But when the Covid-19 situation “appeared” to have improved, she forced her husband to attend a family function along with her. Few days later, she tested positive and had to be shifted to the hospital ventilator as her condition worsened. She was unaware that her husband and mother were also infected and had succumbed to the infection within few days.

When she eventually recovered, she learnt the truth and since then she has had ‘never-ending’ guilt — an unwarranted remorse and shame over things that she has no control over. “The guilt wakes me up every morning and puts me to bed every night. I want to go into the past and change the events of one day, one event in the hope that it will bring my husband and mother back to me. It’s never-ending,” she said. This has had a lingering effect on her and she is now on medication for anxiety and depression.

Psychiatrists term this as “disenfranchised grief ” — hidden grief or sorrow — that is often minimized or not understood by others, which makes it particularly hard to process and work through. The survivor feels responsible for things that are not really their fault, like accidentally infecting a family member with Covid or are in anguish for not being with the family member during their last moments or failing to perform rituals as per tradition. Added with this, there is limited or no avenue to express grief or unwarranted remorse.

This grief is often followed by unjustified guilt — a nagging, self-punishing emotion that keeps surfacing as one tries to continue to navigate the crisis. It could be over small things or situations beyond one’s control. Brijesh, who lost his 72-year-old father during the Covid peak, feels bad even now that he was not able to save his father though he had tested Covid negative. “He had recovered and doctors said that he was fit to be discharged. We were hoping to drive back home together but instead we had to get him back in a bag. Since then it has been a constant conflict with “ifs” and “buts”,” said Brijesh.

“Many Covid patients go to the hospital walking and talking and then slip into critical state and come back home in a plastic bag. The present situation makes acceptance of death more difficult,” said psychiatrist Dr CJ John.

As per official records, Kerala so far has 11,833 Covid deaths. However, doctors state that the actual figures maybe three to five times more than this. Covid death survivor support groups that help people handle trauma said that in a day they now receive minimum 10 calls each requesting for help, “to get them free from trauma and guilt associated with the death of a close person”.

“We are a ritualistic society and the rituals associated with death are part of our grieving and healing process. But due to Covid restrictions that is now not possible and people are increasingly grieving for a longer period that ultimately hampers their emotional wellbeing too,” said Rajesh R Pillai, president, Befrienders India, the nodal body for coordinating the activities of 16 national helplines working towards suicide prevention and Covid death survivor support.

In pre-Covid times, during the last moments of critical patients in ICU, close relatives would be allowed to spend some time with them, hold hands and feed water. But now most hospitals don’t allow that when it comes to Covid patients. Also, after a person dies, many things linked with parting — holding, hugging, touching or kissing —the body that comes home covered in body bag to say goodbye or even many rituals associated with death can’t be performed.

“Any death generates some amount of guilt in people and that is normal a part of grieving. But what has changed now is that there is no social support for the grieving person that key to the normalizing process as friends and relatives don’t visit home or sit together to console due to the social distancing norms. Pathological complicated grief is extremely rare in Kerala and what we see here is normal grief and the main reason for that is social support. But now with the continuing Covid situation this may change,” said Dr Suresh Kumar, technical director, Institute of Palliative Medicine, Kozhikode, who also runs a death cafe.

Meanwhile, as deaths continue to grow, official Covid death or not, for many, the struggle to bring closure on the demise of a close soul only grows bigger and deeper.

(Few names partially changed on request)



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Views expressed above are the author’s own.



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