'Tsunami of grief' as millions of Americans could lose a parent or grandparent to COVID-19

The death toll from the new coronavirus in the United States has already exceeded 5,000, more than the number of people who died in the terrorist attacks of Sept. 11, 2001. But what we aren't quite grappling with yet, according to a new USC analysis, is the tsunami of grief that will rise in wake of the COVID-19 pandemic.

"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," said study author Emily Smith-Greenaway, assistant professor of sociology at the USC Dornsife College of Letters, Arts and Sciences. "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."

The COVID-19 pandemic is expected to substantially increase deaths around the world, including in the United States. Current estimates of fatality rates, combined with the possibility that upwards of 40% the U.S. population will become infected, suggest that COVID-19 could lead to the death of millions of Americans.

As the fatalities rise, so does the grief that follows in their wake.

Estimating the number of family deaths due to COVID-19

Smith-Greenaway and lead author Ashton Verdery of Penn State University looked at preliminary data from China and Italy, which are ahead of the United States in experiencing severe outbreaks and high numbers of deaths from the new coronavirus. The data, which clearly demonstrated the heightened risk of death for older people from the virus, was combined with demographic information about family structures—called kinship models—to estimate the number of Americans who could lose a parent or grandparent to COVID-19.

Rather than trying to predict the death toll, the researchers presented three plausible scenarios by applying current fatality rates from Italy. In one scenario, if 10% of white and black Americans are confirmed infected with the new coronavirus, the estimated number of grieving relatives left behind would be astonishing: More than half a million (537,000) white and black Americans would die. This would mean an estimated 1.24 million white and black Americans would lose a parent and an estimated 2.38 million would lose at least one grandparent.

The researchers also considered the losses of a severe scenario with a 40% confirmed infection rate: the number of bereaved people would skyrocket to an estimated 4.73 million experiencing at least one parental death and 9.12 million experiencing at least one grandparental death.

"America is about to experience an unprecedented loss of life. Even while it is very difficult to predict just how many we'll lose to COVID-19, we wanted to shed light on the collateral damage this will have on families," Smith-Greenaway said. "It is important that the burden of bereavement, and its potential mental and physical health consequences, is factored into discussions of the public health challenge facing America and all nations."

The analysis was published in a special COVID-19 issue of Applied Demography.

After the pandemic, an outpouring of grief will follow

Bereavement and grief in the wake of a family member's death is normal, yet some individuals experience more severe, prolonged mental health consequences, including major depression and anxiety. In addition to its toll on mental health, bereavement is also tied to physical health risks including worse cardiovascular health and mortality.

The risk of experiencing these negative outcomes is more likely in the case of a family member's sudden, unexpected death, which will be the case for many during this pandemic.

"There is still great uncertainty in how the epidemic will play out in the U.S., how many will be infected and how many will die," Verdery said. "What is certain is that each death will be felt by many people, which will add additional bereavement burdens to people's mental health and sever important sources of social support at precisely the time people need it the most."

Smith-Greenaway and Verdery said the potential for clustering of deaths in families due to the highly contagious nature of the new coronavirus will contribute to people losing more than one family member, increasing the risks of mental and physical health problems. Additionally, the contagious nature of COVID-19 is forcing many families to postpone funerals and remembrances, leaving family members to grieve alone.

The researchers acknowledged the analysis of the pandemic's potential collective trauma was a grim exercise, but they said it's important to developing a more complete understanding of why social distancing and other preventive measures are critical.

"This is exactly what we're all trying to avoid: situations where we see these high rates of infection," Smith-Greenaway said. "This analysis is another way to demonstrate just how interconnected we are and to remind us that every life lost will leave a hole in a larger family system."