We know the pandemic has changed how we say "hello" — through masks, and at a six-foot distance — but we're beginning to learn more about how it has also changed the ways we say "goodbye."

Socially distancing means no visits in the hospital, no traditional funerals and no hugs outside your immediate bubble. The typical distractions of work and play now look like your home office, take-out and more time to think. When you go online, turn on the TV or radio, news of the pandemic is everywhere.

Dr. Shamaila Khan is the director of the Center for Multicultural Mental Health and a clinical psychologist at Boston Medical Center. She organizes and runs bereavement groups for people who have lost someone to COVID-19.

Khan says the pandemic has frozen those grieving in what she calls the "complicated grief stage." When grief initially sets in, there's intense pain for the loss, but as people adapt to the loss, that emotional pain becomes less acute, though still present. During the pandemic, Dr. Khan says a lot more people are holding onto these intense emotions for much longer.

"This pandemic is ongoing," said Dr. Khan. "And add to that the current reality of our times — the political divisiveness, the racial unrest, the economic instability — all of these things add to it, and it makes us feel like we don't have a sense of control. When somebody dies, you feel like you didn't have control over this somehow, and to have the pandemic to which there are so many unknowns, it makes people stay in that space longer."

Dr. Khan says that while each person's grief is unique, she and others at the Center for Multicultural Mental Health are seeing a lot of survivor's guilt, where family members or friends feel guilty for being alive while their loved one has died.

"I cannot tell you that amount of people who have mentioned, you know, 'Why did I survive? How did I survive? Why did I not get [COVID]?'" said Khan. "So that's typical survivor's guilt, but with this you hear things like, 'Why couldn't I prevent it from happening? Why didn't I tell my family member to be more careful? Why didn't I tell them to wear a mask? Maybe I should have dropped off wipes for them, or did I cause it somehow?'"

Dr. Khan says resuming normal routines will help those grieving to ease their guilt and move past that intense emotional stage of grief. With the vaccine rollout underway and the first glimmers of hope for a return to normalcy, that process might soon be a reality for many to, finally, say "goodbye."