As the United States marks a grim milestone of a million COVID-19 deaths, mental health and pastoral experts say the nation hasn't yet been able to truly grieve those deaths. They have cared for patients in their last moments and the loved ones they left behind, and for those who lost someone close, they say the impact is lasting and profound.

As a chaplain at Massachusetts General Hospital, Rev. Erica Rose Long has often been in the room to provide support when a family learns there's nothing more that doctors can do to save a coronavirus patient.

"That's when I'm sitting with the families and they're telling me about their loved one," Long told GBH News. "They're telling me they're grieving. And they're also telling me, you know, 'He did everything he could to not get sick.' Or, 'We tried to get him vaccinated and he wouldn't accept a vaccine. He wouldn't get the shot.' And so I'm often with families when they're in that moment of acute grief and trying to make sense of their loved one dying."

In those moments, she said, she listens to families, and affirms their feelings of loss and, often, anger. She asks families to tell her about their loved one, too.

"And in moments like that, you know, we get to hold up someone who's not just a patient, but who means so much to so many people and really honor what this loss is," Long said. "They're not just another number of someone who's dying of COVID. They're a very particular person to this family and to their community."

Since the beginning of the pandemic, more than 19,200 lives have been lost in Massachusetts.

It can be especially hard for family members to grieve a loss, Long said, when the virus means they can't sitting with their loved one in the end. A few patients she saw in the MGH COVID-19 wards were people she knew from her own congregation.

"And I was the only person who could go in their room that they knew," she said. "And that was just devastating, to feel that there were so many people who are so sick who could only talk to their families on a screen while they were here."

A woman in a hospital gown holds up her phone, showing her son and husband, with a printed picture of her newborn baby on her lap
COVID-19 patient and Guatemalan asylum seeker Zully makes a video call with her husband and son, also recovering from coronavirus, days after being removed from a ventilator at a Stamford Hospital ICU on April 24, 2020 in Stamford, Conn. On her bed is a photo of her newborn son weeks after she gave birth through an emergency C-section and was put on a ventilator.
John Moore/Getty Images Getty Images North America

Offering end-of-life care to a patient and family dealing with COVID-19 is also different, she said, because it often feels politicized.

"I've had people who are dying and their family still don't believe it's COVID, that there's still suspicion that it's something else and that COVID isn't lethal. And so that brings a whole other level to it," she said. "It feels heightened to have these conversations at times... because the conversation about COVID is so political in our country right now.

"I sometimes meet with patients right before they're intubated, so they'll ask to pray with me before they're sedated and intubated, and they don't know if they're going to wake up again," Long said. "And I've had folks who in that moment say to me, 'I wish I had gotten vaccinated.' But it's too late coming. So yeah, there's this whole other political layer to it that feels different than other end-of-life [situations]."

For some, the grief is compounded by the loss of multiple family members. At Brigham and Women's Hospital, clinical social worker Sarah Gale remembered one woman in her 90s who had lost at least six family members.

"And she's like, 'why am I here? How could this be?'" Gale said.

"The compounding grief is just enormous and they don't know where to begin to even deal with it," she said. "And it shows up in disease. It shows up in patients coming in complaining about difficulty sleeping, difficulty eating, difficulty maintaining concentration because they're so overwhelmed by grief."

Gale said she tries to help those patients learn coping skills and build resiliency.

"Teaching them how to find their voice, how to settle themselves when they're feeling overwrought with grief, feelings or stress or anxiety or fear," she said.

She also tries to help them stay in the present moment: "To try not to to dwell on the future, what will be, or what might be, or what could happen. Or what terrible thing has happened in the past."

"The compounding grief is just enormous and they don't know where to begin to even deal with it."
Sarah Gale, clinical social worker at Brigham and Women’s Hospital

Gale said some of her grieving patients have traditionally been the strong ones who others usually turn to in difficult times.

"But what I'm seeing is those family caregivers and reliable people are burned out," she said. "They have been in this reactive stress mode for so long. And they're suffering, too. And they have needs, but their needs don't necessarily get met because people aren't used to them having needs."

While the million U.S. deaths have come from every corner of the country, it's communities of color that have disproportionately felt the burden.

Dr. Shunda McGahee cares for patients in those communities as the medical director of ambulatory and community services at Beth Israel Lahey Behavioral Services.

"When you look at the raw numbers, more white people have died," McGahee said. "But when you look at the proportions and the proportionality, and what communities were hit hardest, it is the underserved communities of color which represent the places that had the highest number of COVID cases. The Lawrences, the Haverhills, the Lynns, the Chelseas. These are populations that have 60, 60-plus percent people of color."

And the pandemic restrictions necessary to prevent the spread of the virus have "broken down all of the normal traditional processes that we use to grieve," McGahee said. "The way that we come together, the way that you bring someone food, the way that you sit shiva, the way that you do a viewing. The way that you sit with someone in the hospital. All of those things have been denied."

With a million Americans now gone, the nation has been denied the chance to collectively mourn them, she said.

"I mean, we were able to do more reflection and processing around 9/11," she said. "And we as a nation really have not been able to grieve and wrap our minds around this thing that has affected every single state, you know, all communities. And there's a suspended emotional energy that I really feel is going to explode because that number cannot go unacknowledged, emotionally."