Responding to the fear of dying alone during COVID-19 pandemic.

A recent correspondence published in this journal rightly argues the meaning of creative ritual practices during the coronavirus disease 2019 (COVID-19) pandemic. Recent researches revealed the 'creative ways' to augment the need for spiritual and religious longing, complicated grief and different ways of coping with loss and coping mental health issues during the COVID-19 pandemic. This paper further adds the ways on how to mitigate the reality of dying alone during COVID-19 pandemic. © Crown copyright 2021.

As of this writing, the death toll of the coronavirus disease 2019 (COVID-19) is nearing 3 million. More than 2.8 million people have lost their lives due to the pandemic. The impact of COVID-19 is devastating both for those who lose their lives and for their family, friends, colleagues and all whom their lives touched. A recent correspondence published in this journal rightly argues the meaning of creative ritual practices during the COVID-19 pandemic. Recent researches revealed the ‘creative ways’ to augment the need for spiritual and religious longing, complicated grief and different ways of coping with loss and coping mental health issues during the COVID-19 pandemic. This paper further adds the ways on how to mitigate the reality of dying alone during COVID-19 pandemic.

The term ‘dying alone’ describes ‘approaching death while living alone or dying in a place where significant others are unable to be near’. This situation is not new. During the 1918 influenza pandemic, visiting sick people and attending funerals and wakes were also prohibited. Today, many patients are also dying alone, gasping their last breath without any family or friends there to provide comfort because hospitals have put in place strict no-visitation rules meant to prevent the spread of COVID-19. However, an overwhelmed healthcare system ‘should not be an excuse for mistreatments or, in many cases, unethical behavior’ because every single person who dies is an irreplaceable loss. They are not just numbers or statistics to be added on the COVID-19 death toll.

During this COVID-19 pandemic, death and dying has been disrupted for those dying in hospitals, hospices and at home. As people are dying in the current climate of self-isolation, they are now facing the lack of a traditional funeral or gathering to celebrate that person’s life. For the patient who is in intensive care unit (ICU) or care home, the reality is that they die without the companionship of those they love. For both patients and families, dying from COVID-19 negatively affects the possibility of holding an end-of-life (EOL) discussion and the chances of dying with someone present.

Consequently, if people are unable to say goodbye in the traditional way, then ‘creative rituals’ of mourning and of remembrance will need to be created. One way may be via the online environment (Zoom, Skype, Facetime) or social media (Facebook and Messenger) where this has become a more familiar sight in recent years. Indeed, as we move further along in the post-COVID-19 world, it is necessary to periodically reassess and readjust our approach to best address the needs of people. Telehealth and virtual meetings have become ‘new normal’. In fact, doctors and nurses go the extra mile to care for their patients by providing telecommunication between isolated patients and their families. Such ‘conversation sometimes takes place at the doors to the ICU, over the phone, or in front of the hospital, as families beg to see their loved ones before they die. A seemingly simple request, which in other times would be encouraged, has become an ethical and health care dilemma’. Therefore, ‘providing safe and effective palliative care, including end-of-life care, becomes especially vital and especially difficult’.

There is an urgent need to address the fear of dying alone during and after the COVID-19 pandemic. Finding ‘creative spaces’ of compassionate love and belongingness to patients could mean supporting meaningful companionship at the EOL. Alleviation of all forms of suffering should be one of the immediate responses of all. We have to be aware that while COVID-19 will come to an end because of the vaccines, the effects could be longer term.