As a pandemic presses on, waves of grief follow its path

In a strong voice tinged with her Irish homeland, Fiona Prine talks hauntingly about loss. From her COVID-19 infection and isolation — self-imposed in hopes of sparing her husband, folk-country legend John Prine — to his own devastating illness and death, she’s had more than her share in this year like no other.

Illness and death are the pandemic’s most feared consequences, but a collective sense of loss is perhaps its most pervasive. Around the world, the pandemic has spread grief by degrees.

While less than 1% of the global population is known to have been infected, few on Earth have been spared some form of loss since the coronavirus took hold. With nearly 1 million deaths worldwide, full-blown bereavement is the most recognizable.

But even smaller losses can leave people feeling empty and unsettled.

Layoffs. Canceled visits with Grandpa. Shuttered restaurants. Closed gyms. These are losses that don’t fit neatly into a “Hallmark category.’’ But they are not insignificant — especially when anxiety is already heightened, says psychologist and grief specialist Robert Neimeyer of the Portland Institute for Loss and Transition.

Activities that are part of usual routines, that bring pleasure or purpose, give people a sense of control over their lives. Losing them can result in psychological distress and unease, he says.

In normal times, people look to families, friends, communities for support in coping with loss. But in the pandemic, “We don’t have as much capacity as a human community to meet the needs. Nearly everyone has been affected,’’ he says.

“If you were to approach anyone on the street and ask them 10 times, `What have you lost?', you would hear some remarkable stories.’’

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By the time John and Fiona Prine returned home from a trip to Ireland in late February, the pandemic was spreading. Soon after, Prine had hip replacement surgery, and they hunkered down in their Nashville home for his recovery.

They’d been careful overseas and came home feeling healthy but cautious. Coronavirus tests were almost an afterthought.

“We were doing fine. Happy to be home. John was already up on his feet with a cane,’’ Fiona Prine says.

Prine was 73, a cancer survivor with chronic lung disease, but still performing regularly. His wife and manager, 15 years younger, was protective. She often watched from backstage.

"I knew this would not be a safe virus for John,’’ she says.

When the call came with results showing she’d tested positive, “You might as well have told me I was pregnant,” Fiona Prine says. Hoping to keep her husband healthy, “I literally bolted for the bedroom and locked myself in practically."

His test results were “indeterminate." But he seemed OK.

Her quarantine was tough on both of them. They missed each other, and FaceTimed every evening. “He didn’t like to be away from me,’’ she says. Both news junkies, they followed pandemic developments.

“God, there are so many things I wish were different,” she said in a selfie video while confined to that bedroom as cases mounted worldwide, musicians canceled gigs, businesses shut down and families lost livelihoods.

At her quarantine’s end on Day 10, she zipped down the stairs, in gloves and mask, to be by Prine’s side. He’d been napping more than usual, and she knew he was not OK. She grabbed their pulse oximeter, a device that clips onto a finger to measure blood oxygen levels. It showed just 82%, — too low even for someone with chronic lung disease. In healthy people, 95% and up is normal.

“I immediately drove him to the ER,'' she says. Leaving him at the door was agonizing; she knew instinctively that the virus had already attacked his lungs.

She saw him again almost two weeks later when a doctor called her to the hospital. The Prines spent his final 17 hours together.

Six months later, she’s learning to cope. Grief counseling has helped. But there are random moments when "I’m just absolutely swept away by grief. And I’ve learned not to stifle it.’’

John Prine fans, many who’ve followed him for half a century, feel like family to his wife. They’ve reached out to console each other on social media. Alone in her big house, she reads their messages and posts remembrances of her own.

It is, Fiona Prine says, “a way for me to stay connected to the world."

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In an impoverished mostly Black and rural Georgia county, no one knows the toll of pandemic losses better than Adrick Ingram, the coroner.

The number of COVID-19 deaths in Hancock County, 43 as of Oct. 11, is deceiving. With only 8,530 residents, that amounts to 5 deaths per 1,000 — the highest per-capita rate of any U.S. county.

‘’It has affected our community in a way that I consider tragic," Ingram says.

It has affected Ingram, who is used to seeing grief up close and personal in his dual jobs, declaring cause of death and running a funeral home.

‘’I try my best to compartmentalize, to have empathy but also to find ways to relax my mind and distance myself from my work," says Ingram, 44. "And I have to do that, because it would be way too much otherwise.’’

It has been way too much in 2020.

One out of every four funerals has been a COVID-19 death. Many are people he knew well. “You know their children and their wives,” he says. It makes compartmentalizing “a little bit harder.”

He has a wife and a 7-year-old son. They fear he’ll bring the virus home.

Early on, victims were mostly residents of the county’s two nursing homes. Now it’s younger residents, too. Ingram sees young people in town not wearing masks and gathering in big groups, and it frustrates him.

‘’I see people who aren’t taking it seriously, maybe because they don’t see what I see. They don’t get to look in people’s faces when they’ve lost somebody.’’

When it all gets to be too much to bear, Ingram goes running, or escapes into Netflix.

‘’At some point," he says, “you do take that grief on.”

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Grief is an inescapable part of the job for cancer doctors. For all the recent treatment advances, many patients won’t make it. Dr. Hanna Sanoff of the University of North Carolina has attended workshops and learned from patients how to deliver bad news in person and share in their grief “without losing myself.”

The pandemic upended all that.

“I find myself wholly unprepared to speak of death and dying across cell phones or video links with unreliable connections,” she wrote recently.

Sanoff mourns the loss of that human connection that helps her help others grieve.

“I have not yet figured out how to help guide patients’ struggles’ with cancer, leading them toward a death with dignity and finding personal reward in our relationship, when I cannot see them (or) hug them” she says.

In the three-dimensional intimacy of an office visit, Sanoff can see body language, make eye contact and feel other subtle cues that let her know when to pause, take a breath and give patients time to absorb the gut punch. She can wait through their tears, let them hold their loved ones, embrace them herself, and know better how to show them she wishes she could change their reality.

On a grainy computer screen, all of that is lost.

The grimness of these encounters is palpable in an essay that Sanoff wrote detailing one of them. It was published recently in the medical journal JAMA Oncology.

She knows which patients will take this news the hardest. A kindhearted woman whose pancreatic cancer was no longer treatable — “who loves life, who feels love and laughter and pain and sadness intensely” — was one of them. The patient sat next to her wife as Sanoff gently delivered the blow via laptop.

“From afar I watched grief overtake them, gutted by sorrow for the loss of love so deeply shared,” she wrote.

It hit Sanoff during that awful session how travel bans, social distancing mandates and other pandemic losses have been particularly devastating for the terminally ill.

“This couple lost their final trip to ‘their place'; they will not get their bittersweet final swim in the warm Caribbean,” she wrote. These patients, she wrote, are mourning their impending death “and trying not to rage at the arbitrary injustice of a premature loss of love’s shared joys.”

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Neimeyer, the grief psychologist, says history shows people are pretty good at adapting to loss and hardship, “even following war and conditions of famine, government breakdown and civil unrest.’’

”However, we would be kidding ourselves if we were to ignore the very real impact of the current situation,” he says.

The pervasiveness and persistence of the pandemic could lead to a rise in what is known as prolonged grief — a kind which can be disabling and last for several months. It’s most common after a loved one’s death, but can happen with other losses too.

“We’re soft bodies in a hard world,” Neimeyer says, and sharing that vulnerability — acknowledging personal losses — can help people abide.

Music can, too. Just consider John Prine's final song, “I Remember Everything."

Written about a year before he died, it contains a sense of wonder but also loss and longing. Prine insisted that his other songs were stories about other characters. This one, though, is clearly more autobiographical — right down to its final line: “How I miss you in the morning light, like roses miss the dew.”

The song, Fiona Prine says, can make her cry as she navigates a life without her husband in a loss-filled world changed forever by the pandemic that took him away.

“My heart is with every single family who has lost a loved one in the way that we have,’’ she says. “We and our loved ones will have our own chapter in the history books yet to be written."

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content. Follow AP Medical Writer Lindsey Tanner at http://twitter.com/LindseyTanner.