As deaths from coronavirus continue to mount, researchers are calling attention to another toll of the pandemic: the many people left behind to grieve, in a time of social isolation.
Losing a loved one is a traumatic event at any time. But experts say the ongoing crisis presents unique difficulties for people in mourning -- from the suddenness of the loss, to the societal shifts happening around it.
And a huge number of people will be affected in the months to come.
"This will be a mortality shock that the U.S. has never experienced," said Emily Smith-Greenaway, an assistant professor of sociology at the University of Southern California, in Los Angeles.
Greenaway and colleague Ashton Verdery recently published an analysis estimating how many Americans might lose a parent or grandparent to the pandemic. The numbers are grim: If, for example, 10% of white and black Americans were confirmed to be infected, that could ultimately mean over 500,000 deaths -- taking parents or grandparents from about 3.5 million people.
Greenaway cautioned that the numbers are projections, which necessarily require assumptions about the future. The latest "model" cited by the White House estimates that a little under 82,000 Americans might die of COVID-19 through early August.
But the bottom line, Greenaway said, is that the pandemic will take many lives, and those deaths will have a "ripple effect through families."
What will that look like? Based on existing research, it's likely many people will struggle to deal with their loss.
"The risk factors for a complicated, prolonged bereavement look almost like a script for what's happening now," said psychologist Robert Neimeyer, director of the Portland Institute for Loss and Transition, in Oregon.
He explained that one of the things that helps people cope with a loved one's death is being present with them toward the end -- sitting in the bedside chair for hours, hand-holding, expressing love, asking for forgiveness.
"These things are denied to us right now," Neimeyer said.
Social distancing also means no memorial services, no hugs from family and friends -- the rituals and basic human connections that help bereaved people get through.
"When you can't have something that resembles a funeral," Neimeyer said, "it can feel like you're dishonoring your loved one."
And it is not only people who lose someone to COVID-19 being affected, he noted: Anyone going through bereavement now could struggle.
It's a bleak picture, but both Neimeyer and Greenaway said it's important to prepare for it.
People are not powerless in the situation, Neimeyer said: "We'll need to get creative about ways to mitigate the impact."
In the near term, he said, families sheltering-in-place can still "construct a ritual to honor their loved one" -- something as simple as lighting a candle and reminiscing. With video-conferencing, they can include relatives and friends.
George Bonanno is a professor of clinical psychology at Teachers College at Columbia University, in New York City. He agreed that the rituals people have around death are vital, and creating a "virtual" semblance of them may help.
But, Bonanno said, the pandemic is also creating a broad sense of loss -- lost jobs, lost security, lost freedom, loss of the everyday social connections that make up people's lives. And it's likely to make the death of a loved one even harder, he said.
One reason is because everyone is experiencing those things at once, Neimeyer pointed out. So, at a time when the bereaved need support, friends and relatives are likely struggling, too.
That does not, however, mean you shouldn't ask for help. "We can still reach out, and do it with an empathy for what others are going through, and compassion for ourselves," Neimeyer said.
What do you say to someone in mourning? "That can be hard," Bonanno admitted. "But generally people need to hear, 'How are you?' 'I'm thinking about you,' 'I'm here.'"
And while processing pain is necessary, Neimeyer said, so are distractions.
One of the big challenges now is that the typical distractions -- work, social life, daily routines -- have been upended.
But those virtual connections may help fill the gap, particularly time with friends. In one study, Bonanno found that in both the United States and China, bereaved parents and spouses processed their grief less often with friends than with family or when alone.
"Maybe that's partly because we just want to feel normal with our friends," Bonanno said.
In fact, it's important to take breaks from the pain and talk about ordinary things, he said. "It's OK to let yourself be distracted. It's necessary," Bonanno said.
Mental Health America has more on bereavement and grief.