Cape Town – The unbearably tragic stories are becoming more common and heart-wrenching. A Cape Town teenager losing her parents to Covid-19 in one day (a prominent American even lost his parents to the virus six minutes apart); and three Pretoria siblings hit by a double shock after their father died from Covid-19 three days after they buried their mother due to the virus, to mention but a few cases.
This in a nation that even before the advent of Covid-19 suffered from post-traumatic disorder due to apartheid, with the rise in gender-based violence and senseless, depraved killings under lockdown level 3 adding to South Africans' emotional frailty.
How do they cope with their grief is the question, especially when Covid-19 burial regulations allow for little closure? To add to their woes, lockdown has added multiple stressors and increased uncertainty in people's lives. The loss of a job, an income, is also highly stressful and the loss of a normal way of living and schooling has even seen a rise in attempted suicides by youngsters on the Cape Flats.
Many experts agree that the mental health effects of Covid-19 will continue to be felt long after the pandemic ends. In a commentary in the American Journal of Geriatric Psychiatry, Joseph Goveas, MD, of the Medical College of Wisconsin, and Katherine Shear, MD, of Columbia University, outlined why they believe cases of "prolonged grief disorder" are likely to rise.
Prolonged grief disorder is characterised by intense yearning/longing for the deceased person or a preoccupation with thoughts or memories of the deceased person accompanied by significant distress or impairment.
“Comprehending the reality of a loss is difficult under any circumstances, but even more so when the death is sudden and a loved one is left to die alone,” they wrote.
“In addition to yearning and sadness, most people feel anxiety, guilt or anger. Bereaved people are inclined to protest the death and have a natural tendency to imagine alternative scenarios in which their loved one did not die. Most feel survivor guilt."
The authorities' rationale of the Covid-19 regulations being there "for your own safety" carries little weight for those who regard the coronavirus as "just another bullet that can catch can you". IOL spoke to Cape Flats activist and trauma counsellor Roegshanda Pascoe, Professor Ashraf Kagee, of the Department of Psychology at Stellenbosch University, and Pastor Charles George from Delft about the challenges people are facing due to Covid-19 and the lockdown.
Pascoe said: "Besides losing your loved one to Covid-19, you have this process where it is already traumatic and hard to accept because the person who died had to enter the hospital on their own, their family were not entitled to visit and most of them were not even able to do a video call.
"So there is an instant break of connection, especially when it comes to parents with their children. People are not even allowed to go and identify the body (they can in exceptional cases); they just get notified and the body comes wrapped already when it's a Covid-19 case. The funeral is limited to only 50 people and although you are attending the funeral, the process to really deal with the death cannot happen because there is no closure and that is the worst part.
"There was no chance to really grieve over your loved one because you are still dealing with never being able to connect with the deceased when they were in hospital. So when the person has passed on, all those emotions have to work through before even starting to deal with the loss of the family member, relative or loved one.
"Those people who are grieving have had their stability shaken. So mentally and spiritually you are not only sitting with bereaved people, but with people who are deeply traumatised and soul sick. Covid-19 has come like a tornado upon our people and shaken their world on every level.
"There is a family I am still supporting after they lost a family member. Two of the children wanted to commit suicide because they couldn't come to terms with the fact that their mother had died of Covid-19, that's how bad it is. The family were unable to identify the body and the autopsy report did not specify what the deceased had died of, whether it was of heart or kidney failure, for example, all it says is that they died of Covid-19. So they sit with a lot of unanswered questions.
"Everybody thought the vulnerable people would be the homeless on the street, but they are living and the people that are more careful and protective, those are the ones that we are losing. When people have done everything possible to prevent them from contracting the coronavirus, it's very hard to come to terms with it.
"Mentally our people are very ill at the moment because they can't handle the impact of Covid-19 and what it has brought about in their lives. People on the Cape Flats were already in over their head trying to cope with the daily challenges of gangsterism and shootings. They feel Covid-19 is just perhaps 'another bullet that can catch me'.
"When it comes to counselling and dealing with their problems, there is a lot of stigmas attached to it on the Cape Flats. When they hear you are at a counsellor, the first thing they think is that you are a mental case or crazy."
Highlighting the options available to those who require bereavement counselling and mental support, Kagee said: "People have a great deal of anxiety about getting infected with Covid, about accessing hospital care and being on a ventilator, which is a very distressing experience for a lot of people. People are very anxious about surviving. Then there is the question of grief and bereavement for loved ones who have lost family members.
"There is also a lot of anxiety related to finances and people losing their jobs. So there is a great deal of psychological stress associated with this pandemic.
"It's a very difficult thing to cope with this unprecedented phenomenon. Social support, family support for people who have access to that are things that people find useful. There is Lifeline and the SA Depression and Anxiety Group that are able to assist people and Cape Mental Health.
"There are also very useful apps that can help people to administer their mood, to manage their anxiety and stress associated with Covid and find support for bereavement and grief when they lose loved ones. A lot of people don't have access to devices and data though so those are limitations.
"We are faced with a situation that is unprecedented. People can find support through each other, using WhatsApp groups and those kinds of things. As much as it is necessary to grieve it is also necessary to keep people safe by not congregating in large groups.
"We need to refer people to places where they provide psychological services, for example, The Trauma Centre in Cape Town, which is an NGO that provides free services to people on the Cape Flats, and Cape Mental Health.
"There are specific needs that specific people have and we need to try to address those needs as much as possible. Covid has added an extra layer of stress for a lot of people. So we are faced with multiple stressors and we have to find ways for people to cope that are healthy and safe.
"A lot of issues don't have easy answers and the answers might lie beyond what psychologists can provide. For example, reducing the level of violence in communities, how do we do that? We need better policing, we need people to get jobs, we need proper housing, those are the kind of solutions to the social problems people are experiencing. We need a proper protocol to prosecute people who perpetrate gender-based violence, educate men about gender-based violence, and develop social norms about gender equality and respect.
"Psychologists can do some of the work, but a lot of the work needs to be done by the politicians, the policymakers and the police and the other organs of state that need to intervene beyond a mental health level.
"Different people manage stress in different ways. If you have a hundred people and you give them a single stressor, people will manage that stressor in different ways. Some people might need psychological and psychiatric treatment, others might need social and family support, other people might need other support such as joining a social group or other people might need nothing. So there's not a one-size-fits-all for everyone who experiences a severe stressor."
Commenting on the situation in Delft, the suburb with the second-highest murder rate in the country (20 people were murdered in June and 11 thus far this month), George said: "We've been having a lot of different challenges. Mentally you can see people are starting to crack with everything that is happening.
"We are seeing an increase in attempted suicides, especially young people because of the education pressure. They get their schoolwork via SMS and WhatsApp, they don't have the data to download; a lot of things contributing to people's deteriorating mental condition, especially the youngsters.
"If you see the number of people turning to crime, that's where the release will come because families have lost their income, people have lost their jobs. Government is failing them. If you go to a website, it's offline; if you phone them, you get voicemail, there's a lot of frustration.
"The government is focusing on one thing yet, on the other side, you have healthy people dying, healthy people being challenged mentally because of the amount of pressure they have to deal with, so it's not a holistic approach from their side."
In the UK, Covid-19 Bereaved Families for Justice feel they’ve been abandoned by the government – many South Africans feel the same – and that the pandemic could become a timebomb if left unaddressed.
“There has been no recognition of the emotional, psychological impact to the families that have been affected by this,” they said.