Cassandra Rollins’ daughter was still conscious when the ambulance took her away.
Shalondra Rollins, 38, was struggling to breathe as COVID-19 overwhelmed her lungs. Before the doors closed, she asked for her cellphone to call her family from the hospital.
It was April 7, 2020 — the last time Cassandra Rollins would see her daughter or hear her voice.
An hour later, she had died. Rollins had to break the news to Shalondra’s children, 13 and 15.
More than a year later, the grief remains unrelenting. Rollins says she has suffered panic attacks and depression that make it hard to get out of bed. She’s often startled when the phone rings, fearing someone else is sick or dead.
“You would think that as time passes it would get better,” says Rollins, 57, of Jackson, Mississippi. “Sometimes, it is even harder. … This wound right here, time don’t heal it.”
With nearly 600,000 lives in the United States lost to the coronavirus pandemic — now a leading cause of death — researchers estimate that more than five million Americans are in mourning, including more than 43,000 children who have lost a parent.
The pandemic has inflicted unique torment on mourners, making it harder to move on than with a typical loss, says sociologist Holly Prigerson, co-director of the Cornell Center for Research on End-of-Life Care.
Pandemic-related grief could affect physical and mental health for years, she says, leading to more depression, substance misuse, suicidal thinking, sleep disturbances, heart disease, cancer, high blood pressure and impaired immune function.
“Unequivocally, grief is a public health issue,” says Prigerson, whose mother died from COIVD in January. “You could call it the grief pandemic.”
Like many mourners, Rollins has struggled with guilt, regret and helplessness — for the loss of her daughter as well as Rollins’ only son Tyler, who died by suicide seven months earlier.
“The hardest part is that my kids died alone,” Rollins says. “If it weren’t for this COVID, I could have been right there with her. I could have held her hand.”
The pandemic has kept many from holding funerals even after deaths from other causes.
Prigerson’s research found that families of people who die in intensive care are seven times more likely to develop post-traumatic stress disorder than the loved ones of people who die in home hospice care.
The polarized political climate has even pitted some family members against one another, with some insisting the pandemic is a hoax.
“People holler about not being able to have a birthday party,” Rollins says. “We couldn’t even have a funeral.”
“People say, ‘I can’t wait until life gets back to normal,’” says Heidi Diaz Goff, 30, of the Los Angeles area, who lost her 72-year-old father to COVID. “My life will never be normal again.”
“Grief is invisible in many ways,” said Tashel Bordere, a University of Missouri-Columbia professor who studies bereavement, particularly in the Black community. “When a loss is invisible, and people can’t see it, they may not say, ‘I’m sorry for your loss,’ because they don’t know it’s occurred.”
Black children are more likely than white children to lose a parent to COVID. Even before the pandemic, the combination of higher infant and maternal mortality rates, a greater incidence of chronic disease and shorter life expectancy made Black people more likely to be grieving a close family member at some point.
Everyone Rollins knows has lost someone to COVID.
“You wake up every morning, and it’s another day they’re not here,” Rollins says.
Rollins is the youngest of 11 children raised in the segregated South. She was 5 when her older sister Cora was stabbed to death at a nightclub, according to news reports.
Rollins gave birth to Shalondra at 17. “We grew up together,” she says.
A few months after Shalondra was born, Rollins’ older sister Christine was fatally shot during an argument with another woman. Rollins and her mother helped raise two of Christine’s children.
In many Black communities, Bordere says, the trauma from violence, chronic illness and, death and racial discrimination add up.
“It’s hard to recover from any one experience because every day there is another loss,” she says says. “Grief impacts our ability to think. It impacts our energy levels. Grief doesn’t just show up in tears. It shows up in fatigue, in working less.”
Rollins hoped her children would overcome the obstacles of growing up Black in Mississippi. Shalondra earned an associate’s degree in early childhood education and loved being an assistant teacher to kids with special needs. Shalondra, who had been a second mother to her younger siblings, also adopted a cousin’s stepdaughter after the child’s mother died, raising her with her two children.
Rollins’ son Tyler enlisted in the Army after high school. He was 20 when he killed himself in 2019, leaving behind his pregnant wife.
Tyler’s daughter was born the day Shalondra died.
“They called to tell me the baby was born, and I had to tell them about Shalondra,” Rollins says.
With Shalondra’s death from COVID, her girls lost not only their mother but also the routines that might help mourners adjust to a catastrophic loss. They moved in with their grandmother, saying in the same school district. But they haven’t been in a classroom for more than a year, spending their days in virtual school, rather than with friends.
Shalondra’s death eroded their financial security, too. Rollins, who worked as a substitute teacher before the pandemic, hasn’t had a job since schools shut down. She owns her own home and receives unemployment insurance, she says, but money is tight.
The girls miss their mom terribly.
Makalin Odie, 14, says her mother, as a teacher, would have made online learning easier: “It would be very different with my mom here.”
“My mom always loved birthdays,” says Alana Odie, 16. “I know that, if my mom were here, my 16th birthday would have been really special. I miss everything about her.”
Alana and Makalin both have begun taking medications for high blood pressure. Alana has been on diabetes medication since before her mom died.
Mental and physical health problems are common after a major loss.
“The mental health consequences of the pandemic are real,” Prigerson says. “There are going to be all sorts of ripple effects.”
The stress of losing a loved one to COVID increases the risk for prolonged grief disorder, which can lead to serious illness, says Ashton Verdery, who teaches sociology and demography at Penn State.
Grief can lead to “broken-heart syndrome,” a temporary condition in which the heart’s main pumping chamber changes shape, affecting its ability to pump blood effectively, Verdery says.
From final farewells to funerals, the pandemic has robbed mourners of nearly everything that helps people cope with loss, says the Rev. Alicia Parker, minister of comfort at New Covenant Church of Philadelphia.
“It may be harder for them for many years to come,” Parker says. “We don’t know the fallout yet, because we are still in the middle of it.”
Rollins would have liked to arrange a big funeral for Shalondra. Because of COVID restrictions, the family held a small graveside service instead.
“What happens when people can’t come to your home and people can’t support you?” Parker says. “Calling on the phone is not the same.”
While many are loathe to acknowledge depression because of the stigma of mental illness, mourners know they can cry and wail at a funeral without being judged, Parker says.
“What happens in the African American house stays in the house,” she says. “There’s a lot of things we don’t talk about or share about.”
Funerals play an important role in helping mourners process their loss, Bordere says, helping them move to accepting “a new normal in which they will continue their life in the physical absence of the cared-about person.”
Often, COVID deaths come suddenly, depriving people of a chance to prepare for loss, sometimes even to say goodbye.
Funerals rites are especially important in the Black community and others that have been marginalized, Bordere says.
“You spare no expense at a Black funeral,” she says. “The funeral validates this person’s worth in a society that constantly tries to dehumanize them.”
In the early days of the pandemic, funeral directors afraid of spreading the virus didn’t allow families to provide clothing for their loved ones’ burials, Parker says. So parents and grandparents were buried in whatever they died in.
“It is an indignity,” she says.
Every day, something reminds Rollins of her losses. Yet the memory of her children keeps her going.
When she begins to cry, one thought pulls her from the darkness: “I know they would want me to be happy. I try to live on that.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues.