More than 5.2 million people in the US are mourning the loss of a loved one from COVID-19.

We are a country awash in grief. To date, more than 578,000 people in the US have died from COVID-19, and each death has left behind nine close family members, according to researchers. Nationwide, this means more than 5.2 million people are mourning the loss of a loved one from the coronavirus.

It's not just the death of a loved one from COVID-19 that people are grieving. The pandemic has also caused many Americans to lose a job, a house, or marriage—not to mention their daily routine, the ability to travel freely and safely, the sense that the world is an inherently safe place, and a whole way of life. All of these losses can leave people grieving, author Hope Edelman, a grief and loss coach, tells Health.

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In her latest book, The AfterGrief: Finding Your Way Along the Long Arc of Loss, Edelman writes about the long-term grieving process that millions of Americans are now going through. Here's what Edelman wants you to keep in mind about coping with grief during the pandemic—and beyond.

What grief is, exactly—and how you might experience it

Edelman defines grief as "the involuntary response that we have when we have lost something very dear to us." When we grieve, that response can be emotional, psychological, physical, social, behavioral, and/or spiritual. How grief takes shape in a person varies. For example, grief might show up as a disruption of sleep or appetite. It can create anxiety and fear. People who are grieving might experience heart palpitations; irritability; confusion; brain fog; and feelings of hopelessness, helplessness, or despair. As we long for what we once had, there can also be significant emotional stress.

Grief really only has two stages

You might remember learning about the five stages of grief in school. But there's actually widespread agreement within the bereavement community that grief doesn't happen in those five stages, Edelman says. In her book, she explains that grief is experienced in two stages: "the one when you feel really bad, and the one when you start feeling better."

The first stage of grief can be very intense, lasting from several months to a year or two. How long it goes on depends on certain factors, including who died, what your relationship with that person was like, how they died, how old you were when they died, and what kind of social support you have to help you mourn.

The second stage of grief begins when a person in mourning re-enters the world—when you wake up in the a.m. and your loss isn't the first thing you think about every day, when you laugh again, when you can talk about your loved one without breaking down in tears. "It's also where we can experience enormous growth in the form of appreciation, gratitude, determination, or commitment after someone dies because we learn how precious, how fragile existence can be," Edelman says. "And it often spurs people on to do extraordinary things with the time that they have remaining."

She calls this second stage the "AfterGrief." Entry into the AfterGrief "starts when the most intense reactions to a loss start to diminish," and the stage "extends pretty much for the rest of our lives," according to Edelman.

How to deal with 'sneak attacks' of grief

When you're in AfterGrief, feelings of grief strike at unexpected times. You can't know when you'll hear a song on the radio that reminds you of the person you lost, or when you'll see someone who looks like your deceased loved one. These sneak attacks can churn up a deep emotional response. They can happen years after your loss, and they don't mean that you've grieved wrong or incompletely. "We have to honor those feelings, let them pass through us, remind ourselves that these are normal," Edelman says.

Because you don't know when they're going to happen, there's no way to prepare for grief sneak attacks. However, Edelman says once you know what your grief trigger is, you can proactively try to reduce its intensity.

For example, whenever Edelman would smell Chanel No. 5 perfume, she'd experience a wave of grief because it was a scent she associated with her late mother, who wore it when she went out at night. Edelman would completely avoid the perfume department at stores so she wouldn't risk catching an accidental whiff of the fragrance. "I realized that what I could do instead was imprint new memories on that object," she says. "So I bought Chanel No. 5, and I started wearing it myself when I went out at night. Now when I smell Chanel No. 5, I remember my mother, but I also remember some of the events that I went to as an adult. And now it's a beautiful way to feel connected to my mom, because we're wearing the same perfume to go out at night."

How to prepare for anticipated grief

Sometimes, you have a pretty good idea of when you might experience a grief flare-up; it's another characteristic of being in AfterGrief. For example, you might see or smell the flowers that were blooming during the season your loved one passed away. This seasonal reaction can trigger deeply held memories.

The anniversary of the day that your loved one died can be a time that you experience a spike in grief too. This year, millions of Americans will be marking a year since the death of their close family member or friend to COVID-19. "It's important to recognize that if you're having a response around the one-year point, that doesn't mean that you didn't grieve properly or that you got it wrong," Edelman says. "It's a completely normal response to have an anniversary reaction. It happens to many people, and what it means, oftentimes, is that you're still feeling an emotional attachment to the person who died, you're still missing them, you still feel that love for them. I don't see that as something negative, and I don't think we should paint it that way as a culture."

However, if you feel disabled by that anniversary response—to an extent where you can't engage in your daily functioning—Edelman says that talking to a mental health professional might be useful.

Make a plan for those days that might be extra hard

In addition to the anniversary of a death, other calendar dates that can cause a spike in grief are your deceased loved one's birthday or a holiday when you used to get together. For these days, it's good to have a plan in place for how you are going to spend the occasion, "otherwise, the impulse may be just go under the covers and not get out of bed that day," Edelman says.

Her advice: "Fill the day with something that you can actually look forward to that might commemorate your loved one in some way and bring their memory into the present. You can depart from the plan if you wake up that morning and decide that in the end that's not something you really want to do, or you're not feeling up for it, but it's good to have that plan in advance."

That plan might even turn into an annual ritual that honors the person you lost. "Rituals are important because they connect the past with the present and the future," Edelman says. "If you are taking a memory of something that you once did together, or something that your loved one really enjoyed, and you're engaging in it in the present and you're planning to do it again in the future, it gives newer sense of purpose across time. And that can be very grounding, especially when we are feeling emotionally chaotic."

Edelman also recommends putting together a team in advance—whether it's one person or your entire extended family—that knows you'll be anticipating grief that day. They can be there for you if you need emotional support or want social interaction, so that you don't go through the day alone.

Women and men often grieve differently, but a combination of the styles might be best

Of course, not all women grieve the same, and not all men grieve the same. But there are "feminine" and "masculine" styles of grieving, with about 85% of women and men grieving according to their gender, Edelman explains.

The feminine style of grief is to externalize emotions and express them—to talk with others, cry, lament, and reminisce, say by going to a support group. The masculine style of grief is more internalized and manifests through actions and problem solving, for example by making a video montage memorializing their loved one.

A combination of the styles might actually lead to better adjustment over time, according to Edelman, with men encouraged to express their emotions outwardly and women encouraged to problem solve or grieve through action. "That could also be doing lots of physical activity, like exercise or just moving the body, which we know is good to help with stress hormones and get our endorphins going, to get our bodies moving when we're feeling really low, when we're in a state of grief," she adds.

The pandemic has changed the way we grieve

Even before the pandemic, grieving was a big and ignored public health issue, Edelman says. The pandemic has made the process even harder, since our social interactions and networks have become smaller and briefer this past year due to social distancing. Maybe you couldn't gather at a funeral or memorial service, or you couldn't meet up with your friends and family if you needed support while going through a divorce.

Because of the pandemic, we "don't have access to the familiar or comforting social mourning rituals that we would depend on when we are going through a loss," Edelman says. "People are having to grieve in more isolation than they may have ever experienced before. And that means that they need to tend to their grief on their own, which is not how I believe grief was meant to be tended to. There's a big disconnect between what we need and what we are able to give ourselves during this past year."

Check out Health's collection of mindfulness activities geared specifically to address grief on MyLife.

Many of our mourning practices have been done virtually this year, and Zoom is not an adequate substitute for an in-person event, Edelman believes, so we should return to real life grieving as soon as we can. "It is really important for the mourners to have human comfort, and it's important for the 'village' to come together and mourn the passage of one of its own and to do that in community," she says.

Edelman does hope that mourning events will continue to be a mix of virtual and in-person even after the pandemic, though. That will allow those who are unable to attend IRL to still participate and grieve with others.  

So yes, the pandemic has made it tougher to adequately attend to grief, and it's created more grief for us to deal with. But it's also highlighting the importance of grieving in the first place. This past year, it's been impossible to avoid experiencing, noticing, acknowledging, and talking about grief. Edelman hopes that since the importance of grieving is now in the spotlight, the US will become "a more grief-literate society."

"There is a tremendous amount of activity in the end-of-life area and bereavement services and getting them to more people," she says. "I'm seeing an expansion in awareness and in services, and that can only be a good thing."

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Credit: Julia Bohan-Upadhyay

How to Be OK When You're Not OK  Check out Health's special series on life after loss.