'COVID-19 Cost My Friend Her Life. She Isn't Included in the Death Tolls'

"Have you lost anyone to COVID?" I hesitated when I was asked this question recently and then said "no". It felt like a lie, but the truth was too complicated. My family friend hadn't spent weeks in the hospital, struggling to breathe with the assistance of a ventilator. Doctors whose faces were obscured by masks and goggles hadn't rushed to her bedside as she took her final, painful breath. She wasn't included in the death tolls. She had a bad case of the sniffles in December, then, three months later, she died by suicide.

My recollection of the days that followed her death is a mix of vivid flash-bulb memories and blurs of complex emotions. Questions abounded. "Was she suffering for long?", "Did she have a long history of mental illness?", "Did anyone see this coming?", "Could this be related to post-COVID symptoms?" When a loved one dies by suicide, there are infinite questions and often so few answers.

My friend had COVID-19, and recovered from it, but we will never know how the virus impacted her brain or influenced her mental health. We can never ask her if the experience of worrying about her family getting sick felt like too great a burden. All we know is that the unique circumstances of stress, isolation, and illness contributed to our loved one making a decision none of us ever anticipated.

Mourning is different in a pandemic. Family can't fly in. Funerals have to be small. Warm gatherings of friends who bring hot dishes of food are replaced by long walks in the cool spring air and a friend or two sitting on the patio, bundled in a jacket, six feet away. Hugs for the mourners are sparse. We craved space and time to discuss our friend's life and the circumstances surrounding her death as more details emerged.

While we tried to plan a time to celebrate her life, we had no information to predict when or if a larger gathering would be safe again. We eulogized her in the ways we could: in-depth conversations at the kitchen table, discussions on daily walks with my mother, and tears shed as she sat at the edge of my sister's bed each evening.

Our mourning period was also speckled by evenings spent refreshing over and over at multiple computers trying to get vaccine appointments and hours spent in the car to reach the closest vaccine center. It felt wrong to focus on anything other than our loved one who was gone, but the pandemic permitted no time for recuperation.

Our story may not be the predominant narrative of loss in the past 18 months, but, sadly, my community is not alone. The effects of the pandemic on suicide are more complicated than initially anticipated. Depression rates in the U.S. have soared in the months spent in lockdown as we have been forced away from family and friends and afraid for our lives and our loved ones. Experts warn that the full impact of the pandemic on mental health and suicide may be hard to appreciate for some time. CDC data is provisional, and suicides are more likely than other causes of death to require investigation before the official cause is determined. Reports and research increasingly demonstrate that so-called "long-COVID" may have significant psychological effects, increasing rates of anxiety, depression, and even psychosis.

I was fortunate that my academic schedule allowed me to stay with my family as our community struggled through this unexpected loss. Communicating what had happened to others outside our small town, however, felt isolating. My medical school classes didn't stop. The pressure of performing well on board exams continued, as I holed myself up in my room, struggling to focus on my studies while those around me grieved. While the pain of loss was immense, I felt guilty discussing it openly. It was so clear to me that the whole world was mourning so much.

While the pandemic has provided some with an opportunity to huddle close to family, reflect on their values, and seek out support, certain groups have struggled disproportionately. Suicide rates climbed among, for example, communities of color, who still face higher rates of COVID-19 infection and death and are more likely to have lost jobs and income during the pandemic.

Hundreds of thousands of Americans have lost loved ones in the past 18 months. Many have died as a direct result of a devastating virus that ravages the lungs and attacks the body in ways we still don't fully understand. Others have died as a result of other forms of suffocation. Suffocating under the stress of social isolation, lost jobs, lost opportunities. There have been cases where the physical and psychological toll of long-COVID symptoms has been the cause of death by suicide.

Whenever I share that I recently lost someone close to me, I wonder if others imagine it was due to COVID. In a way, it was. So, as the pandemic continues to stretch on, I encourage people to check on loved ones. Isolation and trauma come in many forms. They affect those living alone and those who have watched loved ones die of COVID as well as people with families and social supports. Those who are struggling may not be who you most expect.

Natalie LaBossier is a medical student at Boston University School of Medicine. You can follow her on twitter @nat_laboss.

All views expressed in this article are the author's own.

If you have thoughts of suicide, confidential help is available for free at the National Suicide Prevention Lifeline. Call 1-800-273-8255. The line is available 24 hours every day.