Since losing her mother to covid-19 in April, Helen Stoba, who lives in Liverpool, UK, has been racked with guilt, anger and confusion. She struggles to focus and has nightmares. “No one truly understands how different the grieving process is at the moment,” she says.

Psychiatrists are observing similar emotions in others who have lost loved ones to covid-19 (see “Stories of loss,” below). They warn that the unique challenges of coming to terms with these deaths could lead to a rise in a condition known as prolonged grief disorder.

Grief tends to ease with time as people adapt to life without the deceased. But about 10 per cent of bereaved individuals develop prolonged grief disorder – severe, unrelenting grief that lasts for six months or more and makes it difficult to function.

Previous research has found that people are more likely to develop the condition if a death is sudden and unexpected, they are experiencing other stressors or they lack social support.

More people are experiencing these risk factors during the pandemic, since the coronavirus often kills swiftly, many bereaved people have additional stressors , such as the loss of their job, and social structures are undermined. “Grieving people tend to appreciate a hug, which is impossible when we are required to adhere to physical distancing,” says psychologist Lauren Breen at Curtin University in Australia.

Many covid-19 deaths also come with extra challenges that could further increase the risk of prolonged grief disorder, says Joseph Goveas, a psychiatrist at the Medical College of Wisconsin. These include not being able to say goodbye in person, covid-19 specific restrictions on rituals like washing, kissing or viewing the body and limits on the number of people who can attend funerals. These may all derail the healing process, he says.

Goveas is also seeing high levels of guilt in patients who have lost loved ones to covid-19. “They feel like they didn’t do enough or they have survivor’s guilt and wonder why they were spared,” he says.

Guilt is an emotion that Stoba feels keenly, because she was not able to be with her mother when she died. “I am devastated that she was alone with no one but medical staff,” she says. Not being able to see her mother in the chapel of rest has also made it difficult to comprehend her death, she says. “Throughout her funeral, I kept asking if they were sure it was my mum in there,” she says.

It is too soon to know whether covid-19 will cause an epidemic of prolonged grief disorder, since it takes at least six months to diagnose, says psychologist Maarten Eisma at the University of Groningen in the Netherlands. But he thinks there is a high risk, since natural disasters tend to increase rates of the condition and covid-19 shares similar features, like causing large numbers of sudden deaths.

Fortunately, there are effective treatments. A talking therapy called complicated grief psychotherapy, for example, has been shown to reduce symptoms of the condition and to work better than antidepressants.

Stoba has found that talking to a bereavement counsellor and joining online support groups have helped. “Being aware of the risk of developing prolonged grief disorder and accessing timely treatment may aid in mitigating a silent epidemic from happening,” says Goveas.

Need a listening ear? Bereavement Trust Helpline , UK: 0800 435 455, Grief Resource Network , US, Griefline, Australia : 1300 845 745