The age of COVID-19 — the numbers

It is October 12th, 2020, 6 months since I wrote my first COVID-19-related Editorial in Palliative & Supportive Care, Volume 18, issue 3; and 9 months since the start of this global pandemic. The numbers in mid-April were alarming: 2.4 million COVID-19 cases reported worldwide and 165,000 deaths globally. We dared not imagine the horrific potential for suffering and death, yet it has indeed come to pass. We watched in horror as the case totals and the death toll rose in wave after wave of the pandemic. Today, the “Numbers” are unfathomable: 38 million COVID-19 cases worldwide and more than 1 million deaths globally. In the United States alone, we have almost 8 million COVID-19 cases and 215,000 deaths. The “Numbers” alone, of course, cannot capture the scope and depth of the fear, pain, loss, grief, and trauma of this global human tragedy. Where leaders and governments have been guided in their policies by science and scientific experts, the toll may have been minimized. In the United States, we face a massive failure of leadership in government and a disregard for the guidance of our best scientific minds and the scientific evidence. We have seen a “politicization” of the management of the pandemic which has led to what many suggest may be the unnecessary deaths of more than 100,000 human lives. A “crime against humanity” that calls for action and accountability in the upcoming elections and beyond.

The age of COVID-19 — Death Terror and mortality salience

We are deeper than ever in the grip of “Death Terror”. The salience of mortality and death has never been more intense or non-remitting; it has invaded our lives and the world like a dense smoky fog that penetrates every crack and crevice of our lives. We inhale it with each and every breath whether we wear a mask or not. Like the airborne virus that it is, COVID-19 has cloaked us all in a mist of constant death awareness. It leaves a film of death salience on our clothes and skin and hair and masks. It is inescapable without the use of what Ernest Becker (Reference Becker1973) taught us in his Pulitzer Prize-winning book The Denial of Death. Becker hypothesized that in order to deal with the existential fact that we human being die, and can die at any moment (what Kierkegaard termed “Dread” and what Becker labeled “Death Terror”), human beings need to be able to deny death at moments, in order not to be driven insane and in order to be able to function. He went on to suggest that in order to manage our “Death Terror”, human beings created “Cultures.” Cultures supply human beings with either a literal or metaphorical solution to the problem of death, often through concepts that provided reassurance that death was not the end of existence. Almost all early humanly created cultures were religions (typically polytheistic at the start and then over time mono-theistic, and then eventually secular and scientific in nature). Becker's work inspired the development of a social psychology movement, developed by my good friend, Solomon et al. (Reference Solomon, Greenberg and Pyszczynski2015), now known as “Terror Management Theory”. Solomon and his colleagues have demonstrated that the “Terror” induced by Mortality Salience can produce both positive experiences (e.g. a greater sense of meaning in life) as well as negative experiences (e.g. intensification of tribal identity in the pursuit of self-preservation, even at the expense of humankind as a whole). At least in the United States, Terror Management Theory would explain the “politicization” of mask wearing as a symbol of identification with “Trumpism” and anti-authoritarian, anti-science motivations to not comply with COVID-19 mitigation practices, such as mask wearing, social distancing, and other restrictions imposed as health prevention measures.

Love in the age of COVID-19

Perhaps this editorial feels more like a piece on “Death in the Age of COVID” than one on “Love in the Age of COVID”, but trust me, it's about love. More specifically, it's about how death teaches us that “Love continues beyond life; beyond the deaths of those we love.” There have been over 1 million COVID-related deaths over these last 9 months, but death from other causes has not taken a holiday. We lost so many in 2020 who were so loved and valued by so many. There are too many to name, and any list I attempt to create will inadvertently leave out someone very special and very beloved, But I do want to mention a number of people who died during this age of COVID that were loved by so many in our circle of colleagues and friends of this journal, and who are still loved today. The very first COVID-related death that I learned of, as the very start of this pandemic in March, was the death of my dear friend and colleague Dr. Ricardo Castaneda, M.D. Ricardo and I met during our Psychiatry Residency Training at the Albert Einstein College of Medicine in New York. We became fast friends and shared a love of Latin and Brazilian music. Ricardo married one of our resident mates Anna Sass and they raised a beautiful family. They divorced but stayed a family. Ricardo was the Director of the Substance Abuse Program at Bellevue Hospital in New York City, and in his spare time was a prolific composer and artist. He died suddenly of a respiratory arrest in the very early days of the pandemic. His death made the lethality of COVID very real for me, very quickly, and very early in the pandemic. Many of you will know Steven Passik PhD, from his days in our Department at Memorial Sloan Kettering and his ground-breaking work on opioids and opioid abuse for the treatment of pain in cancer patients. Steve's beloved father, Isaac Passik, died of COVID in recent months. In Madrid, Spain, two of our beloved colleagues lost their precious fathers to COVID-19. Beatriz Moreno Milan PhD, a member of our MSK Meaning Centered Psychotherapy Consortium in Spain lost her beloved father Genoroso Moreno Gutierrez to COVID-19 a few months ago. She could not visit him; she could not hold his hand as he was dying (something she does always for her patients in the Madrid Hospice where she works). The family could not have traditional mourning and burial rituals. The pain persists, but the love she and her father shared lives on and is eternal. Maria Die Trill PhD, recent President of the International Psycho-oncology Society and a member of the Memorial family since the mid 1980s, recently lost her beloved father Alfredo Die Goyanes to COVID-19. Again, Love continues beyond death.

Finally, on a personal note, my Father-in-Law (my wife Rachel's beloved father) Harold Epstein died five weeks ago of natural causes, just short of his 98th birthday. Rachel was a devoted and constant caregiver to both her parents over the last decade. First for her mother Lillian, and then for her father over the last 5 years since his health declined after Lillian's death. Lillian and Harold shared a 66-year long marriage. Harold was an elegant man whose life spanned the Great Depression, World War II, and the tumultuous events of the 60s, finally reaching the time of COVID. He was a historian by education and spent his life as Executive Director of multiple not-for-profit organizations including the American Federation for Aging Research, The Winston Churchill Foundation, and the Loeb Family Foundation. When he died, my son Samuel said, “When Grandpa died, I lost my Best Friend, my Hero, and my Role Model.” In her Eulogy for her father, Rachel wrote the following:

Passing love along

The pain of loss and grief during this Age of COVID is searing. But these losses; these deaths; the constant Mortality Salience has taught us profound lessons on the meaning of life, the importance of striving to live a live full of meaning while simultaneously striving to find meaning in death — our own deaths and the deaths of those we love. Hopefully, what we've learned is that “passing love along is what we were born to do.”