So Close, Yet So Far

Social distancing is helping to slow the spread of COVID-19, but it comes with a cost. Maintaining connection and intention is key to resiliency.

By Rich Polikoff 

COVID has tested the resiliency and challenged the wellness of Americans like few moments in our history.

Mark Supiano, MD and Kathie Supiano, PhD have witnessed these issues daily through their roles at U of U Health. Mark is a professor and chief of the School of Medicine’s Division of Geriatrics, while Kathie is an associate professor in the College of Nursing and director of Caring Connections: A Hope and Comfort in Grief Program. They work with Utah’s grieving populations and some of its most at-risk people.

What are some of the big challenges people now face?

Kathie: Dying now is really complicated, especially with dying in hospitals or nursing homes. At the start of the pandemic, there was no way for the family to be present at the time of death. 

That really does complicate grief. Many people feel they’ve failed their family member who died. They had promised that they would be present and hold hands and do all those things that we know contribute to good grief. They are devastated and they can’t have the funeral they would have wanted to have, they can’t have the hugs and the gatherings. Resilience happens in the context of a community. 

Mark: We want people to be physically distanced from exposures, but we want people to maintain their social connections. From a resiliency standpoint, staying connected is key, whether that’s with health care providers, your family, your friends, or your support groups.

Loneliness is a risk factor for death and bad outcomes. We have a group of people (the elderly) who are already isolated and lonely; now we’ve superimposed on them this requirement that they keep physically distant.

What should people know about the concept of resiliency?

Kathie: We’re judging people who are struggling and labeling them as not resilient. We’re underestimating the magnitude of the stress that people are enduring with children, schooling, safety, death, the political climate, and I think a lot of what we’re seeing in the anger and the frustration comes from a lack of recognition about the very demanding situation that we’re in.

We need a national strategy on grief that invites the creation of compassionate communities, as well as training to deal with this tsunami of grief that’s going to come. 

What challenges are ahead?

Mark: Early on in COVID, the message was, ‘This is a marathon, it’s not a sprint.’ Why that analogy falls short is that running a marathon, you know where the finish line is. As painful as it is when you hit the wall in mile 20, you know can get through it because it’s going to end relatively soon. None of us know today when this is going to end. The biggest challenge for everyone is to try to maintain that attitude of resilience if every day you’re doing the same thing.

What lessons from previous crises can we draw on currently?

Kathie: In social work, we’re drawing some pretty tight parallels between those who lost someone in the 9-11 attacks. It’s a public death, meaning you know how they died, and the idea of not being present is very parallel to 9-11, when bodies were not found. People feel better about a death if they understand what’s going on. Before the death, nursing homes and hospitals need to have plans to, whenever possible, bring family members in, either through wearing PPE and being in an isolation room, or through technology.

What are some positives you have observed?

Kathie: The funeral industry has really done an incredible job facing this challenge. They’ve never faced anything of this magnitude since the Civil War. They’ve responded with incredible creativity and safety, and of course they’ve cared for the safety of their staff. Every step of the way, they have reassured the family, ‘We know this isn’t what you wanted, but you’ve done the best that you could under these circumstances.’ 

Mark: We’ve been pleasantly surprised at just how adaptable people have been with technology. Many assisted living facilities don’t allow visitors. To set up a virtual visit often requires someone else to be there with the patient. What we’ve been able to do is equip assisted living settings. Now they have an iPad with a platform that provides a one-to-one connection with anyone that is a University of Utah Health provider.

What gives you optimism?

Mark: One of the real pleasures of working with older adults is that the wisdom they have acquired throughout their lifetime is something we can all learn from. I have the pleasure of interacting—now virtually—with several of my patients who are in their nineties and most of the nonagenarians are saying, “You know, I’m fine. We’ve been through worse. We’ll get through this.”