Sadness, despair and anger when a patient dies alone from COVID-19: A thematic content analysis of Twitter data from bereaved family members and friends

SAGE Palliative Medicine & Chronic Care

This episode features Dr Lucy Selman (Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK). Twitter is a rich repository of data reflecting contemporaneous public opinion. The idea of dying alone is contrary to the concept of a ‘good death’ in many cultures, and not being able to say goodbye is a known risk factor for poor bereavement outcomes. During the COVID-19 pandemic, many bereaved people have been unable to be present when their loved one died due to setting-specific infection control restrictions that vary across regions and institutions. Twitter users expressed sadness, despair, hopelessness and anger about their experience and loss during the COVID-19 pandemic, with the challenges they experienced before the death compounded by a lack of social support and disrupted rituals afterwards. A sense of political neglect or mistreatment was frequently expressed, alongside calls for action, but Twitter users also used the platform to encourage positive public health messages, express condolences to and support others, and pay tribute to the deceased. There was ambivalence about the use of video-conferencing technology, which was often presented as an inadequate substitute, and frustration and blame were directed at governments’ inaction and policies as well as the behaviour of the general public. Governments should provide clear guidance to support end-of-life care providers in facilitating and optimising contact with loved ones, even when strict visiting policies are necessary; this must include adequate access to personal protective equipment. Signposting bereaved family members and friends to bereavement services, and proactively identifying and supporting those at particular risk of poor outcomes, is as crucial during a pandemic, as it is in non-pandemic times. Further research is needed to fully understand the emotional toll expressed in these tweets and the immediate and sustained impacts of bereavement during the pandemic.