LOS ANGELES/NEW YORK (Reuters) - Anthony and Rosemary Terio, married for 65 years, died five days apart in separate New York hospitals last spring, two lives among the nearly 200,000 that the United States has now lost to the coronavirus pandemic.
"This pain will never go away for me," said one of their daughters, Lisa Terio-Heath, who, because of the pandemic, had to remain at her home in Greensboro, North Carolina, and witness her family's loss from afar.
It has turned into a year of anguish in the United States and around the world where the death toll stands at nearly 1 million.
For many, the grieving has taken place at a terrible distance. Being present bedside in the hospital, attending funerals, and even simple hugs and the company from friends is often impossible.
"There's a grief tsunami," said Dr. Toni Miles, a professor of epidemiology and biostatistics at the University of Georgia.
Every COVID-19 death in the United States results in about nine survivors who have lost a grandparent, parent, sibling, spouse or child, Pennsylvania State associate sociology professor Ashton Verdery and other researchers wrote in a study published in the Proceedings of the National Academy of Sciences in July.
And swift, unexpected deaths like many of those from COVID-19 can be a potent trigger for depression, anxiety, and substance abuse, which can manifest in myriad ways - including absenteeism, accidents, alcoholism, assault and self harm, experts said.
They can fuel rumination about what could have been different which, left unchecked, can derail the grieving process, said Dr. Katherine Shear, director of the Center for Complicated Grief at Columbia University.
"Whenever anyone dies suddenly, a person is going to say, 'If only ...'," Shear said.
The United States has lost almost 70 times more people to the pandemic than it lost in the Sept. 11, 2001 attacks, the anniversary of which the nation stopped to mourn earlier this month.
So far, there has been no pause yet to collectively mark the losses from the pandemic - an important moment, experts say - perhaps because the death toll is still climbing. By year's end, COVID-19 deaths could top 378,000, according to a projection from the Institute for Health Metrics and Evaluation at the University of Washington.
That would be close to the number of American military deaths during World War Two.
The losses have been particularly pronounced in Hispanic and Black communities, and among the elderly and front line workers.
At the end of May, a research report from Yale University found: "Nationally, the new age-adjusted analysis shows Black people are more than 3.5 times more likely to die of COVID-19 than white people, and Latino people are nearly twice as likely to die of the virus as white people."
In the early weeks, New York City emerged as the epicenter of loss, but since then the disease has spread across the country, leaving a trail of suffering from major cities to small towns in all 50 states.
At a Houston hospital earlier this month, Angelica Mendez, 38, was permitted to spend less than an hour with her mother Catalina before the 86-year-old woman succumbed to COVID-19, leaving seven children and more than 30 grandchildren to mourn her.
Hospital safety rules restricted contact with the family matriarch, with her family saying final goodbyes in a video-call that Mendez made from the hospital.
Compounding the close-knit family's trauma, Mendez said, her father was admitted to the hospital's intensive care unit after testing positive for coronavirus. He was expected to recover.
Similarly, the Terio children saw both their parents, Anthony and Rosemary, hospitalized with COVID-19. Anthony, 86, died on March 31. Five days later, Rosemary, 82, succumbed to the illness.
In all, eight members of the family were infected.
"It went the whole gamut," said Lisa Terio-Heath. "My sister, taking care of my mother, caught it. Then she gave it to her son and her son gave it to his partner. And my brother gave it to his wife. And my other brother caught it and gave it to his wife."
"Nobody could help each other. Everybody was sick," she said. "It was just a really hard, horrible, horrible situation."
While mourning her parents' deaths, Terio-Heath said she is simultaneously angry at politicians who downplay the pandemic and anyone reluctant to wear a face covering that experts say is one of the most effective tools available to guard against the spread of the deadly disease.
"Put a mask on so that you never have to suffer what I went through or know that you possibly contributed to that," Terio-Heath said. "Don't be selfish."
(Additional reporting by Callaghan O’Hare in Houston and Maria Caspani in New York; Writing by Barbara Goldberg in New York; Editing by Diane Craft)
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