The coronavirus has so far caused more than 500,000 deaths, with more than 136,000 of them in the United States. But the impact doesn’t end there.

Although it’s expected that deaths from COVID-19 will impair the health and well-being of surviving family members, the extent of the impact hasn’t been quantified.

Now, researchers at Pennsylvania State University have calculated that each death from COVID-19 will affect approximately nine surviving family members.

“It’s not just individuals themselves who die [from COVID-19]. People are connected to other people,” said Ashton Verdery, professor of sociology, demography, and social data analytics at Penn State and lead author of the study. “We have a general sense that the pandemic has had a lot of effects on families compared to during periods of normal mortality levels, but there hasn’t been an estimate into how large the effect might be, and the potential psychological impact.”

Verdery and his colleagues analyzed kinship networks — the system of relationships that make up an extended family — to determine the number of people who experience the death of a close relative due to COVID-19.

“Our goal was to understand for each death, what are the downstream implications,” Verdery said. “Think about the number as a multiplier — instead of making a prediction of how many people will die, it [the multiplier] represents how many people will be bereaved.”

The COVID-19 bereavement multiplier is a national estimate and defines kin as grandparents, parents, siblings, spouses, and children. While the multiplier was about equal for Black and white Americans, this does not mean that the impact of COVID-19 deaths will be the same. In Philadelphia, for instance, there are higher numbers of COVID-19 deaths among Black residents, meaning that more Black Americans will be bereaved.

There is also a concern that the large burden of family bereavement may lead to a related wave of health challenges. Family members often rely on each other for social and emotional support, and many studies have shown that experiencing the death of a loved one or relative places an individual at greater risk for negative life stressors, worsened health, and relationship strain. Additionally, unexpected deaths are more traumatic for survivors compared with those that are expected.

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Local hospital chaplains say the effect of COVID-19 deaths may be even higher due to the unusual intimate role that health-care workers and hospital personnel played in the pandemic.

“With COVID-19, we had to do some stuff around the time of death that we never had to before,” said Jim Browning, chaplain and pastoral care director at the Hospital of the University of Pennsylvania. “Families were not allowed in the room, and we had to become surrogate family members.”

In many instances, he has counted at least nine people in the hospital affected by a COVID-19 patient’s death, including nurses who stood with patients as they took their last breath and intensive-care-unit secretaries who called the families to tell them that it was time to said goodbye to loved ones on FaceTime.

“Just donning the PPE [personal protective equipment] and having to wear it and not be able to see in the face of their patients was hard for people,” said Claudia Smith, chaplain at the Hospital of the University of Pennsylvania. “That ability to connect eye-to-eye was a loss.”

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The grief may take years to resolve, some say.

“I’ve never seen us so complicated in our grief and loss,” Browning said. “There are scars that are very deep that we’re not acknowledging yet.”

But he sees a bright spot.

“Whenever a COVID-19 patient is released, the hospital plays ‘Here Comes the Sun’ by the Beatles. It’s been played 600 times, and it never gets old. We live for those moments of hope,” Browning said. “We are not declaring victory. We are expressing hope. In hope, we’re going to be together with each other.”