Death in the time of Coronavirus.

As I scroll through my YouTube recommendations, a video from Cambridge University pops up: ‘Spanish Flu: a warning from history’. I can’t shake the ominous feeling that hangs in the room when I notice that it was posted a year ago. Of late, a lot of people are telling us that we should have known, the same way we often conceptualise most courses of natural death. Even if we see it coming, it catches us unaware.

For all the grief and surprise it bears, death has become a surprisingly normal installment of the day of late. Everyday, there are statistics relaying the number of people who have died in the wake of the pandemic. There has been no other time in my life that I could rattle the number of people who had died of a particular cause in a day or in the past couple of months, and I sense that the human relationship with death is changing in ways we would never expect.

When people die, humans tend to carry out a set of rituals to honor them. They bury, cremate, or set them to rest in other ways. Still, there is a period of time necessary to process somebody’s absence- but of late we have too many absences happening at once. In Italy, people were trapped in their homes with the corpses of their loved ones- pleading for help in removing the dead from their homes. Similarly, Italian priests are becoming overwhelmed with the number of blessings they are asked to perform.

In Wuhan, the original epicentre of the epidemic, urns sit solemnly outside houses, and families have only now began to share news of dead loved ones as the lockdown is lifted.

In the west, there is New York, where a family recorded 4 deaths out of the infected 7 members- but could not gather to mourn due to the social distancing guidelines in place.

And in South Africa, pictures circulated of head-counts taking place at funerals. Are you the 101th person? Thank you for your condolences- but we’ll have to ask you to mourn via Zoom. Do you need a shoulder to cry on? We can’t offer that here- that’s not in line with the 2 meter social distancing rule.

And so in a time where death has become some sort of certainty, our abilities to grieve and process it have become altered in way we never anticipated: we are robbed of the intimacy many of our established mourning processes require, and we are simultaneously robbed of the ability to give a human face to each and every number we see: have you ever stopped to wonder how many people are in as big a number 43 000- the current number of global coronavirus deaths?

Simarly, we are robbed of our main mechanism to offer solace: touch. While some people may be lucky enough to be ‘alone, together’, this still does not replicate the familial experience of a joint mourning, and as such, stands to upend our current practices.

And lastly, we are robbed of our illusions of immortality.

A myth has also spread of late: that the old are more likely to die of the virus than the young. The statement is true and false in many ways, but it holds up one perception which, although biologically evidenced, still has a bit of misconception: death is a place of the old, not the young. We don’t expect young people to die, and when it happens we are quick to say that they are gone too soon. We are not used to the young dying of courses of action they can’t control- the only time we can comfortably accept that they are gone is when it is a result of recklessness, as this is a characteristic we commonly ascribe to youth.

But where testimonials are coming in from both healthcare workers and patients, it’s appearing age is not the best predictor of death, which challenges who we expect to die: when it’s the elderly, we comfort ourselves with the knowledge that life had taken most of it’s course. But when it is the young, we find ourselves muddling with excuses that simply don’t suffice in explaining their absence, which is the sticky predicament this pandemic forces us into. As such, is it possible that year 10 post COVID-19, we will be defensive in our expectations of life and expect death from both the old and young?

In Italy, resources are being rationed. People such as the elderly and end stage cancer patients are not being ventilated, so as to make the wisest possible use of resources. But who are we to say that a 29 year old will fare better on ventilation than the 65 year old next to them? Of late it has actually become clear that it’s cardiac injury, both pre-existing or incurred during the course of COVID19 infection, that is the best indicator or likelihood of death.

But back to the ethical question, who are we to decide who is worth the effort? Has it now become a rule of healthcare that if someone is old, they should not be given the effort?

The obvious answer is no, and the obvious answer is also that these are not normal times we are living in. As such, normal restrictions do not apply, but it raises a question as to who we conceive to be the agent of death. For religious individuals, God is to decide your time of birth and time of death — but how do we know that you wouldn’t have survived if we gave you a bit more attention? In short- the recent actions taken by healthcare facilities across the world to ration their resources has forced me question if our actions are letting people die before their ‘destined’ times.

Where healthcare practitioners are being forced to play God, it’s worth taking the time to question how we traditionally perceive the process of death to take place. It’s ironic how, not too long ago, we percieved this process as being entirely in our control, with headline space being taken up by reports of people in Silicon Valley trying to find the keys to longevity and immortality.

Those efforts are not relevant anymore.

So is death something that we can’t decide, or something that scientific endeavors can circumvent? And if we stop circumventing the process, is death the fault of the doctor on call who had 1 ventilator between 2 patients, or do we still believe that this is all part of the script?

Death is being taken as the ‘new’ measure of seriousness.

In the early days of the pandemic, people were quick to claim that the COVID19 mortality rate had not yet reached the levels of the influenza mortality rate, nor had it even infected the same amount of people, but of late the script is changing.

From the above it is evident that COVID19 is the deadlier agent.

But this is where I need to ask the question: why is death the indicator of seriousness? The point of death is too late a reference to say an agent is injurious. What if it was serious the moment it infected a large number of people? We can’t predict the evolutionary course of a virus, and as they are agents that constantly mutate, we can’t predict when a mutation will prove to be fatal- a threat that is imminent if it takes it’s refuge in the bodies of many people, thus being given the machinery to replicate.

I therefore believe we don’t do justice to the ends of healthcare if we phrase them only in the occurrence of death, or in the avoidance thereof.

In the early days, where people previously claimed that COVID19 was no deadlier than a seasonal flu, we did ourselves an injustice by viewing a state of health in terms of death. What if, upon the recognition of the fact that we still new relatively little about the clinical outcomes of COVID19 infection, we did lockdowns and quarantines as soon as people within our borders tested positive? We likely would have endured social distancing for shorter periods of time.

What does it mean to die?

In an era where doctors in New York are writing and revising their wills, these poignant questions are ones that deserve to be asked. Does it mean to become a soul without a body, a soul in the afterlife, a soul waiting to be reincarnated, or a nothingness of inanimate flesh? It’s funny how, of all the possibilities, it seems of late that the first thing you become is a number, added to a tally of other such numbers, all the same and differing only in the fact that they are each other, + 1.

With 43 000 people dead, 43 000 souls are in the air, taking up space. As such, we need to clarify what they mean to us: do we even see them as souls when bodies are being stacked up in butchery refrigerators in New York? With some warning that the worst is yet to come, and with hospital morgue’s being overwhelmed by the number of deaths, I can’t imagine the stack of bodies we’ll be left with in the end: sitting at the back of refrigerated trucks like prime cuts.

The day before my country started it’s official 21 day lockdown, I hurried to a bookstore to get a copy of Aldous Huxley’s dystopian novel: Brave New World. In a time where the world was beset by grief, it seems that the best thing I could think of doing was to envelope myself in yet more terrible visions of the future. Where grief-inducing book within a time grief for me offered a window of escape, the window has narrowed for those dealing with death.

In Ancient Rome, servants followed generals during celebrations of triumph, whispering ‘momento mori’. Many have interpreted it to mean ‘remember, you are a mortal’. It literally translates into ‘moment you died’ or, the slightly more acceptable ‘remember, you must die’.

Where Roman generals reminded themselves of death to remain humble, it seems that the pandemic has taught us to heed the same lessons of mortality at the next 21st we attend.

Your neighbourhood physician-politician. 2nd year medicine. Instagram: @asandevilane

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store