Lessons Learned: Reflections on What We've Lost, What We've Gained, and How to Stay Strong Through COVID-19

Two years ago, on March 10, 2020, Massachusetts Governor Charlie Baker declared a state of emergency in response to the COVID-19 outbreak. That day, fewer than 10 people per day were testing positive for the virus in the Commonwealth. One month later, more than 2,000 people would test positive each day.

Since then, more than 1.6 million Massachusetts residents have contracted COVID-19, and nearly 24,000 have died. In addition to the illness and loss, healthcare providers have spent the last two years laboring through multiple surges. Students of all ages had to quickly adapt to untested remote or hybrid learning strategies, while some office workers attempted to juggle the demands of their careers and family lives-simultaneously. Add to this all the inability to gather with family members, friends and neighbors, and you have a population under unprecedented stress.

Reflecting on two years of the COVID-19 pandemic and its impact on Massachusetts, we asked experts across Beth Israel Lahey Health about managing another year of the unknown, how to shore up our mental resources to heal from what we've been through and how to prepare for whatever may lie ahead.

On Acknowledging What We've Lost:

Barbara Sarnoff Lee, LICSW
Senior Director, Social Work and Patient/Family Engagement, Beth Israel Deaconess Medical Center

It's important to acknowledge that feelings may come up, even if we are not consciously thinking about the anniversary. It is important to give ourselves permission to pause, reflect and accept whatever feelings come forward. There is no 'right way' to feel since each of us experienced the pandemic through our own personal lens of experience. If you anticipate that the anniversary may be hard for you, think about what has helped you in the past during difficult times and try to use those tools. Because so many people have struggled with a loss of connection to friends/family, think about getting together (safely), in person or on Zoom.  

Jessica D'Angio, MDiv, BCC, Multifaith Chaplain
Rebekah Ingram, MDiv, BCC, Multifaith Chaplain
and Nancy R. Smith, MAJS, LICSW, BCC, Jewish Chaplain
Beth Israel Deaconess Medical Center

As a result of the COVID-19 pandemic we have all experienced loss. There are important steps we can take to grieve our personal and collective losses. Would a cultural or spiritual ritual be comforting at this time? Are there traditions or reflective practices such as journaling, being in nature, or preparing a meal that could facilitate expressions of grief? It's important not to put a timeline to your grieving process. Each person's grief and how they grieve is unique.

Hilary Jacobs, LICSW, LADC I
President, Beth Israel Lahey Health Behavioral Services

We have lost so much. People try to deal with grief by minimizing the impact of the loss-especially the losses that are less than death. People have postponed weddings, missed high school graduations and other milestone events. In the context of illness and death and the economic troubles some have experienced, it's easy to overlook these smaller losses. We have to allow them to be acknowledged. It's okay to be sad.

Being grateful is part of being able to manage living through this pandemic. But we have to acknowledge the whole of what we've lost, not just some of it.

Nalan Ward, MD
Chief Medical Officer, Beth Israel Lahey Health Behavioral Services

The pandemic has taken a toll on all of us physically and emotionally, and I think we all feel drained and depleted. I'm an addiction psychiatrist, and I've learned so much from the patients whom I take care of. Many people in Alcoholics Anonymous find so much strength in the serenity prayer-that is to have the serenity to accept the things we can't change and the courage to change the things we can. 

The grief and the healing process start with accepting what we have. These losses created anger, a lot of finger pointing-who did what, who failed to do what and despair in the communities we serve and among our colleagues. I consider all of this as part of the grief process. I think we have to understand that this anger is part of the grief and then we need to process it so we can begin to move forward. 

Processing grief is not straight forward, it's always a two-steps-forward, one-step-back dynamic.

On Coping With Adversity and Self-Care:

Melissa Doyle, LICSW
Clinical Social Worker, Beth Israel Deaconess Medical Center

Self-care is as individualized and fluid as our emotions and reactions to events. What worked early in the pandemic to help us cope may not be working as well now and it may be helpful to pause and reflect what is serving you well in this moment. There is a lot that continues to be out of our control as individuals so identifying what we have some or complete control over can help ground and center us and help us refill our cups. There may be times when self-care isn't enough and getting extra support or working with a professional can be the next best step. 

Pamela N. Peck, PsyD
Director of Clinical Health Services, Beth Israel Deaconess Medical Center

I'm a big believer in acknowledging the anniversary. Acknowledging that, March 13th-for us the day we decided to move our out-patient clinic to primarily telehealth even though we'd never done that before-of course it would bring up memories of our concerns and fears as well as the losses.

But we also need to be willing to think about how far we've come. It's easy to think, "My goodness, it's been two years and we're still here." Well, we are in some ways, and we're not in other ways. This has been a very long marathon, and instead of 26 miles, we're now at 52 miles.

I have also heard people saying they've rediscovered cooking and enjoyed more time with their families than they have in a long time. Of course, those are people who aren't suffering from food insecurity, or who lost their jobs. I don't want to wear rose-colored glasses, but there have been the painful experiences of what we've had to endure, and maybe along the way there have also been some positive things.

Jacobs: People talk about Zoom fatigue, but I really see people using the internet in very positive and creative ways to meet. Especially during the worst of the pandemic, there were a lot of creative, playful fun things that people did-paint nights, game night, wine tastings, cooking classes. Overall, that social connection through social media can actually be very helpful.

Sarnoff Lee: During the height of the pandemic, being online allowed people to experience some of the facial and body language aspects that are so important in our interactions.  That being said, we are still missing some of the sights, sounds, smells that give relationships a three-dimensional quality.  When I think about zoom funerals, I think about the double-edged sword of being online.  On the one hand, it allowed family and friends to grieve together and to participate in some of the rituals related to death.  On the other hand, people are missing the hugs or gentle touch that one gets from others when one is in mourning.  Being online has its pluses, but humans are relational beings and nothing can replace in-person contact.

Ward: There are very basic things we can do to help each other and ourselves.

Avoid habits that are not going to keep us healthy, including drinking and drugs-no judgement, in the moment they may seem to help. But in the long run, there's just no help from these things. What will help are things like:

• Physical activity. It's so important. Get out of your seat, move around, do whatever is possible for your body. This cannot be emphasized enough.

• Sleep. This might take some self-discipline. We could all stay on our screens forever.

• Eating healthy.

• Socially connecting, online or otherwise.

• Establish healthy boundaries between work and home life, particularly if you are working from home.

• Meditation. Learning to breathe. Learning to pause. There are many free apps out there to help you do this. 

• Practicing kindness and checking in with each other. Making sure our friends, family and colleagues know we care about them.

Jacobs: If you're really doing all those things-sleep, exercise, meditating-then they will help. If you find you can't do those things reliably, it's not your fault, but that is an indicator of poor mental health. The acuity we're seeing among patients right now is about people waiting too long to get the help they need.

People should consider reaching out for professional help when they start to move away from things that bring them joy or when they start to be self-isolating-choosing not to engage in the ways that are still available to them.

On Supporting Others:

Peck: There are three key components to offering someone support. (I didn't invent this; it comes from a published paper by Shandfelt, Ripp and Trockel.) First of all, "I see you. "What you are doing is really hard. "I hear you." Being able to not just validate what people are suffering but also their strength and resilience.  And then, "I care for you.: This message can come through personally, or it can come from an institution. Help and support comes from being interested in each person's experience. There's power in those three things.

Ward: It's also important that we remind each other our purpose. As a mental health care provider, I feel we owe it to the communities we serve, that it is our responsibility to step up and provide the best care we can. For me, it is a privilege to be in the position to help others. These values and what I believe in helps me get through the difficult days. I also know that when we are faced with a situation of this magnitude we have to take care of ourselves to be able to provide care to others. This is the message that I share with my staff and team. I try to support them by reminding our shared purpose and thanking them each and every day for what they do.

Doyle: Professionally, re-connecting with why you went into this work and what you value can be important in increasing satisfaction. We must also practice pausing and acknowledging when something goes well. Our brains are finely tuned to hold on to when something goes wrong but it takes attention and practice to integrate positive experiences into our everyday. One way to do that is to intentionally pause throughout your day-get off autopilot and take a few moments to notice what has gone well or where you have made a difference and connect with those feelings.

Patrick R. Aquino, MD
Medical Director, Ambulatory Services and Integrated Care, BILH Behavioral Services
Chair, Division of Psychiatry and Behavioral Medicine, Lahey Hospital and Medical Center

Even as we take this opportunity to recognize the grief, we've all endured these past two years, we must also celebrate the strength that people have exhibited. I think we need to frame the road ahead as an opportunity for growth by focusing not necessarily on the challenges but on the possibilities. So, if there's more flexibility present in your life now than there was before, focus on how you can embrace it rather than focusing on the new challenges of a hybrid workplace, for example.

Organizations are learning about the importance of mindful leadership-leaders being present with staff, being able to hear their concerns and truly listen and empathize. Now more than ever we recognize being supportive and present as an essential skill for successful leadership through the pandemic. Where we may have called them soft skills in the past, they are now considered vital, key attributes for successful leaders.

About Beth Israel Lahey Health

Beth Israel Lahey Health is a health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,700 physicians and 39,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.