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Nancy Kruh always figured that when her mother died, she would be by her side, holding her hand, a comforting, meaningful moment.

It didn't work out that way.

After a long illness unrelated to the coronavirus, Jan Kruh died in April. She was in Manhattan, Kansas, while her daughter quarantined in North Carolina and her husband of 72 years was only allowed to be with her during the final stages.

"The idea of her dying alone was really bracing and sad," said Nancy, a writer who lives in Nashville. "I was so grateful that two of her favorite people at her senior care unit were with her. Still, not being able to be there was just soul-sickening."

That heartache has confronted millions of people during the coronavirus pandemic as restrictions have separated dying people from family and friends, and prevented mourners from sharing their grief in person. The Kruh family is still unsure when and how to get together for a memorial ceremony.

"The isolation hits people very hard," said Rev. Victoria Long, a chaplain at the Suncoast Hospice in Pinellas Park, Florida. "There's a long way to go emotionally when you didn't get to take the journey with them along the way."

Long's hospice helps people cope with the end of life, as well as the bereavement that follows. Technology to connect people online is not the perfect substitute, she said, but it can be a tremendous help.

She recently arranged a video conference call so a woman in hospice care who had suffered a stroke and couldn't talk could see and hear her family.

"She would reach up and touch the different people on the screen," Long said.

Similarly, Long supervises memorial services and bereavement groups online. "Grief is a process, and if you haven't been there, it adds a layer to the pain," she said. "You have to know that it takes time, and you have to follow what brings you peace. I can't stress self-care enough."

Dr. Alan Koenigsberg, a clinical psychiatrist and professor at the University of Texas Southwestern Medical School in Dallas, agreed.

"Even if you think you're prepared for grieving, we never really are," he said. "There's no quick fix. And when you add in the isolation we have now, a difficult time becomes much harder."

His advice for coping sounds simple, although he acknowledged it's easier said than done.

"Give yourself some structure," Koenigsberg said. "Get up in the morning, put one foot in front of the other, do the routine stuff that helps you get through the day. Try to get some exercise and a good night's sleep. And remember that grieving is a normal, healthy response."

Even in the best circumstances, sadness can lead to poor eating habits or alcohol and drug abuse, he said. Isolation increases those risks.

"Talk to people, ask for help if you need it," he said. "And please go get the medical care you need. So many people have held off getting care now (because of fears of catching the virus), they're showing up in emergency rooms in worse shape than they ordinarily would."

Long and Koenigsberg both stressed the importance of maintaining relationships – and the surprising value of virtual connections. Faith communities and support groups, for example, have adjusted to provide help virtually.

"People have created wonderful communities of support online," Long said. "It's different, but it's positive, and it shows me the importance of our ability to adapt."

That has been the case for Nancy as she copes with the loss of her mother and the physical distance from her father.

When she posted news of her mother's death on Facebook, she said, "My page exploded. I got hundreds of expressions of love and kindness, deep and sincere emotions despite the distance.

"It was like a virtual receiving line, and I've responded to every one. This is our human connection right now, and I'm grateful I had the technology to help me respond to my grief. It has made me feel loved, and at the moment, that's the most solace I could ask for."

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