'i promised my husband i wouldn't leave him alone': Burdens due to visit restrictions for dying patients during the COVID-19 pandemic in Germany: A mixed-methods study of bereaved relatives

Background: The COVID-19 pandemic has been followed intensely by global media. News media create a sense-making narrative, shaping, reflecting and enforcing cultural ideas and experiences. We aimed to explore British newspaper reportage of COVID-related death and bereavement and consider clinical implications. Methods: Discourse analysis of the 7 most-read online UK newspaper articles published during two week-long periods in March-April 2020. 55 articles discussed bereavement after a human death from COVID- 19. Analysis was informed by Terror Management Theory, which describes a psychological conflict arising between the realisation that death is inevitable and largely unpredictable and the human need for self-preservation. Results: We identified 3 main narratives: (1) fear of an uncontrollable, unknown new virus and its consequences;(2) managing uncertainty and fear via prediction of the future and calls for behaviour change;and (3) mourning and loss narratives. Within these narratives, the act of 'saying goodbye' (before, during and after death) was central, represented as inherently important and profoundly disrupted. Bedside access was portrayed as restricted, variable and uncertain, with families begging or bargaining for contact. Video-link goodbyes were described with ambivalence, and patients as 'dying alone' regardless of clinician presence. Funerals were portrayed as travesties and grieving alone as unnatural. Articles focused on what was forbidden and offered little practical guidance about what to do if a loved one became seriously ill or died. Conclusion: Reporting reflected the tension between focusing on existential threat and the need to retreat from or attempt to control that threat. Measures to mitigate the impact of COVID-19 on 'saying goodbye' were presented as insufficient attempts to ameliorate tragic situations. More nuanced and supportive reporting is recommended. Clinicians play an important role in offering alternative narratives.