Pandemic Amnesia – Commemoration as a Function of Sustainable Recovery

The recovery phase of a pandemic is not well established, there is no manual or existing literature that enables a true level of preparedness or recovery measures for such a large scale, unpredictable event. There is a term coined Pandemic Amnesia that I investigated because I wanted to understand what the recovery from a pandemic looked like. I know that commemoration of one’s life is the way we heal; human beings mourn, grieve and survive together. The pandemic created a situation where I did not know what recovery looked like, nor did I know what past pandemic recovery phases looked like. 

Why don’t we have pandemic heroes? Recovery methods? Lessons learned and collective memory of past pandemics. And grief. Where is the process for grief? I wondered if people could not have funerals, how would they say goodbye? And if they could not say goodbye, how would we recover as a society when there was no closure? 

This article contains data limited to fall 2022 and before. 

Pandemic Amnesia

In the midst of a pandemic, it is an opportune time to investigate the core concepts that underpin commemoration of disaster as a function of sustainable recovery and begin to understand how commemoration is shifting in the wake of the COVID-19 pandemic to inform sustainable recovery approaches. Pandemics are infrequent; however, they are not unprecedented. There are numerous rituals and practices associated with commemoration of disaster and although each disaster influences communities in diverse ways, there is a common need to honour and remember lives lost and collectively heal from a disaster in order to move toward normalcy. 

Although commemoration of disaster is evident in the numerous memorials for wars, hurricanes and other catastrophic events, the use of how commemoration of disaster contributes to a sustainable recovery process warrants further research. Moreover, biological hazards that lead to disasters, such as pandemics, have profound impacts on the routine practices of commemoration.

How do we commemorate?

The lack of commemorative events and memorials associated to past pandemics indicates there is space for investigation into why other disaster are commemorated differently. In addition, defining how commemoration of disaster contributes to sustainable recovery may uncover ways that meaningful commemoration can be a factor in building resilience, collective healing and reduction of future risks. Despite the enormity of loss and ongoing battle against biological hazard, sustainable recovery from pandemics remains an ambiguous process with little research devoted to the utility, cultural context and commemoration process that enables recognition, healing and closure from such catastrophic events.          

Core Concepts

The three core concepts integral to this paper are defining disaster recovery and sustainable recovery, exploring the relationship between sustainable recovery and commemoration of disaster and exploring of pandemic-specific recovery needs and activities.

Sustainable Disaster Recovery

There are social dimensions of disaster recovery and a propensity to equate post-disaster recovery with physical reconstruction of environment and infrastructure creates a gap in serving the social and cultural recovery needs that may be more critical than physical structures. Community resilience is strengthened through recovery activities that meet community needs. In the context of a pandemic, communities have less experience with catastrophes. Thus far, very few opportunities facilitate adaptive learning to a biological hazard. Research indicates that adaptive learning and adaptive capacity are factors in resiliency and social dimensions, such as sense of place, home and culture are important factors of the recovery process.  

Building Back Better

Long-term resilience is often coined building back better; the notion that a disaster occurred based on vulnerabilities that, when addressed, reduce future risks and drive collective resiliency and recovery strategies. The current literature describes multiple functions of sustainable recovery that lead to building back better, such as return to a sustainable sense of place, home, environment, as well as the importance of commemoration, such as anniversaries or memorials, in the long-term recovery process. Sustainable recovery ultimately follows a holistic approach that restores day-to-day routines and moves into a stable, sustainable new normal.

Commemoration of Disaster as a function of Sustainable Recovery

Commemoration of disaster as a function of sustainable recovery is imperative because cultures throughout history have commemorated the dead. Funerals, rituals and burials are part of our common humanity; however, in looking at commemoration as a specific element in a holistic disaster recovery process, understanding the benefits, impacts and outcomes will shape future research and practice in this area. Whether formal or informal, commemoration is of particular significance in remembering those lost, expressing personal and collective grief and inspiring community-based planning in designing hazard-specific commemorative events.

Commemoration of disaster is such a critical function in sustainable recovery that the World Health Organization (WHO) suggested that key considerations be made for death, burial, funeral and mourning of those lost in the COVID-19 pandemic because banning cultural and religious practices may have severe psychological consequences and emotional difficulties for family members unable to perform burial rituals. Indeed, community remembrance supports local recovery and social resilience. 

Therefore, being unable to participate in commemorative events, such as funerals, rituals and ceremonies may have detrimental mental health effects on survivors. Survivors process disaster from impact to disillusionment to a new beginning; anniversaries, commemorations and memorial services support community healing, promote understanding of the disaster by acknowledging the loss and promote cultural competence at a local level in adaptions to hazard recovery activities.

Biological Hazard – Generated Needs and Activities

Biological hazards pose a specific set of recovery needs and challenges to use disaster commemoration as a function of sustainable recovery. The process of sustainable recovery is non-linear, unpredictable and shaped by a range of social units, from households to societies. Defining the recovery needs and activities for social units requires an understanding of pre-existing vulnerabilities. Biological hazards illuminate the sociobehavioural processes driven by risk perception.

Authorities often focus on mitigating public panic in disasters and avoiding civil unrest. The importance of defining sustainable recovery as more than simply returning to normalcy is crucial in strategizing best practices for a process that does not evolve uniformly or in a temporal, stage-like manner. More research devoted to medical disasters will contribute to a deeper understanding of a holistic, non-linear process and lead to recovery activities that support local cultural and social needs, as well as long-term sustainability in the recovery process itself.

Pandemic Needs

The needs of pandemic survivors have similarities with all disaster. However, activities are unique to various regions of the world, and sustainable recovery actions should assess the recovery needs of population groups to match resources with needs effectively, preventing further adverse health effects.  Pandemic recovery needs include managing sanitation, hygiene and waste disposal in the short and long term, addressing post-disaster perception and psychological impact and respecting local burial customs and practices, when possible. Disposal of dead bodies is a particularly challenging recovery need during a pandemic. Due to the high number of fatalities, the false belief that corpses spread disease and resulting mass burials and cremation; in reality, unburied bodies pose a greater risk of psychological trauma than disease transmission.

Commemoration of disaster from biological hazards poses unique challenges because the needs and activities may not be possible, given the hazard risks. For example, disaster anniversaries serve to acknowledge and respond to painful memories, assess accomplishments in recovery, gather with loved ones to emotionally heal and gain perspective on the disaster. There may be no anniversary during a biological disaster as there is often no specific date associated with a pandemic ending. Accomplishments are invisible, undefined, physical isolation can be psychologically debilitating, and sustainable recovery is an ambiguous target. Recovery from a pandemic is co-existence with the hazard. Thus, commemoration is even more challenging and imperative because there is little natural closure and biological hazard never fully disappears.

Synthesis and Analysis

Impact of Pandemics on Commemoration of Disaster

Historical records of pandemics demonstrate that they are potent catalysts for significant shifts in commemorative practices. Hippocrates (460 BC) theorized that disease was a physical ailment and not evoked by the gods; investigations into the source of disease led to advancements in public health practices and the birth of the modern-day physician. 

Patrons. Congratulatory Death. 

Medical innovation opened a path for new commemorative practices to ensure the longevity of the Roman Empire; burials within city walls were prohibited and cremation became commonplace, as it was viewed as more hygienic. During the Black Death pandemic of the 14^th century, Pope Clement VI consecrated the river Rhone in Avignon so that bodies thrown into it were considered to have had a Christian burial. Ironically, if an individual did survive the great pestilence, the church deemed them a miracle healer and killed them so they would become the saint or patron of the ailment they survived.

By using commemoration of disaster as a portal for acknowledging the actual reality of a pandemic and healing from the trauma of the event, recovery activities from past pandemics may inform how the interplay of spiritual beliefs, political influence and psychosocial factors lead to pandemic amnesia. There are several public health issues currently influencing epidemic recovery and a number of misconceptions that lead to psychological consequences rather than biological risk. A critical example easily observed during modern day disasters is the immediate concern with the disposal of bodies. The public and government concern with the deceased is related to the misconception that corpses spread disease, when in reality the risk is minimal.

Beliefs and History

The illusion that corpses carry a high risk of disease transmission may stem from the risk of pests and rodents being attracted to bodies if not disposed hygienically. The bubonic plague spread through fleas that had bitten infected black rats. The cause of the bubonic plague, unknown to society, appeared to stem from being near a body rather than an infected patient; thus, cremation practices as a public health mechanism came into effect . Therefore, it is not necessarily a misconception in certain circumstances, rather, it is a perceived risk to biological hazard and contextually, there is true risk in certain commemorative practices that unintentionally create situations of disease transmission. 

A crucial concept in this example is knowledge translation and understanding the mechanism in which cultural knowledge is articulated. Knowledge translation in areas of culture and institution, as well as effective interactions and linkages will improve research-to-practice approaches. Rituals used by the bereaved to commemorate loss are culture-specific and understanding how to facilitate safe practices during a pandemic is crucial to both the response and recovery phase, as they occur in tandem and into the long-term. Investigating which adaptive measures have been meaningful in the past and assessing the determinants that inform cultural context will lead to practical, useful activities that integrate disaster commemoration with sustainable recovery.  

Warring Events

Concurrent disasters are frequent, as a primary event often leads to secondary, tertiary and even global impact. War is a disaster that usually occurs concurrently with a pandemic and serves as a comparator for memorials and commemorations during a simultaneous timeframe. Further, the collective healing understood to be gained from war memorials has been absent from pandemics; the scarcity of commemorative events and memorials inhibits survivors of pandemics from utilizing commemoration of disaster as a function of sustainable recovery. In looking at wars and pandemics, we can draw parallels to our circumstances today and understand how to strategize sustainable recovery approaches that embed commemoration as a tool for acknowledgment and awareness of the disaster, collective healing and ensuring risk to the hazard is not recreated.

War is the only disaster that compares in fatalities to pandemics (see Figure 1). The magnitude of loss in a pandemic that coincides with a war is overshadowed; direct examples of concurrent events highlight gaps (see Figure 2) and illustrate the similarities in disaster severity compared to the differences in commemoration. Disasters, such as hurricanes and earthquakes, are more visible and easier to commemorate as a part of public consumption and identifiable heroes; losses in a pandemic are unfathomably high and identification of any hero is ambiguous.

Pandemic Memorials

The Spanish Flu occurred concurrently with WWI (1918-1919). In the United Kingdom alone, there are more than 3,000 monuments to WWI and no public memorial for the 228,000 Britons that died of influenza at that time.  The second wave of the Spanish Flu is associated with an extraordinarily high mortality rate, hitting approximately 12/1000 deaths in 1919 and cases peaked in the age 20-30 range. The number of fatalities cited is between 50 and 100 million people, a number difficult to determine precisely. The scarcity of memorials and enormity of loss warrants genuine questioning of why this phenomenon began, perpetuated and persisted throughout history.

Figure 1

Disaster Fatalities

Figure 2

Disasters by Fatality and Century

What is Pandemic Amnesia? 

There were numerous gaps illuminated in social and safety systems during the COVID-19 pandemic. Commemoration of disaster as a function of sustainable recovery poses many challenges, particularly because pandemics tend to reveal the failures of government to protect society from a hazard and the optics of memorializing victims collide with pandemic generated needs and activities for meaningful, collective closure. 

Pandemics are highly politicized events with macroeconomic consequences. They are economically impossible to manage, as any lessons learned are likely expensive, supply chains are halted and civil unrest leads to precarious circumstances with the potential for creating disasters of their own. It is much easier for governments to hope the depth of loss will be forgotten, and most citizens are more than willing to do this because of the pain, relentlessness and sadness.

Pandemic amnesia is a perpetual forgetting of pandemic experiences, leading to each pandemic, such as COVID-19 labelled as an unprecedented event. The Black Death is undoubtedly the worst disaster in human history. Petrarch, an Italian scholar who lived during the pandemic, is one of the few individuals to have left records of the disaster. He described a type of pandemic amnesia that would occur following the 14^th century pandemic and ascertained that it would be impossible for future generations in imagining the circumstances. He postulated that due to the inconceivable trauma of abandoned towns, fields littered with the dead and the global silence that permeated for sixteen years, commemoration and remembrance would never occur because too few would survive and those who did would never wish to remember.

I have noted through my own experience that very few individuals refer to the pandemic as a disaster or consider memorializing it in a manner comparable to disasters of similar fatality rates, such as war. Pandemics further complicate the need for commemoration because they do not have finite endings. Indeed, a commemoration of disaster as a pathway to collective healing and acknowledgement of the disaster can only be meaningful, sustainable and reduce future risks if there is an acknowledgment that a disaster is occurring. Pandemic amnesia is the by-product of political and economic agendas intertwining with psychosocial, cultural and emotional trauma.

COVID-19 Pandemic

The COVID-19 pandemic has revealed many troubling gaps in our society that existed pre-disaster; however, it also serves as an example of a novel shift concerning commemoration of disaster. Funerals, burials and remembrance of the dead in the context of a pandemic require adaptability. Evidence from past pandemics suggests that citizens are willing to adjust commemoration, provided there are new or alternative options that meet the recovery need and aid in collective healing. 

As we have seen, a pandemic challenges every layer of society and withers away trust in authorities when there appears to be no solution to an invisible threat. Commemoration is challenging in a pandemic because many practices pose public health risks; the loss of commemorative events also poses a public health risk and potentially negative consequences for the bereaved. Every pandemic has reshaped disaster commemoration and thus far, evidence points to the same pattern occurring. Emergent groups have started the process of sustainable recovery by adapting commemoration rituals and acknowledging the reality of the circumstances. Sustainable recovery must include commemoration of lives lost. Otherwise, we risk stagnancy in learning and collective trauma from a lack of closure.

Creating Change Today

COVID-19 is the first pandemic that true commemorations and memorials have started. Social media platforms have begun online obituaries, held virtual memorial services and online eulogies that have helped society cope with the inability to gather for a funeral. China and South Korea have imposed mandatory cremation, aligning with historical accounts of mitigation measures noted in the Roman Empire. 

In North America, live-streamed memorials held in New York for the thousands of lives lost to COVID-19 led to acknowledgement, art installations to memorialize victims have been created and within Canada, countless memorials, commemorative services and websites honour lives lost. For example, a memorial website dedicated to Canadian Healthcare Workers launched and called the collaborative project Lost on the Frontline. In describing the circumstances in Italy during the COVID-19 pandemic, it was a war scenario and citizens implored the government to re-establish spiritual skills as a core competency for public health professionals, embedded into medical curricula. In Africa, where burial rites are diverse and often elaborate, the COVID-19 has overwhelmed the weak mortuary services and many traditional practices of mourning and closure have shifted. In London, St. Thomas’s Hospital is painted with over 150,000 hearts to commemorate each person with a death certificate that mentions COVID-19.

            Globally, there have been changes to every commemorative event in some form, such as funeral gatherings, burial services, gathering to grieve, open-casket services, sitting shiva, synagogues, stone-setting ceremonies and isolated periods of mourning. Changes in commemoration activities are effective in sustainable recovery when the bereaved shape how they say goodbye. Social isolation is known to exacerbate mental health conditions and those who have lost family members during the COVID-19 pandemic are at higher risk for mental health conditions. The creation of a new normal involves a degree of social transformation and long-term disaster loss reduction. Therefore, as alternative strategies reshape commemoration, investigating the impact of innovative modalities will benefit future research, resilience and practice.

Recommendations for Practice

We need to consider commemoration of disaster as a function of sustainable recovery. Moreover, defining sustainable recovery from a pandemic will lead to a path for developing pre-disaster plans for recovery that meet the needs of society.

1. Optimize the information and insights arising from our current situation to develop a build-back better plan for pandemic recovery. This includes exploring how meaningful new forms of commemoration have supported sustainable recovery and developing adaptive, practical approaches to reducing future risk or reoccurrence of the determinants that led to the insufficient commemoration of these devastating events.
   
   
2. Understanding the psychosocial, cultural and spiritual needs of different populations will enable a more targeted approach to utilizing commemorative events as a function of sustainable recovery. As noted, collective healing and acknowledgement weave into all commemorative events; however, what is effective in Africa may be harmful in Canada. Cultural and social factors are crucial to understanding each unique path to sustainable recovery from pandemics.
   
   
3. In Canada, there are online memorials, funerals and locations where the bereaved can acknowledge loss. These actions indicate a shift in commemoration; however, we do not know the impact of these activities. Investigation into the utility of virtual events and adaptions in commemoration arising from COVID-19 will lead to a better understanding of how to meet the needs of our country. Both harm and benefit should be explored to understand the intricacies of commemoration and how to translate adaptive practices into a sustainable recovery.

Conclusion

It is clear that disaster commemoration is commonplace following events such as war, hurricane or earthquake. This is evident in the numerous memorials and anniversary events dedicated to past disasters. Historical accounts of pandemic recovery depict a lack of sustainability and challenges surrounding meaningful adaption of burials, rituals and cultural needs. Moreover, pre-existing vulnerabilities are cultural-specific and while every society has commemorative activities, biological hazards create risk in commemorative practices. Investigating the disaster commemorations from our past and identifying current, practical adaptions that bring meaning to the bereaved and facilitate integrating commemorative activities into sustainable recovery plans for pandemic disasters.