The number of infected cases to Coronavirus 2019 (COVID-19) is rapidly increasing, and as of 11 March 2020, the world health organi- zation (WHO) has raised the risk of infection to COVID-19 to “very high” and later announced the pandemic of COVID-19 (Pirnia et al., 2020a). COVID-19 has infected about 300,000 cases and 16,500 deaths in Iran so far (30 July 2020). Tehran is the epicenter of COVID-19 and has the most number of deaths in Iran.
It is expected that some problems such as psychological symptoms of stress and reduced autonomy and concerns about income, job, se- curity, and so on have been developed during pandemic of COVID-19 (Pirnia et al., 2020b). The long-term effects of isolation and that the fear and panic in the community can lead to more harm than COVID-19. It is necessary to recognize the psychological and pandemic effects of COVID-19 along with physical symptoms for all patients (Shigemura et al., 2020; Tandon, 2020a). One of the unfortunate consequences of the pandemic of COVID-19 is suicide (Kawohl and Nordt, 2020; Tandon, 2020b). Suicide is one of the leading causes of death around the world (Pirnia et al., 2019). A suicide death, while an individual act, creates a “ripple effect” which profoundly impacts the family (Spillane et al., 2019). Suicide is akin to a stone being thrown into a pool of water—ripples spread outwards to the edge of the water. People close to the suicidal person, including family members or people who dis- cover the body, are most vulnerable (Pirnia et al., 2020c). This study was conducted to report a family suicide during the COVID-19 out- break.
In Iran, the first suicide case was reported by a teenage boy on 7 April 2020 in Tehran. He was the son of a father who died three weeks ago (March 18) due to COVID-19. According to his relatives, the lack of mourning rites for his father and the unhappiness of those around him were the cause of the symptoms of depression and suicide for this boy. He complained that no one could see them because of the situation. Two days after the boy’s death, his mother who was 53-year-old and could no longer bear her son’s death, committed suicide by taking two rice pills, and the family’s bitter tragedy ended with the mother’s death. Pandemic of COVID-19 disrupted usual experiences of grief, so modifications of approaches to support grief are needed (Wallace et al., 2020). Traditionally, the initial mourning is a normal mourning that occurs for the death of the patient / family. When the deaths are un- expected (such as those seen in pandemic of COVID-19), the traditional grief rituals (e.g., saying goodbye, viewing and burial), and physical social support is lacking. In this situation, there is a possibility of pro-longed grief disorder (PGD) (Eisma et al., 2020). For patients and their families, they may experience vague feelings about not being aware of the progression of the disease or how the hospital’s policies may change in the face of their patient. These experiences before the death of loved ones have a lasting effect on the experience of mourning (Otani et al., 2017). For loved ones, funerals and burials are postponed or performed without the presence of loved ones, which is a new experience of grief (Wallace et al., 2020).

The survivors’ perception of death, with their dear dignity, plays an important role in their ability to cope with grief and loss (Wang et al., 2020). Funeral services can be helpful in grief expressions, and post- burial mourning should be assessed by a team of experts by telephone / video. A special memorial day can be arranged for families virtually or by the compliance to social distancing rules. As Dame Cecily Saunders said, “how people die remains in the memory of those who live on”. How to use advanced care programs, the quality of the commu- nication, and the provision of self-care can reduce the aspects of mourning associated with pandemics and play an essential role in palliative care. The humanistic aspect of providing support for grief support and mourning should be considered even in the pandemic of a disease.

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