More than 180,000 people around the world have died of COVID-19.

For those that loved them, there’s the additional pain of not being able to say goodbye.

Social distancing guidelines are preventing last rites, funerals, even hugs for comfort.

Minnoli Aya lost her mother to COVID-19 three weeks ago.

Her mother Madhvi, 61, was a physician’s assistant at a Brooklyn, New York hospital.

“There was nothing that her hugs, that her voice couldn’t make me feel better. Everything about her just made me feel like I was safe, and that I was at home,” Minnoli said.

Her mother was on the frontlines of the pandemic when she contracted COVID-19.

Once hospitalized, her family couldn’t be with her.

Her daughter texted her often during the hospitalization.

“None of us can live without you. I believe in you, please fight back. You’re so strong mommy. I love so much more than you can imagine,” she wrote on March 26.

Her mother wrote: “Love you”, and then “Mom be back.”

A day later Minnoli wrote:

“Please don’t give up hope because I haven’t given up. I need my mommy. I need you to come back to me.”

“Love you,” her mother replied.

It was the last thing her mother said to her, she died three days later.

“I continued texting her until her death and even a few days after her passing. I kept texting her, wanting to believe that it wasn’t true that she had passed away,” Minnoli said.

“It’s just hard because I never got to see her face… and, you know, it’s not fair the way she died. And it’s not fair that she left me, and my dad. And I just feel so lost without her.”

A known way to cope with death is through social connection and being with others.

Around the world, memorial services are being held over Zoom, the telephone, and staggered funeral services.

But with social distancing, many may feel an “ambiguous loss” retired psychologist Sherry Cormier said in an American Psychological Association report.

“With an ambiguous loss, it’s very hard to get closure. There’s often a lot of frustration and helplessness, because people feel disempowered,” she said.

Some may also be at risk for prolonged grief disorder, a longing for the deceased and inability to accept the loss that lasts for more than a year.

The disorder can increase the risk of substance abuse, sleep disorders, impaired immune functioning and suicidal thinking, wrote Dr. M. Katherine Shear in the New England Journal of Medicine in 2015.

“The circumstances under which deaths are now occurring, with plenty of unresolved relational issues, represent a perfect storm for producing complicated grief,” said Robert Neimeyer of the Portland Institute for Loss and Transition to the APA.

Risk factors include attachment insecurity, anxiety, experiencing a loss that is sudden and inexplicable, and social isolation.