The world is gearing up for the coronavirus. “Preppers” are stocking sterile gloves and cans of beans. Musicians are postponing long-anticipated concerts. And funeral directors are cleaning out their refrigerators.
The novel disease has infected 89,000 and killed 3,048 people worldwide, mostly in mainland China. At the epicenter of the outbreak in Wuhan, funeral directors “have only been sleeping two to three hours a day,” according to Taiwan News. In Hong Kong, there’s a looming coffin shortage after the Chinese government ordered factories to suspend operations to stop the virus from spreading, according to the South China Morning Post.
In the United States, the situation is hardly so dire. There are at least 74 confirmed cases of coronavirus. Public health officials announced the nation’s first five coronavirus-related deaths, all in Washington state. But as the disease continues to spread, funeral directors will be part of the response.
Coronavirus “has the potential to be very serious, but we’re at a time when it can be dealt with better than at any other time [in history],” says Joseph Stone of Bring Funeral Home in Tucson, Arizona.
Living bodies are, on the whole, more dangerous than dead ones. But corpses with communicable diseases like hepatitis or the seasonal flu can change this morbid calculus. Tuberculosis, for example, can be aerosolized—transformed into tiny droplets in the air—during an autopsy or embalming. In 2000, the New England Journal of Medicine reported the first known cadaver-to-embalmer tuberculosis transmission. The bodies of people with Ebola virus are still infectious a week after death. And other coronaviruses like MERS and SARS can survive on hard surfaces for 24 hours or more, requiring careful disinfection.
Novel viruses put everyone—including funeral directors—on edge. Whenever a new disease emerges, the CDC creates a digital hub for reliable information on what it is, where it is, and how to stop its spread. One of these tabs is dedicated to postmortem guidance for medical examiners and funeral directors, who will inevitably deal with the dead. There are CDC postmortem guidelines for the Ebola virus, Creutzfeldt-Jakob disease, and now COVID-19, the official name of the coronavirus. Local public health authorities, as well as professional organizations like the National Funeral Directors Association, make sure this information makes its way to morticians around the country.
Rob Goff, executive director of the Washington State Funeral Directors Association, saw the guidelines last week. “Unfortunately, it was really geared toward the medical examiner and pathologists with autopsies, so we have to read between the lines,” he said. Because there is still so little information about the coronavirus, the CDC mostly describes what biological samples doctors should harvest, like lung swabs and tissue samples from major organs, to help gather new intel on the disease.
But the CDC did have some information for funeral directors: namely to stay calm and suit up.
When a body arrives at a funeral home, morticians rarely know the cause of death, and almost never have a robust medical history. As such, they follow “universal precautions,” which basically means they assume any and all corpses are infectious, even though the vast majority are not. At a minimum, they wear nitrile gloves and wash their hands religiously. But “touching someone’s skin is far less concerning than sticking your hand in a bag of their organs,” Stone said. So if they’re going to be opening up the body cavity for embalming—or if a medical examiner has already done the bloody work for an autopsy—they strap on safety goggles, medical gowns, and face masks.
“If you’re trained and you’re responsible, you’re safe,” Stone said. “This is the nature of the job we do.”
That hasn’t stopped funeral directors from discriminating in the past. During the AIDS crisis, many morticians refused to deal with the bodies, citing concerns about their own health and that of their families. More recently, funeral directors have refused those who died from Creutzfeldt-Jakob disease, the rare and fatal prion disorder, for similar (and similarly unfounded) reasons. And during the SARS outbreak in Toronto, some funeral homes charged some customers extra.
Stone thinks misinformation and fear around the coronavirus could lead to similar practices today. “That’s our prerogative to say, we’re not working with that. But it’s irresponsible. It’s just stupid,” he says. “Everybody needs to take a deep breath—not necessarily with a mask on—and go wash their hands.”
The bigger concern, it seems, is backlog. Dr. Sally Aiken, of the Spokane County Medical Examiner’s Office, explained what the situation might look like for her community. Right now, she says, about 5,000 people die in Spokane County each year, out of a total population around half a million. Public health officials expect 40 to 70 percent of a population exposed to the coronavirus will get sick. Of those, approximately 2 percent die, mostly among the very old. “Well, in our county, that means 5,000 people are going to die,” Aiken says of this hypothetical scenario. “You’re going to double our deaths.”
That doesn’t sound like an apocalyptic number, but it would put a strain on doctors, public health officials, medical examiners, and funeral directors—and the resources at their disposal. California is already facing a shortage of coronavirus test kits. Before an emergency shipment on Friday, the state was monitoring 8,400 people but had only 200 tests. And some funeral directors have struggled to find masks and NIOSH-certified N95 respirators, according to the NFDA.
Fortunately, since the Spanish influenza of 1918, when millions died and the living struggled to bury them all, our understanding of infectious disease has grown (we can see viruses, for starters, thanks to the invention of the electron microscope) and our attitudes toward death have changed. The “embalm and bury” model, which was effectively the only way to deal with the dead a century ago, is in decline. Now, more than 53 percent of Americans opt for cremation, which reduces direct handling of the dead and, at 1,400 degrees or more in the cremation chamber, is sure to kill off any virus.
“I think the worst-case scenario is this: inevitably other people will get sick and inevitably other people will die,” Stone says. “I just find it hard to believe we would run out of anything that would cause us great difficulty in dealing with this. Funeral homes are so well equipped—we have facilities for refrigeration, we have facilities for embalming, we have facilities for cremation.” Stone’s facility typically deals with 15 to 20 families at a time, but he estimates his team could handle 50 or 60 in a crisis. It would be exhausting, but they could get the job done.
“We’re not there yet. We’re far from it,” he says. “I hope I’m not wrong.”