We must be ready to manage the dead from coronavirus

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Funerals should be postponed and governments must implement body-handling procedures in wake of COVID-19 crisis, writes Dr Romain Fathi.

IN OUR MODERN societies, we provide our loved ones with customised and highly ritualised funerals. They represent their individuality and beliefs, respect their final wishes, and give families a place and time to grieve.

The novel coronavirus, with its increasing death toll worldwide, may prove to be a significant disruption to the ways in which we deal with the dead. Cities and towns in northern Italy are already facing enormous difficulties due to a lack of equipment, infrastructure, personnel, and government guidance on this matter.

Higher death tolls, however, are not just an issue for relatives and funeral workers: they also pose a serious health challenge to the living. Large amounts of unattended bodies are an epidemiological bomb waiting to explode. While viruses need living hosts to thrive, they can still remain active in corpses for varying periods of time. Dealing with the bodies thus becomes a sanitary imperative.

In these times of anxiety, it may help to reflect on the fact that our societies have dealt with similar situations before and that we are not navigating fully uncharted territory. Past experiences of mass death, such as the First World War and the Spanish flu, can teach us a few lessons as to how to deal with large volumes of corpses.

We may need to ask ourselves difficult questions in the coming weeks so we are prepared if the lethality of Covid-19 becomes unmanageable for our funeral homes.  In fact, the handling of contaminated corpses in Iran and Italy – or lack thereof – demonstrates the necessity of preparing exceptional and highly regimented mortuary policies.

Regardless of how long Covid-19 can remain active on corpses (probably no more than a few hours), the corpses will be perceived as dangerous. They become an even greater health hazard when they decompose, as bacteria multiply in the process. Footage of abandoned corpses in Iran shows that they can be both a sanitary risk and a sight which provokes panic.

In the times of a pandemic, attempting to maintain usual funerary practices is the surest way to continue propagating a virus. This can happen through contact with the corpses for the funeral workers and through the transmission of the virus among the funeral’s attendants.

Australia has already banned gatherings of more than a hundred people and funeral homes are preparing for live stream funerals. Australian Funeral Directors Association President Andrew Pinder warned the Government that infrastructure and large amount of equipment would be needed to face a potential crisis.

But will these measures be enough?

During the First World War, numerous states "appropriated" the bodies of the dead and introduced state-driven body disposal policies. These measures also protected those dealing with the dead to prevent further contamination (at the time, dysentery, cholera and typhus were the immediate threat).

Special masks were created to work in mass graves, new cremation practices were tried, quicklime was used on a large scale to accelerate the putrefaction process and rigorous guidelines were established to dispose of corpses as efficiently as possible, far away from springs and water pipes. 

Societies managed to create unprecedented body disposal policies. In doing so, they prevented the outbreak of diseases that would have killed a lot more people than the war or the flu themselves. When we study these policies, a few patterns can be identified that may prove relevant to us now, if required.

First, protecting staff. The Government could set a nation-wide procedure on the handling of Covid-19 contaminated corpses, relying on trained and protected workers to collect and dispose of them. Trained funeral employees, assisted by army personnel, supervised by medical specialists, following standardised procedures, with mass-produced equipment, has proved exceptionally efficient in the past.

Second, pausing funerary rituals. From the preparation of the body to religious rituals and the funeral itself, the farewell ceremonies should be put on hold. If the death toll rises, we won’t have the means to provide each deceased with a proper funeral as attempting to do so would expose funerary workers, families and communities.

Third, imposing temporary measures. During the First World War, millions of men were buried in mass graves as an expedient way to avoid immediate contamination. After the war, they were exhumed and reburied in individual graves, enabling their commemoration in postwar-built Commonwealth War Graves Commission military cemeteries.

Large cremations had proven difficult to implement and mass burials provided a speedy and effective solution. Wartime regulations were strict and remained in place during the Spanish flu outbreak. In France, for instance, the remains of those who had died from the disease could not be exhumed and reinterred anywhere else for three years.

Fourth, identification. Should Covid-19 contaminated corpses be interred hastily, they must at all costs be equipped with at least two stainless steel identification plaques, or chips, or any device resisting oxidation. The trauma experienced by those who grieve "the missing" can be prevented if tried measures are applied systematically and at the earliest possible stage.

Fifth, healing. Once the pandemic is over, legislation will need to allow the organisation of the funerary rituals, both religious and secular, that the families of the dead were deprived of. This will not only ease the mourning process, it will also maintain the pillars of life in society. Funerary practices are one of homo sapiens’ distinctive features and in the aftermath, respecting the dignity and last wishes of our loved ones will be paramount.

Sixth, pedagogy. If this situation is to happen, governments, just as they did in the First World War and the Spanish flu, will have a duty to explain why such drastic protective measures are taken so that populations retain some degree of agency in the fight against coronavirus.

This discussion may sound chilling and premature to some, but it is imperative to have it now if we wish to prevent what could be a second sanitary crisis. Taking care of the dead requires ethics, anticipation and fortitude. Leaving these harrowing decisions to families and local authorities would generate an additional burden of anxiety and may prove even more dangerous to the living.

Dr Romain Fathi is a Senior Lecturer in History at Flinders University and an Affiliated Researcher at the Centre d’Histoire de Sciences Po, Paris. He is an expert in First World War studies and is working on the disposal of human remains in WWI.

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