Recommendations for Funeral Directors
In response to many calls from funeral directors across the country, we are offering these suggestions for the protection of your staff and for the community you serve. You are free to use the material on our website relating to the coronavirus under the terms of Creative Commons license CC BY-SA, and identified on the bottom of the pages by this logo:
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. Please call us if you find any errors or have additional suggestions – (425) 823-1900
No Immunity
Because there is no immunity in the general population, the SARS-CoV-2 virus has the potential to spread rapidly. The strategy of the healthcare industry is to slow the spread as much as possible so hospitals are not overwhelmed with an influx of very sick, and presumably older patients.
This year so far (Q1, 2020) in the Seattle area, the death rate is relatively low, and especially for the month of February. The few deaths from coronavirus are offset by fewer deaths overall. While we have not done an in depth analysis, our impression is that more people spend a lot of time indoors where they are not exposed to seasonal flu or the dangers of navigating Seattle’s crowded freeways.
Bottom line: There have been about 40 deaths in Seattle attributed to the coronavirus as of March 15, 2020, which is small compared to the seasonal flu. Yet the fear in the community is palpable, probably because of the massive international reaction and the very real threat that the spread will grow exponentially. The big unknown question at this time is what will happen when the weather gets hot in summer.
Peak Infectivity
There is evidence that viral shedding from infected individuals is at is peak before symptoms worsen. The implication is clear; when a person has died from the virus, viral shedding and ensuing infectivity will be lower than when the disease first starts. According to the authors of the German study of only nine young patients, “Shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 6-12 days, but was not followed by a rapid decline of viral loads.”
Bottom line: The virus has the potential to be shed in smaller numbers after death in sputum or in stool. We are double bagging all cases followed by thorough disinfecting when we get back to the facility. Dilute 5% sodium hypochlorite to spray surfaces. (Use 1 part bleach to 99 parts cold tap water (1:100 dilution) for disinfection of surfaces.)
Strategy to Avoid Getting or Spreading the Virus
Our experience during the first months and years of the HIV/AIDS that peaked around 1995, taught us that Basic Infection Prevention and Control Guidelines work. They will work during this epidemic just as they continue to work during the on-going HIV/AIDS epidemic.
Funeral Home Premises
Display a sign at your establishment outlining the steps you are taking to limit the spread of the virus, and ask for your clients’ cooperation.
“We are employing procedures recommended by the Centers for Disease Control (CDC) to keep you safe and reduce as much as possible the spread of the coronavirus. Our primary objective is to comfort you in the difficult time of a death in the family, and to make your funeral arrangements as easy as possible.”
The Swiss Federal Office of Public Health has developed suggestions for all of Switzerland. We have adopted it for our funeral establishments. You can download the PDF file HERE
Removal and Handling of Remains
The CDC recommends the following. We always adhere to these standards and during the current epidemic we have not had any personnel become ill with COVID-19
“A funeral or visitation service can be held for a person who has died of COVID-19. Funeral home workers should follow their routine infection prevention and control precautions when handling a decedent who died of COVID-19. If it is necessary to transfer a body to a bag, follow Standard Precautions*, including additional personal protective equipment (PPE) if splashing of fluids is expected. For transporting a body after the body has been bagged, disinfect the outside of the bag with a product with EPA-approved emerging viral pathogens claimspdf iconexternal icon expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.). Wear disposable nitrile gloves when handling the body bag.
Embalming can be conducted. During embalming, follow Standard Precautions including the use of additional PPE if splashing is expected (e.g. disposable gown, faceshield or goggles and facemask). Wear appropriate respiratory protection if any procedures will generate aerosols or if required for chemicals used in accordance with the manufacturer’s label. Wear heavy-duty gloves over nitrile disposable gloves if there is a risk of cuts, puncture wounds, or other injuries that break the skin. Additional information on how to safely conduct aerosol-generating procedures is in the CDC’s Postmortem Guidance. Cleaning should be conducted in accordance with manufacturer’s instructions. Products with EPA-approved emerging viral pathogens claimspdf iconexternal icon are expected to be effective against COVID-19 based on data for harder to kill viruses. Follow the manufacturer’s instructions for all cleaning and disinfection products (e.g., concentration, application method and contact time, etc.).
After cleaning and removal of PPE, perform hand hygiene by washing hands with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water is not available. Soap and water should be used if the hands are visibly soiled.
Decedents with COVID-19 can be buried or cremated, but check for any additional state and local requirements that may dictate the handling and disposition of the remains of individuals who have died of certain infectious diseases.”
Download this file for lists of EPA approved cleaning products:
https://templatelab.com/epa-registered-disinfectant-products/
(Update on Oct. 18, 2021 – SARS-CoV-2 virus has been shown to spread via droplets and aerosols so surface decontamination, while important, is not as urgent as thought when the virus began its rampage. With the Delta variant showing increased infectivity over earlier varieties, avoiding infected people and their droplets/aerosols is the best strategy to avoid becoming infected.
For funeral industry workers, removal personnel, all of the previously discussed precautions are adequate.)
reference: https://www.cdc.gov/coronavirus/2019-ncov/faq.html#protect
- Note: Standard Precautions. as noted above apply equally to CJD
https://www.cdc.gov/prions/cjd/funeral-directors.html
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