CREMATION
of Saran wrap over the face. Place the body in a body bag, and spray the entire body and the outside of the body bag with Dis- Spray. Zip up tightly and gently place in the cremation unit or alternative container. If you do not have a body bag, place the body in a large disposable plastic sheet that is often seen covering the caskets. Wrap the body entirely in the cover and place them in the cremation container. Along with the name of the deceased, write “COVID Positive” on top of the box. Many funeral homes have cremation packages that include a private identification or viewing. Because of the potential exposure to the family and funeral home administration, offer to use FaceTime or Zoom as an alternative. Before taking the deceased to the crematory, inform the crematory operators that the person had COVID.
Because of the lack of embalming and disinfection before cremation, specific steps will be needed for the COVID positive unembalmed body. Contrary to popular belief, the primary reason for embalming is not for preservation, but disinfection. With an unembalmed body that will be a cremation, there is none of the usual disinfectant treatment to destroy the virus. There is no washing with soap and water to decimate the cellular lipid wall surrounding the virus. However, even though our disinfection is limited, we still have to protect ourselves and the crematory operators. Throughout this process, do as minimal manipulation of the body and disturbance of the clothing as possible. Wearing your recommended PPE, introduce 70% isopropyl alcohol-saturated cotton into the nasal cavities and mouth. Place a sheet of cotton or disposable surgical mask saturated with Dis-Spray or 70% isopropyl alcohol over the entire face. To keep the disinfectant from evaporating, place a sheet
TRANSPORTING THE BODY
to schedule a flight, and the origins and destinations have been reduced. In the past, a funeral director could confidently schedule a flight for a specific day and time. Now with the pandemic, they have experienced canceled flights without notice and many cargo stations closing. It is your responsibility to inform the airline scheduling office that the deceased was COVID positive and follow each airline's guidelines.
If shipping human remains using air transport where the cause of death was attributed to COVID, the majority of countries will require embalming. Additionally, many airlines have created significant restrictions as they relate to international and domestic shipping of COVID remains. Since COVID began, airlines have cut their flights by 85%. Many cargo departments have reduced their hours and staff significantly. It is more difficult
ASSISTED PREPARATIONS AND FUNERALS
times, it is vital to use sound judgment when deciding if these rituals can be accomplished safely. If you are ever put into the position where a religious or cultural practice demands to prepare a COVID positive body, you should try to discourage any type of preparation. Unembalmed COVID positive cases have the potential to be contagious, and there is a risk to everyone. If they are persistent, verbally explain the dangers of the disease, distribute the necessary PPE, and have a waiver signed by all participants releasing liability of the funeral home. This liability waiver should not be a generic template, but detailed and drawn up by your attorney. There should be an embalmer present at all times outside the prep room who has a full understanding of the disease. An embalmer can give needed guidance during preparations, discourage unnecessary movements from the prep room, and restrict bathroom breaks. You do not want someone from the burial society wearing their gloves to the bathroom.
Lastly, we will discuss the religious burial groups and societies or families who participate in the preparation of the deceased. The Islamic religion, for example, requires men to wash men and women to wash women. Using a Janazah kit, they will wash and shroud the induvial for burial. Another religious group is the Chevra Kadisha, a Jewish burial society that also prepares the deceased. The issue here is that each burial group is most likely unfamiliar with the strict guidelines for preparing a COVID positive case. They must be wearing the appropriate PPE for their protection. That said, each burial group consists of approximately six to eight individuals. With PPE at an all-time low, and a shortage of bleach and disinfectants, it can be challenging to produce these imperative materials. Then there is the green burial, the do-it-yourself funeral, and the home funeral. In all these circumstances and in these difficult
FUNERAL ARRANGEMENTS
to protect the public. They most certainly will understand the restrictions because of the circumstances. The funeral director should be keenly aware that there is a strong potential that one of the close family members might also be infected with COVID. We all know how easily and quickly this disease is spread, so the funeral director should encourage everyone to not sit close during these arrangements. Before the arrangements and arrival of the immediate family, the chairs should be placed to encourage social distancing. Keep in mind that there has often been a stigma tied to the death of a COVID patient. The news media will often report COVID-related deaths, and social media outlets will also spread the news. This can potentially cause shame and embarrassment for the family. Unfortunately, many families will not be forthcoming in informing the funeral director that their loved one died of COVID-19 complications. Lastly, there is nursing homes or assisted living facilities not allowing the surviving spouse to attend the visitation or funeral. This is because the spouse will be comforted by many individuals, and a lack of social distancing. The health care administration does not want to potentially introduce the virus into the residence facility through a grieving spouse.
When making funeral, memorial, or final disposition arrangements, be sure to check with your current board of health or state laws to determine what restrictions there are on holding a public visitation or funeral. Because the funeral home is a business that is open to the public, masks should be mandatory. Depending on where you live in the country, and according to the laws, there may be restrictions of 10 to 50 individuals at a time in the funeral home or church during a visitation or funeral. This requirement should be mentioned to the family you are serving during the funeral arrangements so there are no surprises. Service times and locations should not be printed in the obituary unless the funeral home has the staff to regulate the number of individuals coming in and out of the funeral home or church. Some funeral homes have created bracelets and have the immediate family pass them out to those attending the service. The bracelet will then be shown at the door of the funeral home or church for allowed entry. Another option to consider is having a drive-by visitation. Many funeral homes have adopted this new technique into their service packages. It keeps the family and mourners safe but also allows friends to show their condolences with appropriate distance. If the deceased died of COVID, inform the family that specific steps will be implemented
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