Undertakers and crematory operators in Maryland say they lack sufficient guidance and equipment to keep employees and mourners safe while their workload spikes — with nearly 1,000 residents killed by the novel coronavirus and many more expected.
One funeral director compared his peers to first responders in their ability to handle large numbers of bodies in instances of mass casualty. The funeral business is lower on the priority list for personal protective equipment — after hospitals and nursing homes — but firms point out that they can be exposed to COVID-19, the disease caused by the virus, either through the dead or their families.
Carlton Douglass, owner of Carlton C. Douglass Funeral Services in Baltimore, said the coronavirus pandemic reminds him of the AIDS outbreak in the 1980s, in which funeral directors treated each body as if it were a victim of the disease.
“We have to assume the same thing right now: that every case is a possible COVID-19 case,” said Douglass, former president of the Maryland branch of the National Funeral Directors and Morticians Association.
At Maryland Cremation Services in Millersville, the staff is seeing about a 30% increase in business, according to co-owners Sean and Dorota Marshall.
Consultations with families are happening over the phone, and ashes are delivered to families at the curb. Transporters routinely pick up bodies from nursing homes, and the company’s two crematory machines are operating seven days a week. The staff is coming in earlier and staying longer to keep up with demand, they say.
“It’s just exhausting,” Dorota Marshall said.
Then there’s the lack of personal protective gear — such as masks, gloves and gowns. The Marshalls say they understand that hospitals and nursing homes should be the top priorities for protective equipment. But, they say, funeral industry workers are exposed not only to bodies but to the families and environments where patients lived.
The U.S. Department of Labor and the Centers for Disease Control and Prevention recommend that death care workers take precautions such as wearing protective equipment. COVID-19 is primarily transmitted through respiratory droplets and can also be passed through intermediary surfaces.
Dr. Natasha Chida, assistant professor of medicine at the Johns Hopkins University School of Medicine, said it’s unclear how long COVID-19 stays in the body after death. However, given the days that typically pass from death to an autopsy to ultimately landing at a funeral home or crematory, she said she believes the likelihood of transmission is low.
“There’s always a theoretical risk, and that’s why we would recommend people to wear gloves ... not just goggles,” Chida said. “But I don’t think it’s a very likely route of transmission.”
The Marshalls say they’ve gotten little information from the state about whether to handle COVID-19 or suspected COVID-19 bodies differently. So they’re operating under the assumption they need protective gear and are constantly “scouring” the internet to find it.
They were excited to get a shipment of 300 masks, only to find that the rubber fasteners snapped off as soon as they put them on.
They’ve resorted to wearing masks for three to four days, which is beyond recommendations. They’re also running out of body bags.
“We have about 100 bags left, and we can’t find any more,” Dorota Marshall said.
Gov. Larry Hogan’s office did not respond to questions from The Baltimore Sun about its plans for handling a large number of bodies, should there be a surge in deaths. But some information has trickled out.
Maryland had requested 15,000 body bags from the federal government’s stockpile but received none, according to federal documents.
And about two weeks ago, Health Secretary Robert Neall publicly said the state was leasing two ice rinks to potentially store bodies, but Hogan walked that back hours later, saying “it’s just something that is being considered."
Jack Mitchell, owner of Mitchell-Wiedefeld Funeral Home in Towson and treasurer for the National Funeral Director Association, said workers customarily wear protective gear when handling dead bodies and put masks on the deceased.
While Mitchell’s funeral home hasn’t seen a drastic spike in bodies, “the cupboard has run bare” for equipment.
About three weeks ago, Mitchell said, he sought to acquire personal protective equipment but found that it wasn’t clear how.
After failing to submit an order through the Maryland Health Department and the Maryland Emergency Management Agency, Mitchell finally got confirmation of an order at the county level.
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While Mitchell waits for his shipment to arrive, he is searching through online vendors to find whatever equipment is remaining.
“We do expect to receive some equipment, but we don’t know when it’s going to come,” Mitchell said. “So in the meantime, we’re kind of fending for ourselves just like everyone else.”
Sean Naron, a spokesman for Baltimore County, wrote in an email that the Baltimore County Health Department is providing “general assistance to funeral homes.”
“However, Baltimore County’s supply of PPE is limited,” Naron wrote, “and following [Maryland health department] guidance, the County is prioritizing requests to priority facilities, including long-term care facilities, emergency medical services, and inpatient hospital facilities.”
Naron also said Baltimore County’s Emergency Operations Center is “coordinating with local hospitals to plan for potential surges and to help in planning for care of decedents.”
Like Mitchell, Douglass’ funeral home hasn’t seen a drastic spike in business, but he sees the warning signs.
“It’s just beginning,” he said.