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When bodies go unclaimed after COVID-19 deaths | COMMENTARY

An orange biohazard tag hangs from a body bag in an isolated refrigerated unit set aside for bodies infected with coronavirus at the Cook County morgue in Chicago.
An orange biohazard tag hangs from a body bag in an isolated refrigerated unit set aside for bodies infected with coronavirus at the Cook County morgue in Chicago. (Charles Rex Arbogast/AP)

As the coronavirus continues its spread across our nation and state, it is not only overwhelming hospitals and health care providers, but also many other valuable sectors that maintain our public health.

In Italy and Iran, the funeral and disposition services have become completely flooded, unable to cope with the increase in bodies that are the unfortunate result of the deadly COVID-19 disease. In New York, refrigerated morgue trucks show that hospitals’ capacities to care for the dead are severely strained, and images of mass graves on Hart Island shocked many around the nation.

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In Maryland, we must make preparations for the pandemic’s full arrival, including the difficult preparations for increased mortality.

Under normal circumstances, many people unfortunately die without family or friends to pay their funeral costs. In Maryland, all bodies are legally required to be transported to a funeral home or the State Anatomy Board within 72 hours after death. If no family can be contacted within the 72 hour window, the body is designated “unclaimed,” and the state assumes the cost of its transportation and disposition. The State Anatomy Board is tasked with managing the disposition of unclaimed bodies as well as those which are deemed to be biohazards. This important role protects the public health of all Marylanders and respects the dignity of the unclaimed.

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Though it is not yet clear whether COVID-19 can be spread posthumously, international governments — including the early-hit Hong Kong — have created regulations regarding the disposition of COVID-19 victims. Maryland should have clear instructions for disposition of bodies with COVID-19, and the anatomy board will play an important role in managing the deceased.

Unclaimed bodies, often overlooked by society, cannot be neglected as we prepare for their numbers to almost certainly increase in the coming weeks. We must look this hard, unfortunate reality in the face and make emergency preparations.

Due to the rise in opioid overdoses, unclaimed bodies have already overwhelmed the State Anatomy Board in the past several years. There have been disturbing stories of “inventory control problems” that have led to families receiving the wrong remains. Although there have been improvements in tracking, the State Anatomy Board will need additional resources to continue to function during this crisis.

Gov. Larry Hogan has taken many important steps to prepare Maryland for the pandemic: declaring a state of emergency, closing public schools and gyms, and providing honest and realistic warnings about the severity of the coronavirus pandemic. He should also mobilize state funds to increase the capacity of the anatomy board to ensure proper disposition of bodies considered biohazards, and all unclaimed bodies in the state.

Under normal circumstances, once the anatomy board has possession of a body, if family members are found, they can reclaim their relative’s body by paying a transportation fee. Although these fees can be waived due to financial hardship, families should not have to worry about navigating a bureaucratic process during this pandemic. A Maryland state bill, Senate Bill 917, was introduced during the most recent legislative session that would have prohibited charging transportation fees to claim a body. Since the bill did not become law, an emergency measure should be considered to waive all fees from the anatomy board during the state of emergency.

In our state, unclaimed bodies can be used for medical research before cremation. The State Anatomy Board should create a plan for the use of unclaimed bodies with COVID-19 in medical research and publicly disclose this information. It is possible, due to the unknown risks of posthumous coronavirus transmission, that the anatomy board decides that no bodies with COVID-19 can be used in research until more is known about safety. That plan should also be publicly communicated.

Although difficult to think about, or talk about, unclaimed bodies need to be an important consideration during the pandemic. Those who died without anyone to grieve them or pay for their funeral were often the most vulnerable in life. As we come together to protect one another through social distancing and hand-washing, we should extend that solidarity after death. The safe and respectful disposition of the dead will be a crucial mark of our respect for our fellow Marylanders during the coming months, and we must act now to mobilize resources prevent the tragedies of other regions.

Mary Peeler (mpeeler2@jhmi.edu) is a fourth-year medical student at Johns Hopkins and a resident of Baltimore City.

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