As the death toll from COVID-19 rises in the United States, coroners, medical examiners, autopsy personnel, funeral directors, and other death care workers are changing the way they handle victims of the pandemic.
Can COVID-19 be Transmitted by a Dead Body?
In the living, COVID-19 is transmitted by droplets from an infected person. Just like it lives on surfaces, the virus may also live on and in a dead body, although it’s not yet known how long it can survive. Per the CDC, a person in the same room as a body will not be at risk of contracting the virus, but when the body is moved or handled, the chance of coming into contact with the virus increases. Moving an infected body can cause droplets to escape from the decedent’s mouth, which often stays open after death. The California Department of Public Health recommends the faces of decedents be covered temporarily with a disposable surgical mask while the body is moved, also suggesting that “workers avoid actions that may result in forceful expulsion of air from the body.” Unfortunately, since masks are in short supply for the living at the moment, this may not be a precaution everyone can take.
Protective Equipment Shortages Affect Death Care Workers
Death care workers are in the same position as healthcare workers when it comes to the shortage of personal protective equipment. Many are forced to reuse N95 masks and other supplies. N95 masks are routinely used in mortuary and autopsy settings when handling bodies with known infectious diseases. The shortage of personal protective equipment puts everyone who handles bodies at risk not just for COVID-19, but for other diseases as well.
Suspending Autopsies
Due to the potential risks, the Occupational Safety and Health Administration has recommended suspending autopsies on patients with suspected or confirmed cases of COVID-19. In their stead, pathologists, medical examiners and coroners are performing nasal and oropharyngeal swabs on decedents. Some jurisdictions are sending death investigators to swab the noses and mouths of the untested dead suspected to have the virus. If a decedent tested positive for COVID-19 while alive appears to have died of the disease, a medical record review is performed in place of an autopsy.
Some autopsies remain medically or forensically necessary. For example, a murder victim who fell ill prior to their untimely death or a young person complaining of flu-like symptoms who suddenly and inexplicably dropped dead. Per the CDC’s guidance on handling postmortem specimens, autopsies on cases like these should be performed in autopsy suites with adequate air-handling systems. The primary precautions autopsy personnel should take center around preventing the aerosolization of the virus. Electric bone saws, which can fling small particles into the air, should not be used or attached to a vacuum if their use is unavoidable. During the procedure, swabs of the nose, mouth, and both lungs along with samples of lung and the upper airway are taken for testing. All confirmed COVID-19 deaths are reported to local health departments and the CDC.
Funerals Still Taking Place
After consulting with the CDC, the National Funeral Directors Association stated that funerals and viewings may still take place. Routine embalming procedures have been deemed adequate to disinfect a corpse, although funeral directors should discourage family members and friends from touching or kissing the body of their loved one. Due to gathering size restrictions, funerals may be livestreamed online to allow friends and family to participate.
Organ and Tissue Donation Impacted
The COVID-19 pandemic is disrupting all aspects of healthcare, including organ transplantation. The rise in cases is impacting the already precious supply of transplantable organs. According to the Association of Organ Procurement Organizations, patients who test positive for COVID-19 cannot donate organs. Some organ procurement organizations have chosen to test all potential organ donors for the virus. Tissue and eye donors aren’t being tested, but additional screening measures, including questions for family members about symptoms, recent travel, and contact with others who may have the virus have been implemented. For many who work in this field, it’s business as usual with long hours and potential exposure to pathogens, this time with an impending shortage of protective equipment.
Remember the Last Responders
While health care workers are on the front lines, death care workers also play an important part in the response to the pandemic. As more deaths occur, the risks to these last responders will continue to increase. Their contributions are essential in tracking mortality rates, protecting the public, and helping grieving family members deal with loss.