Time to think the unthinkable

These are unprecedented times. Across the world, the Covid-19 pandemic sweeps everything before it, heralded by fear and confusion at conflicting government advice, with daily updates of the tens of thousands of people who have become ill, and rising numbers of deaths.

 And while much concern is rightly directed towards the wellbeing of the frontline medical staff battling to support and save the lives of people who are most severely ill, those in the funeral sector are waiting for consistent and clear advice about how to deal with people who have died – who may or may not be carrying the virus.

Currently, there are conflicting official documents relating to handling the bodies of people who have died who have been identified as testing positive for Covid-19, which is now a notifiable disease. (Details of the varying official advice as to levels of PPE required are at the end of this post.)

The guidance we shared from Public Health England in our blog post of March 2^nd has now completely changed – something which we find inexplicable given the vast increase in numbers of people who have tested positive in the last two weeks, and the steady increase in the number of deaths.

14 days ago, Public Health England recommended full PPE, the use of a body-bag and disinfecting all external surfaces prior to moving the body of someone who has died who had tested positive for Covid-19.

Now, the official advice is now that ‘there is no requirement for a body-bag and viewing, hygienic preparation, post-mortem and embalming are all permitted’.

At the time of writing, Public Health England are prioritising testing and not testing either people who are symptomatic at home, or those related to a person who has tested positive.

It is, therefore, entirely possible that people who have died at home may have contracted Covid-19 prior to death but not been tested for it. Equally, it is entirely possible that funeral staff will come into close contact with bereaved people who may be carrying the virus when making arrangements for or carrying out a funeral. None of us know whether the virus is spreading among people as yet asymptomatic in our communities. Logic indicates that we should therefore assume that it is.

Until such time as there is consistent official advice to the funeral sector, and given the acceptance by the government that there are likely to be significant numbers of people in the community currently carrying the virus, potentially without displaying symptoms, we feel that we should be erring on the side of caution, particularly given the close exposure funeral staff can have to those in their care.

The Good Funeral Guide would therefore like to make the following suggestions to funeral directors and staff.

• Assume that everyone in your company, all those in your care, all of the clients you are working with and everyone you encounter during daily activities could be carrying the Covid-19 virus. Put in place as many mitigating procedures as you possibly can.
• Risk assess your daily operations in the light of this fast-developing situation: Have you got adequate handwashing facilities for staff and visitors? What guidance are you giving staff about handwashing throughout the day? Are they following it? Have you got paper towels? How are they being disposed of? Are you ensuring that all surfaces and handles in your premises are disinfected? What about pens? Cups? Kettles? Have you implemented screening questions when taking a first call to ascertain the level of risk to your collection team? Do you have adequate PPE for staff collecting or handling people who have died? How about body bags? Disinfectant? Hand sanitiser? Are any of your staff members in the potentially most vulnerable groups who are likely to be at most risk from contracting the virus? Or do any staff members have vulnerable family members? How are you minimising their exposure to potential infection? Are you minimising physical contact between staff members and between staff and clients? Are you offering clients the opportunity to make funeral arrangements remotely using email and telephone or video calls rather than physical meetings? What about at funerals? Have you advised staff not to shake hands or physically contact mourners? Are all staff members carrying and using hand sanitiser during the course of the day if they are unable to wash their hands? Are you working closely and communicating clearly with your colleagues to ensure everyone is ok, both physically and mentally? What more can you do?
• Stay as up to date and informed as possible. The situation is changing minute by minute.
• Connect with other local funeral companies. Louise Winter, of Poetic Endings, one of the GFG Recommended funeral directors, has set up a support network for London based companies to offer support and resources to each other and to enable a co-ordinated and efficient response to any crisis. Do the same in your area.
• Plan ahead for the possibility that public gatherings may be prohibited. This move could potentially involve gatherings for funerals – either those where there are large numbers of people, or, in the worst-case scenario, completely. Client expectations will need to be managed sensitively and honestly.
• Consider recommending that clients use their own cars to travel to funerals rather than offering limousines. Requiring a staff member to drive up to six people in close proximity in a limousine could be seen as asking individuals to undertake an unnecessary risk.
• Stay in contact with your local crematoria and cemeteries. Some crematoria are already putting restrictions in place such as removing hymn books, prohibiting the carrying of coffins on shoulders and not permitting those who are self-isolating to attend funerals.

We will do our best to relay official advice for the funeral sector on this blog as we access it, however for the time being, common sense dictates that we recommend everyone takes the utmost care to minimise their potential exposure to Covid-19. Vulnerable members of our society need the rest of us to take as much care as we can.

NB Until such time as we consider it safe to do so, the GFG will be carrying out all our business remotely. Accreditation visits will be done using video calls rather than in person, and we will not be attending any conferences or mass gatherings for the foreseeable future.

As everyone should be, we are following the official guidance on hand hygiene, and, because we have highly vulnerable close family members, we are avoiding all unnecessary social contact.

Unprecedented, unknown, unknowable – this is our new normal for now.

The current official guidance regarding people who have died who tested positive for Covid-19 can be found in various documents – links below.

(It is worth noting that some local coroners are issuing guidance requiring that all those who die in the community MUST be brought into a mortuary in a body bag, regardless of whether or not funeral directors suspect the person has had Coronavirus. We have seen copies of these communications.)

The Health & Safety Executive document ‘Managing infection risks when handling the deceased’ advises that body-bags should be used for transporting people who have died from similar notifiable diseases (SARS & MERS) – see pages 48 & 49.

Public Health England’s ‘Interim guidance for first responders and others in contact with symptomatic people with potential Covid-19’ states that personnel handling bodies of those who have died at home where Covid-19 may be suspected should wear gloves and perform hand hygiene – see section 11.

Their ‘Infection prevention and control guidance for pandemic coronavirus’ document is far, far more proscriptive for those caring for people who are alive, recommending that  droplet precautions should be used for patients known or suspected to be infected with COVID-19 in all healthcare settings, and that ‘In all healthcare settings: A FRSM (fluid resistant surgical mask) must be worn when working in close contact (within 2 metres) of a patient with COVID-19 symptoms.’and that ‘Filtering face piece (class 3) (FFP3) respirators should be worn whenever there is a risk of airborne transmission of pandemic COVID-19 i.e. during aerosol generating procedures (AGPs)’

Recommended Personal Protection Equipment for the care of patients with Covid-19 is shown in the table below (page 24 of Public Health England’s ‘Infection prevention and control guidance for pandemic coronavirus’)