In times of crisis, most public attention is given to prevention and mitigation. But in places like Italy, which struggled with its early response to the coronavirus outbreak, a lot of local response has shifted on burying the dead.
Whether they be coronavirus victims or people who died for other reasons, Italian mortuaries, like hospitals, are over capacity. Last week, the Italian military was summoned to transport 60 coffins for cremation in the city of Bergamo. Some families can only drop off their loved ones’ bodies at locked cemetery gates, adding to a backlog of burials. Iran has allegedly resorted to mass burial in recent weeks, changing the way people are accustomed to burying their loved ones in the Islamic Republic.
Americans, too, are used to burying their dead one-at-a-time with dignity and respect. But with counties from Ohio to Indiana struggling with deathcare capacity in healthy times, America may soon have a second crisis in caring for the dead.
“In this country, we have a very strong sense of ethics regarding respect for the decedents and compassion for the bereaved,” said Robyn Gershon, co-author of several papers on mass fatality preparedness. “But in this time of disaster, if, in fact, we exceed our capacity, those things will have to be mitigated.”
While the United States has only seen 500 deaths as of press time, fatalities are still relatively low. But projections from CDC data suggest we could experience 200,000 to 1.7 million fatalities by the end of the COVID-19 pandemic. Adjusted for population, that means Milwaukee County could see anywhere from around 600 to 5,000 deaths. That signals an 8% to 30% increase in annual funerals.
Mark Krause, the owner of Krause Funeral Home, believes Milwaukee is better prepared than most other places in the United States.
“We have a lot of funeral homes compared to other cities, especially compared to those west of Wisconsin,” said Krause. “As you move east, there tend to be more funeral homes that do less volume.”
Krause handles more than 700 cremations in an average year. With two cremation machines, that amounts to about one cremation per day in each machine. But cremations can take several hours, including warm-up and cool-down cycles, removal of ashes, and individual care.
By comparison, Gershon’s study found that New York City only has five crematoriums, some of which can only dispose of 25 bodies per day working around-the-clock. That sort of pace, though, presumes no red tape. Like most jurisdictions, the Milwaukee medical examiner has to grant permits for every cremation, and bodies can’t be cremated less than 48 hours after death has been declared.
While Milwaukee might be well prepared for the disposition of human remains, especially through cremation, coronavirus precautions could delay the needed paperwork. In the event of an Italy-like backlog, many bodies would need to be stored in coolers before the proper arrangements can be made for burial or cremation.
In an email to WUWM, the Milwaukee County medical examiner said they would have room for an unexpected influx of around 75 bodies. They also said hospitals and funeral homes would likely absorb the extra capacity first.
The United Kingdom is setting up temporary morgues in case its coronavirus fatalities rise dramatically. Authorities in Spain have taken control of a Madrid ice skating rink to hold the bodies of coronavirus victims after all 14 of the city’s cemeteries closed.
During the 1918 Spanish Flu pandemic, some extreme measures were taken to handle the dead in a dignified manner. In Philadelphia, prisoners and Catholic seminarians were recruited to dig graves. Movie theaters, breweries, and even a Tennessee YMCA were turned into temporary morgues. Some have argued that the legal mechanisms for taking control of unconventional facilities for cold storage of bodies in the United States are not adequate in the case of a pandemic.
Krause said the best thing a person can do if they expect a loved one is dying, either at home or in a hospital, is to be prepared. That way they can avoid being re-traumatized after the death by not having their loved ones properly laid to rest.
“People need to mourn, and they need to mourn appropriately,” said Gershon. “These things are important for our mental health.”