The coronavirus has killed 114,000 Americans and counting—a mid-sized suburb wiped out in just a few months. As the death toll has risen, mortuary staff, funeral directors, and gravediggers struggled to keep up.
At the peak of the pandemic in New York City, for example, the medical examiner’s office deployed 45 mobile morgues—essentially refrigerated semi-trucks—to store bodies. In early April, the city’s four crematories were operating around the clock, yet still maxing out on capacity. Some funeral homes were forced to turn families away.
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But morticians around the country have struggled to source gloves and masks or respirators, which workers need to pick up bodies from homes or hospitals and to prepare them for burial or cremation. Funeral supply companies were sold out. In Oklahoma, the governor granted “last responders” access to the state’s stockpile. At one point, in mid-May, there was a nationwide shortage of body bags, the plastic wrapping required to transport potentially-infectious corpses.
These harrowing stories made headlines around the world, but they did not come as a surprise to Robyn Gershon, a clinical professor of epidemiology at New York University’s School of Global Public Health and a leading researcher in the United States’ mass fatality infrastructure. And if similar events continue as reopening the country leads to new curves, she won’t be surprised then, either.
That’s because Gershon has rigorously evaluated the emergency response preparedness of sectors, ranging from medical examiners and coroners to faith-based organizations. She’s found many of them wanting. But when it comes to the funeral industry, things have been particularly bleak. “They are, unfortunately, like the poor stepchildren,” she said. Of the sectors she’s studied, “they were the least prepared, with the least surge capacity.” Anyone who’s been paying attention knew going into this that the deathcare wasn’t up to the task of a mass fatality event—coronavirus or otherwise.
In 2011, Gershon and her colleagues published perhaps the only systematic analysis of the deathcare industry’s preparedness for a mass fatality event. The researchers surveyed 492 funeral homes, cemetery operators, and embalmers. They asked them about a number of preparedness measures, including whether or not they had infection control protocols, a stockpile of infection control supplies, and formal arrangements with suppliers to replenish essential tools.
They found “only six of thirteen preparedness checklist items were typically in place,” according to the paper. While 75.4 percent reported relationships with other local funeral homes or cemeteries, just 11.2 percent of respondents said they had a written pandemic plan. And though 63.8 percent of those surveyed said they had a stockpile of supplies like gloves and masks, just 15.4 percent said they had arrangements with suppliers to restock in the midst of a pandemic.
The researchers also surveyed workers about their ability to respond in a crisis. Though 80 percent said they still intended to report to work in a pandemic, many were caretakers of children or older adults, or were older adults themselves, potentially hindering their ability to get the job done in a crisis.
“I was telling them, you have to be prepared, this is how you have to write your plans, this is the kind of PPE you need, and they were shocked,” Gerhson said about her conversations with representatives of the deathcare industry at the time of her research. “They were like, ‘We can’t do all that stuff.’”
Building such capacity is possible, but would take collaboration across industries, years of careful planning, and perhaps even some government oversight, like on the part of FEMA or the CDC. Gershon hoped her research might have spurred people to action, but as the pandemic has shown, the funeral industry was as ill-equipped to address this mass fatality event as the research suggested years before.
But even if they had all the supplies they needed, the deathcare industry was at a disadvantage in other ways. Consistently, Gershon has found that funeral directors suffer from a lack of recognition from their peers in disaster response. “They always seem to be left out,” Gershon said. “I really don’t quite get it because they are such an important element to our public health infrastructure.” Organizations like the Disaster Mortuary Operational Response Team, which brings funeral directors, fingerprint experts, forensic anthropologists, and other experts together in times of crisis, tend to be rare exceptions to the rule.
Early in the coronavirus’ spread, for example, the U.S. Centers for Disease Control and Prevention seemed to misunderstand what exactly it is undertakers do. Initially, the CDC repeatedly offered funeral directors advice on how to collect biological samples from bodies suspected of COVID-19 infection—a task for pathologists, not morticians. The CDC eventually expanded its advice to the funeral industry, including the recommendation to livestream services. But the miscommunication caused additional confusion and frustration to funeral directors.
Gershon’s deathcare research may have been overlooked in the past, but she said it almost never existed. Epidemiologists of all stripes have struggled to get support for research on events like a pandemic. It seems so theoretical—until it isn’t.
That’s doubly true of a study that focuses on funerals. “It was a miracle it was ever funded in the first place,” Gershon said of her study. Now that the research has been born out by the coronavirus, she hopes it will be encouraged to better prepare for the next mass fatality event. But if our attitude to preparedness planning in the past is anything to go by, no one should be holding their breath.
