Washington, DC – A nurse at the Washington Hospital Center places her twentieth call for the day to a young man whose 69-year-old dad is being treated at the hospital for COVID-19. The nurse tries to remain calm as she explains to the young man that his father is critically ill and in the advanced stages of the disease. The prognosis is that he may not survive much longer.
This scene is playing out throughout America for many families, including those living in the United States from other parts of the world. COVID-19 sees no race, religion, color or economic status. It strikes whomever suffers from pre-existing conditions like diabetes, hypertension or other forms of immunodeficiency. Matters are further complicated for those of us who are Muslim, or Hindu, or of African descent. You see, in this new and scary world of sheltering in place, social distancing and wearing personal protective equipment (masks, glove, etc.), no one in our African space is openly discussing or making the public aware that Fatality Management is a critical component of addressing this pandemic.
The U.S. Centers for Disease Control defines Fatality Management as the ability to coordinate with other organizations (e.g., law enforcement, healthcare, emergency management, and medical examiner/coroner) to ensure the proper recovery, handling, identification, transportation, tracking, storage, and disposal of human remains and personal effects. This process also includes certifying cause of death, facilitating access to mental/behavioral health services for the family members, responders, and survivors of an incident.
As many of you have seen, if your loved one tests positive for COVID-19, health officials place them into isolated quarantine when their symptoms advance. Advanced symptoms can mean that the patient is having trouble breathing and their temperature exceed or nears 103/104. At the point where the patient is admitted into the hospital and ends up in the ICU fighting for their lives, understand that family members cannot be allowed to visit or to be in close proximity to the patient in order to avoid a transfer of the contagion. The isolation is both an emotional and psychological shock to family members who, like the frantic young man, receive call from the hospital advising them that their loved one’s condition is fatal.
In addition to assailing our emotional bonds, the fallout from the COVID-19 pandemic has disrupted our religious and cultural practices related to family responsibilities during burial rites. When a loved one dies in the Christian or Hindu traditions, the family can turns to a funeral home or crematorium to prepare the body for final rites. For an observant Muslim, however, this disruption caused by this pandemic is particularly jarring. According to Islamic tradition, family members are required to wash the body of the deceased, drape it in cotton cloth, and bury it within 24 hours. Because of COVID-19, all these rites are off the table. The containment of the virus supersedes any religious practice that may propagate the contagion and spread it within the community. Sick patients are kept in isolation until they recover, but those who succumb to the illness have their bodies disposed of in ways many of us would have never imagined.
In the examples of Fatality Management that we are seeing in the city of New York, mass burial sites are being utilized to dispose of loved ones who have succumbed to COVID-19. These burial sites contain individuals from varying cultures and religious affiliations. This is one of the most painful and shocking realities we face during this pandemic. Local and national governments, especially in Africa, must prepare the public for such circumstances. The key message that must be relayed to the public is that if your loved one dies of COVID-19, it will be will be impossible for public health agencies (hospitals, morgues and the Health Ministry) to hand over the remains of your loved for burial at home. The remains of your loved one must be disposed of by health workers in a manner that prevents the contagion from spreading into the public space. As it stands now, many people are not even practicing social distancing or wearing masks when in public spaces. They may consider it wholly unacceptable to be told that they can no longer bury their loved ones in the usual designated rural family home.
As it stands now, the death rates in Africa are indeed lower than those in the United States, Italy, Spain and Japan. However, all statistical models are telling us that African countries are heading for a peak in the infection rates and a spike in the death/mortality rates unless African governments initiate stringent and immediate Shelter in Place orders along with Social Distancing rules. If one is to analyze the China pandemic models, it is well noted that the Shelter in Place orders lasted approximately 70 days from the time the Chinese government began to initiate mitigation actions to slow the spread of COVID-19. This action resulted in slowing down the spread of the contagion and allowed the health system to mitigate the situation and reduce the number of new infections. It is crucial that in addition to the above noted measures, preparation be made for the efficient and sanitary disposal of human remains if and when the situations arises. According to the CDC, the process by which human remains are to be stored, managed and disposed of includes the following:
- Coordinating facilities (e.g., morgue locations, portable and temporary morgues, decontamination, decedent storage, hospitals, and healthcare facilities)
- Coordinating the family relations process (e.g., notification, grief services, antemortem information, and call centers)
- Procedures to acquire death certificates or permits (including sending human remains to international destinations)
- Regulations for crematoriums and other support groups
- Antemortem data management (e.g., establish record repository, identify repository physical location, enter interview data into library, and balance victim needs with those who have lost family members)
- Personnel needs (e.g., medical and mental/behavioral, including psychological first aid)
- Frequency that critical documentation is reviewed and updated (e.g., comprehensive fatality management mission critical list, and contingency plans with local, state, and private entities regarding final disposition of human remains)
Without question, COVID-10 has disrupted the traditions of our lives. However, what is most crucial is that public health and government institutions face new challenges in addressing this disruption while endeavoring to secure the safety of their citizens, especially those in the front lines. Citizens have shown resistance to measures put in place to mitigate the spread of the contagion but data has shown that when provided crucial information that affects them and their families, they act in compliance with rules that are set. They must now step up and actively participate in ensuring their own safety, wellbeing and survival.
Grace A. Jibril is the Director of HR and Organization Development for the State of Maryland Health Department, Anne Arundel County.