Guidance for Funerals and Bereavement during COVID-19
INTRODUCTION Funerals can pose a risk to public health during a communicable disease pandemic. They are public gatherings where mourners are often in close contact, as they acknowledge and comfort each other with hugs and handshakes. These conditions make it easy for a virus such as the one that causes COVID-19 to spread, especially if a mourner attends who is not even aware that they have the disease. In Newfoundland, public health officials were able to link over 143 known cases of COVID-19 to one funeral home. As of April 5, 2020, that represented over 75% of the COVID-19 cases in Newfoundland and caused their Chief Medical Officer of Health to issue a provincial ban on funerals and wakes. On March 28, 2020, the government of Ontario passed an emergency order limiting funerals to no more than 10 people as part of its measures to stop the spread of COVID-19. These limits can further burden families who are already grieving. Memorials and funeral services are important for the family to experience closure and begin to heal from their loss. The ceremonies and rituals associated with this time are also sacred in both traditional and Christian faith. Members of NAN’s COVID-19 Task Team have prepared the following document to help NAN community members honour the lives of their loved ones safely during COVID-19. NAN acknowledges that different communities will have different practices, values, and beliefs. This document is offered to support community discussion and direction; it cannot replace it. CURRENT FUNERAL HOME PRACTICES The following information comes from the Bereavement Association of Ontario (BAO). The BAO regulates and supports licensed funeral, burial, and cremation services across Ontario. If the funeral of your loved one will be held at a licensed funeral home, the funeral home will observe the following practices: Only 2 people are allowed in the funeral home to make necessary funeral arrangements; most funeral homes will try to do as much planning over the phone as possible during this time. A maximum number of 10 people for the entire funeral home during services, not counting funeral home staff. Each baby or child counts as one person. Families and funeral operators are encouraged to have even fewer than 10 people at funerals and visitations. Mourners should maintain physical distancing and be at least 2 metres (6 feet) apart from all other people during the funeral. A coroner’s certificate and all required and proper documentation is still necessary. The Chief Coroner of Ontario is working on an electronic death certificate and Coroner’s Cremation Certificates are already issued electronically. Pallbearers should wear personal protective equipment (mask and gloves). During a funeral, people should not wait in their cars or wait in a line until they can enter the funeral home, even if physical distancing can be maintained. This would enable the potential spread of COVID-19. Some funeral homes have started to install live-streaming capabilities for mourners who are unable to attend the funeral in person. FUNERALS AND SERVICES IN THE COMMUNITY Planning for funerals and memorials should be considered during pandemic planning. This applies to both deaths from COVID-19, as well as deaths from other causes, which will unfortunately continue during the pandemic. To limit the potential spread of COVID-19 and to safeguard the health of community members, communities should consider similar limits on funeral services as those outlined by the BAO. Some cultural, social and religious practices may need to change to reduce community risk during the pandemic. What that will look like will be different in each community; here are some suggestions NAN has heard from speaking with Elders and community workers: Streaming services and memorials online is an option. Appropriate privacy settings should be discussed and set up prior to the service. If something must be placed in the casket, such as cedar or sweetgrass, a container could be provided during the ceremony. The container could then be placed in the casket after the service by someone wearing appropriate PPE (gloves and a mask). Communities can hold a larger ceremony after the COVID-19 pandemic ends to honour everyone who passed away during that time. Elders can work with family members to offer ceremonies during COVID-19. The family member at the service can make offerings, while the Elder does the ceremony in their home. After a funeral or service, community members can drive by the family’s house to acknowledge their loss and show support. If it is important to touch the deceased as part of ceremony, consult with Elders and traditional knowledge keepers on how to reduce your exposure as much as possible. Consider holding funerals outside where there is more space and better ventilation, though physical distancing rules should still be followed. SAFE PRACTICES AROUND THE DECEASED – DEATH FROM COVID-19 Doctors and researchers do not know enough about COVID-19 to know how long the deceased remains infectious. Until we know more about COVID-19, the recommendation is to treat the deceased as if they are still infectious and take all reasonable precautions. The owner or driver of any vehicle used to transport the deceased should be informed that the deceased is suspected or confirmed to be infected with COVID-19. The vehicle should be disinfected afterwards. A deceased person suspected or confirmed to have COVID-19 should be placed in a body bag before transportation, and a disinfectant applied to the outside of the bag. Anyone who will be handling the deceased’s body should follow best practices to reduce infection: Practice proper hand hygiene before and after contact with the deceased. Avoid any unnecessary movement of the deceased that may expel air from their lungs. Wear appropriate PPE while handling the deceased. ISC-FNIHB PPE requirements for care of the deceased, as of May 4, 2020: gown, gloves, face shield, and surgical mask. Clean and disinfect all surfaces after they are finished handling the deceased. Dispose or disinfect any equipment or supplies used during this time. At the service, families should not touch the body of a person who has died from COVID-19 and should maintain at least 2 metres (6 feet) of distance between themselves and the deceased. It is not recommended that an open casket funeral be held for someone who has passed away from COVID-19. SAFE PRACTICES AROUND THE DECEASED – DEATH FROM OTHER CAUSES It is not advisable to hug a deceased family member during this time and people should stay at least 2 metres (6 feet) away from the body of their loved one. This is from an abundance of caution; it is possible that somebody who passed from causes may also have been infected COVID-19. It may also be possible for one mourner to pass COVID-19 on to another; for example, someone who is infected may leave virus particles on a surface, such as a casket handle, that is then touched by another mourner. PLANNING FOR THE WORST When facing a pandemic, communities should also plan for the worst-case scenario: a very high number of deaths from COVID-19 that overwhelms the community. These are very difficult conversations to have. However, it is easier to determine an appropriate response before it is needed. In the worst-case scenario, community members will be grieving, and community capacity will be exhausted. Elders and knowledge keepers can help with these difficult conversations and provide guidance on a plan that respects community beliefs and values. SUPPORTING FAMILIES AND COMMUNITIES Family members and anyone who cared for the deceased will likely need special support during this time. They may feel lonely or experience guilt that they were not able to provide their loved one with the funeral service they wanted or the ceremonies they had expected. Some ways of providing extra support while following public health guidelines could include: Speaking to the deceased’s loved ones by phone or video chat. Asking if they need anything, like food or supplies, and dropping them off at their house. Sending them a card or letter. These feelings of guilt may be experienced by the larger community as well. Mental health supports and services that can be offered virtually or through telemedicine should be shared with the community.