Calhoun County Coroner Pat Brown said he and other coroners’ offices don’t have set guidelines to combat the spread of COVID-19, so they’re having to make their own.
“We don’t have any clear guidance,” Brown said.
If there are any officially recommended guidelines for coroners’ offices, Brown said, his team would welcome them.
Alabama’s 67 coroners and staff at their offices are responsible for examining the bodies of every person who dies outside of a doctor’s care. Dozens of people die every day, many in those situations, and coroners always have to respond, even in the midst of a disease outbreak that could make the job more dangerous.
Dudley Miller, a Calhoun County deputy coroner, said they’ve drawn their plan from suggestions from the Centers for Disease Control and Prevention, the Alabama and National Funeral Directors Association and the Occupational Safety and Health Association.
Miller, who also owns Cremation Services of East Alabama, said he’s also used his experience handling other diseases like HIV, Ebola and the swine flu for the plan.
Local coroners say they’ve faced several challenges when making those plans, including worries about supply shortages and making sure loved ones feel respected while keeping everyone safe.
Brown said he instructed his staff to explain what they were doing and why to a deceased person's loved ones at every call. He said he wants the community to know that his office is working hard to handle every case with respect.
“To them, that’s their loved one, but these are extreme times and we have to take extreme measures,” Brown said. “My office is doing everything they can to maintain the dignity and respect of their body.”
Brown said his team’s response varies by situation, but beginning Monday, the team will have to determine whether the deceased has been exposed to COVID-19 by asking their loved ones whether they’ve been around anyone who has a confirmed case of the virus, left their home recently or shown any symptoms.
Before the team enters a home, Brown said, they’ll call Miller, explain the situation to him and operate by his recommendations.
Miller said he’s been following the CDC by the minute for updates.
In all cases, Brown said, his team will have to cover the body’s mouth and nose. If disinfectant spray is available, he said, they’ll have to use that to sanitize the body.
If his team can’t rule out the possibility of exposure — such as in a traffic fatality — Brown said they’ll have to don protective gear, including a full-body Tyvek suit, a face guard and two sets of gloves before wrapping the body in a heavy plastic sheet. The team just has to assume the deceased person has the virus, he said.
Brown said his team handles two or three calls a day, and he’s unsure of how many times his team will have to take those precautions.
Cleburne County Coroner Adam Downs said his office’s plan is similar to Calhoun County’s. Downs, whose office has responded to six calls in 2020, said he plans to cover every body’s mouth, nose and eyes, ask the same questions and use the same gear when necessary.
Downs said his team would also ask the deceased person’s household to quarantine themselves for 14 days.
‘We have to double-up’
Miller said the CDC has well informed other first responders and medical professionals on how to protect themselves from the virus, but Calhoun County’s plan takes it a step further in preventing the spread to others.
“We have to double-up on our efforts to protect everyone here,” Miller said.
Brown said decomposition of a body heightens the risk of infection. When a body’s cells die, he said, they begin releasing gases, causing the body to bloat. When those gases are released, he said, they can contain water droplets carrying the virus.
Miller said dead bodies can release “aerosols” into the air every time they are moved, including when they’re placed on a gurney and when they’re moved in a vehicle to a funeral home or morgue.
“We’ve got to minimize what droplets or what aerosols come out of that body,” Miller said. “The goal is to minimize everything that may be a potentially contaminated piece of equipment.”
Ask questions first
Bill Harris, chairman of the Alabama Coroner’s Training Commission, said he recommends all coroners in the state follow the CDC’s guidelines for funeral directors: Use gloves and maybe a mask. If they suspect the body may have been exposed to the virus, Harris said, he urges coroners to use body bags and disinfect those bags after use.
“Probably 75 percent of the coroners and deputy coroners in the state of Alabama are funeral directors or embalmers,” Harris said. “They should know how to handle a dead body that’s been infected.”
He said he’ll begin using Tyvek suits if mass deaths start happening.
He said dead bodies can release air and gas through their mouths, but they more commonly expel those through other areas of the body.
Harris said it’s important for coroners to first ask the necessary questions before deciding how to handle each case.
Harris, who also serves as the Lee County coroner, said he responded to one call last week in which the deceased person was coughing, short of breath and feverish before he died.
“There’s probably 15 or 16 people that were trying to revive him and had intimate contact with him,” Harris said. “It opened my eyes to how fast it could have spread.”
To everyone’s relief, Harris said, the man’s test came back negative.
‘They’ll be OK’
Harris said he knows there is a shortage of protective gear, but is more concerned about how that will affect EMS workers than coroners.
“They’re not handling live people coughing on them,” Harris said of coroners. “As long as they’re cautious, they’ll be OK.”
Brown said the county has invested $1,400 in protective gear and a sanitizing solution. He said those supplies may last his office two or three months.
Before Monday, Brown said, his office hadn’t used any protective gear because they didn’t have any.
Downs said he’s also worried about running out of supplies. He said his office was working on getting more masks.
“At this point in time, we’ve got 10 Tyvek suits,” Downs said. “We’ve got plenty of gloves.”