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New Paper Warns Effects of COVID-19 Fatalities Extend Beyond Health Care System

As communities around the world race to treat patients with COVID-19, a new problem is emerging: how to deal with the rise in fatalities.

As health care organizations around the world struggle to procure sufficient resources to handle the coronavirus disease 2019 (COVID-19) pandemic, a new paper raises alarms about local governments’ ability to handle a surge in fatalities.

In a new article published in the journal Emergency Management Review, Julia Meaton, MSc, PhD, Anna Williams, MSc, PhD, and Helen-Marie Kruger, all of the University of Huddersfield, in the United Kingdom, write that public officials like coroners, municipal clerks, and funeral homes need to be prepared for the impact the virus could have on their work.

“Underestimating the mortality rate could reduce the effectiveness of business continuity plans, whereas knowing what to expect will focus attention on the resources required,” the authors write. “An option would be to have an escalating business continuity plan, where the service prepares for a worst-case scenario, which can then be scaled back depending on the anticipated mortality rate.”

The paper focused on a case study of a single community in the UK, where since 2004 local governments have been required to produce and maintain “business continuity plans” to help avoid delays in processes like the issuance of death certificates and burials during mass-casualty events.

The community referenced for the case study currently records about 4,000 deaths per year.

Meaton and colleagues decided to see how well the community’s plan would work should COVID-19 cause a spike in the number of deaths there.

In a typical week, the community has the capacity to process 120 deaths per week. Using a model based off of a 1% mortality rate, the investigators calculated that over the course of 15 weeks, the local government could see a total of 2262 deaths, of which 2188 would be considered additional deaths attributable to the virus.

If the mortality rate were at the higher end of projections, the community could see nearly 5500 more deaths than normal over the 15-week period.

In such a scenario, Meaton and colleagues conclude that local officials will ultimately be unable to keep up with death registrations and the disposal of remains.

“Practically, not being able to [register] a death or obtain a death certificate will mean that disposal cannot take place,” they write. “There will be a bottleneck of burials and cremations, causing ceremonies to be delayed with mortuaries filled beyond capacity.”

Families will also be unable to conduct business, such as closing bank accounts, selling property, or receiving insurance payments.

The authors list a number of recommendations to help address the challenge. One is to adopt efficiencies such as online death registrations, though they concede that could create the opportunity for misuse. They also recommend retraining or re-assigning staff to deal with registrations and burials, as well as hiring back recently retired professionals with experience at jobs like cremation of human remains.

The authors conclude that making arrangements as swiftly as possible to deal with the potential for mass fatalities will not only help business run more smoothly but will also allow the local government to maintain a humane approach to managing death.

“In a pandemic situation, there is likely to be a necessary change to the 'business as usual' death and bereavement management services,” the authors write. “How humanely these are managed is hugely important for those affected at the time of crisis and the humanity of the government's response will reflect the nature and values of our society, and will be judged accordingly.”