Grieving at home in flu scenario

Canvas was used when coffins ran out during the 1918 pandemic, but this time body bags would be used instead. Picture / Reuters

The dead are unlikely to be cremated during a bird flu pandemic, and body bags will be used if caskets run out.

A draft plan is being finalised this week by the Funeral Directors Association, Government agencies and local authorities to deal with the projected number of casualties.

It will see a prohibition on public funerals in a bid to curb the spread of disease.

Simon Manning, the association's chairman of pandemic planning, said no church services or tangi will take place, as public funerals were a factor in Spanish flu's spread in 1918. Grieving will instead take place in the home.

Any death during a pandemic - bird flu or not - would be dealt with within 48 hours, said Mr Manning.

New Zealand does not have enough freezing capacity to deal with a projected 33,000 deaths, so the 48-hour period allows for bodies to be handled safely and interred without refrigeration.

Mr Manning said cremation is unlikely because two doctors are required to sign off the cremation papers; one of which will need to be the deceased's doctor. During a widespread pandemic, locating them may prove difficult, he said.

The police may also need to disinter the body where suspicious circumstances arise after the pandemic, he said.

There are also question marks around the supply of piped gas to crematoriums.

The association has approached the Government about providing funeral grants worth about $4500 to cover the cost of each burial.

"It will be unreasonable, we believe, for families to be ending up with a bill for something that they haven't necessarily requested," said Mr Manning.

While cemeteries have the capacity, there may not be enough caskets for all bodies.

In 1918, canvas was used to wrap the dead when caskets ran out. Mr Manning said body bags, which are more sanitary and easier to handle, would be used.

Funeral Directors Association members, which look after 85 per cent of deaths in New Zealand, have also been told to train extra staff over the next 12 months.

Members have been told to calculate the workforce needed for their own companies based on projected workload and a 60 per cent absenteeism rate.

Mr Manning's Harbour City Funeral Home in Wellington has 15 staff, but he is looking at having 100 extra casuals trained up for a pandemic. Training will start now, and will include an explanation of what they're likely to encounter during a pandemic, he said.

Mr Manning said if someone dies at home during a pandemic, the first thing to do is to contact a funeral director.

* * *

Best advice, from Dr Tom Miller:
Wash and dry your hands

The series in the Herald preparing the public for the possibility of a bird flu epidemic is highly recommended reading.

One message worth emphasising is that community awareness of hygiene issues, particularly hand hygiene, will have a major impact on limiting the spread of the disease.

A statement that human influenza virus is spread from person to person mainly by an infected person coughing or sneezing needs qualifying.

Much of the present evidence on the spread of respiratory infections suggests that touch contact with a virus contaminated object or surface and the subsequent transfer of the virus to receptive tissues is the more common way for the virus to be spread.

Picture an infected person smothering a sneeze with a hand and then picking up a phone, opening a door, using a bank keyboard or shaking hands. The likelihood of an infectious dose of virus been transferred to the next user is high.

Community recognition of the role of hand hygiene in breaking this cycle will be extremely important. The key is a 20-second wash under running tap water followed by careful and conscientious hand drying. Our research has shown that moisture on the hands greatly enhances the opportunity for microbial transfer and acquisition through touch contact.

Hand hygiene is therefore a two-step process and leaving the washroom with wet hands is inviting the transfer of tens of thousands of micro-organisms at the next point of hand contact.

The Ministry of Health's advice to wash and dry hands regularly and carefully is a message that will need constant reinforcement.

Dr Tom Miller, Department of Medicine University of Auckland

* * *


Death during a pandemic
* If someone dies at home, contact your funeral director, who will get the death certificate, and arrange for the body's transportation, and burial.
* Burial, as against cremation, will most likely be used.
* Cremation requires two doctors to sign off cremation papers. One of them will need to be the deceased's doctor, and locating them may be difficult when medical resources are stretched.
* A death may happen in suspicious circumstances, and police may need to disinter a body to gather evidence. Evidence is destroyed during cremation.
* Question marks also remain over the supply of piped gas to fire the crematoriums.
* There are enough funeral plots for the projected 33,000 dead, but there may not be enough caskets. If caskets run out, body bags will be used.