A disease like SARS is said to have reached the pandemic stage when the spread has no longer been attributed to a particular geographical area or region. More generally, a pandemic occurs when a disease has spread worldwide and has surpassed the mere localized epidemic stage. These types of pandemic diseases  can have a dramatic effect on the basic functioning of the funeral industry and in order to cope with the new issues, there are constantly revisions of the literature regarding the most proper, safe, and effective ways of dealing with such events. Although the world has not seen a pandemic to match the scope of some in less recent history, the outbreak and worldwide transmission of the SARS (Severe Acute Respiratory Syndrome) virus was a small and quickly contained pandemic, but the effects on the funeral industry must not be underestimated.

After such an outbreak of a disease like SARS, which was highly contagious and passed through the most common modes of communication and exchange, the funeral industry was forced to rethink the way it was to deal with future pandemics (and even epidemics for that matter). A new series of codes and guidelines in several sectors were initiated to guide funeral service providers an organized way of dealing with the crisis. It is the aim of this piece to first explore the some of the more general issues related to the pandemic diseases  and then gradually to broaden the terms to include the effects of a pandemic (using SARS as an example) on the funeral industry. Included in this examination of the causal relationships between a pandemic and the funeral industry this paper will also detail the differences in preparation of the body before offering a conclusion explaining the course of the disease in question and closing statements about the overall results of the findings and more general thoughts regarding the changes that have been made as a result of pandemics such as SARS.

Some scholars and medical professionals debate whether or not the SARS virus was an actual pandemic, mostly because they don’t feel the death toll was high enough to classify it such dramatic terms. In the true sense of the definition however, it does seem as though the widespread nature of the disease should indeed classify it as such.“The major spread of SARS outside mainland China can be traced to a physician who had been caring for patients in Guangdong Province, China, and who had traveled to Hong Kong in Feburary. While staying in a hotel in Kowloon Province, 12 people became infected.

In turn, many of these people brought SARS to other countries, including Singapore, Vietnam, Ireland, the United States, and Canada.” Without question, the rapid and inevitable spread across oceans caused a large amount of concern and although the number of deaths was relatively minimal, if the disease had not disappeared—seemingly on its own accord—the pandemic may have been far more devastating. Although estimates differ slightly, “as of 10 May 2003, there were 7,296 known cases, 526 deaths and 3,087 recovered patients from the new disease.” SARS was a highly contagious disease and as a respiratory virus, appeared similar to pneumonia, which made it difficult to diagnose at first. Even with the most sophisticated testing procedures, it was nearly impossible to determine with certainty if a potential patient had the disease and before more reliable tests were developed, the disease continued to spread to Canada, the United States, and other Western countries—mostly because of the speedy nature of air travel. After more cases seemed to be turning up, even without an official diagnosis, potential cases were quarantined and the preparations of the body and subsequent changes in the funeral industry were forced into effect.

Before launching into the host of issues related to the preparations of the body in a case of suspected or confirmed SARS, it will prove useful to take a cursory look at the basic ways in which the funeral industry changed at the onset of SARS—both in the East (where the virus was introduced to humans from animals and where the most casualties occurred) and the West. Although it was confirmed by later reports, most notably from the World Health Organization and the Centers for Disease Control in the United States, there were early fears that funeral service industry workers may face danger from those who had died of the SARS pandemic. A series of reports detailing the processes in which funeral service industry employees must deal with the crisis were disseminated, many of which, particularly at the early stage, offering conflicting information. In Singapore, China, where the outbreak was far more severe, the Infectious Disease Act of 1976 was instituted without delay. This act required “quarantine of contacts, mandatory hospitalization of all suspected and probable SARS patients, and limitation of contact with the deceased’s body resulting in curtailment of death rituals and traditional funeral rites” In her discussion of the results of the Infectious Disease Act, Leong goes on to state, ““Because of the Act, patients who died with SARS or in whom SARS could not be excluded; they had to be buried or cremated immediately after the preparation on the body. Embalming was not allowed” thus the role of the funeral director and industry at large was rather excluded from the process.

Despite the cultural and geographically difference, Canada and the rest of the West acted with uncertainty and fear at the onset of the pandemic and the funeral service industry reacted with equal caution. According to a news release from the Washington Post, during the height of the Western oubreak,“In some cases, government health officials have instructed funeral directors to conduct procedures without embalming bodies. Some coffins have been closed; others have been sealed behind glass for viewing. Some funerals have been postponed because mourners were ordered into quarantine” Strangely, although the aforementioned article was entitled “SARS Rewrites Rituals of Grieving” it seems equally apt for it to have stated the same for the funeral industry; “SARS Rewrites Processes of Funeral Industry” since the unorthodox practice of burial without embalming was, up until the point of the pandemic stage, quite unthinkable. In short, the primary effect of the SARS pandemic on the funeral service industry was the way new rules of circumventing standard practice could be quickly introduced and followed. Although there were minimal reports at first to the contrary, it seems that foregoing these basic practices was necessary as the safest alternative since so much about the disease was hitherto unknown. After the disease had been maintained in the West, a study and the CDC with some information that ran counter introduced set of new guidelines to what was currently being practiced. According to this official statement, which was released to all medical and quasi-medical institutions “Routine infection control practices should be incorporated into everyday funeral service care. There is no evidence to suggest that embalming the human remains of a SARS decedent poses any greater risk than embalming the remains of any other decedent. However, the fact that only a partial autopsy has been performed may create different challenges, which should be considered when handling such remains.” In the case of the SARS pandemic, the funeral industry was left in the dark for a period while the medical and scientific community attempted to discern the health hazards associated with the disease and human remains. It can be fairly assumed that the ultimate effect of this fact on the funeral industry was the growing knowledge that there was going to have be a great deal of communication across disciplines in order for the industry to handle their duty properly and safely. Perhaps in response to this new knowledge, a further series of pamphlets, checklists, and other literature has been disseminated in order to prepare funeral service professionals with the correct course of action should another pandemic become an issue. Among such guidelines were “all purpose” manuals for all levels of dealing with a pandemic situation. After the outbreak of the SARS virus in the West, several health organizations issued statements aimed not only at those involved with taking in the deceased, but all other levels. Broad itemized lists were designed to help hospitals and funeral service industry members organize their efforts to contain the outbreak offering general rules such as asserting that there was a “plan for dealing with mass mortality, including transportation and burial of the dead capacity” While this may seem like practical, common-sense advice, it is clear that after the initial spread of the virus worldwide there was a lack of basic organization at all levels. Armed with the knowledge and foresight offered by the last (thankfully) minor pandemic, there are now new standardized methods of action for all levels—both medical and funeral.

Aside from these changes in organization and other more surface aspects on the funeral service industry in the case of a pandemic, there were also several more functional alterations that had to be made after the disease spread. The report mentioned above details a number of basic procedures to follow, including some very general information regarding sanitation and disposal of biomedical waste. The report makes specific mention of simple processes, such as the removal of gloves, the use of protective eyewear, gowns, and waterproof aprons. More specifically, the report details certain processes to follow that are strictly the result of a respiratory pandemic by stating, “The remains should be unwrapped slowly from the body bag, or carefully lowered to avoid aerosolization or splattering of body substances. Furthermore, when turning and moving the remains, care should be taken to exert minimal pressure on the abdomen and thorax to prevent expulsion of waste material from oral, nasal and other orifices” (5). The precautionary measures are the direct result of the nature of the SARS virus—since it is transmitted through the respiratory system, there are new guidelines for minimizing risk that are specific to such an illness. The report also includes other SARS/respiratory measures, as “When washing the remains, the water pressure should be kept low Instruments and all surfaces splattered or contaminated during postmortem procedures should be decontaminated with a hospital grade disinfectant with a virucidal label claim” (5). Perhaps most interesting out of all warnings and guidelines offered by this report is that there is no steel casket or case necessary and that a closed casket is not necessary either.

Since this report was issued after a great deal of rapid research had been conducted, there was the knowledge that such measures were not important in stopping the spread of the pandemic, but funeral service industry professionals were warned that “relatives of the deceased should be discouraged from superficial contact with the body of a SARS decedent, such as touching or kissing the face” (5) even though there was the seemingly conflicting direction right below these instructions that “there are no extra precautions required for performing cosmetic work on the body of a SARS decedent.” In the whole of this guide there seemed to be a lot of general information that would be commonplace in a non-pandemic situation followed by a host of directions both appearing to discount the possibility of transmission while at the same time reserving it as a possibility. Although funeral service professionals were obligated to take the safest course of action, it seems that in the course of shifting their mode of preparations, there were a few issues that seemed a bit sketchy. The report concluded with the finalizing statement, “There are no extra precautions for either burial or cremation. There is no evidence that interment in a closed coffin present any significant risk of environmental contamination and there is no risk of residual infectivity after cremation” and while this was reassuring, there were still questions about how to best deal with the bodies safely.

With a pandemic such a SARS, particularly because the mode of transmission was so volatile, there were several measures to protect not only the funeral industry professionals, but the grieving families as well. Some of the measures, such as requiring instant burial without embalming or cremation immediately were certainly a new feature in the industry because at first, no one knew quite how to deal with the disease. Cooperation and communication between funeral service industry personnel, clergy, and the families of the deceased became more important under the circumstances and some of the changes were dramatic. The importance of burial rituals is generally a paramount concern for families and taking this “right” away is a difficult decision and process for funeral service professionals. While there is the need to maintain safety at all costs, there is a significant amount of time and training devoted to other elements of the profession (aside from preparation of the body). The funeral service industry must be constantly aware that it is a duty to preserve the public safety above all else, and hopefully, with the new systems of organization that have developed out of the previous pandemic, this painful and trying decision can be softened.

In terms of using the SARS pandemic as the focus of a study about the funeral industry, there seems no better “sample disease” because the virus, at its height, reached across cultural as well as physical boundaries. There have already existed many differences between Eastern and Western funeral customs and since both hemispheres were involved in the pandemic, it is useful to look at the way the cross-cultural changes in the funeral service industry were brought about, how they are alike, and how they differ in the face of a global threat of disease. “Respect at the point of death was also compromised as funeral arrangements were dictated more by law than by choice” While ordinary rites may not be observed in the case of a pandemic (especially if it were to reach more devastating proportions) the ability of the funeral service professional in balancing the needs of the public’s safety and the wishes of the family is crucial. A complete knowledge of traditions is also important in gauging the family’s response to the lack of formal rites. “In some religions, an open casket is important, allowing the mourners to view the body. Some rituals include bowing or kissing an icon placed on the chest of the deceased. With SARS, some clergy have excused family members from mourning traditions.” With cooperation between clergy, family members, and the all-important funeral service industry professional, the awful nature of the quick interment of the deceased can be lessened.

Certainly these considerations of feelings might not be paramount if this pandemic had reached its potential number of hundreds of thousands of victims but again, the case of SARS and the action that immediately followed proved as a sort of “drill” for the funeral service industry and assisted in the drafting more much-needed checklists and detailed lists of processes in the case of another more serious pandemic event. “The SARS pandemic had the potential to wreak havoc on populations worldwide, but strangely, it seemed to disappear on its own. “A 2003 report from the Centers for Disease Control indicated that there have been 8402 SARS cases worldwide with 727 deaths (9.2%). To date 373 cases have occurred in the United States, of which 306 (82%) were “suspected” cases and 67 (15%) “Probable” cases. Only 7 cases, all in the probable category, were laboratory-confirmed as being caused by SARS-associated coronavirus. Recent international travel was the principal risk factor. This outbreak has illustrated the expertise, responsiveness and flexibility of the CDC and WHO in controlling the infection, defining the etiology and providing updated information on a timely basis.” Due its decline, the world was able to gather its bearings and reorganize and rethink its strategy for dealing with infectious diseases on the pandemic scale. The funeral service industry, despite the tragic loss of life, gained the valuable experience in dealing with a modern pandemic and it is hoped that it will be better suited to confront such an event in the future.

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