In his latest blog, Phil Trendall says that the often overlooked role of the emergency planner is crucial in terms of managing the extra pressures that mortuaries, cemeteries and crematoria are now facing as the global death toll from Covid-19 increases.
The recent insightful blog by Lies Scaut and Erik de Soir in the Crisis Response Journal on dealing with bereavement in the current pandemic brought together elements of best practice in a difficult subject area. The news story run by the BBC on the increase in will writing in the last few weeks, coupled with the images of mass pauper burials in New York, have all reinforced a key point about dealing with this international emergency.
We all talk about the need to save lives, but at the same time we know that thousands of people are dying earlier than they would have had not Covid-19 appeared. The subtext of every news story is about death and the fear of death – fear of our own and of those dear to us.
We don’t talk about death very much in the UK, although the subject is not quite so taboo in Ireland and Scotland. We like to think of it as something that happens to other people. Except for specialist professions, most of us have very little contact with the physical reality of death. Gone are the days of the deceased lying in the front parlour at home and, unlike some continental countries, open coffin funerals are almost unheard of.
We have become distanced from the one event that will overtake all of us. One often hears the phrase ‘if I die’. It is not polite to point out that it is always a question of not if, but when. The pandemic has stripped away the protective mechanisms that have allowed us to be ‘socially distanced’ from death. In doing so, what normally happens behind the scenes is now subject to media and public scrutiny. There is now no dodging the question about what to do with the dead.
Around 600,000 people die each year in the UK. More people die in the winter than in the summer. The funeral industry has developed to deal with this volume and with seasonal fluctuations. Any sudden change requires a change in approach. Most undertakers are parts of large chains and can, to a limited extent, use their size to manage changes in demand. But of course the management of the dead involves not just undertakers.
In the Summary of Impacts produced for the Coronavirus Bill (as it then was) the authors spoke of the ‘death management industry’. Cemeteries and crematoria are included in this description. The note makes it clear: "To ensure we can respond effectively to this demand on the death management sector, local authorities may have to direct a fragmented sector and current legislation does not allow this."
To achieve this very wide ranging powers of direction are included in the Act for the potential use of government and local authorities. These provisions include the creation of offences.
The Act takes several other powers relating to the management of the dead, including the ability to make changes to the arrangements for jury inquests and death registration. Of interest is the provision that removes the requirement for a second doctor to confirm the cause of death before cremations. All this is an example of true emergency planning working in the background and contemplating the unthinkable. In other words, thinking about what the public does not want to confront.
The images of the mass burials in New York are very much a product of the local situation and culture. In the UK, burials of those too poor to afford a funeral generally take place in publicly owned cemeteries rather than in what appears to be a pauper’s burial island. All countries have experience of mass buria,l but in the UK this is rare. In the aftermath of the 9/11 attacks I worked in what became the London Resilience Team. We looked at these issues then and I learnt a lot very quickly. Burial places are not just holes in the ground – they are properly surveyed and maintained locations that have facilities for memorials and they are engineered to prevent flooding. They are, ironically as it seems, attractive places that facilitate respectful memory.
I remember one expert at the time pointing out that even during the plagues of 17th century mass burials were the exception. As Scaut and de Soir point out, societies cling to their norms and traditions around death. Gladstone is supposed to have said: "Show me the manner in which a nation cares for its dead and I will measure with mathematical exactness the tender mercies of its people, their respect for the laws of the land, and their loyalty to high ideals."
This was a theme of the Non Statutory Inquiry by Lord Justice Clarke into the identification of the deceased after major transport accidents and which forms the basis of much of UK practice in disasters. Burial space in the UK is in short supply but this pandemic will not cause an immediate shortage. The pressure points come in the period leading up to the disposal of dead.
For some years the government has tried to retreat from the responsibility for national mortuary arrangements. Despite this, the plans for emergency mortuary provision have improved dramatically in the last 20 years. The experience of managing the return of the dead after the South Asian tsunami of 2004 and the most impressive work done to establish and operate a disaster mortuary after the 7/7 attacks are important sources of experience. Mortuaries are places of process where bodies are examined, identified and, when necessary, they are the venue for full post mortem examinations.
Such activities need space, equipment and specialised, highly trained staff. If there is a ‘lucky’ side to a pandemic it is that most of these provisions are not required. The deceased in a terrorist attack or a downed aeroplane require painstaking attention because many of the bodies will be disrupted. In the current situation, whole bodies with a known cause of death present the authorities with the logistical challenge of storage and integrity of identification.
The issue is one of appropriate storage and the adaptation of processes. The authorities need to buy time to allow the funeral sector to catch up and for families to be safe in the knowledge that their loved ones have been handled respectfully and in accordance with their faiths – as far as the current restrictions allow. Public Health England (PHE) has published practical advice and guidance on handling the dead and we should congratulate emergency planners – a group much reduced in times of austerity – for rising to the task of putting into practice plans that were often regarded as fantasy projects by those in charge.
The pandemic has moved into an emotionally different phase. We are at the stage when many people know, or at least know of, someone who has died with the virus. People are being required to confront their mortality and that of those they know and love. Perhaps one of the changes that may emerge in the post pandemic UK is a greater willingness to confront, and to some extent to be comfortable with, the inevitability of death. Perhaps we will allow the subject to be discussed without someone telling us that we are ‘being morbid’.
Every adult should have a will. Every adult should have discussed with their loved ones what they would like to happen at the end of their lives. Death should not be a taboo subject. It is a fact of life.