These days, death and the rites that come with it are quieter, more cautious affairs than before the coronavirus pandemic struck.
Many factors have combined to make this a bad time for funerals, whether someone has died from the coronavirus or not. There's a shelter-at-home order in effect to deter travel, and a Bay Area-wide limit of 10 people for funeral services. Households that have been exposed to the coronavirus are expected to self-quarantine.
And yet, with 43 COVID-19 related deaths in Santa Clara County and 21 reported in San Mateo County, as of Tuesday, the need for funerary and mortuary services remains high.
Local representatives from cemeteries, mortuaries and funeral homes spoke about the difficult balance they must strike as they seek to help survivors grieve for their loved ones in traditional manners without jeopardizing anybody's health or safety.
Death in the age of coronavirus
When someone dies from the coronavirus, a whole network of agencies, all well-adapted to minimizing exposure to germs, springs into action.
At the Santa Clara County Medical Examiner-Coroner's Office, staff are following existing sanitation protocols, according to Chief Medical Examiner Michelle Jorden. The medical examiner's office requires staff members to wear personal protective equipment when examining those who have died and practice good hand-washing hygiene. Now, they've also implemented social distancing protocols.
The county's morgue can hold about 112 bodies, said Jorden, and the medical examiner's office does have a mass fatality plan in place. It is prepared to handle an increased number of deaths, she said in a statement.
For people who work in mortuary or funeral industries and regularly interact with the bodies of those who have died from the coronavirus, the latest guidance on personal protection and hygiene is more or less in line with existing best practices.
Taking precautions to avoid infectious diseases isn't anything new, said Matt Cusimano, funeral director at Cusimano Family Colonial Mortuary, which has been in operation in Mountain View since 1957.
During the peak of the AIDS epidemic, when people still had many questions and fears about the HIV virus, there were similar concerns about how to keep those who work with decedents who had the virus safe, he said.
The mortuary follows the practices laid out by the California Cemetery and Funeral Bureau and takes what are called universal precautions. Embalmers wear personal protective equipment such as a respirator and face plate, double their gloves and wear a smock.
"We're very careful with every case. I would imagine that when we do get a person who's passed away from coronavirus, that's what we would use," he said.
If there were to be a large number of deaths in Santa Clara County, Cusimano said, he believes that local funeral directors would come together to serve families and help them make arrangements.
"It'd be a really unusual funeral director that wouldn't want to participate in something like that," he said. "We all know each other."
Right now is a hard time for families and communities, he said. "It's just tough on everybody."
For family and friends of people who die from COVID-19, though, the latest public health guidelines may be new.
The U.S. Centers for Disease Control and Prevention reports that the coronavirus is believed to be transmitted primarily through an infected person's respiratory droplets. Therefore, getting sick from proximity to a person infected with the coronavirus through this mode of transmission is not a concern after death.
However, the CDC is still figuring out how the virus spreads, and it may be possible to get it from touching a surface or object that has the virus on it and then touching one's nose or mouth. It advises people who are at high risk of developing complications from COVID-19, such as seniors and people with underlying health conditions, to consider not touching a body that has died from the coronavirus.
"There may be less of a chance of the virus spreading from certain types of touching, such as holding the hand or hugging after the body has been prepared for viewing," the health agency reports. It also advises avoiding kissing, washing or shrouding the body.
"If washing the body or shrouding are important religious or cultural practices, families are encouraged to work with their community cultural and religious leaders and funeral home staff on how to reduce their exposure as much as possible. At a minimum, people conducting these activities should wear disposable gloves," it adds.
Grieving-in-place
In many situations, figuring out how to celebrate the life of the deceased is the next big challenge. And it's a challenge made more complex by a strict shelter-in-place order that limits the number of people who can attend funerals to 10. Grieving families are faced with another difficult decision: Who gets to attend the service?
Cemeteries like the Gate of Heaven in Los Altos are having to adjust their procedures and help people find new ways to grieve and mourn that don't increase the risk of spreading the disease.
"We were one of the first to have to figure out, 'What is this going to look like? What kind of procedures do we need to put in place?'" said Heather Gloster, director of cemeteries for the Catholic Diocese of San Jose, which operates the Los Altos cemetery.
A member of the diocese was the first person in Santa Clara County to die of the coronavirus, said Gloster. She was a woman in her 60s who died March 9 at El Camino Hospital in Mountain View.
"We have to protect ourselves and the community," Gloster said, which means making some changes to how faithful Catholics might minister to one another. "We can't provide the physical comfort of a hug, or really cry with the family, (but) we can still pray with them," she said.
In some situations, even a limited number of family members are barred from attending. For instance, if a person dies from COVID-19 in their home, rather than at a hospital, where they may have been in isolation for some time, immediate family members in that household may be directed to self-quarantine for weeks, Gloster said.
In those scenarios, the diocese may conduct a direct burial, in which nobody is present except for cemetery staff and a priest. Families can livestream the burials, she said.
The shift to virtual services has happened rapidly. It was only a few weeks ago, when gatherings for mass were canceled, that the diocese acted to quickly adopt Zoom and video conferencing to provide religious services to homebound parishioners, she said.
Other local mortuaries have yet to see their first death from COVID-19.
"We're worried about it," said Sarah Tapia, an administrator at Spangler Mortuaries, which has locations in Mountain View, Los Altos and Sunnyvale. "We're unsure of what to expect."
The mortuary has switched to making funeral arrangements remotely, which has made the logistical work of funeral arrangements more difficult, Tapia said. "It's easier for things to slip through the cracks."
In addition, the mortuary recently set up the technology to offer livestreamed services. According to one staff member, the facility was in the process of organizing a livestreamed Hindu funeral service, which would be able to be attended virtually by friends and family members in India.
Delayed grief
Not being able to gather to mourn the loss of a loved one, on top of so much community upheaval, Gloster said, may lead people to experience a delayed sense of grief.
Pointing to the concept laid out in Abraham Maslow's hierarchy of needs theory, she said, people often need to have their basic physical needs met before they can move on to addressing their emotional and mental health needs. Many people who lose a loved one right now are already dealing with so many changes a lost job, financial stress. As a result, many are focused more on surviving than grieving.
"Hopefully it won't be that long, and our churches will open back up," Gloster said. "Until then, people are repressing it to kind of survive."
Without hugs, religious rituals or large gatherings where survivors can see their loved one's impact on the community, traditional bereavement practices are being interrupted, said Monica Williams, director of Catholic cemeteries for the Archdiocese of San Francisco, which includes Marin, San Francisco and San Mateo counties. The archdiocese also oversees the Holy Cross Cemetery in Menlo Park.
"We really need, as a people, rituals to say goodbye and help our grieving process," she said. "Grief is difficult on a good day. Grief is much more complicated right now."
As alternatives, she said, they're encouraging families that can't meet in large groups to consider gathering on FaceTime or Zoom at a specific time to share remarks, tell stories, pray, or to plan a gathering of family and friends at a later date to celebrate the deceased.
"We all need to support each other safely and kindly during these times," she said.
Resources and best practices
If you are feeling grief due to the loss of a loved one, or fears, worries and anxieties because of the coronavirus pandemic, Nick Arnett and Janet Childs of Kara, a local grief support nonprofit in Palo Alto, in a recent blog post offer people a few pieces of advice:
Know that you're not alone.
Make sure you're choosing good information sources and getting the facts, not rumors.
Be gentle with yourself and realize that forming new habits in response to change is difficult.
Understand that stress from the pandemic can trigger past trauma that can "cause you to notice and feel the weight of old injuries much more than before the world changed," Arnett and Childs write. That may mean a tendency to become grumpier and more irritable. You can help by being a safe person for others to talk to, talking to a supportive person who will keep your conversation confidential or writing in a journal.
People can also work on strengthening their physical, mental and/or spiritual strength and resilience by getting enough sleep, exercising, eating well, staying connected with friends and family, and thinking about one's values and priorities with a big-picture perspective. Gratitude and generosity help, too.
To request grief support services, call Kara at 650-321-5272 or fill out an online form in English or Spanish.
Find comprehensive coverage on the Midpeninsula's response to the new coronavirus by Palo Alto Online, the Mountain View Voice and the Almanac here.
Kate Bradshaw writes for the Mountain View Voice, the sister publication of The Almanac.
