Pandemic-related excess mortality (COVID-19), public health measures and funerary rituals

Faced to COVID-19, the earliest public health recommendations in France [1] forbade washing of the body and mandated inhumation and cremation within 24 h, recommendations similar to those when case-patients were, more likely than non–case-patients, to have participated in funeral rituals. When a patient is hospitalized for SARS-CoV-2, family and friends were not allowed to be with him or her, and the farewells were done as the patient got into the ambulance. The grieving process, however, implies three phases [2]: viewing of the body, performing a collective ceremony to support those affected, and finally accepting the person's death. The public health measures were difficult to accept, leading to an incapacity of families to grieve their loved ones.

Based on evidence that the virus appears to be transmitted primarily through large droplets -even if other potential modes of transmission [3] are not excluded- and that contamination is more related to the living than to the dead, new recommendations were formulated [4]. Following the usual washing and preparation of the body, several close relatives can now view the face of the body, but there is no obligation of quick inhumation or cremation. This latest measure is leading to the creation of temporary morgues (refrigerated trucks, ice rinks…) where bodies are awaiting treatment. They are in the public mind contemporary versions of medieval mass graves [2]. However, the recommendations between countries, apart from any religious considerations, very different, as is what is done on a daily basis. Thus, while some allow embalming [5] there are also mass burials which contributes to people's anxiety.

In case of an epidemic, to limit contagion while allowing families to grieve and preserving the dignity of the deceased, we recommend to proceed with what has sometimes been achieved in times of epidemics, i.e. a process close to the usual one but simplified and accelerated [2]: Minimal body washing – body wetting without manual scrubbing –; for the Jewish religion the "tahara", the rite of purification of the body of the deceased, must be prohibited; no embalming; for Muslim religion, the Tayammum (dry toilet by placing both hands on a stone or earth) may be sufficient. Allowing friends and relative to view the deceased, without touching him/her, and in small groups by keeping a distance of one meter between people. No funeral wake with several people, if a body bag is to be used, and the family didn't get a chance to see the body before he/her was put in the coffin, a transparent bag can be used, place the body in a coffin within 24 h. Cremations or inhumations should then proceed within 3 days. Always respecting the distance of one meter between people, the closest relatives can attend the burial and it is preferable that people speak to relatives by mobile phone. It seems important to avoid the setting up of temporary morgues or mass graves which reinforce the trauma experienced by families and society.

Declaration of Competing Interest

We declare no competing interests.