This guidance is based on what is currently known about COVID-19 and genetic variants of SARS-CoV-2 that have emerged throughout the world. The virus is predominantly spread through contact with contaminated respiratory droplets released when an infected person coughs or sneezes. Spread from contact with contaminated hands, surfaces or objects is thought to be rare.
The appropriate use of personal protective equipment (PPE) and the use of infection and control procedures by funeral directors, mortuary personnel and cemetery staff, will substantially reduce the risk of transmission of COVID-19 from a deceased person who is infected with COVID-19. The greatest risk of transmission is likely to be from contact with family members attending the funeral home, mortuary or cemetery, who do not wear masks, practice physical distancing and hand hygiene.
The following precautionary strategies should be used to minimise public health risks and to prevent spread of disease:
COVID-19 is a disease caused by a new strain of coronavirus, called SARS-CoV-2, that has not been previously identified in humans.
COVID-19 is spread through droplets produced when an infected person coughs or sneezes, or by indirect contact with contaminated hands, surfaces or objects. People are at most risk of infection if they come in close contact with someone who has COVID-19. COVID-19 spread within households is very common.
The COVID-19 Delta variant is more easily spread and causes more severe illness than previous strains in unvaccinated people.
There is no evidence of increased risk of transmission of COVID-19 to funeral and cemetery workers who handle the bodies confirmed or suspected to be infected with COVID-19. The greatest risk is likely to come from failure to employ correct infection prevention and control measures and close contact with family members.
The NSW government has more information on stopping the spread
Funeral industry personnel and cemetery staff should however employ infection prevention and control measures when handling bodies. Further information go to the NSW Infection Prevention and Control Policy (PD2017_013).
Before accepting deceased persons with COVID-19, funeral directors should review their own infection prevention and control policies and procedures and ensure staff are familiar with these practices. This may include providing training in hand hygiene and how to put on and remove PPE safely.
Standard infection prevention and control, occupational health and safety guidelines should always be followed while handling and preparing a body. All staff should be trained in the correct use of PPE.
Persons in close contact with the body must wear:
After use, PPE should be carefully removed and decontaminated (if reusable) or disposed of into general waste as soon as practicable.
The COVID-19 Delta variant is easily transmissible but the mode of spread is similar to initial strain, it is still droplet, with opportunistic airborne. Aerosol generating procedures should be avoided if possible. Airborne precautions should be employed when performing aerosol generating procedures, such as post-mortem use of oscillating or fast-spinning power tools.
Airborne precautions include:
CEC has more information on the transmission-based precautions.
When transporting the deceased, the body must be placed and secured in a bag or wrapping in a manner that prevents the leakage of any exudate or other substance. Double bagging may be required to achieve this.
The body bag should be clearly and permanently labelled "COVID-19 – Handle with care".
The funeral director should only temporarily remove the body to prepare the body for viewing, cremation or burial.
If the body is being wrapped, the body should first be placed in a body bag to prevent leakage of body fluids (double bagging may be required to achieve this) and wrapped as normal, over the body bag.
Used body bags should be disposed of in clinical waste streams.
Persons who may handle deceased persons with COVID-19, such as funeral directors and morgue attendants, must comply with the guidelines specified in Part 3 of the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019) as published by the National Health and Medical Research Council. When placing a body in a bag or wrapping, a person must comply with standard infection prevention and control procedures consistent with the NSW Infection Prevention and Control Policy (PD2017_013).
The owner or driver of the vehicle used to transport the deceased should be informed that the body is confirmed or suspected to be infected with COVID-19.
There is no change to the usual body transport protocols for COVID-19 related deaths.
Embalming is not recommended for bodies who died from, or with, COVID-19 as it is not clear whether embalming is safe to do.
If embalming must be done, the embalmer should be certified and trained in the use of PPE consistent with contact and airborne precautions. This includes a P2/N95 respirator (mask) which has been fit-checked, gown, gloves and eye protection.
Family or relative viewings of the deceased should be allowed to take place in a funeral director’s mortuary facility after the body has been prepared.
Standard infection prevention and control precautions should be observed. Family members should not kiss or touch the deceased to minimise the risk of transmission.
If a family member does touch the body, they should wash their hands with soap and water immediately afterwards or use an alcohol-based hand rub.
Standard infection prevention and control precautions should be used during the burial of deceased bodies confirmed or suspected to have COVID-19.
Cemetery staff tasked with placing the body in a grave or cremation chamber should perform hand hygiene before and after contact with the deceased body.
Environmental decontamination, including all surfaces and equipment, should be completed regularly with a detergent and disinfectant or dual-purpose product included in the Australian Register of Therapeutic Goods as a listed disinfectant with a specific virucidal ("kills viruses") claim.
Funeral directors must comply with the relevant NSW Public Health Regulations with regards to disposal of bodies. Infection prevention and control precautions should be used during body handling and the cremation of deceased bodies confirmed or suspected to have COVID-19.
Removal of implanted medical devices is not recommended for bodies who died from, or with, COVID-19 as it is not clear whether it is safe to do. Cremation practices should be managed accordingly. If the device must be removed, the person removing it should be certified and trained in the use of PPE consistent with contact and airborne precautions. This includes a P2/N95 respirator which has been fit-checked, gown, gloves and eye protection.
Original: Environmental Health Branch Revision: Strategic Reform and Planning Branch
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning
08/12/2020
Private funeral industry