{"id":22344,"date":"2020-04-06T16:25:18","date_gmt":"2020-04-06T16:25:18","guid":{"rendered":"http:\/\/arknews.org\/?p=22344"},"modified":"2020-04-06T16:25:20","modified_gmt":"2020-04-06T16:25:20","slug":"last-responders-central-arkansas-funeral-homes-and-coroners-prepare-for-a-rising-death-toll","status":"publish","type":"post","link":"https:\/\/arknews.org\/index.php\/2020\/04\/06\/last-responders-central-arkansas-funeral-homes-and-coroners-prepare-for-a-rising-death-toll\/","title":{"rendered":"Last responders: Central Arkansas funeral homes and coroners prepare for a rising death toll"},"content":{"rendered":"\n

Funerals aren\u2019t what people want to think about during a pandemic. In a moment when every ounce of health care workers\u2019 energy is poured into preserving life, when the entire globe is engaged in a concerted effort to stave it off, dwelling on the death count feels borderline treasonous. Then again, death isn\u2019t something people want to think about under normal circumstances, either. <\/p>\n\n\n\n

\u201cThis is a job that everybody tends to forget about, because we deal with death,\u201d Pulaski County Coroner Gerone Hobbs said. \"It\u2019s that thankless job, until it\u2019s your family member. \u2026 I hope that people realize that we play a very important role, that we\u2019re what we call the \u2018last responders.\u2019 You\u2019ve got the first responders, and they\u2019re gonna try to stabilize, and if they cannot, we\u2019re the last responders. That\u2019s the coroner\u2019s office.\u201d<\/p>\n\n\n\n

\u201cThe hardest deaths that we deal with in the industry are the unexpected ones,\u201d Justin Wittenberg, CEO at Ruebel Funeral Home in Little Rock, said. \u201cThe ones where someone dies in a car wreck, or you were with them that morning, and then they\u2019re gone that afternoon.<\/p>\n\n\n\n

\u201cWe have such a culture of hospices and nursing homes where people tend to slowly decline,\u201d Wittenberg said, \u201cand family and friends get to go and see them, to visit with them and come to terms with passing away.\u201d But COVID-19 can kill within days, and the sick are typically quarantined away from their loved ones. \u201cWe\u2019re gonna slowly start encountering clients who have passed away from COVID-19 and were otherwise healthy people, and we know that that\u2019s gonna be very difficult for these families.\u201d<\/p>\n\n\n\n

Funeral home staff, like medical examiners and coroners, are considered \u201cessential workers\u201d<\/a> during the pandemic. That is, while the rest of us are trying to navigate Zoom and AMI school packets, those in the funeral industry are navigating potentially risky cremation and burial procedures. \u201cWe\u2019re out here, just like we were during the HIV\/AIDS crisis,\u201d Hobbs said. \u201cJust like hospitals and the police departments, our office doesn\u2019t close.\u201d<\/p>\n\n\n\n

The Pulaski County coroner\u2019s office certifies about 5,500 deaths a year \u2014 \u201ca lot of cases for a nine-member team,\u201d Hobbs said. As of April 6, Arkansas has had 16 confirmed COVID-19-related deaths, and the virus had spread to at least 64 of Arkansas\u2019s 75 counties. Without widespread testing in the state, though, it\u2019s difficult to know how many cases of the virus Arkansans are incubating, particularly since the disease can present itself without symptoms, as in the case of state Rep. Reginald Murdock (D-Marianna).<\/a> Death tolls are soaring in hotspots like New York City and Los Angeles, and more southerly states like Florida and Louisiana are following in their footsteps. Hobbs\u2019 workload\u00a0 \u2014 and the workload of cases around the state \u2014 can reasonably be expected to rise sharply in coming weeks, even if many COVID-19 deaths are certified by an attending physician, and therefore don't require a visit from the coroner.\u00a0<\/p>\n\n\n\n

\"\"
PULASKI COUNTY CORONER: Gerone Hobbs.<\/figcaption><\/figure>\n\n\n\n

Wittenberg\u2019s job can be demanding even in normal times. \u201cWe really work 24\/7 \u2026  because people pass away at all times of night. Everybody that I know in the funeral industry knows that, and they get a sense of joy and pleasure out of their job by helping people out of the norm, not in this square box of 9 to 5.\u201d Ruebel, like most funeral homes in the state, supplements its full-time staff with a roster of part-time staff it can deploy should business exceed what the staff can handle.<\/p>\n\n\n\n

Kevin Cleghorn, the Saline County coroner and the president of the Arkansas Coroner\u2019s Association, anticipates that resources will be strained in upcoming weeks. \u201cIf we have those projected numbers and they come pretty rapidly, that\u2019s going to overwhelm our hospitals,\" he said \"It\u2019s gonna overload our coroner\u2019s offices. It\u2019s gonna overload the funeral homes.\u201d<\/p>\n\n\n\n

\u201cAnd keep in mind,\u201d Hobbs told us, \u201cWe still have homicide. We still have car accidents. We still have suicide on top of this COVID-19.\u201d<\/p>\n\n\n\n

Those who deal with the dead may also expose themselves to infection. Unlike the Ebola virus, the primary means of coronavirus transmission is through the respiratory system, and human remains of those who died from the coronavirus don\u2019t pose the same threat as those transmitted through the blood or other bodily fluids. The World Health Organization notes in a set of guidelines issued March 24<\/a> that to date, there is no evidence of a living person being infected with coronavirus from exposure to a dead body. Nevertheless, those guidelines recommend a rigorous hygiene and PPE protocol for those coming into contact with a dead body and recommend that funeral homes instruct any visiting family members not to touch or kiss the deceased. <\/p>\n\n\n\n

Typically, Centers for Disease Control says in a set of guidelines issued in March 2020<\/a>, \u201cspread from a living person happens with close contact (i.e., within about 6 feet) via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread,\u201d but adds that \u201cthis route of transmission is not a concern when handling human remains or performing postmortem procedures.\u201d Still unknown, though, is exactly how long the virus may stay active in the respiratory system after death, and whether viral matter that remains on the deceased\u2019s skin can transmit infection to a person who handles the remains. \u201cIt may be possible,\u201d those CDC guidelines say, \u201cthat a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.\u201d <\/p>\n\n\n\n

\u201cThe health care workers are still on the front lines, and we love them for it \u2026  [but] with the funeral home industry and the medical examiners and the coroners, we\u2019re taking a risk as well,\u201d Hobbs said.<\/p>\n\n\n\n

Part of that risk, too, is complicated by the same supply chain shortages the health care industry faces. Both the Pulaski County Coroner\u2019s office and Ruebel Funeral Home, for example, keep PPE (Personal Protective Equipment) on hand at all times, and use it year-round. Josh Taylor, the manager, funeral director and embalmer at Ruebel, orders all the embalming supplies and chemicals the mortuary portion of Ruebel's business needs, but says stockpiling any additional resources in anticipation of a rising death count has been tricky.<\/p>\n\n\n\n

\u201cLuckily, I\u2019ve been a planner,\" Taylor said, \"so I have a lot put back for year-round use. \u2026 But I have run into difficulty trying to get PPE from our regular suppliers. In most instances, they are out of PPE. With gloves and some of the disinfectants that we use, certain companies are putting limitations on them, and I\u2019ve had to look for additional resources elsewhere, which have been very difficult to find.\u201d<\/p>\n\n\n\n

\"\"
JOSH TAYLOR<\/figcaption><\/figure>\n\n\n\n

\u201cWe have coroners all across our state that are having trouble getting PPE,\u201d Cleghorn said. Coroner\u2019s offices around the state vary not only in their size, but in their levels of dependence on other entities, like funeral homes. The Saline County coroner\u2019s office, he said, is \u201ca standalone entity,\u201d and maintains its own supply of PPE. \u201cWe keep on hand gloves, we have arm sleeves, footwear, Tyvek suits, N95 masks, face shields. Even in a regular setting, before COVID, if we got into situations where we needed more advanced gear than we had, we have resources we can contact and have them respond. Even now, with COVID-19, Tyvek is very appropriate, and will protect your clothing and protect your arms.\u201d <\/p>\n\n\n\n

Asked how he protects himself when he comes home from the job, Hobbs laughed and said, \u201cI\u2019m blessed to have a garage!\u201d With the safety of his wife and kids in mind, he told us, his routine was one established well before COVID-19 arose. \u201cI strip immediately, I have hand sanitizer, and I put my clothes in the washer. I go in and wash my hands and take a shower.\u201d <\/p>\n\n\n\n

Will supply levels be enough? \u201cFor what we\u2019ve seen in our county,\u201d Cleghorn said, \u201cwhat we have is adequate at this point in time. However, if the projections come true that are being seen on the national scale, and what the governor has put out in his press release, no. It won\u2019t be adequate in our state, period \u2026 we\u2019re talking about PPE for police, firefighters, coroners, paramedics, EMTs and funeral directors. That is a mass amount of people.\u201d  <\/p>\n\n\n\n

Another big question mark: the availability of a post-mortem testing procedure for COVID-19. <\/p>\n\n\n\n

CDC recommends that \u201cmedical examiners, coroners, and other healthcare professionals should use their judgment to determine if a decedent had signs and symptoms compatible with COVID-19 during life and whether postmortem testing should be pursued,\u201d weighing both specific medical conditions of the deceased as well as broader epidemiological factors, like whether the death was \u201ca part of a cluster of respiratory illness in a closed setting (e.g., a long-term care facility).\u201d<\/p>\n\n\n\n

Neither the Saline County nor the Pulaski County coroner\u2019s offices have access to those tests, though. Cleghorn said it\u2019s \u201cvery rare\u201d for an Arkansas coroner to have access to testing at the moment, though a few hospitals have worked closely with their local coroners to assist with testing. \u201cAnd that has been a huge asset in those areas. But not every county has a hospital. Not every county has those relationships.\u201d<\/p>\n\n\n\n

\u201cRight now, we\u2019re trying to get test kits available to us,\u201d Hobbs said. \u201cThose kits are hard to come by. It\u2019s a question I\u2019ve asked the health department, and nobody can give me an answer.\u201d<\/p>\n\n\n\n

Arkansas coroners\u2019 offices, Cleghorn said, have received a set of COVID-19-specific screening questions from the CDC, to be asked by a 911 dispatcher, EMT or police officer when a death occurs at an Arkansas home. They include asking what sort of symptoms they may have had prior to dying, and whether the deceased left the country or state recently, although that last question becomes increasingly less relevant as the virus spreads within Arkansas state lines. \u201cThis is a whole new screening process \u2026 There have always been established questions that you ask for officer safety, or for the safety of our responders,\u201d Cleghorn said, \u201cbut since COVID-19 came into play, they\u2019ve had to adjust those questions.\u201d If that screening process indicates COVID-19 may have been a factor in the deceased\u2019s death, Hobbs said, the case is escalated to the health department or to the medical examiner\u2019s office. Without adequate testing, though, some COVID-19 deaths may be undiagnosed as such, and therefore undercounted in reports of statewide death rates. \u201cAs soon as we can get some test kits,\u201d Hobbs said, \u201cwe\u2019ll start swabbing if they fall under those guidelines, with those symptoms.\u201d<\/p>\n\n\n\n

As for Ruebel Funeral Home, \u201cevery one of our clients that comes in, we are treating them as if they had COVID-19,\" Wittenberg said. \"That\u2019s just the safest way to do it. We're trying to limit the amount of contact that anyone has with the deceased.\u201d<\/p>\n\n\n\n

In the past, Ruebel has allowed families who plan to cremate their loved ones to see the unembalmed bodies before the cremation process; now, the bodies must be embalmed beforehand. \u201cOnce the body\u2019s embalmed, in theory,\u201d Wittenberg said, \u201cthe COVID-19 has all been destroyed. \u2026 . So that\u2019s a little bit of a change, and it\u2019s a little more expense for the family. And that's unfortunate, but we\u2019re trying to contain a disease.\u201d  <\/p>\n\n\n\n

Arkansas families experiencing a death, whether a result of COVID-19 or unrelated, will also begin to see some changes in the way they grieve -- particularly, whether they can grieve together. \u201cAt this point, we have to limit all indoor gatherings to 10 or fewer people,\u201d Wittenberg said. As Ruebel\u2019s CEO, it\u2019s Wittenberg\u2019s job to enforce those limitations. \u201cI know my staff well,\u201d he said, \u201cand they will want to say yes to these families.\u201d Ruebel, like many funeral homes, is equipped to conduct memorial service remotely, by video, but families have been reluctant to use those services, choosing instead to delay funerals altogether. <\/p>\n\n\n\n

\u201cThey\u2019re saying to me, \u2018No, we want to be around people, and to celebrate this person\u2019s life with friends and family. When we\u2019re allowed to do that, we\u2019ll do it.\u2019 And I totally understand. That\u2019s what a funeral is for, to get together and show love and support for each other and share their memories and reminisce on this person\u2019s life. That\u2019s how we heal \u2014 as a community.\u201d <\/p>\n\n\n\n

The new normal could last a long time, Wittenberg said. \u201cI\u2019m thinking that as this progresses and goes on longer and longer, I\u2019ll get more families saying, \u2018We originally thought we were gonna have to delay, but how much longer can we delay?' \u201d\u00a0<\/p>\n\n\n\n

This reporting is courtesy of the\u00a0Arkansas Nonprofit News Network<\/a>, an independent, nonpartisan news project dedicated to producing journalism that matters to Arkansans.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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