If and when a global avian flu pandemic occurs, medical experts and
government planners hint that "proper burials" as we know them might
not be achievable--or advisable.

Under a mountain of dead bodies, officials are saying that local and
national disease centers will simply be unable to handle tens of
thousands of flu victims' dead bodies.  It's possible the dead will
have to either be buried in mass graves--or, worst case--officials will
be compelled to order mass cremation of bodies that over-worked
mortuaries and undertakers will have to turn away.

Some feel It might be wise, now, to launch studies to determine the
impact such a scenario could present.

In the wake of such chaos and death, would national, state, and local
governments move to place an outright BAN on customary interment?

=====

"A Grisly but Essential Issue"

"Pandemic Plan Skims Over How to Deal With Many Corpses"

By Ceci Connolly
Washington Post Staff Writer
Friday, June 9, 2006; A09

They brought in steam shovels to dig graves. Caskets were rented --
just long enough to hold a brief memorial service -- then passed on to
the next grieving family. The death toll of the 1918 flu pandemic was
so overwhelming that the military commandeered entire trains to
transport dead soldiers; priests patrolled the streets of Philadelphia
in horse-drawn carriages, collecting bodies from doorsteps.

"One of the most demoralizing things was the inability to move bodies
out of the home," said John M. Barry, author of "The Great Influenza,"
the definitive work on the 1918 pandemic. "They just literally stacked
up, sometimes for three, four or five days."

Now, with medical experts and government leaders racing to prepare for
a potential pandemic, a cadre of mortuary specialists has begun quietly
grappling with the grisly but essential question of what to do with the
dead if it happens again.

Opinion is varied on when and how virulent the next global flu outbreak
would be, but even a modest epidemic -- similar to the pandemic that
hit in 1968 -- could kill between 89,000 and 207,000 Americans. If the
next virus mimics the far more potent 1918 strain, the U.S. death toll
could reach 1.9 million.

"It's almost too big to wrap your arms around," said John Nesler, a
specialist in mass fatalities advising the military. If the worst were
to occur, Nesler predicted the impact would be akin to "20 nuclear
detonations" simultaneously knocking out multiple cities and towns.

In either case, experts foresee an 18-month period of funeral homes
being short-staffed, crematories operating round-the-clock, dwindling
supplies of caskets and restrictions on group gatherings such as
memorial services. Morgues and hospitals would quickly reach capacity.
And most of the federal Disaster Mortuary Operational Response Teams
(DMORT) would be too busy in their own communities to deploy elsewhere.

"I can't see myself packing my bags to go to another state to help
out," said Joyce deJong, a Michigan medical examiner who worked on
DMORT teams after the Sept. 11, 2001, attacks and Hurricane Katrina.
"I'll be here dealing with an increase in the number of bodies."

Some fear that the Bush administration, in all its detailed planning
for pandemic flu, has paid scant attention to fatalities.

"It's the one thing nobody wants to address, because it's ugly. People
don't want to think that anyone will die," said John Fitch, senior vice
president for advocacy at the National Funeral Directors Association.
"We can't put our head in the sand and say response stops at prevention
and treatment."

In the 227-page response plan recently released by the White House, the
term "medical examiner" appears just once -- and "autopsy" not at all.
A single paragraph on page 112 recommends that hospitals, medical
examiners and government officials "assess current capacity for
refrigeration of deceased persons, discuss mass fatality plans and
identify temporary morgue sites" to handle surges.

Officials say much more is happening behind the scenes. In March, the
administration helped organize a two-day conference at Fort Monroe in
Virginia with medical examiners, funeral directors, public health
experts and casket makers. Among the more innovative, albeit jarring,
ideas being considered are backyard burials, virtual funerals and
storing bodies at ice hockey rinks.

Seattle's King County came up with the ice rink idea when officials
realized their mass fatality plan would accommodate no more than 50
deaths, perhaps in a plane crash, said interim health director Dorothy
Teeter.

"This is so much bigger," she said. "We project 11,000 potential deaths
in six to eight weeks."

Several participants said they will have to consider temporary mass
graves because they will not have the staff to keep up, especially if
some of their workers or family members contract the flu.

"They would bury the person with all the identification material and
carefully keep track of that information," said Ann Norwood, a senior
analyst at the Office of Public Health Emergency Preparedness at the
Department of Health and Human Services. "After things calm down, we
can locate the family, exhume the casket and put it wherever the family
ultimately would like the body to rest."

"Virtual funerals" broadcast over closed-circuit television or the
Internet would be advised, said Nesler, who ran the Fort Monroe
conference. "The very worst thing you can do during an epidemic is have
large gatherings of people" such as memorial services, he said. Some
families may bury relatives on their own property, said deJong, who is
also chairwoman of the mass fatality management committee of the
National Association of Medical Examiners.

In a pandemic, one problem would likely trigger several more, Norwood
said. Fuel shortages, for instance, would mean added complications
transporting bodies and keeping refrigerated trucks cool.

If funeral directors and other mortuary workers are not given
anti-viral medication or a vaccine when it becomes available, they will
likely stay home, said Robert Fells, external chief operating officer
for the International Cemetery and Funeral Association. "Ironically,
funeral directors were at the bottom of the list," he said. White House
officials said a priority list for medicine and vaccine has not been
finalized.

"Noticeably absent from the discussion" at Fort Monroe were
representatives of the Department of Homeland Security, even though
they will have overall coordinating responsibility in a pandemic, said
Fitch. "Right now, there is no single agency or individual responsible
for mass fatalities."

However, much of the burden will fall to local communities and the
states, Bush administration officials said.

Virginia's chief medical examiner, Marcella Fierro, said local
hospitals, funeral homes and health departments must take the lead, but
the state is trying to help now by developing software systems for
clerical tasks such as keeping track of the dead and contacting next of
kin. She is also compiling a list of retired employees who could step
in.

One of the many lessons to emerge from Hurricane Katrina is that
Americans are not accustomed to seeing unattended bodies on the streets
of a major city, said Michael Osterholm, head of the Center for
Infectious Disease Research & Policy at the University of Minnesota. He
said less-developed countries may be better positioned to deal with
huge numbers of flu fatalities.

If the next pandemic strikes with the same ferocity as the 1918 flu,
even the most thorough planning will not prepare people for the
emotional toll of such widespread death.

"We've forgotten that people do die from infectious diseases, and our
process of dying has become very sanitized," said Norwood, who is also
a psychiatrist. "For the whole Western world, it's going to be a
shock."

http://www.washingtonpost.com/wp-dyn/content/article/2006/06/09/AR2006060900078.html