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Washington — A national shortage of body bags is disrupting the work of funeral directors across the country, raising difficult questions about how to maintain the dignity of the deceased and reduce workers’ concerns about potential exposure to the coronavirus.

The shortage of body bags is a grim reminder of the pandemic’s mounting death toll. More than 81,000 Americans have died of COVID-19, the disease caused by the coronavirus.

Because of the short supply, body bags are sometimes reused two or three times. Sometimes when a body bag is unavailable, the deceased person is wrapped in sheets and a mask is placed on the face.

At times, funeral directors use a material called casket plastic made of similar material, which is thinner than a body bag and can tear more easily. The pandemic has increased the demand and production of heavy-duty plastic covers with names like “Bioshield” or “Bodysealer,” funeral directors and suppliers say. One funeral director reported using expired bags that public health care officials purchased during the H1N1 epidemic.

There is a monthslong backlog on body bags, suppliers and funeral directors say. It’s not clear when the shortage will ease.

On April 1, the Department of Defense confirmed it was seeking 100,000 military-style body bags, or “human remains pouches,” for the use of state public health departments on behalf of the Federal Emergency Management Agency. But as of Tuesday, the federal Strategic National Stockpile and FEMA have distributed just 11,000 body bags to federal disaster mortuary teams since the health crisis began, a Health and Human Services spokesman said.

Hari P. Close II, president of the National Funeral Directors & Morticians Association, said orders are delayed until at least July or August, and suppliers typically can only provide less than one-fifth of what is ordered.

The shortage has left funeral directors calling factory suppliers directly and searching online. But body bags are often out of stock.

“We are experiencing high demand,” reads the website of wholesaler Extra Packaging LLC.

“Due to high demand for PPE’s and universal precautions, some items are very limited and/or out of stock completely,” reads the website of Kelco Supply Co.

The shortage of body bags complicates the process of caring for the dead. For example, funeral directors cannot use the traditional fabric covers used when transporting a deceased patient from the hospital room to the mortuary. Because body bags are in shortage, some have begun using plastic, but funeral directors opt to use milky white plastic instead of transparent plastic to be more respectful of loved ones.

The shortage is driven in part by a lack of tests. Right now, the standard is to treat all deceased patients as if they had COVID-19. That generated a need for more bags.

Under Occupational Safety and Health Administration standards, workers should wear full protective gear and use body bags when a person dies of an infectious disease, but the shortages make it harder.

“You want to have good quality material that won’t rip. Pre-COVID, there were some bags made out of thinner material that rips pretty easily. Now there is this new normal. If it rips now, that’s a significant concern,” said Joyce deJong, a forensic pathologist and board member with manufacturer Mopec.

The Centers for Disease Control and Prevention issued interim guidance on April 30 stating that given the diverse “variety, construction, and conditions of body bag materials,” workers must use “prudent judgment” in deciding what kind of bag to use, and whether two bags are necessary. The CDC outlined precautions for handling the body or bodily fluids of a COVID-19 victim.

The 2006 Veterans Affairs Pandemic Influenza Plan also recommended that mortuary workers use protective equipment against potential airborne transmission of diseases.

The supply shortages are another strain on workers under the extreme stress of a pandemic.

Body bags are not stored in the Strategic National Stockpile, an HHS spokesman said. But mortuary workers see them as a piece of personal protective equipment.

“Body bags, everything is really limited right now. It’s difficult to find all of the PPE you need, especially in hot spot areas,” said Ellen McBrayer, a funeral director in Villa Rica, Georgia.

“I don’t think last responders should be forgotten, especially as the challenge grows and deaths increase,” she said.

Close, of the funeral directors’ association, said he lost a friend in New York to the virus recently. While it’s difficult to say for sure whether the friend, a funeral director, contracted the virus at work, “that funeral home was his life,” Close said. He worked 50 or 60 hours per week by Close’s estimation.

“It hits home,” Close said.

It’s not clear how high the risks are for contagion. According to the National Association of Medical Examiners, the risk for transmission of COVID-19 at least through droplets after death “is thought to be minimal,” but the group noted that coroners wear full protective gear when conducting autopsies.

A greater concern, the association says, is exposure to families during home visits.

“The funeral director is in an awkward situation. You want to show empathy for family but at the same time make sure public safety is in order,” Close said. “I visited the home of a young couple who lost a child. Even though it was not a virus-related death, I entered their home with my full PPE: shoe covers on my feet, mask on, gloves on. I told them, ‘This is for your protection.’ I had to sit down with my staff to talk about the way you have to say it.”

Funeral directors must route any requests for federal assistance for body bags and other personal protective equipment through local public health offices and governors’ offices, according to a FEMA spokesperson. Some funeral directors say they have not found help.

“Every single day, every single day, every single day. I spend a countless amount of time every single day researching suppliers and beating the pavement,” said Kahlen Knapik, a funeral director and the business development manager at National Mortuary Shipping & Cremation.

“It’s very frustrating. We reached out to the state health department and the local health department and they said unless you’re a hospital or first responder, an EMT, there was nothing they would do,” Knapik said. “I don’t think they realize what it is we do. We’re in direct contact with all of this too.”

The National Funeral Directors Association is seeking to acquire supplies and is working with state associations to distribute them.

Suppliers report being left with the difficult decisions about how to obtain more body bags and how to prioritize orders.

“It seems like the overseas market is where things are coming from, but it’s so expensive to get that stuff here on short notice. It’s at a price point our market can’t stand,” said Kelco CEO Alicia Carr.

Carr said she tries to balance the orders from her established customers with the needs of hard-hit funeral homes.

“We’re looking at the CDC site to see where the greatest need is, where the death toll is the highest, ultimately following that as a guide on how we’re allocating these,” Carr said. “From there, I go to the oldest buyer in the system and then go to the next oldest, and so on.”

Funeral workers say the shortage one of many problems.

“Every day when I go home, I need two hours of reflection just to get back into my normal routine – and I’m around death care every day,” Close said. “But it gets to a point where it’s just overwhelming.”

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