Pandemic of 1918 offers lessons on body disposal
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.
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.
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."
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.
"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.
"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."
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.
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.
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."
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.
"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.
"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."