“Right now, I would say it’s doubled,” she said, “and as everyone else is, we’re expecting that every week it’s going to get worse, especially here in New York City.”
Her co-worker Devon Betts, a 37-year-old diener, keeps using the word “surreal.”
“I’ve never been to war, but I feel like this is the closest I will ever get to it,” he says. “You walk into work every day and you’re battling what seems to be an enemy in this virus.”
On Thursday, the death toll in the United States topped 1,000. In New York City, the total deaths reached 385, with over 85 people dying in the city that day and about 135 deaths across New York state. The state is worried enough to have asked the Federal Emergency Management Agency for help in setting up emergency morgues. The Office of Chief Medical Examiner has deployed 45 refrigerated trucks to hospitals around the city, with more trucks in reserve. A giant refrigerated tent that will serve as a pop-up morgue sits outside Bellevue Hospital, empty for now — a stark symbol of the gravity of the pandemic in New York City.
Recent deaths have included Kious Kelly, a nurse at Mount Sinai West, who was in a Facebook photo with two of his co-workers wearing garbage bags because they’d run out of protective hospital gowns. On Thursday, two Metropolitan Transportation Authority workers died of the virus — Oliver Cyrus, a bus operator, and Peter Petrassi, a subway conductor — after weeks of complaints that front-line workers didn’t have proper protective equipment. Both had served for more than 20 years.
With visitors banned and staff strained, almost everyone is dying very much alone.
A system in crisis
The grim reckoning is a reminder that much of postcard-perfect New York is built on death and pestilence: Washington Square Park was originally a cemetery until it overflowed with corpses from a string of yellow fever epidemics, so much so that a new cemetery had to built in what is now Bryant Park. And, of course, Typhoid Mary was a New Yorker. “It appears as if God were punishing this land for its sins,” a Dutch pastor wrote of a dysentery outbreak in 1668.
It’s not just morgue capacity that’s in crisis. The entire apparatus of post-mortem care — or deathcare — has been upended. With scarce supplies, dwindling staff, and the need to avoid exposure to the virus, nurses can’t perform usual palliative care and linger with dying patients. Hospital chaplains are having to perform last rites outside patients’ doors or through video chat.
Funeral homes, responsible for moving bodies out of morgues, are also being overwhelmed. They have smaller morgues than hospitals, and families struggling with quarantine and financial hardship on top of grief sometimes can’t leave their homes to make timely arrangements.
As of last Sunday, Gov. Andrew M. Cuomo (D) mandated that only “immediate family” attend funerals, a number that is further restricted by the Centers for Disease Control and Prevention’s recommendation against gatherings of more than 10 people. Funeral directors are generally asking that only one or two people come in to the home to make arrangements.
Joseph Neufeld, who’s running a funeral home he inherited from his father in Elmhurst, Queens, has had five or six coronavirus funerals. He said a grieving wife and son had to watch their loved one’s casket lowered from within their car because they couldn’t be near cemetery workers. Rabbi Hillel Fox, director of chaplaincy at Northshore University Hospital, said a Jewish woman whose dying wish was to be buried in Israel had to be buried by strangers because Israel’s borders are closed.
Already, some morgues are running out of space. Kilfeather’s hospital is using its morgue, plus the morgue of an adjoining nursing home, plus the refrigerated truck, which can hold up to 45 (once they put in shelves), plus a backup truck. They would never, “God forbid,” she said, “pile people on top of one another.”
Adding to the ethical questions are medical ones, namely if handling coronavirus-infected corpses is dangerous.
“We don’t know,” says Amy Rapkiewicz, chair of the pathology department at Long Island School of Medicine and autopsy director at NYU Winthrop Hospital. Because the coronavirus is transmitted through respiratory droplets, the risk is lower than Ebola, in which patients died from hemorrhaging and vomiting up blood, which turned funerals in Africa into a hotbed of transmission. But Angela Rasmussen, a virologist at Columbia University, said residual virus could remain in the respiratory tract and the intestines — “so the risk isn’t zero.”
The current protocol is to treat the patient as having died from a better-known infectious disease, or Level 3 pathogen, like tuberculosis or hepatitis, where the virus may remain in secretions from the skin that could become aerosolized when the body is moved, and then splash on someone’s face or be breathed in through air. That means extra precautions (again, with scarce supplies) for all the front-line workers involved, including security guards and janitors. But the X-factor is how long the virus lives on skin. Rapkiewicz surmises that it might be in the realm of how long it lasts on plastic. According to a study in the New England Journal of Medicine, that’s up to 72 hours.
The only truly agreed-upon practice is that all body bags should be disinfected with bleach.
Cremation, though, is considered safe, since the virus can’t survive those high temperatures, as well as burial, after an appropriate wait, with precautions.
Autopsies would help, but few are being performed, much to the frustration of pathologists around the country, according to Alex Williamson, chief of autopsy pathology at Northwell Health, who’s organized an ad hoc email discussion of around 100 pathologists. Of that group, only three, Williamson included, have performed a hospital-based autopsy, which requires consent from next-of-kin, on a patient who contracted covid-19, the disease the virus causes. From that, he extrapolates that maybe 5 percent of coronavirus patients are being autopsied across the country “and that’s generous.”
There are some good reasons to avoid autopsies. The Occupational Safety and Health Administration, a federal agency, recommended “suspension of post-mortem or autopsy procedures,” citing “the potential for very high viral load.” Rapkiewicz, who is on Williamson’s email list, explained: “Most people agree that doing brain removal is probably not a good idea,” because, she added, the oscillating saw could send the virus into the air.
“Autopsies are the dead generously teaching us through telling their stories,” said Williamson, explaining their importance. More autopsies mean better treatments and fewer deaths, and possibly a vaccine. They were crucial in understanding HIV/AIDS, he says. “It’s a gift to the living.”
For those who care for the dead, the toll is just beginning. Williamson has started having his team meet every morning to do an emotional check-in.
Betts says he’s so exhausted at the end of every day he just collapses.
On top of all this, Kilfeather hasn’t seen her 11-year-old daughter in two weeks. She had to send her to live with her father after a known coronavirus exposure at the hospital. At work, she is a machine, but “it’s when you stop and you’re going home that you just feel totally defeated,” she says. “Dealing with death alone is emotionally draining. I can’t tell you how many times I’ve cried with parents over their adult children and younger children. But now it’s just like you’ve doubled those emotions because we’re seeing so many more.”