PANDEMIC PLAN How to deal with the dead?

Another flu outbreak could be coming. If it does, how will we handle loss of life?
WASHINGTON POST
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.
Potential disaster
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."
Lack of attention
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.