By Mai Yoshikawa, KYODO NEWS - Apr 16, 2020 - 13:30 | Lifestyle, All, Coronavirus

While healthcare providers are bearing the brunt of the coronavirus pandemic fight, the deathcare industry is bracing for action behind the frontlines, hoping to retain as much of a human touch as possible as virus fatalities mount.

Japan's death toll has been only slowly creeping up as the nation remains one of the least impacted by COVID-19, with 191 virus-related deaths recorded as of Wednesday.

But while the country has so far avoided the extreme scenes seen in some other parts of the world such as unclaimed bodies, shortage of body bags and mass burials, Japan's funeral workers know it is time to adapt, and this can mean an end to traditional farewells from grieving family members.

(Tetsuma Suzuki, a 30-year veteran of the Japanese funeral industry, is pictured in Minokamo, Gifu Prefecture in February 2020.)

[Courtesy of Nouhi Sosai]

When famous Japanese comedian Ken Shimura died at 70 years of age from pneumonia caused by the coronavirus late last month, his brother said his body went straight to a crematorium and his family did not get a chance to say their final goodbye.

This is the brutal reality for many of those dying from coronavirus.

One of the key issues for those who work in deathcare, including coroners, medical examiners and funeral directors, is handling the bodies of coronavirus victims.

The World Health Organization says most infectious agents do not survive long in the human body after death, although the lungs and other organs of the infected person may still contain the live virus.

Nevertheless, standard biosecurity procedures in cases of death from infectious diseases require the body to be sealed into an airtight bag with an identity label as quickly as possible to protect mortuary staff and those handling and transporting bodies.

"It's hard to believe a virus can be active when temperatures in the chamber reach between 800 to 1,000 C. Once they turn into ashes and bones I think we're okay," says Tetsuma Suzuki, a funeral director at Nouhi Sosai in the central Japan prefecture of Gifu.

Still, he says his 80 staffers are uncomfortable coming into contact with the bodies of coronavirus victims because so much is still unknown about the biohazard posed by SARS-CoV-2, the virus that causes COVID-19.

With coronavirus cases, Suzuki decided to stop his staff from accompanying the bodies to crematoriums, and instead outsource the task, even though it will cost the families more. In his 30 years in the business, he has never had to take such a step.

"Our employees perform hand hygiene and wear personal protective equipment, but the threat of infection is very real for them. And we can't afford to lose anyone now," Suzuki told Kyodo News.

(A Kobe public health official shows a sample of a transparent body bag prepared by the city for coronavirus victims in April 2020.)

[Courtesy of Kobe City Office Health and Welfare Bureau]

Nouhi Sosai handled the first and only fatal case of the coronavirus in Gifu Prefecture, reported on April 4. The man in his 70s was pronounced dead in the morning and cremated that afternoon.

Normally Japanese law only allows remains to be cremated or embalmed after a 24-hour waiting period following a death, but exceptions are made in the case of certain specified contagious diseases such as COVID-19.

The funeral home staffers are in touch with the family members of the man who died, two of whom also tested positive for the virus, and are organizing a memorial service for a later date.

Since the coronavirus outbreak, Suzuki says he has been in close contact with public health centers and the All Japan Funeral Directors Cooperation and following their guidance on the handling and disposition of individuals who died from the virus.

According to Suzuki, bodies are to be wrapped in a "bag that looks like a big ziploc," the same leak-proof plastic bag that is used to store badly disfigured corpses, such as those who died from drowning or in a car accident.

In Kobe, meanwhile, where there had been one coronavirus death as of Wednesday, local public health officials are urging greater efforts to ensure victims die with dignity even while the system is under pandemic-level stress.

The major port city in western Japan's Hyogo Prefecture ordered transparent body bags for residents who wish to choose those over the opaque white bags most hospitals use, in case families request a viewing.

Normally it is hospitals via mortuary suppliers who source the polythene bags, not local governments.

"We're preparing for the worst-case scenario, and when that happens, we want to honor the dead and make sure they're treated humanely to the end," Junko Hirayama, a public health nurse from the Kobe Health and Welfare Bureau, said in a telephone interview with Kyodo News.

"Cremation within 24 hours of death is permitted for coronavirus cases, but it's not mandatory. If we can prevent cross infection and leaking of body fluids, which is what this bag does, families can see the face of the deceased and even put flowers in the casket."

However, the efforts have been met with criticism, with some residents complaining that the city is dedicating too many resources toward caring for the dead when they should be caring for the living.

Kobe officials worry that funeral and crematorium operators and other service providers in the industry may sustain long-lasting reputational damage if a potentially deadly coronavirus contamination occurs due to a lack of preparation.

And that worry may be warranted, as overburdened funeral directors like Suzuki are facing myriad challenges.

[Courtesy of Kobe City Office Health and Welfare Bureau]

They must maintain their respected position in the community by acting and operating with a sense of social responsibility while creating alternative mourning rituals to help families find solace at a time when holding traditional rites is impossible.

They also have a responsibility to keep their business running profitably and to ensure their employees stay in work during the economic downturn.

Death has become a big business in Japan, where more than 28 percent of the population is aged 65 and over.

A rising death rate and lack of crematoria have spurred Japan's booming funeral industry in recent years, including drive-through funerals and corpse hotels.

And now, with the coronavirus shaking up the business in unexpected ways, many deathcarers are getting ready to toss aside the idea of massive funeral crowds and Buddhist-style ceremonies held over two days, and reinvent the tradition.

"There's no doubt the coronavirus has affected our business," Suzuki says, explaining that family-only funerals accounted for 30 percent of funerals in the past but spiked to 70 percent in recent months.

"Coronavirus is changing the way people hold funerals. Families are minimizing attendance. I'm afraid small-scale memorial services are going to become the norm after the pandemic. I think we have to get ready to move our business online," he said.

"We're already looking into livestreaming funerals using GoPro cameras and cashless payment options like PayPay. We won't have to worry about not having change. There are advantages."