LONDON — A crisis is coming in the U.K.’s funeral sector. And no one seems to be listening.

It’s no longer business as usual at London-based funeral service Poetic Endings; instead, founder Louise Winter says she is treating every dead body as potentially infected with coronavirus. That means body bags for the dead and high-spec face masks for her staff.

Except there aren’t any. And where they are available, prices have tripled.

“And we're the lucky ones. I've actually bought supplies,” says Winter, who purchased personal protective equipment (PPE) weeks ago when she saw the escalating crisis in China. “[But] there are lots of funeral directors now trying to get the supplies they need and they are finding that all the people we usually go to have got nothing in stock at all. And if they have, then the prices have gone up.”

Another funeral director, Lucy Coulbert, took similar action in January and stocked up the Individual Funeral Company in Oxford, where she is managing director, as best she could.

What’s exasperating for Winter is that while the national policy may now say one thing, local hospital trusts and coroners all have their own policies for dealing with infectious diseases.

But they both know their supplies won’t last forever.

“I’m prepared to keep working for as long as my kit lasts. Once it's gone, my company's closed,” says Coulbert.

While most of the funeral directors Coulbert knows have done their best to prepare, she admits they have “no idea, none whatsoever of the scale of what we're about to face.”

Shifting guidelines

Both Coulbert and Winter point to how the guidance they are getting is constantly changing.

At first, they were told to use body bags and masks, but the most recent guidance from Public Health England (PHE) says: “Where the deceased was known or suspected to have been infected with COVID-19, there is no requirement for a body bag, and viewing, hygienic preparations, post-mortem and embalming are all permitted.”

For more advice, funeral directors can turn to general infection guidance on handling dead bodies or to advice meant for health workers.

Terry Tennens, CEO of the National Society of Allied and Independent Funeral Directors (SAIF), notes that the new PHE guidance was followed by advice from the Royal College of Pathologists and the Association for Anatomical Pathology Technology that viewings should take place behind a window.

"As a result of all this conflicting advice, we're erring on the side of caution, and advising members to carry out full risk assessments and take necessary measures to protect their staff and clients," he said.

What’s exasperating for Winter is that while the national policy may now say one thing, local hospital trusts and coroners all have their own policies for dealing with infectious diseases. “They’re all conflicting,” she says.

Winter feels she has no choice but to ensure her front line team, who go out at all hours to collect the deceased, have the maximum levels of protection. It’s not just the dead body that she is concerned about, but also potential infections in the environment from which the body is being collected.

Deborah Smith, spokesperson for the National Association of Funeral Directors (NAFD), said they want the government to give “specific guidance for anyone working with deceased people.”

Both SAIF and NAFD are part of the Deceased Management Advisory Group, which has been pushing the government to provide clarity on this issue and to supply the sector with a consignment of PPE that can be distributed to those most affected.

Tennens said that they are hopeful that the equipment will be in place in the coming days,“particularly as the death rate increases and demand increases.”

‘We’re making up our own rules’

Announcing increased social distancing measures earlier this week, Prime Minister Boris Johnson assured the public that funerals would still be allowed to go ahead, albeit with only close family members.

Coulbert is so concerned that she has stopped her usual staff from collecting the dead, and is doing that herself with a member of staff who volunteered.

As for how to carry out the funerals, the government has remained silent, with the Deceased Management Advisory Group taking it upon itself to issue guidance on the issue.

But Coulbert wants clear rules from the government.

“A lot of funeral directors genuinely feel like they have been thrown under the bus,” she says, explaining that it’s now up to individual companies to decide what they are willing to do. “We're making up our own rules as we go along, and we are praying that we're making the right decisions.”

Coulbert is so concerned that she has stopped her usual staff from collecting the dead, and is doing that herself with a member of staff who volunteered. “We will work 24 hours a day for as long as we possibly can until one of us gets ill,” she says.

Her company is also no longer offering burial or cremation services with mourners present.

Tennens, from SAIF, also points out that funeral directors are often working with the elderly and vulnerable, who can't afford to be infected with the coronavirus. "We also don't want a situation where lots of funeral directors are unable to work because of illness at a time when they are needed most," he says.

A funeral with masks

For Winter, who is used to spending a substantial amount of time with bereaved family members to arrange a meaningful send-off for their loved ones, her job is now alien to her. Unable to meet in person, plans are made over the phone, and at every turn Winter is having to manage people's expectations.

“A conversation I had today was calling a family we're working with to let them know that my team will have to be at the funeral wearing masks. I didn't want them to think that was because there was any threat or any risk from the person who's died and is in the coffin, but actually we are the risk and they are the risk,” she says.

Winter describes it as a “totally impossible" time. “It's impossible to go through bereavement anyway, never mind in these circumstances,” she says.

But the real fear is that the death toll keeps mounting and funeral directors run out of PPE, or that funeral service companies are unable to operate because too many staff are ill.

“If we cannot keep up, there will be a situation where there will be mass graves,” warns Coulbert.