COVID-19 changes how medical examiners handle bodies. Manatee County opens second morgue
There is a lot that isn’t known yet about the coronavirus that causes the disease COVID-19.
How long the virus lives in the body after someone has died is one of those unanswered questions.
That unknown has caused medical examiners to change their protocols and how they certify a cause of death when COVID-19 is the suspected killer.
In the District 12 Medical Examiners Office, which covers Manatee, Sarasota and DeSoto counties, autopsies are not being done when the person is known or suspected to have COVID-19, according to Chief Medical Examiner Dr. Russell Vega.
“I think most places around the country, and certainly most places in Florida, are minimizing the number of autopsies they’re doing in these cases,” Vega said. “We are sort of stuck in this risk-benefit balance with the facilities we have that aren’t really designed for high-level infectious disease cases like this. We can’t do them at a no risk or very low risk for potential exposure.”
Based on guidance from the Centers for Disease Control, the risk outweighs the benefits of what could be learned about COVID-19.
In preparation for dealing with the COVID-19 deaths, Vega implemented several changes to reduce possible exposure to staff, including reducing the number of autopsies that are done and changing some protocols for those autopsies that are necessary.
One challenge that Vega and emergency planners everywhere had to consider was where a large number of bodies could be stored if there was ever a surge of cases.
An ice rink in Madrid being used to store bodies in March grabbed international attention. But for emergency managers in the U.S., even here in Manatee County, it was a contingency plan that had been considered. More recently, some ice rinks in Michigan and Maryland have had to be used for that.
Manatee County was in a unique situation. After moving the medical examiner’s moved into a new facility a few years ago, the old space was never dismantled.
“We were under the impression that the Health Department was eventually going to take and utilize that space, but fortunately for us that never happen so the space was still as we left it,” Vega said.
With testing only becoming widely available during the course of the past couple weeks, it is difficult to determine if Manatee County has passed its peak or if a surge is still possible.
“In the early days we started looking at projections, we thought we could possibly need more space and Dr. Vega reached out to us,” Public Safety Director Jacob Saur said. “We thought it was the best and quickest facility to get back up and running.”
As of Friday, 72 people in Manatee County had died from COVID-19.
A COVID morgue
Manatee County has not seen a sudden surge in COVID-19 deaths, but the county is now better prepared to store bodies if a spike in deaths does happen.
“There’s different kinds of body storage surges we might have. If you had a big plane crash where you have 200 bodies all at once, obviously that’s not going to cut it,” Vega said. “But when you are talking about bodies that could slowly increase over time to a point where they could reach our capacity. ... For this situation, I think it’s a great solution.”
The other option would have been renting a refrigerated truck..
But there are many problems and costs associated with refrigerated trucks: Where to park them? What would be their power source? How to secure them?
The old morgue still had the body lifts, tables and trays used to move around and hold the bodies. The secured entrance was also still intact.
“All those things made it an easy solution for body overflow storage,” Vega said.
The county liked Vega’s idea and had a team dressed in hazmat suits clean up the entire old facility, including the cooler, which is capable of holding 20 bodies. Manatee County’s Property Management spent about $15,000 on the project, according to county spokesman Nick Azzara.
“Refrigerated trucks and ice rinks is not the best case model,” Saur said. “Ideally you wanted to keep the deceased in a morgue where it’s temperature controlled and secured.”
For now the old morgue sits cool and ready to be used if and when needed.
Cause of death without an autopsy
The medical examiner’s office is charged with certifying the cause of death in any case in which COVID-19 is suspected. But with autopsies being too risky, medical examiners are having to rely on records to help make their determinations.
In order for COVID-19 to be listed as the cause of death, the victim had to have tested positive. Occasionally, that requires Vega and his associates to swab victims after death.
Because autopsies are not being done, traditional autopsy reports are also not being produced in these cases. Instead, the medical examiners are writing short narrative summaries explaining the medical and other records reviewed and how the cause of death was determined.
“We’ve tried to streamline our work because having to certify every COVID death or every COVID-suspected death that comes through has been a big workload for us,” Vega said. “One way to manage that has been to decrease or streamline the rest of our work so we’re probably doing few autopsies on cases that we might have otherwise autopsied in the past and we’re certifying more deaths without viewing the bodies.”
Examples of those cases are deaths resulting from minor traumas like a hip fracture or natural deaths of seasonal residents who don’t have a local doctor to sign off on the death.
“We were already implementing some of those measures in March,” Vega said. “It reduces our workload some but doesn’t reduce it dramatically.”
Part of why those protocols were implemented so early was because there were an unusually high number of death cases in March, with 88 autopsies having to be performed.
Only a few times before had the district had so many death cases autopsied. The busiest period was in July 2016, at the height of the opioid epidemic.
“We did alter our regular autopsy protocols to minimize potential exposure during those autopsies, even if we don’t have knowledge that it’s a COVID positive case under the possibility that it could be one of those undiagnosed asymptomatic cases.”
Before the COVID-19 pandemic, surgical masks were routinely used during autopsies but the medical examiners and other staff now using more protective N95 masks. Additionally, only two people are permitted in close vicinity to any body being autopised.
The office has stopped using an aspirator and changed the way the bone saw is used during autopsies to eliminate creating an aerosols.
Sometimes bodies are even released directly to funeral homes. If a swab is needed to confirm COVID-19, it is handled at the funeral home.
Often times when a body with suspected COVID-19 is brought to the medical examiner’s office, they are often placed in two body bags to add an extra level of protection. The office also wipes down the outside of the body bag, especially in the rare occasions it needs to be opened for a swab or any sort of external examination of the body.
“We don’t routinely swab everyone,” Vega said. “If I had unlimited resources, I would swab every body that comes through here. I would take antibodies test on every body that comes through here because I think that knowledge would be useful for us.”
That data would be useful now and in the future to determine how the disease progressed locally, statewide and nationally, according to Vega.
“I think that information is going to be very helpful but we don’t have enough resources,” he said. “There weren’t enough testing collection kits and there was rationing of the tests that were being performed. We had to use our tests judicially.”
This story was originally published May 8, 2020 at 11:22 AM.
