The Jakarta Post
The increasing number of deaths from COVID-19 has profoundly altered the daily pace for those who work to provide mortuary services.
Employees at Palang Hitam (Black Cross), which provides services in the capital to transport the bodies of the deceased from hospitals to cemeteries, said they had grown busier over recent weeks.
Home to around 10 million people, Jakarta has emerged as the epicenter of the COVID-19 outbreak in Indonesia, with 472 confirmed cases and 899 patients under surveillance (PDP) at the time of publishing, according to its dedicated website.
The death toll in the capital has now reached 46 according to the nation's COVID-19 accelerated management task force, or 59 percent of 78 deaths attributed to the disease in the country.
Data on deaths among suspected cases is unavailable.
“During the first days of the COVID-19 outbreak, we received [just] one call per day to pick up the body [of someone who had died of COVID-19], but now it is around 10 a day,” said Nur Syamsuryah of Palang Hitam.
He added that he and other Palang Hitam workers treated most of the bodies with extreme caution, as if they were unconfirmed cases pending post-mortem test results.
Before the outbreak, Palang Hitam primarily collected and transported the bodies of victims of traffic accidents and homicides, as well as unidentified or unclaimed bodies from hospitals. They also helped transport the bodies of nursing home residents who had died far from their families, as well as those of beggars and the homeless at shelters.
Syam said that Palang Hitam typically provided its services from one or two bodies up to a dozen bodies each day before the COVID-19 outbreak.
“Now, it is like we are always going back and forth transporting bodies from hospitals to cemeteries,” said Syam, recalling that his team had transported 25 bodies on Sunday.
Out of these, 15 were the bodies of people who had either tested positive for the virus or were suspected of having contracted the disease.
Syam and his fellow colleagues, however, declined to supply the cumulative number of the bodies of COVID-19 patients that they had transported to date.
Palang Hitam has 48 employees that are responsible for providing a variety of mortuary services, from washing and preparing the body to driving the hearse.
However, only 25 employees – all under 50 years old – are permitted to handle COVID-19 cases. The staff at hospital morgues help out by preparing the bodies for collection and transportation by Palang Hitam.
With half the team focused on managing COVID-19 cases, Palang Hitam's workers are now worried about how the team will perform, assuming that the outbreak has yet to peak.
“We are overwhelmed, but it’s not like we cannot accept more work. I'd say we could cope well even if we were to handle 20 [cases] now, but we cannot predict what will happen later,” Syam said.
“I'd guess we haven't yet peaked,” his colleague Wahyudi added, referring to the team's capacity.
Wahyudi said that the virus was unlikely to be transmissible after death, as long as the staff at hospital morgues and Palang Hitam followed the proper procedures as set by the Jakarta Health Agency.
The health agency’s procedures require that a body be wrapped in multiple layers of linen and then in plastic sheeting before it is placed inside a coffin. The outside of the coffin should be sprayed with disinfectant before the coffin is enclosed in plastic, and the agency prohibits anyone from removing the coffin from its external wrapping.
Palang Hitam employees must wear disposable masks and gloves at the very least for personal protection. After they have finished work, they are also sprayed with disinfectant. Meanwhile, the used masks and gloves are burned at a cemetery and the hearse is also disinfected.
In addition, Palang Hitam workers must finish collecting and transporting COVID-19 cases within four hours.
“We are not worried about [the risk of transmission] from the bodies," said Wahyudi. He noted that the team was more concerned about the risk of risk was transmission from the deceased's family members and relatives, "since they are the ones who have been monitoring the patient closely". "They might have been [exposed to the virus],” said Wahyudi.
The SARS-CoV-2 virus that causes the disease is transmitted mainly by respiratory droplets that are expelled when an infected person sneezes or coughs. It is unclear how long the virus stays active after death, and the risk of infection is as yet unknown from handling the body of a person who died of COVID-19 or related complications.
The World Health Organization (WHO) has stated in its interim guidelines that “there is no evidence of persons having become infected from exposure to the bodies of persons who died from COVID-19”. The WHO guidelines recommend that all workers involved with preparing a body properly use personal protective equipment like disposable gloves, masks and impermeable gowns.
The Jakarta administration has allocated Pondok Ranggon cemetery in East Jakarta and Tegal Alur cemetery in West Jakarta for burying the bodies of people who have died of COVID-19.
The Indonesian Red Cross (PMI) is also available to provide mortuary transportation services for burial at other cemeteries, as long as the family of the deceased arrange the required paperwork and adhered to precautionary measures.
Wahyudi said that collecting the bodies of people who had died of COVID-19 was sometimes uncomfortable, as Palang Hitam staff might need to convince the surviving family members to release the bodies to their care.
“Some families insist on taking the bodies of the deceased home [for the wake] or to a funeral home themselves, without proper [procedures]. There is a chance that they could open the coffin,” he said.
Jakarta has temporarily closed public facilities to prevent mass gatherings as part of its physical distancing policy, and this includes cemeteries as well as restricting attendance at funerals.
Ricky Putra, the head of the Jakarta Park and Forest Agency's data and information center, said that cemeteries were only permitted to open for burial services attended by only a small number of direct relatives. Cemeteries were closed to ziarah (grave visiting) from March 14 to 30.