Even as Oregon hopes it has averted the worst outcomes of the COVID-19 pandemic, the state is starting to grapple with a new, grim challenge: managing the deceased.
Documents obtained by WW show the Oregon State Medical Examiner's Office is concerned about the state's capacity to handle more bodies in the weeks ahead. Late last week, chief medical examiner Dr. Sean Hurst predicted the state's death care facilities—hospitals, morgues and his own office—might not be prepared for the projected increase in deaths.
"Body storage capacity amongst hospitals in Oregon is limited," says a memo written by Hurst on April 3. "Body storage capacity within the State Medical Examiner system is likewise small. As a result, an increase in COVID-19 deaths will stress the death care system. A slowdown in death care services may occur both due to a restricted workforce or an increase in fatalities."
How many additional bodies, exactly, can Oregon handle? State officials don't know.
WW asked the Oregon Health Authority, the Office of Emergency Management, the Oregon Cemetery and Mortuary Board, and the Oregon State Police's Medical Examiner Division. None of these agencies knows the state's total morgue capacity.
The state medical examiner has a capacity for 70 bodies, according to Capt. Timothy Fox of the Oregon State Police. But the state's mass fatality plan discourages storage of bodies contaminated with a virus at the medical examiner's office: "The MEO morgue does not accept bodies that are contaminated, including with a biological hazard. Thus, this facility may not be available," the plan says.
In his April 3 letter, the state medical examiner recommended implementing "refrigerated trailers with tiered rack space" for additional body storage amid the COVID-19 pandemic. (Such vehicles, called "mobile morgues," have been used in New York City, where deaths are increasing so rapidly public officials are considering using a park as a mass grave.)
Oregon's mass fatality plans, reviewed by WW, indicate the state could, in dire circumstances, resort to storing bodies in airplane hangars, on state fairgrounds and at "national and air guard armories" throughout the state.
Whether the state will need to resort to such measures is unknown. In the days since Hurst's memo, projections for Oregon's COVID-19 deaths have grown sunnier, thanks to the state's residents following Gov. Kate Brown's order to stay home.
Since April 1, researchers at the University of Washington's Institute for Health Metrics and Evaluation predicted approximately 566 deaths statewide from COVID-19. On April 5, new projections from the IMHE, which accounted for more data points than earlier projections, modeled 171 deaths. At press time, at least 33 Oregonians had died from the virus—a tiny number compared to hot spots like New York.
But for weeks, gaps in Oregon's emergency preparedness and health care systems have been exposed by the pandemic. The state responded to concerns about capacity and resources by building a temporary hospital on the state fairgrounds in Salem, and pleading for private stocks of personal protective equipment and hundreds of additional ventilators (140 of which Gov. Brown sent to New York on April 4).
Hurst warned that his office, like the state's health care system, could easily be overwhelmed. He said the medical examiner would have to rely more on hospitals and private funeral homes for the storage of bodies.
"As the day-to-day operations of the State Medical Examiner's Office are not adequately staffed or resourced," he wrote, "the ability to store and process additional decedents at the state's facilities is currently limited."
Funeral homes are already feeling a strain.
Some hospitals and hospice facilities tell funeral homes when someone has died from COVID-19, while others, citing privacy concerns, do not. At Sunset Hills Funeral Home in Eugene each body is treated as if it has the virus.
"Certainly, by the time we're called, the body is still contagious," says Marc Lund, owner of Sunset Hills. "No one's seen anything like this. When we had HIV, when we had hepatitis C, when we had the flu, when we had tuberculosis—none of those things have warranted this level of caution. HIV was extremely scary—I was there. But this is just so much more contagious."
Because of the uncertainty, funeral homes must exercise an abundance of caution in preparing bodies. "I believe our staff has been in contact with people who are COVID-positive and we did not know it," Lund continues.
Sunset Hills has capacity for 10 to 20 bodies at a time. Lund says an influx of COVID-19 deaths could make business more complicated. "Let's not forget," he adds, "there's a normal amount of death that occurs in this community every day. So that's not going away."
At Terry Family Funeral Home in Portland, employees now cover the noses and mouths of the deceased when removing bodies to reduce the spread of COVID-19. The funeral home shares refrigeration with another facility, and the two businesses combined have room for about 80 bodies.
"We just deal with it one at a time. We only got so much space," says owner Dwight Terry. "We never know what people die from. By the time that we find out what people die from, we've already buried them or cremated them."
Funeral services have also been altered. At Sunset Hills, memorials can still take place, Lund says, but they are private only, they must have fewer than 10 attendees, and mourners must stand at least 6 feet apart per the governor's order. The funeral home also tries to plan digital funerals that can be livestreamed, recorded and distributed to family.
At Terry Family Funeral Home, memorial services have stopped completely.
"That's a real tragedy of COVID-19," Lund says. "It's impacting the way people grieve."
The possibility of death from COVID-19 is on the minds of Portland's frontline health care workers, who come face to face with carriers of the virus on a daily basis.
Dr. Erika Moseson, 39, a pulmonologist at Legacy Good Samaritan Hospital in Portland, sees firsthand the dangers of waiting too long to prepare for death and discuss wishes with family. Moseson treats many patients who are on ventilators, rendering them unable to communicate.
She doesn't want to find herself in that position, which is why last week she began preparing her will.
"When you can't breathe, you can't talk. So a lot of people are scared they won't be able to ask for what they want," Moseson says. "It's the worst time in the world to have a conversation. No one has time to have it before you put in the breathing tube."
A nurse at Providence Portland Medical Center, who requested anonymity because she's not authorized to speak to the press, says she reached out last week to her friend, an estate lawyer.
"She volunteered to get mine and my husband's wills in order," the Providence nurse, 45, says. "She let me know she had already done it for two other nurse friends last week. I don't know if I feel better or worse about that."
The decision to prepare her will, she says, was a result of "watching other nurses die on the other side of the country. Nurses that are the same age and healthy, like me."