DALLAS – The first patient to be diagnosed with Ebola in the United States died from the disease Wednesday and now Texas health officials are facing a situation they have not before experienced: how to handle a body that could remain highly contagious for several days.
Thomas Eric Duncan, 42, had been in isolation at Texas Health Presbyterian since Sept. 28. His death comes four days after his condition was downgraded from serious to critical.
Duncan had been on a ventilator for several days and was receiving kidney dialysis. Last weekend he started receiving an experimental drug called brincidofovir. There is no known vaccine for the Ebola virus.
Within hours of his death, the Texas Department of State Health Services said Duncan's body would be cremated using strict protocols recently issued by the federal government.
“We will continue to treat Mr. Duncan with dignity and respect, and we're taking great care to make sure there is no additional risk that others could be infected,” Dr. David Lakey, Texas health commissioner, said in a written statment.
Officials said the plan to cremate was approved by Duncan's family.
“The cremation process will kill any virus in the body so the remains can be returned to the family,” Lakey said in the statement. “No protective gear is needed to handle the remains after cremation.”
In early August, medical missionary Kent Brantly became the first U.S. patient to be treated for Ebola after he contracted the disease in West Africa and was transported to Emory University Hospital in Atlanta.
Soon after, the CDC published a document titled “Guidance for Safe Handling of Human Remains of Ebola Patients in U.S. Hospitals and Mortuaries,” which states that the “handling of human remains should be kept to a minimum.”
Because Ebola is transmitted by direct contact with bodily fluids, the CDC recommends hospital staff should not attempt to clean the deceased or remove any medical lines or tubes. Instead, “the body should be wrapped in a plastic shroud” and immediately placed in two thick and zippered leakproof bags for transport to the morgue.
What this means for family is likely no chance to mourn loved ones at a traditional funeral service.
The CDC recommends autopsies be avoided, and that no embalming be performed.
It’s been a topic of discussion at the Dallas Institute of Funeral Service, where Wayne Cavender is an instructor and administrator.
“Since they don't have a good handle on controlling the disease itself, they are worried about an epidemic,” Cavender told Yahoo News. “So that's one way to help keep it from going further. Because if we embalm, we are going to come in contact with all the body fluids and everything. With universal precautions we shouldn't, but accidents happen on occasion.”
Instead, the CDC says, the “remains should be cremated or buried promptly in a hermetically sealed casket.” The casket must secure “against the escape of microorganisms” and have valid documentation for being airtight.
“There's really not an airtight casket,” said Cavender, who has been in the funeral business for 28 years.
“The sealer caskets that they sell are not a guaranteed-type of sealing issue. It's not completely airtight because you have to have a way to open them up and so forth. It's not like it's vacuum-sealed,” he said.
But the CDC warns that at no point should the sealed bags or casket be opened for viewing.
Duncan had recently traveled to Dallas from West Africa where the World Health Organization estimates that Ebola has killed more than 3,400 people this year. Health officials say ritual burials, where family members wash the body beforehand, in some African countries has caused the epidemic to spread faster.
Cavender said he fully supports the CDC’s stringent standards for this country, but knows it could cost a family a proper goodbye.
“Everybody needs to bury their dead and have a funeral and viewing if that’s what they want,” he said. “That's the government saying you can't do that. It's very unfortunate for the family in that case.”
The CDC has issued similar burial protocols in previous years when illnesses stoked fears of epidemics.
Mary-Catherine Duffy of Rhode Island said her aunt, Maureen Fitzgerald, had to be buried without being embalmed after dying of Creutzfeldt-Jakob disease, an incurable neurological disorder, in 2003.
“Nor could her brain be biopsied due to the fear of contamination of others,” Duffy told Yahoo News by email.
While her family didn't get the funeral they might have preferred, Duffy said she wants anyone in a similar situation to be comforted by knowing that health officials are making the right decisions.
“It is absolutely a heartache and tragedy for the family, however the health of the living should be the priority,” Duffy said. “Mourning can happen in many different ways, tradition sometimes needs to take a backseat, unfortunately. We have her memories to celebrate, and most importantly, no one else was put at risk.”
(This story originally published on Tuesday, Oct. 7, and was updated on Oct. 8.)