I followed New York City 'deathcare' workers as they collected the bodies of people killed by the coronavirus, and I saw a growing, chaotic, and risky battle

·18 min read
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Patrick Marmo, right, and an assistant remove the body of a person killed by the coronavirus from a hospital.

Dave Mosher/Business Insider

  • New York City is the epicenter of the US's coronavirus outbreak.

  • To see how the rising death toll is affecting "deathcare" — services that families use to put the bodies of loved ones to rest — I shadowed Patrick Marmo, a funeral director from Brooklyn.

  • What I saw and heard suggest that the city's resources are strained at best. "No one in the New York City area possibly has enough equipment to care for human remains of this magnitude," Marmo said.

  • Visit Business Insider's homepage for more stories.

On a typical day, Patrick Marmo is responsible for about 40 bodies. By the end of Monday, he had 143.

Marmo, a Brooklyn native and a state-licensed embalmer of 30 years, is the founder and CEO of International Funeral Service of New York, a company based in Sunset Park, Brooklyn. It's one of the largest and best-equipped local providers of "deathcare," the term for services including removing and embalming corpses, arranging funerals, and coordinating burials and cremations.

But Marmo says New York City's coronavirus epidemic is straining his industry to a breaking point.

"I don't know how many more bodies I can take," Marmo told Business Insider. "No one in the New York City area possibly has enough equipment to care for human remains of this magnitude."

The city has quickly become the epicenter of the US's outbreak. A person dies from the virus roughly every six minutes in New York City, and that rate is likely to increase as cases peak over the next few weeks. A simulation by one leading area hospital suggested that admissions would begin to skyrocket even further on Thursday, according to a senior employee. The US government has said 100,000 to 200,000 Americans may die from COVID-19.

Handling the dead in the pandemic has become its own frontline battle. The growing body count in New York City means that available hospital morgue space is dwindling. The city may run out of overflow storage for bodies later this week, Politico reported.

In the wake of COVID-19's carnage, Marmo, his colleagues, and the grieving families they serve face increasingly precarious difficulties of their own, like whether or not they can even hold funerals.

To understand how the industry is coping with the grim situation, I spent the day with Marmo and his staff. What I saw and heard suggests the city is entering a growing, chaotic, and risky battle over its dead.

Editor's note: The following content may not be suitable for everyone, though we have blurred sensitive parts of some images. We're also withholding or redacting some names and other details of workers and the families of the deceased to protect their privacy.

Marmo is a 49-year-old native of Bensonhurst, Brooklyn, with an unmistakable accent. I met him outside the Daniel J. Schaefer Funeral Home, one of a handful of mortuary-service locations he owns across the city.

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Marmo and his 14-year-old business partner, Chip.

Dave Mosher/Business Insider

Marmo's fascination with the industry started with seeing the "Dawn of the Dead" in 1978 (he said he "didn't sleep for days"). But his watershed moment occurred as a kid, when he and a friend named Frank quietly peeked into a funeral home and watched an embalmer work on a body.

"I was like, 'Oh my God.' We couldn't believe what we were seeing, because there was a little crack in the window," he said, though workers soon spotted the kids. "They chased us, but we were young kids and we got away. But me and Frank kept going back. We kept going back."

By the time he was 15, Marmo's morbid curiosity had led to a part-time job at the funeral home.

When the funeral-home doors opened, the staff pulled up N95 face masks and put on surgical gloves.

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Joe Antiocio, International's office manager.

Dave Mosher/Business Insider

I'd brought protective gear too to reduce my risk of exposure as much as reasonably possible while shadowing Marmo and his crew. I also packed a fresh change of clothes for after the assignment.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00084

Dave Mosher/Business Insider

Phones started ringing almost immediately after the home opened at 9 a.m. — families called to seek assistance, while other funeral-home locations tried to work through logistical challenges brought on by the pandemic. An employee said they'd been working 12-hour days and apologized for the chaos.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000031

Dave Mosher/Business Insider

Space for the deceased is waning. Before the pandemic, International typically had 40 open cases on its roster. By the end of the day I visited, it had taken on 11 new COVID-19-confirmed bodies, for a total of about 22, in addition to all the other non-COVID-19 decedents whom families had asked the company to handle.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00033

Dave Mosher/Business Insider

The caseload is only part of the story, though, as it does not include completed cases (i.e., bodies buried or cremated), only those awaiting a final resting place.

By Saturday, International had 43 COVID-19 cases. By Monday, it had 71. That brought its total to 143 cases (including deaths not caused by COVID-19).

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Antiocio helps keep track of cases in International's care.

Dave Mosher/Business Insider

Within the first hour International opened on the day I visited, a family called about a loved one who'd died from complications related to COVID-19. Her body was at a hospital in Brooklyn and needed to be picked up.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000011

Dave Mosher/Business Insider

We piled into a van that the staff calls "Big Black." It's discreet by design: Few people would want to see the "BODY REMOVAL SERVICE" label emblazoned on its side.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00078

Dave Mosher/Business Insider

Still, there is a grim placard in the front window to ensure the car doesn't get ticketed or towed.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00077

Dave Mosher/Business Insider

A box of body tags sits in the front of the car.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00071

Dave Mosher/Business Insider

The van has a pneumatic lift and can accommodate multiple large bodies at a time.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00067

Dave Mosher/Business Insider

As New York City's coronavirus crisis grows, employees are filling it up regularly.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00068

Dave Mosher/Business Insider

As the rate of new COVID-19 patients outstrips hospital resources, more and more bodies are going to morgues. The city has requested emergency mortuary assistance from the Federal Emergency Management Agency, but hospitals have already begun to expand capacity. At least one hospital is using a 53-foot refrigerated semitrailer to temporarily hold overflow.

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Bodies inside an unnamed New York City hospital's makeshift morgue: a refrigerated semitrailer.

Special to Business Insider

"At the rate people are dying, I think [hospitals] are doing a good job even thinking about refrigeration," Marmo said. "With a week's notice, they've prepared pretty well."

When we arrived to pick up the woman's body, our temperatures were checked at the hospital entrance to ensure no one had a fever. The group moved past security into an office area and notified the staff that they would remove the body from the morgue.

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A nurse showing a digital thermometer used for measuring the temperatures of people who go to hospitals or public facilities.

Alfonso Di Vincenzo/KONTROLAB/LightRocket via Getty Images

Marmo wheeled out a gurney while his colleague put on two pairs of surgical gloves, a plastic gown, and a face shield. Typically, far fewer precautions are needed.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00075

Dave Mosher/Business Insider

But these days, Marmo's crew brings along a lot of personal protective equipment for workers who have to get close to bodies as they move them onto gurneys, inside boxes, and into the van.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00073

Dave Mosher/Business Insider

Some people in the deathcare industry have contracted COVID-19, though from where is not clear. "A friend of mine is on a ventilator right now — he's a funeral director," Marmo said. "That guy's fighting for his life."

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00043

Dave Mosher/Business Insider

For removals, Marmo said, he used to send one worker and a $5 bill to hand to a security guard, who would "open the refrigerator door, help verify a person's name, and help you move the body from the refrigerator." Now he sends two workers because many security staff members are too afraid to get close to bodies of people who had COVID-19.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000018

Dave Mosher/Business Insider

Marmo's team also keeps industrial disinfectant spray in the van, since it almost certainly kills the coronavirus.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00072

Dave Mosher/Business Insider

Marmo and his assistant found the body in the hospital morgue, sprayed down the bag (especially its zipper) with disinfectant, and opened it to verify the person's identity.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000019

Dave Mosher/Business Insider

They draped a disinfectant-soaked paper towel over the mouth to ensure that any material inadvertently emitted from the lungs — which harbors the disease — would be at least partly blocked.

After a graceful slide of the body bag onto the van's gurney, the team wheeled their precious cargo out of the hospital and into the van, then drove off to a funeral home.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000015

Dave Mosher/Business Insider

They took the body to De Riso Funeral Home in Brooklyn. As I wondered how they'd move the body from this parlor to a basement below ...

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00093

Dave Mosher/Business Insider

... Marmo's colleague activated a hidden pneumatic lift, which popped out of the floor.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00092

Dave Mosher/Business Insider

A narrow staircase led to the basement, where embalmed bodies awaited dressing for funeral services.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000017

Dave Mosher/Business Insider

Marmo and his colleague moved the woman's body into a refrigerator unit that's between 40 and 45 degrees Fahrenheit to slow decomposition before embalming. Then they carefully yet speedily dressed the embalmed body of a man before leaving.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00095

Dave Mosher/Business Insider

"I don't ask anybody on my staff to embalm them, because I don't want the responsibility of them getting sick on my on my hands," Marmo said of the COVID-19 patients he picks up.

coronavirus covid 19 deceased dead international funeral service new york business insider
coronavirus covid 19 deceased dead international funeral service new york business insider

Special to Business Insider

Driving around the city was surreal in many ways. The streets, for one, were empty even during the weekday morning rush hour. "The only thing on our side is no traffic," Marmo said. "It helps us be more efficient. The demand is so much greater now."

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There was no traffic during the weekday rush hour on I-278, the Brooklyn-Queens Expressway.

Dave Mosher/Business Insider

The city ordered nonessential businesses closed starting on March 22.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00041

Dave Mosher/Business Insider

Many essential businesses decided to close too, like this laundromat near the funeral home. "We will reopen once the virus has settled down," its sign read. But Gov. Andrew Cuomo has said that could take months.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00038

Dave Mosher/Business Insider

Meanwhile, New York state is running out of ventilators, space, and time. Cuomo said last week that the region may need 140,000 hospital beds in the coming weeks; it currently has about 75,000, including a newly arrived US Navy hospital ship to help meet the needs of uninfected patients.

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The USNS Comfort in New York.

Mike Segar/Reuters

Cuomo also said 30,000 ventilators were needed for patients who cannot breathe; the federal government is sending 4,000.

On Tuesday, he said that the state had ordered more from China but that it was "impossible" to get many more because of a slow federal response — and FEMA's outbidding states. (He said the distribution of ventilators now largely depends on the federal government.)

Doctors and nurses are struggling to keep older and other at-risk patients from succumbing to COVID-19. Healthcare professionals need to defend themselves from infection too, but they face a shortage of personal protective equipment such as air-filtering masks, body gowns, and face shields. Those without are resorting to trash bags, hand-sewn masks, and other improvised gear to prevent themselves from getting sick for as long as possible.

Marmo said he was trying to protect his employees and the families who visit his funeral homes. He bought mist-dusters and a barrel of a sanitizing chemical recommended by a professional. He plans to have workers in protective gear regularly spray down facilities to prevent contamination.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00047

Dave Mosher/Business Insider

"It's all hands on deck. We're just trying to keep our masks on, our gloves on, and stay sanitized and disinfect everything as much as we can," said Kareem Elmatbagi, the son of Awad Elsayed Elmatbagi, Marmo's business partner next door at Islamic International Funeral Services, which specializes in Muslim clients. "We're just praying to God that we don't catch it."

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00051

Dave Mosher/Business Insider

Kareem Elmatbagi said he was especially concerned about his father catching the virus and was trying to keep him at home. "My dad's 65. He's a kidney-transplant patient. He's diabetic. He has high blood pressure. He has heart problems. He has a really weak immune system," he said. "He's high-risk."

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00049

Dave Mosher/Business Insider

Exposure to the coronavirus is a tragic and scary complication for the families of patients who die. Those who know they've been exposed must quarantine themselves for 14 days, meaning they might not be able to attend a funeral at all.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00036

Dave Mosher/Business Insider

Others are afraid to be around the body of a person who had COVID-19 because of the risk of exposure (even though embalming fluids destroy viruses), or to be around anyone else at all.

"It's really heartbreaking right now that people can't honor their dead. It's truly sad," Thomas Cheeseman, a funeral director at International, told Business Insider. "Everybody's on hold right now because they don't know what to do. They're afraid to leave their house. Their loved one passed away from it. And now they don't want to be in the room with the loved one because they're misinformed."

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A single rose stuck in a planter outside Daniel J. Schaefer Funeral Home in Brooklyn.

Dave Mosher/Business Insider

During my day at the funeral home, I watched six family members meet to honor an elderly relative who died of the coronavirus and had been embalmed for an open-casket funeral.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00079

Dave Mosher/Business Insider

Marmo said his staff was concerned about allowing the family to have a typical service, since the city has discouraged gatherings of 10 or more people. So he limited the number of people who could attend and asked them to stay at least 6 feet apart (according to guidelines form the Centers for Disease Control and Prevention).

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000026

Dave Mosher/Business Insider

The family agreed to be photographed but asked that their names be withheld and their faces blurred. They burned a long stick of incense as part of their tradition. Relatives who were self-quarantining joined the procession via video chat.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000027

Dave Mosher/Business Insider

Everyone wore face masks and stood far from one another during the rites. It wasn't a tight, warm, and touching service — it seemed awkward and rushed, and the staff commented on how disappointed it made them feel that things had come to this.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000021

Dave Mosher/Business Insider

Even families whose relatives died of other causes, not COVID-19, are affected. International specializes in escorting decedents from other nations back home. But the pandemic has made international travel extremely restricted and complex.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00064

Dave Mosher/Business Insider

One family in particular came to mind for Marmo. "They lost a 7-year-old boy. He came here from Jamaica for special medical treatment," he said. The mother "wants to put her son to rest back home, where he's from," he said, "but she can't get a flight out."

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000020

Dave Mosher/Business Insider

"I told her that I would keep her son with me until this works out," he added.

Collecting payment from people who have lost family members to COVID-19 also comes with complications and risks. Marmo recounted the story of one woman whose husband died from the disease and who was self-quarantining at her home.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00054

Dave Mosher/Business Insider

"She said she's going to wear a mask and gloves. I told her I would do the same. She sat on one side of the dining-room table. I sat at the other. But I was really uncomfortable," Marmo said. "I was hoping she was writing a check. She gave me cash and was counting the bills, just touching them all."

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00066

Dave Mosher/Business Insider

Yet another consequence of the pandemic: Workers said the coronavirus outbreak in New York had complicated and slowed the flow of bodies from hospitals to funeral homes and families and, ultimately, to a final resting place. "We're stuck right now," Marmo said. "We're so new to this. We're in uncharted waters."

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000016

Dave Mosher/Business Insider

Cheeseman said a big factor was the COVID-19 testing speed. New York has ramped up processing, but he said it could still take days to get a result, finalize a death certificate, and obtain a permit to cremate or bury a corpse.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000001

Dave Mosher/Business Insider

Meanwhile, cremations — the most common service — are becoming a logistical nightmare, since crematoriums don't have room to store all the new COVID-19 bodies in an onsite morgue. There are only four crematoriums in the area, Marmo said, adding that they "are overwhelmed" by the new demand.

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A crematorium technician removing ashes and bones from a cremation oven.

Cole Burston/Toronto Star via Getty Images

"We have to confirm with the crematory, because they don't want to hold anything in refrigeration. We have a time slot to be there — so they'll go basically from the car right into the retort, which is the cremation oven," one International employee told me. The person asked not to be named because of the sensitive nature of their work.

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A crematorium technician carefully pouring the ashes of a body into an urn.

Cole Burston/Toronto Star via Getty Images

Back at International's office, I learned that two more COVID-19 bodies had been called in to be picked up from the hospital we'd just left. Cheeseman showed me a few photos on his phone of tent facilities popping up outside hospitals all over the city — for "containment and testing," he said. "And temporary morgues," a colleague added.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000005

Dave Mosher/Business Insider

Bodies in various states of preparation waited inside one of International's morgues. Boxes of COVID-19 bodies awaiting cremation were very evident. There didn't seem to be much space left.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00099

Dave Mosher/Business Insider

New York City's Office of the Chief Medical Examiner is exploring contracts with vetted funeral homes to help with body removal and other mortuary services. "They only have so many transport vehicles," Marmo said. "So it makes sense for them to make an alliance with funeral directors that have the capability of doing transports."

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000007

Dave Mosher/Business Insider

OCME did not immediately respond to queries from Business Insider about this.

An employee said International typically has a maximum capacity of about 90 bodies at a time. But the industry is having to get creative with finding new space. "We're overwhelmed. Everybody's overwhelmed. All of the funeral directors I've spoken to are overwhelmed," Marmo said. "I never thought I would go through anything like this."

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00065

Dave Mosher/Business Insider

For now, some funeral homes have resorted to unused chapel space and other spaces for storing boxed bodies that are imminently headed to a crematorium.

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coronavirus covid 19 deceased dead international funeral service new york business insider 00103

Special to Business Insider

Marmo said it would help if the local or state government set up temporary refrigerated morgue facilities around the city to support private-funeral-home overflow — perhaps chilled tents or semitrailers. "It's still cool out," Marmo said. "If this extends to May or June, how are we going to do this?"

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Workers construct what is believed to be a makeshift morgue behind a hospital in Manhattan on March 25.

Carlo Allegri/Reuters

Marmo added: "I've thought about putting a refrigerated trailer outside the funeral home. But that's horrendous."

Marmo said that if more refrigeration space doesn't come when cases really begin to spike in April and May, a state order to send bodies straight to a crematorium or grave site instead could help people like him handle the volume with integrity. But families would then have to sacrifice funeral services.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00060

Dave Mosher/Business Insider

Marmo is frustrated by and worried about the situation. After the terrorist attacks of September 11, 2001, he said, families could at least get together to honor their loved ones, especially those who'd served. "There's no way they're going to have full police funerals now. There's no way," he said. "After 9/11, at least they were giving people funerals they deserved."

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Firefighters carry the casket carrying New York City Fire Department Chief Peter J. Ganci into St. Kilian Church for his funeral in Farmingdale, New York, on September 15, 2001.

Reuters

Marmo said people sometimes tastelessly joke that his business must be great because of the pandemic, but he strongly disputed that notion.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000028

Dave Mosher/Business Insider

"It's kind of balancing out, because overtime is going to be crazy," he said of his employees working around the clock. "These guys out there and girls? They're breaking their asses."

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 000014

Dave Mosher/Business Insider

After my visit, I wiped down just about every nook and cranny with sanitizing wipes. I also completely changed out of my clothes before leaving.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00097

Dave Mosher/Business Insider

I took a decontaminating shower when I got home, then collapsed from emotional exhaustion. Funeral directors are used to dealing with death, but I was not. And it was abundantly clear to me that much more is yet to come.

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coronavirus covid 19 deceased dead international funeral service new york dave mosher business insider 00090

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