Medical examiners and coroners bear heavy burden during the COVID-19 pandemic and often felt invisible and unsupported – KRQE News 13

by: Staci Zavattaro University of Central Florida via AP The Conversation

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(THE CONVERSATION) We stopped doing heads. It was the second time Id heard a medical examiner say this while I was studying how the roles of medical examiners and coroners have changed during the COVID-19 pandemic.

A medical examiner from Ohio explained to me that opening a skull is one of the mostdangerous parts of an autopsyin the COVID-19 era. This is because the kind of saw often used during autopsies has a beating motion that produces aerosols among theprimary modes of transmissionof SARS-CoV-2, the virus that causes COVID-19. The medical examiner explained that his office would not open a skull unless absolutely necessary for the exam and then would use a high-powered vacuum to reduce particle spread from the process.

This wasone of several policiesand practices medical examiners and coroners in the U.S. had to change when adapting to the ongoing pandemic.

In the early months of the pandemic, doctors and nurses or front-line health care workers received much-deserved praise and recognition for their heroic actions. This includedNew Yorkers banging on pots and pansevery night at 7 p.m. and Denver residents howling like wolves at 8 p.m. in support of front-line workers for months in 2020 a tradition thatreturned in 2021a year after the pandemic began.

But death care workers such as coroners and medical examiners, who also are providing critical services during the ongoing pandemic, have been far less celebrated and recognized. Yet they have been struggling under the unceasing pressure ofexcess deaths,backed-up funeral systemsandincreased data-gathering responsibilities. They have also had to take on additional tasks of reporting COVID-19 data for public health purposes. And these workers have suffered alot of burnout.

I am apublic administration professorwho isstudying public servants in death care services. My work has highlighted the need to better understand the complex roles that these medical professionals play, especially when much of their work is unseen and not well understood by the general public.

The roles of medical examiners and coroners

Since the beginning of the pandemic, medical examiners and coroners have dealt with repeated COVID-19 surges that as of November 2021have left more than 768,000Americans dead. Public health and reporting requirements following COVID-19 deaths added to these professionals already heavy workloads.

Medical examiners and coronersare public servants charged with carrying out medical, scientific and legal death investigations. Medical examiners have board-certified medical training in pathology, forensic pathology or another associated medical field and are appointed by county commissioners or other leaders.Coroners, who receive training in medical and legal investigation, are elected to their roles by voters.

Outside of the context of COVID-19, these death care workers are called in to investigate suspicious, unnatural deaths. The process of death investigation in the U.S. is complicated and bureaucratic, andeach state sets its own criteria. Some states have medical examiner systems, others have a coroner system, while still others might have a hybrid approach.

The COVID-19 pandemic has highlighted the need for additional safety precautions toreduce exposure and spreadfor the protection of medical examiners, coroners and death investigation teams.

COVID-19 and excess deaths

Throughout the pandemic, public-facing offices of medical examiners and coroners offices might have closed, following COVID-19 guidelines, but the behind-the-scenes operations accelerated. The Centers for Disease Control and Preventionestimates that COVID-19contributed tomore than 902,000excess deaths meaningdeaths in addition to those statistically projectedfor an area based on past trends in the U.S. as of late November 2021.

One challenge that became critical in the early months of the pandemic was distinguishing cause of death from manner of death.Cause of deathrefers to a specific and immediate injury, disease or condition that led to a death.Manner of deathis a medical and legal description grouping deaths into five categories for public health purposes: natural, accident, homicide, suicide or undetermined.

These distinctions are critical for accurately tracking and reporting whether someone died from COVID-19-related complications or whether someone died while carrying the virus but from another cause such as a car accident or heart attack, for example. Initially,there was no agreed-upon standardfor deciding what constituted a COVID-19-related death. As COVID-19 deaths surged early in the pandemic, some people began toquestion those numbers, given the medical complexities and unknowns associated with the virus. TheCDC eventually provided guidancein April 2020 on how COVID-19 deaths should be officially reported.

Supporting death care workers as the pandemic drags on

Research has shown that long before the pandemic medical examiners and coroners, who deal daily with psychological stressors such as handling human remains and talking with grieving families, were athigh risk of depression and post-traumatic stress. COVID-19 has taken an already stressful job andadded additional pressure.

A 2020 studycollected stories from forensic workersat the University of Michigan who had to drastically change policies for their personal safety while also finding ways to support and assist grieving families. For example, when social distancing rules prohibited in-person memorial services, the team devised thoughtful ways to use photographs to preserve a loved ones memory. For example, one biomedical photographer provided families with high-quality photos of their loved ones hands or tattoos.

The ongoing pandemic means death care workers are still providing these much-needed services to families. One quality and research manager I spoke with from a medical examiners office in Minnesota noted that people who work at funeral homes are often left out of the support network that health care professionals have received during the pandemic. People believe that health care ends at death, and it does not, he said.

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Medical examiners and coroners bear heavy burden during the COVID-19 pandemic and often felt invisible and unsupported - KRQE News 13