MIAMI — As the coronavirus threatens to overwhelm Florida’s medical system for the living, the outbreak could also affect the doctors who deal in death.
The Miami-Dade Medical Examiner’s Office may not wind up doing many autopsies on the inevitable COVID-19 deaths, but it nevertheless plays a vital role, issuing death certificates for those who succumb to diseases threatening the public’s health.
So forensic pathologists must work closely with doctors at hospitals, all while trying to stay healthy themselves to still be able to conduct autopsies on people who die in other ways — such as car accidents, shootings and suicides. Those autopsies are continuing as normal, while experts say the risk of a pathologist catching COVID-19 during the procedures is low because the doctors normally wear masks, gloves and gowns anyway.
There’s another reason the Medical Examiner’s office may be crucial: if deaths in Florida spike from the highly contagious respiratory disease. When people die outside of a hospice or hospital, the ME’s office typically takes charge of the body.
“We want to make sure we have adequate room in our coolers to accommodate bodies,” said Dr. Emma Lew, Miami-Dade’s chief medical examiner.
Based on what has happened in Europe, the United States could see a deluge of deaths.
In Spain, the number of dead has been so overwhelming that an ice-skating rink has been turned into a temporary morgue to help store the bodies. Hospital morgues in Italy have run out space, leading to lines of coffins at graveyards as corpses await cremation. Britain is setting up temporary morgues to handle the expected corpses.
COVID-19, the illness caused by the coronavirus, has been overwhelming in states such as Washington and New York, the latter now considered the U.S. epicenter of the outbreak.
The state of New York, as of Tuesday morning, had tallied 25,665 cases — and 157 deaths. In New York, the bodies of the victims, so far, are being stored in hospital facilities before being turned over the funeral homes.
Still, New York City’s Office of the Chief Medical Examiner, the largest in the country, has plans in place for mass deaths, which include expanding morgue and autopsy space via collapsible tents. That’s what happened after the terrorist attacks on Sept. 11, 2001.
New York’s Medical Examiner’s office has already closed “forensic biology, molecular genetics, toxicology and histology labs,” except for cases of priority public safety. Investigators and staffers are armed with extra protection gear as they respond to the normal caseload in the city, and body bags get extra disinfectant when they are brought into the morgue.
There isn’t a national uniform system of medical examiner’s offices — it varies from state to state, and sometimes county to county. Generally, medical examiners handle all unnatural deaths and natural deaths that happen outside a doctor’s care, like the elderly man who dies of a heart attack in his sleep at his home.
Most medical examiner’s and coroner’s officers won’t need to do autopsies because the deaths are considered natural, said Dr. Sally Aiken, of Spokane, Wash., the president of the National Association of Medical Examiners.
But if the pandemic escalates — and most health experts believe it will — more people may die in their homes across the United States, where there’s already an acute shortage of forensic pathologists to go around.
“Of course, with escalation of the pandemic, medical examiners and coroners will help the communities in this public health crisis, because of expertise in handling the dead,” said Aiken, the medical examiner in Spokane. Washington state has been extremely hard hit by the virus. “There may be need for increased body transport and storage, for example.”
In Florida, medical examiner’s offices have jurisdiction over all cases of deaths involving “diseases that are a threat to the public health.”
Lew’s office will need to certify each COVID-19 death, although the bodies won’t necessarily be brought to the county morgue for an autopsy. If bodies outside hospitals are suspected of having the virus, nasal swabs are being taken and sent to federal health authorities.
As of 6 p.m. on Tuesday, Florida had recorded 1,467 confirmed COVID-19 cases, with 20 deaths. Broward County has recorded three deaths. Broward Medical Examiner Dr. Craig Mallak declined to do an interview; in an email, he said the county would not authorize him to do one.
In Miami-Dade, there hadn’t been any COVID-19 deaths as of 6 p.m. on Tuesday, although there have been at least five pending cases of “persons under investigation,” deaths that are at least being explored as having links to the virus, Lew said.
Another five were suspected of possible COVID-19, but tests came back negative.
One of those was a 21-year-old man who had recently come back from a cruise and was admitted to Kendall Regional Medical Center with flu-like symptoms. He died. The hospital notified Miami-Dade detectives and the medical examiner’s office, although the body remained at the hospital and a COVID-19 test came back negative.
Across Miami-Dade County, police detectives and crime-scene technicians are still responding to death scenes that are not related to COVID-19. Investigators have gotten more hand sanitizers and white protective suits, just in case they have to go inside a hospital for an unclassified death.
Homicide detectives are also being careful about getting too close when interviewing witnesses and relatives of the dead.
“They are more aware of their surroundings,” said Miami-Dade Lt. Joseph Zanconato, of the homicide bureau. “Maybe instead of an interview in an enclosed space, they might conduct an interview with next-of-kin in an open space.”
At the Miami-Dade Medical Examiner’s Office, across from Jackson Memorial Hospital, nonessential staff is working from home, with forensic pathologists still conducting autopsies like normal.
“For the time being, we just have to be on the alert of any employees who have symptoms and temperatures because, of course, we are in close contact inside a room and we have to really work with each other,” Lew said.
So far, there’s no evidence that COVID-19 poses any significant risk for transmission after death for forensic pathologists.
The illness is most often spread from a living person when he or she coughs or sneezes within six feet or someone else. “This route of transmission is not a concern when handling human remains or performing postmortem procedures,” according to the U.S. Centers for Disease Control and Prevention.
Aiken, of the National Association of Medical Examiners, said forensic pathologists are used to handling bodies infected with other dangerous viral diseases such as HIV and hepatitis.
“I personally have no concern about contracting COVID-19 while performing an autopsy in full (personal protective gear) — surgical gown, face shield, N-95 mask, shoe covers, head cover, 3 pairs of gloves,” Aiken said. “My risk of acquiring COVID-19 is greatest when I’m in the community, just like everyone else.”
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