Death has been a devastating part of the COVID-19 global health crisis. As of April 20, according to the Center of Disease Control and Prevention, there have been 720,630 confirmed cases of the coronavirus disease and 37,202 deaths caused by the disease in the United States.

Behind the numbers of cases and deaths related to COVID-19 are human beings with loved ones and families. Efforts to mitigate the spread of the disease stops COVID-19 positive patients from receiving visitors. And in the event of their decline, people who pass away due to the disease do so relatively alone — without the physical support of their loved ones.

Those loved ones are not able to say their goodbyes gathered around the bedside, nor are they able to lay the deceased to rest with a memorial service, or any of the customary practices. Further, funeral homes in areas such as New York City are facing an extraordinary predicament of being unable to accommodate countless families seeking to funeralize their loved ones – those who passed away as a result of COVID-19, and those who passed away from other causes. This creates an unusual circumstance for those who care for the living and the dead.

Mylon Medley, assistant director of the North American Division communication department, spoke to Wille Bethea, a funeral home director based in Harlem, New York and Eric Moore, the executive medical director of hospice care for AdventHealth in Altamonte Springs, Florida. Both regularly work with the realities of dying and death.

Willie Bethea — Amsterdam Memorial Chapel

Mylon Medley: How long have you been in the funeral home business, and what’s the name of your funeral home?

Bethea: I’ve worked in this business for more than 30 years. I’m the director of Amsterdam Memorial Chapel in Harlem, New York, but I work with Benta’s Funeral Home as well, which is also in Harlem.

On average, how many services have you performed between the two homes over a year?

I’d say 400-500 a year.

How have your clientele increased since the coronavirus disease began spreading rapidly throughout New York City?

We’ve seen about a 60 percent increase so far this year in general. Half of those cases are directly related to COVID-19, which seemed to really pick up overnight around two months ago.

Have you or your industry, especially in New York, experienced anything like this in the past?

Never. We’ve never seen anything like this. Just this week we had to turn away four families because we’re unable to conduct any more services this week.

Let’s talk about staff for both homes. What additional precautions have you taken? Is there any evidence of the virus living in the body postmortem? Have your colleagues been personally affected by the disease?

We always wear protective gear when handling the bodies — gloves, masks, shields. There isn’t any clear data on how long the virus stays in the body. That’s why we try to be extra careful with washing our hands.

Three of our staff contradicted the virus but are expected to fully recover. One other member of our staff is doing a self-quarantine because of exposure. Since we’re down so many people, it’s impacting how many families we’re able to take on.

What are services like with mandated social distancing measures?

We can only allow up to 10 people in the chapel at a time. Cemeteries only allow one person at the grave site, and cemeteries for veterans only allow funeral directors.

How has the grieving process changed for families?

I lift up all the families we serve in prayer. This not normal; it’s not business as usual. What we try to do is prepare them. The main thing we tell them to do is remember their loved ones before their decline. It’s especially sad because people who pass away from COVID-19 die alone since hospitals aren’t allowing visitors. That said, a lot of families are choosing to do direct burial or direct cremation and planning to hold a memorial service later.

What keeps you focused and willing to serve?

I depend on the Lord. I remind myself I’m covered by His blood.

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Dr. Eric Moore — AdventHealth Hospice Care

Mylon Medley: What role do you have at AdventHealth?

Moore: I am the executive medical director of AdventHealth Hospice Care of Central Florida, which is located in Altamonte Springs, Florida.

Do you have any patients with COVID-19?

We hadn’t seen any patients that were positive until April 5. Hospitals are taking extreme precautions in moving COVID-19 positive patients who are on ventilators to our unit so that they minimize the risk of transmission during transport.

As for how social distancing measures related to the coronavirus are affecting our unit ­—unlike the hospital, which is not allowing visitors except in some circumstances, in hospice we allow one designated family member to visit. Thankfully, like the hospital we are also able to use FaceTime or other video or phone messaging programs to help patients stay in touch with loved ones. In hospice, we tend to really believe that hearing is the last things to go. We feel that it’s really beneficial if the loved one hears the voice of a family member during that time.

Do you think your expertise will be called upon to use outside of your unit as AdventHealth addresses the coronavirus disease in the Orlando area?

Depending on what the surge brings and how long it lasts, we may need to adjust our capabilities. That could include hospice management for more beds then we are used to. Based on the most recent modeling and projections, we are not expecting the surge to overwhelm our facilities.

Our biggest challenge is the fact that patients will have loved ones that cannot be close to them during this time. This is a major life event where they may not be able to have support at the bedside. That’s where we come in.

What will you provide?

As is our practice, we aim to relieve symptoms that are unpleasant and provide a place of dignity and comfort for the patient.

We surround them with a multidisciplinary approach. We not only have physicians and nurses, we also have chaplains, and social workers.

We even have bereavement counseling for families. That’s going to be a huge deal in the next few months. Some families are dealing with multiple family members who are passing away due to the disease. The fact that families won’t be able to say goodbye directly may cause “complicated grief,” which is when a person is unable to function normally. They may experience intense crying, anxiety, headaches, or various physical symptoms. It manifests when there is an unsettled understanding of the circumstances related to the death.

What role is your faith playing during this unprecedented time?

I look at hospice as a ministry. It’s a privilege. It’s a time that is so unique in our human experience. We realize a lot of times the hospice physician will be the last physician a person will interact with. That is a huge responsibility.