This guidance contains information for:

• those who are managing a death in secondary care
• general practitioners (GPs) managing a death outside of a healthcare setting
• members of the public who identify a death in the community
• staff in residential care settings including care homes and hospices
• first responders managing a death in the community
• those involved in the transportation of the deceased
• funeral directors and others managing a death in the community, including those organising transport for mourners
• those who are participating in or supporting faith and belief practices that involve close contact with the deceased
• those who are organising transport to and from a funeral

This advice is designed to assist people who are required to manage the bodies of deceased persons during the coronavirus (COVID-19) pandemic. This guidance has been developed to ensure that:

• the deceased are treated with sensitivity, dignity and respect
• people who need to come into contact with the deceased or who work in services providing care for the deceased are protected from infection

Despite the additional precautions required as a result of the coronavirus (COVID-19) pandemic, every effort should be made to treat the deceased with sensitivity, dignity and respect.

• a body bag, coffin or cloth wrapping should be used to manage the risk of contact transmission
• if neither body bag nor coffin has been used, cleaning of the vehicle

This includes mortuary staff, pathologists, anatomical pathology technologists, funeral directors and embalmers and appropriately trained volunteers.

Following a risk assessment of potential post-mortem risk pathways, PHE has developed this guidance with specific reference to the Standard Infection Control Precautions (SICPs) and Transmission-Based Precautions (TBPs) set out in the HSE guidance on managing infection risks when handling the deceased.

The HSE guidance provides advices on the risks of infection from work activities involved with handling the deceased. It also provides guidance for those involved in funeral services, including embalmers, and those involved in the exhumation of human remains.

It covers the safe handling, storage and examination of bodies in hospitals, mortuaries and post-mortem rooms. HSE guidance is not specific to coronavirus (COVID-19) but the SICPs and TBPs described are sufficient for managing the risk with additional precautions taken for Aerosol Generating Procedures (AGPs).

Those handling the deceased should be aware that there is likely to be a continuing risk of infection from body fluids and tissues in cases where coronavirus infection has been identified or is suspected.

For those for whom care of the deceased is part of their faith, rituals such as viewing, keeping watch and hygienic preparations such as washing are an important part of the mourning process. We strongly advise that any rituals or practices that bring people into close contact with the deceased with suspected or confirmed coronavirus (COVID-19) should be undertaken using appropriate PPE under supervision of somebody trained in its use.

Given the increased risk of severe illness for clinically vulnerable people from coronavirus (COVID-19), it is strongly advised that they have no contact at all with the deceased and do not participate in any activities such as washing, preparing or dressing the deceased.

The grieving process and related formal and informal rituals, through which the bereaved mourn the passing of loved ones, are important for the health and wellbeing of the bereaved. Guidance on how to manage a funeral during the coronavirus (COVID-19) pandemic has been developed to balance the needs of the bereaved to mourn appropriately, whilst minimising the spread of coronavirus (COVID-19) infection.

Advice on cleaning and disinfection for the mortuary and similar work place environments is available in the HSE guidance Managing infection risks when handling the deceased with specific reference to appendix 3. This should be read in conjunction with Department of Health (2013) guidance Environment and sustainability. Health Technical Memorandum 07-01: Safe management of healthcare waste which provides information about how to manage waste that can be characterised as clinical waste, the guidance includes practical advice and examples for classifying waste, in particular the infectious and offensive waste streams.

The use of jet washes should be avoided due to the potential for aerosol generation.

Viewing, hygienic preparations such as washing, post-mortem investigations and embalming are all permitted when overseen or undertaken by those trained in handling bodies of the deceased. Those managing the deceased should ensure they can maintain a safe distance (2 metres) from others in the work environment. Embalming can take place when necessary, with appropriate consideration of procedures which may be aerosol generating.

Cremation is permitted. Where the deceased has a medical device that requires removal prior to cremation this should be done using PPE as detailed in Table 1. The majority of medical device removal will require droplet precautions only (for example, pacemakers and intrathecal pumps). Where there is the potential for aerosol generation through the use of high speed tools or the removal of fixion nails, PPE should be used as indicated in the RCPath and AAPT guidance for autopsy procedures (as described in the 2nd column of Table 1 below).