Rituals of grieving rewritten in wake of SARS deaths

TORONTO -- She stood at her car, watching from a distance, as three relatives -- a woman, her daughter and her grandson -- were buried after they died of SARS. The funerals were held outdoors, because survivors had been advised it was better to avoid mourning in a confined space. The deadly virus can spread with coughs, hugs and tears.

"Everything was held at the grave site," said the woman, who said she did not want to be identified because of the social stigma attached to SARS, severe acute respiratory syndrome. "We arrived at the cemetery and we stood by our cars. After the burial had proceeded halfway, we gathered at the grave site. In our religion it is important for family and friends to participate in the actual burial, in burying the person, in putting earth into the grave. But in these cases, a bit of distance needed to be maintained."

The SARS epidemic changed the way people grieve for their dead. In Canada, the only country where the virus has killed people outside of Asia, precautionary guidelines have been issued for mourners and funeral homes. In some cases, it has been advised that the living not wash the dead, as their religion may require. In some cases, government health officials have instructed funeral directors to conduct procedures without embalming bodies. Some coffins have been closed, others have been sealed behind glass for viewing. Some funerals have been postponed because mourners were ordered into quarantine.

While the World Health Organization has announced that the epidemic of the respiratory disease is under control in Canada and elsewhere, people are still dying. In Toronto, the number of deaths attributed to SARS is now 38. And officials warn that some people hospitalized in critical condition also may die. SARS has killed 809 people worldwide, according to WHO statistics. As the deadly outbreak wanes, survivors are still dealing with its emotional toll. The virus, officials say, has devastated some families.

"There may be multiple deaths in some families," said James Young, Ontario's commissioner of public security. "It has been a very traumatic and difficult situation."

Young said public health officials have asked funeral directors to handle bodies as if they were contagious. Officials said any new epidemic brings questions about how to deal with the dead.

"If they know it is SARS, it is probably not a good idea to embalm the body," Young said. "We don't know enough about the virus. We assume the virus dies when the person dies. But we don't know. ... It is out of an abundance of caution."

Similar to AIDS

Young said officials have dealt with the same issues in cases of AIDS, tuberculosis and hepatitis.

Officials said that final funeral arrangements still are left to families and that they have not mandated burial procedures. But if embalming takes place, it should be conducted "using full respiratory precautions including gloves, gowns, masks and goggles," according to a public health advisory published here. "Although we have no evidence of risk to staff who are using these precautions, it may be prudent to avoid embalming the body if possible."

Toronto officials have quarantined several people who attended funerals or wakes of SARS victims.

"We are concerned about the living and the dead," said John Kane, president of R.S. Kane Funeral Home. "Generally families have been quite understanding about our questions about the deceased person. Many of our families, if they have been exposed, they are quite good about taking the quarantine or postponing the funeral."

In some religions, an open casket is important, allowing the mourners to view the body. Some rituals include bowing or kissing an icon placed on the chest of the deceased.

With SARS, some clergy have excused family members from mourning traditions.

"Our Jewish traditions teach us that it is our duty to attend a funeral and to visit a shiva house to give our condolences," Benjamin's Funeral home in Toronto said in a SARS advisory. "However, any individual who may be infected with SARS, or simply not feeling well would be well advised not to attend either the funeral or the shiva."