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on the surface of or within a deceased body, a precautionary approach to handling bodies with infectious disease may be needed. Death care professionals trained in the handling of infectious disease patients will already be versed in applying appropriate measures to reduce exposures but the number of deceased requiring additional precautions can increase in a pandemic where mass fatalities occur. Where there is widespread community transmission, death care professionals may not be aware of infections in patients who were asymptomatic or presymptomatic prior to death; therefore, they may need to apply precautionary measures for all deceased persons. Routine IPAC procedures, and processes for managing deceased with infectious respiratory disease are widely known to death care professionals and those charged with the various stages of transporting deceased, preparing them for burial or cremation, and conducting funeral services. In a pandemic involving a novel virus such as SARS-CoV-2, information is evolving at a rapid pace, and more research is needed to fully understand how the virus can be transmitted during death care. Additional risks can also arise that are associated with contact with the infected living. Mass gatherings such as funerals should be managed in a manner to reduce transmission risks amongst mourners and death care professionals. This can include additional measures to ensure physical distancing and enhanced hygiene are observed. Families, mourners and religious officials may need guidance in applying measures, such as advice on hand hygiene, the use of PPE, and safe distancing practices. Going forward, anticipating future waves of a pandemic, or new pandemics, is difficult. Planning for risk-reducing measures can help to avert future shortages of PPE, storage facilities, and personnel. This may include securing supply chains for materials or updating staff training for death care employees. Municipalities may consider contingencies for storage of the dead by reviewing existing plans for mass fatality events. In addition, the longer-term effects on mental health of those involved in the death care sector, as well as families and loved ones that have not been afforded a typical grieving and bereavement process, may need additional mental health support. The urgency with which the funeral process must be conducted, restrictions on some cultural or religious practices, the lack of ability to grieve with other family members and loved ones, or the exclusion of some loved ones due to quarantine restrictions or limits on attendees may have long-lasting effects for some (Ingravallo, 2020). Death care practitioners or religious leaders may be needed to assist in following up with families or to assist in signposting to bereavement counselling (Public Health Agency of Canada, 2020a; Wang et al., 2020). In turn, psychosocial support may be needed for death care professionals, which could be coordinated in partnership with death care industry bodies. Information was requested on the SARS-CoV-2 transmission risks for individuals who are involved in the handling, transport, and examination of decedents known or suspected to have been infected with COVID-19 at the time of death. The following questions guided the inquiry: How long does SARS-CoV-2 persist on the surface of a body, or in bodily tissues or fluids, that may be encountered post-mortem? Is there evidence for transmission of SARS-CoV-2 from a deceased person to others? Is there evidence that persons involved in the handling, transport, and examination of decedents are at higher risk of COVID-19 infection or mortality? Disclaimer: The information provided here is for the purpose of addressing a specific inquiry related to an environmental health issue. This is not a comprehensive evidence review and has not been subjected to peer review. The information offered here does not supersede federal, provincial, or local guidance, regulations, or occupational health and safety requirements and/or the advice of a medical professional (where applicable). In May 2020, a paper “Death care during the COVID-19 pandemic: understanding the public health risks” reported on the potential risks of exposure to SARS-CoV-2 in death care services and the associated guidance and good practice recommendations for reducing transmission risks. Standard precautions and good practice to reduce transmission risks of infectious diseases are a mainstay of death care professions. Throughout the COVID-19 pandemic, approaches that range from “business as usual” to more extreme precautionary approaches have been taken when handling decedents with known or suspected COVID-19 infection.1,2 This has included the avoidance of procedures such as autopsy in some jurisdictions, despite the potential medicolegal and research benefits of performing such procedures. Other jurisdictions have modified their approaches and protocols for handling decedents. The current inquiry updates the evidence since May 2020 for COVID-19 transmission risks associated with the handling of dead bodies. Guidance and good practice recommendations are not reviewed in this inquiry but are presented in the May 2020 paper, with an updated list of key references included at the end of this document.2-23 What we know about COVID-19 transmission
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