NZ ready for outbreak scenario of 38k deaths

The Government’s general pandemic plan prepares for 38,000 deaths over an eight-week period, with 10,000 of those deaths happening within seven days during an outbreak’s peak.

The Ministry of Health’s New Zealand Influenza Pandemic Plan sets outs the all-of-government strategy and framework for action in the scenario of a pandemic. The comprehensive plan is actioned when a pandemic strikes, and could be used to curb the spread of coronavirus throughout New Zealand.

On Wednesday, the ministry’s director-general of health, Dr Ashley Bloomfield, confirmed eight new cases, which brought the total number of people infected with the virus to 20. The eight cases, which included four in Auckland, two in Waikato, one in Christchurch and one in Invercargill, were associated with overseas travel. Contact tracing for the people sitting near these people on the flights is under way.

The pandemic plan has been in existence since 2002, but has undergone substantial revision since, due to the evolving threat from various diseases and the subsequent all-ofgovernment programme of pandemic planning and exercises that have been implemented.

It details the central government response to a range of issues from the economy, health, defence, work streams and, in the event the disease cannot be contained adequately, mass deaths.

In the United States, mourners are now urged to limit funerals to a small number of people and to let the remainder watch remotely.

But the reality of mass deaths is being felt in Italy, where the pandemic has claimed more than 2500, with 475 dying over a single day.

New Zealand’s plan states that funerals and tangihanga will not be banned. However, there is legislation available to the Government that could override that.

Normally New Zealand averages 599 deaths per week, but if the death toll rises rapidly then core services will become strained and delays are to be expected.

‘‘The standard planning model for a severe pandemic assumes about 38,000 deaths over an eight-week pandemic wave, with approximately 10,000 in the peak week,’’ the document states.

‘‘Clearly, this will have an impact on normal services for dealing with the deceased. Normal DHB emergency planning processes include provision for managing larger than normal numbers of deceased.’’

The pandemic plan outlines the way in which bodies should be handled during a pandemic from the reporting stage through to burial.

In a global pandemic crisis the Government may issue an order for the closure of public centres and for the public to remain at home. The plan indicated that if deaths do occur at home it must be reported to the coroner through the police, who are agents for the coroner. Here is what to expect if mass deaths occur in New Zealand

Low infection risk from bodies

The degree of risk from handling the bodies of people who have died from the disease is considered low. Bodies do not need to be bagged. Viewing and embalming pose only a low risk of infection and are considered safe.

While the disease may not pose a risk, people who have been in contact with the dead person do need to practice hygiene and personal protection procedures such a social distancing and hand washing.

Refrigeration and storage

If the body needs to be stored for the long term it must be kept in a refrigerated containers that can maintain temperatures of below minus 24 degrees Celsius. For shortterm storage, unembalmed bodies may be stored for up to five days.

Overseas transport of bodies

Due to limitations on air travel during a pandemic, bodies will need to be stored, possibly for some time until travel arrangements can be made.

Where a body is to be transported, normal procedure is to consign the body to a funeral director in the country the body is travelling to.

At present the Ministry of Health is not aware of any international regulations relating to the transportation of bodies, but all bodies must be sealed (airtight) in the coffin and then packaged in another box.

For a body returning to New Zealand, health and biosecurity permits are not required.

Tangi, funerals and gatherings

The Ministry of Health does not intend to stop funerals and tangihanga in a pandemic. Instead it will advise on the risk of virus transmission at large gatherings.

However, there are emergency powers available under the Health Act that does give the Government powers to prohibit mass gatherings, which can include funerals and tangi should public health require it.

The legislation can be triggered by the health minister or when an emergency has been declared under the Civil Defence Emergency Management Act – the medical officer of health will decide how that will be implemented.

Burials

Despite the predicted increase in the number of dead in a severe pandemic, the Ministry of Health advocates burial in separate graves or cremation whenever possible.

Mass graves should not be necessary – it is preferred that the body be held in cold storage for later burial.

The reality of mass deaths is being felt in Italy, where the pandemic has claimed more than 2500, with 475 dying over a single day.

Cremation

There should be no barrier to cremation in a pandemic provided all paperwork meets the requirements. FDANZ has indicated to the Government that bodies may not be embalmed if there is undue pressure on the handling of remains. If that is the case, the body must be kept in cold storage and only taken out to be cremated.