Frequently Asked Questions: Funeral and Burial Services for American Indians and Alaska Natives

Coronavirus Disease 2019 (COVID-19) is a new disease, and we are still learning about how it spreads and the severity of illness it causes. The virus that causes COVID-19 is believed to spread person-to-person between people who are in close contact (being within about 6 feet) with one another. Some people without symptoms may be able to spread the virus.

The virus likely spreads primarily through saliva or mucus droplets produced when an infected person coughs, sneezes, or talks. This is somewhat like how the flu (influenza) and other infections such as the common cold spread.

These droplets can land in the mouths or noses of people who are nearby or possibly be breathed in. Droplets can remain on surfaces such as countertops and doorknobs for hours to days.

COVID-19 can cause mild to severe illness. This can result in someone being admitted to the hospital and even an intensive care unit. It can even cause death. People who are infected often have symptoms of illness. Older adults and people of any age who have certain underlying medical conditions might be at higher risk for severe illness from COVID-19. This includes people with serious heart conditions, severe obesity, diabetes, chronic kidney disease (or undergoing dialysis), liver disease, chronic lung disease or moderate to severe asthma, or people who have a weakened immune system (immunocompromised). Everyone can take actions, such as social distancing, to help slow the spread.

Tribes have asked for guidance to help them plan for increased death from COVID-19. While an increase in deaths may be a very difficult topic to discuss and plan for, tribal leaders have resources to help:

• Resources for emergency preparedness.
• CDC Interim Guidance for Administrators and Leaders of Community- and Faith-Based Organizations to Plan, Prepare, and Respond to Coronavirus Disease 2019 (COVID-19).

Tribal leaders can also do the following:

• Postpone large events, including celebrations such as funerals, weddings, baptisms, and holiday gatherings.
• Limit gatherings to a small number (less than 10) of family and friends and ensure social distancing and hand washing.

There is currently no known risk associated with being in the same room at a funeral or visitation service with the body of someone who died of COVID-19.

Anyone who is sick should stay home. These actions help prevent people from getting sick and help stop the spread of the virus.

Also, tribal leaders can help. While each tribe has its own traditions regarding death rituals and funerals (including family feeds, giveaways, and commemorative gatherings), it is important for leaders to determine ways for immediate family members to take part while making sure that

• Vulnerable populations are protected.
• Everyone practices frequent hand washing (hand hygiene) and social distancing (keep 6 feet of space or greater between people).
• Gatherings are limited to 10 or fewer people.

CDC recommends wearing masks in public settings where social distancing is difficult to maintain (for example, at grocery stores and pharmacies). This is especially important in communities where COVID-19 is spreading. So, if you do go to a funeral or gathering, use a mask. But also try to keep about 6 feet from others who are present. You can find more information about using a mask.

Do not place masks on young children under age 2. Also, don’t place a mask on anyone who has trouble breathing or who is unconscious or unable to remove the mask without assistance.

For Tribal Leaders:

• Educate your community about who is at higher risk of getting very sick, such as Tribal Elders and those with diabetes and serious heart or lung conditions.
• Limit the number of people at a gathering to 10 or fewer.
• Clean and disinfect where these activities are held.
• Provide plenty of handwashing sinks with soap and water or ensure there is hand sanitizer with at least 60% alcohol for all.

For Attendees:

• Avoid close contact with people who are sick.
• Stay home and do not engage in burial and funeral practices if you are sick.
• Practice social distancing by putting at least 6 feet of distance between yourself and other people.

More information on large gatherings and events.

You should avoid touching the body of someone who has died of COVID-19, before the body is prepared for viewing.

Though we are still learning more about how COVID-19 spreads, it may be possible that you could get COVID-19 by touching the body of someone who has died of COVID-19. After the body has been prepared for viewing there may be less of a chance of the virus spreading from certain types of touching, such as holding the hand or hugging. But you should avoid other activities, such as kissing, washing, and shrouding before and during body preparation. After any contact with the body, be sure to wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol.

If washing the body, shrouding, or other important religious or cultural practices are observed in a specific tribal community, families are encouraged to consider this guidance and work with their cultural and religious leaders and funeral home staff on how to reduce their exposure as much as possible.

If you participate in these activities, wear disposable gloves (nitrile, latex, or rubber). And you may need additional equipment (called personal protective equipment, or PPE). For example, you may need the following:

• Disposable, waterproof isolation gown
• Face shield or goggles
• Facemask

Following preparation of the body remove PPE and throw away. Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.

Shower after completing body preparation activities. If you did not wear any personal protective equipment while preparing the body, wash your clothes in the warmest setting possible and dry them completely.

For more information see CDC resources on Cleaning and Disinfecting Your Facility or Cleaning and Disinfecting Your Home.

Follow these steps if you are involved in transporting the body of someone who died from COVID-19:

1. If the body of a tribal member needs to be moved, wear disposable gloves and contain the body in a body bag, an impermeable shroud, or another impermeable covering that does not allow body fluids to leak from the enclosure. The virus that causes COVID-19 is not thought to be carried by blood (bloodborne), but leaked fluids could cause exposure to pathogens.
2. If a body bag is used to contain the body, disinfect the outside of the bag with an EPA-approved disinfectant for emerging viral pathogensexternal icon. Be sure to follow the manufacturer’s instructions for cleaning and disinfection products including concentration, application method, and contact time.
3. Following transport of the body, carefully remove your gloves and immediately wash your hands with soap and water for 20 seconds. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol.

People who died from COVID-19 can be buried or cremated. But check for any additional tribal, state, local, or territorial requirements that may dictate the handling and disposition of the body of individuals who have passed from certain infectious diseases.

• Tribal traditional practitioners and family members handling of decedent should follow the precautions outlined for funeral home workers.

After the body has been prepared for viewing and burial, clean surfaces using EPA-approved products in accordance with manufacturer’s instructions for all cleaning and disinfection products (such as concentration, application method, and contact time).

• Products with EPA-approved emerging viral pathogens claimspdf iconexternal icon are expected to be effective against the virus that causes COVID-19 based on data for harder to kill viruses.
• After removal of PPE, perform hand hygiene by washing your hands with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.

Information on cleaning and sanitizing can be found on the CDC website:

• For facilitites
• For households

Spouses and families of American Indian/Alaska Native Veterans may be eligible for burial assistance. Burial benefits can include opening and closing of the grave, perpetual care, a government headstone or marker, a burial flag, and a Presidential Certificate—at no cost to the family. Some veterans may also be eligible to receive money to help cover the cost (burial allowances).

The National Cemetery Administration oversees burial benefits. This office is under the Department of Veterans Affairs (VA), Veterans Benefits Administration. The VA can be contacted at the following phone numbers:

• For burial, survivors’ pension, or other benefits: 1-877-294-6380
• For the status of VA headstones and markers: 1-800-697-6947
• For obtaining bereavement counseling: 1-202-461-6530
• For telecommunications devices for the Deaf and Hard of Hearing services, dial 711.
• Additional informationexternal icon
• VA Survivors and Burial Benefits kitpdf iconexternal icon