March 20, 2020
In light of the growing COVID-19 health crisis, and in response to questions from many
chevros kadisha
, NASCK is suggesting the following set of protocols be followed.
These protocols are based on the best available information from the
CDC
at this time. NASCK has also consulted with the
Office of the Chief Medical Examiner
in NYC and other infectious disease specialists including
Rabbi Dr Aaron Glatt
,
Hospital Epidemiologist and Chief of the Department of Medicine at Mount Sinai South Nassau Community Hospital. Rabbi Dr Glatt also serves as the Associate Rabbi at Congregation Anshei Chesed and Assistant Rabbi at the Young Israel of Woodmere.
In addition, these protocols were also discussed with and approved by
rabbonim
and
poskim
across the spectrum of the
frum
community.
This information will be updated as required.
There are two distinct areas of concern with regard to possible transmission of COVID-19 during the
taharah
process.
a)
Potential transmission
from the
body itself
(whether or not the person had tested positive for coronavirus).
b)
Potential transmission
from the
chevrah
members
to each other because of the close proximity in which they perform a
taharah
.
The following are the UPDATED guidelines and precautions necessary to protect
chevra kadisha
members from possible transmission from the body of the
nifter/es
as they perform a
taharah.
1. Strictly follow the list of universal precautions
recommended by the CDC and OSHA. These include use of:
- Disposable gloves (Nitrile or Latex are recommended)
- Full-length disposable gowns that cover the arms to the wrist
- Face masks. This is now mandatory. Any surgical mask is sufficient. People with glasses who may find that some masks fog their glasses, should find a mask that allows them to breathe without fogging.
- Face shields should be worn either attached to the mask or separately.
- Additional personal protection equipment (PPE) is optional, including booties and head covers. If one is wearing open shoes, foot covers (booties) are mandatory.
2. Add Clorox to the water
used for the
rechitzah
(washing of the body). The mixture should be 1 part Clorox to 10-12 parts water. Lemon-scented bleach, if available, is easier to work with.
3. Prepare any supplies you might need for the
taharah
in advance.
This includes Monsel’s Solution in a cup, toothpicks, Q-tips, cotton towels, chucks, etc.
4. Discard all unused supplies that were present at the
taharah
.
Do not
put them back with your clean supplies.
5. When pouring for the
rechitzah
and the
taharah
,
pour gently in order to minimize any splashing. This also limits the smell of the Clorox.
6. Use of
tishah kabin
is strongly recommended instead of using a
mikvah
.
7. To prevent the possible escape of respiratory fluids from the mouth and nose of the
nifter/es
,
pack the mouth and nose with Webril cotton towels for the entire
taharah
process. These should only be removed once the
nifter/es
has been placed in the
aron
.
8. Clean and sanitize all surfaces
, including counter tops, doorknobs, spigots, etc, before leaving the
taharah
room. Clorox bleach is the preferred sanitizer.
9. Anyone who has any symptoms of any illness may not attend a
taharah
.
10. Make sure your funeral home and
chevra
are well-stocked
with all necessary supplies.
The following are NEW
suggested guidelines to address potential transmission between
chevra
members.
According to infectious disease professionals,
at the moment
, this concern is considered greater than concern about transmission from the body.
These protocols aim to accomplish two clear goals:
- To maintain as much social distancing as possible during the taharah process.
- To limit the amount of time chevra members spend in close proximity to each other.
1. Limit the number of people attending a
taharah
to four
.
If at all possible, have one or two core groups of the same four men / four women doing all the
taharos
in the community during this time.
2.
Chevra
members should don and remove their protective equipment at an appropriate distance from each other.
They should do so in different rooms or at a distance of at least six feet. This ensures that whenever they are in close contact, they are already fully protected.
3. Travelling to the funeral home is best done in
separate cars
.
4. Each
metaher/es
should work separately to set up and prepare for the
taharah
.
This includes:
- One person preparing the aron.
- One person filling the buckets of water. If you have enough buckets, the taharah water should be filled and set aside in a corner, or in the next room.
- One person setting up supplies.
- One person preparing the body by opening the pouch, checking for and removing nail polish, cleaning surface blood, packing the nose and mouth, etc.
- Two chevra members will have to work together to bring in the meis.
5. Once everything is ready,
the
meis
should be completely removed from the wrapping (sheet, pouch, clothing, etc.) and the r
echitzah
can begin.
6. When a
meis
is relatively clean,
the
rechitzah
should be expedited even if it will be more perfunctory, resembling a rinsing more than a full
rechitzah
.
- Follow the usual order of face, right side, etc.
- Any blood on the surface of the meis (torn skin, open puncture, etc.) should be cleaned and saved, and Monsel’s Solution used to stop the flow.
- Foley catheters should be removed.
- Any mucus or fecal matter should be washed away.
- Feeding tubes should be knotted, and intra-venal tubes left in.
- Packing with Webril should be done when necessary, but no internal cleansing should be done.
- Taharah with tishah kabin and dressing in tachrichim should be performed as usual.
7. When the
meis
is not relatively clean and requires a lot of work,
for example:
- When an autopsy has been performed
- When there are extensive bedsores, surgical wounds, or bleeding
- Very heavy cases, especially with skin slippage, etc.
The
meis
should be placed in the
aron
and
tachrichim
laid out on top.
Of course, in these cases, care should be taken to make sure the
aron
is protected from leaking.
8. Once the
meis
is in the
aron
,
no more than two people should be working together, and cleaning of the room should begin (see # 8 above).
9.
The goal is to
work quickly, efficiently, and as separately as possible
to minimize the time chevra members are in close proximity.
Your funeral director may require that additional guidelines or protocols be followed. If these practices affect the performance of basic
taharah
procedure and
kavod hameis,
you may want to discuss it with your rabbinic advisor or
posek
.
Please forward this to all
chevra kadisha
members in your community.
COVID-19 has been declared a pandemic, and while we certainly hope there will not be a significant increase in cases,
r"l,
we must be prepared for this eventuality.
In the
zechus
of our
chesed shel emes
and all the
tefilos
and
zechuyos
of
klal Yisroel
, may we merit the
rachamim
of the
Rofeh Ne’eman,
and the
geulah shleimah b’karov.
With best wishes for a Gut Shabbos,
Rabbi Elchonon Zohn
P.S. On a personal note, I must mention that these guidelines are very difficult for me to recommend and distribute. In so many ways, they contradict what I have taught for many years. However, the underlying basis of all we do is
Toras Emes
and
Minhag Yisroel
. Torah requires that we react to special times with special rules:
עת לעשות לה' הפרו תורתיך (תהלים קיט:קכו)
I believe it is appropriate to feel pained that we are abbreviating procedures that give
kavod
to the
meis
, even though this has become necessary. That feeling of distress on the behalf of the
meis
is a form of
kovod
hameis
on its own. Moreover, perhaps that pain will reduce the possibility that these temporary changes will decrease our sensitivity to the holy work we are privileged to perform.
