Six family members donned medical coats to bid their grandfather farewell while gathering around his coffin this past spring.

Each stroked his face and hands in an emotional experience that almost did not happen.

They were initially told they would not be able to see his body before it was cremated due to tightened rules surrounding dead bodies amid the pandemic. He was diagnosed with the novel coronavirus in a polymerase chain reaction (PCR) test following his death.

The last meeting with the patient became a reality only after his body was embalmed and each of the bereaved family members took measures against infection.

Although the health ministry and medical experts admit that it is unlikely the virus spreads via corpses, hospitals and morticians frequently prohibit in-person farewells out of concerns some people may believe that anyway and that baseless rumors may damage their businesses.

Japan's COVID-19 death toll has surpassed 13,000 people.

To take a closer look at the issue, Asahi Shimbun reporters contacted a family that lost a loved one during the health crisis.

Kazunori Kusayanagi, 56, a self-employed worker in Tokyo’s Nerima Ward, organized a funeral in March for his father, Masao, 88, who was confirmed to have the new coronavirus at a morgue within an undertaker’s office in nearby Kanagawa Prefecture.

Masao’s body was treated by a special technique to ensure safety and the attendees were limited to only six relatives. Each donned medical gowns, surgical masks and gloves.

The participants individually spoke to Masao and thanked him. When the mortician said they could touch his face, they rubbed his cheeks and limbs as if they were tracing the contours of his body.

Purple and yellow flowers surrounded his pillow, along with a trip photo taken to celebrate his “beiju” traditional 88th birthday and a letter addressed to him.

“It is better that we can see the face,” murmured Yuta, 20, a grandchild of Masao. “I would not be able to come to terms with this loss if he had passed without us seeing his face.”

The Kusayanagi family’s life has been at the mercy of COVID-19 since Kazunori tested positive in February. He was diagnosed with it after he had himself examined, just in case, after he heard a friend had contracted the infectious disease.

His wife, Masami, 52, also turned out to be infected. While Masao’s test was negative, he died suddenly of ischemic heart disease six days after Kazunori returned home from his isolation at a hotel.

Police inspected Masao’s body following his death, and he tested positive for the virus.

When he learned about this, Kazunori asked police if he could see Masao, but was told “you cannot see him until after his cremation.” The mortician gave the same answer.

The government guidelines for funerals and cremating COVID-19 patients and those suspected to have contracted the virus state that the wake and funeral can be held if proper steps are taken to prevent infections.

The standards state that “whether services are possible should be considered based on the wishes of bereaved families and others.”

Saki Shoji, 24, a grandchild of Masao, showed the content of the guidelines she found on the internet to the mortician so that the family could see him in person one last time. But the agent denied the request, sticking to “our in-house rule.”

The Kusayanagi family did not give up there and sought out a new way to meet Masao again.

In the process, they found an agency that embalms corpses.

Even though the procedure requires 300,000 yen ($2,736) or so on top of the funeral costs, they decided to use the service. The option was the only means of seeing Masao again that they had discovered.

The family members were given one hour with Masao at the mortuary. After that, his body was sent to a crematorium in Tokyo.

They were not allowed to watch his cremation, so the family was not able to pick his remains up on their own.

However, Kazunori appeared to be satisfied while holding an urn with Masao’s ashes that was returned to the family three and a half hours later.

“I could see his face, say thank you and come to terms with his death,” said Kazunori. “I will look forward with my family.”

Explaining why they agreed to be interviewed, the Kusayanagi family said many bereaved families must be having a similarly tough time with funerals during the coronavirus crisis, so they wanted to share their experience.

LOW RISK, BUT MANY STILL BARRED

According to the government guidelines on funerals for deceased COVID-19 patients and their cremation, there is a low risk of the virus spreading through droplets of stray saliva given that dead people do not cough or sneeze.

The use of body bags and other precautions can eliminate the possibility of contact infection as well, so it is unlikely that funeral attendees would become infected with the virus. The government recommends using a body bag with a transparent section to allow viewing the deceased’s face.

“Even when a body bag is not used, there would be no significant risks,” said a health ministry representative.

But the problem is not that simple for morticians. Some have expressed concerns out of fear of group infections during the transportation of bodies and baseless rumors about infections spreading from the deceased.

For that reason, many undertaker’s offices just “show the deceased’s faces through car windows for a few minutes,” or only allow the bereaved families to “see their ashes,” sources said.

The situation has prompted some funeral providers to start offering embalming services to preserve bodies from decay and repair some of the damage.

Because the body’s blood is removed and chemicals are injected for sterilization and antisepsis during the process, embalmment is also helpful in preventing infections from spreading.

An embalmment expert said the technique has also been used overseas for funerals of patients who died of severe acute respiratory syndrome (SARS) and other deadly infectious diseases.

Yoshinobu Sato, a professor emeritus of forensic medicine at Kyorin University, who once headed the health ministry research team on embalmment, noted that infections cannot spread through droplets from the mouths of dead people.

“Effectively no coronavirus infection risk exists unless the bodies are pressed so strongly that the air inside comes out of the corpses,” said Sato.

He called the current situation problematic, in that few bereaved families are allowed to see their loved ones in person after their deaths despite a low risk of infection.

“What is most problematic is that bereaved family members are so rarely given the time and place to come to terms with their grief,” Sato said. “This kind of technique can be one of the options to help put the funerals back in the hands of the bereaved.”

According to data from the International Funeral Science Association in Japan, which runs the licensing system for official embalmers, 53,000 deceased people--or 4 percent of all deceased individuals--were embalmed last year nationwide.

Among these, dozens of cases were conducted for those who died by the new coronavirus.

(This article was written by Kazuhiro Nagashima and Takayuki Kakuno.)