Planning for pandemic influenza in New York City: Comparing morgue capacity to expected number of fatalities

Background

Critical gaps in preparing for mass fatality during pandemic influenza (PI) exist. Since many agencies and regions will be taxed simultaneously, communities must plan for managing large numbers of decedents without outside assistance. NYC DOHMH assessed maximum citywide decedent storage capacity and calculated an approximate PI fatality count for the development of a citywide mass fatality management plan.

Methods

The Office of Chief Medical Examiner (OCME) provided statistics on storage capacity and operations. The Centers for Disease Control and Prevention's FluSurge 2.0 was used to generate fatality statistics for NYC, assuming a 30% influenza attack rate and 2.1% fatality rate over an 8-week pandemic. A comparison between current storage capacity and expected number of deaths guided mass fatality planning.

Results

The OCME total storage capacity across the 5 boroughs is 1100 bodies and normally operates at 50% of total capacity, with each decedent being held, on average, between 3 to 30 days. Over an 8-week pandemic, there would be approximately 51,747 PI-related deaths, which translates to the OCME managing as many as 918 decedents/day, an approximate sixty-six-fold increase from the average of 14 decedents/day (range: 4-20 decedents/day) the OCME manages normally.

Conclusion

In NYC, the number of decedents/day during a PI event greatly exceeds both the current OCME daily caseload and storage capacity. This analysis led to the development of a Pandemic Influenza Surge Plan for Managing In and Out-of-Hospital Deaths which outlines a plan to manage fatality surge by augmenting storage capacity via body collection points.