Early on in the pandemic, funeral director Brian K. Lewis took care of a woman who passed away after a bout with pneumonia.
He now wonders if she also died of Covid-19.
More and more, Lewis is looking back at the cases he handled the past two months and thinking, yes, the official death toll here should be higher.
"No doubt in my mind," said Lewis, who operates three funeral homes in Buffalo. "Initially, all Covid deaths were not classified as Covid deaths."
Lewis said his funeral homes are handling 30% more cases now than a year ago but the confirmed Covid-19 deaths – eight so far – make up just a portion of that increase.
He suspects some of those others also died of the virus.
Like a lot of funeral directors, John Dengler doesn't think the underreporting of deaths, viewed as a potential problem in virus-torn New York City, is occurring to a great degree here.
He will tell you, though, that he is treating every new body that comes into his care as if it could be a Covid-19 death.
"We're handling every case that way," Dengler said. "We're taking precautions with everyone."
At Dengler, Roberts and Perna, the number of confirmed Covid-19 cases totaled about 15 through the end of last week.
At Amigone Funeral Homes, there were 20 confirmed cases.
"It's too early to tell," said Anthony P. Amigone Jr. when asked about the potential for underreporting Covid-19 deaths.
Amigone said he hasn't seen individuals who he suspected died of Covid-19 but were never tested or added to the state's official death toll.
Nevertheless, like Dengler's employees, his people are abiding by new guidelines put out by the Centers for Disease Control and Prevention and assuming every new case could be a Covid-19 death.
"We're practicing universal precautions," he said. "We assume everyone has everything."
Unlike New York City, where some funeral homes have been overrun with requests and are telling people they need to go elsewhere, funeral directors here seem to be coping with the unexpected increase in deaths.
From his home in Albany, Michael A. Lanotte is watching how the virus spreads and how his members – more than 950 funeral homes across the state – are reacting to the crisis.
Here, in Erie County, funeral directors are handling the increased workload and at the same time taking steps to protect their workers, according to the executive director of the New York State Funeral Directors Association.
Downstate, it's a far different tale.
"We were seeing almost triple the number of cases we normally see," Lanotte said of the requests coming from families in New York City. "You can imagine the stress on the death care industry."
When the outbreak first started, funeral homes focused on new social distancing guidelines and how they would affect face-to-face dealings with families.
A month later, the emphasis is switching to safety and how to meet the overwhelming demand for funerals and cremations.
"There are funeral homes that are simply unable to take on a new family," Lanotte said of his members in New York City.
One of the first responses to downstate's troubles was an army of volunteers – active and retired funeral directors from across the country – who traveled there to help. Gov. Andrew M. Cuomo sign an executive order paving the way for the volunteer effort.
For most people in the business, even retirees, infectious diseases are a rare but well-known risk. Their experience dates back to the AIDS epidemic and most of them are well-versed in when and how to use protective gowns, gloves and masks.
Nevertheless, in Lewis' eyes, this crisis is different.
"I've been doing this for 40 years and I've never been through a pandemic," he said.
To understand what he means, listen to him talk about the people, the families, he took care of.
One of the first was a woman who died of the virus, followed a few weeks later by her husband. And then there was the young man who passed away, only to be followed by his father. And now his mother is ill.
Lewis' point? This disease is killing entire families.
It's a stressful time for funeral directors, many of them still struggling with new social distancing rules. One of their biggest gripes is the loss of in-person meetings between directors and the families seeking comfort and assistance.
"We rarely see anyone face to face anymore," Amigone said of the disease. "It's part of the fabric of our life now."
For Dengler, a veteran of the industry, the lack of human contact is difficult to grasp.
"We can't give them a handshake. We can't give them a hug. Sometimes we can't even meet with them face to face," he said. "This is just not the way we operate."
Like the doctors and nurses on the front lines, funeral directors are putting themselves at great risk, especially during the transportation of individuals from a hospital, nursing home or residence.
Lanotte is quick to remind people that Covid-19 is new to all of us and at this point no one knows for sure how long people remain infected after they die.
"Funeral directors, unfortunately because of all the deaths, are on the front lines as well," he said. "I think its important for people to realize they're unsung heroes, too."