LONDON, ONT. -- The number of COVID-19 cases associated with a London, Ont. funeral continue to rise.

Sixteen people have now tested positive for COVID-19 after a funeral visitation, church service and burial on May 5-6, which was attended by between 180 and 300 people.

The Middlesex-London Health Unit (MLHU) is continuing its investigation but Dr. Chris Mackie addressed the outbreak during Monday’s media briefing.

“It appears to be the visitation was more of the link,” says Mackie. “But all of those exposures generated, you know, close contacts that had to be tested and some, some from each of those would have been coming back positive at this point.”

CTV News London reached out to Needham Funeral Home but have yet to receive a response to our media inquiry.

The day after the visitation, the funeral service was held at Holy Cross Santa Cruz Catholic Church.

The pastor was from out of town but had the faculties to celebrate mass in London, officials say.

“When the funeral happened at the church, our parish staff and the pastor greeted the family and the pastor who is going to be celebrating the funeral mass,” says Matthew Clarke, director of communications for the Diocese of London.

"We worked with funeral home staff to ensure no more than 10 people would be in church. All safety protocols were followed, including contact tracing information masking and distancing, and then they celebrated the funeral mass.”

Clarke says there were reports of people who could not get into the church, due to the 10-person limit, gathering outside the church and across the street.

Following the service, the funeral headed to Woodland Cemetery. Despite rules stating only 10 people can attend a service outdoors, that number was exceeded.

“More than 50 vehicles arrived in procession and created congestion within the cemetery itself - certainly more than the 10-person rule,” says Paul Millward, dean and rector of St. Paul’s Cathedral.

With others wanting to visit loved ones in the cemetery and the ability to drive through the property and stay in your vehicle, it makes managing entrance to the cemetery difficult for funerals.

Prior to the outbreak, the cemetery staff would prepare the grave ahead of the service. They have operated during the pandemic under the assumption that that families will understand and limit the number of people.

After this outbreak, Woodland has made changes by adding a guard at the gates to begin contact tracing, and when a funeral procession arrives, a manager greets them and makes sure only 10 people are part of that gathering.

“We’re now working more closely with our local funeral homes, asking them that when they have services that they identify their vehicles that are in procession with markers that identify that particular funeral home so that we know that they're coming for that service,” says Millward.

“Because we have other family members coming to visit other loved ones on the cemetery grounds, it's hard to manage that. We do now have gates, security, in terms of managing access, that's collecting contact tracing information so that we can observe the one household plus one rule, as outlined by both the province of Ontario and the Bereavement Authority.”

Somewhere during this two-day stretch someone did not follow the rules. Mackie says they have tried to remind operators that serial gatherings put people at risk.

“We don't have details around exactly what was happening,” says Mackie.

“We obviously weren't present at the ceremony, but you can imagine that if people are really moved, as they often are in a funeral, they may have difficulty keeping two metres apart. You may even get some people feel that it's worthwhile to give a hug, even if that's not within the rules. And the situations like this where there are high emotions, a lot of people gathered really do generate at a higher risk than any of us should be exposed to this point. It’s a very unfortunate situation”.

For many people, grieving has especially been difficult during the pandemic.

“It's been really, really hard on our faith community,” says Clarke. “To be able to gather for mass, to be able to gather to have a large funeral for someone who's passed unexpectedly. It’s been a long pandemic for the faithful people in London, but the rules are in place. We’ve been doing everything we can to make sure they are maintained and abided by and people stay safe.”

Millward adds, "For a family it's one of the worst times in their lives and so people are grieving and wanting to be supportive, as they are always. But the complication right now is because of Coronavirus and the requirements about restricting access and social distancing, we have to maintain those protocols as well, to keep our staff safe, and their families, as well as, as the other families."

Due to the large number of people attending the funeral investigators have not been able to contact everyone who attended. The MLHU is asking anyone who attended the gatherings to quarantine as they are considered a high-risk contact.

“It also highlights the issue of serial events,” says Mackie. "That's a situation where you can really get into additional exposures, and where you can really put a large number of people at risk. As limits for indoor gatherings do grow over the next few weeks and months, we absolutely have to avoid these social serial gatherings, that actually can put, you know, dozens and in this case, hundreds of people at risk.”