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Thursday March 28, 2024

Do Covid-19 infected corpses pose risk?

By Fakhar Durrani
April 05, 2020

ISLAMABAD: Could Covid-19 infectious bodies pose any risk to others? The interim guidelines of the World Health Organisation (WHO) claimed there was no evidence of a person being infected from the exposure to corpse who died from coronavirus, therefore, the dignity of bodies should be respected according to their cultural and religious traditions, and their families should also be permitted to complete the funeral rituals with proper protective measures.

Contrary to the WHO’s guidelines, the Punjab government believed that allowing funeral of COVID-19 infected body was not risky. “Keeping the available resources to fight the pandemic, I would not suggest the government to allow public gathering for the funeral,” said Prof Dr Mehmood Shaukat, Chairman corona expert advisory group, Punjab.

Former head of Pakistan Kidney and Liver Institute (PKLI) Prof Dr Saeed Akhtar, on the other hand, believed that the dignity of the corpse should be protected and close family members should be allowed to hold the rituals of funeral. He added the government should provide personal protective equipment (PPE) to them during the funeral.

According to Dr Mehmood, the virus remains in the body for 24 hours and if anyone would make contact with the secretion of the body, would definitely be infected, therefore, the congregation should not be allowed to contain the outbreak. “Our job is to protect the people from getting infected and health officials are adopting every possible precautionary measure to deal with the issues relating to COVID-19. "The dead body is handed over to the concerned people after it is wrapped twice”, he added.

Talking about WHO guidelines for the safe management of a COVID-19 affected corpse, Dr Mehmood said they were general and interim guidelines and what if these guidelines would be changed in future, adding that the priority should ensure public safety. Neither Italy nor Spain was keeping the bodies in mortuaries. “For the sake of public safety, if we avoid congregation and do not allow holding mass funerals, then there would be no harm, the excessive precaution should be adopted for the safety of the people and it was the matter of national interest," he added.

It is important to note that on March 31, the British government — Public Health England (PHE) published a new guidance to ensure funerals should be conducted safely, adding with the social distancing principles. “To help reduce the risk of spreading infection, religious leaders should advise people to restrict the number of attendees in funerals, so the distancing measures of at least two metres (three steps) could be followed among the individuals."

Only members of the deceased families or close relatives should be allowed to attend the funerals, while any suspect having symptoms of COVID-19 should not be allowed to attend. Those who would attend the funerals should need to adhere to social distancing all the time, including funeral prayers, travelling to graveyards and during burials, said the PHE guidelines.

In addition, the PHE guidance strongly advised the members of bereaved family to avoid any contact with the corpse as there was a real threat of transmitting of coronavirus during the rituals. It said the practices that involved close interactions or contact with the corpse should only be carried out when the personal protective equipment (PPE) were used by all the participants.

On March 24, WHO issued interim guidelines for safe management of disposal of a corpse in the context with COVID-19, saying to-date there was no evidence of a person who died having infected by coronavirus, could cause any transmission to others. It said the safety and well-being of everyone should be the first priority before attending the corpse, and advised that the people should ensure to use personal protective equipment (PPE).

According to the guidelines, the dignity of the corpses should be respected according to their cultural and religious traditions, and their families should also be respected and protected. Hasty disposal of a corpse should be avoided, saying the authorities should manage balancing and ensuring the rights of the deceased families. It said the personnel who interacted with the COVID-19 affected corpse should apply standard precautions including hand hygiene before and after interactions, and appropriate PPE.

The WHO guidelines said if there was a risk of secretion, the interactive persons should use facial protections, including face shield or goggles and medical mask. “Wrap body in cloth and transfer it as soon as possible to the mortuary area, there is no need to disinfect the body before transferring the mortuary, body bags are not necessary, although they may be used for other reasons e.g. excessive body fluid leakage, and no special transport equipment or vehicle was required."

According to the guidelines, if a family wished to see the body of their loved one and agreed not to touch or make any contact, should be allowed to do so, using standard precautions at all times including hand hygiene. Give the family clear instructions not to touch or kiss the body, embalming was not recommended.

“Those tasked with placing body in the grave during the funeral, etc., should wear gloves and wash hands with soap and water after removal of the gloves once the burial is complete. Burial by family members at home in contexts where mortuary services are not up to standard or available, or where it is usual for ill people to die at home, families and traditional burial attendants could be equipped and educated to bury people under supervision.

"Any person e.g. family member, or religious leader preparing the deceased, including washing, cleaning or dressing the body, tidying hair, trimming nails or shaving in a community setting should wear gloves before contacting with the body.

For any activity that may involve secretion of fluids, the eyes, nose and mouth protection, including face shield, goggles and medical mask should be used. Clothing gown to prepare the body should be immediately be removed and washed after the procedure or an apron or gown should be worn,” the guidelines say.

“Apply principles of cultural sensitivity and ensure the family members should minimise their exposure to the body as much as possible, while the children, elderly people, and sick having problems including respiratory illness, heart disease, diabetes, or compromised immune systems, should also not be exposed to body. A minimum number of people should be involved during the preparations and others may observe without touching the body at a minimum distance of one meter,” said the guidelines.

Similarly, the people with respiratory symptoms should not participate in the viewing or at least wear a medical mask to prevent contamination of the place and further transmission of the disease to others.

“The belongings of the deceased person do not need to be burned or otherwise disposed of." However, they should be handled with gloves and cleaned with a detergent followed by disinfection with a solution of at least 70 per cent ethanol or 0.1 per cent or 1000 ppm bleach, and the clothing and other fabric belonging to the deceased should be washed in machine with warm water at 60°C-90°C (140-194°F) with the detergent. If machine washing is not possible, linens can be soaked in hot water and soap in a large drum using a stick to stir and being careful to avoid splashing. The drum should then be emptied, and the linens soaked in 0.05 per cent chlorine for approximately 30 minutes. Finally, the laundry should be rinsed with clean water and the linens allowed to dry fully in sunlight,” said the WHO guidelines.