Covid-19 Infection & Burial Of Dead Bodies – A Controversial Issue In Sri Lanka
By A.R. Mohamed –APRIL 10, 2020
Covid-19 Infection & Burial Of Dead Bodies – A Controversial Issue In Sri Lanka – Brief introduction of COVID-19 Virus & How It Causes The Disease
Viruses are considered as the tiniest of the infectious agents and is known to multiply (replicate) only in living cells and can infect all types of animals, plants and other microorganisms including bacteria; and millions of types of viruses are found in the environment. Generally, viral infections provoke an immune response in humans and animals and help the body to eliminate the infecting viruses under normal healthy conditions. This is why most of the virus diseases such as mumps, chicken pox, measles, common flu, dengue are automatically cured without any specific treatment in normal healthy people. In 22 studies, involving all the different types of corona viruses that infect humans, it has been found that these viruses can remain infectious at room temperature only for up to 9 days outside the human body. However, the COVID-19 virus which causes the present corona virus infection has been reported to survive on surfaces only for about 72 hours.
The COVID-19 virus which originated from Wuhan, China is a new type of corona virus which has never been seen before except the current outbreak. It primarily spread from person to person by close contacts (up to 3 metres) and by small droplets of the saliva and nasal discharges when infected people cough or sneeze; and also, while breathing and talking when the virus comes out through the tiny respiratory droplets. A person may also get infected by touching contaminated surfaces and then touching the mouth, nose and eyes. By 7th April 2020, the corona virus COVID-19 has affected 209 countries and territories around the world.
Of all the organs in the body, the lungs are the most affected organs by the COVID-19 virus. The lung alveolar cells (which are the lining cells of the lung respiratory units called the alveoli through which the oxygen and carbon dioxide gas exchange take place during breathing) abundantly produce an enzyme called ACE2 which helps the virus to get into these lung cells. Once the virus enters these cells they start multiplying (replicating) inside them and continue to damage these alveolar cells causing breathing difficulties, respiratory failure and may end-up in death. In addition, the virus also attacks the stomach and the intestines as some of the lining cells in these organs also abundantly produces the above enzyme ACE2 favouring its survival.
The changes that occur after death?
Soon after death, the cells of the lungs, digestive tract and other organs of the body continue to die due to lack of oxygen supply and the entire body tends to decompose. As mentioned above, for the virus to multiply, it needs living cells; but after death due to non-availability of living cells and hence no production of the enzyme ACE2, the virus also stops multiplying and with time they also perish. As a dead body does not cough, sneeze, breath or talk, there is hardly any virus that comes-out from this body; except if any discharges come through the natural openings of the body such as the nose, mouth, anal opening etc. However, it is a general practice even in normal bodies to plug these orifices with cotton wool to prevent any leakage, if any. Thus, a dead body will not spread the disease unless people touch or handle these bodies without protective equipment. Thus, compared with a COVID-19 infected person who will keep on spreading the disease to others for a few days to weeks during coughing, sneezing, breathing etc., a dead body is harmless and safe to handle if the proper hygienic precautions are adopted.
From the above brief note on the nature of the corona virus and by reading the WHO guidelines given below, you will be able to reason-out whether there is any danger to humans if Sri Lanka allows the burial of COVID-19 infected bodies.
WHO Guidelines in handling and burial of COVID-19 bodies
In medical practice all over the world, the World Health Organization (WHO) guidelines are mainly considered as the accepted standards (including Sri Lanka). The WHO in an Interim Guidance issued on 24th March 2020 entitled “Infection Prevention and Control for the safe management of a dead body in the context of COVID-19” mentions the following as regards precautions, handling and disposal of dead bodies. (The full text of the guidelines is given here ). The salient features of these guidelines are as follows:
1. Only the lungs of patients with pandemic influenza, if handled improperly during an autopsy (post mortem), can be infectious. Otherwise, cadavers (dead bodies) do not transmit disease. It is a common myth that persons who have died of a communicable disease should be cremated, but this is not true. Cremation is a matter of cultural choice and available resources. To date there is no evidence of persons having become infected from exposure to the bodies of persons who died from COVID-19.
2. The safety and well-being of everyone who attends to dead bodies should be the first priority. Before attending to a body, people should ensure that the necessary hand hygiene and personal protective equipment (PPE) supplies are available.
3. The dignity of the dead, their cultural and religious traditions, and their families should be respected and protected throughout. Hasty disposal of a dead from COVID-19 should be avoided.
4. Ensure that personnel who interact with the body (burial team) apply standard precautions, including hand hygiene before and after interaction with the body, and the environment; and use appropriate personal protection equipment according to the level of interaction with the body, including a gown and gloves. If there is a risk of splashes from the body fluids or secretions, personnel should use facial protection, including the use of face shield or goggles and medical mask.
5. Ensure that any body fluids leaking from orifices are contained. Keep both the movement and handling of the body to a minimum. Wrap body in cloth and transfer it as soon as possible to the mortuary area. There is no need to disinfect the body before transfer to the mortuary area. 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 is required.
6. Healthcare workers or mortuary staff preparing the body (e.g. washing the body, tidying hair, trimming nails, or shaving) should wear appropriate personal protective equipment according to standard precautions (gloves, impermeable disposal gown, medical mask, eye protection).
7. If the family wishes only to view the body and not to touch it, they may do so, using standard precautions at all times including hand hygiene.
8. Give the family strict instructions not to touch or kiss the body. Embalming is not recommended to avoid excessive manipulation.
9. Adults over 60 years and immunosuppressed persons should not directly interact with the body.
10. In contexts where mortuary services are not standard or reliably available, or where it is usual for ill people to die at home, families and traditional burial attendants can be equipped and educated to bury people under supervision.
11. Apply principles of cultural sensitivity and ensure that family members reduce their exposure as much as possible. Children, older people (more than 60 years old), and anyone with underlying illnesses (such as respiratory illness, heart disease, diabetes, or compromised immune systems) should not be involved in preparing the body.
12. Family and friends may view the body after it has been prepared for burial, in accordance with customs. They should not touch or kiss the body and should wash their hands thoroughly with soap and water following the viewing; physical distancing measures should be strictly applied (at least 1 m between people).
SRI LANKA 