- Guidelines say, COVID-19 dead bodies need to be handled with precautions
- Corpses do not pose any additional risk of COVID-19: Health Ministry
- Bathing, kissing, hugging of the dead body should not be allowed
New Delhi: Since the lockdown has begun, there have been several incidences of families not willing to accept bodies of coronavirus patients fearing contamination, cemeteries denying burials and people attacking vehicles carrying dead bodies and protesting against last rites. A few days ago, friends and family of Dr. Simon Hercules, a 55-year-old Chennai based doctor who died due to COVID-19, were attacked by a mob when they took his body to a burial ground because of which one of his friends had to quietly bury him late at the night without any family members present. “Such incidences happen because of the misinformation around standard operating procedures towards the handling of dead bodies and lack of awareness about COVID-19”, said Dr. Ramana Dhara, Professor at Indian Institute of Public Health (IIPH), Hyderabad.
Dr. Dhara further said,
Unlike haemorrhagic fevers like Ebola, Marburg, and diarrheal diseases like cholera, dead bodies resulting from respiratory illnesses like COVID-19 generally are not known to be infectious.
According to the Ministry of Health and Family Welfare (MoHFW), as of May 7, there have been 1,783 deaths in the country due to COVID-19 with maximum deaths in Maharashtra (651) followed by Gujarat (396). MoHFW has clarified that since the transmission of COVID-19 happens through droplets, there is unlikely to be an increased risk of COVID infection from a dead body to health workers or family members who follow standard precautions while handling body. Only the lungs of dead COVID-19 patients, if handled during an autopsy, can be infectious.
Even after the Health Ministry’s statement on dead bodies not posing risks, on March 30, Maharashtra Civic Body, Brihanmumbai Corporation (BMC) notified a circular that said that all bodies of COVID-19 victims shall be cremated at the nearest crematorium irrespective of their religion. However, the circular was hurriedly withdrawn soon after Cabinet Minister in Maharashtra Government Nawab Malik intervened. BMC then issued a revised order which is currently in force which permits burials. On being asked about the previous circular, a senior official of BMC said to NDTV,
There were concerns regarding the risk of infections that may have led to issuing of the earlier circular stating that only cremation was allowed for all bodies. This has been withdrawn, and now as per the central government’s guidelines, in Maharashtra also, bodies can be cremated or buried as per their tradition and religious beliefs.
With an aim to address concerns and confusions regarding the handling of the bodies of deceased patients, MoHFW had issued COVID-19 dead body management guidelines on March 15.
Health Ministry’s Guidelines On The Management Of Dead Bodies Of COVID-19 Patients
According to the COVID-19 dead body management guidelines of MoHFW, here are some standard precautions to be followed once a COVID-19 patient dies:
– While removing the body from the isolation room, the health worker must perform hand hygiene, ensure proper use of Personal Protection Equipment (PPE) like a water-resistant apron, goggles, N95 mask, and gloves.
– All tubes and drains on the dead body should be removed. Any puncture holes or wounds (resulting from the removal of drains, tubes, or otherwise) should be disinfected and dressed with impermeable material. Plug oral, nasal orifices of the dead body to prevent leakage of body fluids. Place the dead body in a leak-proof plastic body bag. The body bag can be wrapped with a mortuary sheet or sheet provided by the family members.
– If the family of the patient wishes to view the body at the time of removal from the isolation room or area, they may be allowed to do so with precautions. The body will be either handed over to the relatives or taken to a mortuary.
– Embalming of the dead body should not be allowed
– Bathing, kissing and hugging of the dead body should not be allowed
– Autopsies on COVID-19 dead bodies should be avoided. If an autopsy is to be performed, the executing team should take maximum precautions and cover themselves using PPEs.
– Transportation of the body should be done in a body bag, the exterior of which poses no risk to the transporting staff if decontaminated properly. The vehicle, after the transfer of the body to cremation/ burial staff, should be decontaminated with a disinfectant containing 1 per cent Sodium Hypochlorite.
– At the crematorium/ burial ground, the present staff should practice the standard precautions of hand hygiene and use of masks and gloves. Viewing of the dead body by unzipping the face end of the body bag (by the staff using precautions) may be allowed, for the relatives to see the body for one last time.
– The ash does not pose any risk and can be collected to perform the last rites
– Large gathering at the crematorium/ burial ground should be avoided as a social distancing measure
What does WHO Recommends?
Most of the measures recommended by the World Health Organisation (WHO) are similar to those outlined by the Health Ministry. Additionally, WHO has suggested the following with respect to the last rites of deceased patients:
– Children, senior citizens and anyone with underlying illnesses (such as respiratory illness, heart disease, diabetes, and other such conditions) should not directly interact with the body.
– People with respiratory symptoms should not participate in funerals or at least wear a medical mask to prevent transmission to others.
– Although burials should take place in a timely manner, in accordance with local practices, funeral ceremonies not involving the burial should be postponed, as much as possible, until the end of the epidemic.
– 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.
According to Dr Sudhir K Gupta, Professor and Head, Department of Forensic Medicine and Toxicology, All India Institute Of Medical Sciences (AIIMS), in order to ensure safety, bodies should be cremated in electric or gas crematoriums, keeping the body in the body bag and if burial is to be done, the body should be placed in a thick, air-tight coffin at a depth of four to six meters in the ground. The area of the grave should be cemented immediately and precautions should be followed afterwards to avoid scavenging by animals.
Social Workers Coming Forward To Give The Dead A Dignified Send-Off
During the current coronavirus crisis when social distancing norms and misinformation regarding COVID-19 and dead bodies is keeping relatives away from the last rites, of their loved ones, a social worker from Fatehpur in Uttar Pradesh has come forward to give the dead a dignified send-off. Ashok Tapaswai, a 42-year-old businessman started a ‘Tapaswi Seva Rath’ service in January this year in the memory of his parents by converting a truck into a hearse. Just a phone call away, the ‘Rath’ carries dead bodies from hospitals, homes and accident sites to the cremation ground and since the beginning of lockdown, the service has been extended to COVID-19 patients also, free of cost. Mr. Tapaswi told NDTV,
Fatehpur currently has no case of COVID-19 and is in the green zone. However, due to social distancing norms and lockdown, people are unable to perform last rites of their deceased loved ones especially if someone is out of the city. So they call me and I along with some volunteers lend shoulders to the bier and perform cremations and burials on behalf of the relatives. After the nationwide lockdown against coronavirus, the calls for the ‘rath’ have increased. Earlier, I used to get a maximum of 10 calls a day, but now I receive around 20 calls per day.
Mr. Tapaswai tries to help most of the callers and in planning to acquire more ‘raths’ to expand the service due to the increasing demand.
In Mumbai, Mahim Kabrastan Trust has offered to provide burial of COVID-19 victims free of cost at their cemetery. According to an official of the Trust, Mahim cemetery is one of the cemeteries mandated by BMC to bury community members who die due to the coronavirus infection. He said that serving in the times of distress is very important which is why the trust has decided to waive off burial expenses. He further said,
Burial is being done as per the standard operating procedures to ensure zero-risk. Special coffins are being arranged and the place is sanitised before and after the burial.