Mostafa Kamal Majumder
The refusal to accept bodies of coronavirus victims for burial at graveyards in Dhaka City has come as a shock to all. The social media is filled with messages like this. The management of one graveyard in the heart of Dhaka has been found to have put up a big banner urging the authorities concerned to spare their place for the burial of coronavirus dead bodies. Clearly there has been a misgiving that is leading to this kind of disrespect for the dead which is against the Bangladesh culture. In this land of ours the dead are treated with utmost respect during all funeral rites. People carry coffins or boxes with bodies inside to funeral sites for burial. The society does not accept any kind of disrespect at all stages of funeral.
The refusal to accept bodies at graveyards is the result of panic that has been created due to misconceptions about how to deal with the bodies of coronavirus victims. This reminds use of the initial period of spread of the HIV/AIDS pandemic. In Bangladesh the first cases of Human Immunodeficiency Virus positive were dealt with very unkindly. They were not only hunted down and handed over to the police, but people refused to bath in ponds used by them. Even educated people refused to shake hands with HIV positives.
The situation changed after the newspapers and the electronic media started airing informed stories to remove misconceptions about HIV/AIDS. People developed Acquired Immune Deficiency Syndrome after passing about a decade with the virus inside their bodies. Two successive workshops organised for journalists under the sponsorship of the Panos Institute, London, in association with the Voluntary Health Services Society (VHSS) in the early 1990s helped turn the tide of misconceptions about the HIV transmission routes.
The Covid-19 disease caused by the coronavirus is highly infectious. This doesn’t mean that this disease is not being tackled by human societies. The pandemic has attacked the whole globe exacerbating the panic. In a way the health authorities are to take share of the blame for this because they should have taken more care in issuing directives well in time to deal with all aspects of the pandemic.
European Cenre for Disease Prevention and Control (ECDC) in a technical report aimed to support public health preparedness planning and response activities on the safe handling of bodies of deceased persons with suspected or confirmed COVID-19: at the site of death, during transport, storage and preparation before burial/cremation, and during burial/cremation, says –
“There is no evidence so far of transmission of SARS-CoV-2 through the handling of bodies of deceased persons. The potential risk of transmission related to the handling of bodies of deceased persons with suspected or confirmed COVID-19 is considered low and can be related to:
direct contact with human remains or bodily fluids where the virus is present
direct contact with contaminated fomites.
As viable SARS-CoV-2 may persist on surfaces for days , there is the possibility that the virus also persists on deceased bodies. Therefore, unnecessary contact with bodies should be minimised by those not wearing personal protective equipment (PPE).”
This guidance based on research by no means suggests that dead bodies cannot or should not be handled by humans because of the virus if contiguous.
ECDC guidelines say:
“Preparation at site of death Last offices (care after death)
‘Last offices’ refers to the preparation of the deceased directly after death and before transportation. Groups frequently involved in this activity can include healthcare staff, family/mourners and religious officials. Risks of transmission during last offices are mainly related to direct contact with human remains or bodily fluids where the virus is present, or through contaminated fomites or surfaces at the deceased’s care site.
Standard and non-invasive last offices body preparations, such as combing, cleaning and washing, may be performed using appropriate standard precautions and PPE preventing transmission through direct contact.
Minimum requirements include gloves and long-sleeved water-resistant gown. If persons who are not trained in the use of standard precautions and PPE are to actively participate in last offices by touching the body (e.g. family, mourners and religious officials), staff need to ensure that they receive support in this. In case of limited PPE availability or shortage of staff to supervise visitors in their use of PPE, consider to limit direct physical involvement of non-healthcare staff to the extent that is acceptable.
Preparing for transport
Staff responsible for wrapping bodies before transport should wear appropriate PPE to minimise exposure to infected bodily fluids, contaminated objects and other contaminated environmental surfaces. The suggested set of PPE for the staff responsible for bagging/wrapping bodies is gloves and long-sleeved water-resistant gown.”
ECDC suggests administrative measures like giving orientation to hospital morgue/mortuary staff, people engaged in the transport of bodies and those involved in final rites at graveyards or crematories with view to enabling them complete funeral of the dead without any fear or confusion.
Three months after the outbreak, China’s Infection Control Branch of the Department of Health issued 24-page guidelines for handling and disposal of dead bodies.
The guidelines issued on Feb. 20 and now accepted globally have specified the thickness of the leak proof plastic bag. According to guidelines, the body bag should not be less than 150 microns and should accompany with another layer of a mortuary sheet or opaque bag.
Bangladesh’s health authorities should take a cue from this and issue appropriate guidelines and administrative actions so that dead bodies are given for funeral after putting those in appropriate safe bags by professionals from healthcare centres.
There is no time to spare. The coronavirus death rate in Bangladesh is still within manageable limits. If the right kinds of preparations are taken now, misgivings about funeral of Covid-19 dead bodies with surely disappear. And the dishonour of dead bodies -which is against Bangladesh’s culture – will stop hopefully soon.
(The writer if the editor of GreenWatch Dhaka online newspaper)
Mostafa Kamal Majumder