The Indian Council of Medical Research (ICMR) has issued a new set of guidelines for medico-legal autopsy in Covid -19 deaths in the country for those brought dead, and advised that those suspected to have died of the infection can be tested. Issued on May 19, the guidelines state that”it is advisable to collect nasopharyngeal swab of the body either at the emergency department or casualty ward and sent for Covid-19 RT-PCR tests. ”
Last month, the state directorate of medical education and research (DMER) had said that it was not required to collect swabs from bodies unless they were exceptional cases.
Dr. Subhash Salunkhe, technical advisor to the state on communicable diseases, told The Indian Express that they will have to now wait for state directives on the issue. “Since these are nationally-prepared guidelines, they will have to be followed,” he said.
According to sources, however, the reason behind not collecting swabs from bodies also pertained to the high cost of the samples for RT-PCR tests. Storage capacity at the state-run mortuaries is another issue. “If the swab has to be collected from the body, then it will take at least a day or two to get the result, and till such time the body will have be kept at the mortuaries which are already full,” said sources.
For instance, the state’s largest hospital — Sassoon General — has reported over 110 Covid-19 deaths. Here, the mortuary gets at least 25 bodies daily and the storage capacity is 32. Apart from the Covid-19 patients, there are at times several unclaimed bodies. Authorities at Sassoon General Hospital said they were waiting for the state directives on the issue.
According to the guidelines, bodies of suspected Covid-19 patients, which are brought dead to the hospital, can be labeled as medico-legal cases by the doctor in emergency/ casualty duty. The body will be sent to mortuary as a medicolegal case and police will be informed, which may necessitate a medicolegal autopsy for clarity on the cause of death.
The forensic autopsy in these cases can be waived, according to ICMR guidelines. The main aim of these guidelines is from the viewpoint of safety to conduct medicolegal autopsy by avoiding any invasive surgical procedures and avoiding contact with body fluids for mortuary staff, body handlers and doctors conducting post-mortem examination, Dr Sudhir Gupta, professor and head of the department of forensic medicine at AIIMS, New Delhi, told The Indian Express. Prof Gupta and several others were among the key contributors while preparing the guidelines.
Meanwhile, death due to Covid-19 is a non-medicolegal case. The death in hospital or under medical care due to Covid-19 is a non-medicolegal case and no medicolegal autopsy is required to be conducted. The required certification of death has to be done by treating doctors, according to the guidelines.
Doctors, mortuary technicians and other staff performing autopsy are exposed to potentially high and dangerous health risks due to coming in direct contact with infected organs, fluids and secretions, even after taking the highest precautions. Non-invasive autopsy technique should be adopted for forensic autopsy, said Dr Gupta.
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