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Explained: Is burial or cremation safe? How to handle bodies of COVID-19 patients

The Health Ministry's detailed guidelines are for handling of bodies of COVID-19 patients. These allow both cremation and burial, and make no mention of any risk of contamination from bodies if buried.

Written by Tabassum Barnagarwala | Mumbai | Updated: April 6, 2020 11:00:16 am
Coronavirus: A COVID-19 patient is buried in Gujarat. (Express Photo: Javed Raja)

Last week, the Brihanmumbai Municipal Corporation of Mumbai issued a circular that bodies of all COVID-19 patients would be cremated at the nearest crematorium, without any rituals. The circular was later amended, allowing burials only if grounds were large enough.

Why was the order introduced?

The Municipal Commissioner in Mumbai is an empowered officer under the Epidemic Act, 1897, to issue orders to contain the COVID-19 epidemic. The commissioner said the circular was issued after a “community leader brought to my notice that existing burial grounds are in highly dense locality with high chances of contamination in dense community/ residential areas nearby”. This was before the amendment allowing burials in larger grounds.

A general surgeon, aged 85, died in Hinduja Hospital after testing positive for COVID-19. After his body was discharged by the hospital on March 27, the family buried it without civic staff. This reportedly raised concerns in the BMC over whether precautions had been taken.

What has been recommended now?

The BMC has recommended the use of an electric or piped natural gas crematorium. The circular said packing the body in a plastic and burying still holds risk of contamination as decomposition is delayed in plastic. It said not more than five people will be allowed to attend the funeral.

But what about those who traditionally bury their dead?

The circular makes an exception. Those who insist on burial, it says, will be allowed only if the burial grounds are large enough and pose no risk of contamination in nearby areas. The circular does not, however, specify the size of the cemetery where burial will be allowed. The day the circular was issued, Maharashtra Health Minister Rajesh Tope told The Indian Express that the central government’s guidelines for handling dead bodies must be followed in the state.

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coronavirus, Coronavirus india, coronavirus dead patients cremation, how to cremate coronavirus patients, coronavirus india death toll, coronavirus india, coronavirus latest mumbai coronavirus, coronavirus deaths, covid 19 deaths Those who insist on burial, it says, will be allowed only if the burial grounds are large enough and pose no risk of contamination in nearby areas. (Express photo/Javed Raja)

And what do the central guidelines say?

The Health Ministry’s detailed guidelines are for handling of bodies of COVID-19 patients. These allow both cremation and burial, and make no mention of any risk of contamination from bodies if buried.

The body must be sealed in a leak-proof plastic bag. The guidelines allow only the face to be viewed by unzipping the bag, and do not permit bathing, kissing or hugging of the body. Family members are allowed to read religious lines and sprinkle holy water, as long as no one touches the body.

coronavirus, Coronavirus india, coronavirus dead patients cremation, how to cremate coronavirus patients, coronavirus india death toll, coronavirus india, coronavirus latest mumbai coronavirus, coronavirus deaths, covid 19 deaths The body must be sealed in a leak-proof plastic bag. (Express photo/Javed Raja)

Embalming and autopsy must be avoided as the lungs of an COVID-19 patient can be infectious during an autopsy. If tubes or a catheter is removed, the wounds must be disinfected with one per cent hypochlorite solution and dressed in impermeable (leak-proof) material to ensure body fluids don’t ooze out. The nose and mouth must be plugged to prevent body fluids from oozing out.

After the body is put in it, the bag must again be disinfected with hypochlorite. The bag can be covered in a cloth provided by the family. The disinfected bag does not pose a risk during transportation or handling. But those handling it should wear personal protective equipment.

Does burial pose a risk of infection?

Bodies of people infected with microbes such as HIV and SARS-CoV-2 come under Biosafety Levels II and III. Burial is considered safe as the body is sealed. “The body takes 7-10 days to decompose, and the body fluids can take 3-4 days to dry up. Theoretically speaking, the virus lives until there are body fluids. But this infection spreads by droplets. There has been no case recorded where body fluids leaked from a body contaminated groundwater and spread infection,” said Dr Satish Pawar, joint director, Directorate of Health Services, Maharashtra.

coronavirus, Coronavirus india, coronavirus dead patients cremation, how to cremate coronavirus patients, coronavirus india death toll, coronavirus india, coronavirus latest mumbai coronavirus, coronavirus deaths, covid 19 deaths After the body is put in it, the bag must again be disinfected with hypochlorite. (Express photo/Javed Raja)

If the body is cremated, the ash does not pose any risk either. Infection is a risk only for mortuary workers, doctors who do the autopsy and those who handle the body. If all precautions are followed, then both burial and cremation are considered safe. Large gatherings are to be avoided because family members are possible contacts.

How soon must burial or cremation take place?

Dr Harish Pathak, head of the forensics department in Mumbai’s KEM Hospital, said a body must be disposed quickly. If it has to be kept in a mortuary, it should be preserved between 4-6 degrees.°C For disposing of infectious animal carcasses, the World Health Organization mandates a proper incinerator, its primary chamber at 800°C and secondary chamber at 1000°C; for biomedical waste, an auto-clave machine is used.

Here’s a quick Coronavirus guide from Express Explained to keep you updated: What can cause a COVID-19 patient to relapse after recovery? | COVID-19 lockdown has cleaned up the air, but this may not be good news. Here’s why | Can alternative medicine work against the coronavirus? | A five-minute test for COVID-19 has been readied, India may get it too | How India is building up defence during lockdown | Why only a fraction of those with coronavirus suffer acutely | How do healthcare workers protect themselves from getting infected? | What does it take to set up isolation wards?

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