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With the COVID-19 cases rising in the country and more than 30 reported deaths as of 31 March 2020, one of the major concerns linked with the disease now is the right way to manage the dead bodies of infected people. Since COVID-19 is a new disease, it is not known whether the infection can spread through dead bodies too. 

On 15 March, the government of India had released the guidelines for dead body management for COVID-19. The guidelines include everything including the management of bodies in the hospital, autopsy, and burial/cremation.

The AIIMS Department of Forensic Medicine and Toxicology, New Delhi, has also released its own set of guidelines for COVID-19 dead body management. They are mostly the same as the government of India guidelines but they have some additional points, too.

Most health authorities across the globe have released their own set of guidelines, too. They are all mostly the same with minor changes or additions. Most places suggest cremation as the safe way for last rites instead of burial. However, guidelines for burial are also given, just in case. 

Here is a gist of these guidelines.

  1. Indian health ministry guidelines for dead body management
  2. AIIMS guidelines for management of dead bodies of COVID-19 patients
  3. WHO recommendations for the last rites and for handling the belongings of the dead person
  4. Recommendations by the European Union
  5. US CDC recommendations for dead body management
  6. Doctors for COVID-19: Global practices for proper disposal of dead bodies

The Union Ministry of Health and Family Welfare, India, has put the following guidelines for cremation practices and management of dead bodies of COVID-19 patients:

Removing the dead body from the isolation ward/area

  • Remove all the tubes and catheters from the body and disinfect all the puncture wounds with 1% hypochlorite solution. After this, seal all the punctures with impregnable material.
  • All health workers handling the dead body should be wearing personal protective equipment including gloves, N95 masks, goggles, and waterproof apron. They should be careful while handling all sharp objects and dispose of all the catheters and tubes properly in a separate bin. 
  • The nose and mouth of the dead body should be plugged to avoid the leakage of any fluid. 
  • After this, the dead body should be placed in a leak-proof plastic bag, which is cleaned from the outside with 1% hypochlorite solution. A second layer (sheet) can be placed over the plastic bag, either from the mortuary or given by the family.
  • The body can be taken to the mortuary or given to the relatives.
  • The immediate family (if they want to watch the processing) must also follow all the precautionary measures like the healthcare practitioners.
  • All the linen from the dead person should be taken as biomedical waste and hence autoclaved (sterilised) or disinfected. All used equipment should also be disinfected or autoclaved. All the area in the isolation room should be sanitised with 1% hypochlorite solution. The solution should be allowed to air dry after 30 minutes of contact time.
  • Finally, all health practitioners who handled the body should wash and sanitise their hands even after removing the personal protective equipment.

Read more: COVID-19: 10 steps to wear protective instruments for medical practitioners

In the mortuary

In case the dead body is to be kept in the mortuary, the mortuary staff should also follow the precautionary measures that are mandated for healthcare practitioners, including the use of personal protective instruments and hand hygiene. Also, the following guidelines should be followed:

  • All the surfaces in the mortuary should be cleaned with 1% hypochlorite solution while the dead body is in there and after the body is removed. This includes trolleys, tabletop, door handles and floor. 
  • The dead body should be kept at a temperature of 4 degrees Celcius. 
  • Autopsy and embalming of the body should be avoided at all times. 
  • In case autopsy is done, the team should follow all the infection control guidelines and use blunt-ended scissors to avoid pricking injuries.
  • Autopsy team should also wear personal protective gear and the autopsy room should have a negative pressure.
  • The body should be cleaned/disinfected with 1% hypochlorite solution afterwards. 

Transporting the body and guidelines for cremation

Since the body is sealed in the bag, it is not likely to transmit the coronavirus infection. However, anybody handling the body should wear personal protective gear and the ambulance should be cleaned with 1% hypochlorite solution afterwards. At the crematorium, the following things should be kept in mind:

  • Last rites should not be done in large gatherings to avoid the spread of infection just in case someone in the immediate family also has the infection.
  • The staff of the cremation ground should be informed in advance about the rites and the patient.
  • If the family members want to view the dead body, a person in personal protective equipment can open the head side of the bag and allow last viewing. However, nobody should be allowed to touch the body.
  • Bathing of the body should not be allowed.
  • Any ritual that does not involve touching the body would be allowed - sprinkling water, saying prayers from afar, etc.
  • All members of the family and the crematorium ground should wash and sanitise their hands properly after the cremation or burial.
  • Ashes can be collected since they are considered to be non-harmful.

Some of the additional points in the AIIMS guidelines are as follows:

  • The dead body bag should be at least 150 microns thick and should be tagged COVID-19. 
  • If the body is kept in a mortuary, regular temperature checks should be done to ensure that the temperature of the mortuary is set at 4 degrees Celsius. 
  • Autopsy should be avoided if there is no reason for it otherwise.
  • Upper respiratory swabs, nasopharyngeal and oropharyngeal swabs and swabs from lungs should be taken in case of postmortem. And if indicated, separate specimens should be taken to check for other possible infectious microbes.
  • To ensure safety, it is best to cremate all dead bodies in electric or gas crematorium, keeping the body in the body bag.
  • If burial is to be done (for religious or personal beliefs), the body should be placed in a thick and airtight coffin at a depth of four to six meters in the ground. The area around the grave should be cemented immediately. Precautions should be followed afterwards to avoid scavenging by animals.

Read more: Can you get COVID-19 twice

Apart from the recommendations suggested above, the World Health Organization (WHO) has the following guidelines for the last rites of deceased COVID-19 patients:

  • Children, immunocompromised people, those with respiratory diseases and those above 60 years of age should be kept away from the deceased person’s body at all times. (Read more: COVID-19 prevention tips for parents and children)
  • Any last rites that need to be done after the burial should be delayed until the end of the pandemic to avoid large gatherings.
  • There is no need to burn or dispose of off all the belongings of the deceased person (if you don’t want to). But, make sure to handle it properly, wear gloves and clean all those things with a 70% alcohol solution of 0.1% bleach.
  • Any clothing from the deceased person should be either washed in a machine in hot water (at least 60 to 90 degree Celsius) and detergent or put in a drum with stirring occasionally - make sure to avoid splashing. The drums should be emptied after this and the linens should again be soaked in a 0.05% chlorine solution for at least half an hour. After this, the laundry should be washed with clean water and allowed to air dry under direct sunlight.

Read more: 10 tips on how to protect yourself from COVID-19

The European Union has the following recommendations for COVID-19 dead body management apart from the usual recommendations and precautionary measures mentioned above:

To prepare the body after death - washing, combing and cleaning - all nurses and healthcare workers should wear protective gears.

  • If someone has died in the community, all precautionary measures should be taken in case the person was suspected to be a COVID-19 patient. 
  • All the ambulance staff should wear personal protective equipment (gloves, mask, a waterproof suit) and avoid coming in direct contact with any secretions from the body while they transport the body to the designated facility.
  • Embalming can be performed using standard precautions.
  • Burial or cremation of those who have died - whether they were suspected or confirmed patients - can be done as usual.

Read more: Can masks protect against COVID-19

While most places suggest against embalming, the US Centers for Disease Control and Prevention (CDC) says that embalming can be done. However, the funeral home workers should follow all the precautionary measures while preparing the body along with their routine methods of infection prevention. 

Follow all the instructions from the manufacturers to clean and disinfect protective equipment and wear disposable nitrile gloves while handling the body or heavy-duty gloves if there is a risk of getting cut during the procedure. 

If there is a chance of aerosol generation, instal HEPA filters or laminar airflow control to direct the aerosols away from the personnel. If you can’t install the filters, use all precautions to avoid letting the air inside the building; instead, the air should be exhausted to an outside area with no traffic or places where humans can gather.

After handling the body, follow the hand hygiene procedure - wash your hands for 20 seconds with soap and water or use an alcohol-based sanitiser.

Read more: The right way to wash your hands to prevent COVID-19

Dr. Neha Gupta

Dr. Neha Gupta

Infectious Disease
16 Years of Experience

Dr. Lalit Shishara

Dr. Lalit Shishara

Infectious Disease
8 Years of Experience

Dr. Alok Mishra

Dr. Alok Mishra

Infectious Disease
5 Years of Experience

Dr. Amisha Mirchandani

Dr. Amisha Mirchandani

Infectious Disease
8 Years of Experience

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References

  1. Ministry of Health & Family Welfare Directorate General of Health Services: Government of India [Internet]. Delhi. India; COVID-19: Guidelines on dead body management
  2. Department of Health: Hospital Authority. Food and Environmental Hygiene Department: Government of Hong Kong [Internet]; Precautions for Handling and Disposal of Dead Bodies
  3. All India Institute of Medical Sciences [Internet]. New Delhi. India; Protocol of dignified management of COVID-19 dead bodies
  4. World Health Organization [Internet]. Geneva (SUI): World Health Organization; Infection Prevention and Control for the safe management of a dead body in the context of COVID-19
  5. European Centre for Disease Prevention and Control [Internet]. European Union. Sweden; Considerations related to the safe handling of bodies of deceased persons with suspected or confirmed COVID-19
  6. Centers for Disease Control and Prevention [internet]. Atlanta (GA): US Department of Health and Human Services; Coronavirus (COVID-19)
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