Union Health Ministry framing guidelines on handling of COVID-19 casualties

Amid a controversy over the cremation of the 68-year-old woman who died in Delhi after being infected with the novel coronavirus, the Union Health Ministry has begun working on framing guidelines for handling the bodies of those who die of the disease.

Though it is unlikely that coronavirus infection could spread from handling a body, the guidelines are being drafted to dispel any misconception and raise awareness regarding the spread of the disease from a deceased, a health ministry official said.

"Coronavirus infection is a respiratory disease which spreads through droplets and the probability of mortuary or disposal staff contracting the virus from the dead is unlikely as against the case of high-risk pathogens like Ebola and Nipah which have very high chances of spreading through direct contact with body fluids of the deceased," the health ministry official said.

Cremation of a person who died due to coronavirus has no side effect by any methods -- using fire or electrical, gas or by burial, said Sudhir Gupta, head of the forensic medicine department of the AIIMS, New Delhi.

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In case of burial, the surface of the grave should be cemented, he said.

Meanwhile, the AIIMS forensic department has drafted guidelines for workers in the mortuary.

Mortuary and death care workers who have contact with human remains known or suspected to be contaminated must be protected from exposure to infected blood and body fluids, contaminated objects, or other contaminated environmental surfaces, the guidelines said.

They also said the number of people allowed in the autopsy room should be limited.

"Use of an oscillating bone saw should be avoided for confirmed or suspected cases of COVID-19. Consider using hand shears as an alternative cutting tool. If an oscillating saw is used, attach a vacuum shroud to contain aerosols," the guidelines said.

"This virus is most often spread from a living person, occurs with close contact via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. This route of transmission is not a concern when handling human remains or performing post-mortem procedures," Gupta said.

Post-mortem activities should be ideally waived to avoid aerosol-generating procedures and ensuring that if aerosol generation is likely that appropriate engineering controls and personal protective equipment (PPE) are used, he said.

These precautions and the use of standard precautions should ensure that appropriate work practices are used to prevent direct contact with infectious material, percutaneous injury, and hazards related to moving heavy remains and handling embalming chemicals.

The World Health Organisation (WHO) guidelines on 'Infection prevention and control of epidemic and pandemic-prone acute respiratory infections in health care' recommend proper use of PPE in accordance with standard precautions to avoid direct contact with body fluids while moving a body from isolation room or area.

About mortuary care and post-mortem examination, WHO recommends packing and transporting a body with acute respiratory infection to a morgue, crematorium or burial by ensuring it is fully sealed in an impermeable body bag before being removed from the isolation area to avoid leakage of body fluid.

"When properly packed in a body bag, the body can be safely removed for storage in the mortuary, sent to the crematorium, or placed in a coffin for burial," it said.

The global health body advises using personal protective equipment such as disposable, long-sleeved, cuffed gowns for handling bodies; if the outside of the body is visibly contaminated with body fluids, excretions, or secretions, it has to be ensured that the gown is waterproof.

It further recommends that mortuary staff and burial teams apply standard precautions like proper hand hygiene and use appropriate personal protective equipment, including facial protection if there is a risk of splashes from the patient's body fluids or secretions onto the body or face of the staff member.

"Transmission of lethal infectious diseases associated with mortuary care has been reported... manage each situation on a case-by-case basis, balancing the rights of the family with the risks of exposure to infection," the WHO said.

Respiratory pathogens that are transmitted through large droplets, include adenovirus, avian influenza A (H5N1), human influenza and SARS-CoV.

"During an influenza pandemic, the circulating human virus is expected to be transmitted in the same manner as seasonal influenza viruses. Hence, droplet precautions should be applied in addition to standard precautions," it said.

The cremation of the 68-year-old west Delhi resident was performed on Saturday under the supervision of medical authorities.

Doctors from the Ram Manohar Lohia (RML) hospital and from civic bodies oversaw the cremation after the crematorium staff reached out to the authorities seeking directives on ensuring that the infection didn't spread from the body, delaying the last rites by a few hours.

"The situation across the world is sensitive. We had to seek instructions first from MCD and medical authorities. They said the cremation will be done using CNG and the officials had come to supervise the process," Suman Gupta of the Nigam Bodh Ghat Sanchalan Samiti said.

The number of coronavirus positive cases in the country has risen to 84 which includes the two deaths in Delhi and Karnataka, according to the Union Health Ministry.