Risks of Dead Bodies
Associated with an Epidemic
Summary
Epidemics that have generated a large number of victims have been caused
by diseases such as plague, cholera, typhoid fever, tuberculosis, anthrax,
small pox, and influenza. Even though these are highly contagious diseases,
their causing agents do not survive long in the human body after death,
making it unlikely that these epidemics can be transmitted by dead bodies.
HIV remains active in dead bodies kept at two degrees Celsius between
6-15 days, and influenza remains active in the environment for only one
day.(1) Therefore, if the necessary basic hygiene and biosecurity measures
are taken, dead bodies will not transmit diseases, even when the cause
of death is related to infectious diseases.
An epidemic can diminish the operative capacity of the human resources
and the external services necessary for the efficient running of government
and health sector agencies. The following steps should be taken:
- Avoid taking dead bodies to hospitals, as these institutions do not
have enough storage space for this purpose. Therefore, it is important
to have plans that assign other spaces and entities willing to be used
in these cases.
- Define clear procedures to remove victims from homes, elderly homes,
and other places. It is also important to make sure that those bodies
are included in the analysis of confirmed cases and to decide their
final resting place.
- Ensure that a plan is in place so that there are enough human and
transportation resources for the previous actions to be carried out.
It is important that voluntary or new personnel are trained, aware of
procedures, properly supervised and have all the necessary items needed
for their protection.
Dead Bodies and Infection
- There are diseases, such as Hepatitis B and HIV, that have a greater
capacity for transmission than other pathogens (Hepatitis B’s
risk of transmission is between 6%-30%, while HIV’s is 0.5%).(2)
Transmission can happen due to accidents with sharp contaminated objects,
such as fragmented bones, needles, or other objects related to the dead
body; or accidents involving skin lesions during surgical procedures
or by contact with mucous or ocular secretions. It is, therefore, imperative
to follow the usual protection or biosecurity measures: masks, goggles
and double rubber gloves.
- During epidemics it is important to establish a protocol for showing
the adequate use of the personal protection equipment (PPE) to relatives
coming to identify bodies, and to personnel from morgues, funeral homes
and transportation vehicles, the way it is done with assistance personnel.
- As a rule, it is not necessary to keep bodies in bags. The exception
would be bodies leaking secretions or blood (such as those from people
who have died from hemorrhagic diseases, cholera, etc.), or those with
numerous open wounds caused by a traumatic event.
- If personnel are protected against the high-risk agents, they will
also be protected from the lower risk ones.
Coordination
- The plan for the management of dead bodies is not exclusive to the
health sector, and it requires previous planning and coordination with
civil, governmental, military, and police authorities, at the national
and regional level, to speed up decision-making and allocation of resources.
- The plan should also include coordination activities with the civil
society, religious entities, and the mass media to ensure an effective
dissemination of the measures taken to preserve public health during
the epidemics.
Religious Services and Final Disposition of the
Bodies
- The main risk for transmission is exposure to sick people—who
are still alive—particularly getting close to them without protection.
- Religious services present the risk of conglomeration, which also
increase the risk of transmission. It is therefore recommended that
funeral services are regulated by civil authorities, and suggest that
services are quick and private.
- Hurried cremations, mass burials, or inadequate disposal of dead
bodies should be avoided. Experts from public health and management
of dead bodies can advise on this regard. Environmental health experts
should define the adequate places for burial and administrative mechanisms
required to designate an area as a cemetery. It is also important to
preserve water and environmental sources.
- In general, PAHO’s recommendations for the management of dead
bodies in disaster situations should be followed.
Bibliography
- Morgan, Oliver. “Infectious disease risks from dead bodies following
natural disasters.” Rev Panam Salud Pública, May 2004,
vol.15, no.5, p.307-312. ISSN 1020-4989.
- Morgan, Oliver - ed. Management
of Dead Bodies alter Disasters—A Field Manual for First Responders.
Washington. D.C. PAHO, 2006.
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