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Home / Opinion - A call to end the undignified, traumatic Covid-19 burials

Opinion - A call to end the undignified, traumatic Covid-19 burials

2020-09-09  Staff Reporter

Opinion - A call to end the undignified, traumatic Covid-19 burials

As the death toll has risen around the world, it has created an unprecedented challenge for the healthcare workers, forensic experts, governments, communities and most importantly families. 
Traditional funeral practices have been upended globally as countries have come up with cautionary measures to reduce the chance of infection transmission between the living. 
Owing to this, millions of people are grieving their loved ones in isolation and Namibians are no exception. What a sorrowful, disheartening and miserable experience! 

Coronavirus disease (Covid-19) is an acute respiratory illness caused by SARS-CoV virus that predominantly affects the respiratory system. 
Droplets of the virus are deposited on surfaces or objects when an infected person talks, coughs or sneezes. 
The robust question that remains answered is, “How long does the SARS-CoV-2 remains active after host death?” I have probably searched and asked this question to several experts a million times but nobody and no article has probably given me a good answer. 
Additionally, a review of almost non-existent scientific literature leads to the second question, which is, “Can a dead body whose respiratory system is inactive, transmit the virus to those in contact?” 

The most research proven answer and the epidemiologically correct answer is probably “NO” however, due to the nature of this disease several safety measures have to be taken into consideration.
“The greatest risk of Covid-19 is from the living and not the dead,” said Oran Finedan, head of forensics for the International Committee of the Red Cross (ICRC). 

He further stated that whereas the living can go around spreading the virus, as soon as someone’s cells begin to decompose, any viruses living inside also begins to decay. 
How fast this process occurs depends on where the virus lives - and how quickly autolysis occurs in those systems. 
For some viruses, it’s a matter of hours after the death of the host. A small infection risk from people who have died from Covid-19 primarily arises from aerosols generated in the postmortem handling of the recently deceased. 

Hepatitis, for example, exists mainly in the liver, which undergoes rapid autolysis, quickly rendering the body noninfectious.
 The decomposition process “goes both ways”, another forensic expert from the Centre for Disease Control (CDC) stated. When someone dies, their immune system stops working.

“The [viruses] lose their house, but they don’t have the army waiting outside.”
 That can mean, at least for a time, that a virus is able to multiply in a corpse, before factors like autolysis ultimately eliminate the risk.
Safety in handling the dead
The World Health Organisation (WHO) has given guidelines on how to conduct a safe and dignified funeral for persons who succumbed from Covid-19. 
Further to this, the WHO in this guiding document stated that there is no proof that people can become infected with coronavirus if they are exposed to a body that died from it. 

However, until more information is available, caution is key! Especially for the people who come into direct contact with the body- healthcare professionals, mortuary staff or the burial team must ensure that standard precautions are applied. 
This includes proper hand hygiene and use of personal protective equipment when in direct contact with the body.
The Namibian Cabinet through a statement by the minister of health dated 28 August 2020 highlighted the procedures and legal requirements for burials of persons who succumbed to Covid-19 illnesses. 

These procedures seem to have been adopted from Public and Environmental Health Act of 2015 as well as some of the WHO recommendations. 
In a nutshell, it highlights that the state will be conducting such burials, handling of bodies is kept at a minimum and the transportation of bodies is not allowed. 
How terrific! Furthermore, cultural and religious norms of families should be respected.
The gruesome reality at hand

Recently, at a burial of a prominent member of our community, we have witnessed another heartbreaking and traumatic scene as the state handled the burial of this great son of the Namibian soil. 
Orders on burial arrangements were forced on the family to bury him as quickly as possible, at a state demarcated location. This grave is a distance of about 50 metres from other graves. Family members were ordered to stay a distance of about 50 metres from the burial site. 
The body of this great man was in a coffin that was carried by mortuary workers in full PPEs. To add salt to the wound, the normal religious procedures were not allowed. Tombstones and coming close to the grave after burial is also restricted. What a shame my Namibia!
This cautionary move seems to be exacerbating an already traumatic experience for those looking to mourn their loved ones as per the cultural tradition. Covid-19 is not bloodborne like Ebola or Crimean-Congo fever and hence the adoption of guidelines from the Act that was primarily made with those diseases in mind is insensitive and inhumane. 

I must say the Namibian guidelines were made out of fear and panic and without research, consultation or understanding the epidemiology of Covid-19. We have jumped the gun and robbed our people of their human dignity. Is this not stigmatisation of the dead? 
What happened to humanity? We are robbing our people of the right to mourn and find closure as well as putting them at risk of post-traumatic stress disorder as well as mental health issues.
This pandemic has robbed us of many precious and quintessential lives of loved ones who deserves a humane and dignified burial as they meant so much to us. 

I must say the drastic change to the traditional burials is daunting especially because the state is just taking it as business as usual. 
Before I give a few recommendations, I have a few questions to the health ministry regarding the burials of Covid-19 victims:
What is the rationale behind keeping a distance of 50m between the graves of Covid-19 victims?
 Why can’t the bodies of those who succumbed to Covid-19 be sealed in body bags (Shroud) and coffins and then be transported to their districts/regions under strict health guidelines?

 What is the scientific reason that is preventing our loved ones from being buried at our hometown graveyards? Is there also a fear of infection transmission between dead bodies across graves? 
 Why can’t the sealed bodies and coffins of our loved ones be handed over to private undertakers for more respectful and dignified burials?

 Recommendations of safe and dignified funerals

Current evidence indicates that there is little to no risk of Covid-19 infection from deceased individuals. I was appalled to not only sound critical but also give a few recommendations on how this serious and delicate matter should be handled. These were drawn from scientific studies as well as from good examples of how other countries are treating those that died from Covid-19 and their families with sensitivity, dignity and respect.
Allow private funeral undertakers to take over burials of our loved ones for more respectful and dignified burials. This can be done under strict safety regulations below:

The deceased body to be sealed in a body bag then a sealed casket, which should not be opened.
Disinfection of the casket to be done prior to leaving the mortuary and be handled by persons with gloves, aprons and masks. SAVE the full PPEs for the frontline health workers.
Revisit the restrictions of transportation of the deceases to their respective areas of residence. It can be done with strict infection prevention and control guidelines. The danger of infection transmission is in the infected people who are sent back into the community and walking around the shopping malls and streets. NOT THE DEAD!
The 50m distance is unjustifiable and needs to end. The stigmatisation of our loved ones should end!
Decentralise cremation facilities to ensure that families are given a range of options to bury their loved ones decently. 

* Edith Hamukwaya is a lecturer at the University of Namibia. These are her personal views.

2020-09-09  Staff Reporter

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