Dead Body Management in the context of COVID-19: protecting

the living and respecting the dead

Joao Paulo Toledo, MD, MScAdvisor, clinical management of infectious diseases

PAHO – HQ – Washington, D.C., USAVirtual, 18 June 2020

Disclosure

I declare no conflict of interest.

Objectives

1. To present the available guidance on dead body management (DBM) in the context of COVID-19

2. To discuss the concept of standard precautions on DBM in the context of COVID-19

Introduction

• COVID-19 deaths and mass casualties• COVID-19 deaths and healthcare systems

overwhelming:

o Protecting the living: o health workerso personal protective equipment o healthcare systems capacity

o Respecting the dead:o community burials, o grievance, o cultural traditions

Translating the reality …

8 061 550Confirmed cases

440 290Confirmed deaths

216Countries, areas or territories

https://www.who.int/emergencies/diseases/novel-coronavirus-2019 (17-Jun-20)

… into guidance

DBM in the context of COVID-19 (PAHO)

ProcedureHand

hygieneGloves

Surgical Mask

RespiratorLong sleeved

impermeable gownFacial

protection(*)Managing the body inside the isolation room

√ √ √ √ √

Removal of the body from the isolation room or similar area

√ √ √ √ √

Mortuary care √ √ √ √ √

Necropsies √ √ √ √ √(*) – face shield preferred

Table 1 – Use of personal protective equipment according to the procedure related to the mortuary management of COVID-19.

https://iris.paho.org/handle/10665.2/52001

SARS-CoV-2 has been detected in respiratory, faecal and blood specimens;

Wang W. et al. JAMA 2020

Persistence of SARS-CoV-2 on surfacesvan Doremalen N. et al. medRxiv 2020

Standard precautions in the context of DBM – COVID-19 (I)

Hand Hygiene

Rational use of personal protective equipment

Safe injection practices

Sterilization and disinfection

Environmental cleaning

• “(…) A set of practices that are applied to the care of patients, regardless of the state of infection (suspicion or confirmation), in any place where health services are provided. (…)”

PAHO. Prevention and Control of Healthcare associated infections –Basic Recommendations”- PAHO, 2017 (adapted)

Autopsies and COVID-19

“(…) In this document, we highlighted that post-mortem examination does not have a primary diagnostic role: the diagnosis relies on the clinical picture, the results of laboratory tests (nasal and oropharyngeal swabs aimed at identifying viral RNA with PCR techniques), and typical lung CT scans. Autopsy may still have a clinical role in selected cases, but should more appropriately be restricted to research projects, where the collection of tissues may shed new insights on the disease-induced organ damages. (…)”

Sapino A. et al. Virchows Arch.

Resources§ Centers of Disease Control (2020). Collection and Submission of Postmortem Specimens from Deceased Persons with Known or

Suspected COVID-19. Interim Guidance. Available at https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-postmortem-specimens.html

§ European Centre for Disease Prevention and Control. Considerations related to the safe handling of bodies of deceased persons with suspected or confirmed COVID-19. Stockholm: ECDC; 2020. https://www.ecdc.europa.eu/sites/default/files/documents/COVID-19-safe-handling-of-bodies-or-persons-dying-from-COVID19.pdf

§ Pan American Health Organization (2006). Management of dead bodies after disasters: a field manual for first responders. Washington, D.C: PAHO,2006. https://iris.paho.org/handle/10665.2/798

§ Pan American Health Organization (2018). Prevention and Control of Healthcare associated infections – Basic Recommendations (https://iris.paho.org/handle/10665.2/34570.

§ Pan American Health Organization (2020). Dead body management in the context of the novel coronavirus (COVID-19). Interim recommendations, 7 April 2020. https://iris.paho.org/handle/10665.2/52001 (ENG) / https://iris.paho.org/handle/10665.2/52000(SPA)

§ Sapino A, Facchetti F, Bonoldi E, Gianatti A, Barbareschi M; Società Italiana di Anatomia Patologica e Citologia - SIAPEC. The autopsy debate during the COVID-19 emergency: the Italian experience. Virchows Arch. 2020 Jun;476(6):821-823. doi: 10.1007/s00428-020-02828-2. PMID: 32350596; PMCID: PMC7190281.

§ van Doremalen N, Bushmaker T, Morris D, Holbrook M, Gamble A, Williamson B, et al. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1. medRxiv. 2020.

§ Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020.

§ World Health Organization. (2020). Infection prevention and control for the safe management of a dead body in the context of COVID-19: interim guidance, 24 March 2020. World Health Organization. License: CC BY-NC-SA 3.0 IGO https://apps.who.int/iris/handle/10665/331538 (ENG) /https://apps.who.int/iris/bitstream/handle/10665/331538 (CHI) / https://iris.paho.org/handle/10665.2/51981 (PORT) https://apps.who.int/iris/handle/10665/331672 (FRE) / https://apps.who.int/iris/bitstream/handle/10665/331538 (RUS) / https://apps.who.int/iris/bitstream/handle/10665/331538(ARA).

(access date 17 June 2020, 3pm EDT (GMT-4)

Thank you