By Sarah Hannan
There seems to be confusion on performing PCR tests on the dead and the process that is to be followed. Most of the deaths took place at residences which were in isolated zones, while most of the people who died during this time had also been suffering from long-term non-communicable diseases and were receiving treatment.
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An ambulance that transferred a Covid-19 related dead body to the crematorium is disinfectant at Borella Cemetery, 10 November 2020, Photo Pradeep Dambarage [/caption]
“We proposed that the Ministry of Health should issue guidelines for the staff as well as the people in the house on what processes need to be followed. Furthermore, we have to also create awareness on what measures the family could take to ensure that these persons do not get exposed to the virus through a healthy carrier that would be asymptomatic,” Government Medical Officers’ Association (GMOA) Editor Dr. Haritha Aluthge stated.
There were practical challenges that were presented when the bodies were to be retrieved from homes. The Director General of Health Services (DGHS) had promptly responded to the GMOA’s requests and made provisions to publish the necessary guidelines immediately.
A committee to review the Covid-19 deaths too was immediately appointed and the DGHS is providing the necessary leadership for the committee to present the necessary death reviews efficiently.
Ministry of Health DGHS Dr. Asela Gunawardena focused on four instances in the “Guidelines on management of death during the current pandemic of Covid-19" that was published on 17 November and circulated to the Deputy Director General (DDG) of the National Hospital of Sri Lanka, Acting DDG of the National Hospital in Kandy, all provincial directors of health services, all directors of teaching hospitals and general hospitals, all medical superintendents of base hospitals, and all heads of institutions under the Ministry of Health.
Death in lockdown or high-risk areas
The guidelines indicate that any death that occurs in a lockdown area or an area that is identified to be at a high-risk level for Covid-19, will be subjected to PCR testing.
The Inquirer into Sudden Deaths (ISD) or Magistrate, depending on the circumstances according to the Criminal Procedure Code (CPC), will have to conduct an inquiry.
A designated healthcare worker from the Medical Officer of Health (MOH)/Public Health Inspector (PHI) Office will obtain the nasopharyngeal swab under the supervision of the Medical Officer of Health of the area, after which, the dead body is to be placed in a body bag under the supervision of an investigating police officer.
The dead body and the body bag are to be treated with a disinfectant and the body bag will be dispatched to the area Judicial Medical Officer (JMO) along with the sample that was obtained for PCR testing for Covid-19.
If case field sample collection is not feasible, the dead body will be placed in a body bag under the supervision of the investigating police officer and the area police station will have to transport the dead body to the office of the area JMO. In this instance, the dead body will not be treated with a disinfectant. Once the dead body is removed from the premises, that house will be disinfected. The JMO will conduct the post-mortem examination and collect the nasopharyngeal swabs for PCR testing and place the dead body in the mortuary refrigerator until the PCR results are released.
Death during the period of quarantine at home or at a designated quarantine centre
The guidelines indicate that any death that occurs in a lockdown area or an area that is identified to be at a high-risk level for Covid-19 will be subjected to PCR testing.
The ISD or Magistrate, depending on the circumstances according to the CPC, will have to conduct an inquiry.
A designated healthcare worker from the MOH/PHI Office will obtain the nasopharyngeal swab under the supervision of the MOH of the area, after which, the dead body is to be placed in a body bag under the supervision of an investigating police officer.
The dead body and the body bag are to be treated with a disinfectant and the body bag will be dispatched to the area JMO along with the sample that was obtained for PCR testing for Covid-19.
If case field sample collection is not feasible, the dead body will be placed in a body bag under the supervision of the investigating police officer. The area police station will have to transport the dead body to the office of the area JMO. Here too, the dead body will not be treated with a disinfectant. Once the dead body is removed from the premises, that house will be disinfected. The JMO will conduct the post-mortem examination and collect the nasopharyngeal swabs for PCR testing and place the dead body in the mortuary refrigerator until the PCR results are released.
When death occurs elsewhere and not in a healthcare institution
An inquiry is not mandatory for epidemiological purposes of prevention of Covid-19. However, irrespective of a death inquiry, a clearance certificate regarding the status of Covid-19 needs to be obtained by the area MOH/PHI before the body is disposed of.
If the MOH/PHI/healthcare worker requests that the deceased needs to be subjected to a PCR test for Covid-19, a death inquiry according to the above guidelines will be carried out.
When death occurs in a healthcare institution
The clinicians should decide on investigations pertaining to Covid-19 and whether a PCR test is required.
Nasopharyngeal swabs for PCR testing can be obtained by the ward staff. Once the samples are obtained in the ward, the dead body needs to be treated with a disinfectant and then placed in a body bag, which should also be disinfected. The body will be placed in the body bag under the supervision of the nurse in charge of the unit. Once the body is dispatched to the mortuary, the ward needs to be disinfected according to the guidelines.
If a death inquiry is to take place, nasopharyngeal swabs for PCR testing can be obtained by the ward staff. Once the samples are obtained in the ward, the dead body needs to be treated with a disinfectant and then placed in a body bag, which should also be disinfected. The body will be placed in the body bag under the supervision of the nurse in charge of the unit. Once the body is dispatched to the JMO, the ward needs to be disinfected according to the guidelines.
In the instance the hospital does not have the necessary tools to collect the nasopharyngeal swabs for PCR testing, the body needs to be placed in a body bag under the supervision of the nurse in charge of the unit and dispatched to the office of the JMO. The body should not be treated with any disinfectant. Once the body is dispatched, the ward needs to be disinfected according to the guidelines. Once the body reaches the office of the JMO with request for a post-mortem examination and PCR testing, the JMO shall obtain the samples for Covid-19 PCR testing and place the body in the refrigerator.
An ambulance that transferred a Covid-19 related dead body to the crematorium is disinfectant at Borella Cemetery, 10 November 2020, Photo Pradeep Dambarage [/caption]
“We proposed that the Ministry of Health should issue guidelines for the staff as well as the people in the house on what processes need to be followed. Furthermore, we have to also create awareness on what measures the family could take to ensure that these persons do not get exposed to the virus through a healthy carrier that would be asymptomatic,” Government Medical Officers’ Association (GMOA) Editor Dr. Haritha Aluthge stated.
There were practical challenges that were presented when the bodies were to be retrieved from homes. The Director General of Health Services (DGHS) had promptly responded to the GMOA’s requests and made provisions to publish the necessary guidelines immediately.
A committee to review the Covid-19 deaths too was immediately appointed and the DGHS is providing the necessary leadership for the committee to present the necessary death reviews efficiently.
Ministry of Health DGHS Dr. Asela Gunawardena focused on four instances in the “Guidelines on management of death during the current pandemic of Covid-19" that was published on 17 November and circulated to the Deputy Director General (DDG) of the National Hospital of Sri Lanka, Acting DDG of the National Hospital in Kandy, all provincial directors of health services, all directors of teaching hospitals and general hospitals, all medical superintendents of base hospitals, and all heads of institutions under the Ministry of Health.
Death in lockdown or high-risk areas
The guidelines indicate that any death that occurs in a lockdown area or an area that is identified to be at a high-risk level for Covid-19, will be subjected to PCR testing.
The Inquirer into Sudden Deaths (ISD) or Magistrate, depending on the circumstances according to the Criminal Procedure Code (CPC), will have to conduct an inquiry.
A designated healthcare worker from the Medical Officer of Health (MOH)/Public Health Inspector (PHI) Office will obtain the nasopharyngeal swab under the supervision of the Medical Officer of Health of the area, after which, the dead body is to be placed in a body bag under the supervision of an investigating police officer.
The dead body and the body bag are to be treated with a disinfectant and the body bag will be dispatched to the area Judicial Medical Officer (JMO) along with the sample that was obtained for PCR testing for Covid-19.
If case field sample collection is not feasible, the dead body will be placed in a body bag under the supervision of the investigating police officer and the area police station will have to transport the dead body to the office of the area JMO. In this instance, the dead body will not be treated with a disinfectant. Once the dead body is removed from the premises, that house will be disinfected. The JMO will conduct the post-mortem examination and collect the nasopharyngeal swabs for PCR testing and place the dead body in the mortuary refrigerator until the PCR results are released.
Death during the period of quarantine at home or at a designated quarantine centre
The guidelines indicate that any death that occurs in a lockdown area or an area that is identified to be at a high-risk level for Covid-19 will be subjected to PCR testing.
The ISD or Magistrate, depending on the circumstances according to the CPC, will have to conduct an inquiry.
A designated healthcare worker from the MOH/PHI Office will obtain the nasopharyngeal swab under the supervision of the MOH of the area, after which, the dead body is to be placed in a body bag under the supervision of an investigating police officer.
The dead body and the body bag are to be treated with a disinfectant and the body bag will be dispatched to the area JMO along with the sample that was obtained for PCR testing for Covid-19.
If case field sample collection is not feasible, the dead body will be placed in a body bag under the supervision of the investigating police officer. The area police station will have to transport the dead body to the office of the area JMO. Here too, the dead body will not be treated with a disinfectant. Once the dead body is removed from the premises, that house will be disinfected. The JMO will conduct the post-mortem examination and collect the nasopharyngeal swabs for PCR testing and place the dead body in the mortuary refrigerator until the PCR results are released.
When death occurs elsewhere and not in a healthcare institution
An inquiry is not mandatory for epidemiological purposes of prevention of Covid-19. However, irrespective of a death inquiry, a clearance certificate regarding the status of Covid-19 needs to be obtained by the area MOH/PHI before the body is disposed of.
If the MOH/PHI/healthcare worker requests that the deceased needs to be subjected to a PCR test for Covid-19, a death inquiry according to the above guidelines will be carried out.
When death occurs in a healthcare institution
The clinicians should decide on investigations pertaining to Covid-19 and whether a PCR test is required.
Nasopharyngeal swabs for PCR testing can be obtained by the ward staff. Once the samples are obtained in the ward, the dead body needs to be treated with a disinfectant and then placed in a body bag, which should also be disinfected. The body will be placed in the body bag under the supervision of the nurse in charge of the unit. Once the body is dispatched to the mortuary, the ward needs to be disinfected according to the guidelines.
If a death inquiry is to take place, nasopharyngeal swabs for PCR testing can be obtained by the ward staff. Once the samples are obtained in the ward, the dead body needs to be treated with a disinfectant and then placed in a body bag, which should also be disinfected. The body will be placed in the body bag under the supervision of the nurse in charge of the unit. Once the body is dispatched to the JMO, the ward needs to be disinfected according to the guidelines.
In the instance the hospital does not have the necessary tools to collect the nasopharyngeal swabs for PCR testing, the body needs to be placed in a body bag under the supervision of the nurse in charge of the unit and dispatched to the office of the JMO. The body should not be treated with any disinfectant. Once the body is dispatched, the ward needs to be disinfected according to the guidelines. Once the body reaches the office of the JMO with request for a post-mortem examination and PCR testing, the JMO shall obtain the samples for Covid-19 PCR testing and place the body in the refrigerator.