Embedded Files
A global pandemic can place extraordinary strain on health care resources, and where widespread fatalities occur, this can have concomitant effects for the death care sector. Uncertainties can arise, particularly for a novel pathogen, on likely routes of transmission, viability of the pathogen in different settings, and appropriate measures required to minimize risks to those working in the death care sector or family members and others who come into contact with the deceased. This paper provides an overview of SARS-CoV-2, the virus responsible for COVID-19 and what is known about the relative risks of transmission across various stages of the death care process from the point of death through to cremation or burial. A review of guidance across various public health agencies is summarized, highlighting the key precautions and risk reducing measures, as well as considerations for associated risks such as shortages of supplies, personnel, or storage space. Amid a global pandemic, public health is typically involved in investigating and containing localized outbreaks and advising on interventions that aim to reduce community spread in schools, restaurants, recreational facilities, and other public venues. Despite best efforts to control a pandemic, a gradual increase in cases over weeks or months can begin to grow exponentially. This can cause health care systems to be overcome, which can have downstream impacts on the death care sector if high fatality rates are experienced. Uncertainties may arise concerning the relative risks and protocols required in handling the deceased and the additional safety precautions that are needed to protect those who come into contact with the deceased. This may include death care professionals, family members and loved ones, and religious officials attending funerals. A rapid increase in fatalities can also lead to shortages in supplies, personnel, and conventional spaces for storage of the deceased, giving rise to additional public health concerns. This paper examines public health risks that arise through the death care process in the context of the COVID-19 pandemic and examines current guidance on minimizing the risks. During a pandemic, particularly for a novel pathogen, public health and others need to quickly gain knowledge about the transmission pathway of the pathogen and an understanding of high-risk activities, settings, or groups of individuals most at risk. SARS-CoV-2, the novel coronavirus responsible for coronavirus disease (COVID-19) has been classified as a Risk Group 3 (RG3) pathogen in Canada (Public Health Agency of Canada, 2020b). The definition of an RG3 pathogen is (Public Health Agency of Canada, 2015): A pathogen that poses a high risk to the health of individuals or animals, and a low risk to public health. These pathogens are likely to cause serious disease in a human or animal. Effective treatment and preventive measures are usually available and the risk of spread of disease caused by these pathogens is low for the public… In the international community SARS-CoV-2 may also be referred to a Hazard Group 3 (HG 3) pathogen1. SARS and MERS related coronaviruses, rabies, poliovirus, dengue virus, and Mycobacterium tuberculosis are among other HG3 pathogens (Hanley et al., 2020; Stephenson & Byard, 2019). This risk classification can assist professionals is adapting their practices, to ensure appropriate controls are used to reduce risks of infection. The primary mode of person-to-person transmission of SARS-CoV-2 is via direct contact with an infected person and their respiratory droplets, generated by speaking, breathing, coughing, and sneezing. The literature so far has demonstrated that the greatest risk of transmission is associated with prolonged close contact with an infected person, particularly in an indoor or enclosed environment such as a household, health care setting, or where groups gather or work closely together. This could include gatherings such as funerals. For example, an outbreak investigation in Chicago, Illinois, USA, in 2020 found that 16 confirmed or probable cases of COVID-19, including three deaths, resulted from transmission from a primary case who attended two family gatherings, one of which was a funeral (Ghinai et al., 2020). The funeral was for a non-COVID patient, but transmission is likely to have occurred during the event, of approximately 2 hours, where talking, hugging, and sharing of food took place. Contact with surfaces (fomites) that have been contaminated with the bodily fluids of an infected person (e.g., deposition of droplets, aerosols, sputum, or feces) followed by touching of the eyes, mouth, or nose is another recognized mode of SARS-CoV-2 transmission (World Health Organisation, 2020b). The risk of
Report abuse