Connect with us


In pandemics, forensic pathologists deal with morgues, mass graves and infectious remains




A graveyard (Representational image)
A graveyard (Representational image) |

Text Size:

What is the role of forensic pathologists in a pandemic?

Forensic pathologists are physicians who integrate law and medicine to determine the cause, mechanism, manner and time of a person’s death. Their everyday work has important legal, social and economic consequences for family members of the deceased and for the larger community.

During a pandemic, forensic pathologists are heavily involved in managing the crisis, either within their local communities or as part of a humanitarian mission working with vulnerable communities abroad.

Their role in these extremely challenging times is to ensure the proper management of dead bodies, minimizing the spread of the virus, and to guide authorities, hospitals and funeral directors about the “do’s and don’ts” of dealing with these bodies.

There is a general assumption in medicine that dealing with the deceased does not require the same urgency as working with an acutely ill patient, and normally that is true. However, in a pandemic like COVID-19, large numbers of the dead can quickly exceed local capacities if not managed in a timely manner.

With highly infectious diseases, it is urgent that the post-mortem procedures – from death, examination, certification, registration and release of the body to safe cremation or burial – flow as properly and smoothly as possible.

Are the bodies of COVID-19 victims infectious?

While a lot is known about the coronavirus family, much is yet to be understood about the transmission modes and effects on the body of SARS-CoV-2, the virus that causes COVID-19. We don’t know whether human remains are infectious, but the likelihood is high. So forensic pathologists around the world are urging governments to restrict viewing and handling of the body after examination is completed.

During the Ebola epidemic – which claimed around 11,300 lives in West Africa between 2014 and 2015 – handling of the dead was one of the main modes of transmission of the disease. So one of the lessons forensic humanitarians took from this experience – which is now being applied to coronavirus – was that untrained first responders should not be involved in handling human remains during outbreaks of highly contagious diseases.

Also read: Rwanda finds mass graves that could contain 30,000 bodies, 26 years after genocide


Are cities with coronavirus outbreaks able to manage the dead safely?

With the death toll from coronavirus projected to exceed many hundreds of thousands worldwide, governments everywhere are scrambling. But health systems that have planned for pandemics – and allocated sufficient resources to manage them – seem to be in decent shape.

My colleague Dr. Ralph Bouhaidar – a consultant forensic pathologist at the University of Edinburgh – told me that in addition to spending long hours in the Edinburgh City Mortuary, he is closely collaborating with prosecutors, police, funeral directors and hospitals across Scotland to review, assess and update existing procedures for managing “excess deaths in a pandemic.”

Dr. Bouhaidar emphasized that an appropriate COVID-19 response does not “emerge from a vacuum.” Rather, he said, proper management of the dead is “the result of cumulative work and planning…to have an understanding of local capacities and study our resilience in dealing with such possibilities, whilst liaising nationally and internationally with colleagues to share knowledge and experiences.”

So far, with 4,565 confirmed COVID-19 cases and 366 dead, Scotland’s hospitals and morgue are not overwhelmed.

But there are grim reports from hard-hit cities – like New York and Guayaquil, Ecuador, for example – of coronavirus patients dying so fast that bodies are just piling up. Both cities are considering digging mass graves.

When national plans for managing dead bodies in pandemics are exhausted, it leads to the piling up of bodies, issues with storage and refrigeration, and decomposition. That, as a result, increases risk of infection across the community.

Under such conditions, local and federal governments have very limited – yet essential – choices to handle the volume of bodies.

They should allow for the certification of medical deaths due to COVID-19 by the treating clinician, without the need for a post-mortem examination, to enable a swifter flow of the deceased within the system. They must also set up temporary mortuaries big enough to accommodate thousands of bodies. British authorities, for example, are building a special COVID-19 mortuary at the Birmingham Airport to accommodate 12,000 bodies. And, yes, they may need to excavate mass graves.

All this must be done while ensuring a dignified burial for the bodies and proper labeling of the graves as required by international humanitarian law.

What dangers does the COVID-19 pandemic present for forensic scientists?

Despite all protective measures, forensic experts are at constant risk of exposure to this deadly virus. And when pathologists in hard-hit areas contract coronavirus, it intensifies a vicious cycle.

They must absent themselves from work for at least 14 days, and some will die. This worsens an already miserable situation with the handling of dead bodies and, as a result, threatens the health of the entire community.

Forensic scientists from the Red Cross are being sent into refugee camps, war zones and overwhelmed cities on humanitarian COVID-19 missions to provide pandemic assistance. In these places, the risk of contagion is even greater. The morgues they work in there most likely face shortages of staff with expert skills and appropriately equipped mortuaries.

Generally speaking, the forensic examination of a dead person doesn’t require highly complex equipment and machinery compared to other health specialties. Pathologists just need appropriate storage, personal protective equipment, basic dissection tools and specimen collection material.

But our work falls within a larger chains of events. Hospitals must have the capacity to identify the person, determine their cause of death, physically dispose of the body and work through the various legal complexities that these cases attract – and to do so swiftly.

You mentioned how forensic scientists learned about Ebola on the job. What are we learning about coronavirus that’s aiding the pandemic response?

The lessons from Ebola were reflected into the revised “Management of Dead Bodies following Disasters” manual, published in 2016 by the World Health Organization and International Committee of the Red Cross, that is now aiding governments and first responders worldwide in the COVID-19 pandemic.

Today, cross-disciplinary research is underway about COVID-19 that connects the knowledge of forensic pathologists with that of clinical medical practitioners, virologists and biochemists.

In Italy, for example, a study published March 26, led by 25 health professionals across fields, warned health care professionals and morgue staff about specific risks in handling COVID-19 patients and provided guidance for autopsies of suspected, probable and confirmed cases of COVID-19.

Such work, when replicated and carried out across various research teams and countries, will greatly assist in managing this global crisis, formulating an effective treatment plan – and potentially creating a vaccine.

The Conversation is running a series of dispatches from clinicians and researchers operating on the front lines of the coronavirus pandemic. You can find all of the stories here.The Conversation

Ahmad Samarji, Associate Professor of Forensic Science Education & STEM Education and the Assistant Dean of the College of Arts and Sciences, Phoenicia University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Also read: Why it’s still hard to predict who will die from Covid-19


ThePrint is now on Telegram. For the best reports & opinion on politics, governance and more, subscribe to ThePrint on Telegram.

Subscribe to our YouTube channel.


Andhra doctor, suspended for alleging PPE shortage, now beaten by cops for ‘creating nuisance’




doctor with a stethoscope
A doctor with a stethoscope (Representative image) | Pixabay

Text Size:

Bengaluru: A doctor with a government hospital in Andhra Pradesh, who was suspended for questioning the shortage of PPE kits, was admitted to a mental health facility Sunday, a day after he was allegedly manhandled by the police and arrested for creating nuisance in Visakhapatnam.

Dr Sudhakar Rao, a government civil surgeon, was beaten, his hands tied behind his back and dragged by police officers Sunday. During the incident, Sudhakar allegedly verbally abused the Jagan Mohan Reddy government in an inebriated state. Videos of the incident have since been widely shared online.

“The police control room received a call about a person creating nuisance on Beach Road Hospital in Visakhapatnam. The Fourth Town police was rushed there and found that the person was the suspended doctor, Sudhakar.

“When the police tried to control him, he snatched the mobile phone of an officer and threw it away. He is suffering from mental disorder and he was drunk. He was sent for a medical examination,” Vishakapatnam Police Commissioner R.K. Meena told the media Sunday.

Sudhakar was admitted to a mental hospital Sunday after doctors at the King George Hospital in Vishakapatnam said he suffered from anxiety.

“Since the doctor is in anxiety and talking irrelevant things, I have referred him to a mental care hospital in Visakhapatnam,” said Dr Radha Rani, medical superintendent, King George Hospital.

A statement released by the hospital said: “Dr Sudhakar was brought to the KGH casualty ward at 6.30 pm. From the smell, it was found that he was in a drunk condition. Under the influence of alcohol, he did not cooperate with anybody there and kept abusing all. Still, his pulse, BP were checked. Pulse was 98, BP 140/100. Blood samples were sent to forensic lab to ascertain alcohol content in his blood.”

Also read: 6 toilets for 20 houses, inadequate testing: Why Mumbai’s Worli chawls are a Covid hotspot

‘Treatment towards Sudhakar was inhuman’

Sudhakar, who spent more than 10 years at the Narsipatnam Government Hospital in Andhra Pradesh, was suspended from his duties in March after he openly criticised the Reddy government for failing to provide PPE kits and N95 masks to doctors treating Covid-19 patients.

He had alleged that the state government was giving N95 masks and PPE kits meant for doctors to politicians and the police.

A video of Sudhakar criticising the government was also shared widely. In the clip, he can be heard saying: “We are putting our lives at risk here. We are asked to use the same mask for 15 days and a fresh mask will be provided only twice a month.”

Speaking to ThePrint, Dr P. Gangadhar Rao, member of the National COVID Committee of the Indian Medical Association, said the manner in which Sudhakar was manhandled by the police was “inhuman” and “violated” human rights.

“We strongly condemn the way he was taken into custody. He was not carrying a weapon, he was alone, the number of policemen outnumbered him. Why treat him like that? We also saw a video where a policeman beats him with a lathi,” said Dr Gangadhar.

He added that Rao was one of the most experienced anaesthetists the Andhra Pradesh government had.

“Our next step of action is to get Sudhakar to write an unconditional apology for having used filthy language, abusing the chief minister and the government. We will then take our appeal to the CM seeking that he be reinstated,” Gangadhar said.

Also read: Face shields, gowns, masks — the new attire for cabin crew post lockdown


ThePrint is now on Telegram. For the best reports & opinion on politics, governance and more, subscribe to ThePrint on Telegram.

Subscribe to our YouTube channel.

Continue Reading