Countries need better plans for handling of mass corpses caused by disasters

[DB]

http://www.cbc.ca/cp/health/060605/x060538.html

Countries need better plans for handling of mass corpses caused by disasters
20:16:16 EDT Jun 5, 2006

HELEN BRANSWELL




<!-- CPPara1-->TORONTO (CP) - Corpse management should be a fundamental part of national emergency response plans, a study of the way Thailand, Indonesia and Sri Lanka handled human remains after the disastrous South Asian tsunami of late 2004 suggests.
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<!-- CPPara2-->The authors of the work said efforts to rapidly dispose of large numbers of bodies after natural disasters actually can exacerbate the trauma of people who survive but who have lost loved ones.
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<!-- CPPara3-->"Emergency response should not add to the distress of the affected communities by inappropriately disposing of the victims," they said in their paper, published in the June issue of the journal Public Library of Science Medicine.
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Lead author Oliver Morgan said authorities often attempt to deal quickly with large numbers of dead bodies, believing that in doing so they are sending a strong and reassuring signal to traumatized survivors that someone is in control. They often buttress the decision to bury bodies in mass graves, for instance, by claiming - erroneously - that the corpses are a source of contagion for survivors.

Corpses aren't a health risk, so long as they are kept out of drinking water sources, he and others argue. But depriving people of the ability to find and bury their loved ones is.

"They use the argument that the dead bodies cause epidemics. That is not true. It's a health argument for bad management," said Dr. Ciro Urgarte, regional adviser for emergency preparedness and disaster relief for the Pan American Health Organization, the World Health Organization's regional body for the Americas.

PAHO, as it is known, has taken a lead on research into corpse management in disaster settings. In April the Washington-based agency issued a field manual on retrieving, identifying and managing human remains for first responders to disasters.

Despite devastating recent examples of how challenging corpse management can be in disaster settings, little work has been done internationally to set standards or to incorporate lessons learned from previous incidents, Morgan, a researcher with the health policy unit of the London School of Hygiene and Tropical Medicine, said from London
"Very few countries have put any resources into doing that. Even Western countries."

Each disaster is different and poses its own challenges. No single formula will work in developing and developed countries, urban and rural settings. But some factors hold true across the board, said Morgan.

"Really the main lesson from the natural disasters is that rapid and unplanned disposal of human remains shouldn't be promoted as a public health measure, which is often the case," he said.

"And that where possible, every effort should be made to at least in an organized way gather and bury the bodies."

The study suggested marked graves where bodies are buried in a single layer offer better opportunities for exhumation and forensic investigation later.

"My experience is regardless of what the culture or religion the community has which has been affected, the individual response is that people want to find their relatives, identify their relatives and either bury or cremate them, give them the rites that they would normally give them. And I've seen that in all cultures," Morgan said.

"For the individuals affected, that's the overriding desire."

While the study looked at deaths caused by a natural disaster, it offers lessons for emergency planners preparing for a possible flu pandemic, said infectious diseases expert Dr. Michael Osterholm.

Reports from the 1918 Spanish Flu suggest the handling of bodies became an enormous psychological burden on communities. Osterholm, a leading advocate for pandemic preparedness, has warned that the just-in-time economic model used by suppliers of most goods means supplies of coffins will be quickly exhausted when the next pandemic hits.

"Dealing with mass casualties and the timely and respective handling of the dead is similarly relevant regardless of whether it's tsunami, earthquake, hurricane or pandemic influenza," he said.

"We spend far too much time worrying about contagion and not nearly enough time about the psychological impact on the living. The real job we have to do is not to protect the living from some invisible infectious agent.
"What we need to do is support them in their sense of grief and control of the situation. And when you handle the dead in a disrespectful and less than timely manner, it pushes all of our psychological buttons that tell us we're out of control and we cannot deal with the situation."

[DB]

Re: Countries need better plans for handling of mass corpses caused by disasters

Corpses aren't a health risk, so long as they are kept out of drinking water sources, he and others argue. But depriving people of the ability to find and bury their loved ones is.

"They use the argument that the dead bodies cause epidemics. That is not true. It's a health argument for bad management," said Dr. Ciro Urgarte, regional adviser for emergency preparedness and disaster relief for the Pan American Health Organization, the World Health Organization's regional body for the Americas.

I take serious issue with the statements laid out here by Dr. Ciro Urgarte.

An infected body IS a health risk.
I repeat, an infected body IS a health risk.

How have most people become sick from H5N1? From having close contact with infected poultry both live and dead.

There is NO difference in the ability of a dead bird or a dead human to infect another human being and most likely the risk is greater from a human corpse.

Show me the studies where human bodies are not infectious and I will show you a nice piece of fiction.

I can guarantee that there will be other that say the same thing as Dr. Ciro Urgarte. They will say such things because if they do not then people will be fearful of handling dead bodies.

Regardless, even though their intentions might be good (burying dead bodies is better than not burying dead bodies) it will still be a lie to say that they are not infectious.

[LMonty]

Re: Countries need better plans for handling of mass corpses caused by disasters

DB, i think your logic is good, to a point. I do believe though, that human corpses will probably be lower risk than the dead birds currently implicated in B2H infection.

What is the mechanism or situation surrounding dead birds causing infection? I am speculating. but let's think it through. I can see three ways most likely for dead birds to infect others- through contamination of water sources, through direct contact with blood, guts internal organs, etc such as when cleaning a bird for cooking, and through contamination with aerosolized dried feces or wet feces when cleaning or disposing of the bodies.

Using appropriate precautions- I doubt that dead humans would post a high risk of infection, unless you're contaminated with the blood or body fluid from the corpse, in the time frame that the virus is still alive. Once death occurs, the cells will stop functioning and viral replication would come to a screeching halt. Live virions that are still in moist tissue/secretions, etc may pose a risk. But regular shedding during respiration, coughs and sneezes would be gone.

So, I'd speculate that a live human is a much greater infection risk than a corpse. In most cases, in most Western cultures anyway, there is little risk we would be opening the body, coming into contact with secretions while thay still contain live virus is a possiblity. I've wrapped many a fresh dead person to know that they can leak from all orifices, and I'd consider that fluid leakage risky. They may also have virus on hands, and other body parts. Blood, before it dries, may also contain live virus. But that may be very low risk. I'd be far more concerned about fecal material than blood.

IMHO, What they are trying to say is similar to what Dr Sandman and Lanard have been saying about the risk of contracting it from poultry- the risk isnt zero, it may not even be infintesimal. Appropriate safegurds (PPE, mostly Universal Precautions type) should make most contact with the dead low risk, just like using cleanliness and proper cooking techniques would render poultry safe. At least a lot lower risk than other methods of spread, such as fomite or droplet spread.

I would probably be safer from infection when working in the morgue than in the ER! But, even knowing the methods of spread, knowing the relative safety compared to contact with live people-made even higher by people being infectious BEFORE they are symptomatic! -it just FEELS icky [re[aring the body of someone who has died of infectious disease! it's more unnerving, somehow; probably due to cultural conditioning.

We're definitely culturally conditioned that we should avoid corpses, that they are dangerous. Probably to the level of sub conscious taboo! I'm not trying to say there isnt some health risk involved in dealing with a corpse of any infected bird or mammal- there is- but it's probably fairly low if care is taken. Becaue of that culturla conditioning, we wont be as cavalier about dealing with infectious tissue/secretions as we would when plucking, gutting and washing a bird or other animal being butchered for cooking.

I'm just stating what i have deduced from my reading about this in the last few years. If anyone can add or correct this-please do!! i think having the appropriate information about dealing with our dead is important. Both for safety, avoiding spread of infection- and for those who may some day need to actually physically deal with it.
.

[Mellie]

Re: Countries need better plans for handling of mass corpses caused by disasters

If the H5N1 virus can live on a mask or other ppe for many more than 3 days, it can presumably live on the clothing and skin of the deceased. Good grief, that's a no-brainer. The people in Azerbaijan knew to stay away from the funeral. Makes sense to me.

I can only speak for myself, but I have told my family if I get this pandemic flu and die of it, just dig a hole in the backyard and with utmost care not to touch anything without protection, roll me in. Mass grave for me sounds fine if it's deemed to be the best option -- although I can't decide that for others.

Alternatively, I wouldn't mind if they use a backhoe and blade either or add me to the bonfire pile and torch it off if it's winter time.

Of course, after they all get cleaned up, they must follow my written directions for the party. Schnops!!! "Og s&#229; svinger vi p&#229; sidelin igjen, Sk&#229;l!!! and they must sit around and tell Mellie stories!

I plan to survive, but if not, I don't want to take anyone else with me!

[cookaj@plu.edu]

Re: Countries need better plans for handling of mass corpses caused by disasters

HI,
I am writing a paper on "Death Rituals" for my Cultural Psychology class, and was amazed at the relevancy of your discussion with my thesis. In my paper I am trying to prove the statement that the American Media discussion constructs Americans reactions to the corps. Your quote

"Corpses aren't a health risk, so long as they are kept out of drinking water sources, But depriving people of the ability to find and bury their loved ones is."

I believe is true and that because death will happen to everyone alive today a movement to try and stop the horror tagged on death as a topic must be removed if we are going to be able to help the berreaved cope with casulties.

"We spend far too much time worrying about contagion and not nearly enough time about the psychological impact on the living."

I believe that this is TRUE and that we need to focus on the psychological impact that death has on people and that the horror and taboo that has been placed on the corps needs to be substituted with closure and natural grieving instead of burying your horrific and misconceived notions about what death is in your subconscious only to face it years later. In my paper I found it useful to compare Modern America to Ancient Egypt in preparation of the corps for burial and there is a significant difference between the two the one major factor is the amount of time spent preparing the body. In America embalming can take up to three hours, however in Egypt the entire process takes seventy days. I wonder if this has anything to do with our chronic fear of the dead vs. the egyptians indifference to it. (however the egyptians didn't have tv and horror films to watch either teaching them how to respond) I know a lot of people will disagree with me when I say that mass graves are unacceptable, however I would say that is their fear of weeding out loved ones from a pile of unfamiliar bodies. No one said it would be easy to overcome our learned fear but it is something that we as a society need to improve on. I know I sort of rambled on about this topic but I would be interested in anything you have to say on it and any sources you could give me to look up for my research.
Thank You (I look forward to your response)
Ashley Cook

[LMonty]

Re: Countries need better plans for handling of mass corpses caused by disasters

Ashley, welcome!

Interesting topic you wrote on.

In the last 7 months or so, I have been working as a Hospice nurse. The vast majority of my terminal patients die at home- even when they and their loved ones/caregivers know they have the option of hospitalization at the last moment. I have seen very little evidence of fear or withdrawal from a corpse, so to speak, when death does happen the cargivers seem to have to little problem touching the body and even doing or helping with post mortem care.
Most watch carefully to see that the body is treated with respect when the funeral home comes to take them away. For these people, that isnt a corpse -its their husband, child, parent or sibling, and death doesnt change that.

Granted- they have some preparation for the death- something that will be lacking in a pandemic or any situation where death comes suddenly and unexpectedly. But in my many years of experience in ER nursing, where sudden and unexpected death is common- one of the dynamics we frequently had to deal with is the reluctance of the family members to let go, and allow the body to be taken to the morgue.

I think theres a huge difference with dealing with unknown bodies and with dealing with a loved one that has just died. We could rightly say they are both corpses. But in any mass casualty incident like pandemic, I think that people wont react as we culturally think they might.

I propose the horror and shock of loss will be the intitial reaction to death. I think that many wouldnt have fear or loathing of the body- although I think that might set in soon, if its isnt interred or cared for soon, before the post mortem decomposition begins.

I cant help but flash back to an old (Monty Python?) skit, where they spoofed the body pick up wagons for mass graves from plague times with the bit about "bring out your dead". I dont mean to make light of it- I share it because once I learned what might happen in a serious, high mortality pandemic, I couldnt help think that this old practice might not be far off if the worst happened. IMHO that would be the horror, one we are not culturally prepared to cope with. Its one my mind skirts away from dealing with. Yet, in reality, its a foreshadowing of what some communities might need to cope with in a worst case scenario.

It seems...disrespectful, and dehumanizing and it diminishes the uniqueness and importance of that individual when they become part of something like that. It takes away our rituals. I'd postulate it could be potentially emotionally/mentally damaging to the survivors because of that.

So what can we as a society do, to prepare for such a possible necessity, and to find a way to deal with the victims that is the least damaging to the survivors? This has got to be-for me anyway, one of the hardest things that our society should be considering and planning for.