Covid-19 spreading through the dead unlikely: AIIMS study

Fear of transmission has forced authorities to restrain families from doing the last rites of Covid-19 victims

The transmission of Coronavirus through a deceased person is unlikely, a study by AIIMS-Delhi has found, throwing more light into the denial of dignified last rites to Covid-19 victims. The subject is of immense interest considering that India has already seen two waves of the pandemic and a third one is looming large. The lonely last journey of Covid-19 victims is way too traumatic for families and relatives.

Experts say the need of the hour is to assess clinical pathophysiological impact of the virus on human tissues and organs, something not yet done, for future clinical reference and academic purpose.

Dr Sudhir K Gupta, Head of Forensic Medicines, at AIIMS said, "Our team of forensic surgeons collected throat and nasal swab of 100 cases within a span of 12- 24 hours of Covid-19 deaths in past one year and all the reports have come negative for RT-PCR, which clearly indicates that the SARS-CoV-2 virus is not active through mouth and nose post the demise of a Covid-19 patient."

Also Read: Covid-19 doesn't remain active in nasal, oral cavities 12-24 hours after death: AIIMS forensic chief

"Moreover, each body is wrapped in body bags, which are completely sterilized by spraying sodium hypochlorite, and there is zero risk of body fluid leaking if the oral and nasal orifices are properly closed with cotton balls as we do in AIIMS following government guidelines. There is no risk at all of infection spreading from the dead," explained Dr Gupta.

Explaining the rationale behind the study, Dr Gupta said similar to the right to live, dignified last rites is a constitutional right in India. "Our purpose is to ensure that by taking adequate preventive measures and by following government guidelines, close family members can still have a last glimpse of their loved ones, and even perform the last rite in a dignified manner."

Dr. Vedprakash Mishra, national head of the Academic Programme (Indian Programme), UNESCO Chair in Bioethics (Haifa), said the cause of death in Covid-19 patients is a must for exact certification. He said it is important to know through research the impact of the disease on various organs. "It is for this very reason autopsy turns out to be one of the significant and vital modalities towards the said all important dispensation in academic and research interests on the said count."

"There could be prescribed guidelines which may be worked out by the competent authorities but in absence of autopsies vital clues and cues which are getting missed would only pool the ignorance for all times," said Dr Mishra.

"The government should do complete investigation profiling of Covid-19 and autopsy findings should have a pandemic museum with impact of microbial disease on humans and specific organs, so next generation of medicos will have a reference for study and can develop preventive measures," said Amol Deshmukh, Technical Advisor (Forensic), Maharashtra.

"The government should start extended specialisation under social medicine as pandemic medicine and that to integrate with forensic medicine with a specialised para pandemic force just like NDRF," Deshmukh said.

Dr Subhash Hira, Professor of Global Health at the University of Washington-Seattle said the Indian Council of Medical Research hurriedly compiled a set of guidelines from WHO's global norms and they are silent on clinical or surgical autopsy. "Considering that even if this is an integral part of hospital services, clinical/ surgical autopsy is completely omitted in India even when infectiousness of the SARS-COV-2 virus is absent after a few hours of death. However, doctors argue that other extracellular infections caused by bacteria, fungi, rickettsia, etc, in these bodies are a major threat to health care workers. Although that is true, the academic world and research has always performed full autopsies to understand the pathology of new diseases and maintained records and tissue samples for long-term preservation so that historical stages of a disease are not lost," he said.

Citing the example of a remote clinical autopsy performed in Bangalore in October 2020, Dr Hira said the lungs, which are soft and spongy, were more like a leather ball and weighed 2.1 kg instead of 600-700 gm in dead bodies due to other diseases. "There were blood clots and the air sacs were ruptured. It was shocking to see what the virus had done to the lungs, reported Dr Rao. These findings indicated that artificial ventilation or oxygen administration would not have helped the patient much. The patient required thrombolytic therapies to dissolve the clots in the body first. The air sacs were filled with clots and that had to be dissolved first."

Dr Hira added, "It is time ICMR revised its guidelines as more knowledge and information is accumulating, and launches new research protocols."

Dr Rajesh Dhere, head of forensic medicine and toxicology at LTMG hospital and the secretary of Maharashtra Medico Legal Association, said, "The state health ministry needs to direct medical colleges to conduct minimum sixty-plus samples of clinical autopsy to understand the pathophysiological impact of SARS-CoV2. This should be done by all major medical colleges at national level, too."

He added, "The data thus available can be helpful for pharma companies and health scientists, to work on further antidotes or come up with other modes of treatments, for treating Covid-19 patients better and also come up with new preventive care. Also, from an academic point of view, these documented findings will be useful for generations to come and will be a tool kit available with task forces, working hand in hand with the government machinery to tackle any future similar health pandemics," explained Dr Dhere.

Dr Gupta said his team has also started studying the pathophysiological impact of the virus through 30 other cases of Covid-19 death. "Unlike a medico-legal autopsy which usually take around one and half to two hours, a clinical autopsy would take anywhere around six to eight hours, which need to be documented by taking pictures and videography of important organs like lungs, liver, kidney, heart and brain and also blood vessels, which need extensive research. Also, X-ray / CT scan findings need to be documented, which is then compared with the clinical notes of treating experts at hospital, and these clinical notes are compared with the autopsy findings and discussed at length with the team of medical experts from various specialties. Only then the reason for death is ascertained."

"We are still in the process of collecting data and bifurcating the same as per the clinical autopsy requirement and also these specialised experts need to be present as we conduct the pathological evaluations and findings. The priority at this moment for the doctors and front line team is to tackle the present pandemic, with the sole intent of saving lives. We will be gradually expanding our research-based study of the impact of Covid-19 virus on human organs like liver, lungs, brain and blood vessels. Also, these will be documented and a mammoth report will be prepared for future referral purposes for medical students, researchers and governments. The findings will be sent to international journals, for publication, which will be first of its kind data analysis on Covid-19 by AIIMS," said Dr Gupta.