India`s COVID19 second wave is rapidly rising. For the last week, over 350,000 new infections are being reported each day. The death toll has now crossed 220,000, with more than 3,000 people dying every day.[1]  As the number of deaths each day continues to rise, authorities and systems are struggling to cope with the ongoing humanitarian crisis. Cremation and burial grounds across the country are overwhelmed with the bodies as they try to provide answers to the queues of people waiting for hours before they get a chance to bid the final farewell to their loved ones.

COVID-19 has hugely impacted the way we deal with death. Health facilities and workers on the frontlines of the response remain overwhelmed. People across geographies and faiths face extraordinary challenges coping with the departure of loved ones and not being able to perform the last rites as per deeply held customs and traditions.

Dr Elif Gunce Eskikoy, ICRC Forensic expert based in New Delhi, says, “the dead deserve protection and dignity, and perhaps even more so during a global pandemic. Families cannot be with their loved ones during their last moments to bid farewell and pay their respects by performing the last rites according to their faith and customs. Funerals that were once attended by family and friends and entire communities are now a lonely and solemn affair.”

As families of the deceased cope with their loss, death-care workers struggle hard to maintain their sanity as they witness this tragedy day in and day out. “We all are going through difficult times, and we acknowledge the stress and trauma that engulfs this situation” says Dr Elif. However, she emphasizes that it is even more important during this time to follow the laid down guidelines when handling the dead; to take all precautions, to not only put in place but also apply safety measures diligently to protect  ourselves and our communities. Without this we will be doing a greater disservice to communities and to those who are dead.

Since the beginning of the pandemic, the ICRC has developed guidelines and published safety measures to keep body handlers and communities safe. The ICRC encourages authorities and forensic institutions to incorporate these recommendations and resources into their work practices as a part of their COVID-19 planning and response. Funeral homes and morgues have been overwhelmed by mass casualties from COVID-19 already. The ICRC aims to assist authorities and forensic institutions to come to the aid of local authorities and to uphold the rights of bereaved families during this difficult time.

 You can access these guidelines here:

https://shop.icrc.org/covid-19-general-guidance-for-the-management-of-the-dead-en-pdf

https://shop.icrc.org/covid-19-managing-the-dead-safely-pdf-en

• The ICRC guidance on the management of the dead during COVID-19 aims to protect the lives of healthcare workers, body handlers and the rest of the community. With proper preparation and planning, the safety of healthcare workers on the frontline of the response can be ensured as well as the dignity of those who are confirmed/believed to have died due to COVID-19.
• Apart from physical distancing and avoiding contact, the ICRC advocates caution regarding handling COVID-19 dead bodies since it remains unclear how long the risk of infection from the dead body or bodily fluids persists.

In the event of increased deaths, moving bodies between homes, hospitals, mortuaries, crematoriums and cemeteries and body storage will require large numbers of staff for handling bodies and vehicles for transporting them.

When making arrangements for transporting dead bodies, existing legislation and regulations should be followed. Safety and precautionary measures, authority and staff responsible for the transport and final destination should be known.

All deaths must be registered, and a death certificate must be issued.

Personnel from funeral homes have expertise in handling and transporting the dead and they can provide useful and timely support when other facilities are over capacity.

Families should be allowed to view the body of their loved ones; however, everyone should comply with safety protocols in place which may mean that only a few relatives will be permitted because of social-distancing measures in place. It is therefore also important to create an appropriate and comfortable waiting area for families in line with general recommendations for public spaces during the pandemic. At a minimum, facilities must include restrooms (with toilets and washbasins) adapted to the needs and religious beliefs of the bereaved and have trained professionals overseeing the viewings.

Individuals at higher risk of serious COVID-19 infection and vulnerable populations – including people over 60 years of age and those with medical conditions such as heart or lung disease, diabetes, or compromised immune systems – should not be directly involved in preparing the body for burial or cremation.

Clothing worn to prepare the body should be immediately removed and washed after the procedure, or an apron or gown should be worn.

Proper hand hygiene should be performed by washing hands with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water is not available. Soap and water should be used if the hands are visibly soiled.

A person who has died from COVID-19 may be cremated or buried in an existing public crematorium or cemetery. However, where mortality is expected to be high, local authorities and affected communities may assign specific areas in which to carry out cremations or burials. Mass graves are highly discouraged, they are often a demonstration of poor planning by authorities, and they show a disregard for the wishes, customs and religious rites of families and communities. Single graves are respectful and dignified, and they facilitate locating human remains and honouring those buried there.

Unidentified human remains should not be cremated. Burial in single marked graves is the recommended method of disposal. Bodies should be buried in their respective body bags, regardless of whether coffins are used. This serves both to aid future recovery and examination of the remains if necessary (e.g. for identification) and to dispose of the body bags safely.

If mortuary services or funeral homes are not available of their capacities are exceeded, bodies may be prepared and transported for cremation and burial by lay people such as family members or community or religious leaders. In these cases, family members and traditional body handlers can be equipped and advised to safely carry out final rites of loved ones who have died of suspected or confirmed COVID-19.

Communities should be supported to modify traditional funeral practices to facilitate physical distancing and family members should be advised to refrain from kissing or touching the deceased.

All processes should respect humanity and dignity of the deceased and allow for compassion and mourning for the families.

Prayers can be performed at the grave or the cremation site after the burial/cremation of the dead. Alternatively, absentee funeral prayers can be performed on COVID-19 victims.

Click to access posters on dead body management (Hindu, Islamic, Tribals and Sikh burials) online

[1] Death toll as on 5^th May 2021: https://www.mohfw.gov.in/