There is no scientific evidence available yet that says the dead body of a suspected or confirmed COVID-19 patient can transmit the virus. However, the World Health Organisation still urges precautionary measures for handling the bodies of such patients after death.
These are the guidelines the government of Pakistan has provided for burial of COVID-19 patients, based on WHO’s recommendations. We have included Islamic guidelines provided by the ICRC. They apply to both burials by hospital staff and family members.
Personal safety measures
Handwashing is mandatory. Those handling the body should have proper personal protective equipment which includes gowns, heavy duty gloves, face mask or shield and closed shoes. A waterproof apron and N-95 mask are optional if there is a risk of aerosols being generated.
All lines, catheters tubes and any attached medical equipment should be removed before transferring the body. Body bags can be used if there is a risk of fluid leakage. Otherwise, a cloth wrapped tightly will be sufficient.
The mortuary should be kept clean, well-lit and properly ventilated. Disinfect all surfaces before and after handling the body. First, a mixture of soap and water or detergent should be used to clean the surfaces before disinfection.
A 70% ethanol or minimum 0.1% concentration (1000 ppm) of sodium hypochlorite (bleach) for at least one minute can later be used for disinfection. The WHO says “hospital-grade disinfectants may also be used as long as they have a label claim against emerging viruses.”
Contact local or graveyard authorities to confirm any official requirements for burial. Family and friends can view the body from a distance of one metre or more but they should not touch or kiss the body. Physical distancing of at least one metre should be observed between the guests.
Children, older people (>60 years old), and anyone with underlying illnesses such as respiratory illness, heart disease, diabetes, or compromised immune systems should not be allowed at the viewing. Guests must wash hands thoroughly with soap and water after the viewing.
Those placing the body in the grave should wear thick gloves and wash hands with soap and water after removal of the gloves. Clothes worn by the person preparing the body should be immediately removed after procedure, washed with warm water at 60−90°C (140−194°F) and laundry detergent. A disposable apron/gown is recommended.
The belongings of the deceased person do not need to be burned or disposed of. Handle them with gloves and clean with a detergent followed by disinfection with a solution of at least 70% ethanol or 0.1% (1000 ppm) bleach
The deceased’s clothes should be machine washed with warm water at 60−90°C (140−194°F) and detergent. If machine washing is not possible, clothes can be soaked in hot water and soap in a large drum using a stick to stir.
The drum should then be emptied, and the clothes soaked in 0.05% chlorine for approximately 30 minutes. The laundry should be rinsed with clean water and allowed to dry fully in sunlight.
The International Committee of the Red Cross has prepared guidelines for COVID-19 burials keeping in mind the Islamic rites. Ahmed Al-Dawoody, ICRC’s legal advisor on Islamic law, and Oran Finegan, head of forensics for the ICRC, have explained how a dignified burial of those who have died from the virus can take place.
Ghusl, or ritual washing of the body, can be performed as normal wearing complete Personal Protective Equipment (PPE). This includes the PPE mentioned above: heavy duty gloves, gown, a waterproof apron, face shield and goggles, and a mask.
Those handling the body should avoid direct contact with blood, bodily fluids, the face and mouth of the deceased.
The guideline says that if there is a danger of infection through scrubbing during ghusl, then pouring or spraying water on the body is sufficient. Afterwards, all surfaces should be disinfected and disposable objects should be treated as medical waste.
If spraying water also increases the risk of infection, there are two rulings quoted. Dry purification, or tayammum, can be performed according to Iran’s Supreme Guide, Ali Khamenei and his eminence Al-Sayyid Ali Al-Husseini Al-Sistani, the prominent Shia authorities. In case health authorities prohibit any form of ghusl, the body should be buried without it.
2. Shrouding (kafan)
Shrouding of the body can be carried out after health authorities give permission. Three layers of shroud can wrap the body from outside the body bag or a single shroud can also be used. This was declared permissible by Ayatollah Al-Sistani.
3. Funeral prayer (salat al-gha’ib)
Traditionally funeral prayers are offered in congregation. However, a minimum of two people can also perform the prayers as per Islamic rulings, which will further reduce the chance of infection. The prayers must be offered in an open space. The guidelines also mention salat al gha’ib, or absentee funeral prayers, that can be performed on COVID-19 victims.