COVID-19 impact: Those working on post-mortems could get infected, fear Mumbai doctors

Updated: Mar 30, 2020, 08:20 IST | Vinod Kumar Menon | Mumbai

LTMG hospital in Sion has written a letter to dean refusing to conduct autopsies on people who have died of fever-related issues and acute respiratory distress syndrome

The special Coronavirus protective kit comprises face mask, boiler suit, goggles, shoe leggings, hand gloves and waste disposable bags
The special Coronavirus protective kit comprises face mask, boiler suit, goggles, shoe leggings, hand gloves and waste disposable bags

A high-level meeting held by top city forensic surgeons to discuss the modalities of conducting autopsies on patients who have died of Coronavirus brought an important concern to the fore — non-availability of six-layer body bags to wrap such bodies. While Sion hospital has already written to the dean refusing to conduct autopsies on people who have died of fever-related issues and acute respiratory distress syndrome (ARDS), those at the meeting also said special care needed to be taken while transporting such bodies for cremation.

The meeting was chaired by Police Surgeon Dr S M Patil and attended by professors and HODs of Department of Forensic Medicine and Toxicology of three civic medical colleges Nair, LTMG and KEM – Dr Shailesh Mohite, Dr Rajesh Dhere and Dr Ravindra Devkar.

Extra cautious
Sion hospital Dean Dr Dhere said, "We have to be extra cautious while handling such bodies as many a times patients themselves do not reveal their travel history or if they are carriers of the virus, as they do not show symptoms for a couple of weeks, and by the time they visit the hospital it's too late. Also, there are instances when patients undergo treatment for weeks together, but after their deaths the doctor concerned does not issue death certificates. In such cases, the bodies are sent for autopsy, which can be dangerous, as those working on post-mortems could get infected."

In his letter (copy with this paper), Dr Dhere stated that the department handling patients with fever and ARDS should certify the cause of death, as there is a high risk of transmission of the infection from bodies to doctors, attendants and mortuary staff. "If there is any medico legal issue or suspected foul play or any unnatural case, the department concerned should contact the HOD (forensic medicine) for further coordination and decision," the letter concludes.

A source, who was present at the meeting, said, "Civic chief Praveen Pardeshi has directed the dean of Sion hospital, Dr Mohan Joshi to procure body bags at the earliest.

When asked, Dr Joshi confirmed this and said, "We have not found the six-layer-body bags so far. Moreover, each body bag costs around R6,000, so we are also looking for alternatives. Spraying of disinfectants like sodium hypo-chloride on the bodies and covering them with specially treated polythene sheets need to be done."

'Clarity needed'
When contacted, Police Surgeon Dr Patil said, "We need to get clarity on deaths of people who tested negative for COVID-19 and also deaths in home quarantine. The deaths that happen in hospitals get certified by treating doctors. The second concern is about the transportation and cremation of Coronavirus deaths. A forensic surgeon will soon speak to health experts at Kasturba Hospital to understand the method they have adopted to handle and transport bodies of those who died of the virus."

About body bags and protective gear, Dr Patil said, "We have already procured special Coronavirus Protective (PPE) kit, which consists of face mask, boiler suit, goggles, shoe leggings, gloves and waste disposable bags, for the staff who cut open the body. About 100 packets have been ordered, each of which costs between R700-800. And we have equal number of HIV special gear for doctors (each costing R1,000-R1,200), which can be used while dealing with suspected COVID-19 deaths. But if the BMC health department or treating doctors certify every COVID-19 death, then the bodies won't reach the autopsy centre at all."

Infected lungs
A forensic surgeon said, "The Central health department clearly states that in case an autopsy is done on a COVID-19 deceased, special care should be taken while opening the lungs, as it will be highly infected." However, a forensic professor said from the academics perspective, it was important to conduct sample autopsies to study the extent of damage the virus does to lungs and also the severity of the pneumonia can be ascertained. However, in our country, it will be purely the central government who will have to give special permissions and designated place for conducting such specialised autopsies, which can be done by a team of experts whose research work could help medical professionals understand the virus better," a forensic professor said, "In China, multiple autopsies have been done on numerous COVID-19 victims and they are in the process of completing their research findings," said Dr Dhere.

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