Indian Council of Medical Research (ICMR) has said in a draft document that invasive techniques should not be adopted for forensic autopsy in COVID-19 death cases as doctors and other mortuary staff are exposed to potentially dangerous health risks due to organ fluids and secretions.
According to the final draft ‘Standard Guidelines for Medico-legal autopsy in COVID-19 deaths in India’ released by the ICMR, deaths in hospital and under medical care due to coronavirus infection is a non-MLC case and doesn’t require post-mortem and the required certification of death is being done by treating doctors.
Some of the cases of suspected COVID-19 death which are brought dead to hospitals are labelled by emergency doctors as MLC and the body is sent to the mortuary and police are informed which may need post-mortem examination for clarity in the cause of death.
“The forensic autopsy of these cases may be waived off,” the draft guidelines said.
Some of the cases are suicide, homicide or accident and may be positive or suspected case of coronavirus infection. After the inquest procedure, if any crime is not suspected, police have the authority to waive off conduction of medico-legal autopsy, even though labelled as medico-legal case.
“The investigating police officer must proactively take steps to waive off unnecessary autopsies during such pandemic situation,” the draft document said.
As per the procedure of conducting forensic autopsy, the “dissection of bones and tissues will generate aerosol which may lead to spread of infection.
On the basis of same along with external examination, multiple photographs and verbal autopsy (as depicted by WHO)…the post mortem should be conducted strictly avoiding any invasive surgical procedures and avoiding splashing of body fluids contact for staffs, body handlers and doctors conducting post mortem.”
According to the draft guidelines by the ICMR, if the COVID-19 test report is awaited, the body must not be released from the mortuary until the final report is received and after the formalities, it must be handed over to the district administration.
“At no time, more than two relatives must be present near the body and they must maintain a distance of at least one meter from the body.
“The body must be identified by relatives through the plastic bag, without opening the bag, and it must be done in the presence of law enforcing agencies,” it said.
“The body must be taken to the burial/cremation ground in presence of law enforcing agencies, where not more than five relatives of the deceased should be allowed. Large gathering at the crematorium/ burial ground should be avoided as a social distancing measure as it is possible that close family contacts may be symptomatic and shedding the virus,” it said.
These guidelines are based on the current understanding about modes of transmission of COVID-19 sensitivity of diagnostic tests, international autopsy guidelines and knowledge about infrastructure and logistic strength of common mortuaries in India, the document stated.
Complete PPE has to be used while shifting the body in the mortuary if it involves direct handling of the body by the staff.
The body should be packed in a double packing in a leak-proof zipped transparent plastic body bag which is locked properly to avoid spillage of any fluids.
The existing mortuary facility for body storage should be strictly divided into COVID-19 and non-COVID-19 bodies.
In case of burial upper surface should be cemented and earmarked.
The body must be cremated in electric crematorium, wherever possible, so that the movement and handling of the body is minimized, the draft guidelines stated.
Religious rituals which requires touching the bodies should be avoided like bathing, kissing and hugging etc., the document said, adding that ash does not pose any risk and can be collected to perform last rites
