Covid-19 spreading through the dead unlikely: AIIMS study

The transmission of Coronavirus through a deceased person is unlikely a study by AIIMSDelhi has found throwing more light into the denial of dignified last rites to Covid19 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 Covid19 victims is way too traumatic for families and relativesExperts 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 purposeDr Sudhir K Gupta Head of Forensic Medicines at AIIMS said ldquoOur team of forensic surgeons collected throat and nasal swab of 100 cases within a span of 12 24 hours of Covid19 deaths in past one year and all the reports have come negative for RTPCR which clearly indicates that the SARSCoV2 virus is not active through mouth and nose post the demise of a Covid19 patientrdquoAlso Read Covid19 doesnt remain active in nasal oral cavities 1224 hours after death AIIMS forensic chiefldquoMoreover 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 deadrdquo explained Dr GuptaExplaining the rationale behind the study Dr Gupta said similar to the right to live dignified last rites is a constitutional right in India ldquoOur 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 mannerrdquoDr Vedprakash Mishra national head of the Academic Programme Indian Programme UNESCO Chair in Bioethics Haifa said the cause of death in Covid19 patients is a must for exact certification He said it is important to know through research the impact of the disease on various organs ldquoIt 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 countrdquoldquoThere 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 timesrdquo said Dr MishraldquoThe government should do complete investigation profiling of Covid19 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 measuresrdquo said Amol Deshmukh Technical Advisor Forensic MaharashtraldquoThe 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 NDRFrdquo Deshmukh saidDr Subhash Hira Professor of Global Health at the University of WashingtonSeattle said the Indian Council of Medical Research hurriedly compiled a set of guidelines from WHOrsquos global norms and they are silent on clinical or surgical autopsy ldquoConsidering that even if this is an integral part of hospital services clinical surgical autopsy is completely omitted in India even when infectiousness of the SARSCOV2 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 longterm preservation so that historical stages of a disease are not lostrdquo he saidCiting 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 21 kg instead of 600700 gm in dead bodies due to other diseases ldquoThere 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 firstrdquoDr Hira added ldquoIt is time ICMR revised its guidelines as more knowledge and information is accumulating and launches new research protocolsrdquoDr Rajesh Dhere head of forensic medicine and toxicology at LTMG hospital and the secretary of Maharashtra Medico Legal Association said ldquoThe state health ministry needs to direct medical colleges to conduct minimum sixtyplus samples of clinical autopsy to understand the pathophysiological impact of SARSCoV2 This should be done by all major medical colleges at national level toordquoHe added ldquoThe 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 Covid19 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 pandemicsrdquo explained Dr DhereDr Gupta said his team has also started studying the pathophysiological impact of the virus through 30 other cases of Covid19 death ldquoUnlike a medicolegal 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 Xray 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 ascertainedrdquoldquoWe 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 researchbased study of the impact of Covid19 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 Covid19 by AIIMSrdquo said Dr Gupta