Can the novel coronavirus spread from a patient’s dead body to people living around the cremation or burial site?

Both international and national guidelines have a clear response to this question.

“Cadavers do not transmit disease”, say the World Health Organisation guidelines for managing bodies of those who die of Covid-19. Indian health ministry guidelines state that “there is unlikely to be an increased risk of Covid infection from a dead body to health workers or family members who follow standard precautions while handling body”.

For healthcare workers, mortuary staff and others directly handling bodies, these standard precautions involve wearing protective gear like gloves and masks, maintaining good hand hygiene and sanitising everything that the body has touched. For family members, priests and mourners, they involve not touching the body, wearing basic protective gear, and not gathering in groups to pray.

On April 19, however, dozens of Chennai residents made it clear that these guidelines are not common knowledge among the general public.

That evening, Dr Simon Hercules, a prominent neurosurgeon from Chennai, had died after a two-week battle with Covid-19. Civic officials granted permission for his body to buried at a cemetery in Kilpauk area. But outside the graveyard, an angry crowd afraid of being infected by the virus forced the ambulance to turn away.

The ambulance then turned towards a burial ground in Anna Nagar, were protesting locals not only blocked its path but also attacked it with sticks and stones. They broke the vehicle’s windows and injured the driver, a sanitation worker and a civic official, forcing everyone in the ambulance to abandon the body for a while and seek safety.

Late into night, three of Hercules’ colleagues, dressed in complete protective gear, returned to the cemetery with a police escort and buried the doctor themselves. With just one shovel between them, they had to use their bare hands to dig the grave. All the while, they feared the mob that was still outside.

At least 21 people have now been arrested for the violence and everyone from health workers to political leaders have expressed shock and anger over the incident. But Dr Simon Hercules was not the first Covid-19 patient to have been denied dignity in death because of misinformation and irrational fears among other people.

Dr Simon Hercules. Credit: New Hope Medical Centre via Facebook

India has reported at least 718 coronavirus deaths in the past six weeks, and throughout this period, there have been several disturbing reports of people obstructing burials or cremations have continually made news.

A string of cases

Six days before Hercules’ death, for instance, residents near Chennai’s Ambattur crematorium forced officials to cancel the scheduled cremation of a doctor from Nellore who had died of Covid-19 in the city. The protesting residents reportedly grew afraid after seeing hospital staff wearing Personal Protective Equipment enter the crematorium. Finally, the doctor had to be cremated at another location outside the city limits.

In the same week, another doctor was subjected to indignities after he died of Covid-19 at the age of 69 in the country’s North East. Dr John L Sailo Ryntathiang was one of Meghalaya’s most renowned doctors and the state’s first coronavirus patient. When he died on April 15, his family had to be immediately quarantined. Officials planned to cremate him in Shillong’s Jhalupara area and then, as per his family’s wishes, bury his ashes at his farmhouse in Nongpoh outside the city.

However, locals in Jhalupara refused to allow the cremation for fear of infection, protesting in a large crowd outside the crematorium and breaking social distancing norms in the process. Those running the crematorium also claimed that the undertakers had not been provided with proper safety gear. Meanwhile, local leaders of Nongpoh denied burial permissions because Rynthathiang was not a permanent resident of the area. He was finally interred in a church cemetery in the city, 3 km away from the hospital that he owned and where he had died.

The incident grabbed national headlines and prompted the Meghalaya High Court to direct authorities to take action against those who obstruct the last rites of coronavirus victims.

Earlier, in Punjab, when noted Gurbani singer and Padma Shri winner Nirmal Singh Khalsa died of coronavirus on April 2, his cremation was stalled for several hours by residents of his native town. Afraid that his body might spread the virus, the residents gathered around the crematorium and locked the gates. “Smoke raised during the cremation can infect villagers,” said a local leader. After hours of negotiation with them, the local administration finally cremated Khalsa at a secluded spot away from the cremation ground.

On April 8, Punjab reported another disturbing case when a man from Kapurthala refused to accept his mother’s body or perform her last rites after she died of Covid-19, despite block officials offering to provide him with proper protective gear for his safety. Finally, the officials themselves cremated the woman.

Lack of awareness

One of the reasons for such incidents being reported from across the country is inadequate public awareness about the risks that may or may not be involved in disposing of Covid-19 bodies.

The WHO guidelines, for instance, clearly debunk the “common myth” that people who have died of a communicable disease should be cremated rather than buried.

Despite this, on March 30, the commissioner of Mumbai’s civic corporation issued a circular stating that people who die of Covid-19 in the city would have to be cremated irrespective of their religion. Hours later, after intervention from Maharashtra’s minority development minister, the civic corporation withdrew the circular to allow for burials as long as proper precautionary guidelines are followed.

Burials in the city, however, have not been smooth for all coronavirus victims.

A person who died of Covid-19 is bured in Ranchi on April 21. Credit: PTI

“In the first few weeks of coronavirus spreading here, we faced a lot of problems of locals opposing burials Covid patients in their areas,” said Maulana Mahmood Daryabadi, the general secretary of the All India Ulema Council. “Since many graveyards are located in densely populated areas, people wanted the bodies to be taken to more remote kabrastans.”

On April 1, for instance, the trustees of a Muslim cemetery in Mumbai’s Malvani area refused to allow the burial of a 65-year-old local resident, because “he was coronavirus positive”. When the trustees refused to budge despite intervention from the local police and politicians, the man was finally cremated at a Hindu crematorium nearby.

In recent weeks, says Daryabadi, community leaders in the city have made efforts to WHO guidelines to people to help them understand that there are few risks in burying a Covid-positive body. “Things are much better now,” he said.

Not just Covid funerals

To make the last rites of Covid-19 patients easier, several cities across India have designated specific burial grounds and crematoriums for coronavirus cases and issued guidelines to all local religious bodies managing funerals. No more than four or five people are allowed at the site of cremation or burial, and prayers by religious priests must be done from a safe distance. All rituals involving bathing or touching the body are not allowed.

But the lockdown and the social distancing protocols that have been enforced to contain the pandemic have impacted all funerals, not just those of coronavirus patients.

“We cannot do multiple cremations at the same time any more, and even for non-Covid funerals, only immediate family members are allowed in,” said Dilip Pawar, the furnace operator at Mumbai’s Chandanwadi crematorium. To ensure that funerals are conducted quickly and to prevent people from lingering at the site, the crematorium is now doing only electric cremations. “There are some caste groups that usually insist on traditional funeral pyres, but for now, we are not allowing those.”

Before April 20, only four to five people were allowed at all funerals in Mumbai. After the lockdown rules were marginally relaxed, 20 people have been allowed for non-coronavirus funerals.

“But we have maintained that only immediate family members – spouse, parents, children – can attend funerals,” said Father Nigel Barrett, the spokesperson for the Archdiocese of Bombay, the governing body for Mumbai’s Catholic community.

In the initial weeks of the lockdown, Catholic cemeteries also faced staff problems because of travel restrictions on citizens. “Most of our grave diggers are daily wage workers from slum areas who were initially not being able to travel when they were needed for a funeral,” said Elroy Noronha, an undertaker in suburban Mumbai. “But now we have been able to convince municipal authorities to give them travel passes so they can step out without fear. Because without them, how can we do the funeral?”