Delhi Govt Says No Covid-19 Testing After Death But ICMR Says Suspected Cases Should Be Tested

The Delhi government which was facing allegations of covering up COVD-19 deaths had recently decided that the tests will not be carried out after the patient's death even if the person is suspected to have died of coronavirus.

¡°No sample for Covid-19 test will be taken of dead body. However, if doctors are satisfied from clinical examination that the cause of death may be Covid-19 infection, the dead body may be released as suspect Covid-19 infected dead body,¡± the Delhi Health Department had said in an order.

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The Indian Council of Medical Research, on Tuesday however recommended that all suspected Covid19 cases should be tested for infection even after the death of the patients. The document ¡®Standard Guidelines For Medico Legal Autopsy In Covid 19 Deaths In India' released by the ICMR said that ¡° it is advisable to collect nasopharyngeal swab at the emergency department/casualty/ward/ICU and should be sent for COVID-19 RT-PCR test in all suspected cases before moving the body to mortuary for preservation if the same was not sent in due hospital course.¡±

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According to the guidelines, the deaths in hospital and under medical care due to coronavirus infection is a non-MLC case and doesn't require postmortem examination and the required certification of death will be done by treating doctors. Bodies of suspected COVID-19 patients, which are brought to hospital, may be labelled as medico legal cases by the doctor in emergency and it will be sent to mortuary and police will be informed, which may necessitate a medicolegal autopsy for clarity in the cause of death. "The forensic autopsy of these cases may be waived off," the guidelines said.

As per the procedure of conducting forensic autopsy, "along with external examination, multiple photographs and verbal autopsy (as depicted by WHO) 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 guidelines, if COVID-19 test report is awaited, the body must not be released from a mortuary until the final report is received and after the formalities, it must be handed over to the district administration.

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"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 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," it said.

These guidelines are based on the current understanding about modes of transmission of COVID-19 sensitivity of the diagnostic tests, international autopsy guidelines and knowledge about infrastructure and logistic strength of common mortuaries in India, the document stated. Complete personal protective equipment (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. Incase of burial, upper surface should be cemented and earmarked.

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The body must be cremated in electric crematorium, wherever possible, so that the movement and handling of the body is minimised, the guidelines stated. Religious rituals, which require touching the bodies, should be avoided like bathing, kissing and hugging of the dead bodies, the document said, adding that the ash does not pose any risk and can be collected to perform the last rites.