You may recall that at the end of last year, the Court of Appeal ruled that the ban on open-air-pyre cremations of COVID-19 victims return to the High Court for urgent hearing.
There is currently no scientific basis for this ban, and that is not just my opinion. As stated by many experts in the country, it is not just unnecessary, but places a tremendous burden on those bereaved families at a time when they are most vulnerable.
Consultant pathologist Dr Ryan Rattan is one of the doctors who has been at the forefront of the pandemic when it comes to mortuary services. His views are expressed below.
“The COVID-19 pandemic has strained mortuary services across the world. Within recent times T&T has been no exception. This has mostly been caused by increased death rates, but also contributed by additional safety measures required in handling COVID-19 positive bodies (CPB), PCR swabbing, and the unavoidable staff shortages caused by infected personnel.
It is crucial to note however, that in the almost-two years of the pandemic there has been no credible case of transmission from a cadaver unrelated to autopsy.
Having said that, the notion that dead bodies are a nidus of disease comes with good reason when one considers the Plague in medieval Europe and Ebola in Western Africa.
But COVID-19 is different from those.
We now know that the primary route of infection for COVID-19 is respiratory via droplet infection and aerosolisation. That is to say coughing, sneezing, speaking, and breathing - activities of which the dead are incapable.
However, risk of skin contamination from bodily fluids remains. Therefore, in T&T there is guidance on avoiding contact with dead bodies if appropriate PPE is not being worn. This is consistent with recommendations from the WHO.
In the UK, CPBs are categorised as a hazard group 3 (HG3), meaning they can cause severe human disease but there is effective prevention or treatment available. HIV and tuberculosis are also HG3 pathogens. By contrast, Ebola is an HG4 pathogen and autopsies are never performed.
In other countries of the world such as the UK, autopsies on CPB are permitted, but not routine since the cause of death is mainly known. When autopsies are required, they are performed in strictly ventilated mortuaries.
Here in Trinidad and Tobago, apart from suspected homicides, autopsies are not performed on CPB. The major risk at autopsy is the aerosol generating procedures involved in opening the head and chest. As we move toward increased vaccination status of staff, enhanced ventilation systems and training on different evisceration techniques, this current stoppage may be revisited.
The CDC and WHO in written recommendations allow for disposal of bodies by burial and cremation and therefore the current ban on open pyre cremations in T&T is unusual. There is also no evidence to suggest that there needs to be separate burial grounds for CPB.”
It is therefore hoped that this current ban on open-air cremations is swiftly overturned in view of the lack of any medical and scientific justification.
