> top > projects > LitCovid-sentences > docs > PMC:7148714 > annotations
LitCovid-sentences  

PMC:7148714 JSONTXT 22 Projects

Annnotations TAB TSV DIC JSON TextAE-old TextAE

Id Subject Object Predicate Lexical cue
T1 0-48 Sentence denotes International Committee of the Red Cross (ICRC):
T2 49-116 Sentence denotes General guidance for the management of the dead related to COVID-19
T3 118-126 Sentence denotes Abstract
T4 127-520 Sentence denotes Based on its forensic capacity and experience gained worldwide from the management of the dead in emergencies, including epidemics, the International Committee of the Red Cross has been asked by the authorities and other relevant stakeholders in some of its operational contexts to advise on the management of the dead from COVID-19 infection, for which it has prepared the following guidance.
T5 521-729 Sentence denotes This includes advice on the handling of COVID-19 fatalities and a set of considerations for managers faced with the need to plan for adequately responding to a possible surge in fatalities caused by COVID-19.
T6 731-746 Sentence denotes 1 Introduction
T7 747-1083 Sentence denotes The International Committee of the Red Cross (ICRC) is an impartial, neutral and independent organization established in 1863 whose exclusively humanitarian mission is to protect the lives and dignity of victims of war and other situations of violence as well as to assist in the response to humanitarian emergencies, such as epidemics.
T8 1084-1304 Sentence denotes The ICRC acquired forensic capacity in the early 2000 to support its humanitarian operations around the world, including for ensuring the proper and dignified management, documentation and identification of the dead [1].
T9 1305-1713 Sentence denotes Based on its forensic capacity and experience gained worldwide from the management of the dead in emergencies, including epidemics (e.g. Ebola [2]), the ICRC has been asked during the present COVID-19 pandemic by Governments and other relevant stakeholders in some of its operational contexts for advice on the management of the dead from COVID-19 infection, for which it has prepared the necessary guidance.
T10 1714-1850 Sentence denotes This guidance paper applies to the management of bodies or human remains of persons believed/confirmed to have died because of COVID-19.
T11 1851-1981 Sentence denotes It is meant to provide a practical overview of key recommendations for the management of infectious dead bodies and human remains.
T12 1982-2138 Sentence denotes In addition, it is also meant for practitioners, managers and planners, including decision makers involved in the overall response to the COVID-19 pandemic.
T13 2139-2284 Sentence denotes Guidance for those actors directly or indirectly involved in the management of the dead in relation to the pandemic is divided into two levels:1.
T14 2285-2496 Sentence denotes General guidance and support in the management (handling) of the dead, covered by the section “The Management of the Dead Associated To COVID-19 - Technical Recommendations for Healthcare and Death Care workers”
T15 2497-2499 Sentence denotes 2.
T16 2500-2698 Sentence denotes General guidance and support to the authorities in their response to the increased deaths associated with the pandemic, covered by the section “Protracted Response to Increased Deaths from COVID-19.
T17 2699-2757 Sentence denotes A Preparatory Guideline for a Mass Fatality Response Plan”
T18 2758-3028 Sentence denotes The planning or implementation of activities for the management of the dead related to COVID-19 should be always framed by the following fundamental principles:o The safety and wellbeing of staff involved in managing the dead from COVID-19 should be the utmost priority.
T19 3029-3312 Sentence denotes To this effect forensic best practices should always be informed by the advice and latest recommendations from national health authorities and international health organizations, especially the World Health Organization (WHO) [[3], [4]], for health personnel handling COVID-19 cases.
T20 3313-3507 Sentence denotes o The humanitarian imperative which should guide the proper management of the dead in any circumstance requires that the dignity of the deceased and of their next of kin be respected throughout.
T21 3508-3722 Sentence denotes o Every effort should be made to ensure the reliable identification of the dead, failing which their proper documentation and traceability are essential for making their future recovery and identification possible.
T22 3723-4020 Sentence denotes o The management of the dead from COVID-19 should not impede the medico legal investigation of death where required by the authorities (e.g. suspicious deaths, deaths in custody, etc.) but additional special health and safety precautions should be adopted for the necessary post-mortem procedures.
T23 4021-4354 Sentence denotes In view of the rapid evolution of the COVID-19 pandemic, the novelty of the agent and the pace of new information arising from the knowledge gained about the virus, its effects and its control, the present guidance provides general recommendations and the necessary reference documentation, which are based on evidence learnt so far.
T24 4355-4654 Sentence denotes The measures required for effectively assisting in the management of the large numbers of dead from COVID-19 may likely need an increase of the human and material resources available, including for building local capacity and supporting and/or carrying out the recovery and identification processes.
T25 4655-4926 Sentence denotes This guidance should be read in conjunction with the general guidance for management of dead bodies previously developed by the Pan American Health Organization (PAHO)/WHO, ICRC, and the International Federation of Red Cross and Red Crescent Societies (IFRC) in 2016 [5].
T26 4927-5137 Sentence denotes The general procedures to be followed when undertaking the recovery and identification of human remains of persons known or suspected to have died from COVID-19 are those outlined in Annex 6 of this Manual [5].
T27 5138-5226 Sentence denotes However, this Annex was drafted for handling the dead from HG4 pathogens, such as Ebola.
T28 5227-5403 Sentence denotes Therefore, some of the guidance provided for in Annex 6 is excessive for COVID-19, including on the level of PPE and disinfection required as well as on the disposal of bodies.
T29 5405-5518 Sentence denotes 2 Management of the dead associated to COVID-19, Technical Recommendations for Healthcare and Death Care workers
T30 5519-5854 Sentence denotes This part provides guidance on the measures required for effectively assisting in the management of the large numbers of dead from COVID-19 that may likely need an increase of the necessary human and material resources, including for building local capacity and supporting and/or carrying out the recovery and identification processes.
T31 5856-5897 Sentence denotes 2.1 Important considerations of COVID-19
T32 5898-6013 Sentence denotes SARS-CoV-2, the virus which causes COVID-19, is classified as a HG3 (hazard group 3) pathogen (such as HIV and TB).
T33 6014-6110 Sentence denotes In some infected people it may cause a severe and acute respiratory syndrome which can be fatal.
T34 6111-6217 Sentence denotes There is presently still no vaccine or effective cure for COVID-19 infection and treatment is symptomatic.
T35 6218-6456 Sentence denotes The virus is known to spread mainly person-to-person:• Through respiratory droplets and fomites [4] produced when an infected person coughs or sneezes, between people who are in close contact with one another (within about 2 m or 6 feet).
T36 6457-6546 Sentence denotes Infective aerosol and droplets may also be produced from splashes of contaminated fluids.
T37 6547-6752 Sentence denotes • Infection is also possible from contact with contaminated surfaces or objects by touching a surface or object that has the virus on it (e.g. fomites) and then touching own mucosa of mouth, nose, or eyes.
T38 6753-6873 Sentence denotes The virus is known to normally survive a few hours outside the host, but this may extend to days in some conditions [6].
T39 6874-7155 Sentence denotes Working in environments overcrowded with people infected with COVID-19 is a risk factor (e.g. collecting the dead from an overcrowded detention facility), for which the personal protective equipment (PPE) recommended in this guidance provides adequate protection, if properly used.
T40 7156-7282 Sentence denotes The virus is easily neutralized with water and soap and with standard disinfectants, such as bleach and ethanol solutions [6].
T41 7283-7838 Sentence denotes Any post-mortem activities, from recovery, transport, to autopsies and handover to families and burial, should be therefore conducted with a focus on avoiding aerosol generating procedures, such as splashes of contaminated fluids; and ensuring that if aerosol generation is likely (e.g. when using an oscillating saw, which is NOT recommended) that appropriate engineering controls and PPE are used and that the disinfection of contaminated surfaces and equipment, together with thorough personal hygiene, especially hand-washing, are rigorously observed.
T42 7839-8141 Sentence denotes These precautions and the use of standard precautions such as those recommended in this guidance should ensure that appropriate work practices are used to prevent direct contact with infectious material, percutaneous injury, and hazards related to moving heavy remains and handling embalming chemicals.
T43 8143-8225 Sentence denotes 2.2 General principles for the management of human remains infected with COVID-19
T44 8226-8407 Sentence denotes • Any activity undertaken in relation to the management of known or suspected COVID-19 fatalities must be preceded by a preliminary evaluation and risk assessment (see section 3.1).
T45 8408-8606 Sentence denotes • Staff undertaking recovery and identification of human remains infected or suspected to be infected with COVID-19 must be specifically trained for the task of managing the dead and the use of PPE.
T46 8607-8793 Sentence denotes The operation should be supervised by suitably qualified staff, at the minimum a forensic professional trained and experienced in the management of the dead in challenging circumstances.
T47 8794-9106 Sentence denotes • The procedures adopted must seek to limit the potential for staff exposure to COVID-19, prevent as far as is possible the spread of COVID-19 resulting from the process, allow for the timely and accurate recovery and identification of the human remains and ensure the dignity of the dead throughout the process.
T48 9107-9384 Sentence denotes • The management of large numbers of dead bodies requires that all necessary measures be adopted to ensure their documentation and traceability throughout, from recovery to storage and final disposal, to avoid their loss or misplacement and/or of the corresponding information.
T49 9385-9485 Sentence denotes Special procedures should be put in place for the management and protection of the data on the dead.
T50 9486-9831 Sentence denotes • Where potential conflict arises between existing cultural practices and additional safeguards to prevent further exposure and propagation of the virus, the latter must take precedent and efforts should be made for ensuring that this is understood, accepted and supported by the concerned community or religious authorities and the next of kin.
T51 9833-9881 Sentence denotes 2.3 Technical recommendations for body handlers
T52 9882-9973 Sentence denotes "Body handler" refers to any individual involved in the physical handling of human remains.
T53 9974-10367 Sentence denotes This includes, but is not limited to, healthcare practitioners and healthcare assistant personnel, death care workers including forensic doctors, pathologists and other forensic experts, autopsy technicians, non-forensic personnel charged with recovery and transportation of human remains, individuals involved in body preparation for body disposal, for funerals or other commemorative events.
T54 10368-10704 Sentence denotes Body handlers should take precautions when handling the remains of individuals that have died from COVID-19.• Use of standard PPE – Gloves (Ensure that gloves are unpunctured, nitrile gloves preferred)/aprons/long sleeved gowns/overalls to protect skin and clothing from contamination by infected material/Face masks and eye protection:
T55 10705-10955 Sentence denotes Googles or face shields/Full-face masks: FFP3 masks or N95 respirators are currently considered best for preventing inhalation of aerosols and in case of splashes during the body handling process to protect the face, eyes, nose, and mouth (Table 1 ).
T56 10956-11002 Sentence denotes Table 1 Transmission based precautions (TBPs):
T57 11003-11085 Sentence denotes Personal protective equipment (PPE) for care of deceased during COVID-19 pandemic.
T58 11086-11288 Sentence denotes Table adapted from guidance developed by Department of Health and Social Care, Public Health Wales, Public Health Agency (PHA) Northern Ireland, Health Protection Scotland and Public Health England [7].
T59 11289-11520 Sentence denotes Low risk Procedures∗:Admission of deceasedPreparation for viewingRelease of deceased Medium risk Procedures∗∗:Rolling deceasedUndressing deceasedSignificant manual handling High risk Procedures:Autopsy and other invasive procedures
T60 11521-11550 Sentence denotes Disposable gloves Yes Yes Yes
T61 11551-11587 Sentence denotes Disposable plastic apron Yes Yes Yes
T62 11588-11613 Sentence denotes Disposable gown No No Yes
T63 11614-11671 Sentence denotes Fluid-resistant (Type IIR) surgical mask (FRSM) Yes No No
T64 11672-11722 Sentence denotes Filtering face piece (FFP)∗∗∗ No FFP2 or FFP3 FFP3
T65 11723-11760 Sentence denotes Disposable eye protection Yes Yes Yes
T66 11761-11847 Sentence denotes Protective footwear (e.g. rubber boots which can be disinfected after use) Yes Yes Yes
T67 11848-11921 Sentence denotes ∗If procedure likely to cause droplet contact, use medium risk procedure.
T68 11922-12135 Sentence denotes ∗∗If procedure likely to generate aerosols, use high risk procedure. ∗∗∗ECDC (European Centre for Disease Prevention and Control) recommends the use of FFP3 masks for performing aerosol-generating procedures [15].
T69 12136-12323 Sentence denotes In case of shortage of Class 3 respirators, the use of Class 2 respirators (e.g. FFP2) may be considered, on a case by case basis and after assessing the risks of the procedures required.
T70 12324-12426 Sentence denotes • Shoe protection is desirable, ideally consisting of rubber boots which can be disinfected after use.
T71 12427-12560 Sentence denotes • If there is a risk of cuts, puncture wounds, or other injuries that break the skin, wear heavy-duty gloves over the nitrile gloves.
T72 12561-12646 Sentence denotes • Where possible use double body bags or body bags for infectious cases if available.
T73 12647-12759 Sentence denotes • Disinfect any non-disposable equipment being used during the handling of the remains as per standard practice.
T74 12760-12877 Sentence denotes • Used PPE should be properly disposed of to avoid contact with people, food, drink, or eating and drinking utensils.
T75 12878-12918 Sentence denotes Biohazardous waste incineration is best.
T76 12919-13039 Sentence denotes • Avoid contact with your face and mouth, as well as food, drink, or eating and drinking utensils, during body handling.
T77 13040-13116 Sentence denotes • Rigorously wash hands after body handling and prior to eating or drinking.
T78 13117-13203 Sentence denotes • Do not engage in any other activity during the body handling or preparation process.
T79 13204-13356 Sentence denotes • Following the body handling or preparation process, rigorously wash hands and disinfect surfaces that may have come in contact with the infected body.
T80 13357-13486 Sentence denotes • Be aware of any hazards, in addition to COVID-19, which may be present in the environment and site of the location of the body.
T81 13487-13628 Sentence denotes • Ensure that any potentially contaminated staff clothing is not taken to their place of residence or those of others before proper cleaning.
T82 13629-13821 Sentence denotes • The potential for COVID-19 in human remains continues to pose a cross contamination hazard for some time after they have been removed from the site of recovery (hours and possibly days [6]).
T83 13822-13923 Sentence denotes • Similarly, personal effects of the deceased may also continue to pose a cross contamination hazard.
T84 13924-14121 Sentence denotes If they are to be returned to next of kin, careful consideration must be given to an appropriate means of decontamination to ensure that the health of those receiving these items is not endangered.
T85 14122-14301 Sentence denotes • Similarly, documentation created during the recovery, transport, examination, storage and burial process may become infected with COVID-19 and should be disinfected accordingly.
T86 14302-14468 Sentence denotes • The process of recovering and identification of human remains of COVID-19 fatalities will generate waste products which are also potentially infected with COVID-19.
T87 14469-14652 Sentence denotes Careful consideration must be given to safe management and disposal of this waste to ensure that the safety of those involved is not compromised and the spread of COVID-19 is avoided.
T88 14653-14778 Sentence denotes • Transport the body to the mortuary (or disinfection location if no post-mortem examination will occur) as soon as possible.
T89 14780-14828 Sentence denotes 2.4 Considerations for post-mortem examinations
T90 14829-14950 Sentence denotes Deaths known to be caused by COVID-19 are natural deaths and in general would not require a full-post mortem examination.
T91 14951-15163 Sentence denotes However, this may be required in certain circumstances (e.g. deaths in custody [8]) or when other factors are suspected (e.g. accident, suicide, homicide) regardless of the COVID-19 status of the deceased person.
T92 15164-15424 Sentence denotes The decision for carrying out a full or partial post-mortem examination is normally the responsibility of the jurisdictional authority in charge (e.g. coroner, prosecutor, judge), sometimes after discussions with the investigators and forensic medical doctors.
T93 15425-15640 Sentence denotes If there is no need for autopsy in COVID-19 suspected cases, sampling technique used to confirm the cause of death is identical to the one used for making diagnosing of COVID-19 suspected cases for patients [20,21].
T94 15641-15958 Sentence denotes For conducting autopsies, in addition to the above the following PPE is recommended: double surgical gloves interposed with a layer of cut-proof synthetic mesh gloves, fluid-resistant or impermeable gown, waterproof apron, goggles or face shield and FFP3 masks or NIOSH-certified disposable N-95 respirator or higher.
T95 15959-16127 Sentence denotes For further guidance, see the briefing issued by The Royal College of Pathologists [[9], [24]], as well as that from a consortium of Italian forensic pathologists [22].
T96 16128-16315 Sentence denotes When possible, appropriate designed rooms with proper ventilation should be used for the examination, to minimize the risk for transmission of airborne pathogens as much as possible [19].
T97 16317-16377 Sentence denotes 2.5 Special considerations in case of non-identified bodies
T98 16378-16849 Sentence denotes Where required the forensic procedures recommended by the ICRC for the identification of the dead are applicable to the identification of those infected with COVID-19 [[16], [17], [18]], with certain caveats as follows:• Remains infected with COVID-19 with persistent agent may pose a cross contamination hazard to unprotected people hence visual recognition by next of kin should be strictly controlled and follow the necessary precautions, including the wearing of PPE.
T99 16850-17063 Sentence denotes Furthermore, due to the likely complexity of the recovery operation and the greater time taken, remains may have decomposed beyond the point where visual recognition is of any value by the time they are recovered.
T100 17064-17232 Sentence denotes • All those involved in the examination and identification process of human remains known or believed to be infected with COVID-19 are required to wear appropriate PPE.
T101 17233-17329 Sentence denotes This PPE has an impact on the wearer’s dexterity and their ability to perform fine motor skills.
T102 17330-17436 Sentence denotes In addition, the performance of invasive techniques may increase the risk to staff of cross contamination.
T103 17437-17523 Sentence denotes For these reasons, the use of invasive techniques should be avoided wherever possible.
T104 17524-17753 Sentence denotes • The extra safeguards required for the handling of infected remains potentially increases the time required to perform the identification and post mortem process as well as the physiological burden on the staff undertaking them.
T105 17754-17897 Sentence denotes • Where it is decided to conduct identification (and post mortem examination), this should also be conducted within the temporary holding area.
T106 17898-18054 Sentence denotes This will help avoid overwhelming and contaminating normal mortuary facilities and endangering their staff, which will be expected to run business as usual.
T107 18056-18111 Sentence denotes 2.6 Special considerations for temporary holding areas
T108 18112-18312 Sentence denotes The purpose of the temporary holding area is to serve as a place where recovered bodies and human remains infected with COVID-19 can be safely stored until arrangements can be made for their disposal.
T109 18313-18552 Sentence denotes Where recovered bodies and human remains continue to pose a risk of cross contamination, staff working in the temporary holding area (including those involved in the identification and post mortem process) must wear appropriate PPE always.
T110 18553-18635 Sentence denotes Attention must be paid to contamination control within the temporary holding area.
T111 18636-18858 Sentence denotes Dependent on the type and persistency of agent to which the remains have been exposed, it may be necessary to undertake some or all the following steps:• Disinfection of body bags upon arrival at the temporary holding area
T112 18859-18935 Sentence denotes • Placing of original body bag containing the remains inside of a second bag
T113 18936-19021 Sentence denotes • Disinfection of the outer bag following the identification or post mortem procedure
T114 19022-19175 Sentence denotes • Wearing of two layers of gloves (the outer pair being nitrile gloves) by all personnel when handling body bags or remains to reduce cross contamination
T115 19176-19323 Sentence denotes • If the case has been tested positive to COVID 19, the body bag should be clearly and permanently labelled, such as: “COVID-19 – Handle with care”
T116 19324-19500 Sentence denotes • Records should be kept of all movements of human remains within the temporary holding area and strict adherence to health and safety protocols should be ensured at all times.
T117 19501-19637 Sentence denotes There must also be a continuous means of communication between the temporary holding area and the team coordinating the overall process.
T118 19639-19719 Sentence denotes 2.7 Special considerations for final disposal of remains/hand over to relatives
T119 19720-20035 Sentence denotes • Decisions on the final disposal of bodies and human remains infected with COVID-19 will vary according to local, cultural and religious context, for which there may be a need to consult with relevant stakeholders, particularly religious representatives, to ensure that changes to standard practice are acceptable.
T120 20036-20169 Sentence denotes Transparent conversation with such societal leaders is likely to be essential to sustain trust between authorities and the community.
T121 20170-20398 Sentence denotes • If final disposal is to take place off-site, human remains should be placed in a second outer body bag. (If the human remains have already been double-bagged, the outer bag should be removed and replaced with a new outer bag).
T122 20399-20478 Sentence denotes This outer bag should be thoroughly disinfected prior to release from the site.
T123 20479-20739 Sentence denotes • Cremation of unidentified human remains should be avoided, and burial in single graves is the preferred method of disposal [5], but care must be taken to ensure that run-off from the decomposing human remains is managed so as not to contaminate ground water.
T124 20740-20828 Sentence denotes Bodies should be buried in their respective body bags, regardless of the use of coffins.
T125 20829-20976 Sentence denotes This will help in their future recovery and examination if necessary (e.g. identification) as well as taking care of the disposal of the body bags.
T126 20977-21079 Sentence denotes • Personal belongings of the deceased infected with COVID-19 may present a cross contamination hazard.
T127 21080-21263 Sentence denotes Consideration should be given to decontamination of such possessions prior to handing them over to the next of kin to avoid the spread of contamination and associated risks to health.
T128 21264-21487 Sentence denotes Where it is not possible to decontaminate possessions, careful consideration must be given as to whether it is appropriate to hand such possessions to the next of kin or whether they should be stored for later safe release.
T129 21488-21641 Sentence denotes If a decision is made to dispose of such objects as contaminated waste, they should be duly documented, together with a justification for this procedure.
T130 21643-21693 Sentence denotes 2.8 Considerations for decontamination procedures
T131 21694-21883 Sentence denotes • Decontamination procedures can be divided into those for the staff undertaking the management of the dead procedures (along with their equipment) and decontamination of the human remains.
T132 21884-22037 Sentence denotes The objectives are to ensure the health and safety of those carrying out the handling of the dead and to prevent the unnecessary spread of contamination.
T133 22038-22257 Sentence denotes • The decontamination approach should be considered as part of the planning process with a view to ensuring the most effective method is adopted, including processes for management of waste generated during the process.
T134 22258-22494 Sentence denotes • The most suitable approach is to place human remains into two body bags at the site of recovery and manage the contamination on the outside of the bag by a combination of contamination monitoring and washing of the outside of the bag.
T135 22495-22855 Sentence denotes • Decontamination of the body is not advisable, mainly because bodies may release inhaled vapor from the respiratory system or other internal contamination via other routes after initial decontamination and vigorous decontamination of bodies or body parts may destroy forensic evidence or obscure identifying marks which may make identification more difficult.
T136 22856-23020 Sentence denotes • The exact method chosen (if any) for decontamination of the body bags should follow the standard procedures for COVID-19 and the use of recommended disinfectants.
T137 23021-23099 Sentence denotes • Decontamination of staff will be as per the method defined for the PPE worn.
T138 23100-23284 Sentence denotes • Upon completion of the process, prior to removal of any equipment from the temporary holding area, care must be taken to ensure that it does not present a cross contamination hazard.
T139 23285-23412 Sentence denotes This will involve monitoring each piece of equipment for contamination and decontamination of equipment as is deemed necessary.
T140 23413-23552 Sentence denotes • Any equipment which cannot be disinfected from COVID-19 must be disposed of as infected waste, following standard biosecurity procedures.
T141 23553-23628 Sentence denotes This usually requires their controlled storage, transport and incineration.
T142 23630-23687 Sentence denotes 3 Protracted response to increased deaths from COVID-19:
T143 23688-23743 Sentence denotes A Preparatory Guideline for mass fatality response plan
T144 23744-23892 Sentence denotes There is a likely probability in some context for a significant increase over a very short period of time in the number of fatalities from COVID-19.
T145 23893-24132 Sentence denotes This can easily overwhelm local capacities available to mange the deceased, with the subsequent additional pressure on the health and medico legal systems as well as on other service providers involved in the Management of the Dead (MotD).
T146 24133-24355 Sentence denotes This section provides guidance/advice for decision makers and managers of concerned structures in their preparation and planning a response to an increase in deceased individuals that may overwhelm their normal capacities.
T147 24356-24538 Sentence denotes It contains essential elements that should be considered by the highest Government authorities and Ministries as part of a Mass Fatality Response Plan (MFRP) for the COVID-19 crisis.
T148 24539-24664 Sentence denotes Normally a crisis management coordination centre should be activated to coordinate the emergency response including the MotD.
T149 24665-24888 Sentence denotes In the absence of a crisis management coordination centre, or in case the centre has not incorporated the MotD in their response, a coordination group should be established with main focal points from relevant institutions.
T150 24889-25016 Sentence denotes This section focuses on elements unique to mass fatalities or excess deaths caused by infectious diseases such as the COVID-19.
T151 25017-25298 Sentence denotes Most of the following recommendations should ideally be part of an existing mass fatality response plan (see the ongoing efforts from various countries and regions to create specific guidelines for the dead as a part of their directives [[10], [11], [12], [13], [14], [15], [22]]).
T152 25299-25415 Sentence denotes In the absence of a contingency plan, the following provides general guidance on essential elements for such a plan.
T153 25416-25570 Sentence denotes Concrete steps/measures are also presented to address in a quick manner and with an integrated and comprehensive response, the increased number of deaths.
T154 25571-25908 Sentence denotes General recommendations of a MFRP;• A National Disaster Contingency plan should always include a MFRP drafted with input from all actors with the relevant mandates to deliver proper management of the dead, ensure the dignity of and respect to the deceased individuals and their families and to undertake investigations where appropriate.
T155 25909-26007 Sentence denotes The plan is a coordination framework that identifies key actors, their roles and responsibilities.
T156 26008-26172 Sentence denotes These plans are supplemented with operational guidelines with specific actions that need to be conducted along the continuum of a legal death enquiry/investigation.
T157 26173-26294 Sentence denotes • The MFRP should describe a multi-agency communication and coordination strategy for all actors involved in the process.
T158 26295-26526 Sentence denotes This will allow the different actors to understand their responsibilities with full knowledge of an agreed upon set of standardized and complementary activities and practices that respect the interests of all actors and the public.
T159 26527-26613 Sentence denotes • A MFRP describes the activation criteria and mechanism for mass fatality management.
T160 26614-26763 Sentence denotes This includes the legislation on response by the different authorities, the hierarchy of delivery and command and control structure for the response.
T161 26764-26883 Sentence denotes It facilitates reporting conduits that are followed at all levels and by all actors to meet all complementary mandates.
T162 26884-27008 Sentence denotes • Routine death enquiries/investigations should confirm the identity and where, when, how and by what means the person died.
T163 27009-27162 Sentence denotes These investigations are for all sudden, unexpected or unexplained deaths, including unexpected deaths from infectious disease outbreak such as COVID-19.
T164 27163-27227 Sentence denotes • Not all deaths from COVID-19 will occur in a medical facility.
T165 27228-27393 Sentence denotes Therefore, proper training and supervision must be provided to first or emergency responders attending a reported death to ensure safe management of the death scene.
T166 27394-27485 Sentence denotes • Basic management of the dead practices should be followed and are essential in all cases.
T167 27486-27636 Sentence denotes These procedures are particularly important when the volume of deaths increases sharply, exerting stress on both human resource and facility capacity.
T168 27637-27715 Sentence denotes • Adequate attention to families of the deceased is also part of the response.
T169 27716-27918 Sentence denotes • A public communication and media strategy, delivered through designated communication centres and/or broadly accessible networks, should provide regular, reliable and transparent public communication.
T170 27919-28088 Sentence denotes This conduit should represent the plans and operational aspects of the consortium of actors participating in the response and offer regular updates and progress reports.
T171 28089-28203 Sentence denotes Protection of personal information legislation must be complied and SOPs must be implemented to ensure protection.
T172 28204-28306 Sentence denotes • The MFRP does not merely provide direction for the adequate mass handling and/or disposal of bodies.
T173 28307-28584 Sentence denotes On the contrary, the plan describes operational practices, the supporting financial, administrative and logistical systems that allows for the professional and dignified search for, recovery, examination, identification, storage and return of bodies to the families for burial.
T174 28585-28892 Sentence denotes All these steps should be generating standardized documentation which contains important information that should be protected and centralized to support not only investigative aspects of case management, but it is also required for planning, operations, logistics, administration and finance, and reporting.
T175 28893-29090 Sentence denotes It also describes policies and procedures in relation to managing unclaimed and unidentified bodies, documentation of identification features for future comparison, and their temporary disposition.
T176 29091-29244 Sentence denotes All these phases require a thorough understanding of existing capacities, capabilities, and prior acknowledgement of the gaps where solutions are needed.
T177 29245-29347 Sentence denotes • A MFRP describes occupational health, safety requirements that protect responders and practitioners.
T178 29348-29524 Sentence denotes It lays out risk assessment criteria and establishes a dissemination mechanism to educate responders about reducing their risk of infection during infectious disease outbreaks.
T179 29525-29766 Sentence denotes Equally, it addresses the need for skills training on safety control mechanisms, safety tools and equipment to first responders, mortuary personnel, laboratory technicians, and other individuals involved with body and human remains handling.
T180 29767-29951 Sentence denotes This would also include the importance of safety bulletins communicated to families and communities where COVID-19 infected bodies were recovered to reduce their further contamination.
T181 29952-29989 Sentence denotes • Mass graves are highly discouraged.
T182 29990-30141 Sentence denotes They are often a demonstration of poor planning by authorities, shows a disregard for the wishes, cultural/religious rites of families and communities.
T183 30142-30233 Sentence denotes Single graves are respectful and dignified, they promote the traceability of human remains.
T184 30234-30436 Sentence denotes This can only be accomplished, however, by collaborative planning between authorities and other relevant industries, such as funeral homes, crematoriums and cemeteries and most importantly the families.
T185 30437-30514 Sentence denotes • Mass fatality events often include deaths of both nationals and foreigners.
T186 30515-30739 Sentence denotes Internationally accepted best practices and procedures that promote the dignified and professional management of the dead and respectful engagement with people of different backgrounds, cultures and religions must be upheld.
T187 30740-30986 Sentence denotes This will facilitate the sometimes complex administrative and legal procedures of foreign governments when seeking repatriation of bodies to the country of residence or requesting assistance with notifications of death to relatives living abroad.
T188 30987-31107 Sentence denotes Shipment of bodies across international boundaries may be delayed until the infection is deemed no longer transmissible.
T189 31108-31210 Sentence denotes Planning should include participation of airline companies expected to provide the shipment of bodies.
T190 31211-31377 Sentence denotes We list hereafter essential practical questions that will help in the rapid assessment of the existing health and medico legal systems to respond to increased deaths.
T191 31378-31688 Sentence denotes These questions are also applicable in the assessment of the response in place by detention centres in case of sudden increase of number of deaths in custody related to the pandemic:• Does a MFRP or Annex related to death management exist to guide a multiagency response to an increase in deaths from COVID-19?
T192 31689-32020 Sentence denotes • Do you have the support of the Ministry of Health, Ministry of Justice, Ministry of Interior, Cabinet of Ministers, directly through the Office of the President’s Disaster Management Department to activate the existing contingency mass fatality plan -as part of a National Disaster Management Plan or develop an emergency option?
T193 32021-32240 Sentence denotes • What agencies have a mandate to respond to multiple deaths in a large scale or protracted event and who would be the primary lead agency to work towards a coordinated approach to delivering a plan and implementing it?
T194 32241-32344 Sentence denotes • What is the current capacities and capabilities of all agencies involved in the management of deaths?
T195 32345-32476 Sentence denotes • What percentage of increased case load would overwhelm agencies at their current capacity and trigger the activation of the plan?
T196 32477-32652 Sentence denotes • Are the current personnel adequately trained in safety precautions and equipped with appropriate personal protective equipment to handle a surge in infectious disease cases?
T197 32653-32695 Sentence denotes Are they insured against injury and death?
T198 32696-32850 Sentence denotes • Have arrangements been made with non-government groups and the corporate sector to secure additional support as well as to procure additional equipment?
T199 32851-33041 Sentence denotes • Does the plan insist on dignified and professional management of deceased persons and respect in terms of engagement and complying with the wishes of the families and communities affected?
T200 33042-33247 Sentence denotes • Do the law enforcement community and medicolegal practitioners have the additional resources to ensure that all sudden and unexpected deaths are thoroughly investigated even during an infection outbreak?
T201 33248-33368 Sentence denotes • Does the plan provide guidance towards compliance with protection of personal information legislation and regulations?
T202 33369-33555 Sentence denotes • Will the families and communities (and media) be able to rely on regular, reliable and transparent communication from competent source that represents all response agencies and groups?
T203 33556-33629 Sentence denotes Where will they go to receive updates and status reports on the response?
T204 33630-33815 Sentence denotes • Who will recover deceased persons from their homes and what training and equipment will they receive to protect themselves and the bereaved families in an infectious disease outbreak?
T205 33816-33906 Sentence denotes • What additional refrigerated storage space is available for a surge in deceased persons?
T206 33907-34038 Sentence denotes • What labelling, and body tracking methods are conducted to effectively manage large numbers of bodies accumulating in mortuaries?
T207 34039-34299 Sentence denotes • Is there a standardized file management (including standardized forms) process to ensure all facilities and agencies involved work coherently and collaboratively in one system that allows for centralization of all data related to the management of the death?
T208 34300-34441 Sentence denotes • How will caseload information be centralized to assist with further planning and targeted deployment of additional resources and equipment?
T209 34442-34580 Sentence denotes • Are there sufficient cemetery spaces and/or crematorium operations to receive and respond sin a timely manner to the increase in deaths?
T210 34581-34671 Sentence denotes • What is the short- and long-term approach to managing unclaimed and unidentified bodies?
T211 34672-34902 Sentence denotes • What administrative processes and additional support will ensure that families receive medical certificates of death, burial permits, autopsy reports and other important documentation to resolve financial affairs, estates, etc.?
T212 34903-35029 Sentence denotes • Who will pay for the additional personnel, facilities and the activities themselves during a protracted mass fatality event?
T213 35030-35183 Sentence denotes The following sections outline the key steps in providing a protracted response to increased deaths from COVID-19, from the recovery to the repatriation.
T214 35185-35217 Sentence denotes 3.1 Management and coordination
T215 35218-35335 Sentence denotes • Identify who has been designated as the lead Ministry/Department responsible to coordinate the Government response.
T216 35336-35797 Sentence denotes • Identify a focal point of each of the agencies, including service providers responsible for the management of the deceased and their families and clarify roles and responsibilities based on the different phases of the MotD such as recovery and transportation of the deceased, post-mortem examinations if required, identification of the deceased, storage and disposal, burial and handover to families, death registration, attention and information to families.
T217 35798-35859 Sentence denotes • Establish a coordination group with a multiagency approach.
T218 35860-36015 Sentence denotes It is important to include hospital administrators, religious authorities, municipal services, cemeteries and crematoriums for a truly integrated response.
T219 36016-36174 Sentence denotes While not involved in the process, the private sector are key resources and should be engaged recognizing there might be limitations as per local regulations.
T220 36175-36371 Sentence denotes • Ensure a proper response is in place to cover all those aspects of the management of the dead process, including consider the investigative needs of law enforcement agencies in cases that apply.
T221 36372-36497 Sentence denotes • Local authorities should also ensure that any participation by volunteers or private businesses follow the same procedures.
T222 36498-36688 Sentence denotes • A good understanding of the local capacities for MotD, mainly in relation to transportation, storage and body disposal is a baseline to determine further steps in the multiagency approach.
T223 36689-36857 Sentence denotes • Ensure there is sufficient capacity in terms of infrastructure, human resources, materials and self-protective equipment to respond to the increased number of deaths.
T224 36858-36962 Sentence denotes If this is not available, the coordination group should resort on alternatives for the required support.
T225 36963-37143 Sentence denotes • Ensure management level or coordination staff at the different entities provide clear procedures and recommendations in relation to the handling of bodies to all those concerned.
T226 37144-37435 Sentence denotes • Additional health and safety issues that could arise from the MotD especially during the transportation of bodies, such as manual handling of bodies (large weight, several times), staff working in cold temperatures for prolonged periods of time, psychological impact, hazardous substances.
T227 37436-37513 Sentence denotes Ensure support and adequate response to staff working under these conditions.
T228 37514-37677 Sentence denotes • Any activity undertaken in relation to the management of known or suspected COVID-19 fatalities must be preceded by a preliminary evaluation and risk assessment.
T229 37678-37808 Sentence denotes The evaluation should include determination of the number, location and condition -including COVID-19 status-of the human remains.
T230 37810-37858 Sentence denotes 3.2 Recovery and transportation of the deceased
T231 37859-38051 Sentence denotes In the event of increased number of deaths, movement of bodies between homes, hospitals, mortuaries, cemeteries and body storage will require large capacities for manual handling and vehicles.
T232 38052-38229 Sentence denotes Outline arrangements for transporting the dead bodies considering the following aspects:• Know the legislation and regulations in place, including occupational health and safety
T233 38230-38255 Sentence denotes • Know who is responsible
T234 38256-38286 Sentence denotes • Do they have the capacities?
T235 38287-38360 Sentence denotes • Is there any involvement of police/judicial authorities in these cases?
T236 38361-38491 Sentence denotes • Where should bodies confirmed positive or suspected to be positive cases of COVID-19 be transported? (Specific morgue/mortuary?)
T237 38492-38571 Sentence denotes • When the number of casualties exceeds the capacities for body transportation?
T238 38572-38667 Sentence denotes Identify the support required in terms of vehicles, infrastructure, materials, human resources.
T239 38668-38779 Sentence denotes Identify alternatives sources for support and ensure their understanding of their role in the broader response.
T240 38780-38851 Sentence denotes • Do they know/understand the required safety or precautionary actions?
T241 38852-38979 Sentence denotes • Is the necessary insurance coverage provided for these additional resources not routinely deployed in management of the dead?
T242 38981-39044 Sentence denotes 3.3 Medical certificate, death certificate, death registration
T243 39045-39157 Sentence denotes The following questions should be considered when preparing a response plan:• What are the regulations in place?
T244 39158-39355 Sentence denotes Any specific guidance/regulation to consider in pandemic cases? (i.e. normally the physician certifies the death, but if not witnessed such as a death at home with suspicion of COVID 19, who signs?
T245 39356-39380 Sentence denotes Autopsy mandatory? etc.)
T246 39381-39452 Sentence denotes • In the case of deaths in detention what legislation must be followed?
T247 39453-39560 Sentence denotes Consider working with legal and ministerial authorities to adapt in the case of a large increase in deaths.
T248 39561-39665 Sentence denotes • Who is responsible for issuing the medical certificate, death certificate, and the death registration?
T249 39666-39725 Sentence denotes • Do they have the capacities in case of exceeding numbers?
T250 39726-39917 Sentence denotes Measures in place for enough doctors to sign death certificates, for offices to register deaths, etc. -Considering governmental offices not working, reduced activities, social distance, etc.-
T251 39919-40045 Sentence denotes 3.4 Post-mortem examinations in general and within the medico legal death investigation system (infectious and routine cases)
T252 40046-40117 Sentence denotes • Review existing legislation for infectious diseases (i.e. influenza).
T253 40118-40220 Sentence denotes • Local authorities should take measures to ensure that medico legal services continue to be provided.
T254 40221-40452 Sentence denotes A contingency plan should be established to properly provide management of the dead services to victims of the pandemic and other non-pandemic related cases, especially when bodies are taken to the same facilities/hospital morgues.
T255 40453-40676 Sentence denotes • Consider ensuring that autopsies can be performed in appropriate forensic facilities and designed rooms with proper ventilation adapted to minimize the risk for transmission of airborne pathogens as much as possible [19].
T256 40677-40770 Sentence denotes • Families of the deceased should be properly informed about any delays, measures taken, etc.
T257 40771-40819 Sentence denotes Outline plans to properly handle both caseloads.
T258 40820-41073 Sentence denotes • Consider: deploy judicial and forensic resources efficiently to improve decision making in required cases, additional forensic resources that can help in the management of the dead related to the pandemic event, distribution of cases if possible, etc.
T259 41075-41092 Sentence denotes 3.5 Body storage
T260 41093-41225 Sentence denotes • Body storage refers to the need for temporary storage of the deceased due to an unmanageable surpass in existing storage capacity.
T261 41226-41344 Sentence denotes Body storage differs from temporary mortuaries that entail the capacity to conduct post-mortem examinations/autopsies.
T262 41345-41501 Sentence denotes • Establish a mechanism to coordinate the procurement, staffing and storage of all bodies, identify potential facilities/premises suitable for body storage.
T263 41502-41587 Sentence denotes • The coordination group should be informed about the existing body storage capacity.
T264 41588-41694 Sentence denotes Existing facilities may be found within hospitals, public and private funeral homes and forensic services.
T265 41695-41720 Sentence denotes Consider military assets.
T266 41721-41801 Sentence denotes • In some cases, universities may have additional storage capacities for bodies.
T267 41802-41904 Sentence denotes Some limitations exist in towns and cities where there is only the public mortuary capacity available.
T268 41905-42310 Sentence denotes • Even if the decision is to bury bodies as soon as possible, or to cremate identified bodies in certain contexts, the body will undoubtedly remain in storage for a period of time before burial while administrative and logistical requirements are satisfied (i.e. while the death certificate is issued, the authorization for cremation or burial, ongoing investigations, awaiting family notification, etc.).
T269 42311-42376 Sentence denotes Therefore, additional body storage must be addressed in advanced.
T270 42377-42576 Sentence denotes • All phases of the MotD, even when capacities are increased, may incur additional challenges during a pandemic as handling bodies believed to be infectious require additional precautionary measures.
T271 42577-42652 Sentence denotes A proper storage area allows for continuity of other stages of the process.
T272 42653-43121 Sentence denotes • Be aware of the minimum standards for setting up temporary body storage facilities such as single level facility or establishment with suitable access for loading/unloading, secured premises, permanent access for big capacity vehicles, entrances, exits and windows obscured from media and the public, electricity and plumbing, appropriate height for stacked shelves, identification and body viewing facilities, office spaces, staff amenities, and welfare facilities.
T273 43122-43408 Sentence denotes Other considerations such as sealed floors, impervious concrete or covered in non-slip waterproof rubber flooring, cleaning of surfaces, appropriate disposal of waste, etc. should be revised considering also local regulations, environmental risk assessments, environmental permits, etc.
T274 43409-43478 Sentence denotes • Prepare a list of equipment to consider for temporary body storage.
T275 43479-43727 Sentence denotes • During the MotD it is especially important in the storage and transportation phases that body identification and labelling is carried out with at least three identifiers including one unique identifier (i.e. body number, date, place of recovery).
T276 43728-43887 Sentence denotes In storage facilities is imperative to have a proper bay numbering in place to avoid the release of mistaken bodies or cause unnecessary delays in the process.
T277 43888-44019 Sentence denotes Authorities responsible must ensure operating procedures follow the recommendations for MotD of infectious/contaminated bodies [5].
T278 44021-44043 Sentence denotes 3.6 Viewing of bodies
T279 44044-44491 Sentence denotes A family viewing area should be facilitated especially if bodies will remain for a certain period of time, or because in line with mitigation of social contact, only few relatives will be permitted access to facilities to complete the required documentation for burial, it is important to allocate an appropriate and comfortable waiting areas for families, following also general recommendations for public spaces in the framework of the pandemic.
T280 44492-44513 Sentence denotes Minimum requirements:
T281 44514-44665 Sentence denotes Hygienic rooms, sensitive to the bereaved needs and beliefs, with washing facilities and ensure trained professionals oversee the viewing arrangements.
T282 44667-44702 Sentence denotes 3.7 Body disposal/burial/cremation
T283 44703-44933 Sentence denotes • Personnel from funeral homes have expertise in the handling and transportation of the dead, though usually without any legal obligation to respond to emergencies, can be considered useful support when capacities are overwhelmed.
T284 44934-45027 Sentence denotes They can be of timely support to process registrations of the death, permits for burial, etc.
T285 45028-45126 Sentence denotes They may also offer suitable body storage facilities at their funeral homes should the need arise.
T286 45127-45331 Sentence denotes • Important to review the existing regulations for burial permits and cremation and ensure that the relevant authority issues a decree or instructions to facilitate the burial permits as much as possible.
T287 45332-45456 Sentence denotes • When considering cemeteries for burial of bodies, it is important to consider issues such as permits, land available, etc.
T288 45457-45505 Sentence denotes Temporary burial of bodies may be necessary [5].
T289 45507-45536 Sentence denotes 3.8 Repatriation of deceased
T290 45537-45780 Sentence denotes In the case of repatriation of human remains, is important to be aware of local regulations, procedures, and concerned authorities that go beyond the routine death (such as consulates, border authorities, authorities of the receiving country).
T291 45781-45917 Sentence denotes A coordination group should establish contact with concerned authorities responsible for issuing repatriation permits in both countries.
T292 45918-46084 Sentence denotes Generally, a Freedom from Infection or Transmissible Diseases Certificate is required that is normally issued by the forensic practitioner or the attending physician.
T293 46085-46414 Sentence denotes In the case of COVID-19, it would be important to have a consolidated opinion on procedures based on rules and regulations applicable at the time (consider appropriate ways of solving this in advance in order to help alleviate the time and the burden for respective families in need of repatriation of their deceased loved ones).
T294 46416-46426 Sentence denotes Disclaimer
T295 46427-46753 Sentence denotes Produced by the International Committee of the Red Cross (ICRC) Advisory Group on the Management of COVID-19 Related Fatalities, these guidelines contain official recommendations from the ICRC for the management of infectious dead bodies and human remains and complements their existing guidance on the management of the dead.
T296 46754-46837 Sentence denotes This document does not contain peer reviewed original data or experimental results.
T297 46838-46995 Sentence denotes Any expressed guidance, advice, or opinions are solely those of ICRC and may not necessarily represent the views of the journal’s editorial team or Elsevier.
T298 46997-47030 Sentence denotes Declaration of competing interest
T299 47031-47084 Sentence denotes The authors have no conflicts of interest to declare.