Culture and pandemic control at cross-roads: navigating the burial guidelines for COVID-19-related deaths in a Ghanaian setting.

BACKGROUND: Despite the large volume of scientific evidence on the rapid spread of the COVID-19 pandemic and associated high morbidity and mortality, little is known about the sociocultural disruptions which ensued. The current study explored the nuanced navigation of the COVID-19-related death and burial protocols and its impact on traditional burial and funeral rites in Ghana. METHODS: This qualitative study was based on the 'focused' ethnographic design. Data were collected using key informant interviews from nineteen COVID-19-related bereaved family members and public health officials involved in enforcing adherence to COVID-19-related death and burial protocols in the Cape Coast Metropolis of Central region of Ghana. Recursive analysis was conducted to generate the themes and sub-themes from the data. RESULTS: The overarching theme was "Uncultural" connotations ascribed to the COVID-19-related death and burial protocols. The COVID-19-related death and burial protocols were ubiquitously deemed by participants to be 'uncultural' as they inhibited deep-rooted indigenous and eschatological rites of separation between the living and the dead. This was fueled by limited awareness and knowledge about the COVID-19 burial protocols, resulting in fierce resistance by bereaved family members who demanded that public health officials release the bodies of their deceased relatives. Such resistance in the midst of resource limitation led to negotiated compromises of the COVID-19-related death and burial protocols between family members and public health officials. CONCLUSIONS: Insensitivity to socio-cultural practices compromised the implementation of the COVID-19 pandemic control interventions, particularly, the COVID-19-related death and burial protocols. Some compromises that were not sanctioned by the protocols were reached to allow health officials and families respectfully bury their dead. These findings call for the need to prioritize the incorporation of sociocultural practices in future pandemic prevention and management strategies.

Potential SARS-CoV-2 contamination of groundwater as a result of mass burial: A mini-review.

The recent COVID-19 disease has highlighted the need for further research around the risk to human health and the environment because of mass burial of COVID-19 victims. Despite SARS-CoV-2 being an enveloped virus, which is highly susceptible to environmental conditions (temperature, solar/UV exposure). This review provides insight into the potential of SARS-CoV-2 to contaminate groundwater through burial sites, the impact of various types of burial practices on SARS-CoV-2 survival, and current knowledge gaps that need to be addressed to ensure that humans and ecosystems are adequately protected from SARS-CoV-2. Data available shows temperature is still likely to be the driving factor when it comes to survival and infectivity of SARS-CoV-2. Research conducted at cemetery sites globally using various bacteriophages (MS2, PRD1, faecal coliforms) and viruses (TGEV, MHV) as surrogates for pathogenic enteric viruses to study the fate and transport of these viruses showed considerable contamination of groundwater, particularly where there is a shallow vadose zone and heterogeneous structures are known to exist with very low residence times. In addition, changes in solution chemistry (e.g., decrease in ionic strength or increase in pH) during rainfall events produces large pulses of released colloids that can result in attached viruses becoming remobilised, with implications for groundwater contamination. Viruses cannot spread unaided through the vadose zone. Since groundwater is too deep to be in contact with the interred body and migration rates are very slow, except where preferential flow paths are known to exist, the groundwater table will not be significantly impacted by contamination from SARS-CoV-2. When burial takes place using scientifically defensible methods the possibility of infection will be highly improbable. Furthermore, the SARS-CoV-2 pandemic has helped us to prepare for other eventualities such as natural disasters where mass fatalities and subsequently burials may take place in a relatively short space of time.

Twins Separated at Birth: Across a Country and Around the World/Twin Research: Memorial Tribute to Isaac Blickstein, MD; Infanticide and Sacrifice of Archaic-Aged Twins and Triplets; Prehistoric Twin Burials; Highlights from a Conference on Three Identical Strangers/Media Reports: An Atypical Twin Father; An Actor's Twin Brother; Twin Link to Tulsa, Oklahoma Massacre; Superfetated Twins; Twin Comedians and Script Writers; Indian Twins' Loss to COVID-19.

Every reared-apart monozygotic (MZ) twin pair offers a fresh perspective on human developmental questions. This is true regardless of whether the co-twins were raised in the same country or across the globe. The members of two pairs of separated MZ female twins have recently come to attention. In one case the twins were raised by different families in Argentina; in the other case the twins were raised by different families in Sweden and Vietnam. The perceptions and perspectives of these twins are insightful. The twin research section that follows begins with a tribute to our late esteemed colleague, Dr Isaac Blickstein (1953-2020). Research concerning the infanticide and sacrifice of Archaic-aged twins and triplets and prehistoric twin burials is reviewed next. Highlights from a conference focused on the 2018 film Three Identical Strangers are also included in this portion. The final section of this article includes media reports of an atypical twin father, an actor's twin brother, a twin link to the 1921 Tulsa, Oklahoma massacre, the birth of superfetated twins, twin comedians and script writers and Indian twins' tragic loss to COVID-19.

COVID-19 in the autopsy room-requirements, safety, recommendations and pathological findings.

Modern technologies enable the exchange of information about the expansion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the continually increasing number of the coronavirus disease 2019 (COVID-19) cases almost in real time. The gravity of a current epidemiological situation is represented by the mortality rates, which are scrupulously updated daily. Performing autopsies on patients with either suspected or confirmed COVID-19 is of high importance since these might not only improve clinical management but also reduce the risk of SARS-CoV-2 infection expansion. The following paper aimed to present the most crucial aspects of SARS-CoV-2 infection from the point of view of forensic experts and pathologists, recommendations and safety precautions regarding autopsies, autopsy room requirements, possible techniques, examinations used for effective viral detection, recommendations regarding burials, and gross and microscopic pathological findings of the deceased who died due to SARS-CoV-2 infection. Autopsies remain the gold standard for determining the cause of death. Therefore, it would be beneficial to perform autopsies on patients with both suspected and confirmed COVID-19, especially those with coexisting comorbidities.

Changing landscapes of death and burial practices: public health response in time of COVID-19 pandemic.

In a recent correspondence published in this journal, the author calls for spiritual interventions for the living and the dead that be considered by the medical community especially in the time of COVID-19. This paper further elaborates on the need to consider the death and burial practices of bereaved families of patients who died of COVID-19 with strict observance of health protocols. Death and burial practices are significant moments in finding meaning for bereaved families in accepting the demise of their loved ones during this pandemic.

How COVID-19 pandemic is changing the Africa's elaborate burial rites, mourning and grieving.

There are diverse burial rites in Africa which have been practiced for decades depending on the deceased place of origin, culture, religion and the position held in the community. Unlike the developed countries where burials are usually conducted as private ceremonies, funerals in Africa are elaborate and are usually public ceremonies involving the entire members of families, friends and well-wishers. Religion and culture are usually the deciding factors when decisions are made on how the deceased should be buried but generally cremation is not commonly practiced in Africa. COVID-19 pandemic was generally accepted to originate from Wuhan in China and this pandemic has extended to Africa. Most countries in Africa responded to the COVID-19 pandemic by adopting the same strategies used by the Western countries in curbing the spread of the virus through the imposition of restrictions on movements, lock down and the introduction social distancing rules which are align to Africa way of living. These control strategies had put a lot of pressures on the weak mortuary services in Africa, altered the traditional methods of observing burial rites, mourning and grieving. COVID-19 pandemic has changed the various traditional ways Africans mourn grief and bury their love one. The dead bodies of people suspected or confirmed to have COVID-19 should be treated with respect, ensuring the rights of the dead to a dignifying burial are upheld while adhering to standard precautions including use of appropriate PPEs, hand hygiene before and after the burial procedure.

[Safe management of COVID-19 dead bodies in sub-Saharan Africa: could families be allowed to bury their dead?] / Gestion sécurisée des dépouilles de personnes décédées de la COVID-19 en Afrique sub-Saharienne: et si on laissait les familles enterrer leurs morts?

Sub-Saharan African countries have been hit by the Coronavirus 2019 pandemic (COVID-19) since March 2020. Besides the resulting health and economic disasters is the psycho-socio-cultural problem related with the management of corpses of people dead from the disease, which might hinder the implementation of the response strategy. In Cameroon for instance, the current corpse management policy is very disputed. In fact, although they were recently made more flexible, the restrictions applied to burials still ban any transfer of dead bodies between cities. In light of the African cultural considerations of dead persons, the disputes observed between the families and the health personnel, the legislation and the available scientific evidence, this article analyses the risks and benefits of allowing families to bury their relatives. It thereafter suggests solutions that reconcile dignity (by allowing families to bury their dead relatives in their homes) and safety (by ensuring a sealed handling and the surveillance by a judiciary police officer). Applying these solutions could improve the population's trust towards the health system, and positively contribute to COVID-19 case prevention, identification and management.

International Committee of the Red Cross (ICRC): Cemetery planning, preparation and management during COVID-19: A quick guide to proper documentation and disposition of the dead.

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 planning, preparation and management of cemeteries during COVID19. The management of the dead process includes proper documentation and appropriate disposition, including temporary burials. If there is a sudden and significant increase in the number of deaths, local capacities can quickly become overwhelmed. This guidance, prepared for the COVID19 pandemic, can be applied to any incident involving mass fatalities when the local capacity to provide safe, appropriate and dignified burials is overwhelmed. Specifications on size, spacing, excavation depths, and information about other important considerations are provided. In addition, it provides recommendations on how to correctly map graves while ensuring the traceability and correct management of bodies in a cemetery. Procedures for receiving bodies, as well as measures to ensure the health and safety of relatives and cemetery staff are also covered in this guidance.

Ethics Trade-Off Between Hazards Prevention and the Safeguard of Death Dignity During COVID-19.

Urgent measures established to contain the transmission of COVID-19 and prevent biological hazards included very restrictive interventions on public Holy Masses and funerals. Italy banned any burial procedure and the decision particularly affected both catholic and islamic communities. The dignity of death and the religious competence as cultural competence during COVID-19 epidemic represent important aspects of the epidemic preparedness. This article provides relevant considerations about the topic from an ethical perspective.

Advance Care Planning Engagement and End-of-life Preference Among Older Chinese Americans: Do Family Relationships and Immigrant Status Matter?

OBJECTIVES: To examine how immigrant status and family relationships are associated with advance care planning (ACP) engagement and end-of-life (EOL) preference in burial planning among older Chinese Americans, the largest subgroup of Asian Americans. DESIGN: Cross-sectional survey. SETTING: Communities in Honolulu, Hawai'i. PARTICIPANTS: Participants were 430 older Chinese Americans aged 55 years and older. MEASURES: Measures included ACP contemplation, ACP discussion, and EOL preference in burial planning, immigrant status, family cohesion, family conflict, demographic information, and health status. RESULTS: Results show that in comparison to foreign-born Chinese Americans, US-born Chinese Americans were more likely to have ACP contemplation [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.39-5.63], ACP discussion (OR 3.02, 95% CI 1.50-6.08), and preferences for burial plans at the end of life (OR 4.56, 95% CI 2.04-10.18). Family conflict increased the possibility of having ACP contemplation (OR 1.21, 95% CI 1.07-1.38), ACP discussion (OR 1.22, 95% CI 1.07-1.39), and EOL preference in burial planning (OR 1.22, 95% CI 1.04-1.42), whereas family cohesion was not associated with these study outcomes. CONCLUSIONS AND IMPLICATIONS: This study suggests that ACP should be adapted to be more culturally appropriate, especially in a time of coronavirus and xenophobia, such as framing ACP as a tool to help families reduce stress while fulfilling filial obligations, in order to ensure equitable access to ACP.

Dignity and rights of the dead and their families: A compromise in the time of coronavirus disease 2019.

The biological aspects and economic impact of coronavirus disease 2019 have been extensively discussed in the literature. However the social, cultural and legal aspects of the pandemic, especially regarding the dignity and rights of the deceased and their families - have so far received little attention. This communication discusses restrictions and violations of the rights of the deceased and their families and their privileges to carry out funerary practices and rituals during the pandemic caused by the novel severe acute respiratory syndrome coronavirus 2.

Management of the dead during COVID-19 outbreak in Malaysia.

The emergence of a novel human coronavirus, SARS-CoV-2, causing severe respiratory tract infections in humans, is affecting all countries of the world and has become a global health concern. Since the virus was first identified in December 2019, the number of deaths have been propagating exponentially, causing countries across the world, including Malaysia, to increase emergency measures to combat the virus. Due to the fact that the COVID-19 pandemic does not discriminate its victims, it is of paramount importance to construct a plan for management of the dead for all suspected or confirmed COVID-19 cases, including the unidentified deceased, as an essential portion of the humanitarian forensic action approach. This document provides an overview on ways to maximize the local collective capacity from various government agencies to manage the dead based on the prevailing regulations and legislation in the country, in preparation for possible large scale deaths from this pandemic. The National Institute of Forensic Medicine Malaysia has improvised procedures and guidelines for management of the dead within the existing regulations in order to achieve a balance between medicolegal requirements and the safety of personnel managing the bodies of the deceased with suspected or confirmed COVID-19 infection; at the site of death, during transport, during postmortem procedures, storage and preparation before and during burial or cremation as well as environmental cleaning and disinfection, involving various agencies in the country. A form of temporary controlled burial is as an option to allow the reinvestigation of a decedent to help formally identify victims of the pandemic such as undocumented migrants or refugees who were previously not identified. Due to the different legal requirements and mortality rates between countries, there is no one-size-fits-all approach to the management of the dead. Whenever possible, every opportunity and assistance must be given to families to mourn their loved ones, even in times of crisis or an outbreak, in order to sustain an appropriate level of dignity and respect.