A roadmap to the safe practice of forensic medicine in the COVID-19 pandemic.

The COVID-19 pandemic has forced forensic practitioners to consider how we perform our normal duties, especially when those duties involve humans. The potential for contracting the virus from working in close contact with living sufferers is high, and we have yet to fully determine the risk of infection from the deceased. In an attempt to support the community, the Journal of Forensic & Legal Medicine has drawn together three articles which underline the importance of continued forensic medical practice during the pandemic and highlight some factors to consider in a Roadmap towards safe practice. Our Roadmap has intentionally taken an international perspective and supports other work we have published in the Journal on our collective response to the COVID-19 crisis.

A review of the management and safe handling of bodies in cases involving COVID-19.

Wuhan Municipal Health Commission, China, reported a cluster of cases of 'pneumonia of unknown aetiology' in Wuhan, Hubei province in late 2019. The causative organism was eventually identified as a novel coronavirus. Subsequently, the disease spread to more provinces in China, then the rest of the world, and the World Health Organization declared it a pandemic. The virus was named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the disease was termed COVID-19 (Coronavirus disease). Since then, an increasing number of people have succumbed to this infectious disease. High contagiousness and rapid spread of the disease has been a matter of concern, as it may overburden healthcare systems. Hence, it is vital to implement strict infection prevention and control measures to curb the spread of the disease. This article reviews the guidelines available for the handling of bodies of deceased persons with suspected or confirmed COVID-19, and for their safe disposal. It also provides a summary of recommendations for conducting autopsies in cases where COVID-19 is suspected.

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.