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To Bury or not to Bury: That is the Question

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By M.C.M. Iqbal PhD

The decision to make cremation the mandatory form of disposing the COVID-19 dead in Sri Lanka was based on the premise that there was (i) insufficient evidence on the possibility of the virus leaking out of the buried bodies from the cemeteries, (ii) the possibility of the virus entering the water table, and (iii) as a consequent to (ii), transmission of the virus among the population. The cremation decision was based on precautionary principles, as the SARS-CoV-2 is a new virus with many unknowns.

During the last few months, considerable scientific evidence has been published in international peer reviewed journals on many aspects of the novel coronavirus and its environmental impact. It is now time to lift the veil of ‘unknowns’ and move towards making informed decisions.

Viruses and virology is the domain of microbiologists, more specifically virologists. However, some basic knowledge in biology can help us understand the present pandemic and the various precautionary measures.

 

The virus

Let us begin with the virus. The official name of the virus is SARS-CoV-2 and the disease it causes is called COVID-19. A single virus particle (called a virion) consists of an outer shell made of protein, enclosing and protecting the RNA, the genome or in layman terms the software that runs the virus. It is very tiny (20 to 400 nanometres) and cannot be seen through a microscope (see Figure). The genome is like an instruction manual for our cells and the entire body to function. Once the virus enters our living cells (called infection), it stops the normal function of a cell and hijacks the cell machinery to produce more copies of itself, causing the cell to eventually burst open, infecting new cells with virus particles and initiating a chain reaction. Thus, living cells are necessary for the virus to survive and make copies. The only mission of the virus is to make more copies of itself.

Viruses are broadly divided into Enveloped and Non-Enveloped viruses. The envelope is an outer covering on the virus composed of a fatty substance (lipids) and proteins (see Figure). The SARS-CoV-2 virus is an enveloped virus.

The Coronavirus that you see illustrated has knob-like spikes on the surface embedded in the lipid envelope. These spikes are vital for the virus to gain entry into our cells in the throat and lungs (respiratory tract): imagine this as the key (spikes) to open the door (cells in the throat and lungs). Fortunately, this envelope provides a soft target and is easily broken down by soap, detergents and other disinfectants such as alcohol. Without this envelope the virus cannot infect us – it has no key to enter our cells. Hence the emphasis on washing our hands with soap and disinfecting the environment with alcohol and detergents – this is sufficient to destroy the virus.

The Non-Enveloped viruses do not have this lipid layer. They have a hard protein coat resistant to common disinfectants, enabling the virus to survive in the outside environment. Examples are the Poliovirus and the viruses causing dysentery.

 

Stability of the virus in the environment

In the past few months, scientists all over the world have looked at the potential risks of the SARS-CoV-2 virus entering wastewater and serving as a source of infection. Untreated waste (particularly from hospitals) and surface waters are a potential source of disease transmission and research done in these areas are at the initial stages. The virus is shed from patients who are under treatment in hospitals or quarantined at home, through their daily ablutions, sputum, and vomit, which can enter wastewater. Besides, faeces and urine from infected patients are also sources for the virus to enter sewage channels and seep into the water table. How stable are they in the outside environment?

A study on the stability of the virus on different surfaces under different environmental conditions simulated in a laboratory was done by the School of Public Health, Faculty of Medicine, Hong Kong and published in a leading medical journal, the Lancet Microbe (Chin et al. 2020). The major outcomes of this study were:

Temperature:

The virus is highly stable at 4 °C (e.g. in the fridge) but sensitive to heat. When the incubation temperature is increased to 70 °C, the virus is inactivated in five minutes. At 22 °C virus is not detected after 14 days and at 37 °C it is not detected after two days. The last two are feasible temperatures in Sri Lanka.

Stability on surfaces:

Infectious virus could not be recovered from printing or tissue paper after three hours, from wood or cloth after two days. The virus is more stable on smooth surfaces. Infectious virus could not be recovered from day four from glass and banknotes, and from steel after seven days.

Disinfectants:

The virus did not survive common disinfectants such as household bleach, ethanol, etc. It survived soap for five minutes. It also tolerates a pH range of 3 to 10. i.e., it cannot tolerate very low (acidic) or high (very basic) pH. The RNA of the coronaviruses, in general, is extremely fragile and can be rapidly degraded by enzymes (called RNAses) abundant in the natural environment (Brisebois et al. 2018).

 

Can the virus leak into

the environment?

Theoretically virus particles can enter the soil environment after burial of a COVID-19 victim if the corpse is not isolated in the grave by a ‘leak proof’ plastic body bag, as decay and decomposition sets in gradually. However, what enters the soil environment is not an intact virus capable of causing an infection. Once the patient dies, the virus in the body cells cannot multiply and they begin to disintegrate. Viruses need living cells within which they can multiply.

We should remember that the virus is not an active living organism capable of defending itself and transferring to a new host. The decomposing body releases a range of chemicals and enzymes that would breakdown the virus. Other micro-organisms, either from the decomposing body or living in the soil environment, would consume these virus particles. Thus, they have a short survival time in the outside environment where detergents and other chemicals in the wastewater and enzymes produced by bacteria can damage the virus envelope (WHO 2020).

Many people have died in the past due to very infectious bacterial (Pneumonia, Tuberculosis, Typhoid, Cholera) and viral (Polio, HIV, Ebola) diseases. Cremation was never mandatory for those patients and there has never been any outbreak of epidemics attributed to cemeteries where these patients were buried. Disease causing pathogens are very specialized micro-organisms that can survive only in their living hosts. Once they leave their host and enter the natural environment, they cannot compete with the free-living microorganisms.

 

The question of the water table

The water table is a huge body of water below the surface of the soil. You can find this out by looking into the nearest well. In low lying areas, such as in Colombo, the water table is close to the soil surface particularly during the rainy season. In the up-country regions or the dry regions, the water would be several metres deep in the well.

What is the risk of the virus entering the water table and infecting us? First, chances of finding a complete virus particle capable of causing infection are very small, due to reasons given above. Second, those living in urban areas do not consume ground water directly. The water we consume is disinfected at the Water Treatment plants of the Water Board and we also boil the water at home. The WHO has indicated that the virus survives only two days in dechlorinated tap water and in hospital wastewater at 20 ºC, and that there is no evidence that coronaviruses have caused infections through drinking water (WHO 2020).

Thirdly, drinking water is not a source of infection: the virus has to enter through our mouth, nose or eyes to enter the cells in our throat and lungs (respiratory tract), which is the main point of entry. Thus, infection of humans by the corona virus found in the water table is very unlikely. To quote Prof. Malik Peiris ‘COVID-19 is not a waterborne disease’. Full stop.

 

Corpse handling during COVID-19

Few peer reviewed papers have been published on handling and disposal of corpses of people who died from COVID-19. A publication by Nanayakkara et al in October 2020 reviews practices worldwide and also the risk of infection after burial from bacterial and viral diseases.

They conclude that due to inadequate knowledge available of COVID-19, it would be prudent to follow the safe corpse handling guidelines recommended by the WHO. They also state that because virus multiplication ceases as there is no living host, the virus can only spread to other humans by touching the corpse as COVID-19 is a respiratory virus spread mostly by respiratory secretions. The publication refers to WHO guidelines (WHO 2020), which states that graveyards of those who died from highly infectious diseases should be at least 30 metres from groundwater sources used for drinking water, and grave floors must be at least 1.5 metres above the water table, with 0.7 metre unsaturated zone and that surface waters from graveyards must not enter inhabited zones. Similar guidelines are also available from the Centres for Disease Prevention and Control of the USA (CDC 2020).

Rajanikanta et al. 2020, in an Indian perspective on handling the dead, emphasize the importance of handling the dead with dignity for the deceased and the surviving family. They also underline that more precautions need to be taken to prevent spread of the virus during handling the bodies, as SARS-CoV-19 is a new virus whose virulence and period of survival in the dead body is not yet entirely known. They suggest prevention of infection can be done by disinfection of the dead body with chlorine-based solution, enclosing it in a puncture proof body bag, minimal contact with the body and using airtight boxes for cremation or burial.

A recent article in the British Medical Journal, Global Health, where the authors reviewed the available literature to scope and assess the effects of specific strategies for the management of bodies of COVID-19 victims, stated, “There is scarce evidence on the transmission of coronavirus disease 2019 (COVID-19) and other coronaviruses from the dead bodies of confirmed or suspected cases” (Yaacoub et al. 2020).

Finally, internationally renowned Sri Lankan virologist, Prof. Malik Peiris has unequivocally stated, in an interview with the BBC Sinhala (https://www.bbc.com/sinhala/sri-lanka-55348348) that COVID-19 is not a water borne disease and the negligible chances of this virus entering the water table. In fact, in a three-minute video he provides a simple explanation to a layman on the period of infection of the virus, and transmission of the virus from a dead body. (https://www.youtube.com/watch?v=K8ZYxZ-QajI&t=13s).

 

So, what does science tell us?

= The SARS-CoV-2 virus is fragile in the external environment and has a very limited period of survival (Firquet et al. 2015).

= Detection of the virus in the environment by PCR is an indication that the viral RNA is present; to determine if this is viable and able to cause infection, the suspected sample should undergo a cell culture test.

= The virus is not water borne: The present evidence is that the infection route into the respiratory tract is through the mouth, nose and eyes. The global pandemic in almost all the nations and millions of infected people, has not shown evidence of other routes of infection, such as by consuming food or water.

= The virus does not survive common disinfectants such as household bleach, ethanol, and hand soap solution (Chin et al. 2020).

The current pandemic, unlike other localised occurrence of diseases, is being played out on the global stage: almost all the countries are involved, under all conceivable climatic conditions. One cannot imagine a better scenario to draw conclusions. Science is a process, that makes deductions from rigorous sifting of evidence. Science would immediately jettison an inference if evidence is presented to the contrary. Since the outbreak of the pandemic this year, literally hundreds of peer reviewed publications have been published – that is available on the web for anybody to access.

 

How can we offer safe burials?

By taking the above into account, a safe burial protocol is suggested to prevent the virus from entering the environment.

Immediately after death, the body is surface disinfected and then place in a puncture proof, body bag with a disinfectant. This can be enclosed further in another body bag.

The body bags are transported from the morgue to the burial site in a plastic or aluminium box.

Burial sites should be located at least one km away from human settlements, and in a region where the water table is very deep (e.g., in the dry zone). A large block of land is available in Oddamavadi in the EP.

Finally, the grave could be lined with lime (calcium oxide- CaO), which would form calcium hydroxide in contact with moisture. This would provide an extreme basic pH, in which the virus would be destroyed.

Further guidelines stipulated by the WHO and the Health Authorities in Sri Lanka should be followed.

The stigma associated with Covid-19 and the fear of being cremated are now forcing some sectors of the community to avoid PCR/antigen testing. This could lead to uncontrolled eruption of new clusters. The cremation of Muslims dying of COVID-19 has polarized and created resentment within the community. As this article shows, the science is out there as is the evidence, to show that safe burial can be accommodated for this epidemic.

Legal, social, cultural and emotional views have been expressed in these columns and elsewhere. Except for a few courageous voices from others, the aggrieved community has been left without assistance. To quote Rev. Martin Luther King Jr, “The ultimate tragedy is not the oppression and cruelty by the bad people, but the silence over that by the good people.” 

One of our greatest attributes as humans is to empathise with fellow humans. Let us practise this!

 

(The writer does research in the Plant and Environmental Sciences. He can be contacted at mcmif2003@yahoo.com)

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Opinion

Reminiscences of Colombo University Arts Faculty and Library

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Whilst extending my felicitations to the University of Colombo on the centenary celebrations of the Faculty of Arts and the Library of the University, I would like to record my contribution towards these two units as the Registrar of the University.

It was during Prof. Stanley Wijesundera’s tenure as the Vice-Chancellor (VC) in 1980 that the proposals for the buildings in respect of the Chemistry Department, Physics Department, New Administration, Faculty of Law, Faculty of Arts and the Library were mooted and submitted to the Treasury. At that time it was the National Buildings Consortium that assigned the Consultants and the Contractors for the new buildings to be constructed. Within that year the Treasury allocated sufficient funds for the Chemistry, Physics, Faculty of Law and the New Administration buildings. However, no funds were allocated to the Faculty of Arts and only Rs. 7.5 million was allocated for the Library building.

With the funds allocated the Chemistry, Physics, Law Faculty and the new Administration buildings were able to get off the ground. The construction work in respect of the other two buildings could not commence due to non-allocation of sufficient funds, even though the consultants and the contractors and already been selected.

As the Minister of Finance at that time was from Matara, he was more interested in getting the required buildings for the newly established University of Ruhuna completed, which was in his electorate. This meant that the University of Colombo would not get any funds for new buildings other than those buildings where the construction work had already begun.

The university needed a building for the Faculty of Arts very badly as this Faculty had the largest number of students. The Vice-Chancellor requested me to draft a letter to the Minister of Finance. Accordingly, I drafted a letter and submitted to the VC for his signature. He told it was an excellent letter, and he signed without a single amendment and submitted same to the Minister. The Minister approved the releasing of the funds. Now the consultants to the building project studied the area required for the building and found that a small portion of land was necessary from the land of the Planetarium. My efforts to get the land from the person in charge of the Planetarium, the Senior Assistant Secretary and the Secretary himself were not fruitful. I told the VC of the position and that he would have to speak to the Minister in charge of the Planetarium, Mr. Lionel Jayathilaka. He got the Minister on line and addressing him by his first name and informed the Minister of the problem. The Minister immediately got it attended to. However, when the construction work started, they found that the additional land area was not necessary.

At that time, the payments to the consultants of building projects was 15% of the total value of the cost. So, in designing the building they tried to add various unnecessary items to jack up the cost. When the first phase was completed, the building looked monstrous and it was like a maze, as it was difficult to find your way out once you get in. I requested the architect to add some coloured tiles on the floors and the stairway and a few decorations on the walls. The university had a never ending tussle with the contractor as he was like Shylock asking for more, when everything had been paid. He tried various tactics but did not succeed in getting anything more as I was adamant not to give in.

When the second stage of the building project came up, I told the consultant to drop all the unnecessary items and have a straight forward building. This was done by the new contractor at much less cost to the university.

The Library building was the last of the buildings planned in 1980 that was awaiting construction. When Mr. Richard Pathirana became the Minister of Higher Education, I spoke to the two engineers who were assigned the task of supervising the building projects of the universities, and managed to get the funds passed by the Treasury for the construction of the Library building. When the Minister came on a visit to the university, he told me that the building that should have been done for Rs.7.5 million will cost Rs.253 million. I told him that the Treasury never gave any money after approving the initial funding of Rs.7.5 million. Anyway, I had achieved what I wanted to do and the building was successfully completed. Now the furniture for the Library had to be procured. When quotations were called the suucessful tenderer had brought a sample of the study tables. I rejected this as it was inferior to what I wanted and asked the officer concerned to get the design of the furniture from the library in the University of Peradeniya. This was done and the furniture was installed. The official opening of the new Library was arranged. By that time I had retired from the position of Registrar and was the Director of the Institute of Workers’ Education. Even though I was instrumental in getting the building done, I was not invited for the function. That is gratitude!!

 

H M Nissanka Warakaulle

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Opinion

Ali Sabry bashing

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Justice Minister Ali Sabry has appealed to his critics to spare him from the criticism that he was behind the calling of applications for the appointment of Quazis for Quazi Courts (The Island/23.01.2021). In my view, the allegations levelled against Justice Minister Ali Sabry are unfounded and uneducated. If you are an educated and unbiased citizen of this country, you’ll understand it better. The applications for Quazis for Quazi Courts have been called by the Judicial Service Commission, an independent Commission chaired by the Chief Justice of this country. If you aren’t happy with this decision, you have to take it up with the Chief Justice, not the Justice Minister. He has no control at all over the Judicial Service Commission. In a way, criticising that Justice Minister influenced the Judicial Service Commission, chaired by the Chief Justice, tantamounts to contempt of the Supreme Court. Moreover, Quazi Courts have been in existence for well over 70 years, and it hasn’t affected the Sinhalese or the Tamils nor has it been incompatible with the common law of this country. If there is any serious discrepancy, it can be rectified. But I wonder why the calling of applications for Quazis has now become an issue. I also wonder if the removal of Quazi Courts was promised as a part of the subtle 69 mandate. This is not the first time similar allegations have been made. When Rauf Hakeem was Justice Minister, Member of Parliament Pattali Champika Ranawaka  made serious allegations that more Muslim students were admitted to the Law College and led many protests and ultimately a group of monks stormed the Law College in protest. He had charged that Law College entrance exam papers were leaked and criticised the then Justice Minister Rauf Hakeem for it. He  knew very well that Law College came under the Council of Legal Education chaired by the Chief Justice and  Attorney General and two other Supreme Court judges among others were  members of this Council, yet he had made these allegations with a different motive. Amidst international outcry, Muslim Covid victims have been denied burial. To make the situation worse, some vindictive, venomous elements are now trying to create another bad scenario that Muslims can’t marry either according to their faith, and tarnish the image of this country internationally and drive a wedge between communities. Therefore I earnestly ask the law abiding and peace loving citizens of this country to work against these vindictive, venomous elements.  

 

M. A. Kaleel 

Kalmunai. 

 

 

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Opinion

What do Northern political parties seek?

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Political parties, based in the North, are reported to be getting prepared to attend the UNHRC sessions next month. For several decades, the only thing they did for their constituents is to spread feelings of hate among them, against the government and the people living in the South. Today, we have two important issues where India is involved – re. the Colombo Harbour and the death of four fishermen. There is another perennial issue of Indians fishing in our waters. Have these parties uttered a single word on those matters? What do they expect to gain, or achieve for the Northerners, even if they could prove SL war crimes allegations at the UNHRC? Can they honestly say that they were not a party to the LTTE and other terrorist outfits which looted, tortured and killed hundred or thousands of civilians, both in the North and the South?

Other than shouting about the rights of their people, have they done anything for the wellbeing of the people in those areas? Whatever was given to the people were those given by the Government on a national basis. Excellent example is the conduct of C V Wigneswaran, who held the high position of Chief Minister of the Northern Province for five years – had he done any significant service for the people? Those parties never complain about India for the killings, torturing and raping done by the IPKF, or the damage and loss due to the activities of Indian fishermen.

India too overlooks all that, and to keep Tamil Nadu happy, forces the SL government to grant whatever the Northern Parties demand.

 

K SIRIWEERA

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