BY Dr. Anpudeen Yoonus Lebbe – MBBS, Sri Lanka
The significance of enshrining certain human rights in the constitution as fundamental rights lies in the fact that they are so important that they should be protected at all times. However, some of the fundamental rights can be abridged under exceptional circumstances. Health consideration is one such exception when it is so serious that such abridgement is warranted.
The dignified disposal of an individual as his last rights falls within the ambit of the fundamental rights enshrined in our constitution and denial thereof can be justified only under exceptional circumstances.
The question one needs to examine here is whether the situation that has got enveloped in the country today with respect to disposal of Covid-19 victims where certain communities particularly Muslims and Catholics complain to have been denied their religious rights for burial is scientifically justified.
What is Covid-19 virus?
It is a kind of Corona virus and the Corona viruses have existed in the world for so long. Coronaviruses (CoV) are a large family of viruses causing a spectrum of diseases ranging from the common cold to more severe diseases such as the Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). The recent outbreak of coronavirus disease in 2019 (COVID-19) has become a public health emergency worldwide. SARS-CoV-2, the virus responsible for COVID-19, is spread by human-to-human transmission via droplets or direct contact. Corona viruses are enveloped, single stranded RNA viruses. Enveloped viruses are less stable in the environment than non-enveloped viruses such as enteroviruses.
Science has evolved with research, studies, analysis, experiments, evidence and so forth, and it is not advanced with assumptions and myth. WHO stated that it is a common myth that persons who have died of communicable diseases such as Covid-19 should be cremated, but this is not true. Cremation is a cultural choice and available resources. bit.ly/2JWte00
Time-to-time communicable diseases had been encountered the world over with different kinds of new species of virulent organisms and it was managed under some common criteria. It is not going to stop with Covid-19, it will appear off and on with different varieties of organisms as long as the world exists. All species including human beings in the world maintain their equilibrium by various natural events or mechanism such as tsunami, earth quake, land slide, cyclone, flood, etc and Covid-19 also seems to be one such mechanism.
It is manifestly clear from the stance of the WHO on the disposal of those who die of Covid-19 that burial of such bodies does not spill any harm to the environment provided that the guidelines of the WHO given below are strictly followed.
Important guidelines of the WHO
Burial is the preferred disposal method in general and should be used unless the customs and wishes of the family dictate otherwise.
- Burial sites/cemeteries
Burial sites should be determined through consultation with the affected community and local authorities. Soil conditions, water table level and available space must be considered in their selection. Graveyards should be located at least 50m from groundwater sources used for drinking water and at least 500m from the nearest habitable buildings.
Ideally, an area of at least 1500 square meter of land per ten thousand population is required for burial ground.
- Burial depth
It is important that bodies are buried at sufficient depth to eliminate odours and prevent disturbance by carrion and dogs. A covering of soil of at least 1.0m is recommended.
The base of any grave should be at least 1.5m above the groundwater table where possible, to minimise contamination. In general, it is not necessary to line graves unless there is an especially high risk of contamination.
There are no health advantages of cremation over burial but some communities may prefer it for religious or cultural reasons. Factors against it are the amount of fuel required by a single cremation (approx 300kg. wood) and the smoke pollution caused. For this reason, cremation sites should be located at least 500m downwind of habitable dwellings.
Key recommendations for the disposal of the dead are,
Respect the wishes and social customs of the families.
The reasons given by the technical committee.
In this backdrop it is pertinent to have a look at the reasons reported to have been put forward by the technical committee members for compulsory cremation in Sri Lanka.
Two reasons of the committee figure prominent.
Firstly, the caution against burial appears to stem from the claim that Sri Lankan people use Wells for drinking water. This claim fails to account for details relating to the percentage of such people using wells or areas where using wells is predominantly in practice, thus giving the impression that all over Sri Lanka wells are used.
The denial of burial based on the claim referrd to above should be viewed in the light of the report released by the WHO in 2017 according to which 2.2 billion out of 7.5 billion people in the world do not have safely managed drinking water facilities in their premises, and 435 million people take water from unprotected wells and springs and 144 million people collect untreated surface water from lakes, ponds, rivers and streams. https://www.who.int/news-room/fact-sheets/detail/drinking-water
What is of significance here is the WHO’s clearance for burial notwithstanding the above report.
It should further be noted that chlorination of water in wells and ponds was initiated in Sri Lanka around 4 decades ago in order to prevent water born diseases. Hypochlorite is a liquid form of chlorine and is used as disinfectant which could prevent Covid-19 spread even if it were a water borne disease whereas it is not.
Covid-19 is an airborne infection that it can be spread through air droplets and direct contacts. Each organism has its own behavior and routes of transmission.
Routes of transmissions of organisms are,
- Person to person/direct contacts/touch
4.Contaminated blood or other bodily fluids
In this routes of transmissions, Covid-19 takes the first 3 routes.
Secondly, the reason they adduce to support their denial of burial is the prevalence of high water table or ground water level and High humidity in Sri Lanka which, they appear to entertain the fear would facilitate the transmission of the virus. Given here below is the extract from the U. S. Geological Survey Circular 1186 which serves as answers to this claim.
“Water beneath the land surface occurs in two principal zones, the unsaturated zone and the saturated zone. In the unsaturated zone, the spaces between particle grains and the cracks in rocks contain both air and water. Although a considerable amount of water can be present in the unsaturated zone, this water cannot be pumped by wells because capillary forces hold it too tightly”.
“In contrast to the unsaturated zone, the voids in the saturated zone are completely filled with water. The approximate upper surface of the saturated zone is referred to as the water table. Water in the saturated zone below the water table is referred to as ground water. Below the water table, the water pressure is high enough to allow water to enter a well as the water level in the well is lowered by pumping, thus permitting ground water to be withdrawn for use”. https://pubs.usgs.gov/circ/circ1186/html/gen_facts.html#:~:text=In%20contrast%20to%20the%20unsaturated,referred%20to%20as%20ground%20water
Further, the U. S. Geological Survey Circular 1186 affirms WHO’s guidelines for burial of dead bodies of those who have died of any etiology including Covid-19. Hence, burial will not cause the transmission of any organisms if the guidelines are strictly followed. The U. S. Geological Studies referred to above make it crystal clear that Covid-19 virus or any other organisms in the decomposed dead bodies will not enter into the wells or other means which are used for drinking water or cultivation of agriculture if the corpses are buried in the unsaturated zone 1.5m above the water table, 1m below the land surface and 50m away from groundwater sources used for drinking water and cultivation.
If the technical committees’ statement is correct, then people have to suffer on a daily basis from minor to major diseases due to different types of organisms from the decomposed bodies of those who die of any cause, despite strict adherence to WHO’s guidelines for burial of dead bodies.
Water table or ground water level is low in the dry zone compared to wet zone and most of the land in Sri Lanka is situated in the dry zone. The moral obligation of the Hydrogeologist is to do thorough studies and recommend suitable places, where ground water level is lower than 2.5m and groundwater sources used for drinking water at least 50m away, to bury the dead bodies of those who die of any reasons.
It is not appropriate for Hydrogeologist to take upon themselves the onus to advise the government on the mode of disposal of bodies of Covid-19 victims as it is not solely an area within their academic boundary except to report to the government on the condition of the soil and water. It is up to the virologist together with other experts connected thereto to guide the government in the light of the report of Hydrogeologists on the soil and water condition to arrive at a conclusion on the mode of disposal of the dead bodies. However, such advice tendered to the government should be based on scientific evidence if at all burial is to be ruled out. It is paradoxical that these experts in sheer ignorance of their professional ethics have recommended exclusive cremation in the absence of any scientific evidence that burial is harmful.
No individual expert is competent to arrive at any conclusion on the question of burial of Covid-19 infected dead bodies as it requires multifaceted expertise. A group of experts possessed with knowledge in all the relevant fields in respect of the disposal in question should, after necessary scientific studies, analysis, research, etc put forward their conclusion with the findings of such exercise. However, the technical committee is yet to be reported to have released any such report.
The government should not shirk its responsibility under the pretext of following expert advice which is not science based but arbitrary and infringe on the rights of the dead in respect of a dignified disposal.
In conclusion it should be stated that there is no scientifically proven or established health consideration warranting the abridgement of one’s last rights. This is beside the statement of the WHO “Health considerations alone provide no justification for cremation”.