Africa: We Need to Talk About Burials - COVID-19 in Africa

analysis

Various measures can be taken to avoid burial grounds becoming potential reservoirs for the coronavirus.

As the death toll from the coronavirus continues to rise, communities in Africa and elsewhere need to think seriously about how to safely dispose dead bodies. This is especially important after a recent study in Thailand found that COVID-19 can spread from corpses.

The first set of risks arises from burial rituals, of which there are countless across Africa. Many communities believe it is the responsibility of the living to ensure the transition of the dead to a better place and to prevent spirits from coming back to haunt them.

In parts of West Africa, it is common for family members to wash and clean the body before burial. Other practices include the "love touch" whereby family members touch the face of the deceased. If the person was prominent, like a traditional healer, mourners may even lay over the corpse to acquire spiritual gifts. These rituals all hold deep cultural meaning, but unfortunately they can contribute to the spread of disease, as they did during the 2014-15 Ebola outbreak in West Africa.

The second set of risks comes after burial. Scientists have found that fluid from decomposing bodies can contain pathogenic microorganisms including viruses. Researchers have shown that graveyards often contain vast amounts of heavy metals that leach from coffin materials. In a previous study, I was part of a team of scientists in South Africa which found that graveyards can contain dangerous bacteria that may contaminate groundwater.

In short, without precautions, burial grounds could become potential environmental reservoirs for the coronavirus.

Limited options for burials

During natural disasters and pandemics when large numbers of people die, bodies need to be removed and disposed of as fast as possible before they start to decompose. During the current pandemic, many countries have resorted to mass burials. In New York, deceased COVID-19 victims have been buried at a mass grave in Hart Island. In South Africa, the Cemetery Association has called on municipalities to prepare sites for similar measures.

This is not the WHO's guidance on burials in emergencies. It says that "common graves and mass cremation are rarely warranted and should be avoided" in favour of individual burials.

The options for many countries, however, may be limited. In practice, individual graves may not always be possible due to a scarcity of land. Meanwhile, cremation requires large amounts of energy and contributes to air and water pollution. Many countries have general guidelines for burials, but as in South Africa, these may stipulate that "in a state of emergency or national disaster exemption for relaxation from existing environmental regulations may be required."

How to reduce the risks

When it comes to COVID-19, there are numerous uncertainties. For example, we do not know how long it can survive in the soil or whether it could leach into nearby groundwater and infect humans.

However, we do know it can spread through corpses, similar to Ebola. We also know that many graveyards across Africa are encroached on by human habitats and that other viruses, like the poliovirus, can migrate through the soil and contaminate groundwater.

For these reasons, and given the high infectivity of COVID-19, precautions must be taken when burying victims of the coronavirus. Based on what we know, there are some measures that can be taken.

If there are to be mass burials, for instance, their sites should be distant from human settlements. If burials must be done in existing cemeteries, which are often within cities, they should be done as far away as possible from bodies of water or where people live. Any of these sites should be highly secured to prevent unauthorised access.

It is also possible to limit leaching into the soil, for example by lining graves with plastic materials. At the same time, we must find ways to treat bodies to prevent them spreading the virus before burial. On this matter, the WHO recommends the use of chlorine solution instead of lime to disinfect the bodies, as lime has limited effect on infection pathogens.

The general population meanwhile should be informed of the potential dangers from exposure to the corpses of COVID-19 victims. Traditional rituals in some parts of the world, like kissing and hugging the dead body, should be discouraged. And, finally, scientists should study the survival of the virus and its potential migration through the soil, so we might learn more.

At this point in time, we do not know when we will have effective treatments for the coronavirus or when the death toll will abate. Until then, we must do what we can to limit the disease's transmission, including from the dead to the living.

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