Large disasters - like earthquakes - or the Typhoon that struck the Philippines over the weekend, can sometimes generate hundreds or even thousands of deaths, while at the same time degrading that society’s ability to handle the dead. Initial recovery efforts are, out of necessity, directed towards helping the survivors while the recovery of bodies takes secondary importance.
As a result, bodies can sometimes remain unrecovered for days or even weeks, and rapidly and inevitably, decomposition takes hold. Particularly in warm, wet environments.
There is a pervasive belief that decomposing bodies pose an epidemic risk, one that has been often exacerbated by careless media coverage. It stems, I suppose, from the old belief that illness could be transmitted via bad odors – the Miasma Theory – which was widely held up until the end of the 19th century.
While scientifically incorrect, it was an understandable deduction at the time. Epidemics generate dead bodies, decaying bodies become odiferous in a hurry, and so linking the smell with disease in a pre-germ-aware society was probably inevitable.
While borne of faulty logic, it probably did encourage people to quickly bury their dead and to dig their latrines some distance from their wells. So it had some public health value.
But with few exceptions, decaying bodies do not pose a serious threat of spreading disease. If they did, the life expectancy of medical examiners, morticians, and rescue and recovery personnel around the world would be substantially shortened. Having done my share of body recovery, I can assure you that while always unpleasant, it rarely poses a serious health risk.
There are some exceptions, of course. Primarily when deaths are produced by certain types of infectious diseases, like Cholera, Ebola, CCHF or other hemorrhagic fevers, Nipah, Tuberculosis, Typhus, or plague.
But the truth is, if any of these diseases are in the affected population, you are probably more likely to contract one from dealing with the survivors that from the dead.
The World Health Organization has a technical document that discusses the disposal of bodies after a disaster.
WHO Technical Note for Emergencies No. 8
This technical note provides guidance on the disposal of dead bodies in emergency situations. Where there are many fatalities, the collection and disposal of bodies becomes an urgent need. This is not usually due to any health-related risks, which are likely to be negligible, but is important because of the possible social and political impact and trauma. So emergency relief teams should primarily be concerned with the mental health of the community and its need to carry out the cultural obligations and traditions to take care of the dead, rather than potential disease transmission.
Physical health risks
The widespread belief that corpses pose a risk of communicable disease is wrong. Especially if death resulted from trauma, bodies are quite unlikely to cause outbreaks of diseases such as typhoid fever, cholera, or plague, though they may transmit gastroenteritis or food poisoning syndrome to survivors if they contaminate streams, wells, or other water sources.
Mental health risks
The psychological trauma of losing loved ones and witnessing death on a large scale is the greatest cause for concern. It is therefore, important to collect corpses as quickly as possible to minimize this distress. It is, however, not necessary to rush their burial or cremation. This does not allow for the correct identification and record taking of the details of the dead. Nor does it give the time for the bereaved to carry out the ceremonial and cultural practices, which would normally occur after a death.
(Continue . . .)
An editorial by Claude de Ville de Goyett, published by PAHO in 2004, tackles this myth as well:
Last stop is an article that appeared in the Canadian Journal of Infectious Diseases and Medical Microbiology in 2005.
Can J Infect Dis Med Microbiol. 2005 Sep-Oct; 16(5): 269–270.
Simple precautions may greatly reduce the potential risk of transmission of any pathogenic microorganisms associated with the handling of corpses. The practice of basic hygienic measures, such as handwashing, the use of universal precautions as outlined in several documents and the use of personal protective equipment will greatly mitigate the risk of transmission of any potential pathogens from corpses (10). These practices include the use of gloves when handling corpses, avoidance of handling of personal items with contaminated gloves or hands, and the use of personal protective equipment (gowns, masks and eyewear) as appropriate if splashes are anticipated.
In summary, there is no compelling evidence to suggest that corpses themselves pose a risk for an acute epidemic of an infectious disease. It is more likely that the increased risk of infection occurs in the postevent period and that a higher risk of water-borne diseases is associated with flooding where there is contamination of drinking water facilities and a lack of proper sanitation.
Bottom line, I’d certainly want to wear disposable gloves and a surgical mask when doing body recovery work after a natural disaster, but I wouldn’t worry unnecessarily over the health risks.