Burial, Cremation Dilemma Needs a Re-think - EDITORIAL

The controversy over whether the bodies of those, who die of the COVID-19 infection, should be buried or cremated is continuing unabated with some groups urging the government to stick to its policy of mandatory cremation irrespective of the dead person’s religious persuasion. They fear that the burial of infected bodies could pollute ground-water resources and be a source of spreading the infection. Other groups are urging the government to allow the bodies of Muslims, who die of the viral infection, to be buried in keeping with their religious teachings and rituals. 

The anti-cremation protests gained ground after the body of a 20-day-old infant --who allegedly died at the Lady Ridgeway Children’s Hospital of COVID-related complications -- was cremated despite its Muslim parents pleading that the infant’s body be handed over to them.

It is against this background that we carry two statements, one by the College of Community Physicians of Sri Lanka (CCPSL) and another by the Sri Lanka Medical Association (SLMA) which say the dead person’s family members should be given the choice to decide whether the body of a person, who dies of COVID-infection, is to be cremated or buried under the strict guidelines recommended by the Ministry of Health.

In the statements posted on their respective websites; the CCPSL said there was no solid evidence to indicate whether the burial of dead bodies would increase the spread of the disease. It said under the available scientific evidence and the impact of the decision on cremation and pandemic control by adhering to global guidelines, each citizen of Sri Lanka should be allowed to either opt for cremation or burial according to his or her family’s wishes.
The statements from the country’s most authoritative bodies on the subject adds more heft to statements by Virologists, Epidemiologists and other experts against Sri Lanka’s current policy of cremating the remains of all persons who have succumbed to the pandemic.

The CCPSL said there were cultural implications of COVID-19 in relation to disease spread, case detection, treatment, prevention and control and also in relation to the management of dead bodies. These complex interactions may create situations, which may adversely affect pandemic control activities with the current guidelines on safe disposal of dead bodies of persons infected with SARS-CoV-2 virus, have created such a situation in Sri Lanka.

The CCPSL said, at the outset of the pandemic, it had accepted the government’s decision to cremate the corpses of all those who died of COVID-19.
“However, the subsequent accumulation of evidence forces us to rethink and revise the recommendations. This position paper is intended to voice a scientific opinion in this debate after examining the currently available evidence,” it said

Meanwhile, the Sri Lanka Medical Association (SLMA) in its response to the issue of COVID-19 death management said the ongoing COVID-19 outbreak has affected people the world over and the global economy.  It said since the virus was first identified in December 2019, the number of deaths has been increasing exponentially, causing countries, including Sri Lanka, to develop and enhance emergency measures to combat the virus.
In the recent past, the disposal of COVID-19 dead bodies has affected ethnic harmony in Sri Lanka. In view of Sri Lanka’s cultural diversity, it is essential to have a proper policy, which is acceptable to all for the disposal of the dead.

Based on the limited scientific evidence available at the initial stages, a decision was made by the Health Ministry’s Director General of Health Services (DGHS) to cremate the bodies of those who die of COVID-19. Since then, there has been significant unrest among some communities regarding the government’s decision to impose compulsory cremation as the only avenue of disposal of COVID-19 deaths. As a result, it was also found that people were generally reluctant to cooperate with COVID control measures implemented by the Government. 
In view of these considerations, the SLMA said it had decided to review the situation as a matter of urgency, taking into account some of the new scientific knowledge available regarding the COVID-19 disease and based on observations it has made and relying on currently available scientific information. The SLMA says the burial of COVID-19 bodies could be permitted in Sri Lanka
On our part, we hold no brief for either Burial or Cremation but believe that given the views expressed by eminent medical professionals, the onus is with the government to resolve this contentious issue with empathy and compassion keeping in mind that in the final count, what matters is the greater good of all our citizens.