COVID: As death toll rises, bodies wait in queue for last rites

In contrast to the management of bodies of non-COVID-19 patients, the COVID-19 deaths need to be managed with the utmost care by the frontliners, and expedited for burial or cremation.

Kuala Lumpur Hospital (HKL) forensic pathologist Dr Salmah Arshad said that the existing space in the IPFN morgue was not sufficient, and the victims were now placed in containers which were turned into makeshift morgues that could store 12 to 20 bodies of COVID-19 patients.

She said that the IPFN morgue can store up to 36 bodies but there were additional spaces for this purpose, including the Tunku Azizah Hospital (up to 10 bodies), Tuanku Mizan Armed Forces Hospital (four) and the National Cancer Institute (two). There are 52 coffins, and back-up containers to store the bodies.

"For bodies that are to be cremated, it depends on the crematorium. In the Klang Valley, there is only one location, which is managed by the Kuala Lumpur City Hall (DBKL). DBKL also provides non-COVID-19 cremation services, so we have to wait for our turn," she told Bernama.

According to Dr Salmah, for the remains of non-Muslims, the next-of-kin can choose whether the body is to be buried or cremated, and each cremation process takes between two and three hours, compared with non-COVID-19 cases, which take 45 minutes to an hour.

The 41-year-old specialist doctor, who has been in the forensic field for 13 years, said that the increase in the number of brought-in-dead (BID) cases due to the outbreak was increasingly worrying.

She said that during the first wave of the pandemic, the death rate of COVID-19 outside the ward was only one or two cases a month, compared with now which reached three or four such cases daily.

"Compared with last year, we rarely receive cases (deaths) at home, (on the contrary) we receive cases at the hospital. That means patients are admitted to the ward, are treated, and die in the hospital. What worries me now is the deaths outside the hospital, which have not been treated. The symptoms are too rapid and this is depressing.

"Indeed, there have been changes. In the past, we expected deaths involving elderly patients, and diseases such as heart, kidney and obesity. In the first wave, those were the factors that contributed to the risk of death last year.

"We cannot predict the third wave because it involves both young and old. The youngest we received who died at home was in their 20s and had no illness. Now everyone has to be careful and follow the standard operating procedures (SOPs), because everyone can be exposed and die because of COVID-19," she said, and advised people to be vigilant, even with the neighbours next door.

She did not rule out the possibility that mutations and variants in the virus contributed to changes in the categories of victims, including young people with no history of health problems.

On the post-mortem process involving the case of BID COVID-19 or suspected COVID-19, Dr Salmah, who started working at HKL early last year, said that the CT (computed tomography) scanning method was used to reduce the risk of infection to staff on duty.

The method is to detect the condition of the lungs and other organs of the deceased, such as lung infection or pneumonia without conducting a regular autopsy.

"We only do external checks. Post-mortem via CT scan to see the condition of the lungs or other organs. Does the lung show severe bacterial infection or pneumonia due to COVID-19? So we can put the cause of death as 'Covid pneumonia' or 'pneumonia due to Covid'," she said.

Meanwhile, HKL IPFN assistant medical officer Hisham Mohd Nordin explained that the COVID-19 cremation process time doubled from normal as two layers of body bags made of thick, high-density plastic were used.

After nearly four years serving in the Forensic Department, Hisham, who was responsible for managing bodies, said that should a person die as a result of the outbreak there would be no immediate family members to pay their last respects to the deceased, as in most cases they were under follow-up quarantine.

"Mostly family members (living together) would be under quarantine. It is very sad when the next-of-kin cannot pay their last respects to the victims. We use our discretion with the health inspector to persuade the next-of-kin to send a representative (who is not a close contact) to deal with the remains.

"The condition of the staff here is that we are all very tired. There were times when we had to handle 15 cases in one night. My advice is to follow the precautionary measures and adhere to the SOPs. When the government suggests taking a vaccine, take it... We want to achieve herd immunity," he said.

He said that the public should assist all frontliners, not only from the Forensic Department but also in hospital wards, and especially in the Intensive Care Unit, by complying with the SOPs and applying self-discipline.

To follow the interview with Dr Salmah and find out about the management of the remains of COVID-19 patients, watch the second part of the documentary 'Gelombang Kembali: Bilakan Berakhir?' produced by Bernama TV, to be broadcast on Friday at 8.30 pm.