A perspective on cremation over burial in Sri Lanka: In a time where positive is the new negative
Sri Lanka is one of the very few countries that has made the cremation of deceased Covid19 victims mandatory. This is a matter of science, politics, religion and people, all intertwined to decide the fate of the dead. It is a sensitive topic that should be carefully examined. Raging over this issue will not lead to any solutions.
To begin, let’s talk science. The main reason behind recommended cremation is that buried Covid19 victims might contaminate groundwater. Here is a summary based on some recent scientific evidence about it (to my knowledge). The primary modes of transmission of the Covid19 virus are through air droplets, direct contact and indirect contact (hand-mediated transmission). To date, there is no scientific evidence for the transmission of Covid19 to humans through water sources. However, there is another side to this matter. First, there is evidence for the presence of the Covid19 virus in river water, wastewaters, sewage samples and faecal samples of infected patients (La Rosa et al., 2020; Guerrero-Latorre et al., 2020). Second, modelled data (i.e., not collected physical evidence) suggest that the virus can survive in water for up to 25 days (Shutler et al., 2020). Third, wastewaters and sewages can contaminate natural water environments too, since they are usually connected in some way. Lastly, based on data obtained for other forms of human coronaviruses (i.e., not Covid19), the survivability of the coronaviruses in water strongly depends on the temperature; higher temperatures usually inactivate the viruses (La Rosa et al., 2020a).
Collectively, there is evidence for the presence and likely persistence of the Covid19 virus in water environments, but there is no evidence as of now for its transmission through water sources (not even for other forms of human coronaviruses). For now, we can only speculate that the virus “might” contaminate water and act as a mode of transmission. The lack of evidence could also be due to the fact that the Covid19 virus is still new, and researchers have not had enough time to get to the bottom of it. Nonetheless, it’s a potential risk that we should definitely be concerned of. It imposes a greater risk for countries that do not have adequate sanitation facilities, although higher temperatures seem to provide some level of defence in minimising the survival of the virus in water.
Next, let’s talk about Sri Lanka’s political situation. In a pandemic situation, it makes sense to prioritise the living over the dead. With an unstable financial situation, the government is currently going through challenging tasks such as detecting, monitoring, treating and preventing the spread of the virus. While we have to be sympathetic towards the government and cooperate with their decisions, I do have an opinion about how the government is dealing with this issue though. On the one hand, there seems to an extra level of strictness in making sure the Covid19 infected bodies are cremated, because there is a potential yet unproven risk. On the other hand, the government is being lenient in preventing the spread through already proven modes. There is strong scientific evidence to show that social distancing and wearing of face masks are of the most important measures that help us flatten the curve, but we can clearly observe large crowds gathering with minimal social distancing, with some of them without masks. Some of these gatherings are unfortunately government initiated/supported events such as opening ceremonies. Muslims and people of other faith are equally guilty of this. This leads us to the question, are the government and the people prioritising potential risks over proven risks?
A very common opinion floating around these days is that decisions should be based only on science that favours the safety of people. Yes, in an ideal scenario it would make sense to do so. However, we also do a number of things during this pandemic, keeping safety a lesser priority. We consider the status of our economy and plan to re-open borders for tourists. Local lockdown measures are eased to help people earn and survive. The government also cannot spend all their money on Covid19-related matters only, and instead, they have to spend it on aspects like education, infrastructure and industrial development too. These are matters we consider for the long-term survival of the nation. If people’s safety is the only priority, all money should be invested on Covid19 related matters, and strict curfews and nationwide lockdowns would be necessary until we have zero Covid19 cases in Sri Lanka. These are not sensible measures in the long-run and would in fact kill people in many other ways. So, it’s important to realise that beating the pandemic is more than just preventing the spread of the virus. Accordingly, I see no reason why we should not bring religious and culturally sensitive matters into this pandemic’s bigger picture. Yes, we need to learn to live with the virus, but we have always needed to learn to live with people.
Given the potential risks associated with possible Covid19 contaminations of groundwater, it could be risky to allow burial using the typical methods that we used to have before the pandemic. There are some standard guidelines issued by the WHO, for both safe burial as well as cremation (WHO Interim Guidance, 04 September 2020), which is followed by a huge majority of countries across the world. Some countries have also published scientific papers on how they safely deal with the burial of deceased Covid19 victims (e.g., Khoo et al. 2020). As of now, there is no evidence that links burial to Covid19 transmission (Also read: https://ccpsl.org/wp-content/uploads/2020/12/CCPSL-Position-Paper-on-the-debate-about-compulsory-cremation-of-victims-of-COVID-19.pdf). Further, we should realise that groundwater contamination can happen in many other ways too, for instance, wastewaters of hospitals that treat a huge number of Covid19 patients also eventually end up connecting to water sources in some way. In addition, we have also heard people talking in the news mentioning that Denmark is going to exhume millions of buried minks and this is good reason for us to cremate dead bodies in Sri Lanka. It should be noted that Denmark did not do this based on scientific evidence supporting contamination of water or those supporting transmission of the virus through water. It happened as a result of local residents raising concerns over potential groundwater contamination (BBC News, 21 Dec 2020). Accordingly, burying infected bodies still remains a “potential” risk, not a proven one. The Denmark issue is still at its early stages and too immature to extrapolate it into a dialog about burial and cremation of human bodies.
If WHO recommendations for burial seem insufficient for scientifically credible reasons, should we be thinking of adding one or more additional layers of protection during burial, or should we ignore all possible alternatives and go straight to cremation? When additional layers are introduced, it’s possible that they incur higher costs. At a time when the government is financially struggling to even secure the required amount of testing kits/facilities and the required amount of vaccines in the long run, who will bear these costs? Since this is a pressing issue for Muslims, will the Muslim community come forward to bear the additional costs? We have politicians and lawyers raising concerns over this issue, but what we really need is a documented, evidence-based alternative. Those with knowledge about science, healthcare, economy, religion, law and politics should come together to formulate policies and procedures that can be officially presented to the government for the next course of action. Proposing a viable solution could be more effective than raising concerns against the problems.
Recommended measures for burying or cremating those who die from Covid19 should be based on strong scientific evidence. When scientific evidence is not strong, considering other factors would help the nation survive in the long run. Religious and cultural sensitivities should be taken into account in a way that they do not affect the rest of the living people. Potential risks should not be ignored, and at the same time, viable solutions should not be ignored too. On a separate note, as Muslims, if we think that people of other faiths are insensitive to this matter concerning burial, we should also think about why they are insensitive. Is this something that happened in one night, or did our history somehow contribute to this insensitivity?
YES, we need to learn to live with the virus now, but we also need to learn to live with people whether there is a pandemic or not. The farewell to the dead is as important as the welcome to the new-born.
- Dr Miflah Hussain
References
BBC News (21 Nov 2020). Retrieved from: https://www.bbc.com/news/world-europe-55391272
Chin, A., Chu, J., Perera, M., Hui, K., Yen, H. L., Chan, M., … & Poon, L. (2020). Stability of SARS CoV-2 in different environmental conditions. The Lancet Microbe, 1(1).
Guerrero-Latorre, L., Ballesteros, I., Villacrés-Granda, I., Granda, M. G., Freire-Paspuel, B., & Ríos-Touma, B. (2020). SARS-CoV-2 in river water: Implications in low sanitation countries. Science of the Total environment, 743, 140832.
Khoo, L. S., Hasmi, A. H., Ibrahim, M. A., & Mahmood, M. S. (2020). Management of the dead during COVID-19 outbreak in Malaysia. Forensic Science, Medicine, and Pathology, 1.
La Rosa, G., Bonadonna, L., Lucentini, L., Kenmoe, S., & Suffredini, E. (2020a). Coronavirus in water environments: Occurrence, persistence and concentration methods-A scoping review. Water Research, 115899.
La Rosa, G., Iaconelli, M., Mancini, P., Ferraro, G. B., Veneri, C., Bonadonna, L., … & Suffredini, E. (2020). First detection of SARS-CoV-in untreated wastewaters in Italy. Science of The Total Environment, 139652.
Shutler, J., Zaraska, K., Holding, T. M., Machnik, M., Uppuluri, K., Ashton, I., … & Dahiya, R. (2020). Risk of SARS-CoV-2 infection from contaminated water systems. MedRxiv.
WHO Interim Guidance (04 September 2020). Retrieved from: https://apps.who.int/iris/rest/bitstreams/611416/retrieve
Xiao, F., Sun, J., Xu, Y., Li, F., Huang, X., Li, H., … & Zhao, J. (2020). Infectious SARS-CoV-2 in feces of patient with severe COVID 19. Emerging infectious diseases, 26(8), 1920.