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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 2  |  Page : 65-68

Facing COVID-19: Forensic doctors of public security departments should improve infected cadaver identification and personal protection procedures


1 Forensic Identification Center of Yinchuan Bureau of Public Security, Ningxia, China
2 Institute of Forensic Science, Ministry of Public Security, Beijing, China

Date of Submission30-Apr-2020
Date of Decision02-Jun-2020
Date of Acceptance09-Jun-2020
Date of Web Publication09-Jul-2020

Correspondence Address:
Jian Wang
No. 17, Muxidi South District, Beijing 100038
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfsm.jfsm_35_20

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  Abstract 


Because of the nature of the human identification system, forensic doctors working in public security departments are responsible for cadaver examination and conducting crime scene investigations. These processes contain inherent risks, which often include various injury, poisoning hazards, and probable exposure risks with virus such as COVID-19. This paper discusses the occupational protections used for forensic doctors, such as crime scene corpse identification, autopsy building construction, risk assessment, and protective measures. Finally, we suggest the introduction of relevant rules and regulations that could guarantee the stability and safety of crime scene investigations and cadaver examinations. These measures may be helpful for forensic institutes and doctors working in public security departments.

Keywords: Cadaver identification, coronavirus disease 2019, forensic doctors, personal protection


How to cite this article:
Fu JB, Wang J. Facing COVID-19: Forensic doctors of public security departments should improve infected cadaver identification and personal protection procedures. J Forensic Sci Med 2020;6:65-8

How to cite this URL:
Fu JB, Wang J. Facing COVID-19: Forensic doctors of public security departments should improve infected cadaver identification and personal protection procedures. J Forensic Sci Med [serial online] 2020 [cited 2020 Sep 20];6:65-8. Available from: http://www.jfsmonline.com/text.asp?2020/6/2/65/289284




  Introduction Top


Because of the nature of the public security system, forensic doctors working in these departments face occupation-related hazards when performing crime scene investigations and cadaver examinations. Some experts have begun to address the safety of forensic doctors during such work. These risks include human factors such as overworking, health concerns, psychological abnormalities, monitoring errors, and other personnel-related hazards. Material factors are also relevant. These include machinery, equipment, facilities, materials, and other hazards that can be pose a physical, chemical, or biological threat to an individual through their respiratory tract, digestive tract, skin, or mucous membranes. In addition, significant environmental and management factors must also be considered.[1] Despite these risks, there are few discussions about personal protection for forensic doctors conducting high-risk autopsies. During the coronavirus disease 2019 (COVID-19) pandemic, adequate personal protection to prevent occupational exposure to this virus is a serious need for these professionals. Here, we discuss how to properly identify infectious cadavers and implement appropriate personal protective measures.


  Current Postmortem Examination of a Deceased Individual With Confirmed or Probable Exposure to an Infectious Disease Such as Covid-19 Top


In the 21st century, public security bureaus have gradually increased investments into autopsy room construction and personal protection. In some places, autopsy facilities specifically for decomposed or infectious corpses have been developed and constructed. These measures have improved the safety of forensic examinations and autopsies. However, autopsies of deceased individuals with a severely infectious disease, such as COVID-19, still pose a challenge.

According to governmental laws, autopsies and examinations of deceased individuals who have been positively diagnosed with or are suspected to have an infectious disease should be held in independent autopsy rooms and auxiliary facilities that have adequate lighting, proper air conditioning, fewer people present, and a sufficient amount of supplies. In addition, public security organizations have formulated a series of standards for autopsy procedures. However, detailed and specific operation steps for forensic doctors still urgently need to be developed.


  Risk Assessment of a Deceased Individual With Confirmed or Probable Exposure to an Infectious Disease Such as Covid-19 Top


After summarizing 30 years of practical experience in forensic medicine, we have determined that the following cases should be carefully considered during the current COVID-19 pandemic:

Four types of notable cases that currently need extremely strict requirements to prevent infection

  1. The murdered individual had been infected with COVID-19
  2. The murdered individual was most likely infected with COVID-19, such as a person who lived in or traveled throughout an epidemic area or had close contact with an infected patient
  3. The deceased individual was diagnosed with COVID-19 but died of another cause
  4. An unidentified deceased individual who was suspected of having COVID-19.


If one of the abovementioned cases occurs, forensic doctors should ensure that the autopsy facilities and staff are qualified through national trainings. The forensic doctors should cooperate with the Centers for Disease Control and Prevention (CDC) and request support from local government to sufficiently prepare for forensic examinations. Performing autopsies on infectious corpses without detailed protective measures may lead to dangerous outcomes that could be fatal.

Five types of special cases that currently have sufficient preparations

  1. The deceased individual is a local citizen who has never lived in nor traveled throughout an epidemic area
  2. The deceased individual never had close contact with any person who had or was suspected of having COVID-19
  3. The deceased individual had traveled or lived in an epidemic area but was not infected with COVID-19
  4. The deceased individual had close contact with a COVID-19 patient but was not infected with COVID-19
  5. The deceased individual's family members or relatives are COVID-19 patients and are being medically treated.


Because a virus has a specific amount of time, it can survive in a corpse; forensic doctors should conduct autopsies after this period. This would greatly minimize the infection risk and protect the health of the forensic doctors by preventing occupational exposure. Currently, there is no systematic research report describing the survival time of the novel coronavirusin vitro or in a cadaver. However, relevant studies of other coronaviruses may provide valuable information for evaluating the survival time of the novel coronavirus. In 2004, a study on the resistance of the severe acute respiratory syndrome (SARS) coronavirus[2] found its survival timein vitro varied with temperature. Under no-light conditions at 20°C, it could survive 2 days in hospital sewage, domestic sewage, and dechlorinated water, 3 days in feces, 14 days in normal saline, and 17 days in urine. At 4°C, the virus could survive for more than 14 days in the various types of water mentioned above and for more than 17 days in feces and urine. A study on the resistance of Hendra virus[3] showed that it can infect both humans and horses, resulting in acute respiratory disease. Its survival ability in winter was stronger than that in summer and was greatly affected by ambient temperature. In a case report where the death was caused by a Middle East respiratory syndrome coronavirus (MERS-CoV) infection,[4] MERS-CoV was still detected in nasal secretions 3 days after death. The abovementioned studies suggest that it is necessary to extract samples from the corpse and perform viral nucleic acid testing as an effective method for personal protection.

Assessment and identification of infectious disease risk factors

The World Health Organization (WHO) Laboratory Biosafety Manual uses biosafety level (BSL)-1 to BSL-4 to indicate the corresponding biosafety protection level of laboratories engaged inin vitro operations. Similarly, it uses animal biosafety level (ABSL)-1 to ABSL-4 to indicate the corresponding biosafety protection level of laboratories conducting animal operations.[5] The UK's Control of Substances at Risk to Health Regulations 2002 (COSHH)[6] protects professionals from exposure to biologically harmful factors including bacteria, viruses, parasites, and fungi. These biological agents are divided into four hazard groups. This grouping system is a useful reference tool for forensic doctors to evaluate biological hazards in crime scene investigations and cadaver examinations during an infectious disease outbreak such as the COVID-19 pandemic.


  Protective Measures during an Autopsy of a Deceased Individual With Confirmed or Probable Exposure to an Infectious Disease Such as Covid-19 Top


Personal protective measures that are suitable during crime scene investigations

During crime scene investigations, forensic scientists must strictly follow the related laws and standardization requirements to properly complete disinfections, protections, investigations, examinations, and other procedures. They should wear appropriate personal protective equipment, establish a safe environment, and generate a plan before examining the corpse. Photos should be taken before deciding whether extraction of any samples is necessary. Method of sample extraction should be based on the different situations described above in Section 2. For the four types of cases that need strict requirements (Section 2.1), it is better to extract material evidence from the corpse in the laboratory unless it could be lost during transport of the body. During examination of a deceased individual infected with COVID-19, forensic doctors should prevent excretions from the oral and nasal cavities and also be cautious of the stomach contents and urine. The corpse should be wrapped in a plastic bag and packaged securely. For the five types of special cases that currently have sufficient preparations (Section 2.2), it is recommended to conduct body examinations and material evidence in the laboratory to avoid cross contamination.

Personal protective measures during autopsies

Laws such as Regulations on Autopsy and Examination of Patients with Infectious Diseases or Suspected Infectious Diseases clearly regulate the diagnosis and treatment process, surgery protection, and preventive measures necessary for patients with (or suspected of having) an infectious disease during hospitalization. However, strict regulations and protective measures for autopsy facilities and workers need improvement, and specific emphasis should be placed on handling of corpses with infectious diseases or suspected infections.

Personal protective measures for forensic doctors

The novel coronavirus is known to have latent or asymptomatic infections.[7] Because of the COVID-19 pandemic, patients and their close relatives may resort to judicial proceedings because of a death or dispute pertaining to COVID-19 prevention, infection, diagnosis, or treatment. In this situation, judicial organizations and other relevant departments would initiate investigation procedures, which would include forensic pathological autopsies, histopathological examinations, biochemical laboratory examinations, etc. Considering severely infectious diseases such as COVID-19, the investigation departments, as well as the forensic doctors, should pay more attention to protections needed for these investigational activities.

Autopsy precautions for deceased individuals who presumptively died of COVID-19

In the Practical Guidelines for Infection Control in Health Care Facilities, the WHO recommended the following autopsy precautions for decedents of SARS:

  1. Prevent the production of aerosols by: avoiding the use of power saws, conducting procedures underwater if there is a chance of aerosolization, avoiding splashing when removing any organs, and placing a clear plastic bag over the cadaver's head while eviscerating the brain (some facilities are equipped with special tents for this procedure)
  2. Use a minimal amount of equipment during the autopsy
  3. Avoid using scalpels and scissors with pointed ends
  4. Never pass instruments and equipment by hand – always use a tray
  5. If possible, use disposable instruments and equipment
  6. Keep the number of staffs present to a minimum.[8]


COVID-19 is similar to SARS in that both have displayed droplet, contact, and airborne transmission routes. Therefore, the practical guidelines suggested by the WHO for SARS should also be followed for COVID-19 to avoid infection or transmission during investigations and examinations.


  Countermeasures and Suggestions Top


For case investigations, comprehensive analysis, and personal protection, we believe that forensic doctors of the public security departments should follow the instructions we have described here. First, nucleic acid testing and other diagnostic measures should be performed to confirm or rule out any suspected infections. Next, the inspection steps described above should be followed during extractions of any blood, urine, sputum, secretions, or feces from a body. In addition, public security organizations should strive to obtain the support of the local government and cooperate with the CDC to build a standardized laboratory that meets the requirements of occupational protections for forensic doctors.

Local departments should initiate the construction of specific laboratories dedicated to potentially infectious autopsies to provide safe and comfortable facilities for forensic doctors. This mission is an important component of forensic science development.

In addition, we suggest that the leading department of forensic science develops a handbook on occupational protection in forensics for investigations and examinations related to infectious diseases, including COVID-19. We believe that this handbook should be published as both a paper edition and a mobile phone application and includes risk assessment methods, classifications of potential hazards, and effective protective measures.

Acknowledgments

This article was originally released in Chinese language in Chinese Journal of Forensic Medicine.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jiao-Yong L. Occupational safety of forensic medical in crime scene investigation. Chin J Forensic Med 2019;34:210-1.  Back to cited text no. 1
    
2.
Xin-Wei W, Jin-Song L, Min J, Bei Z, Qing-Xin K, Nong S, et al. Study on resistance of SARS-coronavirus. J Environ Health 2004;21:67-71.  Back to cited text no. 2
    
3.
Scanlan JC, Kung NY, Selleck PW, Field HE. Survival of hendra virus in the environment: Modelling the effect of temperature. Ecohealth 2015;12:121-30.  Back to cited text no. 3
    
4.
Mahallawi WH. Case report: Detection of the Middle East respiratory syndrome corona virus (MERS-CoV) in nasal secretions of a dead human. Taibah Univ Med Sci 2018;13:302-4.  Back to cited text no. 4
    
5.
WHO. Laboratory Biosafety Manual [R/OL]. 4th ed. WHO; 2004. Available from: http://www.who.int/csr/resourse/publications/biosafety. [Last accessed on 2020 Mar 05].  Back to cited text no. 5
    
6.
The Control of Substances Hazardous to Health Regulations 2002 (COSHH) [EB/OL]. Available from: http://adlib.everysite.co.uk/adlib/defra/content.aspx?id=000il3890w.184syy0qzuu4c3. [Last accessed on 2020 Mar 05].  Back to cited text no. 6
    
7.
Zhibin H, Ci S. Screening and management of asymptomatic infection of corona virus disease 2019 (COVID-19). Chin J Pre Med 2020;54:E025.  Back to cited text no. 7
    
8.
WHO. Practical Guidelines for Infection Control in Health Care Facilities [R/OL]; 2020. Available from: https://iris.wpro.who.int/ bitstream/handle/10665.1/5389/9290222387_eng.pdf. [Last accessed on 2020 Mar 05].  Back to cited text no. 8
    




 

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