Safe management of bodies of deceased persons with suspected or confirmed COVID-19 infection: a rapid systematic review

Article type
Authors
Yaacoub S1, Schünemann HJ2, Khabsa J1, El-Harakeh A1, Khamis A3, Chamseddine F1, El-Khoury R1, Saad Z4, Hneiny L5, Cuello-Garcia C6, Muti-Schünemann GEU7, Bognanni A8, Chen C9, Chen G10, Zhang Y11, Zhao H12, Abi Hanna P13, Loeb M14, Piggott T6, Reinap M15, Rizk N16, Stalteri R6, Duda S6, Solo K6, Chu D6, Akl EA17
1Clinical Research Institute, American University of Beirut
2WHO Collaborating Centre for Infectious Diseases; Research Methods and Recommendations and the Michael G. DeGroote Cochrane Canada Centre, McMaster University
3Hull York Medical School, University of Hull
4Global Evidence Synthesis Initiative, American University of Beirut
5University Libraries, Saab Medical Library, American University of Beirut
6Department of Health Research Methods, Evidence, and Impact, McMaster University
7Medical School, Vita Salute San Raffaele University
8Department of Health Research Methods, Evidence and Impact, McMaster University
9The Fourth Clinical Medical College, Guangzhou University of Chinese Medicine
10Dongzhimen Hospital, Beijing University of Chinese Medicine
11Health Research Methods, Evidence & Impact, McMaster University, Ontario
12Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences
13Infectious Disease Division, Beirut Rafic Hariri Hospital
14Department of Pathology and Molecular Medicine, McMaster University
15London School of Hygiene and Tropical Medicine
16Division of Infectious Diseases, American University of Beirut
17Department of Internal Medicine, American University of Beirut
Abstract
Background: Proper strategies to minimize the risk of infection in individuals handling the bodies of deceased persons infected with 2019 novel coronavirus (COVID-19) are urgently needed.

Objectives: The objective of this study was to systematically review the literature to first scope, and then assess the effects of, specific strategies for the management of the bodies of deceased persons with suspected or confirmed COVID-19 infection.

Methods: We searched on March 26, 2020 five general electronic databases, four COVID-19 specific electronic databases, and three Chinese databases. We searched for guidance documents providing practical advice on the handling of bodies of deceased persons with suspected or confirmed COVID-19 infection. Then, we sought primary evidence of any study design on COVID-19 and other coronaviruses. We also searched for evidence relevant to contextual factors (i.e., acceptability, feasibility, resource use and impact on equity).

Results: We identified 23 guidance documents providing practical advice on the steps of handling the bodies: body preparation, packing, and others and advice on the handling of the dead bodies and the use of personal protective equipment (PPE) by individuals handling them. We did not identify COVID-19 evidence relevant to any of these steps. We identified one study proposing an uncommon strategy of handling autopsies for severe acute respiratory syndrome patients. The study provided very low certainty evidence that it reduced the risk of transmission.

Conclusions: While a substantive number of guidance documents propose specific strategies, we identified no study providing direct evidence for the effects of any of those strategies. While this review highlights major research gaps, it allows interested entities to build their own guidance based on the identified guidance documents.

Patient or healthcare consumer involvement: Patient involvement is not applicable, however the findings of this review will inform the response of the World Health Organization on the safe management of the bodies of deceased persons with suspected or confirmed COVID-19 infection in this pandemic.