Decision 2233/QD-BCDQG processing of corpses of confirmed or suspected SARS-CoV-2 cases

GUIDELINES

for processing of corpses of confirmed or suspected SARS-CoV-2 cases in the community

(Attached to the Decision No. 2233/QD-BCDQG dated May 29, 2020 of the National Steering Committee for COVID-19 Prevention and Control)

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PART I

GENERAL INFORMATION ON COVID-19 PANDEMIC

1. Acute respiratory infection caused by the new strain of SARS-CoV-2 virus (COVID-19) is an acute infectious disease of group A, a group of particularly dangerous infectious diseases, capable of very fast transmission, wide spread and high mortality rate or unknown causative agent. This disease so far has not had specific drug or vaccine. Disease prevention mainly relies on personal hygiene measures, early detection and isolation, close monitoring of suspected cases, prevention of community transmission and ensuring environmental sanitation.

2. Transmission and incubation period

- This disease is transmitted from person to person by inhalation, through droplets of saliva or nasopharyngeal secretions when an infected person coughs, sneezes, or is spread by touching certain objects containing the virus and then touching the eyes, nose and mouth with hands.

- The incubation period is about 14 days. Carriers of the SARS-CoV-2 virus are capable of transmitting the virus to those around them.

- The virus shall be facilitated to spread through direct contact with infected cases, especially in crowded places such as factories, railway stations, bus stations, airports, festivals, public transportation vehicles, shopping malls, supermarkets, markets, restaurants, hotels, parks and tourist attractions, etc.

3. Symptoms

- Infected patients may have the symptoms of acute respiratory infection such as fever, cough, sore throat, shortness of breath, pneumonia, severe pneumonia, which can cause acute respiratory failure and risk of death, especially in the elderly, immunocompromised people, and those with chronic diseases.

- Some people infected with SARS-CoV-2 virus may have mild clinical presentations without, making it is difficult to detect.

- Suspected case: Means a person who show at least one of the following symptoms: Fever; cough; sore throat; shortness of breath or pneumonia and have one of the following epidemiological factors:

+ He/she has traveled to/been through/stayed in/returned from a country or territory that has confirmed cases of COVID-19 transmitted domestically according to the information of the World Health Organization within 14 days from the date of entry.

+ He/she has traveled to/stayed in/returned from an active outbreak in Vietnam within 14 days prior to the onset of illness.

+ He/she has been in close contact with a confirmed case or suspected case within 14 days prior to the onset of illness.

- Confirmed case: Means the suspected case or any person having a positive test with SARS-CoV-2 virus that are carried out by testing establishments permitted by the ministry of Health.

- Close contact: Means a person who has been in contact within 02 meters with a confirmed case or suspected case during the illness, including:

+ A person who lives in the same house or household as a suspected or confirmed case during the illness.

+ A person who is in the same teamwork or office as a suspected or confirmed case during the illness.

+ A person who is in the same group of travel, business, entertainment, party, meeting, etc. with a suspected or confirmed case during the illness.

+ Person who sits in the same row, in front or behind 02 rows of seats of the same vehicle (train, car, airplane, ship, etc.) as the confirmed or suspected case during the illness. In a number of specific case, depending on the epidemiological investigation result, health agencies shall decide to expand the list of close contacts to passengers traveling in the same vehicle.

+ Anyone who has been in close contact with the confirmed or suspected case during the illness in other situations.

4. Some principles and concepts on prevention and treatment of COVID-19

- There are currently no specific drugs and vaccines available for the treatment and prevention of COVID-19, therefore the most used measures are supportive and symptomatic treatment. The main preventive measures are early detection and isolation of confirmed cases, isolation of first-round contacts (close contacts of confirmed cases), second-round contacts (those who are in contact with close contacts).

- Droplet precautions shall be taken in order to avoid direct infection by inhaling airborne virus-containing droplets through coughing, sneezing, talking, and contact precautions to avoid indirect infection by touching contaminated surfaces and then touching the eyes, nose, and mouth. General preventive measures include: limiting leaving home when unnecessary. Anyone leaving home must wear a mask and keep a safe distance as prescribed; frequently wash hands with soap and clean water or hand sanitizer; keep the house clean and well ventilated; make electronic health declaration.

- The minimum distance and wearing mask shall comply with regulations of the Government or the National Steering Committee for COVID-19 Prevention and Control.

- Washing hands with soap and clean water for at least 30 seconds or cleaning hands with hand sanitizer.

- Hand sanitizer: Must contain at least 60% alcohol or antibacterial active ingredients according to the Ministry of Health's regulations.

- Surface disinfectant solution: (i) Disinfectant solution containing at least 70% alcohol (ii) Mixing toilet cleaning solution (containing about 5% sodium hypochlorite) in the ratio of 20 ml of cleaning solution with 01 liter of water, (iii) or Solution containing 0.5% active chlorine after mixing.

PART TWO

GUIDELINES FOR PROCESSING OF CORPSES OF CONFIRMED OR SUSPECTED SARS-CoV-2 CASES IN THE COMMUNITY

I. Objectives

Preventing the spread of COVID-19 in the community.

II. Scope and subjects of application

- This guidance applies in case of COVID-19 pandemic at level 5 according to the regulations of the National Steering Committee for COVID-19 Prevention and Control and the possibility of people dying of SARS-CoV-2 in the community.

- Places with suspected or confirmed SARS-CoV-2 deceased (hereinafter referred to as people dying of SARS-CoV-2) in the community, funeral homes, crematoriums, cemeteries, transportation vehicles.

- People participating the processing of corpses of confirmed or suspected SARS-CoV-2 people (hereinafter referred to as corpses with SARS-CoV-2), people in close contact with people dying of, or corpses with, SARS-CoV-2 and people in contact with close contacts of people dying of, or corpses with, SARS-CoV-2.

- Agencies, unions and organizations related to people dying with SARS-CoV-2.

- Subjects of application do not include people dying with SARS-CoV-2 in health establishments, concentrated quarantine areas. For people dying of SARS-CoV-2 at health establishments, to comply with the Decision No. 468/QD-BYT dated February 19, 2020 of the Minister of Health on promulgating the guidance on prevention and control of acute respiratory infection caused by Coronavirus disease 2019 (COVID-19) at medical examination and treatment establishments.

- Corpses shall be identified as suspected SARS-CoV-2 corpses in the community in the following cases:

+ The deceased have at least one of the following symptoms: fever, cough, sore throat, shortness of breath, or pneumonia before death;

+ The deceased have been in contact with a confirmed SARS-CoV-2 person within 14 days prior to the time of death;

+ There is at least 01 COVID-19 confirmed case in the areas where the deceased have resided;

+ The deceased have died in public places without determining the cause of death.

III. Processing of corpses with SARS-CoV-2

Corpses with SARS-CoV-2 must be cremated; the burial is permitted in case the cremation cannot be carried out.

1. Preparing equipment, tools, chemicals

- Cleaning equipment: containers/buckets, wipes, disinfectant sprayers/spraying machines, etc.

- Corpse bags, yellow infectious waste bags.

- Disposable personal protective equipment, including:

+ Medical masks.

+ Goggles.

+ Waterproofing anti-epidemic sets.

+ Hood caps covering the entire head and neck.

+ Rubber gloves.

+ Rubber boots or waterproofing shoes covers

- Surface disinfectant.

- Hand sanitizer.

2. Steps of processing of corpses with SARS-CoV-2

The corpse of a person dying of SARS-CoV-2 should be immediately handled as follows:

2.1. Calling the local government, health agency or the Ministry of Health (via the telephone number: 1900 3228 or 1900 9095) to get the advice and support for processing of the corpse. Restricting unauthorized people to entering the area with the person dying of SARS-CoV-2, except for health staff and participants in processing of the corpse.

2.2. Processing of the corpse with SARS-CoV-2:

- The corpse must be closely covered in a corpse bag with waterproof material lining inside. If there is no corpse bag, closely wrapping up the corpse with a thick layer of cotton fabric, then covering the corpse with a layer of nylon and sticking or tying it. Using the warning tag or sticker with the content “THI HÀI NHIỄM SARS-COV-2” (CORPSES WITH SARS-COV-2) on the outside of the bag.

- Cleaning the outside of the corpse bag with surface disinfectant. Prioritizing the use of disinfectant with 0.5% active Chlorine.

2.3. Shrouding of the corpse with SARS-CoV-2:

Corpse shrouding must be executed within 6 hours from the death or from detecting the corpse.

- On the bottom of the coffin, putting a nylon sheet large enough to cover the corpse, closely wrapping up the corpse with the underlying nylon sheet.

- Tightly shutting the coffin. Checking and sealing all coffin gaps (if any), avoiding the leaking of fluid.

- Cleaning the entire coffin surface with surface disinfectant.

2.4. Disinfection, environmental treatment of the entire area, chamber, room with the deceased:

- Collecting all waste, including the deceased’s linen, personal belongings to be disposed, personal protective equipment and waste generated during the processing of the corpse. Waste must be collected into the yellow bag and tied tightly. Then, putting the yellow bag into the second yellow bag and tightly tying it. Second yellow bag must be labelled “CHẤT THẢI CÓ NGUY CƠ CHỨA SARS-CoV-2” (POTENTIAL COVID-19 WASTE) and transferred for handling according to regulations.

- Cleaning all surfaces of the area with the deceased with a surface disinfectant:

- Cleaning surfaces to be disinfected with the surface disinfectant, from clean to dirty place, from inside to outside, top to bottom.

+ Positions to be cleaned:

* Room where the corpse is placing: floors, walls, the deceased’s bed, tables and chairs, wardrobes, doorknobs, etc.

* Others on the room: floors, walls, toilets, faucets, kitchen, windows, doors, etc.

* In case a person dying of SARS-CoV-2 is detected in a public place, disinfecting the entire area where the deceased is detected, its surrounding area as well as relating areas.

- After the processing of the corpse, all participants must wash their hands with clean water and soap, then disinfect their hands with hand sanitizer.

2.5. Transportation of the corpse with SARS-CoV-2

- Transporting the coffin to the place of cremation or burial.

- Persons accompanying the vehicle transporting the coffin must wear adequate personal protective equipment.

- Right after transporting the coffin to the place of cremation or burial, the entire surface of coffin-transporting vehicle must be disinfected with a surface disinfectant.

- After disinfecting the coffin-transporting vehicle, the participants must take off personal protective equipment according to regulations; clean their hand with clean water and soap, then disinfect their hands with hand sanitizer.

2.6. Cremation, burial

a) Cremation:

- The corpse with SARS-CoV-2 must be cremated within 24 hours since the time of death.

- After the cremation, cleaning and disinfecting floors, walls, door of the reception room, related tools and equipment with a surface disinfectant.

- After the cremation and disinfection, people participating the cremation must take off personal protective equipment according to regulations; clean their hand with clean water and soap, then disinfect their hands with hand sanitizer.

b) Burial:

- Selecting a place that is high, at the end of the wind direction and not flooded to dig a grave.

- The corpse must be buried within 24 hours since the time of death.

- After the burial, people participating the burial must take off personal protective equipment according to regulations; clean their hand with clean water and soap, then disinfect their hands with hand sanitizer.

2.7. Personal protective equipment:

- Persons involved in processing, shrouding, transportation, cremation and burial of the corpse; disinfection and environmental treatment must always wear personal protective equipment and put on and take off their personal protective equipment in accordance with regulations.

- After being removed, personal protective equipment shall be collected into a yellow bag and the top of the bag must be tightly tied. Then, putting the first yellow bag into the second yellow bag and tightly tying the latter. The second yellow bag must be labelled “CHẤT THẢI CÓ NGUY CƠ CHỨA SARS-CoV-2” (POTENTIAL COVID-19 WASTE) and transferred for handling according to regulations.

3. Treatment of people in contact with people dying of, or corpses with, SARS-CoV-2

People in contact with people dying of, or corpses with, SARS-CoV-2 must be in quarantined patient rooms according to Section IV of the Interim Guidance on Surveillance and Prevention of COVID-1, issued together with the Decision No. 963/QD-BYT dated March 18, 2020 of the Minister of Health.

IV. Implementation organization

1. Provincial-level People's Committees

- To direct the Department of Health, the Department of Natural Resources and Environment and People's Committees at all levels to disseminate, develop plans, implement, inspect and supervise the implementation of the Guidelines.

- To direct crematories and burial facilities in the area to develop plans according to the Guidelines.

- To direct to establish teams to process corpses in case of level 5 pandemic according to regulations of the National Steering Committee for COVID-19 Prevention and Control.

- To support and provide necessary force sources for the organization and implementation of processing of corpses with SARS-CoV-2, disinfecting and conducting the environmental treatment.

2. The Department of Natural Resources and Environment

- The Department of Health shall direct local medical establishments to coordinate with local authorities in, processing of corpses with SARS-CoV-2.

- The Department of Natural Resources and Environment shall direct the timely collection, transportation and treatment of infectious waste arising in the course of processing corpses with SARS-CoV-2 as prescribed.

3. Provincial-level Centers for Disease Control/Centers for Preventive Medicine

- To provide professional and technical training for health units and related units in the locality in the implementation of these guidelines.

- To organize inspection of the processing corpses with SARS-CoV-2 in the community.

- To direct the district-level medical centers to direct, disseminate and guide health units and relevant units in commune level; organize the communication on the implementation of guidelines for the community; participate in processing corpses with SARS-CoV-2 in the community.

4. People’s Committees of districts and communes with suspected or confirmed SARS-CoV-2 deceased

- To disseminate and propagandize the provision of guidance in the area.

- To establish teams to process corpses with SARS-CoV-2 and provide adequate chemicals, equipment and means according guidelines.

- Direct heads of the neighborhoods/villages, relevant departments and agencies to immediately notify the local authorities cases dying of SARS-CoV-2.

- To direct commune-level health stations to coordinate with corpse-processing teams.

- To ensure security and safety in processing corpses with SARS-CoV-2.

- To organize the inspection and supervision of the implementation of these guidelines.

5. Crematories and burial facilities

- To prepare adequate chemicals and equipment according to guidelines.

- To carry out the cremation and burial of corpses with SARS-CoV-2 in accordance with these guidelines to ensure safety