Alarm, anger over state instruction to test bodies for Covid-19
Fears of health risks and bodies lying too long in private homes
A new directive from the health department that anyone who dies of natural causes outside a hospital be tested for Covid-19 before a death certificate is issued has thrown the funeral industry into confusion.
The instruction, issued on Wednesday by health director-general Sandile Buthelezi, has sparked anger and confusion among undertakers and health professionals who say it will delay burials and pose health risks.
A body cannot be buried or cremated before a death certificate has been issued.
The new regulation is aimed at improving statistics on the number of Covid-19-positive people dying outside of hospitals. This data could affect SA's Covid-19 death toll, which is currently 2%. Health experts believe the number could be four times higher.
The directive states that "testing must be done before the human remain[s] are released to the funeral undertaker".
Those in the profession said it would cause chaos. A concern was that bodies would potentially remain in homes with families for a day or more before a doctor could do a swab. This would cause trauma for families and loved ones, they said.
But, after an urgent but inconclusive virtual meeting with undertakers and doctors on Thursday, the department yesterday told the Sunday Times the Covid test could be done at undertakers' mortuaries.
However, confusion continued with undertakers and doctors voicing concerns over:
- How doctors would be selected to take swabs;
- Whether undertakers, funeral policies, families of the deceased or medical aids would pay doctors to take the swabs;
- Whether test kits were readily and immediately available for all of SA’s undertakers;
- Who would supply the test kits; and
- How delays in having swabs taken would affect body-storage capacity at undertaker firms.
Pieter van der Westhuizen, the general manager of leading undertaker firm Avbob, said when it came to natural deaths, bodies were taken to funeral parlours.
"Before Covid-19, if the deceased had a GP, it usually took 48 hours before the doctor signed the forms so a death certificate could be issued. A big problem is if the deceased did not have a GP. The difficulty is finding a doctor who is not the deceased's GP to sign the death certificate. These doctors are few and far between. What will happen now with doctors being required to come out to funeral parlours to take swabs and sign these additional forms for deceased who are not their patients?
"If we are already struggling, how on earth will we get doctors to come out now under this instruction? This is going to create major delays in burials and will directly impact on capacity.
2% - SA’s current Covid-19 death rate
"Given the shortage of test kits and testing backlogs, we want to know where these kits would come from, if they were readily available, who would pay for the kits, which doctors were to be utilised and who would pay them for their call-out time?
"The health officials at Friday's meeting, who were from various sections of the department, promised clarity soon. We are not sure when that clarity will arrive, though."
Jodene Smith, MD of Doves Funeral Services, said the company's understanding of the directive was that bodies could only be removed by undertakers once the Covid testing had been done.
"If this is the case, it will definitely cause delays, especially as we do not have enough laboratories to conduct tests. It could potentially see bodies remaining at homes for days, or piling up in mortuaries causing capacity constraints.
"This instruction creates a lot of turmoil, especially for families who are already traumatised and in mourning. The requirement now of testing is going to create even more trauma for families."
Natural deaths occurred in SA between May 6 and August 4, according to the SA Medical Research Council
Smith said that from the onset of the pandemic there had been much uncertainty around burials.
Libo Mnisi, president of the South African Funeral Practitioners Association, said the instruction would delay burials and pose severe health risks.
"Does the government realise how many people die at home every day? Our data shows increasingly more people are dying at home, not only from Covid-19 but also because they are not collecting their medication from their doctors because they are scared of becoming infected with the disease.
"Doctors come to certify deaths at the funeral parlour when they have time. There is no way they will follow this instruction."
Health department spokesperson Popo Maja said yesterday that the doctors who would take the samples would be from the public and private sectors, and would be asked by undertakers, in whose areas they practised, to come to the undertakers' premises or mortuaries and certify death and take swabs for testing.
"The instruction comes into effect immediately. The instruction does not prevent an undertaker from removing a body to a mortuary once an emergency services official has certified death."
Asked about who would pay the doctors for their time, Maja said: "The state will cover the costs of all the indigent."
On the requirements of testing and potential delays in results because of backlogs, he said the testing would not delay burials.
"It is not a requirement to have the results before burial.
"This measure is for the public health authorities and government to have an idea of how many deaths are due to the Covid-19 pandemic."
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