Running out of burial land
Cape Argus Oct 2019
6Apr, 2020
Guidelines for the Preparation of Mass Burials and Cremation of COVID-19 Victims
The South African Cemeteries Association (SACA) urges municipalities to be prepared for an increase in the death rate due to the Covid_19 pandemic in context of the rate of infection internationally. Whilst everything reasonably possible is being done to contain the pandemic with the lockdown, our socioeconomic conditions will nevertheless pose an incredible challenge to achieve the objective of containment measures. A large section of our population in excess of 5 million live in informal settlements and an even greater number (in excess of 13 million) live in townships. High density living as a result of this and other circumstances that force people together is unfortunately ideal for the spread of the pandemic. It is also evident that with high infection levels there will be an expected level of fatality.
In anticipation of the increase in the death rate, municipalities are recommended to put plans in place if this has not already been done. Ideally remains should be cremated as is advised by the health authorities locally and internationally, however this may pose a challenge as South Africa has very few crematorium facilities. The following recommendations are provided to guide municipalities.
Burials
- Identify land within cemeteries to be prepared for emergency burials for bodies identified as infected. If this is unavailable, then consider adjacent vacant land to existing cemeteries that may be expropriated if private or incorporate it into the existing boundary of the cemetery if the land is municipal owned.
- Identify any other suitable state owned or municipal land if the above option is not available.
- Consideration must be given to suitability of land with regards to distances from communities and residential areas, high water tables and water sources.
- Current legislation requires cemeteries to be located 350m from ground water sources used for drinking purposes and at least 500m from the nearest habitable building.
- The preferred burial site should have a soil of sand-clay mix of low porosity and a small fine-grain texture; the water table should be at least 2.5m deep in order to allow for traditional grave depth of six feet (1.8 meters).
- For areas with higher water tables, the local government may determine a reasonable depth with additional walling recommendations to protect underground water; and the covering soil shall not be less than 1m, should two bodies be buried in the same grave, 300mm of soil shall be maintained between the coffins or bodies.
- SACA advises that in a state of emergency or national disaster exemption for relaxation from existing environmental regulations (above) may be required.
- Application for the relaxation of environmental regulations may include the distance between the burial ground and residential area reduced to 100m. (WHO recommends 100m-500m)
- Water table requirements reduced to less 2.5m but greater than 2m if burying two bodies per grave or no less than 1.8m if burying a single body per grave. There should be a level of soil of at least 0.5m between the water table and the barrier/ plastic lining.
- Reduction of the distance between the burial site and water sources like rivers, lakes etc to 100m. (WHO recommends 50m)
- Plastic linings similar to that used in land filled sites for the prevention of leachate should be used. This should not be biodegradable.
- Bodies should be buried in clearly marked, individual graves, although multiple trench communal graves may be unavoidable in mass disasters.
- These graves should have a numeric or other recognisable grave marking system so that associated details of the deceased can be recorded against the relevant number.
- Graves should ideally be assessible from at least two sides to allow access at a later stage by families, or for exhumation if the threat of infection is later eliminated and families request this.
- The paths between trenches must be wide enough to allow for mechanical backfill which is the preferred least labour-intensive method.
- In mass trench graves bodies should be spaced at least 0.5m apart with clearly set permanent beacons identifying the ends of the trench grave site in order to identify burials of individual through measurement.
- If bodies are to be buried above each other in trenches, then soil must be backfilled to achieve 0.3m between bodies. The record must also indicate the position of the body in the grave in terms of bottom to top.
- Burials should be conducted during the day in clear weather to prevent complications with collapses and falls and to ensure good visibility for recording.
- Details of personnel employed in the exercise will need to be kept for further reference if required.
Cremation
- Whilst cremation is the preferred method for the treatment of covid19 infected bodies there are few crematoria available. Consideration should be given to using incinerators and also procuring portable cremators or incinerators. The challenges for procurement could take over 6-8 weeks.
- Storage facilities need to be functional or increased by the use of portable refrigeration containers which may accommodate approximately 100 bodies per container.
- All existing/new/portable storage facilities must be certified compliant by an environmental health practitioner operating within the local authority.
- Observe strict personal hygiene and put on appropriate personal protective equipment including gloves, water resistant gown / plastic apron over water repellent gown, and surgical mask. Use goggles or face shield to protect eyes, if there may be splashes.
- Do NOT smoke, drink or eat. Do NOT touch your eyes, mouth or nose.
- Coffins brought into the crematorium should be sprayed and the path into the crematorium cleared and regularly sprayed.
- All surfaces which may be contaminated should be wiped with “1 in 49 diluted household bleach” (mixing 1 part of 5.25% bleach with 49 parts of water), leave it for 15-30 minutes, and then rinse with water. Metal surfaces could be wiped with 70% alcohol.
- Ashes once cooled may be packaged for the family and handed to the undertaker. Packages should be wiped down with bleach solution and handed over whilst ensuring good hand sanitation.
- After use, the disposable items such as gloves and protective clothing should be disposed of in a plastic bag.
- The above guidelines have considered recommendations from various accredited international and national organisations.
We remain committed to keeping you informed and will provide updates as and when necessary.
Keep safe and healthy!
Executive Committee, South African Cemeteries Association.
6Apr, 2020
Recommendations for Burial and Crematoria Services during Lockdown
The South African Cemeteries Association would like to advise the following with regards to the management of burials and cremations during the pandemic that we are facing as South Africans. We urge municipal officials to discuss and implement these protocols with cemetery staff whilst also adhering to the official guidelines from the National Department of Health.
Whilst cemetery and crematoria services are not listed as essential services it is our view that our current circumstances may challenge this fact and require us to review our classification of the service. The capacity of mortuary services to hold bodies which may unknowingly be infected may also pose a risk to personnel and public in the environment. People may also die of seemingly natural causes whilst unknowingly being infected.
In context of the above the following are suggested and recommended for the consideration of municipalities.
Burial and Cremation Services During Lockdown
Bookings to be spread to seven days of the week. i.e There are bookings that will be approved on weekdays to avoid weekend congestions. Documentation from undertakers should be scanned and emailed through with proof of payment at least 24 hours before the burial. All original documents to be kept with the undertaker.
Graves should be allocated in a scattered manner to avoid congestions of different processions.
Funeral procession should be limited to 30 minutes.
Whilst government regulations with regards to the Disaster Management Act refers to no more than 50 people at funerals consideration must be given to the total number of funerals that may occur within a cemetery and to ensure that number of people in total are kept to a minimum. This can be done by advising families to limit numbers to not more than 20.
Public ablution facilities to be sanitized after every use. Burial bookings will only be accommodated between 10:00 and 15:30 for both weekdays and weekends. Cemeteries must be manned for burials only with the minimum staff required for excavation and back filling as determined by the number of burials for the day. We recommend two staff for a burial.
The follow protocols discussed at training workshops held by SACA are also provided for consideration by municipal cemetery and crematoria staff.
INFECTION TRANSMISSION AND CONTROL
In order for an infection to spread, three elements are required:
- the parasite causing the infection has to have a source infection
- the parasite has to have a susceptible host (possibly you)
- the parasite requires a means of transmission
Infectious disease can spread in a variety of ways e.g. through the air, from direct or indirect contact with another person, soiled objects, skin or mucous membrane, saliva, urine, blood and body secretions and through sexual contact. To remember the most common way that infection is transmitted – remember the R A T.
R – Respiratory – some infections are spread when an infected person sneezes and coughs out tiny airborne droplets. The droplets in the air can be breathed in directly by another person, or indirectly enter another person through contact with contaminated surfaces and hands.
A – Alimentary – some infections are spread when microscopic amounts of faeces from an infected person with symptoms, or an infected person without symptoms (a carrier), are taken in by another person. The faeces might be passed directly from soiled hands to mouth or indirectly by way of soiled objects, surfaces, food or water.
T – Touch – some infections are spread directly when skin or mucous membrane comes into contact with other skin or mucous membrane. Infections are spread indirectly when skin or mucous membranes come into contact with contaminated objects or surfaces.
Infections are also spread by:
Saliva: Some infections are spread by direct contact with saliva (such as kissing) or indirect contact with contaminated objects (children sucking and sharing toys).
Urine: Some infections are spread when urine is transferred from soiled hands or objects to the mouth.
Sexually transmitted diseases: These diseases are most commonly transmitted by sexual contact.
Infection control techniques
These simple guidelines enable everyone to do something to avoid getting infections.
Careful hand washing:
Remember to wash your hands thoroughly with soap and warm or hot running water for at least 10 seconds:
- before preparing food
- between handling raw and ready to eat foods
- before eating
- after going to the toilet or touching anything soiled
Keep work equipment clean:
Keep equipment that comes into contact with potentially contaminated body fluid clean using disinfectant.
Keep your skin integrity:
- ensure that the skin on your hands remains soft and not cracked or peeling
- use moisturiser if necessary
- check nails and cuticle areas
- Wear PPE such as:
- gloves
- ear protection
- eye cover
- foot cover
- hair cover
- mask
Managing exposure to body substances:
If any person has contact with body fluids, the following procedures should be observed:
- if body fluids get on the skin, irrespective of whether there are cuts or abrasions, wash well with soap and water
- if the eyes are splashed, rinse the area gently but thoroughly with water while the eyes are open
- if body fluids get in the mouth, spit it out and rinse the mouth with water several times
- incidents occurring at work should be reported immediately to your supervisor or occupational health and safety officer
Surface cleaning of body substances:
If body fluids are splashed onto a surface, the following cleaning procedures should be used:
- remove as much of the spill as possible with a paper towel or other disposable material
- clean the area with warm water and detergent, using a disposable cleaning cloth or sponge
- disinfect the area with a solution of household disinfectant
- remove and dispose of your gloves, paper towel and cleaning cloth in a sealed plastic bag after use; the plastic bag may then be thrown into the contaminated waste receptacle
- wash hands thoroughly with soap and warm water
Disposal of Contaminated Waste:
Contaminated wastes describe a range of items that we would work with when conducting exhumations or working in areas where you might be exposed to body fluids. When disposing of contaminated waste, it is crucial to:
- follow regulations pertaining to disposal of Contaminated Waste
- use only specific Contaminated Waste bags that have the ‘Biohazard’ logo
- always secure the Contaminated Waste bags with a strong, secure tie or tape securely
- always wear gloves when handling/moving Contaminated Waste
- either incinerate waste or place in a contaminated waste container
- Laundering contaminated clothing/garments:
- commercial laundering will sufficiently decontaminate any laundry that comes from gravedigging
- grossly contaminated laundry is to be treated as infectious waste and disposed of accordingly
Keeping clean:
Person-to-person spread, especially by soiled hands, is the major means of spreading infectious disease. Regular cleaning is vital to maintain a healthy working environment.
Cleaning with detergent and warm water will help maintain a clean and safe working environment. Remove all visible dirt as you clean. Clean up as you go.
We remain committed to keeping you informed and will provide updates as and when necessary.
Keep safe and healthy!
Mr Pepe Dass, Chairperson of South African Cemeteries Association.