Effect Measure

I’m not sure why I’m bothering to say this — again — but it always seems to be necessary. The horrific oil pipeline explosion in Nigeria that took over 260 lives is now being treated as a possible focus of epidemic disease because of the decaying bodies. Dead bodies in mass casualties do not cause disease, no matter how many times we see reports like this:

Nigerian health officials are disinfecting the site of an oil pipeline explosion that killed more than 260 people and injured dozens more.

Fumigation work began on Tuesday night, according to health officials.

“Our concern is to prevent an outbreak of disease,” said Ayo Alaba-George, a senior local government health official.

“We are worried about the tragic health implications of allowing human parts to decay and cause disease in the place.” (al Jazeera)

The accident happened when thieves tapped into the government run oil pipeline, trying to divert fuel into tanker trucks. As local residents arrived hours later to fill jerry cans from small pools left over from the vandalism, a fire started followed by the catastrophic explosion. There is a current fuel shortage in this oil rich country, why, I have no idea. It is a safe bet [link fixed] that most Nigerians are not profiting from the riches that lie beneath their country.

Infectious disease comes from infectious disease organisms, not the organisms involved in the normal breakdown of organic materials to simpler parts, which we call “decay.” If this misguided disinfection effort is really the work of Nigerian “health officials,” then the fight against bird flu there doesn’t look bright for that benighted country.

Addendum: If you are still dubious, you may find some additional information here, from WHO’s Pan American Health Organization. Disease outbreaks are rare from mass casualty siutations except for flooding, where water supplies may be compromised. In these cases, however, it is bad sanitation from the living bodies, not the dead ones, that is the usual culprit.

Comments

#1 crfullmoon
December 28, 2006

I am sorry any nation’s leaders keep the people poor, and misinformed.

Still a common misconception of public and officials;

disgust problem, yes, dismay problem, yes, but, dead bodies from disasters usually not a disease problem, unless you contaminate the drinking water.

(There’s a PAHO link that explains disaster fatalities management on the Flu Wiki’s Consequences/Dead bodies/Mortuary page.)

Identifying the dead for emotional and legal reasons, or at least not panicking and having mass graves just to tidy things up right away, would be better for next of kin.

Locals still think mass graves for panflu would have to happen; local cemetery dept hadn’t heard of “collective burial”(basically; id and don’t dump pdf p 9.), and other who believe any officials’ “disaster” plans (put the sick into influenza specialty care units, put all the bodies in refrig.trucks and ice rinks, for “central processing”, send unidentified bodies to the sherrif, send “unattended” or “suspicious” deaths to be examined) will break down in a panflu fortnight (or sooner, if anything causes the grid to go down), think they themselves, or, apt dwellers, ect, will have to pick up the slack, but id and legal record keeping, is still more important in the long term than simply getting the dead out of sight.
Currently what to do if large numbers of animals (poultry, pigs) have to be culled from H5N1 or fall sick in the wild and carnivores (including dogs and cats) become infected and die is a whole other corpse management problem.
The poultry aren’t the danger; the virus we can’t see is. Even if poor people lose their flocks, contaminating the village mud or groundwater, or having the kids watch the culls, or having people steal the culled birds to eat because they are so hungry, as has happened, shows most places cannot handle this challenge in a way that will stop transmission.

Perhaps no place can; with the rich getting righer and the poor doing more and more desperate things to survive, like eating sick poultry, or trying to get fuel by carrying it off in cans and plastic bags, (besides all the other horrific things happening in refugee camps, ect).
#2 Darin
December 29, 2006

Revere:
Paragraph after quotation,

…”There is a current fuel shortage in this oil rich country, why, I have no idea. It is a safe bet that most Nigerians are not profiting from the riches that lie beneath their country.”

“It is a safe bet” is linked to something, but it’s borked.

Crfullmoon: I’m not sure if it’s because it’s late or I’ve been listening to Monty Python songs/skits for the last week, but after reading your post all I can about is the Monty Python and the Holy Grail ‘Public Health’ skit.

Ripped from

http://www.imdb.com/title/tt0071853/quotes

The Dead Collector: Bring out yer dead.
[a man puts a body on the cart]
Large Man with Dead Body: Here’s one.
The Dead Collector: That’ll be ninepence.
The Dead Body That Claims It Isn’t: I’m not dead.
The Dead Collector: What?
Large Man with Dead Body: Nothing. There’s your ninepence.
The Dead Body That Claims It Isn’t: I’m not dead.
The Dead Collector: ‘Ere, he says he’s not dead.
Large Man with Dead Body: Yes he is.
The Dead Body That Claims It Isn’t: I’m not.
The Dead Collector: He isn’t.
Large Man with Dead Body: Well, he will be soon, he’s very ill.
The Dead Body That Claims It Isn’t: I’m getting better.
Large Man with Dead Body: No you’re not, you’ll be stone dead in a moment.
The Dead Collector: Well, I can’t take him like that. It’s against regulations.
The Dead Body That Claims It Isn’t: I don’t want to go on the cart.
Large Man with Dead Body: Oh, don’t be such a baby.
The Dead Collector: I can’t take him.
The Dead Body That Claims It Isn’t: I feel fine.
Large Man with Dead Body: Oh, do me a favor.
The Dead Collector: I can’t.
Large Man with Dead Body: Well, can you hang around for a couple of minutes? He won’t be long.
The Dead Collector: I promised I’d be at the Robinsons’. They’ve lost nine today.
Large Man with Dead Body: Well, when’s your next round?
The Dead Collector: Thursday.
The Dead Body That Claims It Isn’t: I think I’ll go for a walk.
Large Man with Dead Body: You’re not fooling anyone, you know. Isn’t there anything you could do?
The Dead Body That Claims It Isn’t: I feel happy. I feel happy.
[the Dead Collector glances up and down the street furtively, then silences the Body with his a whack of his club]
Large Man with Dead Body: Ah, thank you very much.
The Dead Collector: Not at all. See you on Thursday.
Large Man with Dead Body: Right.
#3 crfullmoon
December 29, 2006

Inventory the neighborhood shovels,
and handcarts, or make-do substitutes now.

(Be sure and draft a few “don’t warn the public officials”
to assist in caring for the dying and dead.)
What sort of field-expedient death certificate process and record keeping of where the bodies are buried (pre-internet London used to do quite well with church scribes and quill pens and such)localities can prep for now will be important, to any surviving public.
#4 Path Forward
December 29, 2006

It is crucial to spread the word that in general, corpses from natural disasters do not cause epidemics.

It is simultaneously important to convey information about the specific situations in which some corpses may cause disease: such as when they contaminate local water supplies.

Corpses are also more likely to pose a risk to those who are handling their bodies if the dead people had certain pre-existing diseases. Some of these pre-existing diseases are fairly common in Nigeria — for instance, tuberculosis and HIV/AIDS:

Adult prevalence of HIV/AIDS in Nigeria, as of 2003: 3.6 – 8.0% (datum from WHO/UNAIDS, http://tinyurl.com/vvnwf)

Tuberculosis prevalence per 100,000 population: 531 (datum from WHO Nigeria country profile, http://tinyurl.com/tdrn8)

Here is some western (UK) guidance on managing the risk to funeral workers. It lists some of the infectious diseases which present “minimal” versus “quantifiable” risk:

http://tinyurl.com/y7msdt
Commun Dis Public Health 2001; 4: 283-7

Code of practice for funeral workers: managing infection risk and body bagging

Objectives
To provide funeral workers with:

— advice on viewing, washing and touching of deceased,
— evidence-based guidance on use of body bags that avoids breaching patient confidentially

A practical risk assessment classification follows,
though some infections may fall in more than one group:

1. Infections that pose minimal transmission risk and are
preventable with hygienic practice. Usually there is
available prophylaxis or treatment for such infections.
Examples are chicken pox, influenza, measles,
meningitis, mumps, rubella, scarlet fever, and
whooping cough.

2. Infections causing severe human illness, but with limited or
no transmission risk. Such infections have intermediate
insect and animal vectors rarely met with in the
UK. These infections may, however, be transmitted
by accidental blood inoculations, transplantation
or in research work. Examples are yellow fever,
rabies, malaria and anthrax.

3. Infection hazards, which present a quantifiable risk.

– Airborne droplets or particles – tuberculosis,
– Discharges from body orifices – typhoid and paratyphoid fevers, amoebic or bacillary dysentery and food poisoning,
– Inoculation risks – HIV infection, hepatitis B and C infections, leptospirosis and brucellosis,
– Skin lesions – staphylococcus aureus and streptococcus pyogenes,
– Skin infestations – body lice and scabies.
#5 carl
December 30, 2006

Dumb, perhaps, question from non-public health person: Since it is common to see warnings concerning disease from corpses I would presume there is some history of, at least, association (if not direct causality) between large numbers of corpses and disease. Does/do the organisms associated with the putrification process attract or facilitate other organisms that are disease vectors?
#6 revere
December 30, 2006

carl: No real associations. Piles of corpses may be in areas dangerous for other reasons, of course (like bad sanitation, contaminated water supplies or falling debris), but the idea that decaying organic matter was the source of disease is old and was the predominant theory priorr to the germ theory. It was called miasma theory.
#7 M. Randolph Kruger
December 30, 2006

Carl-Revere is right on this. There are only secondary reasons for having them piled up like cordwood to move them out and get them into the ground but given a month or two in the sun, exposed to rain, bacterial breakdown, its a bag of bones pretty quick. Now if there were transmissible pathogens and no one is sure how long bird bug would be active in a body (couldnt be long) and a skunk, hyena, rat, mouse got ahold of it then it could start it back up the food chain again-maybe and not proven yet.

Katrina myth-bodies polluted the water. Shit, New Orleans had the worst water on this planet short of the Yangtze prior to that.

They are going to have to make a decision about what to do with them though. A lot of places have shallow wells and that could present a short term problem if they didnt handle it properly and AIDs patients say had active virus still in them if a bird bug got them. Smallpox for instance is active for about 200 years in a grave. LIttle biowarfare training there. Want to start an epidemic? Go dig one up and watch what happens. Did happen in the 80′s? in Montreal or Toronto. They were exhuming bodies for a development and relocating them.

So its really a matter of preference. I like reefer trucks and dry ice myself. Set the thing on -20 for a reefer truck and/or put the bodies into a concreted area with walls on it and make a pool type arrangement. Or a small pool and drop the dry ice in next to them and cover it for about an hour. Those guys are like rocks and very easy to handle afterwards. They dont bend. Sounds gross but I can tell you that if a body is all funked up and been out for a while before you get to them its a damned stinking gooey mess. You can put dry ice next to them and cover and come back a little later and its at least tolerable. Freezing them makes it a lot easier. Viruses and most bacteria also dont survive contact with dry ice or the acid thats produced when it comes into contact with water. Kids dont try this at home.
#8 Victoria
December 30, 2006

Hey Randolph – Would burning the bodies, nice and toastie, prevent contamination of the water supply etc.?
#9 SCW AZ Gilmore
December 30, 2006

Revere wrote: “. . .the idea that decaying organic matter was the source of disease is old and was the predominant theory priorr to the germ theory. It was called miasma theory. . .”

This applies to natural disasters, but whats the best guestimate for a stiff loaded with pan flu virus???

Thanks
#10 revere
December 30, 2006

SCW: Don’t think there is an estimate possible, but remember the virus isn’t alive. It can only replicate in live cells. How long it would remain replicable I don’t know, but the frozen corpses from 1918 didn’t have replicable viruses, just fragments of RNA that could be reconstructed after laborious effort. Remember, too, that flu passes from person to person through the living activities of the host. The role of fomites (inanimate objects) in passing th virus is unknown. So you would be in much more danger from living flu cases than dead ones.
#11 crfullmoon
December 30, 2006

Victoria, improper combustion temperatures, lack of fuel; lots of reasons more than smoke and sparks might get spread around by the heat. (Destroying evidence before legal death certificate might also leave authorities -or neighbors- suspicious?)

SCW AZA Gilmore; live, asymptomatic, or sick, people (the “quick”) are better at getting you infected than “the dead”. Contact precautions and hygiene, but…it may more be the attitude of the living towards dead bodies than any major disease risk.

Please read also: Ken West�s �PREPARING FOR THE PANDEMIC A guide for cemetery and crematorium managers� April 2006 http://www.iccm-uk.com/downloads/Preparing%20for%20a%20Pandemic.pdf

and the “White Paper From USNORTHCOM Pandemic Influenza March 2006 event
… Cremation Association of North America, “DHS, DOD, Red Cross, US Senate in attendance, and “for the first time” the Private Sector was invited”, such as NFDA, ICFA “ect…
http://www.cremationassociation.org/docs/WP-Pandemic0603.pdf

…”"With the potential of a PI event on the horizon
it is critical
that deliberate planning and prior coordination affect a synchronized approach …

Conclusion… mass fatality/mortuary operations must move to the forefront of disaster planning rather than continue as a topic
no one wants to address for all levels of government” …
#12 Victoria
December 30, 2006

Great answers to my question. I was thinking worse case scenario (as mental exercise). What would happen if there were 20,000 deaths per day – 140,000 deaths or more per week, 600,000 or more deaths in the first month of such a pandemic in say New York City. The crematoriums/cemeteries would quickly cease operating, due to overload, and lack of staff. How would you get rid of all those bodies? Identification of the dead after a day or two would be impossible. The stench would not be tolerated. Places like Coal Fired Power Stations, brick factories, foundries etc., would have to be used in order to dispose of the dead. Corpses in themselves might not cause disease, however, flies, rats and fleas do – Cholera, typoid and the like would inevitably ensue. The above is just a horrible mental exercise. Could it happen?
#13 revere
December 30, 2006

Victoria: No, it is not likely to happen, at least in the US. We don’t have endemic typhus (rats, fleas) or cholera (waterborne), so the corpses and whatever they attract wouldn’t be a source. People who worry about this, also are looking for cold places to stroe bodies until they could be buried. Skating rinks, meat storage places, etc. Note that cemetaries are full of corpse and aren’t dangerous places to be near. And cities are already full of rats, an estimated two per inhabitant.

The bottom line is that infectious diseases come from infectious disease organisms. These bugs do not spontaneously generate. They have to be there first and then find a place to grow. Viruses aren’t even alive and need live cells to replicate. They don’t “eat” or divide.

It just doesn’t happen as a general proposition.
#14 M. Randolph Kruger
December 31, 2006

Victoria-You recall the funeral pyres of the 1347-> Plague. When it got back to China the mandarins and warlords were instructed to used slave and prisoner labor to dig pits 120 feet by 120 feet and about 20 feet deep in and around Beijing. They were to build 14 for every town and it went by size or something like that of the city. Some obviously shared. Other labor was pressed into service collecting the bodies and that was likely one crapload of Chinese folks and take them to the pits and stack them in piles until it reached the edge of the pit. This was one of their first engineering feats. This gave walkways between the stacks. Then trees were cut and an arrangement some how of suppporting the structure was arranged. It would figure. Humans stacked in rows with a two foot walkway at the foot, then the head which was the foot for the next row. Large trees cut and placed in the walkways as supports and then 8-10 feet of logs stacked on top of the support structure with brush and trash, etc stuffed down in the walkways as they went from say south to north loading the pits up. About 3 pounds of wood I am told would incinerate flesh down to the bones. So say a body was about 1.5 feet and 20 feet deep (i am sure it was less in places) you would get maybe 12 or 13 bodies in there and the boidy is about 2.5 feet across so give or take maybe 10 x 12 bodies per row x say 10. 1200 per pit. Why the 14 pits? They would take them and use two or three a day then move to the next pits whle the others cooled off enough to start the process again. The ashes from wood and bodies couldnt be more than say a foot of degradation in the use so in about a week you would have toasted 8 or 9000, and been starting on the next 9. So what 50-60,000 a week would have gone into the pits. Plus there was an incentive to put the weak and sick in there along with the dead. They had possessions. Thats not a lot of pits. Some place like Beijing would have had dozens like that. Schenzen and Singapore had them too. It wouldnt have been too hard to collect enough wood to do it either. A single oak type tree at only 80 feet weighs a whopping 25,000 pounds. My bet it was double stacked and would have made an Aggie homecoming bonfire look like wussies had put it together.

Re those neighbors CRF, they wont have suspicions. I’ll get them and their little dog too!
#15 crfullmoon
December 31, 2006

“Skating rinks, meat storage places, etc” rely on electricity/fuel, which is easily disrupted and hard to regain,

and, are not near the final disposition place, which makes extra transportation problems, to and from the cold storage

-if they weren’t planning on trying to centralize bodies for paperwork under non-pandemic-time-laws, using single authority figures -for “efficiency”!- they needn’t move the bodies from place of death to pile up somewhere, then, hope they can get transported again for final disposition. (By which time, even more people may be sick, dead, or fled.)

Right now, they better rethink using schools and other buildings for panflu hospices, unless they are near burial sites.
(How many tents or portable hospitals-in-a-box do the military/nat’l guard have that can be set up near collective burial trenches? Now our ground is freezing up here and the locals wouldn’t pre-dig, despite none of our workers living in town. Someone: leave the keys to the equipment and the fuel shed where the cemetery neighbors can find them, please…)

(Ok, in the megacities, burning bodies plus all the garbage might have to be a go, but, try and be prompt, same-day, and keep up with id, even if it is some sort of decription, and keep records.)

2005 estimate: NYC = 19,254,630 people, (2004) persons under age eighteen = 23.8%, persons over sixty-five = 13.0%, persons per sq mile = 401.9.

Yes Victoria, there could be very high fatality rates, from all causes.
#16 M. Randolph Kruger
December 31, 2006

CRF-you I did check at the behest of the EMA about those tents and there arent enough to house more than 200,000 anywhere in this country. Then you get into sanitation problems. People are going to gravitate towards food and capabilities. There arent going to be a lot. On the other hand hotel rooms as a rule have their own a/c units so thres an out there.

As far as bodies they are making plans and big ones. I am not at liberty to say exactly what but you have read about them I am sure. I would make sure though that I had a shovel or two available for on the spot problem correction.
#17 Victoria
December 31, 2006

Randolph, I spoke to my elderly mother (ex WHO) about the problems associated with large numbers of corpses. Apparently the safest way to get rid of a large number of corpses is to dig a large pit about 100 feet deep – 100 feet wide and to place the corpses in layers on top of each other putting large amounts of lime in between the layers. The lime aids greatly in the decomposition process. This is how large numbers of bodies, around the world, are disposed every year.