Once again: dead bodies don't cause disease epidemics

Coincidence. My brother is a reporter, and he was covering the Myanmar aftermath. On May 8th he sent me an IM asking me about cholera in the aftermath, specifically questioning this quote he had obtained:

The cholera outbreak has begun, said one medical worker. People have nothing to drink so they drink water from the creeks and rivers. So that is how the outbreak began.

These waterways are dirty because they are littered with bodies and animals. The survivors know the water is dirty, but they have no other choice and have had to drink the dirty water. Thats how they contracted cholera. "

My brother specifically asked me if dead bodies were a cholera hazard. I said No, it was spread by fecal contamination -- and he observed "fecal? well, the flooding must have dredged up a lot of outhouses and other shit (literally)"

So at least one reporter for a major newspaper was sharp enough to question the public health official, check the facts, and reach the (probable) correct conclusion.

(That said, I didn't look at his story, so I don't know what the editors did to it at the other end.)

Thank you for this information. I posted about you post in my blog (see Animot, "Cadaveres, Catastrofes e Saude Publica")

layork: Glad to hear it. My impression is that there is indeed less of this (I think WHO has been active in getting the word out) but I heard it twice on NPR, so still work to be done. The human rights part of this is often overlooked.

I'll have to admit my ignorance on this. For some reason I just assumed that typhoid was a result of something polluting the water supply as a result of the decomposition of bodies. It always seems that typhoid is one of the go to diseases you hear about after disasters. Had I taken a moment to look it up I'd find something completely different.

Well, I can think of one exception: Ebola. I gather that a major vector for the spread of ebola outbreaks is from people trying to handle the dead bodies of victims of the disease.

Put me in the ignorant cap too, but don't dead bodies contain a non-zero amount of fecal matter? So isn't there a non-zero possibility of a dead body contaminating water? So i agree with 1 dead body != epidemic, but doesn't lots of dead bodies mean lots of fecal matter, possibly causing an epidemic?

Epicanis: You are correct, although in the case of Ebola it is not the presence of dead bodies but handling patients/corpses with a lot of body fluids with infectious material as is the case for Ebola. Collecting such bodies for mass burial would also expose workers. Moreover Ebola is not very contagious so doesn't fell people like mass casualty situations.

JohnG: Most fecal matter isn't pathogenic, although it can contain pathogens. The pathogens like to live at body temp and rapidly die off in corpses, as noted. The main problem is not fecal matter from dead bodies but fecal matter from live bodies getting into the water and food from lack of sanitation. If you dispose of the bodies and don't do anything about the water you get epidemics. If you do something about the water and food and don't dispose of the water you don't.

As I always say, live bodies transmit infectious diseases more efficiently than dead bodies (even Ebola).

Very interesting post - I had never heard this before. My (non-biologist) thinking would have been that upon death, the immune system stops working and all those nasty germs would suddenly have a field day.

This is not to disagree with the o.p.,
but it's rather ironic that Semmelweis
showed that handwashing after autopsy
would reduce spread of disease, and here
we are 140-someodd years later, saying
bodies don't cause disease.

Even in Semmelweis's day, autopsies were
performed only on dead bodies.

Sorry, I could not resist.

Red Crayon --

Good point, but it wasn't actually the dead bodies doing it -- it was the live humans sticking their hands into the dead bodies, and then sticking their hands into/onto other live humans.

Dead bodies don't deliver many babies.

Even in Semmelweis's day, autopsies were
performed only on dead bodies.

Have you read every jot and tittle of the PATRIOT Act?

Have you seen how the press goes after Hillary Clinton?

Do you remember the Swift Boat Veterans?

You all might find this beneficial. It is the military response to this situation.

http://chppm-www.apgea.army.mil/hmwp/factsheets/37-032-0905revision.pdf

and this too....

http://chppm-www.apgea.army.mil/documents/TG/TECHGUID/TG195a.pdf

Suggest you download and print it for future (unknown) pandemic response.
.

Okay so now I have a question. That is mass burials. Mass burials violate the basic human rights? I cant find that anywhere in the UN Declaration of Human Rights..

http://www.un.org/Overview/rights.html

I do agree that when they are used that one should identify them to the nth degree, especially in light of what may be coming. The numbers for the Black Death 1, 2 and 3 were skewed badly. Using the normal growth of population methods it took us almost 6 generations to bring the population back to the level of the first hit. So looking at that and you have seen me post about the time in motion just to bury the estimated 5% 56,000 in Tennessee and with every mortuary doing individual burials and working 12 hour days it would take them 1.5 years just to bury the dead. This doesnt count the ones that go every week anyway.

So what is a better method? Our own DHS has instructions on how to bury a body in your yard if collection is not possible. The military calls it 2 pounds of wood for each pound of weight for each human body to burn it to bone disintegration with methods on how to do it. In fact, will we even have time to bury them at all along with the resources to do it? What does the basic human right mean in a pandemic? Is someone going to give a damn? If its anywhere near as bad as they say or above 8% then I cant see that the US or UN or most any other country would survive no matter what we did. It would descend into chaos with pockets of normalcy rather than normalcy with pockets of chaos.

Then there is the above post. While I respect Revere's position on it there is apparently a hazard according to US Code. But not from the apparent pandemic strains of anything, its bacteria from rotting flesh. Do we bury them or burn them? If you bury them around here without a sealed casket you run the risk of polluting the ground water due to artesian well inflow due to drought. Note Revere, I sent this one to the health dept for the official view on what to do in Tennessee at least in the western district. Louisiana, mass incineration may be the only way to get rid of the bodies because they dont have enough plots out there to put everyone in a single one, or above ground. Everyone in the S. of Tennessee SHALL be interred in a waterproof container by law, or cremated. No other processes are recognized.

FYI guys--Let Revere respond in his own time on everything.. .He is up to his neck with the passing of his brother in law. This might not be the time and subject we want to press on. Maybe Revere would like to shift to something else?

Hi Randy, we talked recently on this subject and I incorrectly assumed dead bodies caused disease...

Revere, "[Writers misuse the horrific imagery] to portray the urgency of a situation because they believe it themselves and understand that it is an image that readers can connect to."

Hey, I'm still learning and obviously make mistakes. I agree Randy, lets change the darned subject for now. How 'bout the news on GSKs Prepandrix!?!

Randy: The human rights issue isn't about laws or regulations. It isn't even that much about "rights." It is about human rights. There may be many pressures to dispose of bodies in a mass casualty -- lack of space, psychological, etc. -- but the point of the post was that public health isn't among them, although it will likely be used as a lever to relieve the other pressures. The consequences on mass burial for the survivors and relatives isn't discussed often enough (or hardly at all) and gets completely lost if one assumes that mass burials and or cremations is forced on us because if we didn't do it we would all die of epidemic disease. On the contrary, it is an option and often not the best one of the available ones. In some circumstances it might be the best one (although I would think that would be rare) but it won't be for public health reasons. And this is a public health blog.

Do we want decaying bodies to contaminate a water supply? No, of course not, although the reasons have little to do with the likelihood decaying bodies, which don't usually have much pathogen load, causing epidemic disease. It has to do with the fact that if they can do this it means that the integrity of the water supply as a protected or disinfected source has been compromised and this is the main worry. It means that it has become a conduit for anything that might get into it, of which the output from live bodies, human and animal, is the main concern.

So again, this isn't about regulations or the US Code. It is about the consequences of our actions on our fellow human beings. Sometimes we have to do things that are unpleasant or cause pain and distress. But if we do, we should be clear why we are doing them.

Jonny-You bum, how are you?

No you are right they dont cause disease but apparently they can carry disease. But its weird stuff too and it looks like they'll be asking whether they had an HiV status on the pickup. The military slash and burn as Revere points out might be to ensure that there is not one single chance of infection. E.g. a whole section in a pamphlet on body disposals via incineration. Tag, bag, and burn but unlike the Nazi's they would already be dead. Reading accounts of London in 1342 where the "bonefires" -later changed to "bonfire" I wonder if burials were even an option back then? They found mass graves of course but was it more a case of expedience or lack of firewood. Both would take a lot of horsepower to do.

But Jon, Revere makes a damned good point. Human dignity in a pandemic? Will there be any? If they go to this or are planning it pre-pandemic they had better be real good communicators. Else you come to get granny or your child with the plan being to toss them onto the fire there is going to be hell to pay. I think that telling someone that there will be no funeral is going to be hard to take and there just arent going to be enough coffins or bags. I bought 70 b. bags for just this purpose just in case that one of my employees or their family members didnt make it, or me for that matter.

I used it only once in my military career and its a nasty business on a good day. Getting them into the bag fast is very important else you might not like what happens. Grisly. I also want them all tagged and named, and their personal possession are returned to family members. None of this gold-teeth, and jewelry stuff from Auschwitz and yes I think there will be certain measure of attempts at that.

Good post Revere.

Since historical references have come up, let me point-out that a medaeval siege tactic was to hurl dead animals and such filth into the beseiged city to supposedly spread disease.... Maybe this worked though as a form of terrorism, if the inhabitants believed that it wold be successful. Of course, a rain of bloated cows would be pretty traumatic ("Fetchez la vache!.... RUN AWAY!"). One thing I got from the original post is that these people did not die of cholera, pox or plague, but disaster-trauma. I suspect that bodies of people dead of a communicable disease, a plague, would be much more dangerous than those dead of drowning or violence. Still, the Indonesians refused to eat fish after so many of their countrymen were dragged out to sea: the "Ick Factor" seems almost primal in our nature (instinct?) and may be related to historical risk of contamination during epidemics....

Very informative post. I linked to it from my blog.

Thank you. That's all... I've always heard the "general wisdom" to the contrary and something struck me as not right about it.
Question: approximately how many hours would it take for dead-of-pandemic bodies to become unlikely transmitters of pathogens? Because I keep wondering about the expected bird flu, and expect I would volunteer to help but want to protect myself.

Samantha-You have pathogens on your skin so you could get "it" from that. Apparently there are hazards from certain types of patients... HIV, hep A-C, but does anyone know how long B. Flu stays alive? 35 days at 30 degrees in dirt and chicken crap. How long in a body?

Might be the reason that the military wants them into a bag or onto a fire? What kind of dignity can and would there be if there are 100 million casualties? Again though Revere brings up the interesting points.

G'day revere. I get the point that unburied bodies are not a disease risk, and the value of pointing this out (e.g. my wife just came in and said 'of course they are')

Tradition has people poisoning wells by throwing a dead animal into the well. Does this make the water dangerous or not?

We take care with meat, not to let it stand at room temperature for long, etc. Will the dead animal in the well feed salmonella or other food poisioning organisms?

davidp: There are a number of issues rolled together here. I'll try to separate them.

i. pathogens come from other pathogens. This means that healthy people who die of trauma or drowning or famine aren't teeming with pathogens and won't produce new pathogens when they die. The idea of spontaneous generation of disease from decay is an ancient and hard to eradicate idea and lies just beneath the surface of much of this;

ii. there is a difference between potable water and contaminated water. Water that is foul tasting is a public health risk because it drives people to drink less safe water that may be more dangerous (pathogens don't have a taste but the same things that contaminate a water supply with pathogens might have bad tastes so bad tastes are a commonsense indicator of contamination); You don't have to put a dead animal in the water. You can put anything in the water that makes it undrinkable;

iii. someone who carries pathogens in his/her gut and who dies can contaminate a water supply theoretically but usually doesn't, for two reasons: the pathogen population decreases rapidly with death; and the body's contents don't usually get into a water supply. If the body can get into a water supply so can many other things and it is the ejecta of live bodies that can get into a water supply we are most concerned about because it is this material that has the highest density of replicating pathogens. This also explains the food poisoning example. You can't get food poisoning in your example until you eat the food. You can't epidemic disease from corpses until you are exposed to the pathogens and in the mass casualty case this means through water or food. So the name of the game is to protect water and food. The analogy would be to say we can eliminate food poisoning by eliminating food. We don't do that. We protecdt the food and water supply, which also protects us from the much more dangerous live bodies.

iv. Experience has never found an epidemic caused by rotting corpses, as the WHO statement says.

Hope this helps.

Revere: Is there any evidence to show if the earthquake and resulting Tsunami could be in any way a contributing factor for the specific mutation in the Indonesia H5NI virus with increased human mortality as a result of the mixing and close proximity of live and dead (or dying) animals and humans, with the stresses that result, and the contamination by all types of pollutants? Is one incident of mixing of live and dead (or dying) animals and humans under substandard living conditions (including eating sick animals and not having enough water to wash hands after handling contaminated or infected objects) after a big earthquake enough to trigger a vital mutation? Would random sampling in the earthquake affected areas to closely monitor any changes in the circulating H5N1 virus be helpful?

flulearner: One could speculate endlessly on what might have happened or could happen but there is no evidence. Viral mutations happen by mechanisms that are not thought to be related to the environment (this is always subject to modification as we learn more). But I know of no evidence to support your speculations. Regarding your question of random sampling, it needs to be sharpened. What does it mean to sample for H5N1 randomly? The underlying idea would seem to be that any viral particle has an equal chance of being selected for study (what kind of study?). Once you say that you begin to see the difficulties.

Thanks for the great reply revere.

Short version: If you can, I'd sure change that title, Revere. It's true: dead bodies don't cause disease epidemics--after the bugs they're carrying have had a chance to die off. This is not just a blog, it's also an educational source to a lot of people who aren't scientists. They're going to read your title, and that will be the only thing they take away. AnnieRN

Annie: Actually they don't cause them in any case, at least according to WHO who has a lot of experience with natural disasters":

"There has never been a documented case of a post-natural-disaster epidemic that could be traced to dead bodies," said the doctor, who helps oversee emergency and humanitarian services in the region.

I work in emergency management. People here are sick to death of me pointing this out. They all groaned the moment they heard the media repeating the "dead bodies disease" shit, because they knew I was about to rage.

I honestly don't understand how this foolish belief persists. That quote from WHO is the same I use: name one single corpse-related epidemic, ever.

Revere, I understand your logic, but here's the acid test: Who here is willing to get multiple new cuts on his/her hand, cut open the belly of an AIDS patient who died five minutes ago, and plunge their hand in? Sorry, but I don't believe it. It's the reason that coroners and morticians wear protective gear when they do autopsies and prepare bodies for burial. I'm not questioning the "whether or not an epidemic has ever happened on a large-scale" argument. I'm talking about one-at-a-time, passage of infectious material which could transfer to another--living--person. It doesn't make sense scientifically, either: A person's gut is contaminated with various bacteria, including those in the spore stage. It takes a while for those to die. AnnieRN

Annie: I think we are talking about different things. I am referencing the mass casualty epidemic disease connection. The title of the post is quite literally accurate and it is a message that badly needs to be delivered as the consequences to misconstruing this point are potentially disastrous and almost always deleterious. It does not pertain to individuals handling materials, including corpses, that have infectious or transmissible materials.

There may be an instinctive aversion to being around dead bodies which gets rationalized as a fear of disease. Dead things of all types do "smell bad". The only reason something "smells bad" is if there are good evolutionary reasons to avoid it.

There are other reasons to avoid dead things in general, what ever it was that killed them (usually a predator of some sort) may still be around. Carrion attracts scavengers. In Africa many of the scavengers are also hunters and their presence would increase the local danger. Some flies attracted to carrion also can consume living flesh (such as the screw worm (which is New World, but there are Old world versions too)).

daedalus2u: "The only reason something "smells bad" is if there are good evolutionary reasons to avoid it."

No, it's more complicated. What smells bad is partially culture. Consider limburger cheese and the like. Chacun a son gout (too lazy to put in diacritical marks).

So China ia closing towns and wasting millions on disinfectants in the disaster zones ? Surely they could use the money for tents and food. The WHO is there and they are not disuading them from doing it ? Flies cannot carry disease from animal to body then ? The rodents and dogs being culled for nothing if there is no risk ? The Chinese just don't have a clue ? So 1000's of dead humans and animals, dead from whatever, piled up in an area causes absolutely no risk ? What happens if they DO start dying from a contagious disease ? I guess if I was in a secluded room with a dead body, then I would not be at risk of getting a disease, that may be correct."Contrary to popular belief, dead bodies left from natural disasters such as the China earthquake and Myanmar cyclone are not a source of disease or a health threat to survivors", the World Health Organization said Friday. When 4 of a family die from bird flu SYMPTOMS and one test positive,the WHO does not acknowledge the other 3 ? Contrary to popular belief..I think the WHO is a health threat to survivors.

treyfish: You seem to have two things in mind, the foremost being your feelings about WHO and bird flu. That is a different topic and one worth discussing. We've done it here incredibly often. But don't confuse it with the main point, that in a natural disaster (meaning not a pandemic or devastation from epidemic disease) there are many adverse consequences from believing -- incorrectly according to all the evidence and scientific knowledge we have -- that the corpses of people killed by trauma will induce epidemic disease. Acting on that belief only makes things worse and doesn't make them any better.

Chinese authorities can perpetuate and act on the same incorrect beliefs as journalists and people who comment on blogs. They can also act contrary to the public's health, as their (in)action at the local level on bird flu shows. WHO is not "letting" them do this. WHO has no authority in China and even the Chinese central government cannot seem to control what goes on in the provinces.

We know China is infested with bird flu.Massive human deaths from trauma do not carry the slightest risk of spreading epidemic disease through water contamination or spread through flies? Mix in some animal deaths.The WHO is led by a Chinese Dr..one Dr. Margeret Chan... I suppose she just hasn't told them yet, they are wasting all those resources.Maybe they are doing it to calm the public and proving how safe and caring they can be.

treyfish: "Massive human deaths from trauma do not carry the slightest risk of spreading epidemic disease through water contamination or spread through flies?"

The evidence and the science say "no." I cite some of the arguments in the comments. You are free to believe what you wish for whatever reasons.

No, a pile of dead humans due to traumatic injury will not cause an epidemic by itself..This report in their own papers, does claim traumatic death victims cannot cause disease.WHO: Crowds, not corpses, the real health risk
By Shan Juan (China Daily)
Updated: 2008-05-20 09:20 http://www.chinadaily.com.cn/china/2008-05/20/content_6697426.htm Yet, they are still spraying dead towns and at least one town is shut off to all for safety reasons,epidemics being one of them. Here is a SNIP from a recent story about a different town, with some animals mixed in..."Villagers dead chicken abandonment in rivers."
"Is close to explodes plague.. City of Deyang to be in danger"'

Although Sichuan disaster area excessive seven, but because large quantities of victim remains and the domestic animal corpse cannot obtain properly processing, breeds each kind of germ highly rottenly, passes through the rain water again the washout, starts to pollute the water source, the disaster area downstream city many people faced with is compelled to drink the poisonous water, at present has the diarrhea the disaster victims grow day by day, the large-scale plague erupts imminently..." http://svsurl.systransoft.com/?t=outputframeset&link=trans&task=11d1def…

I'm glad to see you setting the record straight on this, it always bugs me when i see articles continuing to spread this myth.

Here's another thing that bugs me though:

This is a basic human right of surviving family members.

The implication is that the dead don't have rights, only the survivors. Follow that logic, and you could conclude that it's ok to desecrate the grave of someone, as long as they were some homeless person that no one cared about. That's crazy.

While I guess I could see the argument that the dead don't have rights, I think the living have the right to know that society will do their best to insure their body will be treated with respect after they die. Regardless of whether there is anyone else to care about it.

(this applies to the "funerals are only for the living" concept too. No, funerals are at least partly for the dead, so that they could know before they died that they would get a decent funeral when they do die)

Sorry if this strays off the science of the discussion.

rob: It doesn't really say what happens if there are no surviving family. Once you ask the question I think you will come up with various answers, but it is a good question to ask and I hadn't thought about it. In this specific instance I think it doesn't matter as any policy wouldn't check first to see if there were survivors and use a mass grave if there weren't. But I take your point which is an interesting one. I don't know how I feel about this in general. I know that for me personally, it is a matter of indifference, although I also admit to leaving instructions there are to be no religious services at any event marking my demise (assuming there is one; again I am indifferent since I won't exist any more by that time). So on reflection your point is a good one.

...although I also admit to leaving instructions there are to be no religious services at any event marking my demise...

Though I'm an atheist, I'm not going to ruin all the fun for everyone else by stipulating any pre-burial rituals. While they're wailing and gnashing their teeth in grief, I'll be with the FSM, laughing our asses off. (I'll be the one gnawing on his holiness's delicious ricotta-filled elbows.)

trog; I agree with you about this. My instructions are accompanied by a chuckle and the warning if they did I'd rise from the dead. I figured that would be incentive for them not to.

I wasn't really knockin' you; I'd just as soon they compost me in some garden, or whatever practical use can be made of me. (Who said "finally!"?)

Revere, I'm not trying to beat this to death, but I want to clarify one thing in particular. Your title said, "Dead bodies don't cause epidemics." In that dead bodies are not the cause of human-to-human transfer of infection resulting in widespread disease, I agree.

In your blog post, however, you erred by adding an additional statement; you mis-translated that fact in your statement, "Dead bodies aren't a public health risk."

The acts of Semmelweiss and his colleagues were direct contradictions of your second statement. He and the other physicians were trained to do autopsies, wipe the blood/bodily fluids on their coats (the more gore, the better the reputation of the physician, by the way) and to go directly to the bedsides of laboring women, many of whom died of post-partum infection. The extremely high rate of post-partum deaths of women and newborns after being treated by these physicians became so well known among the public that many, many women refused to go to the hospitals, specifically because they were terrified that their labor and deliveries might be managed by these physicians. The risk of death was so well known that eventually many women agreed to go to the hospital only if they could be assured that the deliveries would be managed only by midwives. Others refused to go at all and delivered at home, preferring to take the chance that they would survive any type of delivery, over the greatly increased risk of death at the (filthy, infected) hands of the physicians.

Obviously, the infectious materials in those dead bodies--and how they were included in the chain of infection to pregnant women and newborn infants--were a definite public health risk. Once Semmelweiss broke that chain by requiring the physicians under him to wash their hands, the risk to the public largely ended. Semmelweiss is still considered by many scholars to have committed suicide by intentionally cutting his hand during an autopsy, then refusing any type of treatment for it. He died from the similar type of infection he spent many, many years trying to end. AnnieRN

Incidentally, according to one text at Yale University, the high rate of postpartum infection (i.e. peurperal fever) in the Vienna Hospital in Semmelweiss' era was specifically called an "epidemic". (http://elane.stanford.edu/wilson/Text/5c.html)

On the CDC website, in a study by Watson, Gayer, and Connelly, is the result of a study of dead bodies and disease transmission. In most cases of traumatic multiple deaths, there is no huge need for mass burials, but the writers go on to say that in three specific cases of multiple deaths by infectious disease--cholera, shigellosis, and hemorrhagic disease--there is a need for disinfection of the body, to prevent transmission of disease.

Thank you for your patience. AnnieRN

Annie: The post was quite specific that the context was a mass casualty event where bodies pile up. The sentences from the post you found not accurate have to be read in that context, or said another way, as you have them they were taken out of context. In the case of an epidemic from transmissible disease the usual public health practice is at least isolation, including any infectious dead bodies but more importantly live ones. So that context is quite different. The bottom line here for our discussion, I think, is that we are talking at cross purposes. Your points are correct but in my view not relevant to the pos. But bringing them up is useful to add precision to the conversation, so I thank you for that.

AnnieRN: I read your cautious points. I speculate from another angle: The cause of death is a factor to consider. The dead bodies from natural disasters like earth quake, cyclone happen in very short period; while the deaths from fighting war prolong for longer time.

The dying bodies (untreated) are more serious than dead bodies I suppose. I am not sure is there any speculation of 1918 pandemics in relating to the war time's incidence?

Thank you, Revere. I wasn't trying to be confrontational or even to be a general pain in the neck. I appreciate your continuing in the conversation for the sake of accuracy. :) AnnieRN