Dispelling disaster myths about dead bodies and disease: the role of scientific evidence and the media

Increased incidence of cutaneous Staphylococcusaureus infections after the 2010 floods in the Var department of France: Rumour or reality?

BACKGROUND

Natural disasters are typically associated with the emergence of infectious diseases. On 15 June 2010, severe storms caused flooding in the Var department (France). A rumour about increased risk of Staphylococcusaureus skin infections after bathing in the sea began to circulate on Internet a few days after the floods. The aim of this study was to compare the rumour with the true incidence of cases of infection.

METHODS

Since 1999, we have been conducting a prospective survey of S. aureus skin infections in our hospital to study their clinical, laboratory and epidemiologic features. We compared data on cases of Staphylococcus skin infection recorded in our institution from 2008 to 2012.

RESULTS

We found that there was no increase in S. aureus skin infections after the floods compared to the previous and subsequent years.

CONCLUSION

We had a unique opportunity to check the rumoured increase in incidence of infectious disease with the true incidence. In our study, the fear of S. aureus skin infections following flooding proved to be unfounded.

Ethical and sociocultural challenges in managing dead bodies during epidemics and natural disasters

Background

Catastrophic natural disasters and epidemics claim thousands of lives and have severe and lasting consequences, accompanied by human suffering. The Ebola epidemic of 2014–2016 and the current COVID-19 pandemic have revealed some of the practical and ethical complexities relating to the management of dead bodies. While frontline staff are tasked with saving lives, managing the bodies of those who die remains an under-resourced and overlooked issue, with numerous ethical and practical problems globally.

Methods

This scoping review of literature examines the management of dead bodies during epidemics and natural disasters. 82 articles were reviewed, of which only a small number were empirical studies focusing on ethical or sociocultural issues that emerge in the management of dead bodies.

Results

We have identified a wide range of ethical and sociocultural challenges, such as ensuring dignity for the deceased while protecting the living, honouring the cultural and religious rituals surrounding death, alleviating the suffering that accompanies grieving for the survivors and mitigating inequalities of resource allocation. It was revealed that several ethical and sociocultural issues arise at all stages of body management: notification, retrieving, identification, storage and burial of dead bodies.

Conclusion

While practical issues with managing dead bodies have been discussed in the global health literature and the ethical and sociocultural facets of handling the dead have been recognised, they are nonetheless not given adequate attention. Further research is needed to ensure care for the dead in epidemics and that natural disasters are informed by ethical best practice.

Natural Disasters

Natural disasters are the result of a hazard overwhelming highly vulnerable community, often resulting in mortality and morbidity. Over the past decade, over 300 natural disasters occur yearly around the world affecting millions and cost billions. The disaster cycle is a framework used to base a coordinated plan to respond, recover, prevent, and prepare for a disaster. Access to clean water, proper sanitation, food/nutrition, shelter, and the threat of communicable diseases are concerns that have the potential to be detrimental to the management of a natural disaster, slowing the recovery process.

Infectious diseases following disasters

Infectious diseases following natural disasters tend to occur as a result of the prolonged secondary effects of the disaster, mostly when there is an interruption of public health measures resulting from destruction of the local infrastructure. This article will review the infectious risks that occur as a result of natural disasters, with a focus on the mechanism of disease spread, infectious diseases after specific disasters, and various evidence-based interventions.

Differences in opinions on disaster myths between first-year and sixth-year medical students

OBJECTIVE

We aimed to determine the influence of a medical school program on altering the opinion of medical students on disaster myths.

METHODS

This cross-sectional survey study was conducted in October 2005 in Hacettepe University Faculty of Medicine, Turkey, with the participation of 191 (83.0%) first-year and 232 (80.8%) sixth-year medical students. The opinions of the students with regard to 22 disaster myths and the influence of the medical school program on these opinions were evaluated. Chi-square test was used in the statistical analysis.

RESULTS

One hundred and fifty-nine first-year (83.2%) and 178 (76.7%) sixth-year students had knowledge about disasters (chi2=2.75, P=0.972). Television was cited as the leading source of knowledge among both first-year (63.9%, 122) and sixth-year (62.1%, 144) students. The medical school was the last resource for knowledge as reported by first-year students (0.5%, one student), and ranked fourth as a knowledge resource according to sixth-year students (47.0%, 109 students). Statistically significant differences were determined in opinions between the two groups of students, with sixth-year students having a higher rate of correct answers in only seven myths. In 17 myths, the number of correct responses for both groups was below 60%.

CONCLUSION

If the myths and realities in disaster situations are valid, we demonstrated that the medical education curriculum at one of the leading medical faculties in Turkey failed to correct the misconceptions of the medical students. As the opinions of students regarding disaster myths may reflect those of their trainers, similar surveys conducted among the faculty would be informative.

Mass fatality management following the South Asian tsunami disaster: case studies in Thailand, Indonesia, and Sri Lanka

BACKGROUND

Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters.

METHODS AND FINDINGS

After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24-48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support.

CONCLUSIONS

Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies.