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 Table of Contents  
EDITORIAL
Year : 2020  |  Volume : 9  |  Issue : 3  |  Page : 79-81

Does the Corpse teach the living? - Anatomy in the era of COVID -19


1 Assistant Professor, Department of Anatomy, JSS Medical College, Mysore, Karnataka, India
2 Professor (Additional), Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission28-Sep-2020
Date of Decision05-Oct-2020
Date of Acceptance06-Oct-2020
Date of Web Publication15-Oct-2020

Correspondence Address:
Kumar Satish Ravi
Department of Anatomy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/NJCA.NJCA_49_20

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How to cite this article:
Pushpa N B, Ravi KS. Does the Corpse teach the living? - Anatomy in the era of COVID -19. Natl J Clin Anat 2020;9:79-81

How to cite this URL:
Pushpa N B, Ravi KS. Does the Corpse teach the living? - Anatomy in the era of COVID -19. Natl J Clin Anat [serial online] 2020 [cited 2020 Nov 28];9:79-81. Available from: http://www.njca.info/text.asp?2020/9/3/79/298167




  Introduction Top


The COVID-19 pandemic is the biggest global health crisis of this era and the greatest challenge mankind have faced since the Second World War. Coronavirus appeared in Asia but since its occurrence it has touched all the continents except Antarctica. This pandemic is not only a health crisis but an unprecedented socio-economic predicament as well. Indian Government is taking all possible measures and steps to face this unprecedented global challenge of COVID-19.

COVID-19 is an infectious ailment caused by Novel Coronavirus. Since its recent discovery, the pathogen was named because of its distinct spiky appearance. Word “COVID-19” is derived from the CO of Corona, VI of Virus, and D stands for the disease. The novel coronavirus also called severe acute respiratory syndrome (SARS) coronavirus 2 is an RNA virus, spherical bearing club shaped surface projection giving it a spiky appearance. The viral disease was first reported in Wuhan City of China in December 2019 and within a short period, it disseminated worldwide affecting millions of people owing to its high transmission rate.[1]

The chief mode of transmission of this virus is through droplets (talking, sneezing, or coughing). With an average incubation period of 2–14 days, these viruses can cause a spectrum of flu-like symptoms and critically in a few cases death. The virus remains infectious on various nonliving things ranging from hours to several days. Although the mortality rate of COVID-19 is low, both the nonavailability of a specific regimen of treatment and vaccine has made the disease more ominous.[2],[3] On March 11, 2020, the World Health Organization announced COVID-19 as pandemic which barrelled through more than 114 countries within a short period of 3 months.[4] Currently, the deadly disease has resulted in 32,508,287 cases, killing 9,89,246 people around the globe.[5]

Pandemics are not new, the world has witnessed many such conditions starting from black death (Plague), Columbian exchange, Great plague of London, Cholera Pandemics to recent Flu pandemics.[6] There is a vast literature on the great pandemics but very sparse information available regarding the management of corpses during these catastrophizes. In olden days, where there was a lack of both man power and a proper protocol for handling the dead. The cadavers were left in the street piling up as there was a dearth of embalmers and Coffins too, eventually leading to rotting.[7]


  History Top


The flu pandemics which mostly spread by respiratory route can cause disastrous effects. Although the chances of spread of novel coronavirus from a dead body are very negligible, utmost care has to be taken by the health-care workers, burial ground staff and family members as the body fluids of the corpse may prove to be a source of infection.[8] Nowadays, with in advert use of social media which can both inform and misinform the public by giving different dimensions to burning issues corpus management during the pandemic has become a social issue too.[9],[10]


  Guidelines on Corpse Handling Top


In view of the declared pandemic on March 15, 2020, the Government of India has issued guidelines on the management of the dead body due to COVID-19. The main infection control practices include maintaining proper hand hygiene, use of personal protective equipment, safe handling of sharp objects, instruments, and disinfection of environmental surfaces which comes in contact with the corpse therefore, the health care workers and staff who are involved in the isolation area, mortuary, transportation, and burial ground should be trained meticulously in the above said infection prevention control measures. Further, staff should be trained and proficient to perform the last rites, not only in a dignified manner but also with adequate mandatory social distancing norms. In this regard, the relatives may be allowed to do the religious rituals according to their customs, which does not require touching of the cadaver such as bathing and kissing. Again, here the relatives should be urged to maintain strict social distancing norms and also to wear PPE kit as suggested by the authorities.

As of now embalming of cadavers due to COVID-19 is not allowed owing to the potential risk of virus transmission through body fluids. However, the autopsy of such cadavers can be done by adept staff who are well versed with infection control measures. In all these cases, a suitable disinfectant, preferably 1% hypochlorite is used to disinfect the surfaces and instruments.[8]


  COVID 19 – and Anatomical Sciences Education Top


Medical education has suffered a mammoth impact because of the COVID-19 pandemic, starting from procuring cadaver for dissection to cancellation of classes and clinical postings to medical students.[11] Medical institutions are temporarily closed no didactic lectures, small group teaching, and clinical postings. The reduced exposure among specific specialities will result in detrimental effects on competencies and skills.[12] This break in the fast-paced medical curriculum will have magnanimous impact and future repercussions not only on the budding doctors by posing limitations to hands-on learning but also to the society as a whole.[13]

During previous pandemic SARS, few medical colleges in China, Canada had withdrawn formal teaching and in one medical college online teaching was adopted. During this pandemic to follow social distancing norms to avoid medical students in becoming potential vectors for viral transmission, and to flatten the curve of the pandemic, most of the medical institutions have switched on to recorded lectures or online teaching using various platforms to complete the curriculum, which has become quite popular in various other countries. These impressive accomplishments emphasize that even in times of adversity, curriculum can be completed within the stipulated time frame.[12]

Anatomy and cadavers are two inseparable terms. Dissection being an integral part of anatomy,[14] COVID-19 has adversely affected cadaver procurement for teaching purposes as embalming is not allowed during this pandemic. In the light of guidelines issued by the Government of India not to perform embalming of the cadavers of COVID-19 patients.

Many medical institutions are dependent on body donation programs and procurement of unclaimed cadavers for dissection purpose. As a result of COVID-19, body donation and organ donation has come to a standstill in most of the medical colleges. Although there are reasonable guidelines for organ donation, due to their nonspecific nature and lack of adaptability the process has suffered a huge setback.[15] This can add to the existing shortage of cadavers for dissection and learning purpose [16] this can imperatively result in switching from traditional methods to virtual dissection, which is being followed by a handful of medical colleges in India.[11] With the newly introduced curriculum based medical education, learning anatomy dissection virtually is unrealistic as the tactile element and real-world complexities of the body cannot yet be simulated satisfactorily.[17] Dissection hall is a place where the students conceive the minds of the future surgeon. While virtual dissection overcomes the problems associated with wet laboratories such as scarcity of cadavers, cost of management, formalin allergy,[14],[18] the debate continues between real and virtual classes. Although medical education and indeed medicine as a profession was never designed to be fully online, necessity has compelled the medical educators to adopt virtual teaching, where team-based learning, interaction, the act of dissection and physical examination skills is effectively learnt.[19]


  Closing Remarks Top


Indeed, it is very tough to come to an inference due to uncertain unique challenges and the knowledge gap that exists concerning novel coronavirus. There has to be a feisty quest for the development of safe and effective methods of embalming of COVID-19 cadavers ensuring standard precautions. Embalming of cadaver is essential to withstand the body donation programs for dissection to overcome the cadaver predicament. The paucity of cadavers is bound to ensue in days to come. In majority of the medical institutions, Anatomical Sciences is studied by the dissection of the corpse. The dissected corpse being the most accepted means of teaching-learning modalities of Anatomy. This may severely affect the teaching and learning of Anatomy as corpse dissection may not be feasible in days to come. A road map has to be configured in view of CBME else virtual dissection with other added methods of blended learning becomes inevitable.



 
  References Top

1.
World Health Organization. Naming the Corona Virus Disease (COVID-19) and the Virus that Causes It. 2020. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that- causes-it. [Last accessed on 2020 Sep 24].  Back to cited text no. 1
    
2.
Khan G, Sheek-Hussein M, Al Suwaidi AR, Idris K, Abu-Zidan FM. Novel coronavirus pandemic: A global health threat. Turk J Emerg Med 2020;20:55-62.  Back to cited text no. 2
  [Full text]  
3.
Stawicki SP, Jeanmonod R, Miller AC, Paladino L, Gaieski DF, Yaffee AQ, et al. The 2019-2020 novel coronavirus (severe acute respiratory syndrome coronavirus 2) pandemic: A Joint American College of Academic International Medicine-World Academic Council of Emergency Medicine Multidisciplinary COVID-19 Working Group Consensus Paper. J Glob Infect Dis 2020;12:47-93.  Back to cited text no. 3
    
4.
World Health Organisation. WHO Director – General's Opening Remarks at the Media Briefing on COVID-19; 11 March 2020. Available from: https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on- covid-19---11-march-2020. [Last accessed on 2020 Sep 24].  Back to cited text no. 4
    
5.
Worldometer. Coronavirus Cases; 2020. Available from: https://www.worldometers.info/coronavirus/?utm_campaign=homeAdvegas1?. [Last accessed on 2020 Sep 24].  Back to cited text no. 5
    
6.
20 of the Worst Epidemics and Pandemics in History; 2020. Available from: https://www.livescience.com/worst-epidemics-and-pandemics-in- history.html. [Last cited on 2020 Sep 24].  Back to cited text no. 6
    
7.
Scanlon J, Mc Mohan T. Dealing with mass deaths in disasters and pandemics disaster prevention and management. 2011;20:172-85.  Back to cited text no. 7
    
8.
Government of India. COVID-19: Guidelines on Dead Body Management. 1st ed. New Delhi, India: Government of India, Ministry of Health and Family Welfare, Directorate General of Health Services (EMR Division); 2020. Available from: https://www.mohfw.gov.in/15844x23700568_COVID19GuidelinesonDeadbodymanagement.pdf. [Last accessed on 2020 Sep 25].  Back to cited text no. 8
    
9.
Hamburg M, Choffnes ER, Sparling PF, Mack A, Lemon SM. Ethical and Legal Considerations in Mitigating Pandemic Disease: Workshop Summary. Washington (DC): National Academies Press (US); 2007.  Back to cited text no. 9
    
10.
The Hindu. Coronavirus-Enquiry Ordered into Dumping of Dead Bodies; 2020. https://www.thehindu.com/news/national/karnataka/coronavirus-inquiry-ordered-into-dumping-of-dead-bodies/article31953574.ece. [Last accessed on 2020 Sep 25].  Back to cited text no. 10
    
11.
Ravi KS. Dead body management in times of Covid-19 and its potential impact on the availability of cadavers for medical education in India. Anat Sci Educ 2020;13:316-7.  Back to cited text no. 11
    
12.
Ahmed H, Allaf M, Elghazaly H. COVID-19 and medical education. Lancet Infect Dis 2020;20:777-8.  Back to cited text no. 12
    
13.
Chandran S, Deshpande S. Surviving COVID 19 as a medical student. Indian Med Assoc 2020;11.  Back to cited text no. 13
    
14.
Pushpa NB, Bhat D, Pushpalatha K. Students' perception on dissection and prosection in learning gross anatomy. Int J Anat Radiol Surg 2019;8:25-7.  Back to cited text no. 14
    
15.
Moris D, Shaw BI, Dimitrokallis N, Barbas AS. Organ donation during the coronavirus pandemic: An evolving saga in uncharted waters. Transpl Int 2020;33:826-7.  Back to cited text no. 15
    
16.
The Hindu. Cadaver Shortage Tells on Medical Education; 2018. Available from: https://www.thehindu.com/news/cities/Hyderabad/cadaver-shortage-tells-on-medical-education/article24362332.ece. [Last accessed on 2020 Sep 25].  Back to cited text no. 16
    
17.
Murphy B. Why the Virtual lab Won't Replace the Real Thing? 2020. Available from: https://www.ama-assn.org/education/accelerating- change-medical-education/why-virtual-anatomy-lab-won-t-replace- real-thing [Last accessed on 2020 Sep 25].  Back to cited text no. 17
    
18.
Mattone DC. Prosection or dissection? A comparative study of students' opinions on the use of cadavers in community colleges. In partial fulfilment of the requirements for Biol 505, 2008:1-18.  Back to cited text no. 18
    
19.
Ferrel MN, Rayan JJ. Impact of medical education on COVID-19. Cureus 2020;12:7492.  Back to cited text no. 19
    




 

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