China’s Escalating Coronavirus Response – Mandated Cremation

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The `official’ numbers we get from China are highly suspect, and based on numerous anecdotal reports of people being turned away from hospitals, likely only represent a fraction of the cases on the Mainland.

Presumably, the `sickest of the sick‘ are the ones being hospitalized, and `milder‘ cases are sent home to be cared for by their families, but that may not be entirely true.  Some patients may be too sick to travel to a hospital, or unable to handle the queue. 

While the numbers are worrisome, the CFR (Case Fatality Rate) remains reassuringly low – at least when compared to MERS-CoV or Avian Flu.  But again, there are (unconfirmed) reports of many `pneumonia deaths’ not being counted.

Against this backdrop we are seeing a truly remarkable, albeit draconian, response by the Chinese government, including the quarantining of major cities and tens of millions of people, the rapid construction of`hospitals’, the closure of schools, factories, and most public venues; an apparent willingness to sacrifice the economic engine of their nation in order to combat this outbreak.

While laudable, perhaps even `heroic’ , these actions appear to be a disproportionate response to the threat, at least based on the official numbers we’ve seen. 

Adding to the mystery (and the concern), we’ve a new edict from China’s National Health Commission – issued yesterday – which raises even more questions; a document picked up by the Newshounds at FluTrackers that now orders the disposal of all confirmed or suspected coronavirus bodies by cremation.

Exactly why Chinese authorities would feel the need to mandate cremation for all coronavirus victims isn’t clear, but based on the documentation, they are obviously worried about infection control. 

First, a (translated) brief announcement which curiously buries the word `cremation’ near the bottom, followed by a link to (and translated text from) newly issued guidelines.

Interpretation of the Documents of Guidelines for Handling the Remains of Patients with Pneumonia Infected with New Coronavirus (for Trial Implementation)

Published: 2020-02-01 Source: Medical Administration

In order to do a good job in the disposal of the remains of patients with death from pneumonia infected with new coronavirus, and prevent the risk of disease spreading, the National Health and Health Commission, the Ministry of Civil Affairs and the Ministry of Public Security jointly issued the Guidelines for the Disposal of the Remains of Patients with Pneumonia Infected with New Coronavirus (for Trial Implementation). 

The document highlighted the problem orientation, and put forward the overall requirements, division of responsibilities, and the procedure and relevant provisions for the disposal of remains. The specific duties of the medical institutions, funeral homes, disease control institutions, health and health administrative departments, civil affairs departments and public security organs are specified, and detailed provisions are made on the whole process of reporting the death of patients, sanitation and epidemic prevention treatment, handling procedures, transfer of bodies, personnel protection, cremation of bodies, etc. Through this document, all departments and institutions shall be urged to perform their duties, work smoothly, and improve the standardization of the disposal of mortal remains. 

Related Links: Notice on Issuing the Guidelines for the Disposal of Remains of Patients with Pneumonia Infected with New Coronavirus (for Trial Implementation)

Notice on the issuance of guidelines (trial) for the disposal of the remains of pneumonia patients with the new coronary virus infection

Published: 2020-02-01

Source: State Health Administration Medical Letter (2020) No. 89

Provinces, autonomous regions, municipalities directly under the Central Government and Xinjiang Production and Construction Corps Health Committee, Civil Affairs Office (Bureau), Public Security Bureau (Bureau):

Now the “new coronary virus infection of pneumonia patients’ remains disposal guidelines (trial)” issued to you, please combine with the actual, conscientiously implement. 

Office of the National Health and Health Commission, General Office of the Ministry of Civil Affairs General Office of the Ministry of Public Security
February 1, 2020   (Information Disclosure Form: Active Disclosure)

Remains of pneumonia patients with new coronary viral infection

Disposal Guidelines (Trial)

In order to do a good job in the disposal of the remains of pneumonia patients with new coronary viral infections (hereinafter referred to as patients with new coronary pneumonia) and to prevent the risk of disease transmission, this work guide is formulated in accordance with the relevant requirements of the Law of the People’s Republic of China on the Prevention and Control of Infectious Diseases and the Regulations on the Disposal of the Remains of Victims of Major Emergencies (Minfa (2017) No. 38).

  First, the overall requirements

In accordance with the principle sanitization of people-oriented, standardized according to law, timely and sound, near cremation, suspected from the principle, the implementation of unified leadership, graded responsibility, mutual coordination, territorial management, scientific norms of disposal of the remains of patients with new coronary pneumonia, strengthen health protection, prevent the risk of disease transmission, to protect human health and social safety.

  Second, the division of responsibilities

Medical institutions are responsible for issuing medical certificates of death in a timely manner, notifying funeral homes to pick up and transport remains, and doing a good job in the disinfection of the remains and other health and epidemic prevention work.

The funeral home is responsible for the timely receipt of the remains, the establishment of temporary funeral services dedicated channels and special crematoriums, in accordance with the operating procedures to do a good job of cremation of the remains, and issue dissonance certificates.

The disease prevention and control institutions are responsible for supervising and guiding health and epidemic prevention work, do a good job in the training of relevant personnel in the protection of knowledge and skills, and disinfect funeral vehicles, cremation equipment and related places.

The administrative department of health and health shall be responsible for formulating technical documents related to health and epidemic prevention, such as the disinfection of human remains, and guiding medical institutions to do a good job in the standardized disposal of the remains of patients with new coronary pneumonia in their institutions.

The civil affairs department is responsible for a comprehensive understanding of the funeral services in the region and the situation of available resources, timely coordination, guidance and other service institutions to do a good job in the disposal of the remains of patients with new coronary pneumonia.

The public security organs shall give priority to the vehicles transporting the remains and give priority to the traffic facilities, and shall investigate and punish the illegal and criminal acts in the process of transporting the remains in accordance with the law.

Third, the disposal process of the remains

(i) Death report. After the death of a patient with new coronary pneumonia, the medical institution shall report to the administrative department of health and health at the corresponding level, the administrative department of health and health shall inform the civil affairs department at the corresponding level, and the civil affairs department shall inform the relevant funeral home to make preparations for the transportation and cremation of the remains.

(2) Health and epidemic prevention treatment. For the remains of patients with new coronary pneumonia who have died, the remains shall be disinfected and sealed and strictly sealed by medical personnel of the medical institutions in accordance with the provisions of the Technical Guide for the Prevention and Control of New Coronary Virus Infections in Medical Institutions (First Edition).

(iii) The handover of formalities. Medical institutions shall, after completing the treatment of the body’s health and epidemic prevention, issuing a death certificate, and contacting relatives for cremation, contact the funeral home to pick up the remains as soon as possible, and indicate in the body transfer form that the health and epidemic prevention treatment and immediate cremation opinions have been carried out. If the relatives of the patients with the new coronary pneumonia refuse to show up or refuse to transfer the remains, the medical institutions and funeral homes shall persuade them to be invalid, and if the medical institution signed the body, the remains shall be directly cremated by the funeral home, and the public security organs of the district shall cooperate with the relevant work.

(4) Transfer of remains. The transport of the remains shall not be carried out by units and individuals other than funeral homes. The funeral home arranges full-time personnel and special body transport vehicles to the designated place of medical institutions, and transports the remains to the designated special body transport vehicle shipping to the funeral home according to the designated route.

(5) Personnel protection. The disease prevention and control institution shall guide medical personnel and personnel transporting and disposing of human remains, etc., and carry out health protection in accordance with the requirements of disease contact protection.

(6) Cremation of the remains. After the body is transported to the funeral home, the funeral home shall set up a temporary special channel, and the full-time staff of the funeral home shall send the body directly into the special crematorium for cremation. The remains shall not be stored or visited, and it is strictly forbidden to open the sealed body bag throughout the whole process.

(7) The transfer of ashes. After the cremation, the funeral home service staff picked up the ashes, and issued a cremation certificate, together with relatives to take away. If the family refuses to take it, it shall be treated according to the unclaimed remains.

(8) Environmental disinfection. The disease prevention and control institutions strictly disinfect the transport vehicles, equipment tools, cremation workshops, and remaining areas of the remains, and treat the funeral waste harmlessly.

(9) Information management. Medical institutions and funeral homes shall promptly register and deposit the disposal of the remains of patients with new coronary pneumonia into business files, and the handling shall promptly report to the same level of disease prevention and control institutions and civil affairs departments.

Fourth, the relevant provisions

(1) The remains of patients with new coronary pneumonia who have died in the province (region or city) shall be cremated in the near vicinity, shall not be buried or otherwise preserved, and shall not be transported. The remains of patients with new coronary pneumonia who have died outside the province (region seunging) shall not enter the province and shall be cremated on the spot in accordance with the principle of proximity.

(2) After the death of a patient with new coronary pneumonia, a farewell ceremony for the body and the use of the remains for other forms of funeral activities shall not be held.

(3) The remains of patients with new crown pneumonia of ethnic minorities shall be cremated on the spot in accordance with the provisions of the Law on the Prevention and Control of Infectious Diseases. After cremation, the ashes may be placed in accordance with ethnic customs.

(4) If foreigners and people from Hong Kong, Macao and Taiwan in China die in china due to pneumonia from the new coronavirus infection, the remains must be cremated locally in accordance with the provisions of the Law on the Prevention and Control of Infectious Diseases. The cremated ashes may be transported out of the country as the family members of the deceased wish.

(5) The remains of patients suspected of new coronary pneumonia (including those who use preventive and control measures such as isolation observation) shall be treated in accordance with the principle of “suspected from having” to prevent the spread of the epidemic.

(6) The relevant expenses such as the transportation and cremation of the remains shall be settled in accordance with the relevant provisions.


Annex: 1. Protection standards for the transport of human remains of pneumonia patients with new coronary viral infection and methods for transporting vehicles

2. Transfer order for the remains of patients killed by pneumonia with the new coronary virus infection

3. Registration form of cremation of the remains of patients who died of pneumonia with the new coronary virus infection

Annex 1

Remains of pneumonia patients killed by new coronary virus infection
Protection standards for transport personnel and methods for disinfection of transport vehicles

Protection of the body transporter

Refer to the Pneumonia Prevention and Control Program (Third Edition) of New Coronary Virus Infection (3rd Edition) and Annex 5 The Personal Protection Guide for Specific Groups (First Edition) body disposal personnel self-protection standards, or in accordance with the protection requirements of medical personnel in the isolation room of pneumonia patients/suspected patients entering the new coronary virus infection.

It is recommended to wear work clothes, disposable work caps, disposable gloves and long-sleeved thick rubber gloves, disposable protective clothing, medical protective masks, goggles or protective face screens, work shoes or rubber boots. Transport personnel to do a good job of hand hygiene, can use hand sanitizer and flowing water to wash their hands or use quick-drying hand disinfectant.

Second, on the disinfection of vehicles transporting the remains

When transporting vehicles without visible contaminants, spray 1000mg/L of chlorine-containing disinfectant or 500mg/L of chlorine dioxide disinfectant onto the surface of the vehicle for 30 minutes. When transporting vehicles with visible pollutants, should first use disposable absorbent materials to get 5000mg /L to 10000mg/L of chlorine-containing disinfectant (or can achieve a high level of disinfection of disinfection wipes/ dry wipes) to completely remove the pollutants, and then in accordance with the vehicle without visible pollutants treatment. Pay attention to the protection of precision instruments during spraying disinfectant.

RELATED LINKS: Guidelines for the Disposal of The Remains of Pneumonia Patients With New Coronary Virus Infection (Trial)