One more time: Dead bodies don't spread disease

[Skeptic Ginger]

How many times must the facts be repeated before erroneous 'common knowledge' is corrected?

Once again the idiots on the news are repeating the same bad medicine, "if they don't pick up those dead bodies in Haiti, epidemics will ensue."

No, they will not.

Contaminated potable water might be an issue, dead bodies piled up in the streets or not.

The tragedy and pain of seeing piled up bodies is a real issue.

But for crying out loud, do these news reporters have such a short term memory deficit they've already forgotten the lack of infection risk from piled up bodies was clarified in the last mass casualty disaster, and the one before that, and the one before that?

Is Dr Gupta on CNN unaware of that fact given his medical expertise? Has he not corrected the idiots reporting on Haiti, at least on CNN?

Apparently not. :rolleyes:

[Skeptical Greg]

Some Dr. was straitening Diane ( PicklePuss ) Sawyer out on this, on a spot I saw tonight .

[Eos of the Eons]

Maybe they mean an epidemic of maggots? *ducks and runs*

[patchbunny]

How many times must the facts be repeated before erroneous 'common knowledge' is corrected?

Apparently at least one more time. It's news to me.

[Slimething]

Maybe they mean an epidemic of maggots? *ducks and runs*

My thoughts, too. I think it's a metaphor for the carrion that attracts vectors and the liquefied flesh that grown pathogens and gets into everything. And the zombies. Let's not forget the zombies.

[Skeptic Ginger]

Apparently at least one more time. It's news to me.
I have no issue that members of the public have yet to learn this supposed common knowledge is bunk. My issue is that the news media continues to perpetuate the falsehood. They have no excuse. It's been brought to their attention time and time again.

[Skeptic Ginger]

My thoughts, too. I think it's a metaphor for the carrion that attracts vectors and the liquefied flesh that grown pathogens and gets into everything. And the zombies. Let's not forget the zombies.The zombies....:eek: ... the zombies!

Quick, get your head smashing weapons out, must destroy the brains, must destroy the brains.

[Eos of the Eons]

If you only smash the brains you leave the rest to parasites that will get zombified by the eating of the zombied flesh. They will get a thirst for human brainz, and then you'll see an epic epidemic!


I think it's a metaphor for the carrion that attracts vectors and the liquefied flesh that allows for the growth of pathogens and gets into everything.

Fixed that for ya
:D

[Fnord]

I have no issue that members of the public have yet to learn this supposed common knowledge is bunk. My issue is that the news media continues to perpetuate the falsehood. They have no excuse. It's been brought to their attention time and time again.

No excuse? Keeping anxious viewers tuned in so that the sponsor will pay more for the advertising time isn't enough of an excuse?

;)

[KingMerv00]

I have no issue that members of the public have yet to learn this supposed common knowledge is bunk. My issue is that the news media continues to perpetuate the falsehood. They have no excuse. It's been brought to their attention time and time again.

Would you mind posting a link then? :)

[jasonpatterson]

I have no issue that members of the public have yet to learn this supposed common knowledge is bunk. My issue is that the news media continues to perpetuate the falsehood. They have no excuse. It's been brought to their attention time and time again.

Well heck, they also 'report both sides of the vaccination controversy' as if the anti-vaxxers had a leg to stand on, and all the rest. It sucks, but I don't expect much of anything in the way of correctness from the news as regards science.

[Ziggurat]

Contaminated potable water might be an issue, dead bodies piled up in the streets or not.

If water infrastructure doesn't work and people have to get water from ditches, creeks, etc, then don't these two issues become related?

[Ivor the Engineer]

The zombies....:eek: ... the zombies!

Quick, get your head smashing weapons out, must destroy the brains, must destroy the brains.

If there's one thing the Haitian people should know how to deal with, it's zombies. (http://en.wikipedia.org/wiki/Haitian_Vodou#Myths_and_misconceptions)

[Undesired Walrus]

I have no issue that members of the public have yet to learn this supposed common knowledge is bunk.

It's a shame we aren't all as wonderful as you.

[Ivor the Engineer]

If water infrastructure doesn't work and people have to get water from ditches, creeks, etc, then don't these two issues become related?

I think the mixing of daily excreta produced by the living with sources of drinking water and food spreads disease long before runoff from dead bodies does.

[Darat]

If water infrastructure doesn't work and people have to get water from ditches, creeks, etc, then don't these two issues become related?

That was my first thought; plus of course the bodies will be food for animals such as rats, which again will contribute to disease being spread. I can't see how a dead body rotting in the middle of a street where people are living won't contribute to disease spreading and so on.

[Darat]

I think the mixing of daily excreta produced by the living with sources of drinking water and food spreads disease long before runoff from dead bodies does.


What about rats? They can be disease vectors for a myriad of diseases - such as typhus and even plague.

[Ivor the Engineer]

What about rats? They can be disease vectors for a myriad of diseases - such as typhus and even plague.

What did the people die of? I thought it was large objects falling on them, blood loss and (presumably about now) dehydration. So there is no disease for the possible vectors to spread from the bodies.

[Ivor the Engineer]

For those not convinced:

http://scienceblogs.com/effectmeasure/2008/05/once_again_dead_bodies_dont_ca.php

[Darat]

What did the people die of? I thought it was large objects falling on them, blood loss and (presumably about now) dehydration. So there is no disease for the possible vectors to spread from the bodies.

I wasn't meaning that the likes of rats would pick up diseases from the bodies rather that such a ready source of food for rats would encourage rats into areas where they will have more contact with survivors and the food and water supplies and that would help spread diseases.

[Darat]

For those not convinced:

http://scienceblogs.com/effectmeasure/2008/05/once_again_dead_bodies_dont_ca.php

I don't think anyone thinks that diseases somehow spontaneous arise from the dead bodies and according to the link "The major threats after a disaster come from dirty water and unsafe food and lack of sanitation facilities. The latter creates more contaminated water and unsafe food. When people start getting diarrheal disease the whole thing becomes a terrible positive feedback loop.". And if you've got more animals, such as rats, running about because of an increased food supply then they will contribute to the contamination of water and food supplies.

[Fiona]

I think it is interesting. Like Darat I did not believe that disease spontaneously arises from dead bodies: but nevertheless I did think that they constitute a health hazard because of flies and rats and that kind of thing flourishing and spreading the disease which is already there.

But I notice that the article Ivor linked talks about the human rights of families and the need to treat dead people with respect and follow local custom. All of which I grant; and I know from reading about the work Patrizia Stefanoni did after the Tsunami that people go to great lengths to identify everyone after a disaster.

But I can't help but wonder how you balance these things. Most places do not have a custom of disposing of their dead by having them eaten (the towers of silence are an exception) and I think that the idea that those who are dear to you will become food for dogs and rats etc might be quite as distressing. I do not know really.

I also wonder what the impact of unburied bodies is on mental health. I imagine that the trauma of major disasters is great and perhaps it makes not a lot of difference if the bodies are in your face or not. But I find that hard to believe

Is there research on how people actually react to these things? The linked article says that the fear of disease cause people to spend time and resources on things which are not necessary at the cost of more useful activity. Well if there is a shortage of manpower for useful stuff then yes: but there is also the "boil water" effect: and it is not nothing. How does that factor in?

[GreyICE]

The fear does not originate, as the article quoted by Ivor suggests, from:

The idea that dead bodies have to be buried quickly or doused in disinfectant comes from a primal fear that seems almost impossible to eradicate.

It comes from the fact that in the past, dead bodies tend to pile up in uncontrollable numbers after a plague. Plagues do leave contaminated bodies, obviously.

Given everything, I think the best solution would be to airseal a warehouse and use nitrogen tanks to purge the interior, and then use a monitor to check oxygen levels. That should stop the aerobic bacteria from working.

P.S. The fear is perfectly rational.

P.P.S. If there's any risk the water supply is contaminated, you boil it. Common sense.

[Dikken]

I thought that one of the dangers of ebola was the transmission of the disease during the washing of the bodies prior to burial.

[truethat]

I agree with Darat and Fiona, although I have to say I didn't really realize that I did think that dead bodies spread disease.

My bad.

Just seems horribly unhealthy to have dead bodies everywhere emitting gasses and whatnot. Certainly flies and rats and other animals coming out would not seem healthy.

[Fiona]

A very good point about plague, Greyice: one of those which had not occurred to me but as soon as you said it it was very obvious. Thanks for that

[fls]

i dunno. It seems like dead bodies would make a lovely culture medium.

Linda

[BenBurch]

i dunno. It seems like dead bodies would make a lovely culture medium.

Linda

You also have to factor in the WHERE. There is just a lot of disease in Haiti to begin with.

HIV infection is in more than 1/8 of the population. So careful handling of bodies and fluids from them is really vital.

[BenBurch]

There also was a diphtheria outbreak this last year.

[patrick767]

So can we go so far as to say people drinking water from a cistern that has a dead body in it are not at increased risk of disease? That's the sort of thing that I've always heard. Corpses contaminating a water supply is bad and not just because that would be some nasty tasting water. True or not?


It comes from the fact that in the past, dead bodies tend to pile up in uncontrollable numbers after a plague. Plagues do leave contaminated bodies, obviously.

Certainly. The bodies themselves would be plague ridden at least when very fresh. Probably more importantly in times past, they'd attract the rats that harbored the fleas that carried the worst documented plague in history and probably other diseases at various times.

[BenBurch]

Water boiling is fine and well if you have time, fuel, fire, and a vessel. And if you have the education to know you need to.

[Piscivore]

Aren't the intestines of bodies filled with E Coli when they are alive? Do those bacteria just go away when they die?

[dudalb]

My thoughts, too. I think it's a metaphor for the carrion that attracts vectors and the liquefied flesh that grown pathogens and gets into everything. And the zombies. Let's not forget the zombies.

Hell, Haiti is where the word "Zombies" originated.

[dudalb]

You also have to factor in the WHERE. There is just a lot of disease in Haiti to begin with.

.

No kidding. Napoleon lost a whole Army to disease when he was trying to reconquer Haiti circa 1803. And that was a big factor in his decision to give up his ideas for a French empire in the Americas and to sell Louisiana to the US to cut his losses.

[AvalonXQ]

If you only smash the brains you leave the rest to parasites that will get zombified by the eating of the zombied flesh. They will get a thirst for human brainz, and then you'll see an epic epidemic!

OH NOES! Not an epicdemicTM!

[JoeTheJuggler]

Contaminated potable water might be an issue, dead bodies piled up in the streets or not.
So is the ability to use the streets to get trucks and ambulances in and out--especially since so many streets are broken.

The tragedy and pain of seeing piled up bodies is a real issue.
And that's pretty important. I can't imagine what the people of Haiti are going through, but I think it would have to be made worse by the sight of tens of thousands of dead bodies--possibly including the bodies of loved ones.

Dumping them into a mass grave seems to be a very practical way of dealing with it.

[ktesibios]

Aren't the intestines of bodies filled with E Coli when they are alive? Do those bacteria just go away when they die?

As Revere pointed out in his blog post, if the organisms are adapted to life in the environment of a human's innards, it's reasonable to expect them to die off due to the destruction of their habitat.

Also, while there are specific strains of E. Coli that are pathogenic, in general the bacteria that inhabit us are just along for the ride. There's no reason to expect them suddenly to turn dangerous just because we've had the bad luck to get gished by a collapsing building.

[Ivor the Engineer]

<snip>

Given everything, I think the best solution would be to airseal a warehouse and use nitrogen tanks to purge the interior, and then use a monitor to check oxygen levels. That should stop the aerobic bacteria from working.

<snip>

"Sorry, we haven't got any drinking water or food for you or the other several thousand people in the queue yet, we're busy filling this warehouse with dead people."

[Ixion]

No kidding. Napoleon lost a whole Army to disease when he was trying to reconquer Haiti circa 1803. And that was a big factor in his decision to give up his ideas for a French empire in the Americas and to sell Louisiana to the US to cut his losses.

IIRC, He lost most of his army to yellow fever and malaria, carried by mosquitoes. Last I checked, mosquitoes don't bite the dead.

[Fiona]

???

Ivor you cannot make food or water appear by refraining from moving dead bodies. If there is more urgent work to be done then I presume that we can rely on the aid agencies to prioritise: if it is your case that they are unable to do so because they do not know that dead bodies are not lethal then you might be right: but I really doubt it.

I think this is a false dichotomy and I have the impression that the situation is more complicated than you imply. Busy work is important in crisis situations: people's reactions to what they see are important too (though I do not know if facing bodies in the street fades to insignificance for all or many or some in this kind of disaster). Clearing bodies out of the way of emergency vehicles matters I would think.

Do you really think that people with a lot of experience cannot make sound judgements because they all buy into a myth which has been shown to be a myth? I am not convinced

[fls]

How many times must the facts be repeated before erroneous 'common knowledge' is corrected?

Once again the idiots on the news are repeating the same bad medicine, "if they don't pick up those dead bodies in Haiti, epidemics will ensue."

No, they will not.

Contaminated potable water might be an issue, dead bodies piled up in the streets or not.

The tragedy and pain of seeing piled up bodies is a real issue.

But for crying out loud, do these news reporters have such a short term memory deficit they've already forgotten the lack of infection risk from piled up bodies was clarified in the last mass casualty disaster, and the one before that, and the one before that?

Is Dr Gupta on CNN unaware of that fact given his medical expertise? Has he not corrected the idiots reporting on Haiti, at least on CNN?

Apparently not. :rolleyes:

I don't actually expect reporters to ever get the facts right, which means that it doesn't bug me when they don't. :)

I would think (hope?) that the professionals involved on the ground would know what the risks are and are not, so I'm not sure how much it matters whether Joe Blow sitting in his armchair in Podunk knows.

Linda

[Ivor the Engineer]

???

Ivor you cannot make food or water appear by refraining from moving dead bodies. If there is more urgent work to be done then I presume that we can rely on the aid agencies to prioritise: if it is your case that they are unable to do so because they do not know that dead bodies are not lethal then you might be right: but I really doubt it.

I think this is a false dichotomy and I have the impression that the situation is more complicated than you imply. Busy work is important in crisis situations: people's reactions to what they see are important too (though I do not know if facing bodies in the street fades to insignificance for all or many or some in this kind of disaster). Clearing bodies out of the way of emergency vehicles matters I would think.

Do you really think that people with a lot of experience cannot make sound judgements because they all buy into a myth which has been shown to be a myth? I am not convinced

:confused:

The professionals will know what needs to be done and when.

[AvalonXQ]

Last I checked, mosquitoes don't bite the dead.

Wait, so the zombie epicdemicTM is already immune to the majority of Haiti's air defenses?!

[Ivor the Engineer]

Here's a paper on the risks of dead bodies in such situations:

http://publications.paho.org/english/dead_bodies.pdf

[Soapy Sam]

Hands up everyone on this forum who ever smelled a days old corpse.

Not a prettified, enbalmed, refrigerated corpse. A warm, cosy , rat, cat and dog gnawed, maggot infested, blowfly ridden corpse.

OK. Now keep your hand up if you ever smelled a thousand of them.

Believe me. Burying dead people IS a priority. Maybe no in Wisconsin, or Glasgow, but by Monday in Port au Prince, it really will be.

[mhaze]

If water infrastructure doesn't work and people have to get water from ditches, creeks, etc, then don't these two issues become related?

And the explosion of rats.

[Ivor the Engineer]

And the explosion of rats.

http://www.vetmed.ucdavis.edu/vetext/INF-DI/ZVBD-nat-disasters.pdf

Rodent vectors

It would be understandable to worry that after natural disasters rodents, such as rats and mice, might increase in numbers and act as vectors, posing an increased risk of disease to survivors and response personnel.

Rodents are associated with many zoonotic diseases including:


Plague8
Salmonellosis9
Leptospirosis10
Rocky Mountain spotted fever11
Tularemia12


However, after natural disasters the number of rodent vectors decreases as a result of drowning, illness and destruction of their habitats.


Populations of rats and mice usually do not begin to increase again until 6 to 10 months after a disaster.13
Traps and baits commonly sold in grocery, garden and hardware stores, if regularly used according to package directions, can keep household rodent numbers low.


http://www.paho.org/english/DD/PED/te_rdes.htm

Rodents and Mice in Natural Disasters

When natural disasters strike, rats and mice endure the same suffering as humans do. Many of them are crushed to death or drowned, die of starvation, or fall prey to infections. Their populations are frequently decimated. Moreover, there is often displacement among the survivors, who wander to new areas in search of protection, shelter, and food. Fearful and disorganized, it takes time for them to regroup and reorganize their social behavior, become familiar with their new environment, find safe havens, locate food and water, and memorize their movements. All this occurs before they reproduce again. Reproductive activity among wild rodents and commensal rats usually declines during the rainy season.

Colony building and reproduction only will begin when their new ecosystem has stabilized. Thus, the reestablishment of a rodent population after a disaster will take six to ten months under favorable conditions.

The infections carried by the new populations can be transmitted to people when the conditions favor contact with contaminated rodent urine or feces or with their ectoparasites, vectors of the infections. This contact also occurs between various species of commensal and wild rodents, permitting transmission and cases of emerging or heretofore unknown infections in new geographical areas.

In conclusion, during the emergency the spread infection by rodents will not be an immediate concern. However, the activity and growth of rodent populations should be monitored as part of the surveillance of these diseases.

[ElMondoHummus]

The US CDC has got a collection of good information on this topic:
http://www.bt.cdc.gov/disasters/

[Andrew Wiggin]

I thought the traditional solution to too many bodies was a pit and quicklime or somesuch. Other than leaving them to rot, what do the modern disaster consultants say?

A

[Magyar]

Hands up everyone on this forum who ever smelled a days old corpse.

Not a prettified, enbalmed, refrigerated corpse. A warm, cosy , rat, cat and dog gnawed, maggot infested, blowfly ridden corpse.

OK. Now keep your hand up if you ever smelled a thousand of them.

Believe me. Burying dead people IS a priority. Maybe no in Wisconsin, or Glasgow, but by Monday in Port au Prince, it really will be.


I think this brings up a subject that hasn't been talked about. Perhaps it did start out on erroneous facts but I think that the psychological toll on "normal" people seeing bodies in that kind of condition and quantity contributes to raising emotional stress, anger, which leads to higher possibility of riots and disorder.

When ever something like this happens people always talk about "why does it take so long to get help there" Or "why don't we just drop food/water out of planes"

For rescue workers THE number one issue when going into a place like this is creating some level of security and order. I guess it's just part of the human condition, but people in these kinds of conditions abandon civility pretty quickly - some faster than others - as you could see on CNN yesterday even in small crowds.

[fuelair]

Hands up everyone on this forum who ever smelled a days old corpse.

Not a prettified, enbalmed, refrigerated corpse. A warm, cosy , rat, cat and dog gnawed, maggot infested, blowfly ridden corpse.

OK. Now keep your hand up if you ever smelled a thousand of them.

Believe me. Burying dead people IS a priority. Maybe no in Wisconsin, or Glasgow, but by Monday in Port au Prince, it really will be.

Putrescene and Cadaverene: products of decay of bodies, odor alone frequently induces vomiting (not good for starving/dehydrated living persons).

[Fiona]

There was a rat died under the floor in an office I was working in last year. Just one rat. The smell made it impossible to work there, for just the reason fuelair cites. I did not fear it was spreading disease in the way suggested. But it wasn't nothing

[Eos of the Eons]

The OP doesn't suggest nothing be done, or that it is in any way okay to leave bodies rotting all over.

Contaminated potable water might be an issue, dead bodies piled up in the streets or not.

The tragedy and pain of seeing piled up bodies is a real issue.

But for crying out loud, do these news reporters have such a short term memory deficit they've already forgotten the lack of infection risk from piled up bodies was clarified in the last mass casualty disaster, and the one before that, and the one before that?

Is Dr Gupta on CNN unaware of that fact given his medical expertise? Has he not corrected the idiots reporting on Haiti, at least on CNN?

Apparently not. :rolleyes:
The OP addresses the media misinformation and the failure to improve despite their "experts".

What infectious disease is a risk from a dead body? INFECTIOUS. This means communicable. Infectious diseases require a living host because they use you to make more of themselves, especially viruses. Infectious means it can be passed person to person. You won't get HIV from a dead decaying body. You won't get measles from a dead decaying body. You won't get the flu from a dead decaying body.

I knew someone who was studying to become a reporter, and they had to define a lot of words and make sure they were using them properly. But, since they are ignorant of anything else, especially science, they still can't use some words properly and quite often can't even find an "expert" to do it for them without putting words in the expert's mouth, or finding a pseudoexpert that does a worse hackjob on the topic than the journalist even would. [aside: are there any journalists that have backgrounds in specializations like history, geology, biology, etc.]

It drives me crazy too, as people then go on to blather on ignorantly about what this or that article said without even knowing they sound ridiculous too, even though it's not really their fault.

[Ivor the Engineer]

The OP doesn't suggest nothing be done, or that it is in any way okay to leave bodies rotting all over.


The OP addresses the media misinformation and the failure to improve despite their "experts".

What infectious disease is a risk from a dead body? INFECTIOUS. This means communicable. Infectious diseases require a living host because they use you to make more of themselves, especially viruses. Infectious means it can be passed person to person. You won't get HIV from a dead decaying body. You won't get measles from a dead decaying body. You won't get the flu from a dead decaying body.

I knew someone who was studying to become a reporter, and they had to define a lot of words and make sure they were using them properly. But, since they are ignorant of anything else, especially science, they still can't use some words properly and quite often can't even find an "expert" to do it for them without putting words in the expert's mouth, or finding a pseudoexpert that does a worse hackjob on the topic than the journalist even would.

It drives me crazy too, as people then go on to blather on ignorantly about what this or that article said without even knowing they sound ridiculous too, even though it's not really their fault.

While there is little risk to the general population from dead bodies, there is a risk to those who have to handle and/or move the dead from diseases such as HIV and Hepatitis B. In the article (http://publications.paho.org/english/dead_bodies.pdf) I posted earlier it recommended such people wear basic protective equipment and practice good hygiene to reduce their risk of contracting diseases from exposure to the bodily fluids of cadavers.

[Estellea]

To be fair Eos, cadavers can be a source of infection for numerous diseases such as HIV, HBV, HCV, cholera, typhoid and viral haemorrhagic fevers. But the risk of infections of survivors by those doesn't appear to be higher during a natural disaster, which is what the OP (I believe) was discerning, contrary to what the media reports.

Este

[babbits]

Apparently at least one more time. It's news to me.

Cholera or hemorrhagic fevers can be transmitted if people are drinking runoff water. And this is not unimaginable, since sources of clean drinking water are always interrupted after a serious earthquake.

But the disease would have to be present in the earthquake victims in order for the surface water to be contaminated. That's what's unlikely.

[Eos of the Eons]

To be fair Eos, cadavers can be a source of infection for numerous diseases such as HIV, HBV, HCV, cholera, typhoid and viral haemorrhagic fevers. But the risk of infections of survivors by those doesn't appear to be higher during a natural disaster, which is what the OP (I believe) was discerning, contrary to what the media reports.

Este
You have to pretty much have to get their body fluid in your blood system x hours after death to get any of those diseases right? Those diseases don't spread via human death meltdown into the water system, etc. So, to be fair, unless you are taking a dead body and squeezing it into an open wound of yours, then calling dead bodies a source of infectious disease is quite a stretch.

[Eos of the Eons]

While there is little risk to the general population from dead bodies, there is a risk to those who have to handle and/or move the dead from diseases such as HIV and Hepatitis B. In the article (http://publications.paho.org/english/dead_bodies.pdf) I posted earlier it recommended such people wear basic protective equipment and practice good hygiene to reduce their risk of contracting diseases from exposure to the bodily fluids of cadavers.
There is only a real risk x amount of time after death, and especially with HIV, only a risk x amount of time after death if their blood comes into contact with yours somehow. The risk is incredibly minimal even to those handling the dead bodies extremely carelessly.

[EeneyMinnieMoe]

I know I'll sound like the least informed person here- but isn't it very important to bury or destroy bodies quickly after a cholera epidemic (and plague epidemic, as mentioned before)?

Cholera isn't an air borne disease, of course, but dead bodies can certainly contaminate the water supply and spread cholera through dirty water.

I think I just answered my own question.

[The Fallen Serpent]

The point I have picked up is that the clearing of the dead needs to take account the actual situation. Rescue, supply and security for the living victims is of utmost importance. How dead bodies affect those issues determines the priority of body clearing and the proper methods to do so. With an epidemic outbreak of certain diseases, these bodies need to be disposed of or more really separated from the living with reasonable haste. In a natural disaster such as this it is best to protect against the mental anguish and exposure to nauseating conditions these bodies cause but proper time to identify the dead and handle the remains as is appropriate for the families can be done. No need to over react and prioritize removing bodies from the rubble to burn or bury with lye while people are still trapped and in need of assistance.

[Eos of the Eons]

I know I'll sound like the least informed person here- but isn't it very important to bury or destroy bodies quickly after a cholera epidemic (and plague epidemic, as mentioned before)?

Cholera isn't an air borne disease, of course, but dead bodies can certainly contaminate the water supply and spread cholera through dirty water.

I think I just answered my own question.
lol, of course you're not totally misinformed. It is spread by live peoples' feces in water. So, if a person is dead x amount of time and their feces manage to contaminate water sources in x amount time after death IF they had cholera, then there might be a concern. There is more concern about live people spreading the disease though.

V. cholerae seemed to simply “disappear” at times when cases were not occurring (prior to the arrival of the monsoons (http://daac.gsfc.nasa.gov/CAMPAIGN_DOCS/atmospheric_dynamics/ad_images_dao_animations.html) in South Asia, for example). How does an epidemic get its start if humans are not the source of the initial infection?


...Seasonally dependent epidemics can now be described in ecological terms (http://geo.arc.nasa.gov/esdstaff/health/projects/cholera/cholera.html). Warm, intense episodes of precipitation falling on coastal and nearby inland regions transforms the temperature and salinity profiles of estuaries. These changes create favorable growth conditions for the dormant bacterium, and also, most importantly, for phytoplankton species. Humans that harvest (http://www.ocean.udel.edu/mas/masnotes/rawshellfish.html) these contaminated food organisms in spring-time, and ingest them raw place themselves and the rest of their local communities at risk from acquiring cholera. A bacterial cell concentration of 103/ml of water is necessary to allow an infectious dose of V. cholerae to accumulate within mollusks and crustaceans.

http://www.medicalecology.org/water/cholera/cholera.htm

There are many variables that lead to disease outbreaks. The live people are more likely to cause disease spread now that there are limited resources to ensure water quality. Cleaning up dead bodies is essential for other reasons.

[HarryKeogh]

In an article on cnn.com today...

http://www.cnn.com/2010/HEALTH/01/14/haiti.mass.fatalities.bodies/index.html?hpt=T2

The fear of disease is frequently the reason for rapidly burying bodies in mass graves. But contrary to popular belief, bodies do not cause epidemics after natural disasters, experts said.
"The reality is that most of the disease that live in us -- once our body is dead they can't survive very long," said Oliver Morgan, an epidemiologist at the Centers for Disease Control and Prevention.
Fecal matter from the deceased could contaminate the water supply, posing a risk, but "it's nowhere near the risk of all the survivors living in the streets with no sanitation," said Morgan, who contributed to the World Health Organization's guidelines on managing bodies after a natural disaster.
There has never been an epidemic after a natural disaster that was traced to exposure to bodies, according to the WHO.

[Skeptic Ginger]

If water infrastructure doesn't work and people have to get water from ditches, creeks, etc, then don't these two issues become related?Dead bodies are not the issue. Unpotable water is no worse because dead bodies are in it than if sewage is in it.

[Skeptic Ginger]

I thought that one of the dangers of ebola was the transmission of the disease during the washing of the bodies prior to burial.And the mass casualties from tsunamis and earthquakes are infected with ebola, how?

[Skeptic Ginger]

i dunno. It seems like dead bodies would make a lovely culture medium.

LindaAs does a garbage dump. Should we fear garbage dumps as sources of epidemics?

[Skeptic Ginger]

So can we go so far as to say people drinking water from a cistern that has a dead body in it are not at increased risk of disease? That's the sort of thing that I've always heard. Corpses contaminating a water supply is bad and not just because that would be some nasty tasting water. True or not?So is a human corpse worse than a few rats in the same cistern?

But more importantly, tell me how bodies piled up in the streets end up in cisterns?

[Skeptic Ginger]

Aren't the intestines of bodies filled with E Coli when they are alive? Do those bacteria just go away when they die?Those would be the same e-coli we all have in our intestines. They are critical for digesting food.

You may be thinking of pathogenic e-coli. Those are not typical normal flora of the human gut.

[Skeptic Ginger]

No kidding. Napoleon lost a whole Army to disease when he was trying to reconquer Haiti circa 1803. And that was a big factor in his decision to give up his ideas for a French empire in the Americas and to sell Louisiana to the US to cut his losses.So now all infectious microorganisms are a single disease?

Good grief!

The Haitian Debacle: Yellow Fever and the Fate of the French (http://www.entomology.montana.edu/historybug/napoleon/yellow_fever_haiti.htm)

[BenBurch]

Hep-A can live outside of the body for weeks and weeks. I think it is silly to say you can disregard safe procedure in handling mass casualties.

[Skeptic Ginger]

So is the ability to use the streets to get trucks and ambulances in and out--especially since so many streets are broken.


And that's pretty important. I can't imagine what the people of Haiti are going through, but I think it would have to be made worse by the sight of tens of thousands of dead bodies--possibly including the bodies of loved ones.

Dumping them into a mass grave seems to be a very practical way of dealing with it.[SIDE TRACK/STRAW MAN] Go find another thread. There are several of them to choose from.

[Skeptic Ginger]

I don't actually expect reporters to ever get the facts right, which means that it doesn't bug me when they don't. :)

I would think (hope?) that the professionals involved on the ground would know what the risks are and are not, so I'm not sure how much it matters whether Joe Blow sitting in his armchair in Podunk knows.

LindaSince I witnessed CNN repeating this particular myth, I've not seen them focusing on it as they have in past mass casualty disasters. So maybe they are learning.

But at some point, I do think it is legitimate to note the news media is still claiming the Earth is flat. And the claim one must bury all the bodies post haste because disease is pending if not, is the equivalent of claiming the Earth is flat.

[Skeptic Ginger]

Here's a paper on the risks of dead bodies in such situations:

http://publications.paho.org/english/dead_bodies.pdfThis is proof you are capable of learning.

[Skeptic Ginger]

Hands up everyone on this forum who ever smelled a days old corpse.

Not a prettified, enbalmed, refrigerated corpse. A warm, cosy , rat, cat and dog gnawed, maggot infested, blowfly ridden corpse.

OK. Now keep your hand up if you ever smelled a thousand of them.

Believe me. Burying dead people IS a priority. Maybe no in Wisconsin, or Glasgow, but by Monday in Port au Prince, it really will be.And another straw man sucks eggs.

Please re-read what the thread is about.

Thank you.

[Skeptic Ginger]

And the explosion of rats.So that's your claim then? We must hurry and bury the bodies lest we have a rat population explosion?

[Skeptic Ginger]

I thought the traditional solution to too many bodies was a pit and quicklime or somesuch. Other than leaving them to rot, what do the modern disaster consultants say?

AThey say, take photos so relatives can determine where lost loved ones lie, then bury them. They say do not bulldoze the bodies into mass graves under the misconception leaving the bodies unburied risks some nebulous epidemic risk.

And this is not the priority. The priority in the first week after a mass casualty event such as a major earthquake is to dig out the living and get food, water and shelter to the survivors.

[Skeptic Ginger]

I think this brings up a subject that hasn't been talked about. Perhaps it did start out on erroneous facts but I think that the psychological toll on "normal" people seeing bodies in that kind of condition and quantity contributes to raising emotional stress, anger, which leads to higher possibility of riots and disorder.

When ever something like this happens people always talk about "why does it take so long to get help there" Or "why don't we just drop food/water out of planes"I'd say it's clear, we need to better educate people ahead of a disaster that food, water and shelter are going to take 72 hours or more to get there.

That is what our local disaster plan includes preparation for. It's unmet expectations causing much of the problem today in Haiti, not dead bodies in the streets.

People get desperate if they don't know what to expect or if what they expect does not happen. If they know that food and water will be 72 hours away, they know what is happening has an end. If they think rescue should be now, they don't understand why help hasn't yet arrived.

You seem to be claiming that removal of dead bodies should precede distributing food and water. And that will make people calmer? Seriously?

For rescue workers THE number one issue when going into a place like this is creating some level of security and order. I guess it's just part of the human condition, but people in these kinds of conditions abandon civility pretty quickly - some faster than others - as you could see on CNN yesterday even in small crowds.So scooping up the bodies is your first priority?

[Skeptic Ginger]

While there is little risk to the general population from dead bodies, there is a risk to those who have to handle and/or move the dead from diseases such as HIV and Hepatitis B. In the article (http://publications.paho.org/english/dead_bodies.pdf) I posted earlier it recommended such people wear basic protective equipment and practice good hygiene to reduce their risk of contracting diseases from exposure to the bodily fluids of cadavers.Unless you are sucking the blood of the dead, or unless they have ebola, even handling dead bodies is not going to infect anyone, given basic easily managed precautions: don't suck on bloody dead bodies. :rolleyes:

Seriously! Your skin makes a fine barrier against bloodborne viruses. Hand washing would be nice. But unless you are eating the blood off your hands, tell me how many people are getting hep B or HIV from handling corpses?

I don't know of a single case documented in the literature. Perhaps someone can find a case for us. Ebola, yes. Hep B or HIV, not too likely.

[Skeptic Ginger]

To be fair Eos, cadavers can be a source of infection for numerous diseases such as HIV, HBV, HCV, cholera, typhoid and viral haemorrhagic fevers. But the risk of infections of survivors by those doesn't appear to be higher during a natural disaster, which is what the OP (I believe) was discerning, contrary to what the media reports.

EsteI've made no claims bloodborne organisms all die with the host. This is not about mortuary worker occupational hazards.

You are correct, the OP is saying, "the risk of infections of survivors by those [infectious organisms] doesn't appear to be higher during a natural disaster", (ebola epidemics excepted).

[autumn1971]

But what of the miasmas?!
Or the Humours?
Don't even get me started on the evil night-vapours.

[Skeptic Ginger]

Cholera or hemorrhagic fevers can be transmitted if people are drinking runoff water. And this is not unimaginable, since sources of clean drinking water are always interrupted after a serious earthquake.

But the disease would have to be present in the earthquake victims in order for the surface water to be contaminated. That's what's unlikely.And AFAIK, there was not an epidemic of cholera in Haiti just prior to the earthquake.

[Skeptic Ginger]

I know I'll sound like the least informed person here- but isn't it very important to bury or destroy bodies quickly after a cholera epidemic (and plague epidemic, as mentioned before)?

Cholera isn't an air borne disease, of course, but dead bodies can certainly contaminate the water supply and spread cholera through dirty water.

I think I just answered my own question.All you need to be concerned about in a cholera epidemic is the water supply. And it doesn't take a corpse to contaminate a water source, it takes fecal material getting into water that is not treated before the next person drinks it. There was one famous epidemic that occurred because a person with cholera flushed his crap down the john on a train as it was going over a bridge on a river. An epidemic then occurred in the town downstream from the bridge.

[Skeptic Ginger]

In an article on cnn.com today...

http://www.cnn.com/2010/HEALTH/01/14/haiti.mass.fatalities.bodies/index.html?hpt=T2
Yes, I have to admit that after I posted the OP, CNN cleaned up their act a tad.

Good for them.

[Skeptic Ginger]

It's a shame we aren't all as wonderful as you.Are you bothered having some misinformation you've been clinging to challenged?

[Skeptic Ginger]

That was my first thought; plus of course the bodies will be food for animals such as rats, which again will contribute to disease being spread. I can't see how a dead body rotting in the middle of a street where people are living won't contribute to disease spreading and so on.And I fail to see how that dead body will contribute to the spread of disease.

[Skeptic Ginger]

I think it is interesting. Like Darat I did not believe that disease spontaneously arises from dead bodies: but nevertheless I did think that they constitute a health hazard because of flies and rats and that kind of thing flourishing and spreading the disease which is already there. It's an hypothesis. Now you just need to see if your hypothesis squares with the evidence, rather than assuming your hypothesis constitutes facts one can support a conclusion with.

But I notice that the article Ivor linked talks about the human rights of families and the need to treat dead people with respect and follow local custom. All of which I grant; and I know from reading about the work Patrizia Stefanoni did after the Tsunami that people go to great lengths to identify everyone after a disaster.

But I can't help but wonder how you balance these things. Most places do not have a custom of disposing of their dead by having them eaten (the towers of silence are an exception) and I think that the idea that those who are dear to you will become food for dogs and rats etc might be quite as distressing. I do not know really.

I also wonder what the impact of unburied bodies is on mental health. I imagine that the trauma of major disasters is great and perhaps it makes not a lot of difference if the bodies are in your face or not. But I find that hard to believeWhat, you don't think the effects of the earthquake are enough? The dead bodies in the streets must be so much more traumatic we need to get those bodies out of sight as the first priority?

No one is saying dead bodies piled up in the streets is a minor thing. All I said in the OP was that we know from the evidence regarding epidemiology that unburied mass casualties are not a source of epidemics. I said it is time for the news media to remember this basic common knowledge fact since it has been pointed out to them time and time again in disaster after disaster.

Is there research on how people actually react to these things? The linked article says that the fear of disease cause people to spend time and resources on things which are not necessary at the cost of more useful activity. Well if there is a shortage of manpower for useful stuff then yes: but there is also the "boil water" effect: and it is not nothing. How does that factor in?How does boiling water factor in? Are you serious?

There are still people who might be saved if people dig them out. There are people who will die without food, water, medical attention, and security. No one is going to die immediately because there are bodies in the street.

[dropzone]

The other day I gouged my leg on a hunk of relatively-clean angle iron, my bedframe. The old dear is 86 so me mum's immediate fear was that I would contract tetanus from the rusty metal. I had to explain how tetanus had nothing to do with rust and was really an anaerobic bacterium connected with barnyards and the ways it could be introduced into people included getting jabbed by rusty, and dirty, nails and other sharp objects found and contaminated in barnyards.

For the most part my bedroom has been minimally-affected by anaerobic bacteria and the wound continues to heal with no untoward locking of my jaws as I ponder the world's problems.

[Cynic]

And I fail to see how that dead body will contribute to the spread of disease.


Yes you do.

It's naive to think that distraught, untrained people are going to take the proper precautions while handling mangled, likely bleeding bodies whose clothing will have also be soiled with urine and excrement -- bodies that under the circumstances might have died minutes beforehand. It's naive to think that these same people are going to have jugs of hand sanitizer, body bags, gloves, and the knowledge and discipline to use any sort of sterile techniques. They're going to wipe their hands on their clothes, put their fingers in their mouth (potentially transferring blood borne pathogens), wipe the tears from their eyes (potentially transferring blood borne pathogens), wipe... other things.

That's the reality. Many of those recent and soon-to-be dead people had blood borne pathogens prior to the earthquake and people who aren't careful can contract it from them. Warning the general public -- many of whom are going to have open, bleeding wounds themselves -- to avoid handling the recently deceased except under the direction of professionals and others who have been trained and equipped to understand and deal with the risks makes sense, regardless of what of myths you think have been dispelled. You grab enough bloodied dead guy's upper arms with your bare hands -- hands that are likely roughed up and bleeding from the effort of moving debris -- long enough and you will eventually catch something.

[fls]

How does boiling water factor in? Are you serious?

I think Fiona was referring to sending the husband off to boil water during childbirth.

Linda

[fls]

As does a garbage dump. Should we fear garbage dumps as sources of epidemics?

Don't you think we'd be a bit anxious if we were living in a garbage dump?

I think that the concern expressed comes from a loss or breakdown in those barriers which usually protect us from infection.

Linda

[BenBurch]

I think Fiona was referring to sending the husband off to boil water during childbirth.

Linda

Which you use to clean up after...

[fls]

But at some point, I do think it is legitimate to note the news media is still claiming the Earth is flat. And the claim one must bury all the bodies post haste because disease is pending if not, is the equivalent of claiming the Earth is flat.

Isn't that a bit dismissive of legitimate concerns?

Anyway, the news media perpetuating common myths is certainly not limited to this particular topic. :)

Linda

[BenBurch]

Don't you think we'd be a bit anxious if we were living in a garbage dump?

I think that the concern expressed comes from a loss or breakdown in those barriers which usually protect us from infection.

Linda

http://www.straight.com/article-102902/rats-yes-but-bacteria-love-garbage-strikes-too

[Fiona]

And this is not the priority. The priority in the first week after a mass casualty event such as a major earthquake is to dig out the living and get food, water and shelter to the survivors.

Did anyone disagree with that?

I'd say it's clear, we need to better educate people ahead of a disaster that food, water and shelter are going to take 72 hours or more to get there.

That is what our local disaster plan includes preparation for. It's unmet expectations causing much of the problem today in Haiti, not dead bodies in the streets.

People get desperate if they don't know what to expect or if what they expect does not happen. If they know that food and water will be 72 hours away, they know what is happening has an end. If they think rescue should be now, they don't understand why help hasn't yet arrived.

Really? I am not so sure that people get desperate because of unrealistic expectations. I would have thought that hunger, thirst, violence, injury, and helplessness would have been factors too. I am really not at all convinced that people don't know it takes time to get help to a disaster area: I think perhaps that knowledge is not much use if you have no water for 72 hours

You seem to be claiming that removal of dead bodies should precede distributing food and water. And that will make people calmer? Seriously?

So scooping up the bodies is your first priority?

I do not think anyone said anything of the kind. However you have said yourself that resources such as food and water are not immediately available for distribution. Some things can be done at once: you can try to dig trapped people out. But that is dangerous, and without heavy lifiting equipment it is not even possible in some instances. You can try to organise shattered people so that those resources you do have are used well. And you can put people to "busy" work. The feeling that you can do something constructive is helpful for traumatised people: folk do not react well to utter helplessness. And that is the point of "boil water", as fls realised

In disaster situations there is a lot of effort put into identifying those who have died (at least as I have read about dna experts following the tsunami in 2004): so it does not seem that the agencies act on the headlines which have so exercised you. At least not in that case: and so far as I know the various bodies which are first line responders tend to be the same in each of these situations: they have expertise and that expertise grows with experience.

But to follow your own style of argument: are you really arguing that it is better for people who have been devastated by a disaster do nothing? They should just sit there (with their proper understanding that bodies do not spread disease) and wait for the food and water and medical supplies to arrive? They should understand they can do nothing useful or constructive whatsoever and they should not try to do those things they actually can do on grounds that those things are not helpful in the only terms that you believe are relevant?


It's an hypothesis. Now you just need to see if your hypothesis squares with the evidence, rather than assuming your hypothesis constitutes facts one can support a conclusion with.

Sure. Did I say the hypothesis constitued facts? I thought I had said "I did think...". You seem to think that is present tense. It isn't

What, you don't think the effects of the earthquake are enough? The dead bodies in the streets must be so much more traumatic we need to get those bodies out of sight as the first priority?

Did I say it was a first priorty? I think I said that if there was more urgent work then that would of course come first. I think I said that I trusted the disaster relief agencies to know how to prioritise. I think I said that I did not know what effect bodies would have on mental health; perhaps it would make not a lot of difference in face of such trauma. I don't know. I don't think you do either.

No one is saying dead bodies piled up in the streets is a minor thing. All I said in the OP was that we know from the evidence regarding epidemiology that unburied mass casualties are not a source of epidemics. I said it is time for the news media to remember this basic common knowledge fact since it has been pointed out to them time and time again in disaster after disaster.

You did. And I think you are right, on the facts and on the evidence. it is useful to me to learn that, because I did not know it. I do not think you are completely right for reasons others have given: buildings fall on the well and the unwell, so some of those bodies will have disease: and some of that disease may be transmissable, even if that is not very likely. Animals and insects will spread disease though perhaps to a lesser extent than I had thought. But even if you are completely right there are other factors to consider, and it is perfectly legitimate to use your op as a platform to look at those other aspects. If you don't like that then perhaps, having made your point, you should leave the thread. You do not have control of how the conversation goes.

There are still people who might be saved if people dig them out. There are people who will die without food, water, medical attention, and security. No one is going to die immediately because there are bodies in the street.

See above

[Perpetual Student]

And I fail to see how that dead body will contribute to the spread of disease.

How do you know that? Have conclusive studies been conducted for every known pathogenic microbe that could be transmitted through handling or being in the proximity for an extended period of decaying dead bodies?

[Eos of the Eons]

How do you know that? Have conclusive studies been conducted for every known pathogenic microbe that could be transmitted through handling or being in the proximity for an extended period of decaying dead bodies?
Uh, yes actually. Try studying microbiology. Human infectious diseases rely on us being live hosts.

As was pointed out already in this thread, the pathogens in our bodies also die shortly after we do. Most of the parasites that then break us and our now dead pathogens down are not commonly infectious.

[JoeTheJuggler]

I've made no claims bloodborne organisms all die with the host. This is not about mortuary worker occupational hazards.

I think it is. In this situation, with corpses piled up in the streets, people mucking through them looking for loved ones, what might ordinarily be "mortuary worker occupational hazards" have become "public health hazards".

Again, dumping them into mass graves as soon as it is possible sounds like a perfectly good solution to me. Unfortunately, many people will bemoan the inability to perform their religious funeral rituals, and might claim that it somehow disrespects the dead people. I think for practical reasons, they will just have to beyond those sentiments.

It would be tragic for even one living person to die simply because of concern for respect for a dead person.

[fls]

Uh, yes actually. Try studying microbiology. Human infectious diseases rely on us being live hosts.

As was pointed out already in this thread, the pathogens in our bodies also die shortly after we do. Most of the parasites that then break us and our now dead pathogens down are not commonly infectious.

How do you explain foodbourne illness, then? It's not like the hamburger harbouring E coli is alive.

Linda

[Eos of the Eons]

How do you explain foodbourne illness, then? It's not like the hamburger harbouring E coli is alive.

Linda

I didn't say immediately after death that the pathogens aren't a concern. Spore forming microbes are the worst. Thing is, how many of those haiti corpses contain that dangerous killer e-coli? It's the disaster that killed them. As been mentioned previously in the thread, it would be a concern of there was an outbreak like that going on at the time of their deaths, and nobody is going to be eating the corpses, and how long does it take for something like that to die with the dead body? Hamburger gets consumed shortly after the dangerous contamination, and the meat would have been uncontaminated had the body not been butchered for consumption.

How long are infectious diseases able to last in a dead body, and what is the risk of that disease getting passed to others before they are dead along with their host?

The risk is extremely low, and WHO was already quoted.

[Corpse Cruncher]

And it doesn't take a corpse to contaminate a water source, it takes fecal material getting into water that is not treated before the next person drinks it. .
Excuse me I don't contaminate water, neither am I responsible for any epidemics involving bridges. I was fully exonerated of it all. :D


Aside from that. Don't forget fecal matter is also airborne. Either via plop n drop of flush and go.



Decaying bodies give off gases. Those gasses must contain particles that support or carry lurgies and all manners of other spreadable horrors.

Our bodies are crawling with bacteria and such like. I would assume a dead body, or even a decaying body, is a highly probable source of spreading infection. Basing that reports show bodies bing burned to cut down the risk of contamination nd infections add weight to the risk.

I am not sure on how long such contaminates are able to sustain themselves without a live host. That and those that survive on decaying matter, how long they could sustain or the numbers needed to be classed as a serious risk.

[Ivor the Engineer]

Nasty E. coli survival characteristics:

http://www.about-ecoli.com/

Stx-producing E. coli organisms have several characteristics that make them so dangerous. They are hardy organisms that can survive several weeks on surfaces such as counter tops, and up to a year in some materials like compost. They have a very low infectious dose meaning that only a relatively small number of bacteria, less than 50, are needed “to set-up housekeeping” in a victim’s intestinal tract and cause infection.

[Soapy Sam]

And another straw man sucks eggs.

Please re-read what the thread is about.

Thank you.

Could I have that in English?

I'm not arguing with your principal point. I'm pointing out that merely being around large numbers of rotting corpses can make you physically sick.
They smell even better when half cooked. What remains after a firefight is something that must be smelled to be believed. If cinemas had smell there would be no war movies.

[Corpse Cruncher]

Could I have that in English?

I'm not arguing with your principal point. I'm pointing out that merely being around large numbers of rotting corpses can make you physically sick.
They smell even better when half cooked. What remains after a firefight is something that must be smelled to be believed. If cinemas had smell there would be no war movies.
If people all were sent to work in morgues, that might put an end to wars. If the smell doesn't get you the scene will.

I certainly know what you are saying about a half cooked corpse. It is one smell that never seems to leave you.

[Skeptic Ginger]

Could I have that in English?

I'm not arguing with your principal point. I'm pointing out that merely being around large numbers of rotting corpses can make you physically sick.
They smell even better when half cooked. What remains after a firefight is something that must be smelled to be believed. If cinemas had smell there would be no war movies.
The thread is about the misconception piles of dead bodies cause epidemics.

Oozing crap under your feet draining out of said body piles is clearly going to nauseate some (most) people. Careless handling of dead bodies so that one gets draining body fluids in one's eyes, nose, mouth or on broken skin can transmit bloodborne diseases, mostly hepatitis B since both HIV and hep C require larger volumes of blood to transmit infection and such exposures are less likely when simply handling a dead body, even an oozing one and even without gloves.

I am not saying folks shouldn't bring up these issues for discussion in this thread. But bringing them up under the context that these not-in-dispute facts support the misconception piles of dead bodies risk causing epidemics doesn't hold up.

Do people reading this thread actually think I'm saying leave the bodies out to rot, it'll feed the rats and dogs and save space in cemeteries for people with the money to afford burial plots?


There are 2 issues, one is: which priorities are higher than body removal, and the other is: can we reasonably collect information to identify the dead before bulldozing them into mass graves?

In order to make the best decisions here, one needs to base said decisions on facts, not on myths.

It is a fact a pile of oozing dead bodies has a somewhat high priority for removal under disaster circumstances. It is a fact people suffer when they don't know what happened to a loved one and identifying bodies in mass casualty events does serve a purpose. It is a fact that it is not always going to be possible to collect identifying information before burying the dead in mass graves.

None of these facts make the false belief that 'piles of dead bodies must be buried quickly in order to prevent epidemics' a true belief.

[Skeptic Ginger]

Could I have that in English?
....Straw man defined: arguing facts not in dispute by the person you are arguing with.

[Eos of the Eons]

Excuse me I don't contaminate water, neither am I responsible for any epidemics involving bridges. I was fully exonerated of it all. :D


Aside from that. Don't forget fecal matter is also airborne. Either via plop n drop of flush and go.



Decaying bodies give off gases. Those gasses must contain particles that support or carry lurgies and all manners of other spreadable horrors.

Our bodies are crawling with bacteria and such like. I would assume a dead body, or even a decaying body, is a highly probable source of spreading infection. Basing that reports show bodies bing burned to cut down the risk of contamination nd infections add weight to the risk.

I am not sure on how long such contaminates are able to sustain themselves without a live host. That and those that survive on decaying matter, how long they could sustain or the numbers needed to be classed as a serious risk.

There's a difference between the things that break us down when we're dead compared to infecting us when we're alive.

[geni]

They do aparently make good roadblocks:


http://news.bbc.co.uk/today/hi/today/newsid_8460000/8460678.stm

[JoeTheJuggler]

The thread is about the misconception piles of dead bodies cause epidemics.

<snip>

None of these facts make the false belief that 'piles of dead bodies must be buried quickly in order to prevent epidemics' a true belief.

I think your defining the issue so narrowly is very nearly a straw man. Why is the issue only about causing epidemics and not about the very real public health concern posed by literally tons of rotting corpses in close contact with the survivors?

I think your points are more accurate in nearly any situation closer to normal than the situation in Haiti right now.

Tens of thousands of corpses--rotting and mutilated, a nearly destroyed infrastructure, and so on, is an incredibly extreme situation.

[Ivor the Engineer]

They do aparently make good roadblocks:


http://news.bbc.co.uk/today/hi/today/newsid_8460000/8460678.stm

I'm not sure exactly how to interpret bodies being used to make road blocks. The only rational explanations I can think of are that either people were trying to slow down vehicles so they could steal their contents, or they were trying to redirect aid conveys to the areas where they are currently living.

[geni]

I'm not sure exactly how to interpret bodies being used to make road blocks. The only rational explanations I can think of are that either people were trying to slow down vehicles so they could steal their contents, or they were trying to redirect aid conveys to the areas where they are currently living.

Neither:


http://www.latimes.com/news/nation-and-world/la-fg-haiti-roadblock17-2010jan17,0,1993795.story?page=1

[kerikiwi]

the very real public health concern posed by literally tons of rotting corpses in close contact with the survivors?

.

What is that public health concern?

[Soapy Sam]

Straw man defined: arguing facts not in dispute by the person you are arguing with.

Irony exemplified: objecting to facts complementary to the discussion.:rolleyes:

[Deetee]

I don't think anyone thinks that diseases somehow spontaneous arise from the dead bodies.....

Today's Observer has a piece about the disposal of the dead (http://www.guardian.co.uk/world/2010/jan/17/haiti-unburied-bodies-earthquake).
Clearly, the reporter, Paul Harris, has not a clue what he is talking about.
He writes from New York.
Yet the bodies pose an increasing and potentially devastating health risk to survivors. Decomposing bodies can spread deadly diseases among people already sick and weak from lack of basic resources. They can poison water supplies and create airborne infections.Yeah, right....
:mad:

[JoeTheJuggler]

What is that public health concern?

Several have been mentioned in the thread.

Contaminated drinking water, for one. (That is, the stuff in and on a decomposing body, while not infectious as they might be in living people, are definitely not conducive to sanitary conditions.) Blocking ambulance and supply truck access is another. The mental health concerns is another.

Skeptigirl even ceded that there are such occupational hazards to mortuary workers, and I pointed out that what are these kinds of risks under ordinary circumstances are certainly public health hazards in this extreme situation, where pretty much the entire public is exposed to corpses the way a mortuary worker might be.

[Deetee]

Yes you do.

It's naive to think that distraught, untrained people are going to take the proper precautions while handling mangled, likely bleeding bodies whose clothing will have also be soiled with urine and excrement -- bodies that under the circumstances might have died minutes beforehand. It's naive to think that these same people are going to have jugs of hand sanitizer, body bags, gloves, and the knowledge and discipline to use any sort of sterile techniques. They're going to wipe their hands on their clothes, put their fingers in their mouth (potentially transferring blood borne pathogens), wipe the tears from their eyes (potentially transferring blood borne pathogens), wipe... other things.

That's the reality. Many of those recent and soon-to-be dead people had blood borne pathogens prior to the earthquake and people who aren't careful can contract it from them. Warning the general public -- many of whom are going to have open, bleeding wounds themselves -- to avoid handling the recently deceased except under the direction of professionals and others who have been trained and equipped to understand and deal with the risks makes sense, regardless of what of myths you think have been dispelled. You grab enough bloodied dead guy's upper arms with your bare hands -- hands that are likely roughed up and bleeding from the effort of moving debris -- long enough and you will eventually catch something.

Ah, so it is the survivors - those who still are alive - who pose the risk to their rescuers? Makes sense.

Once they are dead, their potential pathogens start to die off. After a day or two, no body will be infectious for anything.

[JoeTheJuggler]

Neither:


http://www.latimes.com/news/nation-and-world/la-fg-haiti-roadblock17-2010jan17,0,1993795.story?page=1

Yes, I thought the roadblocks made of corpses was primarily an expression of anger and frustration.

[JoeTheJuggler]

All you need to be concerned about in a cholera epidemic is the water supply. And it doesn't take a corpse to contaminate a water source, it takes fecal material getting into water that is not treated before the next person drinks it.

And these tens of thousands of bodies in the streets have no fecal matter? Or are they somehow being isolated from the water supply? (Remember most of the normal infrastructure is destroyed.)

[Deetee]

Several have been mentioned in the thread.

Contaminated drinking water, for one.

Stands to reason that the risk of contamination of water in a disaster area without sanitation is far more likely to occur because the survivors continue to defecate again and again wherever, rather than the static source of dead bodies which will produce little in the way of contaminants.

Also what is meant to be "contaminating" the water? Intestinal bacteria?
We all have these in our guts already.

Only if people develop infectious pathogenic diseases such as cholera, typhoid etc will bodily effluent be truly infectious/dangerous.

And it is obvious that the already dead would not actually have these illnesses.

[JoeTheJuggler]

Stands to reason that the risk of contamination of water in a disaster area without sanitation is far more likely to occur because the survivors continue to defecate wherever, rather than the static source of dead bodies which will produce little in the way of contaminants.
Yes, the situation is really bad. But the existence of a risk (even a greater risk) of contaminating the water by live people doesn't mean there is no such risk from the corpses, or that it makes sense to ignore these risks.

Also what is meant to be "contaminating" the water? Intestinal bacteria?
We all have these in our guts already.
And our guts tend to stay separated from the environment. Not so with dead people.

And it is obvious that the already dead would not actually have these illnesses.
I don't see how that's obvious. No one who had an infection was killed in the earthquake?

[JoeTheJuggler]

Another reason I think dumping these bodies in mass graves is a good idea is simply the manpower. If they process the bodies the way they would under ordinary circumstances, you'd be taking an awful lot of man-hours away from doing something useful.

[Deetee]

Yes, the situation is really bad. But the existence of a risk (even a greater risk) of contaminating the water by live people doesn't mean there is no such risk from the corpses, or that it makes sense to ignore these risks.
The risk from the mobile, repeatedly-defecating living in a disaster zone without sanitation far far outweighs the risk from the dead (and not just in terms of numbers)

And our guts tend to stay separated from the environment. Not so with dead people.
No. Once, twice a day (and more if we develop diarrhoea) our intestinal contents will be purged into the environment.

I don't see how that's obvious. No one who had an infection was killed in the earthquake?

Let's imagine that at any time in place X around 0.1% of the population has a truly infectious problem such as typhoid. With decent sanitation and good luck, an epidemic outbreak may be unlikely. Let's suppose there are 1 million people.

Now imagine there is a disaster. 10% of the population dies, and 90% are left without potable water and no sanitation.

That's 100,000 dead, of whom 100 might be carriers of typhoid. Their bodies lie under rubble and on the streets. From the time of death, bacteria start to die in the bowel. Anaerobic bacteria which can survive on dead tissue, will initially multiply in numbers, then decline. fermentation in the body from dead tissue and gas from bacteria will bloat the corpses. They might rupture, discharging intestinal contents which may be infectious, but if the contents do not immediately make their way into the water supply there is little risk of infecting others, and the risk disappears after a short time since this is a once only phenomenon.

The remaining 900,000 (including 900 with typhoid) have no sanitation and no safe water supplies. They are likely to defecate frequently over the next couple of weeks, may develop diarrhoea, and on each occasion providing an opportunity to contaminate whatever water there is available. The risks of typhoid spreading are very real.

So hypothetically there could be 9x as many humans as a source, those sources discharge infectious material maybe 28x more (2 episodes per day for 2 weeks), meaning it is 500x more likely a survivor will be the source of a typhoid epidemic rather than a corpse.

The risk really comes from the living, not the dead.

[MikeSun5]

Once again the idiots on the news are repeating the same bad medicine, "if they don't pick up those dead bodies in Haiti, epidemics will ensue."

My issue is that the news media continues to perpetuate the falsehood. They have no excuse. It's been brought to their attention time and time again.

Okay, sure. Diseases are not spread by dead bodies. But right now, in the scheme of things, who is that incorrect statement harming? It's not like Port au Prince residents are watching the news, right? I don't think a common misconception blurted on CNN is going to negatively affect anyone in Haiti right now. Hell, if anything a misconception like that could help expedite the removal of the bodies. They may not spread disease, but they're demoralizing and disgusting.

Also, you're convoluting the rescuers with the survivors by simply saying "they." The people pulling victims from rubble are mostly foreign rescue teams, while the people handling bodies are local residents with little to no access to sanitation (or the news).

Maybe they can't cause epidemics, but as mentioned earlier mutilated corpses are extremely unsanitary and can definitely spread sickness -- especially in a place where most can't even find clean WATER.

Hand washing would be nice.

WTF? Is that supposed to be funny? :confused:

[JoeTheJuggler]

I'm watching 60 Minutes coverage of the situation in Haiti, and the reporter's piece on the dead bodies program did not say that the concern is for an infectious epidemic.

He said there is a public health risk (primarily the stench), and cited some of the problems I've mentioned--mostly the lack of manpower to handle the bodies as they normally would.

[Darat]

Dead bodies are not the issue. Unpotable water is no worse because dead bodies are in it than if sewage is in it.

But it is certainly no better.

[Skeptic Ginger]

I think your defining the issue so narrowly is very nearly a straw man. Why is the issue only about causing epidemics and not about the very real public health concern posed by literally tons of rotting corpses in close contact with the survivors?

I think your points are more accurate in nearly any situation closer to normal than the situation in Haiti right now.

Tens of thousands of corpses--rotting and mutilated, a nearly destroyed infrastructure, and so on, is an incredibly extreme situation.I started the thread after hearing the folks on CNN repeat the usual, "they have to get those bodies buried before they cause an epidemic".

You are welcome to talk about anything related in the thread. That wasn't my concern. I merely said all those rationales for getting rid of the bodies sooner rather than later did not support the premise, piles of dead bodies lead to epidemics.

[Skeptic Ginger]

But it is certainly no better.So you think dead bodies in the streets in Haiti are contaminating the non-existent potable water?

If there was potable water, would it be potable if it were open to street drainage of any kind? Where do you think those thousands of people are performing their toileting exercises?

[Skeptic Ginger]

I'm watching 60 Minutes coverage of the situation in Haiti, and the reporter's piece on the dead bodies program did not say that the concern is for an infectious epidemic.

He said there is a public health risk (primarily the stench), and cited some of the problems I've mentioned--mostly the lack of manpower to handle the bodies as they normally would.I agree that much of the news coverage since I started this thread has been more accurate about the risk of dead bodies causing epidemics.

I credit the Internet, be it Twitter, forums, blogs or even just posts to the editors. I think this particular kind of factual error on the news is becoming more and more amenable to correction when those who know it is an error immediately give feed back to the media.

[Darat]

So you think dead bodies in the streets in Haiti are contaminating the non-existent potable water?

If there was potable water, would it be potable if it were open to street drainage of any kind? Where do you think those thousands of people are performing their toileting exercises?

I think you should re-read your post that I was responding to.

[Skeptic Ginger]

Okay, sure. Diseases are not spread by dead bodies. But right now, in the scheme of things, who is that incorrect statement harming?Some one has to be harmed for me to start a thread or be annoyed? Really?



Also, you're convoluting the rescuers with the survivors by simply saying "they." The people pulling victims from rubble are mostly foreign rescue teams, while the people handling bodies are local residents with little to no access to sanitation (or the news).If you have evidence that unburied mass casualties are the source of epidemics (ebola deaths excepted) then I'd be interested in seeing it. If not then you are merely speculating [X] is possible. But the evidence is already there that [X] doesn't happen.


Maybe they can't cause epidemics, but as mentioned earlier mutilated corpses are extremely unsanitary and can definitely spread sickness -- especially in a place where most can't even find clean WATER.What "sickness" would that be?



WTF? Is that supposed to be funny? :confused:No, I was being serious.

As long as you don't swallow a significant amount of blood, neither hep C nor HIV will likely be transmitted from just getting blood or body fluids on your hands. We know this from a large amount of data on occupational exposures.

Hep B can be transmitted with very small amounts of blood but the vast majority of people even in areas where hep B is highly prevalent are not carriers.

[Uncayimmy]

What "sickness" would that be?
Gastroenteritis. "Most people recover easily from a short bout with vomiting and diarrhea by drinking fluids and easing back into a normal diet. But for others, such as babies and the elderly, loss of bodily fluid with gastroenteritis can cause dehydration, which is a life-threatening illness unless the condition is treated and fluids restored."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095048/
A risk of gastroenteritis may be present for the general public if corpses have contaminated the water supply (6). This risk usually occurs in the later phases of a natural disaster. A study (7) in the municipal area of Villanueva, Nicaragua, which was hit by Hurricane Mitch, was conducted in a three-month period following the disaster. The study found that the incidence of acute diarrhea and acute respiratory disease significantly increased following the disaster compared with predisaster data. The incidence of acute diarrhea increased from 2849 to 6798 per 100,000 inhabitants after the disaster (P<0.01), while the incidence of acute respiratory disease increased from 295 to 1205 per 100,000 inhabitants (P<0.01). In addition, three cases of leptospirosis were ascertained, but no predisaster data were available for comparison (7). A cluster of hepatitis A infections occurred in Aceh Province, Indonesia, in the month following the tsunami that struck on December 26, 2004, but it was thought that the water-borne nature of hepatitis A and other water-borne diseases that occurred were caused by a lack of safe water and sanitation and spread by overcrowding rather than through the presence of corpses (8,9).

[Ivor the Engineer]

Gastroenteritis. "Most people recover easily from a short bout with vomiting and diarrhea by drinking fluids and easing back into a normal diet. But for others, such as babies and the elderly, loss of bodily fluid with gastroenteritis can cause dehydration, which is a life-threatening illness unless the condition is treated and fluids restored."

:confused:

From the article you linked to:

In summary, there is no compelling evidence to suggest that corpses themselves pose a risk for an acute epidemic of an infectious disease. It is more likely that the increased risk of infection occurs in the postevent period and that a higher risk of water-borne diseases is associated with flooding where there is contamination of drinking water facilities and a lack of proper sanitation.

[Cynic]

Ah, so it is the survivors - those who still are alive - who pose the risk to their rescuers? Makes sense.

Once they are dead, their potential pathogens start to die off. After a day or two, no body will be infectious for anything.


The news outlets citing the information in question pertains to the very, very recently dead and dying, meaning will die and will then be moved. Telling people that it's perfectly safe to touch those people without taking precautions is wrong and irresponsible. It should also be noted that not all tissue in the body dies all that quickly -- some of it is anaerobic.

Because of the reasons I stated in the post you responded to, much care should be taken with the recently dead. The survivors are also a serious risk, but they are not what the OP is about. The OP is about the very recently dead and the very recently traumatized, untrained people with possible injuries, no equipment, and cuts on their hands from moving debris.

[fls]

I'm not sure that it's helpful to imply that killing something renders it effectively sterile. I think it is helpful to point out that the living pose a greater risk of transmission. However, I think part of what worries people is that they have relatively less control (or at least that may be the perception) over whatever can be transmitted from dead bodies - their pre-mortem health status is unknown, barriers to the exposure of body fluids have broken down, bodies may contaminate water supplies, etc. - compared to those who are living.

It was interesting watching 60 Minutes last night, showing the bodies being dumped into trucks with a front-end loader after they had interviewed soldiers complaining about the lack of transportation of supplies to the affected area. If this represents a trade-off (it was mentioned that the bodies were being moved because of public health issues) over the use of resources, it shows that Skeptigirl's concerns re: harm are valid.

Linda

[Deetee]

From this paper
Infectious disease risks from dead bodies following natural disasters. (http://www.ncbi.nlm.nih.gov/pubmed/15231077)

Victims of natural disasters usually die from trauma and are unlikely to have acute or "epidemic-causing" infections. This indicates that the risk that dead bodies pose for the public is extremely small. However, persons who are involved in close contact with the dead-such as military personnel, rescue workers, volunteers, and others-may be exposed to chronic infectious hazards, including hepatitis B virus, hepatitis C virus, HIV, enteric pathogens, and Mycobacterium tuberculosis. Suitable precautions for these persons include training, use of body bags and disposable gloves, good hygiene practice, and vaccination for hepatitis B and tuberculosis.

These risks (blood borne viruses etc) are a risk not just from dead bodies which may have the infection, but any survivors pose this risk to their rescuers. I would argue that a rescue worker dealing with a live survivor is far more likely to throw caution to the wind in their rush to conduct a rescue than would be a person recovering a corpse.

Speaking for myself, if I was trying to save someone's life I'd grab them and help even without gloves. If I had to shift a rotting corpse, be sure I'd be wearing gloves, for aesthetic reasons if nothing else, and if there was a visible discharge of bodily fluids I'd make sure to avoid contact.

So, to reiterate, it seems the living are the real source/risk of infection. As Linda says, scarce resources should be used in the most productive manner possible, and measures to save lives and provide humanitarian assistance to the survivors are more important than pouring efforts into dealing with the tiny risks posed from the dead in case they might infect you with something.

[Cynic]

No one is disputing that, Deetee.

[Agatha]

The BBC are discussing this: http://news.bbc.co.uk/1/hi/magazine/8465464.stm

[Rolfe]

That's a very good article.

Rolfe.

[Uncayimmy]

:confused:

From the article you linked to:

Please try to keep up. There's a little button that links back to the post that is being quoted. You can follow it back as far as needed for context. In this case Mike Sun said, "Maybe they can't cause epidemics, but as mentioned earlier mutilated corpses are extremely unsanitary and can definitely spread sickness -- especially in a place where most can't even find clean WATER." Skeptigirl replied, "What sickness?"

I answered that question.

[Deetee]

Please try to keep up. There's a little button that links back to the post that is being quoted. You can follow it back as far as needed for context. In this case Mike Sun said, "Maybe they can't cause epidemics, but as mentioned earlier mutilated corpses are extremely unsanitary and can definitely spread sickness -- especially in a place where most can't even find clean WATER." Skeptigirl replied, "What sickness?"

I answered that question.

Yes, you did give it a go.

But you then pointed out in your quoted referenced that"it was thought that the water-borne nature of hepatitis A and other water-borne diseases that occurred were caused by a lack of safe water and sanitation and spread by overcrowding rather than through the presence of corpses"and Ivor merely pointed out that your reference also concluded: In summary, there is no compelling evidence to suggest that corpses themselves pose a risk for an acute epidemic of an infectious disease.So, considering that Mike Sun implied corpses in themselves could cause disease (he added the rider "especially in a place where most can't even find clean WATER"), your answer was not a very good one.

[Uncayimmy]

Yes, you did give it a go.

But you then pointed out in your quoted referenced thatand Ivor merely pointed out that your reference also concluded: So, considering that Mike Sun implied corpses in themselves could cause disease (he added the rider "especially in a place where most can't even find clean WATER"), your answer was not a very good one.

Huh?

Nobody in this thread as far as I can tell is arguing the corpses lead to epidemics, which by definition means diseases spread from person to person. The fact that my reference clarified what illnesses were and were not spread by corpses makes it an excellent answer. Why would you say that it's a bad answer? Mike said, "Diseases are not spread by dead bodies." He also said, "Maybe they can't cause epidemics, but...[corpses] can definitely spread sickness."

For some odd reason, our resident nurse practitioner with years of experience asked, "What 'sickness'?" The answer is simple: gastroenteritis. The article I cited touched on a few other issues as well, which only added to the body of information in this thread and did not contradict in any way, shape or form the answer that I gave.

[MikeSun5]

Some one has to be harmed for me to start a thread or be annoyed? Really?

Okay... so your answer to my question is "me." Got it. :D

If you have evidence that unburied mass casualties are the source of epidemics (ebola deaths excepted) then I'd be interested in seeing it.[QUOTE]

Did I say I had evidence? Did I say there was evidence? Nope. I did not.

[QUOTE=Deetee;5527150]...considering that Mike Sun implied corpses in themselves could cause disease (he added the rider "especially in a place where most can't even find clean WATER")...

Along with skeptigirl, you should also re-read the posts and pay a little more attention. I didn't imply that at all.

What "sickness" would that be?

Examples have been given, so I won't repeat -- but I do have a question for you:
Exactly how sterile do you think a mutilated, decomposing corpse is?

[Renfield]

Disease does grow and spread in a dead body, though, no? That's where the bad smell comes from. Not to mention it attracts vermin and bugs, as others have pointed out.

Definately not sanitary to have around.

[Uncayimmy]

Disease does grow and spread in a dead body, though, no? That's where the bad smell comes from. Not to mention it attracts vermin and bugs, as others have pointed out.

Definately not sanitary to have around.

It depends on how you define disease. If you're talking something like the flu, measles, or strep throat, then the disease dies with the person (or very shortly thereafter). That's what most people mean by disease.

The fact that a corpse is unsanitary isn't really a matter of "disease" - it's just unsanitary. Not to be crude, but unless you stuck your finger up my butt, you wouldn't come in contact with my fecal matter dealing with me while I'm alive. Toss my corpse out in the street for a few days and then try to move it, yeh, something nasty might come oozing out. Get that into a cut or swallow it, and you'll probably live to regret it.

[Skeptic Ginger]

Gastroenteritis. "Most people recover easily from a short bout with vomiting and diarrhea by drinking fluids and easing back into a normal diet. But for others, such as babies and the elderly, loss of bodily fluid with gastroenteritis can cause dehydration, which is a life-threatening illness unless the condition is treated and fluids restored."This is exactly the myth about dead bodies I am talking about. Did you not bother to read your own source? Perhaps you didn't get past the headline.

Gastroenteritis epidemics come from infected people's feces, not just bacteria and fecal material.

From your own source:In summary, there is no compelling evidence to suggest that corpses themselves pose a risk for an acute epidemic of an infectious disease. It is more likely that the increased risk of infection occurs in the postevent period and that a higher risk of water-borne diseases is associated with flooding where there is contamination of drinking water facilities and a lack of proper sanitation.

[Skeptic Ginger]

The news outlets citing the information in question pertains to the very, very recently dead and dying, meaning will die and will then be moved. Telling people that it's perfectly safe to touch those people without taking precautions is wrong and irresponsible. .....More straw men.

Care to point to the thread which made the claim you are calling irresponsible? You may need the post clarified if this is what you think it said.

[Skeptic Ginger]

From this paper
Infectious disease risks from dead bodies following natural disasters. (http://www.ncbi.nlm.nih.gov/pubmed/15231077)



These risks (blood borne viruses etc) are a risk not just from dead bodies which may have the infection, but any survivors pose this risk to their rescuers. I would argue that a rescue worker dealing with a live survivor is far more likely to throw caution to the wind in their rush to conduct a rescue than would be a person recovering a corpse.

Speaking for myself, if I was trying to save someone's life I'd grab them and help even without gloves. If I had to shift a rotting corpse, be sure I'd be wearing gloves, for aesthetic reasons if nothing else, and if there was a visible discharge of bodily fluids I'd make sure to avoid contact.

So, to reiterate, it seems the living are the real source/risk of infection. As Linda says, scarce resources should be used in the most productive manner possible, and measures to save lives and provide humanitarian assistance to the survivors are more important than pouring efforts into dealing with the tiny risks posed from the dead in case they might infect you with something.

For the record, I treat about 100 occupational blood exposures a year, and have for the last 18 years or so.

There are a number of extensive epidemiological studies that indicate persons with occupational risk of blood exposure rarely have greater rates of hepatitis C infection than matched controls. There are a couple studies showing a very small increased risk among phlebotomists suggesting if you stick yourself with a large bore needle right out of a person's vein, there might be a small risk of transmitting hepatitis C. (**Note this risk differs considerably from IV drug users who for whatever reason that differs from occupational needle sticks, get infected at very high rates.)

There are 2 good studies regarding the transmission of HIV in occupational exposures. One looked at 1,100 HIV infected occupational blood exposures prospectively. It took 10 years to collect that much data. 4 people got infected.

The other study compared 33 occupational HIV infections retrospectively with about 630 HIV exposures that did not lead to infection of the health care worker. The difference between getting infected and not was the amount of viral load one was exposed to the and the percutaneous depth of the exposure.

If you get a deep gash from a bloody scalpel freshly coated in HIV infected blood, you could get HIV. If you hold a bleeding femoral artery (takes serious pressure) for 30 minutes with extensive open skin in direct contact with the blood, you could get HIV.

The vast majority of occupational exposures to both HIV and hepatitis C infected blood do not lead to infection of the health care worker. It can happen, but it is rare and take a fairly large amount of blood getting inside of your body, not just on your skin.

There are not any documented occurrences that I am aware of for either hep B, C or HIV being spread to large numbers of people through contaminated water. If anyone is aware of any instances, I'd really be interested in a link to the data source. And there are many instances of other infections linked to water sources, of course. So we know water can get contaminated. Yet we don't see bloodborne infections transmitted from contaminated water. It's probably because the dose required to infect a person does not occur in water contamination situations.


Hepatitis B is a little more easily transmitted and blood in a mouth can transmit the infection though that is still a rare means of transmission. Again, I am not aware of any hepatitis B outbreaks or epidemics related to contaminated food or water sources. I'd love to see the data if anyone can find any.

[Skeptic Ginger]

Please try to keep up. There's a little button that links back to the post that is being quoted. You can follow it back as far as needed for context. In this case Mike Sun said, "Maybe they can't cause epidemics, but as mentioned earlier mutilated corpses are extremely unsanitary and can definitely spread sickness -- especially in a place where most can't even find clean WATER." Skeptigirl replied, "What sickness?"

I answered that question.It appears that even with Ivor highlighting the pertinent section of your own source, you still didn't read it. :rolleyes:

Here, let me help you:A risk of gastroenteritis may be present for the general public if corpses have contaminated the water supply (6). This risk usually occurs in the later phases of a natural disaster. A study (7) in the municipal area of Villanueva, Nicaragua, which was hit by Hurricane Mitch, was conducted in a three-month period following the disaster. The study found that the incidence of acute diarrhea and acute respiratory disease significantly increased following the disaster compared with predisaster data. The incidence of acute diarrhea increased from 2849 to 6798 per 100,000 inhabitants after the disaster (P<0.01), while the incidence of acute respiratory disease increased from 295 to 1205 per 100,000 inhabitants (P<0.01). In addition, three cases of leptospirosis were ascertained, but no predisaster data were available for comparison (7). A cluster of hepatitis A infections occurred in Aceh Province, Indonesia, in the month following the tsunami that struck on December 26, 2004, but it was thought that the water-borne nature of hepatitis A and other water-borne diseases that occurred were caused by a lack of safe water and sanitation and spread by overcrowding rather than through the presence of corpses (8,9).

No where in that piece does it relate the contaminated potable water with the corpses specifically. The water is going to be contaminated from people with no potties to poo in!!! Some of those people are going to have GI infections. Some of those pathogens are going to flow into the sames streets the corpses are piled up in.


Here is the source (#6) cited in the paragraph: Infectious disease risks from dead bodies following natural disasters. (http://www.ncbi.nlm.nih.gov/pubmed/15231077)Disease transmission requires the presence of an infectious agent, exposure to that agent, and a susceptible host. These elements were considered to characterize the infectious disease risk from dead bodies. Using the PubMed on-line databases of the National Library of Medicine of the United States of America, searching was done for relevant literature on the infection risks for public safety workers and funeral workers as well as for guidelines for the management of the dead and prevention of infection. A small but significant literature was also reviewed regarding the disposal of the dead and the contamination of groundwater by cemeteries. RESULTS: Victims of natural disasters usually die from trauma and are unlikely to have acute or "epidemic-causing" infections. This indicates that the risk that dead bodies pose for the public is extremely small....CONCLUSIONS: Concern that dead bodies are infectious can be considered a "natural" reaction by persons wanting to protect themselves from disease. However, clear information about the risks is needed so that responsible local authorities ensure that the bodies of disaster victims are handled appropriately and with due respect.In other words, handing body fluids is a risk for disaster workers. D'uh! Piled up dead bodies do not cause epidemics (again, with the caveat if an epidemic killed the people that is a different story, this is about mass trauma deaths.)

[Skeptic Ginger]

Huh?

Nobody in this thread as far as I can tell is arguing the corpses lead to epidemics, which by definition means diseases spread from person to person. The fact that my reference clarified what illnesses were and were not spread by corpses makes it an excellent answer. Why would you say that it's a bad answer? Mike said, "Diseases are not spread by dead bodies." He also said, "Maybe they can't cause epidemics, but...[corpses] can definitely spread sickness."

For some odd reason, our resident nurse practitioner with years of experience asked, "What 'sickness'?" The answer is simple: gastroenteritis. The article I cited touched on a few other issues as well, which only added to the body of information in this thread and did not contradict in any way, shape or form the answer that I gave.Gastroenteritis was not one of the epidemics piles of bodies killed by trauma was going to cause.

A single infection in a disaster worker handling a corpse is not an epidemic.

And epidemics can be food borne, air borne, water borne or vector borne and an epidemic is not limited to direct person to person spread. Malaria, Dengue, & Yellow Fever, for example, can occur in epidemics and are not spread from person to person typically.

[Cynic]

Care to point to the thread which made the claim you are calling irresponsible?


Sure:


Unless you are sucking the blood of the dead, or unless they have ebola, even handling dead bodies is not going to infect anyone, given basic easily managed precautions: don't suck on bloody dead bodies.


The above is a gross and dangerous oversimplification of the matter. Given the realities "on the ground" in Haiti, people should be advised to leave bodies alone until they've got the proper guidance and equipment to deal with it with minimal risk. Over an 1/8th of Haiti's population is HIV positive -- yes, extensive careless exposure will increase those numbers.

While it would seem to contradict advice for the untrained and unprepared to leave bodies alone, there are reasons to keep them out of the water supply. Earlier in the thread you expressed confusion about why a human body would be worse than a few rats in a cistern. The answer is, rat pathogens are far less likely to be human-compatible. That's why it's considered perfectly acceptable to use cow manure on to fertilize crops but human feces is a horrible idea.

All that said, I admit I misunderstood your initial intent in scolding the press -- subsequent conversation quickly drifted into areas of different focus. Absolutely, initial emphasis should be on recovering and sustaining the living. But leaving bodies laying about is still also a bad idea for many reasons, most of them already detailed in this thread. The only thing worse than recovering, identifying, and burying 200,000+ bodies is doing that after they've been out stewing in the sun for a couple of weeks. There is little reason both tasks can't be organized and executed in tandem, so long as priority is placed on saving lives and emphasis is placed on the living.

[Skeptic Ginger]

Examples have been given, so I won't repeat -- but I do have a question for you:
Exactly how sterile do you think a mutilated, decomposing corpse is?Not any more sterile than rotting tomatoes.

You do know I hope that microorganisms by far outweigh (literally) all the multi-celled organisms on the planet. Only an extremely tiny fraction of those microorganisms are pathogenic and even fewer of them are pathogenic to humans.

[Uncayimmy]

This is exactly the myth about dead bodies I am talking about. Did you not bother to read your own source? Perhaps you didn't get past the headline.

Gastroenteritis epidemics come from infected people's feces, not just bacteria and fecal material.

From your own source:

Look, nurse, I read the source. It says, "A risk of gastroenteritis may be present for the general public if corpses have contaminated the water supply (6). This risk usually occurs in the later phases of a natural disaster."

You really need to slow down and start paying attention to what others are saying because you are looking like an idiot. I'll summarize Mike Sun's points for you.

* Corpses do not cause epidemics
* Diseases are not spread by dead bodies.
You're okay with these first two, right? I mean, we all seem to agree on this point.
* The people handling bodies are local residents with little to no access to sanitation (or the news)
* Dead bodies can make people "sick"

And that's when you jumped in with all this crap about "what sickness" is associated with a corpse. I gave you one example. The article I cited gave several other examples. All Mike was doing was pointing out that sickness is associated with corpses and is a concern because locals are handling the corpses. This is 100% true, and has been stated in every reference you've made so far. Maybe if you weren't so frantic writing your posts you'd see when people are agreeing with you.

As for his larger point about what the harm is for journalists getting it wrong, that's actually a good point. In an ideal world everybody understands the risk of corpses. To summarize those points:
1. Corpses don't cause epidemics.
2. Most infectious diseases die with the person or shortly thereafter.
3. Some infections can stick around, so if you're handling a corpse, you need to take precautions.
4. Corpses can contaminate a water supply, but in most natural disasters, potable water is already an issue.

So, numbers 1 and 2 should help officials understand that delaying the removal of corpses does not increase a risk to general population except in the case of #4. Number 3 is an important message for everyone.

The problem, though, is that if you don't get the complete message out to the general population, people might be seriously harmed. In other words if people see #1 and #2 and miss #3, that's a bad thing. The only people who really need to know #1 and #2 are the people allocating resources. Everybody should know #3.

So, lighten up.

[Skeptic Ginger]

It depends on how you define disease. If you're talking something like the flu, measles, or strep throat, then the disease dies with the person (or very shortly thereafter). That's what most people mean by disease.

The fact that a corpse is unsanitary isn't really a matter of "disease" - it's just unsanitary. Not to be crude, but unless you stuck your finger up my butt, you wouldn't come in contact with my fecal matter dealing with me while I'm alive. Toss my corpse out in the street for a few days and then try to move it, yeh, something nasty might come oozing out. Get that into a cut or swallow it, and you'll probably live to regret it.
UncaYimmy, you have so much to learn about pathogens and the microbiological world.

Pathogens may or may not die with the host. Anthrax, for example, doesn't.

As for your fecal matter being confined to your ass, that depends greatly on your personal hygiene habits.

If those organisms are living happily in your gut without making you ill, what makes you think the same organisms would cause illness in someone else?

[Skeptic Ginger]

Sure:I addressed my comments in more detail in post #145 (http://forums.randi.org/showthread.php?postid=5528265#post5528265) above. Nothing I said in the post which concerned you was irresponsible or not factual.

You seem to be talking about the kind of circumstances you would have in an environment in which public health and government were still intact. Admonitions to leave the bodies in Haiti up to the non-existent 'officials' to deal with isn't very practical advice given the circumstances.

[Skeptic Ginger]

Look, nurse, I read the source. It says, "A risk of gastroenteritis may be present for the general public if corpses have contaminated the water supply (6). This risk usually occurs in the later phases of a natural disaster."I know what it said. I also happen to know what they meant. This could go on ad nauseum here. Suffice it to say, nothing in that paragraph or in the cited source offers any kind of evidence corpses make the water supply any worse than streets full of feces. Unless you do a study which controls for the two variables, my money is on the feces in the water, being the source of the problem.


* Corpses do not cause epidemics
* Diseases are not spread by dead bodies.
You're okay with these first two, right? I mean, we all seem to agree on this point.
* The people handling bodies are local residents with little to no access to sanitation (or the news)
* Dead bodies can make people "sick"

And that's when you jumped in with all this crap about "what sickness" is associated with a corpse. I gave you one example. The article I cited gave several other examples. All Mike was doing was pointing out that sickness is associated with corpses and is a concern because locals are handling the corpses. This is 100% true, and has been stated in every reference you've made so far. Maybe if you weren't so frantic writing your posts you'd see when people are agreeing with you.

As for his larger point about what the harm is for journalists getting it wrong, that's actually a good point. In an ideal world everybody understands the risk of corpses. To summarize those points:
1. Corpses don't cause epidemics.
2. Most infectious diseases die with the person or shortly thereafter.
3. Some infections can stick around, so if you're handling a corpse, you need to take precautions.
4. Corpses can contaminate a water supply, but in most natural disasters, potable water is already an issue.

So, numbers 1 and 2 should help officials understand that delaying the removal of corpses does not increase a risk to general population except in the case of #4. Number 3 is an important message for everyone.

The problem, though, is that if you don't get the complete message out to the general population, people might be seriously harmed. In other words if people see #1 and #2 and miss #3, that's a bad thing. The only people who really need to know #1 and #2 are the people allocating resources. Everybody should know #3.

So, lighten up.I have a hard time not continuing to correct your factual errors, even though this is really getting repetitive.


1. Corpses don't cause epidemics.... check (except if they died from infection with pathogens)


2. Most infectious diseases die with the person or shortly thereafter. .... No, you totally have this wrong. And it isn't the issue. People killed in earthquakes and other natural disasters don't generally have infectious diseases in the first place.

And while there may be issues with endemic chronic infections like HIV, those are not known to spread in the water supply.


The rest of your post is just quibbling.

[Cynic]

I addressed my comments in more detail in post #145 (http://forums.randi.org/showthread.php?postid=5528265#post5528265) above. Nothing I said in the post which concerned you was irresponsible or not factual.

You seem to be talking about the kind of circumstances you would have in an environment in which public health and government were still intact. Admonitions to leave the bodies in Haiti up to the non-existent 'officials' to deal with isn't very practical advice given the circumstances.


Somehow citing studies about occupational risks don't seem convincing when you try to apply them to non-professionals. Non-professionals, especially under the circumstances in Haiti for both the bodies and the survivors, will cause those study statistics to inflate dramatically. The fact is, handling bodies is dangerous. Fact is, you poo pooed that fact to the point where anyone taking your credentials seriously might get the mistaken impression that handling bodies was perfectly harmless until one were to (quote) "suck the blood from the bodies". It is the very fact that there is little in the way of officials that the dangers associated with dead bodies should be emphasized, not handwaved away because you've deemed knowing the truth to be an impracticality.

[Uncayimmy]

UncaYimmy, you have so much to learn about pathogens and the microbiological world.
Well, let's see what your years of education and training can do to teach me.

Pathogens may or may not die with the host. Anthrax, for example, doesn't.
I already knew that. However, it pretty much does stop growing when the host dies. Did you think I was making some sort of absolute statement or do you think I was making a shorthand point about infectious diseases and corpses?

As for your fecal matter being confined to your ass, that depends greatly on your personal hygiene habits.
You're just spoiling for a fight, aren't ya? Do you really want to debate the accuracy of my statement that if you deal with me while I'm living, you're not going to come in contact with my fecal matter unless you stick your finger up my butt? Really? I mean, do your really think I was making some sort of absolute statement about the transfer of fecal contamination among humans?

If those organisms are living happily in your gut without making you ill, what makes you think the same organisms would cause illness in someone else?
Oh, I dunno, nurse. How about we rub a turd into a bloody gash on my leg and find out?

[Uncayimmy]

Most infectious diseases die with the person or shortly thereafter. .... No, you totally have this wrong. And it isn't the issue. People killed in earthquakes and other natural disasters don't generally have infectious diseases in the first place.
Really? I am "totally" wrong to say that "Most infectious diseases die with the person or shortly thereafter." Really?

The WHO says, "Most agents do not survive long in the human body after death (with the exception of HIV -which can be up to 6 days) and the source of acute infections is more likely to be the survivors. Human remains only pose health risks in a few special cases requiring specific precautions, such as deaths from cholera or haemorrhagic fevers."

You got a problem, take it up with them.

And while there may be issues with endemic chronic infections like HIV, those are not known to spread in the water supply.
Did I say that it did?

The rest of your post is just quibbling.
No, it's not quibbling at all. I was pointing out that you didn't pay attention to what MikeSun was saying. Of course, you didn't listen the second time either.

[Belz...]

It depends on how you define disease. If you're talking something like the flu, measles, or strep throat, then the disease dies with the person (or very shortly thereafter). That's what most people mean by disease.

Viruses, sure. I was under the impression that bacteria would continue to live long after.

[Capsid]

Viruses, sure. I was under the impression that bacteria would continue to live long after.And their spores and toxic fungi?

[Uncayimmy]

Viruses, sure. I was under the impression that bacteria would continue to live long after.

I would guess that when it comes to bacteria, it all depends on the environment (temperature, sunlight moisture) and what you mean by living (spores). I'm going by what the WHO said: "Most agents do not survive long in the human body after death..." Beyond that I don't have much to offer.

[Deetee]

Maybe they can't cause epidemics, but as mentioned earlier mutilated corpses are extremely unsanitary and can definitely spread sickness -- especially in a place where most can't even find clean WATER.

This statement seems to be the bone of contention. I am overjoyed everyone agrees that epidemics do not result from corpses. But what precisely do you mean by "can definitely spread sickness"?

To me as an infection specialist, if something is spreading sickness this could quite easily produce an epidemic, which by definition exists when there is a transmissable disease spreading from one person to another, resulting in a large number of people becoming sick. Your statement therefore reads like an oxymoron.

You have yet to quantify this risk, and explain what the precise nature of this "sickness" is that is being spread and how, although you seem to imply that the risks of it happening are especially great if no clean water is available (from which I infer that you presume a risk even when there is clean water available, but that if there is no clean water available it is especially risky).

Unca Yimmy also appears to see no paradox in the juxtaposed statements "can't cause epidemics" and "can definitely spread sickness". He has proposed "gastroenteritis" is the sickness in question. (I would regard and manage a spreading outbreak of gastroenteritis in a disaster area as an epidemic). The reference he cites as evidence indicates the risk of gastroenteritis from the corpses contaminating water supplies is however small, and the study concluded "diseases that occurred were caused by a lack of safe water and sanitation and spread by overcrowding rather than through the presence of corpses"

[Uncayimmy]

To me as an infection specialist, if something is spreading sickness this could quite easily produce an epidemic, which by definition exists when there is a transmissable disease spreading from one person to another, resulting in a large number of people becoming sick. Your statement therefore reads like an oxymoron.
Well, maybe there's a problem in terminology between laypersons and experts. Let's take salmonella (just off the top of my head and not related to the corpse issue). While it's certainly possible for salmonella to spread from human to human, the outbreaks (as I understand them) are usually due to food contamination. An "outbreak" typically occurs because a bunch of people eat the same contaminated food. To me, that's "spreading" sickness.

By contrast, I would consider something like measles to be an epidemic. For example, I recall reading about an unvaccinated person returning with measles from an overseas trip and arriving back in his community, which had a large percentage of unvaccinated people. There was an outbreak of measles, which in this layperson's terminology would be an "epidemic" in that small community. It started from that one person and spread person to person as measles will do.

Regardless of whether my terminology is correct, do you understand how I am differentiating the two? When I think of corpses spreading sickness, I think of the entire mass of corpses of being one unit, just as I think of all those jars of Peter Pan peanut butter as one "unit" that spread salmonella.

Mike Sun was specifically referring to ordinary people handling corpses, not trained workers. He also noted their lack of access to proper sanitation. The WHO says, "Gastrointestinal infections are more common as dead bodies commonly leak faeces. Transmission occurs via the faeco-oral route through direct contact with the body and soiled clothes or contaminated vehicles or equipment. Dead bodies contaminating the water supply may also cause gastrointestinal infections."

Honestly, I'm just not seeing why Mike's statement and my defense of it are being attacked so hard.

[Cynic]

Unca Yimmy also appears to see no paradox in the juxtaposed statements "can't cause epidemics" and "can definitely spread sickness".


There is room in the middle between "can spread sickness" and "epidemic", especially since "epidemic" is such a wishy-washy concept in the first place. It isn't just the presence of corpses (near the water supply), it's also improper handling them (especially the recent ones) that is at issue. There is no paradox or contradiction here. It isn't one or the other. Some of the people handling recently the various body fluids of the very recently dead with no gloves or other means of sanitation are going to pick up a few issues such as HIV, HepA, etc. Those can be transferred that way, and therefore will be, statistically speaking.

[Deetee]

There is a disconnect between saying they will not cause epidemics, and then saying they can definitely spread diseases while implying that the risk of this is especially high if water supplies get contaminated (giving the precise circumstances for epidemic waterborne spread rather than person to person transmission).

Whatever, I am not trying to argue for the sake of it. I just found your defence of his position at odds with my interpretation of the evidence, but its no big deal.
:cool:

[Uncayimmy]

DeeTee, I appreciate that this is not a pissing contest. I genuinely don't understand the disconnect, and in the context of this thread (getting information to the masses), I think it's important to be able to explain things properly. It's not just the press informing people, but ordinary folks like myself who might write a blog entry, post somewhere else, or tell some friends. Those people, of course, may tell others.

The way I see it the message is tricky. On one hand a lot of people seem to think that unburied corpses present a serious danger to the living, even if they have no direct contact with the body. This leads to pressure to expend resources on dealing with the dead at the expense of helping the living. Granted, for cultural and psychological reasons people will want the bodies to be out of sight and buried properly, and there's not much you can do about that. But given the choice between hauling corpses or getting food and shelter to the living, the latter is more important.

Where there is potential for confusion is that we don't want people thinking that corpses are harmless. Bodies need to be handled with care. There are plenty of places in the world where people don't get their water from a faucet, so it's important to understand that if dead bodies are in or around what is normally a clean stream or well, there exists the potential for contamination. Likewise, if you handle a corpse without protection, your body and clothes can be contaminated.

So, the message is not simply that corpses don't pose a real danger. The message is understanding the types of dangers that corpses pose. The OP objected to the statement that ""if they don't pick up those dead bodies in Haiti, epidemics will ensue." If we say that statement is false, then what exactly is the message that needs to get out?

For example, who are they? In my mind "they" are the relief workers rather than ordinary citizens. If "they" don't remove the corpses, then I would think that ordinary citizens are going to do it. I probably would. I have a wife and two kids, so I'm not likely to leave them and join the relief efforts in the event of a natural disaster. However, I would probably want to do something about the corpses in the immediate vicinity. It's a lot easier to keep vermin and children away from a single pile of corpses than it is to watch over each one individually.

I, being a reasonably educated person, would take precautions in handling the bodies. But let's take someone who is not as well informed. If you get the simple message out that the the authorities are not removing the bodies because they don't present an immediate danger, what might the repercussions be? I would worry that some people would have cavalier attitudes towards the corpses and not take proper precautions.

And thus we have to communicate that while a pile of corpses is not going to result in an outbreak of some exotic disease, people should nonetheless avoid handling them without taking safety measures.

Another alternative is to let the citizenry believe that the corpses present a danger and not bother to try to explain things. They might then choose not to handle them, which is probably a good thing. And if the people allocating the resources understand that there's no immediate need to deal with them, then resources won't be diverted from more important relief efforts. Sure, the citizenry might get pissed off, but as long as they don't riot, who cares? In the end we have authorities properly allocating their resources and the masses staying away from the corpses, which in my mind is a good thing.

It's not a simple issue.

[Cynic]

There is a disconnect between saying they will not cause epidemics, and then saying they can definitely spread diseases while implying that the risk of this is especially high if water supplies get contaminated (giving the precise circumstances for epidemic waterborne spread rather than person to person transmission).


That's why I put the focus on handling bodies rather than transmission through water supplies. The effects of transmission through body handling are self-limiting, because eventually the bodies will lose their ability to transmit anything, the need to handle the bodies will cease, sanitation will improve, etc. The additional risk is the result of a temporary circumstance, which is different than something like the flu, which is elevated even under normal conditions. HIV rates are high in Haiti to begin with so I'd be surprised if this situation doesn't spike it a bit before it levels off.

[JoeTheJuggler]

Mike Sun was specifically referring to ordinary people handling corpses, not trained workers. He also noted their lack of access to proper sanitation. The WHO says, "Gastrointestinal infections are more common as dead bodies commonly leak faeces. Transmission occurs via the faeco-oral route through direct contact with the body and soiled clothes or contaminated vehicles or equipment. Dead bodies contaminating the water supply may also cause gastrointestinal infections."

Honestly, I'm just not seeing why Mike's statement and my defense of it are being attacked so hard.

That's pretty much the point I was making earlier. I think it's a bit of a strawman to consider *only* the mythological threat of epidemic as the only public health risk of tens of thousands of decomposing bodies piled up in close proximity to survivors (many of whom are severely injured, near starvation, etc.). And the shortage of manpower to deal with the bodies the way they ordinarily would.

Skeptigirl answered this by pointing out that she was addressing that narrow point because she heard that canard used on a CNN broadcast. So far, I've not heard anyone repeat it. I've only seen references to the horrendous smell, the physical problem (blocking streets and piling up in and around mortuaries), and sanitation issues. Also, the point skeptigirl even mentioned in the OP--the emotional stress of seeing rotting corpses all over the place on top of all the other problems the people are facing.

At any rate, I appreciate the education on the narrow point that most infectious pathogens die shortly after the person dies. But as for the policy question, I think it makes perfectly good sense to truck the bodies off and dump them into mass graves as soon as is practically feasible. It sounds like the most reasonable way of dealing with them.

The loudest objections to this, I suspect, will be religious--and perhaps the issue of where the mass graves are located (an issue already raised on this thread)--you'll definitely run into NIMBY sentiment, and understandably so.

[Skeptic Ginger]

Somehow citing studies about occupational risks don't seem convincing when you try to apply them to non-professionals. Non-professionals, especially under the circumstances in Haiti for both the bodies and the survivors, will cause those study statistics to inflate dramatically. The fact is, handling bodies is dangerous. Fact is, you poo pooed that fact to the point where anyone taking your credentials seriously might get the mistaken impression that handling bodies was perfectly harmless until one were to (quote) "suck the blood from the bodies". It is the very fact that there is little in the way of officials that the dangers associated with dead bodies should be emphasized, not handwaved away because you've deemed knowing the truth to be an impracticality.If you have any studies or data that demonstrate outbreaks of disease occur from piled high corpses that died of trauma, put the studies out there.

If you have any studies of rescue worker or lay person epidemics or even individual case reports of infection related to piles of corpses, let's see them.

[Skeptic Ginger]

Well, let's see what your years of education and training can do to teach me.


I already knew that. However, it pretty much does stop growing when the host dies. Did you think I was making some sort of absolute statement or do you think I was making a shorthand point about infectious diseases and corpses?


You're just spoiling for a fight, aren't ya? Do you really want to debate the accuracy of my statement that if you deal with me while I'm living, you're not going to come in contact with my fecal matter unless you stick your finger up my butt? Really? I mean, do your really think I was making some sort of absolute statement about the transfer of fecal contamination among humans?


Oh, I dunno, nurse. How about we rub a turd into a bloody gash on my leg and find out?I'm trying to help you understand something, but you are more concerned with winning the pissing contest. It prevents a lot of learning.


Separate in your mind, if you will, pathogens from the vast majority of microorganisms.

Separate in your mind, if you will, the means of transmission from the host and separate the host from the reservoir.


Viruses need a host cell to replicate. So replication does stop when the host cell dies. Bacteria and other organisms can replicate outside the host.


Certain things amplify organisms. An active infection, for example, is going to produce more organisms than colonization without active infection.


Certain things make an organism more likely to spread if the means of transmission occur. In particular, what is the dose required for an infection to occur? Think of it like a fire. If you have lots of fuel, it only takes a spark to get a blaze. If you have wet wood, you can probably still get it to burn if you have a big enough ignition source and you apply it for a long enough time.

Take that same fire example, if there is fuel everywhere, you get a big conflagration. If the fuel is spread far apart, the fire burns itself out.



Now take those principles and apply them here.

You need a pathogen, not just germs.
You need a susceptible host.
You need a means of transmission.
You need a reservoir for those germs be it an infected individual or a contaminated water source.


If you don't have any one of these things, you are not going to get an epidemic. With the corpses from mass trauma, you don't have the pathogens.

With HIV infected corpses, you don't have a means of transmission. If the infected blood touches rescuers' skin, the virus does not penetrate the barrier and no means of transmission occurs.


And so on.....

[Skeptic Ginger]

Really? I am "totally" wrong to say that "Most infectious diseases die with the person or shortly thereafter." Really?

The WHO says, "Most agents do not survive long in the human body after death (with the exception of HIV -which can be up to 6 days) and the source of acute infections is more likely to be the survivors. Human remains only pose health risks in a few special cases requiring specific precautions, such as deaths from cholera or haemorrhagic fevers."

You got a problem, take it up with them. I suggest you consider the benefit of years of education and experience vs reading a couple paragraphs and expecting every detail to be included in those paragraphs. ... but I digress...


I would be concerned about HIV in a corpse beyond 6 days, but I wouldn't expect the infected corpse to pose a risk to anyone unless they were sucking it's blood. Perhaps if you were trapped in the rubble with massive open wounds and a dead body was dripping blood into your wounds. :rolleyes: And, you must have been reading something that only applied to HIV since hepatitis B virus is still infectious at least 2 weeks in dried blood.


But now we are back to those straw men. I said at least a couple times, if you are talking about mass casualties from ebola (or some other infectious disease like cholera) then the bodies are an issue. This discussion is about mass casualties from trauma.

The second straw man, is claiming I've said HIV infected corpses are never a source of infection under completely different circumstances than are being discussed.

If these piled up bodies risk an epidemic of HIV, let's see the epidemiological evidence. Find a case that has been described in the literature of an HIV epidemic from oozing corpses.




Did I say that it did?I'm not sure how it is you think an epidemic is going to be caused by piled up corpses if you aren't talking about contaminated water. Do you expect an HIV epidemic because kids are going to play in or around the bodies? :rolleyes:

[Skeptic Ginger]

Viruses, sure. I was under the impression that bacteria would continue to live long after.They do. UY has gotten in over his head here and he's trying to fudge his answers to pretend he knew all along stuff he's finding he didn't know.

[Skeptic Ginger]

Well, maybe there's a problem in terminology between laypersons and experts. Let's take salmonella (just off the top of my head and not related to the corpse issue). While it's certainly possible for salmonella to spread from human to human, the outbreaks (as I understand them) are usually due to food contamination. An "outbreak" typically occurs because a bunch of people eat the same contaminated food. To me, that's "spreading" sickness.

By contrast, I would consider something like measles to be an epidemic. For example, I recall reading about an unvaccinated person returning with measles from an overseas trip and arriving back in his community, which had a large percentage of unvaccinated people. There was an outbreak of measles, which in this layperson's terminology would be an "epidemic" in that small community. It started from that one person and spread person to person as measles will do.

Regardless of whether my terminology is correct, do you understand how I am differentiating the two? When I think of corpses spreading sickness, I think of the entire mass of corpses of being one unit, just as I think of all those jars of Peter Pan peanut butter as one "unit" that spread salmonella. Your definitions and your divisions of epidemic vs outbreak vs spreading sickness are imaginary divisions. I suggest you look up the definition of outbreak, epidemic, and route of transmission. This has nothing to do with 'lay terminology'. It has to do with you not understanding some basic principles of infectious disease.

Mike Sun was specifically referring to ordinary people handling corpses, not trained workers. He also noted their lack of access to proper sanitation. The WHO says, "Gastrointestinal infections are more common as dead bodies commonly leak faeces. Transmission occurs via the faeco-oral route through direct contact with the body and soiled clothes or contaminated vehicles or equipment. Dead bodies contaminating the water supply may also cause gastrointestinal infections."

Honestly, I'm just not seeing why Mike's statement and my defense of it are being attacked so hard.And I've said repeatedly that even an unskilled person handling a corpse is extremely unlikely to get HIV from that action. That point has been repeatedly overlooked as readers focus on all the wrong things about what I posted.

Occupational exposure evidence: doesn't mean it doesn't apply to other situations. The bottom line is HIV is not easy to catch unless you are sharing contaminated needles for IV drug use, getting a contaminated infusion of blood, or having unprotected sex with an infected partner.

[Skeptic Ginger]

There is room in the middle between "can spread sickness" and "epidemic", especially since "epidemic" is such a wishy-washy concept in the first place. It isn't just the presence of corpses (near the water supply), it's also improper handling them (especially the recent ones) that is at issue. There is no paradox or contradiction here. It isn't one or the other. Some of the people handling recently the various body fluids of the very recently dead with no gloves or other means of sanitation are going to pick up a few issues such as HIV, HepA, etc. Those can be transferred that way, and therefore will be, statistically speaking.The corpse has to have hepatitis A and it has to be in the acute phase to be a risk to the water supply. Hep A is only infectious for about a week.

We are back to confusing germs with pathogens.


If the corpse did not have a contagious disease before dying, it isn't going to acquire one rotting in the street.

There has been a discussion about the high rate of HIV in Haiti. This is a legitimate concern. However, if HIV were going to spread via blood contaminated water, there would be evidence by now of outbreaks associated with contaminated water. I know of no such occurrences. I'd love it if someone had any actual evidence this could occur. It would change this discussion dramatically.


The issue here is, what does the evidence support, not, what can we imagine dead bodies might pose a risk for?


There is no evidence of bloodborne viruses spreading in water sources. It would be interesting to see if it were even possible, since you can get infected from swallowing blood and semen. For some reason, probably dose and the viability of the viruses in open water sources, it does not appear to occur.


As for the touching of dead people, even those who are bleeding or oozing, and even without gloves on, this is just not a common source of infection. HIV and hep C are highly unlikely to be spread this way. Hep B might be, but in a population with a high prevalence of hep B, more people are immune than are active carriers. The risk would still be very low.

[Belz...]

With HIV infected corpses, you don't have a means of transmission. If the infected blood touches rescuers' skin, the virus does not penetrate the barrier and no means of transmission occurs.

Indeed. Provided the handler isn't bare-handed and isn't sporting cuts from all that hard work.

[Belz...]

They do. UY has gotten in over his head here and he's trying to fudge his answers to pretend he knew all along stuff he's finding he didn't know.

Uh-huh... but if "they do", doesn't that pose a health risk ?

[Estellea]

If you have any studies or data that demonstrate outbreaks of disease occur from piled high corpses that died of trauma, put the studies out there.

If you have any studies of rescue worker or lay person epidemics or even individual case reports of infection related to piles of corpses, let's see them.Skeptigirl, rescue workers in a natural disaster scenario are thought to have about the same risks as those with occupational exposure. In some cases, exposure potential may be lesser or greater, depending upon handling and disease endemicity: http://www.ncbi.nlm.nih.gov/pubmed/15231077 Tuberculosis is probably a greater concern than HIV.

Este

[Cynic]

As for the touching of dead people, even those who are bleeding or oozing, and even without gloves on, this is just not a common source of infection. HIV and hep C are highly unlikely to be spread this way. Hep B might be, but in a population with a high prevalence of hep B, more people are immune than are active carriers. The risk would still be very low.


OK, look. As a healthcare professional I want you test this resolve. For the next few dozen bloodied, soiled patients you're faced with, I want you to go out in the parking lot and scrape your hands on the concrete until they're nice and bloody, then come back and treat them with your bare hands. After you do, please refrain from washing up afterward. If at all possible, try to maintain a state of malnutrition and dehydration so that your immune system isn't at its peak.

Are you willing to do that? Why or why not?

You need to stop relying on statistical studies if you can't understand what the statistics represent.

[Skeptic Ginger]

Indeed. Provided the handler isn't bare-handed and isn't sporting cuts from all that hard work.That's just not true. I keep trying to tell you guys what the actual evidence supports. Many of you keep insisting on a black and white answer, blood on broken skin can spread HIV.

IT RARELY DOES, under those circumstances. Cases of acquiring HIV from getting blood or body fluids on broken skin are almost non-existent.

[Skeptic Ginger]

Skeptigirl, rescue workers in a natural disaster scenario are thought to have about the same risks as those with occupational exposure. In some cases, exposure potential may be lesser or greater, depending upon handling and disease endemicity: http://www.ncbi.nlm.nih.gov/pubmed/15231077 Tuberculosis is probably a greater concern than HIV.

EsteI'm not sure what your point is and that article was cited earlier.

I have over a dozen fire departments (EMS workers) who contract for my services to prevent and treat them for occupational exposure to infectious disease.

There have been studies done on 6 departments comparing the EMS workers to matched controls and they had the same rates of hepatitis C as the controls. This came about after a lab screened the Philadelphia Fire Department for hep C and found a very high rate. The fire fighters union went on a mass campaign about the hep C risk and it was a big deal for years.

But CDC re-examined the lab company's data and found it was flawed. And they undertook further testing. And there are other occupational epidemiological studies, as I mentioned, which found that thousands and thousands of hep C exposures to health care and EMS workers only resulting in transmitting infection extremely rarely. And yet in some populations, hep C is rampant, in particular IV drug users.

What I'm saying is one needs to look beyond the blanket statement, blood can be infectious, and evaluate the other factors that lead to (or not) infection transmission.

[Skeptic Ginger]

....

You need to stop relying on statistical studies if you can't understand what the statistics represent.:id:

[Fiona]

Why are IV drug users at increased risk where professionals are not? Is it due to lack of hygiene and precautions which professionals take?

I read this piece

http://www.energyinst.org.uk/content/files/guidance.pdf

Occupational risk of transmission from significant exposure to blood borne viruses (BBV)
The risk of infection from Hepatitis B is about 30 per 100 where the source is known to be HBeAg positive

That is not an insignificant figure.

Are the studies you are relying on based on those like your fire department example? I presume that those who work in fields where that level of risk is known offer immunisation since that is said to be effective? or have guidelines for prevention and post-exposure action? If that is the case then would one expect an elevated incidence over the general population? I really don't know. The article I cited above puts the incidence of infection for Hep C much lower at 3 per 100 exposures. There is no immunisation available, and no post exposure action which serves to prevent disease.

Have I missed anything which shows that the base level of infection from fresh bodies is very much less than that from live people: or that the 30 per 100 infections from exposure is not a base line with relevance to those who might handle such bodies in a disaster and with none of the recommended precautions?

[Uncayimmy]

Uh-huh... but if "they do", doesn't that pose a health risk ?

Exactly. I can't believe there is so much resistance to the notion that corpses present a health risk. Nobody, and I mean nobody in this thread is saying they will result in epidemics of infectious diseases. However, improper handling of corpses can lead to sickness. This is why the CDC and WHO have guidelines for handling them. Chances are lots of people with no training, experience or equipment will be handling corpses.

Corpses can taint the water supply (they leak feces). Nobody I've seen is arguing that something like AIDS is going to spread via the water supply, but that doesn't change the fact that it's not a good idea to drink from a stream with corpses in it. If the municipal water supply is already tainted, so what? Not everyone gets their water from a faucet.

On top of that it was irresponsible for Skeptigirl to say that since we all have bacteria in our gut that it must mean that it's safe. You definitely don't want feces in an open wound, and you probably don't want it in your eyes either. While we need the gut flora, they belong in the gut, not in our wounds. As I understand some of them can cause serious infections.

So, really, I'm just not getting why this is such a bad thing to point out.

[Estellea]

I'm not sure what your point is and that article was cited earlier.I can see now that it was previously linked. The point is, is that there is a potential for disease exposure, albeit not epidemic, by handling corpses from natural disasters.

I have over a dozen fire departments (EMS workers) who contract for my services to prevent and treat them for occupational exposure to infectious disease.

There have been studies done on 6 departments comparing the EMS workers to matched controls and they had the same rates of hepatitis C as the controls. This came about after a lab screened the Philadelphia Fire Department for hep C and found a very high rate. The fire fighters union went on a mass campaign about the hep C risk and it was a big deal for years.

But CDC re-examined the lab company's data and found it was flawed. And they undertook further testing. And there are other occupational epidemiological studies, as I mentioned, which found that thousands and thousands of hep C exposures to health care and EMS workers only resulting in transmitting infection extremely rarely. And yet in some populations, hep C is rampant, in particular IV drug users. I assume you mean this one? (http://www.ncbi.nlm.nih.gov/pubmed/14638560) Well if you look at the exposure potential for HCV, it was very low:
Most exposures to blood reported by the Atlanta first responders were with intact skin (174 per 100 person-years). Contaminated needle sticks (0) and mucosal exposures to blood (1 per 100 person-years) were relatively rare.In an environment that has a relatively low HCV endemicity. As for HBV:
In contrast, prior to routine hepatitis B immunization (and implementation of universal precautions), both the incidence and prevalence of HBV infection were substantially higher among hospital-based health care workers than among the general population, and infections were consistently associated with the degree of occupational blood exposure. A higher than expected HBV prevalence also was found among EMTs and paramedics, but not among firefighters who spent less than 20% of their time as EMTs.Now, when you have very high disease endemicity in developing or underdeveloped countries, very few responders that have been vaccinated for HBV, post-exposure prophylaxis is lacking, as is personal protection and proper hygiene and experience with handling/storing corpses and helping survivors, cautioning people to 'not suck corpse blood' is no substitute for improving the aforementioned precautions. It is also not outside the realm of probability to assume that exposure risks are increased under such extreme conditions.

What I'm saying is one needs to look beyond the blanket statement, blood can be infectious, and evaluate the other factors that lead to (or not) infection transmission.I'm afraid that I didn't read your posts that way at all since the discussion has moved past 'dead bodies don't cause disease epidemics'. I think your blithe dismissal of the infection potential that corpses can actually have is what has provoked some ire.

Este

[GreyICE]

Exactly. I can't believe there is so much resistance to the notion that corpses present a health risk. Nobody, and I mean nobody in this thread is saying they will result in epidemics of infectious diseases. However, improper handling of corpses can lead to sickness. This is why the CDC and WHO have guidelines for handling them. Chances are lots of people with no training, experience or equipment will be handling corpses.

Corpses can taint the water supply (they leak feces). Nobody I've seen is arguing that something like AIDS is going to spread via the water supply, but that doesn't change the fact that it's not a good idea to drink from a stream with corpses in it. If the municipal water supply is already tainted, so what? Not everyone gets their water from a faucet.

On top of that it was irresponsible for Skeptigirl to say that since we all have bacteria in our gut that it must mean that it's safe. You definitely don't want feces in an open wound, and you probably don't want it in your eyes either. While we need the gut flora, they belong in the gut, not in our wounds. As I understand some of them can cause serious infections.

So, really, I'm just not getting why this is such a bad thing to point out. This.

[Skeptic Ginger]

Why are IV drug users at increased risk where professionals are not? Is it due to lack of hygiene and precautions which professionals take?It is not yet known why, but it is clear there is a difference. Either vein to vein needle use or repeat exposures are two hypotheses but it has not been tested.

In the US in the large cites where IVD users have been screened, over 70% are infected with hep C in every study. But when you look at all the occupations which are know to be at risk for hep B due to blood exposures, only phlebotomists and IV nurses show higher rates of hep C than matched controls. The difference between occupational exposures and IVD users hep C rates is shocking, but true.


I read this piece

http://www.energyinst.org.uk/content/files/guidance.pdf



That is not an insignificant figure.Hepatitis e antigen is a transient condition that occurs when a person is in the initial stages of hepatitis B infection. It is an extremely severe situation but fortunately not every hep B carrier is e antigen positive.

There is one case where a cardiac surgeon infected 19 patients with hepatitis B and there was no evidence he ever punctured himself or his gloves during any of the surgeries. The researchers were able to recover hep B virus from the inside of his gloves and he had no specific skin lesions. This was an unusual case.


I'm not discounting the risk of spreading hep B here. What I did say, however, was that in a high prevalence country for hep B, a good proportion of the adult population is already infected if they have not been vaccinated. About 85% of those infected clear the virus on their own and never get sick. Another 5% (roughly) experience acute hepatitis B and either die or recover, again without becoming carriers. So you are going to have ~10% of those infected remaining as carriers and a whole lot of people in the community where the prevalence is high already having recovered from the infection and having resulting lifelong immunity.

It would appear, however, from the WHO website that Haiti has no significant hep B vaccine programs.



Are the studies you are relying on based on those like your fire department example? I presume that those who work in fields where that level of risk is known offer immunisation since that is said to be effective? or have guidelines for prevention and post-exposure action? If that is the case then would one expect an elevated incidence over the general population? I really don't know. The article I cited above puts the incidence of infection for Hep C much lower at 3 per 100 exposures. There is no immunisation available, and no post exposure action which serves to prevent disease.

Have I missed anything which shows that the base level of infection from fresh bodies is very much less than that from live people: or that the 30 per 100 infections from exposure is not a base line with relevance to those who might handle such bodies in a disaster and with none of the recommended precautions?I've already addressed this. Hep C and HIV are extremely unlikely to be transmitted from these bodies. Hep B is possible. The percentage of hep B carriers in a high prevalence country is still going to be less than 10%. And if the prevalence of carriers is 10%, the prevalence of antibodies and therefore immunity is going to be very high, maybe even as high as 80%.

So the odds of a non-immune person contacting the blood of a carrier cadaver becomes very low.

Slave Trade and Hepatitis B Virus Genotypes and Subgenotypes in Haiti and Africa (http://www.cdc.gov/eid/content/15/8/1222.htm)In 7,147 blood samples of pregnant Haitian women, HBsAg prevalence was 5%, ranging from 1.0% to 8.5%, depending on the sampling clinic. The tests here were for surface antigen, IE carriers. If you surveyed the same population for core antibody, you'd find the majority had past infection if you see 5% carrier prevalence in a population.

[Skeptic Ginger]

I can see now that it was previously linked. The point is, is that there is a potential for disease exposure, albeit not epidemic, by handling corpses from natural disasters.Have you found any epidemiological data here that goes beyond "potential"?

I assume you mean this one? (http://www.ncbi.nlm.nih.gov/pubmed/14638560) Well if you look at the exposure potential for HCV, it was very low:
In an environment that has a relatively low HCV endemicity. As for HBV:
Now, when you have very high disease endemicity in developing or underdeveloped countries, very few responders that have been vaccinated for HBV, post-exposure prophylaxis is lacking, as is personal protection and proper hygiene and experience with handling/storing corpses and helping survivors, cautioning people to 'not suck corpse blood' is no substitute for improving the aforementioned precautions. It is also not outside the realm of probability to assume that exposure risks are increased under such extreme conditions.That is only one of dozens of studies looking at the occupational risk of hep C. I have reviewed dozens and dozens of different studies. I was not going to produce a bibliography here. I know the data inside out, so if someone wants a lit review they are on their own, but I stand by my knowledge in the medical specialty I practice in.

When the initial studies of hep B occupational risk were done, dentists, ED and OR workers and ICU staff (in that order from high to low) had higher rates of markers for hep B than matched controls. Studies of the prevalence of hep B in EMS and in police or corrections fields is seriously lacking.

Comparable studies looking at the epidemiology of hepatitis C in numerous occupational settings has not found any appreciable occupational risk even among those occupations whose risk of hep B ( a marker for blood exposure risk ) was high. It would appear that an exposure type such as a deep puncture from a large bore needle fresh out of the vein of an infected person is needed to spread hepatitis C with an occupational blood exposure.

This study is consistent with what the data in general shows: The risk of HCV transmission after percutaneous exposure increased with deep injuries and procedures involving hollow-bore needle placement in the source patient's vein or artery. (http://www.ncbi.nlm.nih.gov/pubmed/16231252?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed)



As for hep C prevalence in Haiti, one is still looking at less than 5% (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC539356/) of the population. In a subset, mainly IVD users, you see 70+%, but much of the HIV prevalence in Haiti is from sexual exposure, not from exceedingly high rates of IVD use.

It's been my experience that EMS and police have more frequent exposures to hep C infected blood relative to hep B carriers. HIV exposures are even rarer in this area but that can differ if for example you looked at EMS workers in NY City where the HIV rate among the drug users is much higher than it is in this county. So I don't think your argument is valid that the corpses in Haiti would have more risk fro hep C than occupational exposures in the US.





I'm afraid that I didn't read your posts that way at all since the discussion has moved past 'dead bodies don't cause disease epidemics'. I think your blithe dismissal of the infection potential that corpses can actually have is what has provoked some ire.

EsteIt's interesting how one can become angry when one's beliefs are challenged. But the fact of the matter is, there is no evidence that corpses killed by trauma in mass casualty events are the source of epidemics. And that is all I said in the OP.

For the rest of the discussion, I've only been trying to show that rationalizing why those corpses pose a threat when the data indicates they do not, is not consistent with critical analysis of the question.

Producing data or evidence of the corpses actually being a source of an outbreak would be evidence the corpses pose a risk. Rationalizing they pose a theoretical risk would be valid, except when that rationale includes overestimating the actual risk.

[Darat]

Several posts moved for breaches of Rule 12 (and some follow-up replies).

[Belz...]

That's just not true. I keep trying to tell you guys what the actual evidence supports. Many of you keep insisting on a black and white answer, blood on broken skin can spread HIV.

IT RARELY DOES, under those circumstances. Cases of acquiring HIV from getting blood or body fluids on broken skin are almost non-existent.

Yes, and it's the "almost" that bugs me. Would you take that risk ?

[MikeSun5]

OK, look. As a healthcare professional I want you test this resolve. For the next few dozen bloodied, soiled patients you're faced with, I want you to go out in the parking lot and scrape your hands on the concrete until they're nice and bloody, then come back and treat them with your bare hands. After you do, please refrain from washing up afterward. If at all possible, try to maintain a state of malnutrition and dehydration so that your immune system isn't at its peak.

:clap: :clap: Seconded. ...also, after handling said oozing bodies, go eat some healthy dirt cookies (http://worldfocus.org/blog/2009/02/19/dirt-poor-haitians-eat-cookies-made-of-mud/4120/) -- without washing first.

skeptigirl, you should be all over this one! No HIV, Hepatitis, or any pathogens are present, and per your words, dealing with these legions of decaying bodies would be no different than handling some old tomatoes, right? :rolleyes:

[UnrepentantSinner]

The thread title is misleading because, depending on time since death, you can still get an STD by having sex with a corpse.

[fls]

I have to admit that I don't know what to think anymore. I decided to crunch a few numbers.

If we assume that handling a bloody body without gloves when you have cuts or scrapes on your hands is similar to an occupational exposure, then it turns out that the chance of dying from HCV (albeit many years later) from handling one body in Haiti is about the same as the chance of dying if you acquire the swine flu.*

It seems to me that we have been given very different messages here when it comes to whether we should be worried about the swine flu and whether we should be worried about handling dead bodies in Haiti.

Linda

*(prevalence of HCV (0.044 x 0.75) x risk from exposure (0.03) x risk of chronic disease (0.75) x risk of progression to severe cirrhosis and hepatocellular carcinoma (0.20) = 0.00015) (risk of death from swine flu = 0.0002)

[fls]

The thread title is misleading because, depending on time since death, you can still get an STD by having sex with a corpse.

Generally the risk is greater for the receptive party. There may be some technical difficulties accomplishing this.

Linda

[Cynic]

I have to admit that I don't know what to think anymore. I decided to crunch a few numbers.

If we assume that handling a bloody body without gloves when you have cuts or scrapes on your hands is similar to an occupational exposure, then it turns out that the chance of dying from HCV (albeit many years later) from handling one body in Haiti is about the same as the chance of dying if you acquire the swine flu.*

It seems to me that we have been given very different messages here when it comes to whether we should be worried about the swine flu and whether we should be worried about handling dead bodies in Haiti.


Indeed. And that's very conservative considering that occupational exposure assumes gloves (sometimes doubled), soaps, alcohol sprays, bleach solutions, not to mention careful monitoring of by blood sample and pro-active immunizations and early intervention for positive results.

The difference with swine flu though is that it's easy to pass on after the fact. Transmission from corpses would decline severely over a short amount of time because their ability to transmit anything will decline and because there won't long be a reason to handle them. How the communicable the diseases acquired are determines the next problem, I suppose, but I expect it wouldn't go much beyond the normal background of Haiti.

[GreyICE]

I'm curious. Are there any disease that are not actually HIV?

[Cynic]

Thousands. Why do you ask?

[Estellea]

Have you found any epidemiological data here that goes beyond "potential"?Yes, here is a case study (http://content.nejm.org/cgi/content/full/342/4/246), here (http://www.ncbi.nlm.nih.gov/sites/entrez/9604188) and here (http://www.ncbi.nlm.nih.gov/sites/entrez/8810591) are epidemiological surveys, and this one (http://www.ncbi.nlm.nih.gov/pubmed/11081356) seems to be a result of cadaver contamination of the water supply as suggested by this. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095048/) Although I can verify that when I receive the full text.

That is only one of dozens of studies looking at the occupational risk of hep C. I have reviewed dozens and dozens of different studies. I was not going to produce a bibliography here. I know the data inside out, so if someone wants a lit review they are on their own, but I stand by my knowledge in the medical specialty I practice in. A few solid representations for being able to compare the risk of infectious disease by cadavers to handling some rotten vegetables would suffice.

When the initial studies of hep B occupational risk were done, dentists, ED and OR workers and ICU staff (in that order from high to low) had higher rates of markers for hep B than matched controls. Studies of the prevalence of hep B in EMS and in police or corrections fields is seriously lacking.

Comparable studies looking at the epidemiology of hepatitis C in numerous occupational settings has not found any appreciable occupational risk even among those occupations whose risk of hep B ( a marker for blood exposure risk ) was high. It would appear that an exposure type such as a deep puncture from a large bore needle fresh out of the vein of an infected person is needed to spread hepatitis C with an occupational blood exposure.

This study is consistent with what the data in general shows: The risk of HCV transmission after percutaneous exposure increased with deep injuries and procedures involving hollow-bore needle placement in the source patient's vein or artery. (http://www.ncbi.nlm.nih.gov/pubmed/16231252?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_SingleItemSupl.Pubmed_Discovery_RA&linkpos=4&log$=relatedarticles&logdbfrom=pubmed)Is this any reason to a.) broadly apply these circumstances to a relief operation in a underdeveloped/developing country after a natural disaster? and b.) be so dismissive of emphasising the importance of proper handling of cadavers after a natural disaster to prevent personal infection risks?


As for hep C prevalence in Haiti, one is still looking at less than 5% (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC539356/) of the population. In a subset, mainly IVD users, you see 70+%, but much of the HIV prevalence in Haiti is from sexual exposure, not from exceedingly high rates of IVD use.

It's been my experience that EMS and police have more frequent exposures to hep C infected blood relative to hep B carriers. HIV exposures are even rarer in this area but that can differ if for example you looked at EMS workers in NY City where the HIV rate among the drug users is much higher than it is in this county. So I don't think your argument is valid that the corpses in Haiti would have more risk fro hep C than occupational exposures in the US. First, you can see yourself that disease endemicity is highly variable depending upon cohort and geographic area and that is certainly something to be mindful of and next, hep C isn't the only concern; my argument isn't pivotal upon that, particularly since there are other organisms which have a much higher transmission rate.

It's interesting how one can become angry when one's beliefs are challenged. But the fact of the matter is, there is no evidence that corpses killed by trauma in mass casualty events are the source of epidemics. And that is all I said in the OP.It appears as though it is accepted that cadavers don't cause disease outbreaks; that is not the belief that you are challenging any longer. You seem to be arguing that cadavers do pose a disease risk to responders is a logical extension of cadavers causing epidemics, it isn't. As far as the original assertion that cadavers cause disease epidemics, doesn't it seem equally absurd to dismiss the personal risks that first responders may encounter following a natural disaster?

For the rest of the discussion, I've only been trying to show that rationalizing why those corpses pose a threat when the data indicates they do not, is not consistent with critical analysis of the question.But there are data that indicate there is disease transmission from handling cadavers and not a single health agency agrees with you with regards to infection risk when handling cadavers.

Producing data or evidence of the corpses actually being a source of an outbreak would be evidence the corpses pose a risk. Rationalizing they pose a theoretical risk would be valid, except when that rationale includes overestimating the actual risk.An outbreak of disease emanating from cadavers is not the only outcome that should be considered. I think that the WHO's (http://www.who.int/hac/techguidance/ems/flood_cds/en/) statement is reasonable and doesn't overestimate the actual risk at all:
Contrary to common belief, there is no evidence that corpses pose a risk of disease "epidemics" after natural disasters. Most agents do not survive long in the human body after death (with the exception of HIV -which can be up to 6 days) and the source of acute infections is more likely to be the survivors. Human remains only pose health risks in a few special cases requiring specific precautions, such as deaths from cholera or haemorrhagic fevers.

However, workers who routinely handle corpses may have a risk of contracting tuberculosis, bloodborne viruses (such as Hepatitis B/C and HIV), and gastrointestinal infections (such as rotavirus diarrhoea, salmonellosis, E. coli, typhoid/paratyphoid fevers, hepatitis A, shigellosis and cholera).

* Tuberculosis can be acquired if the bacillus is aerosolized (residual air in lungs exhaled, fluid from lungs spurted up through nose/ mouth during handling of the corpse).
* Exposure to bloodborne viruses occurs due to direct contact with non-intact skin of blood or body fluid, injury from bone fragments and needles, or exposure to the mucous membranes from splashing of blood or body fluid.
* Gastrointestinal infections are more common as dead bodies commonly leak faeces. Transmission occurs via the faeco-oral route through direct contact with the body and soiled clothes or contaminated vehicles or equipment. Dead bodies contaminating the water supply may also cause gastrointestinal infections.

The public and emergency workers alike should be duly informed to avoid panic and inappropriate disposal of bodies, and to take adequate precautions in handling the dead (see prevention below). Even this rather cautious, albeit rational statement is at odds with your contention that corpses may be handled with the same precautions as rotting vegetables.

Este

[Rolfe]

Seems to me we have two rather separate propositions here.

1. Having piles of decomposing human corpses around will/may lead to epidemics.
A. No, it won't, where these are traumatic deaths of previously normal people, as opposed to deaths from an already-ongoing epidemic.

2. People who are handling the decomposing corpses risk exposure to disease agents some of the casualties might have been carrying. This risk is not high, but a few clean-up workers may well contract something, therefore reasonable hygiene precautions should be taken whenever possible.
A. Yes, this is a fair view of the situation.

Anybody in this thread actually disagreeing with any of that?

Rolfe.

[Cynic]

Not I.

[Fiona]

That is my understanding

[Estellea]

My understanding as well.

Este

[GreyICE]

Thousands. Why do you ask?

Based on the direction of discussion, it seemed like a logical question.

ETA: I agree with Rolfe

[Cynic]

Based on the direction of discussion, it seemed like a logical question.

It's just that the high prevalence of HIV in Haiti combined with it's unusual ability to survive (up to 6 days) makes it a particular concern in this instance. If I were more aware of the incidence rates of other diseases in Haiti, I'd be better prepared to suggest others to watch.

[Deetee]

Generally the risk is greater for the receptive party. There may be some technical difficulties accomplishing this.
Linda

Rigor mortis can come in handy sometimes.

[Deetee]

It's just that the high prevalence of HIV in Haiti combined with it's unusual ability to survive (up to 6 days) makes it a particular concern in this instance. If I were more aware of the incidence rates of other diseases in Haiti, I'd be better prepared to suggest others to watch.
Perspective:
Dead bodies with HIV (disaster victims) are potentially infectious for less than a week.
Live bodies with HIV (disaster survivors and the rest of the population, rescuers included) are potentially infectious for their entire lives.
(...and 6 days after ;))

[GreyICE]

It's just that the high prevalence of HIV in Haiti combined with it's unusual ability to survive (up to 6 days) makes it a particular concern in this instance. If I were more aware of the incidence rates of other diseases in Haiti, I'd be better prepared to suggest others to watch.

Hell, anything. We've got tetanus, gangrene, and measles listed here:
http://english.aljazeera.net/news/americas/2010/01/201011925913148759.html

I doubt they didn't exist in Haiti before the earthquake.

P.S. AJ got it right:
Corpses were being burned or dumped in mass graves but Andrus told a news conference on Monday that this was unnecessary and could damage the mental state of survivors.

[Belz...]

Seems to me we have two rather separate propositions here.

1. Having piles of decomposing human corpses around will/may lead to epidemics.
A. No, it won't, where these are traumatic deaths of previously normal people, as opposed to deaths from an already-ongoing epidemic.

2. People who are handling the decomposing corpses risk exposure to disease agents some of the casualties might have been carrying. This risk is not high, but a few clean-up workers may well contract something, therefore reasonable hygiene precautions should be taken whenever possible.
A. Yes, this is a fair view of the situation.

Anybody in this thread actually disagreeing with any of that?

Rolfe.

That sounds reaso-nable.

[Uncayimmy]

Generally the risk is greater for the receptive party. There may be some technical difficulties accomplishing this.

Now that is what I call putting the E in JREF! Many thanks!

From Dr. Hook's "Freaking at the Freaker's Ball (http://www.lyricsbox.com/dr-hook-lyrics-freakers-ball-wqnn69l.html)"

Well there's gonna be a freakers ball
Tonight at the freakers hall
And you know, you're invited one and all
...
White ones, black ones, yellow ones, red ones
Necrophiliacs looking for dead ones
The greatest of the sadist and the masochists too
Screaming "Please hit me, and I'll hit you"

Hs5MAWinxqQ

[Uncayimmy]

Seems to me we have two rather separate propositions here.

1. Having piles of decomposing human corpses around will/may lead to epidemics.
A. No, it won't, where these are traumatic deaths of previously normal people, as opposed to deaths from an already-ongoing epidemic.

2. People who are handling the decomposing corpses risk exposure to disease agents some of the casualties might have been carrying. This risk is not high, but a few clean-up workers may well contract something, therefore reasonable hygiene precautions should be taken whenever possible.
A. Yes, this is a fair view of the situation.

Anybody in this thread actually disagreeing with any of that?

Rolfe.

No argument from me. I would add one more:

3. Because corpses of previously healthy people may leak feces and gut flora, people should take precautions to avoid coming into contact with anything the corpses may have come into contact with, which in addition to clothes and tools includes naturally running water that under ordinary circumstances is considered "clean enough" to handle.
A: Yes, this is something that people should be aware of because even something as mild as diarrhea or infected cuts can turn nasty quickly in a situation where sanitation and health care are compromised.

[GlennB]

No argument from me. I would add one more:

3. Because corpses of previously healthy people may leak feces and gut flora, people should take precautions to avoid coming into contact with anything the corpses may have come into contact with, which in addition to clothes and tools includes naturally running water that under ordinary circumstances is considered "clean enough" to handle.
A: Yes, this is something that people should be aware of because even something as mild as diarrhea or infected cuts can turn nasty quickly in a situation where sanitation and health care are compromised.

Would this be why the doctor in 'Fawlty Towers' objected to Basil and Manuel dumping the dead guy's body on the kitchen prep table? ;)

[JoeTheJuggler]

Rigor mortis can come in handy sometimes.
Rigor mortis is the result of muscles in contraction. I don't think it does what you seem to be thinking (something caused by hydraulics).

;)

[Uncayimmy]

Would this be why the doctor in 'Fawlty Towers' objected to Basil and Manuel dumping the dead guy's body on the kitchen prep table? ;)

That makes no sense. After all, that's where you cut vegetables.

[Skeptic Ginger]

Yes, and it's the "almost" that bugs me. Would you take that risk ?The longer this discussion drags on, the further it gets away from the point. It's a straw man here to imagine I said one could not spread a bloodborne infection through a blood exposure. It's really annoying to have to repeat oneself over and over addressing straw men.


What I did say was, under the circumstances of a mass casualty event such as the Haiti earthquake, the corpses in the streets did not pose any imminent threat to the survivors.

Multiple citations have been posted here supporting the claim piles of corpses in mass casualty events (not caused by epidemics) are not a source of epidemics by not being removed quickly.

All sorts of hypotheticals were then presented as evidence the piles of bodies did pose a significant health risk if not promptly removed.

Here's the hypothesis:
A small percentage of those corpses are going to have chronic infections, that is the nature of a carrier state. Those that don't harbor pathogens are not going to acquire them as their flesh rots. Blood exposure is a source of transmission of certain chronic infections, in particular, HIV, hep B and hep C.

Therefore, leaving the corpses around on the streets risks spreading the infections.


But the problem here is, hypotheses are not evidence or data, they are ideas. You must then find evidence to support those hypotheses. Especially when there are flaws with the hypothesis. And, further, no one has been able to present evidence that the potential risk amounts to a real risk.


Here are the reasons I've cited against the hypothesis. Please pay attention. The discussion is limited to the mass casualty circumstances such as those in Haiti currently. Nowhere in this thread have I said infections are never spread through blood exposures.

The evidence is extensive that Hep C and HIV are not transmitted through small exposure events. They both take a large amount of infectious blood getting past the exposed person's skin.

If you consider less than 10% of the corpses even carry these viruses, (there was only a 2.2% prevalence of HIV in Haiti in 2007 and the rate has been declining , not rising (http://hivinsite.ucsf.edu/global?page=cr02-ha-00)), and you multiply that by the risk of a large exposure event (large amount of blood, deep puncture) you just don't get any significant numbers of people at real risk of getting infected from those corpses.

Is it possible for someone to get infected? If they go out of their way to suck blood, maybe.

Hep B is more contagious and can be transmitted with a small exposure event. In 2006 in a national survey of pregnant women in Haiti, 5% were hep B carriers (I cited this earlier). And that is a lot. But when you have 5% of the population with active hep B infection, a very large % of the population is going to be immune. The nature of hep B is that 85% of the infections resolve leaving the person immune to further infection and cured of the infection they did get.

So now you need a small exposure event but only 5% of the corpses are carriers of the virus and a huge % of the population are immune to hep B. Again, the chance of hep B transmission is very low under the circumstances.

[Skeptic Ginger]

:clap: :clap: Seconded. ...also, after handling said oozing bodies, go eat some healthy dirt cookies (http://worldfocus.org/blog/2009/02/19/dirt-poor-haitians-eat-cookies-made-of-mud/4120/) -- without washing first.

skeptigirl, you should be all over this one! No HIV, Hepatitis, or any pathogens are present, and per your words, dealing with these legions of decaying bodies would be no different than handling some old tomatoes, right? :rolleyes:It would help if you actually quoted my words. It would appear from your paraphrasing that you don't understand at all what I've said.

[Skeptic Ginger]

I have to admit that I don't know what to think anymore. I decided to crunch a few numbers.

If we assume that handling a bloody body without gloves when you have cuts or scrapes on your hands is similar to an occupational exposure, then it turns out that the chance of dying from HCV (albeit many years later) from handling one body in Haiti is about the same as the chance of dying if you acquire the swine flu.*

It seems to me that we have been given very different messages here when it comes to whether we should be worried about the swine flu and whether we should be worried about handling dead bodies in Haiti.

Linda

*(prevalence of HCV (0.044 x 0.75) x risk from exposure (0.03) x risk of chronic disease (0.75) x risk of progression to severe cirrhosis and hepatocellular carcinoma (0.20) = 0.00015) (risk of death from swine flu = 0.0002)Your numbers need adjusting. The .03 risk** is for all occupational blood exposures, but when you look further it turns out we can further stratify that risk. Blood on cuts and scrapes is much closer to zero risk. A deep puncture with a large bore needle just out of a vein or sharing IVD needles vein to vein are probably the minimum exposure you need to contract hep C. So I don't agree with your calculations.

**The sources for these numbers which are repeated routinely in occ. blood exposure guidelines are not consistent with the epidemiological data, but say the number is valid for the sake of your discussion.

Then you have to consider how many people would be at risk if you want to compare this to the flu risk, you need numbers of people who are going to come in contact with the blood, how many of those contacts would have an actual exposure. With influenza, the number of cases are in the millions.


In addition, no one is suggesting never removing the bodies. In the OP all I was concerned with was the myth that piles of corpses were the source of epidemics if one didn't clear them promptly. The rest of this has been about the actual risk vs the perceived risk of transmitting a bloodborne pathogen. See post 211 above for a review of that issue.

[Skeptic Ginger]

Indeed. And that's very conservative considering that occupational exposure assumes gloves (sometimes doubled), soaps, alcohol sprays, bleach solutions, not to mention careful monitoring of by blood sample and pro-active immunizations and early intervention for positive results.You misunderstand the stats here. The number Linda is using comes from exposure incidents, not health care worker days or patient encounters. She's talking about the risk with an exposure not the risk of an exposure. And for hep C there is no vaccine or post exposure prophylaxis.

[Uncayimmy]

LOL!

Skeptigirl, you need to spend more team reading and less time posting. You have this strange notion about what the topic is really about. I don't know how many people have told you that we agree that there is no evidence of a risk of epidemics due to corpses lying around. We've all moved on and said as much. Repeatedly. Yet you keep taking everything we say and trying to shoehorn it into somehow disagreeing with your OP. The reason you see straw men is because of your own perceptions, not what any of us are saying.

It's like you said that OJ should have been locked up for murdering his ex-wife. We agreed. Then we started talking about what a great running back he was. You say, "Running back, schmunning back! That's no excuse for murder. Besides, he's old and overweight."

"But," we counter, "OJ was in great shape. He was a joy to watch. I loved those Avis commercials when he jumped over the chairs in the airport!"

"How can you say the man was a joy to watch? He's a murderer. Here's the evidence. He didn't need to jump over a chair to commit those murders. He didn't need to run fast to get home because he was in his car."

Get it? Go read Rolfe's post. She sums it up quite nicely. It's called thread drift.

[MikeSun5]

It would help if you actually quoted my words.

Fine. :rolleyes:

It's a straw man here to imagine I said one could not spread a bloodborne infection through a blood exposure. It's really annoying to have to repeat oneself over and over addressing straw men.

It is a straw man here to imagine anyone other than the news source you're pissed at has ever claimed that dead bodies could cause a mass epidemic of HIV and/or hepititis. You are arguing with the wall in that regard.

What I did say was, under the circumstances of a mass casualty event such as the Haiti earthquake, the corpses in the streets did not pose any imminent threat to the survivors.

That is if your defininition of "imminent threat" does not include gastroenteritis, infected wounds, etc. I will take the blame for using the word "sickness." It implied disease when it shouldn't have. Anyway, you seem to be saying that decomposing bodies are okay to have laying around. Maybe in a laboratory, but in a neighborhood full of rubble with no sanitation? No water?? Not so much.

We've established that decaying corpses don't cause epidemics, but having them strewn about a disaster area where people are struggling to live is not a healthy idea.

[MikeSun5]

LOL!

Skeptigirl, you need to spend more team reading and less time posting.

...beat me to it.

[Darat]

...snip...

That is if your defininition of "imminent threat" does not include gastroenteritis, infected wounds, etc. I will take the blame for using the word "sickness." It implied disease when it shouldn't have. Anyway, you seem to be saying that decomposing bodies are okay to have laying around. Maybe in a laboratory, but in a neighborhood full of rubble with no sanitation? No water?? Not so much.

We've established that decaying corpses don't cause epidemics, but having them strewn about a disaster area where people are struggling to live is not a healthy idea.


I thought about this thread when I was watching a TV report this morning. It was showing some people filling up containers with water that was from a fractured water pipe, the water was streaming out and they were scoping it up from a puddle, now the water looked crystal clear and if it is coming from a still working supply (or reservoir) of drinking water it is probably safe. But then I thought "I wonder if they had bothered to move any dead bodies out of the stream of water since it is apparently not a matter of concern if you have a dead body in your water supply..." " (Yep even my internal monologues are sarcastic.)

[Deetee]

Just twisting things round a bit, devil's advocate like.:

Rescuers spread diseases.

We have evidence, most of it posted in this thread, that there are relatively high prevalences of HIV and Hep B in Haiti.
Most rescuers are likely to have injuries to their skin and be bleeding.
Most victims will have similar injuries.
If you think there is a real risk of bodies spreading viruses to the rescuers during salvage/rescue, then the reverse obviously applies, and rescuers will spread infections to the rescued.
Why are people not discussing/getting concerned about this risk?

[Darat]

Just twisting things round a bit, devil's advocate like.:

Rescuers spread diseases.

We have evidence, most of it posted in this thread, that there are relatively high prevalences of HIV and Hep B in Haiti.
Most rescuers are likely to have injuries to their skin and be bleeding.
Most victims will have similar injuries.
If you think there is a real risk of bodies spreading viruses to the rescuers during salvage/rescue, then the reverse obviously applies, and rescuers will spread infections to the rescued.
Why are people not discussing/getting concerned about this risk?

The risk involved in certain death i.e. not being rescued, weighed against a possible risk would always (at least to me) come out in favor of being rescued! :)

[Deetee]

It is a straw man here to imagine anyone other than the news source you're pissed at has ever claimed that dead bodies could cause a mass epidemic of HIV and/or hepititis. You are arguing with the wall in that regard.

Where did SG claim that this was said regarding HIV and Hep? [We have moved on to this topic, but only in the context of individual risk exposure to rescuers from blood contact and I don't see anyone ever claiming it would result in epidemics of this. Perhaps you should also spend more time reading the posts.]

I think we are all agreed that the risk of epidemics of say gastroenteritis from contact with the bodies is just about non-existent. The original sources of the "epidemic" nonsense were outlets like CNN and I quoted an extract from the Observer paper in the UK which claimed the same thing. It's not too hard to find media reports of this "risk".


We've established that decaying corpses don't cause epidemics, but having them strewn about a disaster area where people are struggling to live is not a healthy idea.

Agreed.

[Skeptic Ginger]

Yes, here is a case study (http://content.nejm.org/cgi/content/full/342/4/246), here (http://www.ncbi.nlm.nih.gov/sites/entrez/9604188)From the first cite: generation of potentially infectious aerosolsMycobacterium TB (mTB) has to either be injected (rarely TB abscesses have occurred from occupational needle sticks, or inhaled. You cannot be infected from mTB getting into your mouth or an open wound. (Like tetanus mTB doesn't grow in a wound open to the air, and mycobacterium bovis which one gets from unpasteurized milk is a different organism.) Surgery and autopsy where bone saws are used generate aerosols. And some disposal processes where infectious materials are ground up before burning have spread TB.

The embalming process included the aspiration of blood and other body fluids from the cadaver's hollow organs and the infusion of preservatives and disinfectants into the arteries under 1.4 to 2.3 kg (3 to 5 lb) of pressure. The aspirated body fluids and perfused liquids were then emptied into drains. Either part of the process may have resulted in the generation of aerosols. The frothing of fluids through the cadaver's nose and mouth or the release of trapped air bubbles through these orifices during cadaveric spasms may also have generated aerosols.Even considering the last sentence there, you are talking about inside a room and close contact. TB is not spread outdoors in the open air. The amount of bacteria aerosolized by an exploding bloated corpse is not going to infect anyone more than a foot away from the material. This is not a risk of mass casualties in the streets. This is a risk of inhaling a concentrated aerosol indoors.


and here (http://www.ncbi.nlm.nih.gov/sites/entrez/8810591) are epidemiological surveys,However, elevated rates were observed for inhalation therapists (SMR: 2.9; 95% CI: 1.2 to 6.0), and lower-paid health care workers (SMR: 1.3; 95% CI: 1.1 to 1.5). Elevated rates were also noted for funeral directors (SMR: 3.9; 95% CI: 2.2 to 6.1) and farm workers (SMR: 3.7; 95% CI: 3.4 to 4.1). These data suggest that even in communities with relatively low rates of tuberculosis certain occupations may be associated with an elevated risk.Lower paid workers are likely foreign born and have higher rates of positive PPDs from their country of origin. Farm workers are getting mycobacterium bovis not mycobacterium tuberculosis. And inhalation therapists are responsible for sputum inductions where you get a person with active TB to cough forcefully thereby aerosolizing it.


and this one (http://www.ncbi.nlm.nih.gov/pubmed/11081356) seems to be a result of cadaver contamination of the water supply as suggested by this. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2095048/) Although I can verify that when I receive the full text.I don't see anything there suggesting cadaver contamination of the water supply. It was a hurricane. That means lots of rain. That means flooding and that means potable water sources tend to get contaminated.

A few solid representations for being able to compare the risk of infectious disease by cadavers to handling some rotten vegetables would suffice.

Is this any reason to a.) broadly apply these circumstances to a relief operation in a underdeveloped/developing country after a natural disaster? and b.) be so dismissive of emphasising the importance of proper handling of cadavers after a natural disaster to prevent personal infection risks?Is this discussion about the ideal circumstances managing disaster casualties? I missed that somewhere. Do you think I teach workers in bloodborne pathogens classes they don't need gloves or shouldn't bother following up if they get a needlestick? That's mind bogglingly absurd if that is what you think I've said here.



First, you can see yourself that disease endemicity is highly variable depending upon cohort and geographic area and that is certainly something to be mindful of and next, hep C isn't the only concern; my argument isn't pivotal upon that, particularly since there are other organisms which have a much higher transmission rate.

It appears as though it is accepted that cadavers don't cause disease outbreaks; that is not the belief that you are challenging any longer. You seem to be arguing that cadavers do pose a disease risk to responders is a logical extension of cadavers causing epidemics, it isn't. As far as the original assertion that cadavers cause disease epidemics, doesn't it seem equally absurd to dismiss the personal risks that first responders may encounter following a natural disaster?That's the straw man other people continue to argue against. It has little to do with what I've been saying.


But there are data that indicate there is disease transmission from handling cadavers and not a single health agency agrees with you with regards to infection risk when handling cadavers. Your examples are not relevant to mass casualties in the streets, only to occupational procedures where aerosolizing of potentially infectious TB disease exists.

An outbreak of disease emanating from cadavers is not the only outcome that should be considered. I think that the WHO's (http://www.who.int/hac/techguidance/ems/flood_cds/en/) statement is reasonable and doesn't overestimate the actual risk at all:
Even this rather cautious, albeit rational statement is at odds with your contention that corpses may be handled with the same precautions as rotting vegetables.

EsteThe discussion I'm trying to have is not about ideal cadaver management. It is about the need to or not to remove bodies quickly to avert epidemics. And while I understand the discussion moved on to describing the risk of bloodborne pathogens, it still isn't about ideal management of cadavers, it is about how much risk do they really pose. The more I try to keep the discussion to the actual data about those risks, the more people keep insisting on potential risk rather than real risk. And while you've made an attempt to post about real risk, these examples are not really relevant to piles of bodies in the streets.


From the WHO link (which was cited before):Risk posed by corpses

Contrary to common belief, there is no evidence that corpses pose a risk of disease "epidemics" after natural disasters. Most agents do not survive long in the human body after death (with the exception of HIV -which can be up to 6 days) and the source of acute infections is more likely to be the survivors. Human remains only pose health risks in a few special cases requiring specific precautions, such as deaths from cholera or haemorrhagic fevers.

However, workers who routinely handle corpses may have a risk of contracting tuberculosis, bloodborne viruses (such as Hepatitis B/C and HIV), and gastrointestinal infections (such as rotavirus diarrhoea, salmonellosis, E. coli, typhoid/paratyphoid fevers, hepatitis A, shigellosis and cholera).

* Tuberculosis can be acquired if the bacillus is aerosolized (residual air in lungs exhaled, fluid from lungs spurted up through nose/ mouth during handling of the corpse).
* Exposure to bloodborne viruses occurs due to direct contact with non-intact skin of blood or body fluid, injury from bone fragments and needles, or exposure to the mucous membranes from splashing of blood or body fluid.
* Gastrointestinal infections are more common as dead bodies commonly leak faeces. Transmission occurs via the faeco-oral route through direct contact with the body and soiled clothes or contaminated vehicles or equipment. Dead bodies contaminating the water supply may also cause gastrointestinal infections.

The public and emergency workers alike should be duly informed to avoid panic and inappropriate disposal of bodies, and to take adequate precautions in handling the dead (see prevention below). All of these have been addressed. The corpse has to have had the pathogen in order to be a source of it.

You have to aerosolize mTB, you don't get it from direct contact.

Despite what people think I've written, I've not said blood is never a source of infection. I've said repeatedly the risk is minimal under these circumstances and not a rationale for the priority of rapid body removal to prevent an outbreak.

[Skeptic Ginger]

Seems to me we have two rather separate propositions here.

1. Having piles of decomposing human corpses around will/may lead to epidemics.
A. No, it won't, where these are traumatic deaths of previously normal people, as opposed to deaths from an already-ongoing epidemic.

2. People who are handling the decomposing corpses risk exposure to disease agents some of the casualties might have been carrying. This risk is not high, but a few clean-up workers may well contract something, therefore reasonable hygiene precautions should be taken whenever possible.
A. Yes, this is a fair view of the situation.

Anybody in this thread actually disagreeing with any of that?

Rolfe.No, not disagreeing at all. The only modification I'd make is that from my perspective, the actual documented epidemiology of blood exposure risks I've cited is being discounted while the hypothetical risk of transmission of bloodborne diseases is being overblown.

[Skeptic Ginger]

It's just that the high prevalence of HIV in Haiti combined with it's unusual ability to survive (up to 6 days) makes it a particular concern in this instance. If I were more aware of the incidence rates of other diseases in Haiti, I'd be better prepared to suggest others to watch.How high do you imagine that prevalence is? I cited a source that said it was 2.2% and dropping. While that is high relative to the US, it doesn't translate to very many of the corpses.

[Skeptic Ginger]

Just twisting things round a bit, devil's advocate like.:

Rescuers spread diseases.

We have evidence, most of it posted in this thread, that there are relatively high prevalences of HIV and Hep B in Haiti.
Most rescuers are likely to have injuries to their skin and be bleeding.
Most victims will have similar injuries.
If you think there is a real risk of bodies spreading viruses to the rescuers during salvage/rescue, then the reverse obviously applies, and rescuers will spread infections to the rescued.
Why are people not discussing/getting concerned about this risk?Or the survivors posing a risk to the rescuers.

[Belz...]

The longer this discussion drags on, the further it gets away from the point. It's a straw man here to imagine I said one could not spread a bloodborne infection through a blood exposure. It's really annoying to have to repeat oneself over and over addressing straw men.

It was a yes or no question, girl. I believe you mentioned rotting vegetables at some point, but I'm pretty sure you'd be more careful in handling corpses. I simply want you to confirm or deny my suspicion.

[Rolfe]

No, not disagreeing at all. The only modification I'd make is that from my perspective, the actual documented epidemiology of blood exposure risks I've cited is being discounted while the hypothetical risk of transmission of bloodborne diseases is being overblown.


I think, indeed, it's just your perception.

Rolfe.

[fls]

Your numbers need adjusting. The .03 risk** is for all occupational blood exposures, but when you look further it turns out we can further stratify that risk. Blood on cuts and scrapes is much closer to zero risk. A deep puncture with a large bore needle just out of a vein or sharing IVD needles vein to vein are probably the minimum exposure you need to contract hep C. So I don't agree with your calculations.

I agree that the types of exposure one will have removing bodies - from contact of body fluids with intact skin to penetrating injuries from sharp objects contaminated with blood (e.g. broken bones) - will vary. Will this be substantially different from occupational exposures? I don't know. But if your defense is that the overall risk is simply much lower than that of swine flu, otherwise you'd let us exhibit some concern over the handling of dead bodies, I'm still not sure I feel as confident as you do that we are there. After all, my back of the envelope calculation was for a single contact and a single disease. Even if you lower the rate of acquisition of HCV by one order of magnitude to 3 in 1000, from the kinds of exposures that would occur during the salvaging of bodies, once you've handled a dozen bodies, your risk is back up to the risk of dying from acquiring swine flu. And that doesn't take into account the other diseases which you are also at risk of acquiring.

So, I still don't understand why in one case, derision is directed at those who express concern (corpses) and in the other case, derision is directed at those who don't express concern (swine flu).

**The sources for these numbers which are repeated routinely in occ. blood exposure guidelines are not consistent with the epidemiological data, but say the number is valid for the sake of your discussion.

But I presume that you are aware that the sensitivity of epidemiological data will be low compared to the data gathered from studying occupational exposures, so it is to be expected that this level of risk will be lost in the 'noise' of an epidemiological study?

Then you have to consider how many people would be at risk if you want to compare this to the flu risk, you need numbers of people who are going to come in contact with the blood, how many of those contacts would have an actual exposure. With influenza, the number of cases are in the millions.

Whereas the number of dead (last number I heard thrown out on the news) is 200,000. So even assuming about one exposure per body, we're only looking at about 30 deaths from HCV. Is that the cut-off, then?

In addition, no one is suggesting never removing the bodies. In the OP all I was concerned with was the myth that piles of corpses were the source of epidemics if one didn't clear them promptly. The rest of this has been about the actual risk vs the perceived risk of transmitting a bloodborne pathogen. See post 211 above for a review of that issue.

As far as I can tell, the posters here have generally indicated that their perceived risk is low (all those who weighed in agreed with Rolfe's second statement). It appears that the argument is over whether or not it is reasonable to be indifferent to the risk when the perceived risk is low?

Linda

[Estellea]

From the first cite: Mycobacterium TB (mTB) has to either be injected (rarely TB abscesses have occurred from occupational needle sticks, or inhaled. You cannot be infected from mTB getting into your mouth or an open wound. (Like tetanus mTB doesn't grow in a wound open to the air, and mycobacterium bovis which one gets from unpasteurized milk is a different organism.) Surgery and autopsy where bone saws are used generate aerosols. And some disposal processes where infectious materials are ground up before burning have spread TB. No, the primary transmission route of M. tuberculosis is inhalation and the infectious dose is very low. You have also failed to recognise or read that embalmers do not routinely open cadavers:
How might we explain the occupational risk of tuberculosis among funeral home workers, including embalmers who generally do not open the chest cavity of the deceased? Hypothetically, the practice of embalming, which is common in this country, may result in the generation of infectious aerosols. Routine embalming procedures include the aspiration of blood and other body fluids from the deceased's hollow organs and the infusion of preservatives and disinfectants (under as much as 3-5 lbs of pressure) into the arteries (James F. Burnside III, Certified Funeral Service Practitioner [CFSP], personal communication, 1996) Using gravity feed, hollow organs such as the heart, lungs, and kidneys are routinely perfused. These procedures may result in the generation of infectious droplets.

The aspirated body fluids and perfused liquids are routinely emptied into floor, table, or sink drains, again possibly resulting in aerosol generation. In addition, fluid build-up in the deceased's chest cavity from putrefaction of tissues and organs may result in frothing and gurgling at the deceased's nose and mouth. Residual air in the deceased's lungs may be released when the body is moved and shifted about. In addition, cadaveric spasms, which occur when groups of muscles contract, may lead to lung purge and the release of trapped air bubbles through the nose and mouth. Once infectious aerosols are generated, tubercle bacilli may remain viable for extended periods of time.22-24

Even considering the last sentence there, you are talking about inside a room and close contact. TB is not spread outdoors in the open air. The amount of bacteria aerosolized by an exploding bloated corpse is not going to infect anyone more than a foot away from the material. This is not a risk of mass casualties in the streets. This is a risk of inhaling a concentrated aerosol indoors. Yes, these surveys were under circumstances that occurred in closed rooms with varying ventilation. MTB is spread outdoors although the exposure risk is reduced, not non-existent and it is recommended that corpses are not stored in closed warehouses after disasters. I simply fail to see how you can be so dismissive of a realistic, albeit probably low risk of contracting infectious diseases from cadavers without proper handling.

Lower paid workers are likely foreign born and have higher rates of positive PPDs from their country of origin. Farm workers are getting mycobacterium bovis not mycobacterium tuberculosis. And inhalation therapists are responsible for sputum inductions where you get a person with active TB to cough forcefully thereby aerosolizing it. That is quite a leap without having read the article.

Is this discussion about the ideal circumstances managing disaster casualties? I missed that somewhere. Do you think I teach workers in bloodborne pathogens classes they don't need gloves or shouldn't bother following up if they get a needlestick? That's mind bogglingly absurd if that is what you think I've said here.

That's the straw man other people continue to argue against. It has little to do with what I've been saying.I should certainly hope that if you are in a position to instruct others on personal protection, that you aren't as imperious as you have appeared to be here, regarding personal risk for rescue workers after a natural disaster. Here are the examples of your posts where you do appear to be rather dismissive of the potential risks that cadavers can pose for emergency responders:
http://forums.randi.org/showpost.php?p=5521937&postcount=77
http://forums.randi.org/showpost.php?p=5521967&postcount=84
http://forums.randi.org/showpost.php?p=5528300&postcount=149
http://forums.randi.org/showpost.php?p=5531431&postcount=167
http://forums.randi.org/showpost.php?p=5531544&postcount=169
http://forums.randi.org/showpost.php?p=5531591&postcount=171
http://forums.randi.org/showpost.php?p=5531624&postcount=172

Your examples are not relevant to mass casualties in the streets, only to occupational procedures where aerosolizing of potentially infectious TB disease exists.You see, we don't have good data to directly quantify the disease risks to emergency responders during or after natural disasters. So policy is derived from what we do know about disease mechanisms, microbial ecology and surveys of occupational hazards. Your arguments on this seem rather paradoxical for on one hand, you are extrapolating occupational risks (that have more controlled circumstances) to the risk on the ground in underdeveloped/developing countries for bloodborne diseases but when provided with evidence of MTB infection from cadavers, occupational risks are no longer relevant.

The discussion I'm trying to have is not about ideal cadaver management. It is about the need to or not to remove bodies quickly to avert epidemics. And while I understand the discussion moved on to describing the risk of bloodborne pathogens, it still isn't about ideal management of cadavers, it is about how much risk do they really pose. The more I try to keep the discussion to the actual data about those risks, the more people keep insisting on potential risk rather than real risk. And while you've made an attempt to post about real risk, these examples are not really relevant to piles of bodies in the streets.Again, you are using data selectively. We don't know what the actual risks are because we lack data that quantifies this for disaster rescue operations. We have to base it upon what we do have and there are infectious disease risks and responders need to be adequately informed and protected.

From the WHO link (which was cited before):All of these have been addressed. The corpse has to have had the pathogen in order to be a source of it. The point was to demonstrate that while you are rather dismissive disease risk and post some rather absurd suggestions to avoid it, agencies like the WHO, who are probably much more informed on such matters, takes it a bit more seriously.

You have to aerosolize mTB, you don't get it from direct contact.And cadavers can still aerosolize TB baccilli and TB baccilli can remain viable for a time after that.

Despite what people think I've written, I've not said blood is never a source of infection. I've said repeatedly the risk is minimal under these circumstances and not a rationale for the priority of rapid body removal to prevent an outbreak.No, you haven't claimed that blood is never a source of infection, you have however, advised people 'not to suck corpse blood', likened the risk to handling rotten tomatoes and been generally dismissive of the personal risks that rescue workers have being in contact with cadavers. The argument that corpses are responsible for disease epidemics is long gone.

Este

[ElMondoHummus]

As a digression: Popular Mechanics leads off an article with a statement about how the risk the dead pose is low to the surviving population:


If there is some good news to be shared, it is that these bodies pose little health risk to Haiti's surviving residents and to the health workers who are taking care of them.

That dead bodies might be dangerous is a "myth that has been perpetuated time and time again," says Steven Rottman, director of the UCLA Center for Public Health and Disasters. After almost every major natural disaster in history, survivors and the media have voiced concern that corpses could transmit infectious diseases. But if the disasters have struck populations that have, for the most part, been vaccinated against major communicable diseases like measles, "the risk of dead bodies following natural disasters being a source for spreading infectious diseases is very, very small," Rottman says.

That's because people who die in natural disasters like earthquakes or hurricanes are typically healthy. "They may have other medical conditions, but they're not living with highly communicable diseases," he says. "They die from injuries."


Link: http://www.popularmechanics.com/science/health_medicine/4343222.html

[Skeptic Ginger]

I agree that the types of exposure one will have removing bodies - from contact of body fluids with intact skin to penetrating injuries from sharp objects contaminated with blood (e.g. broken bones) - will vary. Will this be substantially different from occupational exposures? I don't know. But if your defense is that the overall risk is simply much lower than that of swine flu,You brought the claim up comparing the risk of 2009 H1N1 with the risk posed by the corpses, I didn't. I'm unconvinced you used the proper denominator in your comparison. If we can reach an agreement on the denominator, then we can look at the matter of whether or not I am using the same standard here as I use in promoting influenza vaccine. (I assume that was your point so if it wasn't then by all means correct me.)

I've pointed out a couple flaws in your reasoning. Everyone infected with H1N1 has the same risk in that they are all infected. You were comparing the risk of an H1N1 infected person having severe disease with the risk of a person exposed to the blood of a cadaver having severe disease. But your denominators are not comparable. The risks you compared were the risk given an exposure incident vs the risk given H1N1 infection. Not everyone handling a corpse and certainly not everyone in the vicinity of a corpse is going to have an actual exposure incident.

Whereas the number of dead (last number I heard thrown out on the news) is 200,000. So even assuming about one exposure per body, we're only looking at about 30 deaths from HCV. Is that the cut-off, then?I don't see any evidence supporting the estimate there would be one exposure per cadaver. That's really extreme. How are you defining an exposure and how do you figure one exposure per cadaver in your estimate?

Further, with flu there are millions infected. With the Haiti casualties, there is no evidence there are millions meeting the actual criteria of a blood exposure to a cadaver that was not promptly removed.

But my main argument with your calculation was the estimate that any exposure had [X] risk. I've said repeatedly that both HIV and hep C are not seen being transmitted with small blood exposure incidents. It's not that infection is rare, it is that there is a minimum exposure threshold that needs to occur before any risk occurs and even then infection transmission is still rare.

After all, my back of the envelope calculation was for a single contact and a single disease. Even if you lower the rate of acquisition of HCV by one order of magnitude to 3 in 1000, from the kinds of exposures that would occur during the salvaging of bodies, once you've handled a dozen bodies, your risk is back up to the risk of dying from acquiring swine flu. And that doesn't take into account the other diseases which you are also at risk of acquiring.This is where there is a disconnect from what the data actually shows vs the perceived risk. There is no evidence hep C or HIV are EVER transmitted with minimal blood exposures.

Take HIV. There is a single case documented of HIV being transmitted through a bite and that was in an assault during a robbery. The bite was extensive and the biter had late stage (IE hi viral load with mouth sores) HIV. Multiple proactive searches of patients of HIV infected surgeons, household caregivers of HIV infected persons and dental patients of HIV infected dentists have been reviewed. Transmission to these minimally but not zero exposure risks persons was not found.

Cases of transmission with low blood volume exposures have been searched for relentlessly and cases were just not forthcoming. Please, by all means, prove me wrong. I'll change what I say to exposed workers and lower my threshold for recommending HIV PEP in a heartbeat if further data is forthcoming showing I'm wrong on this.

As for the blanket statement: But I presume that you are aware that the sensitivity of epidemiological data will be low compared to the data gathered from studying occupational exposures, so it is to be expected that this level of risk will be lost in the 'noise' of an epidemiological study?It depends on the extent of one type of study over the other. Occupational risk of hepatitis C infection has been evaluated in thousands and thousands of individuals in various occupations which have known blood exposure risk, including evaluating the effect of length of employment in the job with the risk. These studies include employees whose work practices changed over time from more risky to less risky. Only a very small risk was detected and only in occupations involving phlebotomy.

Orthopedic surgeons, known to have a tremendous exposure history and known to have substantial risk of hep B before the vaccine was available were surveyed in one very large study. No greater rate of Hep C than matched controls was found.

I have defended in court the right of a fire fighter (EMS provider) to collect industrial insurance benefits for a hepatitis C infection the employer had no evidence was not work related. And in this country a number of hep C infected fire fighters are collecting industrial insurance benefits for their infections. But this is not evidence the actual rate of hep C transmission in EMS work is more frequent than extremely rare. I happen to believe if you put yourself at risk of infection, you deserve medical care if infection occurs. But it is a separate issue from determining actual risk.

People have a tendency to consider industrial insurance claims as evidence hep C is frequently transmitted to EMS workers. The two data sets are not comparable, but they do lead to a certain perception regarding occupational hep C risk.

I'm more than happy to discuss the actual risk comparisons here if you'd care to keep going with this. At least it's more interesting than just repeating my discussion of the actual risk of HIV and hep C transmission with exposure incidents.


My discussion of hep B risk from the cadaver piles was also entertained here. The calculation of risk would be the risk of the cadaver being infectious (5%) times the chance of an actual exposure (go ahead and estimate one exposure per cadaver, I have no better estimate and I see no way to determine it from the data available to me) times the number of people experiencing that exposure incident who are still susceptible to hep B (because if 5% are carriers and only 10% of the infections result in carrier states, that leaves a very large percentage of the population with immunity) times the percentage of people getting infected who will actually experience disease (15%) and lower that by the fact the older you are when you get infected, the less likely disease is to occur (an interesting fact about hep B) and you end up with a pretty small hazard posed by the corpses.

I defer to your expertise here turning this data into an actual risk calculation. I make no claim to understand these stats better than you do. The only claim I make is to know with considerable expertise what the data shows the actual occupational risk to be for blood borne infections.




... otherwise you'd let us exhibit some concern over the handling of dead bodies, I'm still not sure I feel as confident as you do that we are there.

So, I still don't understand why in one case, derision is directed at those who express concern (corpses) and in the other case, derision is directed at those who don't express concern (swine flu).

As far as I can tell, the posters here have generally indicated that their perceived risk is low (all those who weighed in agreed with Rolfe's second statement). It appears that the argument is over whether or not it is reasonable to be indifferent to the risk when the perceived risk is low?

LindaThis started off as a reply to the claimed rationale that risk of exposure to blood borne pathogens was reason mass cadavers in the streets posed a risk of epidemics. The more I cited the problem with that rationale, that the data did not support the fact large numbers of cadavers risked many if any actual cases of blood borne pathogen transmission, the more thread contributors perceived my comments to contradict their existing beliefs that cadavers posed some risk of disease transmission.

I'm pleased the thread consensus has shifted to recognition mass casualty cadavers are not a significant risk to the population, including being a negligible risk of blood borne pathogens if the bodies are not promptly removed.

[Skeptic Ginger]

No, the primary transmission route of M. tuberculosis is inhalation and the infectious dose is very low. You have also failed to recognise or read that embalmers do not routinely open cadavers:Feel free to read up on the transmission of mTB. I'm sorry, but that's the best I can say to this at the moment.

Yes, these surveys were under circumstances that occurred in closed rooms with varying ventilation. MTB is spread outdoors I strongly suggest you review transmission of this organism before you continue putting your foot in your mouth here.

although the exposure risk is reduced, not non-existent and it is recommended that corpses are not stored in closed warehouses after disasters. I simply fail to see how you can be so dismissive of a realistic, albeit probably low risk of contracting infectious diseases from cadavers without proper handling.Because I know what I am talking about. Sorry. You just don't.

That is quite a leap without having read the article.It's not about the article. This is the field I have made my living at, very successfully, for the last 18 years.

You are taking a couple articles and making the assumption that after reading them, you understand the issues of mTB transmission. But you clearly do not.

I should certainly hope that if you are in a position to instruct others on personal protection, that you aren't as imperious as you have appeared to be here, regarding personal risk for rescue workers after a natural disaster. Here are the examples of your posts where you do appear to be rather dismissive of the potential risks that cadavers can pose for emergency responders:
http://forums.randi.org/showpost.php?p=5521937&postcount=77
http://forums.randi.org/showpost.php?p=5521967&postcount=84
http://forums.randi.org/showpost.php?p=5528300&postcount=149
http://forums.randi.org/showpost.php?p=5531431&postcount=167
http://forums.randi.org/showpost.php?p=5531544&postcount=169
http://forums.randi.org/showpost.php?p=5531591&postcount=171
http://forums.randi.org/showpost.php?p=5531624&postcount=172

You see, we don't have good data to directly quantify the disease risks to emergency responders during or after natural disasters.We have extensive data on what it takes to transmit blood borne infections.

So policy is derived from what we do know about disease mechanisms, microbial ecology and surveys of occupational hazards. Your arguments on this seem rather paradoxical for on one hand, you are extrapolating occupational risks (that have more controlled circumstances) to the risk on the ground in underdeveloped/developing countries for bloodborne diseases but when provided with evidence of MTB infection from cadavers, occupational risks are no longer relevant. I've asked repeatedly for any data that suggests the research we have on transmission of these organisms differs in a mass casualty event.

I'm still waiting............

Again, you are using data selectively. We don't know what the actual risks are because we lack data that quantifies this for disaster rescue operations. We have to base it upon what we do have and there are infectious disease risks and responders need to be adequately informed and protected.I can understand other people not feeling confident they have the data to quantify the risks involved here. But I do have the confidence to quantify it. I've been working in this field as I said, for 18 years now. If you have evidence contradicting my assessments, post it. So far all you posted was about the risk of handling cadavers in confined spaces using procedures that aerosolized mTB. I explained this risk to you and why it doesn't apply to corpses rupturing outdoors.

I'm sorry you don't know that, but you shouldn't dismiss what I do know without taking the time to learn a bit about the transmission of mTB.

The point was to demonstrate that while you are rather dismissive disease risk and post some rather absurd suggestions to avoid it, agencies like the WHO, who are probably much more informed on such matters, takes it a bit more seriously.

And cadavers can still aerosolize TB baccilli and TB baccilli can remain viable for a time after that.

No, you haven't claimed that blood is never a source of infection, you have however, advised people 'not to suck corpse blood', likened the risk to handling rotten tomatoes and been generally dismissive of the personal risks that rescue workers have being in contact with cadavers. The argument that corpses are responsible for disease epidemics is long gone.

EsteI'm going to bed. You don't know what you are talking about. It's a shame. Your initial posts appeared very well informed.

[GlennB]

No, the primary transmission route of M. tuberculosis is inhalation and the infectious dose is very low. You have also failed to recognise or read that embalmers do not routinely open cadavers:

Feel free to read up on the transmission of mTB. I'm sorry, but that's the best I can say to this at the moment.

I strongly suggest you review transmission of this organism before you continue putting your foot in your mouth here.


From this report (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm) :

"M. tuberculosis is carried in airborne particles called droplet nuclei that can be generated when persons who have pulmonary or laryngeal TB disease cough, sneeze, shout, or sing (30,31 (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm)). The particles are approximately 1--5 µm; normal air currents can keep them airborne for prolonged periods and spread them throughout a room or building (32). M. tuberculosis is usually transmitted only through air, not by surface contact. After the droplet nuclei are in the alveoli, local infection might be established, followed by dissemination to draining lymphatics and hematogenous spread throughout the body (33). Infection occurs when a susceptible person inhales droplet nuclei containing M. tuberculosis, and the droplet nuclei traverse the mouth or nasal passages, upper respiratory tract, and bronchi to reach the alveoli. "

So now I'm :confused:

[Skeptic Ginger]

Actually, before I leave for the night, here is the basic core curriculum on mTB from the CDC (http://www.umdnj.edu/~ntbcweb/corefr.htm). I don't expect people to believe on its face, that I know how mTB is and is not transmitted. But there are times when it gets tiring to continually prove to people via citation after citation that they don't know what they are talking about.

That said, this debate will likely go on and on if I don't nip this particular aspect of it in the bud.


The probability that TB will be transmitted depends on three factors: the infectiousness of the person with TB, the environment in which exposure occurred, and the duration of exposure. (See Infection Control for more information on infectiousness.)...

...Extrapulmonary TB is rarely contagious; however, transmission from extrapulmonary sites has been reported during aerosol-producing procedures, such as autopsies and tissue irrigation.

...TB is transmitted through the air rather than by fomites or direct contact...

...Engineering controls are based primarily on the use of adequate ventilation systems; these may be supplemented with high-efficiency particulate air (HEPA) filtration and ultraviolet germicidal irradiation (UVGI) in high-risk areas. These strategies are designed to reduce the concentration of infectious droplet nuclei in the air, to prevent the dissemination of droplet nuclei throughout the facility, or to render droplet nuclei noninfectious by killing the tubercle bacilli they contain....

...The air from these rooms should be exhausted directly to the outside and away from intake sources.In other words, the way you prevent the spread of mTB is to dilute the concentration of the bacteria which are in the air within the 'droplet nuclei'.

Outdoors, the bacteria are immediately dispersed and become too dilute to transmit infection.

[Uncayimmy]

It's not about the article. This is the field I have made my living at, very successfully, for the last 18 years.
You said the above to present yourself as authority for the statement below:

Lower paid workers are likely foreign born and have higher rates of positive PPDs from their country of origin. Farm workers are getting mycobacterium bovis not mycobacterium tuberculosis. And inhalation therapists are responsible for sputum inductions where you get a person with active TB to cough forcefully thereby aerosolizing it.

I just want to make sure your credentials are made clear to everyone reading this thread, especially Estella. The following are in reverse chronological order which is why the numbers change.

"For the record, I treat about 100 occupational blood exposures a year, and have for the last 18 years or so."

"Seasonal flu has yet to arrive in the northern hemisphere and H1N1 is not gone. I'd get your kids and yourself both vaccines. But then I am biased. This is the field of health care I have worked in for the last 18 years, (NP, private practice, occupational infectious disease hazards)."

"Well there you go, pure unsupported TCS opinion vs an ARNP, MSN, 30 years experience in nursing with 20 of those as an FNP, certified in occupational health, and the last 18 years specializing in infectious disease prevention who also happens to read medical research with a voracious appetite."

"I have had a particular interest in bad medicine beliefs in my practice over the last 18 years. There are patterns. I already mentioned one, claiming your child's autism is related to a sentinel event. Whether or not Jett had autism (and there is evidence that was the case) blaming such a condition on cleaning solution fumes and Kawasaki Disease fits a pattern."

"It's a pandemic. I have been working in the field of infectious disease for 20 years and in health care much longer than that. I have an education, a license to practice, and actually have had a successful practice for the last 18 years which says I am more than qualified to assess the data and draw such a conclusion."

"This is not something I am unaware of. I actually have a minor in business administration to go with my master's in nursing and I've run my own business successfully for the last 18 years. "

"It's you. Infectious disease is the field I have specialized in for the last 17 years, rob. I understand why you are misreading the line. Anyone not familiar with this particular issue would read it as you are."

"You may not realize I've spent from Sept to Dec every year for the last 17 years addressing this specific fallacious belief system. Yes, I am sensitive. But I think if you review your post, you may see that it sounds like you are agreeing, not that you are noting other non-causal coincidences."

"As to my expertise, I'm a Nurse Practitioner with 30 years of experience in a variety of medical practices. I've had my own practice for the last 16 years and while I specialize in infectious disease, I've had the position of Infection Control at a local inpatient psychiatric hospital for the last 3+ years as one of my contracts. Being the curious person I am, I've learned a lot about psychiatric medicine during that time."

"I work with these disease risks every day. I have a master's in nursing and a license in family practice as well as certification in occupational health. I have spent the last 15 years of my career running a practice that specializes in infectious disease hazards of health care workers and infection control in health care settings."

"Just so you know where I come from, and not because I think only a health care provider can read scientific literature, I give you my background. I have a Master's in Nursing Science. I am a nurse practitioner, certified in both occupational health and family practice. I specialize in infectious diseases and have for the last 15 years on top of 15 additional years as a nurse."

[Skeptic Ginger]

From this report (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm) :

"M. tuberculosis is carried in airborne particles called droplet nuclei that can be generated when persons who have pulmonary or laryngeal TB disease cough, sneeze, shout, or sing (30,31 (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm)). The particles are approximately 1--5 µm; normal air currents can keep them airborne for prolonged periods and spread them throughout a room or building (32). M. tuberculosis is usually transmitted only through air, not by surface contact. After the droplet nuclei are in the alveoli, local infection might be established, followed by dissemination to draining lymphatics and hematogenous spread throughout the body (33). Infection occurs when a susceptible person inhales droplet nuclei containing M. tuberculosis, and the droplet nuclei traverse the mouth or nasal passages, upper respiratory tract, and bronchi to reach the alveoli. "

:confused:(emphasis changed)

In your airway there is a mucus coating mTB bacteria cannot grow on. The bacteria will not grow in your mouth or gut (M bovis is a different organism that does grow in the gut). The bacteria must reach the alveoli to establish infection.

Throughout your airway you have defense mechanisms that collect debris before it reaches the alveoli. And the few bacteria that manage to get to the alveoli are attacked by macrophages.

THEREFORE you must breathe in aerosolized particles containing mTB in sufficient concentration to pass all those defense mechanisms and reach the alveoli in sufficient quantity to establish infection.

It has to be indoors, the air must be relatively full of bacteria, you must be in there a sufficient amount of time for infection to occur.



And that's not even getting into the other issue which is only 10% of the people who get infected with mTB will ever go on to develop TB disease. (It's higher for HIV infected individuals.) And while we do know that immunocompromised persons with TB infection can be infected with additional strains, it is not clear that persons with normal immune systems can be infected more than once. Most adults in Haiti if they grew up there are already infected with mTB. They have latent TB infection of which only 10% will ever develop active TB disease.

[Skeptic Ginger]

As a digression: Popular Mechanics leads off an article with a statement about how the risk the dead pose is low to the surviving population:



Link: http://www.popularmechanics.com/science/health_medicine/4343222.htmlThank you for a breath of sanity here.

[Skeptic Ginger]

You said the above to present yourself as authority for the statement below:



I just want to make sure your credentials are made clear to everyone reading this thread, especially Estella. The following are in reverse chronological order which is why the numbers change.

"For the record, I treat about 100 occupational blood exposures a year, and have for the last 18 years or so."

"Seasonal flu has yet to arrive in the northern hemisphere and H1N1 is not gone. I'd get your kids and yourself both vaccines. But then I am biased. This is the field of health care I have worked in for the last 18 years, (NP, private practice, occupational infectious disease hazards)."

"Well there you go, pure unsupported TCS opinion vs an ARNP, MSN, 30 years experience in nursing with 20 of those as an FNP, certified in occupational health, and the last 18 years specializing in infectious disease prevention who also happens to read medical research with a voracious appetite."

"I have had a particular interest in bad medicine beliefs in my practice over the last 18 years. There are patterns. I already mentioned one, claiming your child's autism is related to a sentinel event. Whether or not Jett had autism (and there is evidence that was the case) blaming such a condition on cleaning solution fumes and Kawasaki Disease fits a pattern."

"It's a pandemic. I have been working in the field of infectious disease for 20 years and in health care much longer than that. I have an education, a license to practice, and actually have had a successful practice for the last 18 years which says I am more than qualified to assess the data and draw such a conclusion."

"This is not something I am unaware of. I actually have a minor in business administration to go with my master's in nursing and I've run my own business successfully for the last 18 years. "

"It's you. Infectious disease is the field I have specialized in for the last 17 years, rob. I understand why you are misreading the line. Anyone not familiar with this particular issue would read it as you are."

"You may not realize I've spent from Sept to Dec every year for the last 17 years addressing this specific fallacious belief system. Yes, I am sensitive. But I think if you review your post, you may see that it sounds like you are agreeing, not that you are noting other non-causal coincidences."

"As to my expertise, I'm a Nurse Practitioner with 30 years of experience in a variety of medical practices. I've had my own practice for the last 16 years and while I specialize in infectious disease, I've had the position of Infection Control at a local inpatient psychiatric hospital for the last 3+ years as one of my contracts. Being the curious person I am, I've learned a lot about psychiatric medicine during that time."

"I work with these disease risks every day. I have a master's in nursing and a license in family practice as well as certification in occupational health. I have spent the last 15 years of my career running a practice that specializes in infectious disease hazards of health care workers and infection control in health care settings."

"Just so you know where I come from, and not because I think only a health care provider can read scientific literature, I give you my background. I have a Master's in Nursing Science. I am a nurse practitioner, certified in both occupational health and family practice. I specialize in infectious diseases and have for the last 15 years on top of 15 additional years as a nurse."Is there a point here?

[Uncayimmy]

Is there a point here?

Some people might not be aware of your credentials and think that you're just making stuff up as you go along. It happens. I'm just trying to help.

[stilicho]

Some people might not be aware of your credentials and think that you're just making stuff up as you go along. It happens. I'm just trying to help.

I've read most of this but it appears to me that the prioritisation of the US/UN interventionists since the earthquake has been on search and rescue, opening the transportation links, providing security, restoring power, and supplying food and water.

Removing the dead appears to be far down the list somewhere.

Is this perhaps because those in control of the situation actually know what the OP is claiming? I have watched and read quite a bit about the developing crisis (some would say the ongoing series of crises) and corpse removal is scarcely featured.

[fls]

You brought the claim up comparing the risk of 2009 H1N1 with the risk posed by the corpses, I didn't. I'm unconvinced you used the proper denominator in your comparison. If we can reach an agreement on the denominator, then we can look at the matter of whether or not I am using the same standard here as I use in promoting influenza vaccine. (I assume that was your point so if it wasn't then by all means correct me.)

I've pointed out a couple flaws in your reasoning. Everyone infected with H1N1 has the same risk in that they are all infected. You were comparing the risk of an H1N1 infected person having severe disease with the risk of a person exposed to the blood of a cadaver having severe disease. But your denominators are not comparable. The risks you compared were the risk given an exposure incident vs the risk given H1N1 infection. Not everyone handling a corpse and certainly not everyone in the vicinity of a corpse is going to have an actual exposure incident.

Right, I was comparing two risk levels. I wasn't attempting to state that the risks were formed in the same way, just that the resulting risk levels were similar.

I don't see any evidence supporting the estimate there would be one exposure per cadaver. That's really extreme. How are you defining an exposure and how do you figure one exposure per cadaver in your estimate?

For the blood-bourne pathogens, an exposure would be contact with those body fluids which can transmit disease. Like occupational exposures, this would represent a range from prolonged contact with blood on intact skin to penetrating injuries with contaminated objects. Of course, we don't know how often an exposure would occur per cadaver (if any). Since the deaths involve mass trauma, it seems reasonable to guess that a substantial portion have injuries which expose body fluids. It might not be every cadaver, but I wouldn't know how much less than that it would be. One could use evidence from the situation on the ground to modify that guess (I don't have any information like that).

Further, with flu there are millions infected. With the Haiti casualties, there is no evidence there are millions meeting the actual criteria of a blood exposure to a cadaver that was not promptly removed.

I agree. In the case of the flu, the small risk is distributed relatively evenly. In the case of exposure to blood-bourne pathogens, it is a much larger risk affecting a smaller proportion. So while the calculated individual risk is similar when spread out over the affected population, you get to that risk through different routes. How much does that matter? I chose H1N1 because it had been discussed recently. I could have chosen polio instead, which represents a high risk for those who acquire it, but a low risk of acquisition (similar to the situation in Haiti whereby 'acquisition' is 'high risk exposure'). But as far as I know, you would recommend immunization against polio despite that, so it doesn't look like this distinction matters.

But my main argument with your calculation was the estimate that any exposure had [X] risk. I've said repeatedly that both HIV and hep C are not seen being transmitted with small blood exposure incidents. It's not that infection is rare, it is that there is a minimum exposure threshold that needs to occur before any risk occurs and even then infection transmission is still rare.

I agree. As I said in my previous post, the types of exposures will vary. As 'occupational exposures' represent a range of low (or no) risk to high risk, the overall risk from occupational exposure really reflects how many of those exposures exceed that threshold and to what extent. I used the 3 in 100 number for my calculations simply because it was the number which you had already referred to. But it would also make sense to stratify that into exposures which exceed the minimum by a low, moderate and high amount. Then it would be applied to the relative frequency of those types of exposures. Like I said earlier, I don't know if the number of exposures which exceed that threshold is different from the number of occupational exposures which exceed that threshold. The situations are so different I'm not even sure I could guess which direction the difference might lay. If you want to present numbers that represent the risk of acquisition from various levels of exposure, I agree that that would be a better approach.

This is where there is a disconnect from what the data actually shows vs the perceived risk. There is no evidence hep C or HIV are EVER transmitted with minimal blood exposures.

I agree. What I'm suggesting is that some exposures are not minimal, but rather more substantial. I gave an example earlier of what that might look like - a deep penetration from a broken bone from an infected body.

As for the blanket statement: It depends on the extent of one type of study over the other. Occupational risk of hepatitis C infection has been evaluated in thousands and thousands of individuals in various occupations which have known blood exposure risk, including evaluating the effect of length of employment in the job with the risk. These studies include employees whose work practices changed over time from more risky to less risky. Only a very small risk was detected and only in occupations involving phlebotomy.

Orthopedic surgeons, known to have a tremendous exposure history and known to have substantial risk of hep B before the vaccine was available were surveyed in one very large study. No greater rate of Hep C than matched controls was found.

It’s the difference between a study like that EMS workers you referred to earlier:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4929a3.htm

and that on HCV incidence after exposure:

http://www.ncbi.nlm.nih.gov/pubmed/1427651

The study on EMS workers doesn’t tell you the risk of acquiring HCV after an exposure. Instead, it reflects the number of times that EMS workers have a needlestick accident caring for a patient with HCV. Since this depends upon the prevalence of HCV in the population cared for by EMS workers and the prevalence of needlestick accidents, it doesn’t actually tell you whether or not the people salvaging cadavers in Haiti are at risk when the prevalence of HCV is different and the type and frequency of accidental exposure is different. And it doesn’t tell you whether or not there were enough accidents of the type described in the article from Japan to show up as an overall difference in frequency. On the other hand, the information in the article from Japan can be used to inform you of the risks in Haiti, because one only needs to know the number of comparable exposures that may occur during cadaver salvage operations.

I'm more than happy to discuss the actual risk comparisons here if you'd care to keep going with this. At least it's more interesting than just repeating my discussion of the actual risk of HIV and hep C transmission with exposure incidents.

Yeah, because that is really where the distinction lies.

My discussion of hep B risk from the cadaver piles was also entertained here. The calculation of risk would be the risk of the cadaver being infectious (5%) times the chance of an actual exposure (go ahead and estimate one exposure per cadaver, I have no better estimate and I see no way to determine it from the data available to me) times the number of people experiencing that exposure incident who are still susceptible to hep B (because if 5% are carriers and only 10% of the infections result in carrier states, that leaves a very large percentage of the population with immunity) times the percentage of people getting infected who will actually experience disease (15%) and lower that by the fact the older you are when you get infected, the less likely disease is to occur (an interesting fact about hep B) and you end up with a pretty small hazard posed by the corpses.

I defer to your expertise here turning this data into an actual risk calculation. I make no claim to understand these stats better than you do. The only claim I make is to know with considerable expertise what the data shows the actual occupational risk to be for blood borne infections.

I guess we could do the same for Hep B, if we were looking to add up all the risks. But the type of exposure matters much less for Hep B, and so I don’t think it helps us with considering HCV or HIV risks. And I think that what is really at issue is how comfortable we are dismissing the possibility of moderate to high risk exposures. I don’t think experience with occupational exposures tells you what happens on the ground in a disaster area. I suspect the information from WHO, which talks about a small risk, is more likely to reflect experience from disasters.

This started off as a reply to the claimed rationale that risk of exposure to blood borne pathogens was reason mass cadavers in the streets posed a risk of epidemics.

I really don’t think anyone ever made that claim, even in the news reports you were responding to.

The more I cited the problem with that rationale, that the data did not support the fact large numbers of cadavers risked many if any actual cases of blood borne pathogen transmission, the more thread contributors perceived my comments to contradict their existing beliefs that cadavers posed some risk of disease transmission.

I’m sorry, but I don’t understand the difference. You state that the data does not support any actual cases of blood borne pathogen transmission. That seems to clearly contradict the idea that cadavers pose some risk of transmission. If you think that cadavers don’t pose any risk and others think they pose some risk (which seems to also be the position of the WHO), doesn’t it make sense that contributors would challenge you?

I'm pleased the thread consensus has shifted to recognition mass casualty cadavers are not a significant risk to the population, including being a negligible risk of blood borne pathogens if the bodies are not promptly removed.

Huh? That seemed to be the consensus at the start of this discussion (ETA: except for the part about the risk being negligible - more like 'low but present'). I think the issue is whether or not some care (with respect to infection risk) needs to be taken over the removal of bodies, which then extends to the issue of how and when it happens.

Linda

[Estellea]

Feel free to read up on the transmission of mTB. I'm sorry, but that's the best I can say to this at the moment.

I strongly suggest you review transmission of this organism before you continue putting your foot in your mouth here.

Because I know what I am talking about. Sorry. You just don't.

It's not about the article. This is the field I have made my living at, very successfully, for the last 18 years.Even in my short time here, I've come to recognise this tactic of yours; it's boring and ineffective. No need to apologise, I'm good.

You are taking a couple articles and making the assumption that after reading them, you understand the issues of mTB transmission. But you clearly do not.Those studies were for your benefit and to demonstrate that the risk of disease transmission from a corpse is not that of rotting vegetables and no blood-sucking required, strictly speaking of course.

We have extensive data on what it takes to transmit blood borne infections.Yes, for occupational exposures in a developed country and disease risk is not limited to blood borne pathogens. The risk is also not zero now is it?

I've asked repeatedly for any data that suggests the research we have on transmission of these organisms differs in a mass casualty event.

I'm still waiting............Therein lies the problem, as I have repeatedly stated; we lack data regarding quantifying personal responder risk of disease during an operation following natural disasters. And yet, still not a single public health agency agrees with your assessment of personal risk to disaster responders, so they must be interpreting the value of the available data differently than you.

I can understand other people not feeling confident they have the data to quantify the risks involved here. But I do have the confidence to quantify it. I've been working in this field as I said, for 18 years now. If you have evidence contradicting my assessments, post it. So far all you posted was about the risk of handling cadavers in confined spaces using procedures that aerosolized mTB. I explained this risk to you and why it doesn't apply to corpses rupturing outdoors.And yet, I remain remarkably unimpressed with your appeal to authority.

I'm sorry you don't know that, but you shouldn't dismiss what I do know without taking the time to learn a bit about the transmission of mTB. This is a most interesting debate tactic; you claim that inhalation is not the primary route of exposure for MTB but then proceed to argue that it is and provide supporting evidence for that. I'm sure there is a name for that but escapes me at the moment. MTB can be spread outdoors and I have already added the caveat that the risk of infection is markedly lowered but again, not zero:
http://nejm.highwire.org/cgi/content/full/338/10/633
http://www.journals.uchicago.edu/doi/full/10.1086/323127
Again, for your benefit, not mine.

I'm going to bed. You don't know what you are talking about. It's a shame. Your initial posts appeared very well informed.Oh nothing has changed. You seem to be arguing at cross-purposes here; on one hand, you exalt your experience for treating occupational blood exposures and should (hopefully) see the importance of pre and post exposure protection and prophylaxis yet callously dismiss handling cadavers, even in the face of what agencies such as the WHO recommends.

Este

[Estellea]

I've read most of this but it appears to me that the prioritisation of the US/UN interventionists since the earthquake has been on search and rescue, opening the transportation links, providing security, restoring power, and supplying food and water.

Removing the dead appears to be far down the list somewhere.

Is this perhaps because those in control of the situation actually know what the OP is claiming? I have watched and read quite a bit about the developing crisis (some would say the ongoing series of crises) and corpse removal is scarcely featured.That is always, or should be the case, i.e. emphasis on the survivors for a rescue operation. Given the nature of massive corpse removal, it is also not surprising that it is de-emphasised; it is rather disturbing after all.

Este

[fls]

That is always, or should be the case, i.e. emphasis on the survivors for a rescue operation.

Este

Especially since, quite amazingly, they are still pulling out some live people.

Linda

[Estellea]

Especially since, quite amazingly, they are still pulling out some live people.

LindaI know, these stories of survivors weeks post disaster that are eventually rescued never cease to amaze me.

Este

[Rolfe]

After the case of Magdeline Makola (http://www.dailymail.co.uk/news/article-1201123/I-friends-death-Nurses-graphic-account-day-kidnap-nightmare-boot-car.html), I can believe all this. She was kidnapped, tied up and with duct tape over her mouth so she couldn't call out, and shoved in a car boot. The car was left in a car park over the Christmas period and she was there for ten days with no food or water. I didn't think that was possible, but it obviously is. I suppose the only difference is the temperatures were very low.

Rolfe.

[MikeSun5]

Where did SG claim that this was said regarding HIV and Hep? [We have moved on to this topic, but only in the context of individual risk exposure to rescuers from blood contact and I don't see anyone ever claiming it would result in epidemics of this. Perhaps you should also spend more time reading the posts.]

Reading the posts, eh? :D Nice try.

To answer you question: she claimed it was said in the OP, and then she went on to say:

Multiple citations have been posted here supporting the claim piles of corpses in mass casualty events (not caused by epidemics) are not a source of epidemics by not being removed quickly.

Then she went on to cite a myriad of numbers to support a claim that nobody was really denying. There was skepicism that dead bodies weren't as harmless as skeptigirl says they are, but no outright denials of her claim. Despite that, she kept arguing her side as if there were many.

For the umpteenth time, we all agree that HIV and hepititis epidemics cannot be started by corpses or exposure to them. The only epidemic that I've noticed so far seem to be attitudes like this:

Because I know what I am talking about. Sorry. You just don't.

[Uncayimmy]

I've read most of this but it appears to me that the prioritisation of the US/UN interventionists since the earthquake has been on search and rescue, opening the transportation links, providing security, restoring power, and supplying food and water.

Removing the dead appears to be far down the list somewhere.

Is this perhaps because those in control of the situation actually know what the OP is claiming? I have watched and read quite a bit about the developing crisis (some would say the ongoing series of crises) and corpse removal is scarcely featured.

I don't think you've read as much as you think you've read. See Rolfe's post with a brief summary and how everyone agreed with it.

Everyone from the very start has agreed that removing the dead is a low priority and that if they are left alone, epidemics will not arise. We all moved on except Skeptigirl. We began discussing the issue that untrained people may be handling bodies, and caution needs to be taken when doing so. She likened the danger of corpses to be that of rotting tomatoes, which is a far cry from what the WHO and CDC say about handling bodies. This position has not been retracted.

[stilicho]

We began discussing the issue that untrained people may be handling bodies, and caution needs to be taken when doing so. She likened the danger of corpses to be that of rotting tomatoes, which is a far cry from what the WHO and CDC say about handling bodies. This position has not been retracted.

Thanks for pointing that out. I'll go with what the WHO and CDC say, then, and the NIH if they have anything to add.

[Ivor the Engineer]

Corpses from natural disasters don't cause epidemics, but are still a low risk to the health of people who have to handle them directly. Therefore:

i) the removal of corpses is a very low priority in such situations.

ii) when the bodies are moved, the people coming into contact with them should wear basic protective equipment such as gloves and possibly goggles and face masks.

End of thread?