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Safe management of bodies of deceased persons with suspected or confirmed COVID-19: a rapid systematic review
  1. Sally Yaacoub1,
  2. Holger J Schünemann2,3,
  3. Joanne Khabsa1,
  4. Amena El-Harakeh1,
  5. Assem M Khamis4,
  6. Fatimah Chamseddine1,
  7. Rayane El Khoury1,
  8. Zahra Saad5,
  9. Layal Hneiny6,
  10. Carlos Cuello Garcia7,
  11. Giovanna Elsa Ute Muti-Schünemann8,
  12. Antonio Bognanni7,
  13. Chen Chen9,
  14. Guang Chen10,
  15. Yuan Zhang7,
  16. Hong Zhao11,
  17. Pierre Abi Hanna12,
  18. Mark Loeb13,
  19. Thomas Piggott7,
  20. Marge Reinap14,
  21. Nesrine Rizk15,
  22. Rosa Stalteri7,
  23. Stephanie Duda7,
  24. Karla Solo7,
  25. Derek K Chu7,
  26. Elie A Akl1,7,16
  27. the COVID-19 Systematic Urgent Reviews Group Effort (SURGE) group
  1. 1 Clinical Research Institute, American University of Beirut, Beirut, Lebanon
  2. 2 WHO Collaborating Centre for Infectious Diseases, McMaster University, Hamilton, Ontario, Canada
  3. 3 Research Methods and Recommendations and the Michael G. DeGroote Cochrane Canada and McGRADE Centres, McMaster University, Hamilton, Ontario, Canada
  4. 4 Hull York Medical School, University of Hull, Hull, UK
  5. 5 Global Evidence Synthesis Initiative, American University of Beirut, Beirut, Lebanon
  6. 6 University Libraries, Saab Medical Library, American University of Beirut, Beirut, Lebanon
  7. 7 Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
  8. 8 Medical School, Vita Salute San Raffaele University, Milano, Italy
  9. 9 Guangzhou University of Chinese Medicine, The Fourth Clinical Medical College, Guangdong, China
  10. 10 Beijing University of Chinese Medicine, Dongzhimen Hospital, Beijing, China
  11. 11 Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
  12. 12 Infectious Disease Division, Rafik Hariri University Hospital, Beirut, Lebanon
  13. 13 Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
  14. 14 London School of Hygiene and Tropical Medicine, London, UK
  15. 15 Division of Infectious Diseases, American University of Beirut, Beirut, Lebanon
  16. 16 Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
  1. Correspondence to Dr Elie A Akl; ea32{at}


Introduction Proper strategies to minimise the risk of infection in individuals handling the bodies of deceased persons infected with 2019 novel coronavirus (2019-nCoV) are urgently needed. The objective of this study was to systematically review the literature to scope and assess the effects of specific strategies for the management of the bodies.

Methods We searched five general, three Chinese and four coronavirus disease (COVID-19)–specific electronic databases. We searched registries of clinical trials, websites of governmental and other relevant organisations, reference lists of the included papers and relevant systematic reviews, and Epistemonikos for relevant systematic reviews. We included guidance documents providing practical advice on the handling of bodies of deceased persons with suspected or confirmed COVID-19. Then, we sought primary evidence of any study design reporting on the efficacy and safety of the identified strategies in coronaviruses. We included evidence relevant to contextual factors (ie, acceptability). A single reviewer extracted data using a pilot-tested form and graded the certainty of the evidence using the GRADE approach. A second reviewer verified the data and assessments.

Results We identified one study proposing an uncommon strategy for autopsies for patients with severe acute respiratory syndrome. The study provided very low-certainty evidence that it reduced the risk of transmission. We identified 23 guidance documents providing practical advice on the steps of handling the bodies: preparation, packing, and others and advice related to both the handling of the dead bodies and the use of personal protective equipment by individuals handling them. We did not identify COVID-19 evidence relevant to any of these steps.

Conclusion While a substantive number of guidance documents propose specific strategies, we identified no study providing direct evidence for the effects of any of those strategies. While this review highlights major research gaps, it allows interested entities to build their own guidance.

  • systematic review
  • public health
  • prevention strategies
  • respiratory infections

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Handling editor Soumyadeep Bhaumik

  • Contributors EAA and HJS conceived the study. EAA, HJS, SY, DKC, SD, KS, PAH, ML and NR designed the study. SY, SD, and KS coordinated the study. SY and LH designed and ran the search. MR, NR and RS searched the grey literature for guidance documents. SY, JK, AE-H, AMK, FC, ZS, REK, LH, CC, GC, YZ and HZ assessed eligibility and abstracted data. GEUM-S, AB, PAH, MR and HJS assessed eligibility. EAA, HJS, SY, JK and AE-H analysed and interpreted the data. CCG summarised data and developed the infographics. SY and EAA drafted the manuscript. HJS and TP contributed to writing the manuscript. All authors contributed to the interpretation and subsequent edits of the manuscript. EAA attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding The funding of this article was provided by the World Health Organization, American University of Beirut, and McMaster University.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data are available on request to the corresponding author.