If you followed the news during the Ebola Virus outbreak in the Democratic Republic of the Congo, you might remember reading that the funeral practices in the region were not compatible with outbreak control measures. Traditional funeral practices in Africa include washing and touching the body extensively after someone dies to prepare them for burial. This poses a problem because many viruses, including Ebola, are passed through bodily fluids such as sweat and blood and remain contagious after the infected person has died.
Maintaining the boundaries of dignified burials, respecting cultural practices, and reducing transmission from deceased individuals to their surviving family and friends is a significant challenge facing frontline healthcare professionals during many disease outbreaks, including COVID-19.
Recently, scientists have turned to Nipah virus (an infectious respiratory illness) transmission in Bangladesh to understand disease transmission dynamics. Contact patterns, or contact tracing, is used to track how viruses spread from one person to another. Whether, like COVID-19, the virus is spread by respiratory droplets, or like Nipah or Ebola by bodily fluids, contact patterns show how the virus spread by examining the chain of infection. This aids epidemiologists in tracking how viruses move through populations, and can improve future outbreak preparedness.
They found that, similar to Ebola, the number of personal contacts between a sick person and their friends and family increases rapidly as they person approach death. This is because family and friends want to visit the person, fearing it is their last chance to see them, and people begin to arrive for funeral preparations. The sickest (and likely most contagious) people had more contacts, leading the researchers to conclude that end-of-life preparations spread the virus rapidly.
This suggests that disease control efforts should focus on funeral practices, an approach we have also seen during the current pandemic, with friends and family mourning their loved ones over Zoom. However, this is an instance where scientific best practices intersect with important human rights and ethics considerations — for example, in 2014 the WHO released a "safe and dignified burial" protocol to ensure that deceased Ebola patients, their families, and their cultural practices are treated respectfully.