The persistence of Ebola virus transmission in Sierra Leone, Liberia and Guinea took everyone by surprise. Previous outbreaks had lasted only weeks. The World Health Organisation’s response to Zika in South America has been significantly influenced by criticisms of the speed of its response to the events in West Africa. But a recent note in the Morbidity and Mortality Weekly Report from the US Centers for Communicable Disease Control and Prevention is a reminder that the absence of virologists, public health doctors and nurses wasn’t the only reason for the size of the Ebola epidemic.
According to the MMWR article, by Kathryn Curran et al., at least 28 people who attended a rural funeral in the Moyamba District in Sierra Leone in September 2015 went down with Ebola; eight died. Transmission of the virus at another funeral – of a healer who practised in Guinea where the infection already had a firm hold – had caused the first case of Ebola in Sierra Leone. The amplification from funeral outbreaks is one big difference between Ebola in West Africa and in Uganda and Sudan. ‘Immediate, safe, dignified burials by trained teams with appropriate protective equipment,’ Curran and her colleagues write, ‘are critical to interrupt transmission and control Ebola during times of active community transmission.’
A relative of mine was an undertaker. He closed the eyes of the dead and plugged their natural orifices with cotton wool. But he didn’t worry about catching anything. He died at a ripe old age from lung cancer. Contrary to commonly held beliefs, corpses are very poor sources of contagion. It doesn’t matter whether they are fresh or stinking, bloated, green and covered with mould.
Typhus fever is transmitted by lice, which leave the dead as the body cools, walking with precision towards new warm hosts at speeds of up to 30 cm per minute. But it wasn't transmitted at wakes, even during the great 19th-century epidemics in Ireland, because, as Patrick Buxton points out in The Louse (my copy used to belong to Alexander Haddow, the co-discoverer of Zika virus), lice don’t like a host with a fever. They leave it days before death. Being a funeral director in the UK is safe work. Crematorium operators are more at risk: they have been injured by exploding bodies that blew because they still contained a defibrillator or pacemaker.
Even the plague and cholera didn’t put undertakers at risk (dead bodies don't breathe or defecate into drinking water). This gave strength to the arguments of the 19th century anti-contagionists, who believed that cholera was not spread person to person but caused by a poisonous miasma that arose in the soil de novo and spread through the air in effluvia such as sewer gases.
But a literature trawl reveals another nasty infection, apart from Ebola, that can be caught from corpses. According to C.J. Polson in The Disposal of the Dead (1953), 'death in itself appreciably reduces the danger which results from contact with a body' infected with smallpox. 'The mortality rate amongst funeral directors is no greater than the average rate for the community as a whole, and their occupation does not appear to hold special danger of infection.' Those at risk in the UK from catching smallpox from corpses were pathologists and mortuary attendants who had done post mortems on undiagnosed cases.
In Sierra Leone, however, two outbreaks of smallpox in 1968 were linked to funerals. It was thought that the index cases were both members of secret societies. The most important ones are the Poro for men and the Sande for women. They operate in Sierra Leone, Guinea, Liberia and Ivory Coast. Funeral-associated outbreaks linked to secret society practices were highlighted by the WHO in the final stages of smallpox eradication in Sierra Leone as being unique to that country. The relationship between secret societies and funerals is not unique to West Africa, however. My relative was tyler at the most important masonic lodge in town. That was good for his undertaking business.