Seeing the Approval Minutes No. NT 535 of 6.04.2020 of the General Directorate of Health Care and Public Health of the Ministry of Health, considering:
— the provisions of Article 7 (k) of Law No 95/2006 on health reform, republished, with subsequent amendments and additions;
— the provisions of Article 20 (5) of the Technical and Sanitary Rules on funeral services, burial, cremation, transport, decomposition and reburial of human corpses, cemeteries, human crematoria, as well as the professional criteria to be fulfilled by the providers of funeral services and the level of the guarantee fund, approved by Government Decision No. 741/2016,
Pursuant to the provisions of Art. 7 para. (4) of the Government Decision no. 144/2010 on the organization and functioning of the Ministry of Health, with subsequent amendments and additions, the Minister of Health issues the following order:
Article 1
The Annex to the Order of the Minister of Health No. 436/2020 for the approval of the Specific Protocol on the Management in Case of Death of Patients Infected with the Novel Coronavirus (SARS-CoV2), published in the Official Gazette of Romania, Part I, No. 207 of 13 March 2020, is amended and replaced by the Annex which is an integral part of this Order.
Article 2
The county and city public health departments of Bucharest, the National Institute of Forensic Medicine “Mina Minovici”, the institutes of forensic medicine in the university medical centers, the forensic medicine services, the personnel of the health facilities, as well as the entire staff of the funeral service providers who come into contact with the deceased will carry out the provisions of the present order.
Article 3
This order is published in the Official Gazette of Romania, Part I.
Minister of Health,
Nelu Tataru
Bucharest, April 6, 2020.
Nos. 570.
APPENDIX
(Appendix to Order No. 436/2020)
PROTOCOL SPECIFICO
on the management in case of death of patients infected with the novel coronavirus (SARS-CoV2)
In hospitalized cases for which the diagnosis of infection with the new coronavirus (SARS-CoV2) is confirmed (reconfirmed) during the period of admission to the health unit, the evolution being followed by death, anatomopathological autopsy of the corpse to confirm/specify or complete the clinical diagnosis of death already confirmed by laboratory analyzes (specific tests) is no longer necessary and is to be avoided because of the risks of transmission of the infectocontagious disease, possible in the conditions of the exercise of the profession in medical personnel.
The medical certificate establishing the death will be completed and issued by the attending physician of the patient in the hospital ward. Autopsies carried out for scientific purposes in accordance with the approved research protocol in each health facility shall be permitted, subject to the protective measures provided for in this Protocol.
The death in the sanitary unit with beds of persons who have been positively confirmed for COVID-19 infection and the diagnosis of death with new coronavirus infection (SARS-CoV2) can be declared forensic cases strictly in accordance with Art. 185 of Law No. 135/2010 on the Code of Criminal Procedure, with subsequent amendments and additions (NCPP); in these cases, it will be announced in the most shortly the competent forensic institution for ordering the removal of the corpse and conducting the forensic autopsy.
This specific protocol applies similarly to the following cases of death, which are considered to be deaths of patients infected with the novel coronavirus (SARS-CoV2), confirmed as positive:
a) persons in isolation at home, in the records of the directorates of public health;
b) persons in quarantine, in the records of the directorates of public health and other state institutions.
In the above situations, when forensic autopsy is not ordered, in accordance with the provisions of Art. 185 of the NCPP, the family doctor will issue the medical certificate establishing the death, based on the patient's medical record.
c) persons admitted to the hospital suspected of being infected with COVID-19, in whom testing for confirmation has not been performed.
In this situation, the medical certificate establishing the death will be able to be completed and issued by the attending physician of the patient in the hospital ward, if the forensic autopsy is not ordered.
Regarding the identification of the person at admission, during the epidemic period, confirmed SARS-CoV2 patients will be given an identification bracelet with the first and last name, legibly completed and verified on the basis of the identity document where possible, if not, the identity document will be photocopied, the copy conforming to the original will be signed by a medical professional and included in the observation sheet.
In the event of the death of the patient, in the event of the loss of the identity document or the inability of the owners to bring the original identity document, the copy will be used to draw up the medical certificate establishing the death.
Health units will be informed by telephone about severe/critical cases and the occurrence of death. In the event of death, presentation to the hospital for the recovery of the deceased within 24 hours of death, for members living at a distance of less than 100 km from the place of death and a maximum of 48 hours if they live more than 100 km away or in special situations.
In the event that the owner declares that he cannot personally deal with formalities within the established time limit (hospitalization, quarantine, serious illness, etc.), he will send a statement on his own responsibility and a delegation to another person or funeral pump company. It is not allowed to leave the owner from isolation or quarantine to identify or pick up the deceased.
If the owner or his delegate does not appear within the time limit, the medical certificate confirming the death will be issued, and the social worker will notify the social service of the town hall and declare the death to the marital status.
1. Measures to treat the patient infected with the new coronavirus (SARS-CoV2) if they have severe symptoms of the disease
The attending physician or a designated medical professional shall notify the competent forensic medical institution from the time of the patient's life if it falls within the cases provided for in art. 185 NCPP. If there are suspicions about the cause of death, the forensic institution and judicial bodies are notified to pick up the body and conduct a forensic autopsy.
2. Measures relating to the transportation of the deceased from the hospital ward to the morgue
The corpse of the deceased person from COVID-19 without traumatic injuries is not embalmed. It is placed in a double waterproof bag, sprayed with TP22 biocidal products, and stored in the refrigerator in the morgue. The elevator and stretcher used are disinfected with TP2 products.
3. Measures relating to personnel involved in the handling of corpses in the health facility
The staff will wear: waterproof jumpsuit or waterproof robe, mask with visor, goggles, two rows of gloves, rubber boots. After each operation — hand wash and disinfect with TP1.
4. Measures concerning the belonging of the deceased
The owners who make the identification will wear disposable PPE: robe, mask, boots, gloves. A maximum of two people can see the body. The corpse is sprayed with TP22 and placed in two sturdy bags, then into a sealed coffin, which no longer opens until cremation/cremation.
5. Measures relating to the transport of corpses to institutions of forensic medicine
In case of death at home with suspected COVID-19, the corpse does not rise until the authorities arrive. Transportation is carried out only on the basis of the prosecutor's order and using authorized means, observing the same rules of protection.
6. Measures relating to staff in the courts of forensic medicine
Autopsies are carried out in dedicated biohazard premises with a separate circuit. The staff wears fully waterproof equipment, three pairs of gloves (as needed), boots, a visor. Instrumentation and premises are disinfected with TP2. The presence of staff is limited.
7. Measures on contaminated corpses autopsied
Contaminated autopsied corpses are necessarily embalmed, sanitized without cosmetics, sprayed with TP22, placed in two vinyl bags, and then in the coffin, which is sealed. All suspected cases are treated as confirmed.
Medical documents required for autopsy are processed electronically and submitted to the competent institutions. Confirmation through COVID testing is done in collaboration with the public health directorates. Failure to comply with the protocol is sanctioned according to the law.
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