As Liberia struggles to manage the fallout from the West African Ebola outbreak, it has become clear that the challenges and dangers posed by the virus do not end at death.
This is particularly complicated by traditional funeral customs in which the corpse is washed and prepared for a lengthy vigil. During the wake, friends and relatives paying their respects customarily touch and kiss the deceased before the body is buried.
Because the bodies of people who die of the virus can still be highly contagious, kissing and handling a corpse presents an obvious risk in a country being ravaged by Ebola. Peter Piot, the director of the London School of Hygiene and Tropical Medicine and a scientist who helped identify Ebola in 1976, gave an interview last month in which he expressed alarm that regional cultural beliefs were worsening the spread of the disease.
To help prevent dangerous funeral proceedings after Ebola deaths, special teams go out to collect the bodies, which are later cremated.
But those teams don't always collect the bodies. There have been increasing reports in Liberia of corpse collectors allegedly accepting bribes to provide death certificates falsely validating that the victim did not die of Ebola, allowing the funeral practices to continue.
The stigma associated with the virus is also exacerbating the risk posed by Ebola in Liberia and other West African countries. Families often try to keep Ebola deaths secret, and stage illegal late-night burials to avoid the notice of the authorities.
"This is a huge problem because of the dynamics of the disease," Abdul El-Sayed, assistant professor of epidemiology at the Mailman School of Public Health at Columbia University, told VICE News. "Unfortunately, the bodily fluid of recently passed victims continues to carry Ebola virus for up to three days following death. The body's immune system stops fighting the disease, allowing virus to replicate unabated."
"It's rather clear that in addition to providing treatment units and contact-tracing, educating those in affected regions regarding the dangers of unsafe burial practices should be at the top of the public health agenda to address this epidemic," El-Sayed said.
A recent Wall Street Journal article on the situation in Liberia referred to sources who said that some collection teams had offered to provide falsified death certificates for anywhere from $40 to $150. It noted that local officials and funeral-home directors were adjusting their protocols to ensure that the certificates are legitimate, confirming the documentation with the hospital or doctor that signed it.
In April, the Liberian government created telephone hotlines that citizens can call to report deaths or suspected Ebola cases. When a death is reported on the hotline, Liberian officials send out workers — either from the government or from humanitarian organizations — to recover the body and ensure safe disposal. Municipal authorities sometimes outsource the retrieval work.
Mary Moran, a professor of anthropology and Africana and Latin American studies at Colgate University, told VICE News that it's not surprising Liberians are willing to pay a bribe to respectfully send off their dead.
"As in most countries, people with money will try to get what they want," she said. While acknowledging the danger of handling (let alone kissing) infected corpses, Moran emphasized that she doesn't think traditional funerals are the among the main avenues of infection.
"All the evidence is that the overwhelming route of transmission is from sick people to those trying to care for them," she said.
A World Health Organization report released last week noted that more than 4,033 people have died from Ebola since the outbreak began. Liberia has suffered the most casualties, with more than 2,300 dead.
The organization warned on Tuesday that if Ebola isn't contained within the next two months, the disease could infect as many as 10,000 people per week in West Africa. Ebola has infected about 1,000 people per week over the last month.
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