The number of probable COVID-19 cases in the first 3-month interval was 16 (84.21%) from 19 corpses. This delay in diagnosis is because the hospital does not yet have a PCR or RMT device. It has to send nasopharyngeal or oropharyngeal swab samples to other cities such as Jakarta, where the RT-PCR results have only been out for about 7 days or more. Meanwhile, in the second 3-month interval, the number of probable COVID-19 cases who died was 42 (46.15%) of the 91 corpses. During this period, the hospital had PCR and RMT machines to obtain a diagnosis of COVID-19 immediately. The high number of probable cases is probably caused by the people who have brought the patient to the hospital if their condition is severe or critical. Hence, their status is still probable until the patient dies.
Examination of nasopharyngeal swab or oropharyngeal swab specimens using RT-PCR and RMT aims to improve the ability to diagnose COVID-19 (Afzal 2020; Anonim 2021). The RT-PCR test had limitations, including the fastest test results were known after 24 h, and running PCR was carried out after the minimum sample size had been met to save on the reagents use and other consumables. On the other hand, RMT has several advantages, namely (1) the same accuracy as RT-PCR in detecting viral nucleic acids, (2) test results can be obtained 1–2 h, and (3) this equipment is available in many districts/cities in Indonesia, which has been used in tuberculosis diagnostic examination programs so far (FDA 2020; GeneXpert 2021; Anonim 2021).
The COVID-19-positive corpses need to be carried out by postmortem swabs for social reasons, even though the postmortem swab is not required in the COVID-19 corpse handling protocol. The social reason is to make the status of the corpse clearer so that the family can accept the protocol for handling infectious bodies. Therefore, the RMT result can become a tool for negotiation when handling the COVID-19 corpse is needed. Then, the forcible removal of the COVID-19-positive corpse by the family can be avoided.
In this study, there were several reasons for refusal to handle the COVID-19 corpse in the first 3-month interval, namely the family did not believe that the deceased died because of COVID-19, the COVID-19 corpse handling protocol was not in accordance with religious law, and the negative stigma of the COVID-19-positive corpse was in the form of fear of being shunned by neighbors and family. The religious reasons are the basis for the rejection of the COVID-19 corpse handling protocol. In conservative religious communities, the new legal provisions related to handling infectious corpses are difficult to accept, causing social conflict between the community and the hospital. The conflict that cannot be handled will result in the forcible removal of the COVID-19-positive corpse.
The reason for refusing COVID-19 corpse handling in the second three-month interval is the family’s distrust of the diagnosis of COVID-19. This is most likely influenced by fake news or hoaxes spread around the COVID-19 outbreak, such as the COVID-19 conspiracy theory and the allegation that the COVID-19 examination and corpse handling is only for the benefit of the hospital business. This negative prejudice has caused distrust in the diagnosis of COVID-19.
According to Hinduism, death is a series of transition processes to another life (reincarnation). A ritual of respect is needed so that the soul (atman) achieves a new, better life. There are differences in Hindu religious rituals in India, which are divided into 15 regions. Therefore, it is crucial to assess variations in practices and death beliefs among different groups (Gupta 2011). The majority of Hindu sects in Indonesia are Balinese Hindus. However, the religious philosophy is the same as in India, such as reincarnation, karma, dharma, ahimsa, atman, and moksha (McDaniel 2010; Yoga Segara 2018). However, in the practice of religious rituals, there are some differences. One of the differences in the funeral rituals for the corpses of Hindus in Indonesia is that the cremation process/burial must wait for a good day according to the instructions of Hindu religious leaders (pedanda). Sometimes, the process of waiting for the auspicious day takes up to a month or even more, especially since the corpse is a religious figure or community figure. Thus, embalming is a must so that the body remains intact until the day of the funeral.
The embalming process is not recommended according to the WHO protocol, but if it has to be done in forensic cases, it must be done in a negative pressure room (Kementerian Kesehatan 2020; WHO 2020). Unfortunately, most morgues in Indonesia do not own this facility, including hospitals in Lombok, Indonesia. This facility is only available in the isolation treatment room for COVID-19 patients.
Funeral rituals for adherents of Islam are bathing, wearing the shroud, praying the body, and delivering the funeral as soon as possible after death (Sarhill et al. 2001; Gatrad and Sheikh 2002). Local elements included in the ritual are bathing the corpse carried out by the closest family accompanied by religious leaders who are usually old to lead prayers, flowing clean water to clean all dirt, both on the surface of the body and dirt in the body such as feces, urine, and phlegm by pressing stomach and chest, and the use of a white shroud without plastic; the funeral does not use a coffin, and the cheeks of the corpse rest on the ground.
The ritual is prohibited in the COVID-19 protocol because it can cause virus transmission to officers and families who carry out the ritual (Kementerian Kesehatan 2020; WHO 2020). However, if it is carried out in a negative pressure room and complete PPE, the entire series of bathing and the use of the shroud can be carried out. This innovation is an acceptable alternative for most religious conservative groups.
