A RETROSPECTIVE STUDY OF FINDINGS AND CHALLENGES IN CONDUCTION OF COVID-19-POSITIVE AUTOPSIES
DOI:
https://doi.org/10.22159/ajpcr.2023.v16i1.46321Keywords:
COVID-19 autopsy, SARS-CoV-2, Pandemic autopsy, Minimal invasive autopsyAbstract
Objectives: In this article, we report our observations as well as the innovations which were adapted in the resource-limited settings which are present in most parts of the country. The standard protocols were adopted for complete COVID-19 autopsies that were conducted.
Methods: The present retrospective study was conducted in the Department of Forensic Medicine and Toxicology, Government Medical College, Amritsar. The medicolegal autopsies were conducted completely in confirmed positive COVID-19 cases. In the medicolegal cases, complete autopsies were conducted, where the investigating officers did not forgo the autopsy. A total of ten COVID-positive autopsies were conducted from July 2020 to August 2021.
Results: Gross findings of various organs during autopsy include that of lungs showing relatively unremarkable lungs with mild edema and consolidation, brain showing edema, and subarachnoid hemorrhage, pancreas showing necrotic and hemorrhagic changes, and kidneys flea-bitten and were contracted.
Conclusion: Although a complete autopsy is desired to provide the best possible understanding of the disease process, its variants, such as core biopsies and echopsies, can be taken up as safer alternatives, especially in resource-limited centres. Experience, preparation, and experience are the significant vital aspects which help in managing the COVID-19-positive autopsy. The institution needs to develop guidelines as well as standard operating procedures for the smooth and safe conduct of autopsies in COVID-19 dead bodies.
Downloads
References
Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: Implications for virus origins and receptor binding. Lancet 2020;395(10224):565-74. doi: 10.1016/S0140-6736(20)30251-8, PMID 32007145
Centers for Disease Control and Prevention. Collection and Submission of Postmortem Specimens from Deceased Persons with Confirmed or Suspected COVID-19. Available from: https://www.cdc.gov/ coronavirus/2019-ncov/hcp/guidancepostmortem-specimens.html [Last accessed on 2020 Mar 26].
Occupational Safety and Health Administration (OSHA). COVID-19 Control and Prevention. Available from: https://www.osha.gov/SLTC/ covid19/controlprevention.html [Last accessed on 2020 Mar 26].
Hanley B, Lucas SB, Youd E, Swift B, Osborn M. Autopsy in suspected COVID-19 cases. J Clin Pathol 2020;73:239-42. doi: 10.1136/ jclinpath-2020-206522, PMID 32198191
World Health Organization. Infection Prevention and Control for the Safe Management of a Dead Body in the Context of COVID-19: Interim Guidance. Geneva: World Health Organization; 2020.
Fineschi V, Aprile A, Aquila I, Arcangeli M, Asmundo A, Bacci M, et al. Management of the corpse with suspect, probable or confirmed COVID-19 respiratory infection-Italian interim recommendations for personnel potentially exposed to material from corpses, including body fluids, in morgue structures and during autopsy practice. Pathologica 2020;112:64-77. doi: 10.32074/1591-951X-13-20, PMID 32324727
Salerno M, Sessa F, Piscopo A, Montana A, Torrisi M, Patanè F, et al. No autopsies on COVID-19 deaths: A missed opportunity and the lockdown of science. J Clin Med 2020;9:1472. doi: 10.3390/ jcm9051472, PMID 32422983
Fusco FM, Scappaticci L, Schilling S, De Iaco G, Brouqui P, Maltezou HC, et al. 2009 cross-sectional survey of procedures for post-mortem management of highly infectious disease patients in 48 isolation facilities in 16 countries: Data from EuroNHID. Infection 2016;44:57-64. doi: 10.1007/s15010-015-0831-5, PMID 26267332
Rakislova N, Fernandes F, Lovane L, Jamisse L, Castillo P, Sanz A, et al. Standardization of minimally invasive tissue sampling specimen collection and pathology training for the child health and mortality prevention surveillance network. Clin Infect Dis 2019;69:S302- 10:S302-10. doi: 10.1093/cid/ciz565, PMID 31598667
Castillo P, Ussene E, Ismail MR, Jordao D, Lovane L, Carrilho C, et al. Pathological methods applied to the investigation of causes of death in developing countries: Minimally invasive autopsy approach. PLoS One 2015;10:e0132057. doi: 10.1371/journal.pone.0132057, PMID 26126191
Keten D, Okdemir E, Keten A. Precautions in postmortem examinations in Covid-19-Related deaths: Recommendations from Germany. J Forensic Leg Med 2020;73:102000. doi: 10.1016/j.jflm.2020.102000, PMID 32658758
Kim MY, Cheong H, Kim HS, Working Group for Standard Autopsy Guideline for COVID-19 from The Korean Society for Legal Medicine. Proposal of the autopsy guideline for infectious diseases: Preparation for the post-COVID-19 era (abridged translation). J Korean Med Sci 2020;35:e310. doi: 10.3346/jkms.2020.35.e310, PMID 32830471
Centers for Disease Control and Prevention Centers for Disease Control and Prevention: Collection and Submission of Postmortem Specimens from Deceased Persons with Confirmed or Suspected COVID-19. Available from: https://www.cdc.gov/coronavirus/2019- ncov/hcp/guidance-postmortem-specimens.html [Last accessed on 2020 May 10].
Osborn M, Lucas S, Stewart R, Swift B, Youd E. Briefing on COVID-19. Autopsy Practice Relating Possible Cases COVID. 2019-nCov, Novel Coronavirus from China;19:2019/2020). London, United Kingdom: Royal College of Pathologists; 2020.
Rakislova N, Marimon L, Ismail MR, Carrilho C, Fernandes F, Ferrando M, et al. Minimally invasive autopsy practice in COVID-19 cases: Biosafety and findings. Pathogens 2021;10:412. doi: 10.3390/pathogens10040412, PMID 33915771
González-Arnay E, Martín-Olivera R, Quintero-Quintero YC, Hernández-Guerra AI. Proposal for a harmonized protocol for COVID-19 screening and necropsy in forensic sciences facilities. J Forensic Leg Med 2020;76:102067. doi: 10.1016/j.jflm.2020.102067, PMID 33032204
Zhang J, Wang X, Jia X, Li J, Hu K, Chen G, et al. Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China. Clin Microbiol Infect 2020;26:767-72. doi: 10.1016/j. cmi.2020.04.012, PMID 32304745
Paganelli CR, Goco NJ, McClure EM, Banke KK, Blau DM, Breiman RF, et al. The evolution of minimally invasive tissue sampling in postmortem examination: A narrative review. Glob Health Action 2020;13:1792682. doi: 10.1080/16549716.2020.1792682, PMID 32713325
Castillo P, Martínez MJ, Ussene E, Jordao D, Lovane L, Ismail MR, et al. Validity of a minimally invasive autopsy for cause of death determination in adults in Mozambique: An observational study. PLoS Med 2016;13:e1002171. doi: 10.1371/journal.pmed.1002171, PMID 27875530
Guidelines for Handling, Treatment and Disposal of Waste Generated During Treatment/Diagnosis/Quarantine of COVID-19 Patients; 2020. Available from: https://www.mohfw.gov.in/ pdf/63948609501585568987wastesguidelines.pdf [Last accessed on 2020 Jul 28].
Carpenito L, D’Ercole M, Porta F, Di Blasi E, Doi P, Fagara GR, et al. The autopsy at the time of SARS-CoV-2: Protocol and lessons. Ann Diagn Pathol 2020;48:151562. doi: 10.1016/j.anndiagpath.2020.151562, PMID 32653819
Youd E, Moore L. COVID-19 autopsy in people who died in community settings: The first series. J Clin Pathol 2020;73:840-4. doi: 10.1136/ jclinpath-2020-206710, PMID 32605920
Yadav J, Patel B, Mahaluxmi S, Js S. COVID-19 autopsy in India: Protocols, procedures, and experiences. Cureus 2021;13:e18984. doi: 10.7759/cureus.18984, PMID 34820239
Barton LM, Duval EJ, Stroberg E, Ghosh S, Mukhopadhyay S. COVID-19 autopsies, Oklahoma, USA. Am J Clin Pathol 2020;153:725-33. doi: 10.1093/ajcp/aqaa062, PMID 32275742
Parekh U, Kanchan T, Krishan K. Inexplicable COVID-19! Would pathological autopsy be the panacea? Acta Biomed 2021;92:e2021175. doi: 10.23750/abm.v92i1.11019, PMID 33682800
Lacy JM, Brooks EG, Akers J, Armstrong D, Decker L, Gonzalez A, et al. COVID-19: Postmortem diagnostic and biosafety considerations. Am J Forensic Med Pathol 2020;41:143-51. doi: 10.1097/ PAF.0000000000000567, PMID 32379077
Published
How to Cite
Issue
Section
Copyright (c) 2022 DR JASPINDER PRATAP SINGH JP SINGH, DR MANPREET KAUL
This work is licensed under a Creative Commons Attribution 4.0 International License.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.