COVID-19 Autopsy in India: Protocols, Procedures, and Experiences

Yadav, Jayanthi; Patel, Brinda; Mahaluxmi, S; JS, Sravan

doi:10.7759/cureus.18984

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…Later, the same authors, further, emphasized that the diagnosis of COVID-19 would have been missed without an autopsy, and hence, it proved that complete autopsies in case of COVID-19 cases were critical for confirmation of the viral infection as well as distinguishing the potential confounders from the true virus-related pathology [24]. The gross findings of the present study are consistent with the study conducted by Yadav et al (2021) [23], Parekh et al (2021) [25], and Lacy et al (2020) [26].…”

Section: Discussionsupporting

confidence: 89%

“…A similar number of cases were autopsies of the COVID-19 dead bodies in the study conducted by Youd et al (2020) [22], where a total of nine autopsies were conducted, and all the autopsies were conducted on the orders of the coroner/magistrate, and no consent from the deceased relatives was required, and the intention was finding the cause of death. In another study by Yadav et al (2021) [23], which was a prospective observational study conducted on non-medicolegal cases where major obstacle was taking consent from the relatives of the deceased. The usefulness and importance of the clinical knowledge and details of the deceased were emphasized by Carpenito et al (2020) [21] and have been one of the important steps in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, there is a major focus on methods and modifications that need to be adopted while conducting highly infectious cases. The authors, thus, recommend covering the dissected area with [23].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A Retrospective Study of Findings and Challenges in Conduction of Covid-19-Positive Autopsies

KAUL

Singh

KUMAR

et al. 2022

Asian J Pharm Clin Res

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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.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Retrospective Study of Findings and Challenges in Conduction of Covid-19-Positive Autopsies

KAUL

Singh

KUMAR

et al. 2022

Asian J Pharm Clin Res

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“…Since no specific guidelines were available for COVID-19 autopsies, the procedures were performed as per guidelines for highly infectious autopsy cases given by the Center for Disease Control and Prevention (CDC) [ 28 ], Royal College of Physicians (RCP) [ 29 ], COVID-19: Guidelines on Dead Body Management [ 30 ], and World Health Organization (WHO) [ 31 , 32 ]. Since these autopsies were performed on the cadavers infected with SARS-CoV-2, which is potentially infectious and highly transmissible, movement in and out of the autopsy room was strictly limited.…”

Section: Methodsmentioning

confidence: 99%

Organ Involvement in COVID-19: A Molecular Investigation of Autopsied Patients

et al. 2022

Self Cite

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Precise reasons for severe manifestation of SARS-CoV-2 remain unanswered, and efforts have been focused on respiratory system management. Demonstration of unequivocal presence of SARS-CoV-2 in vital body organs by cadaver autopsy was the only way to prove multi-organ involvement. Hence, the primary objective of the study was to determine presence of the SARS-CoV-2 in various organs of patients succumbing to SARS-CoV-2 infection. A total of 246 samples from different organs of 21 patients who died due to severe COVID-19 illness were investigated by qRT-PCR, and SARS-CoV-2 was detected in 181 (73.57%) samples and highest positivity of SARS-CoV-2 being (expectedly) found in nasopharynx (90.4%) followed by bilateral lungs (87.30%), peritoneal fluid (80%), pancreas (72.72%), bilateral kidneys (68.42%), liver (65%) and even in brain (47.2%). The deceased patients were categorized to three subgroups based upon the extent of organs in which SARS-CoV-2 was detected by qRT-PCR (high intensity ≥80%, intermediate intensity = 65–80% and low intensity ≤65% organs involvement). It was conclusively established that SARS-CoV-2 has the property of invasion beyond lungs and even crosses the blood–brain barrier, resulting in multi-system disease; this is probably the reason behind cytokine storm, though it is not clear whether organ damage is due to direct injury caused by the virus or result of inflammatory assault. Significant inverse correlation was found between the Ct value of lung samples and number of organs involved, implying that higher viral load in lungs is directly proportionate to involvement of extrapulmonary organs and patients with higher viral load in respiratory secretions should be monitored more closely for any warning signs and the treatment strategies should also address involvement of other organs for better outcome, because lungs, though the primary site of infection, are not the only organ system responsible for pathogenesis of systemic illness.

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SARS-CoV-2 persistence and infectivity in COVID-19 corpses: a systematic review

Putra

Hidayat

Zhuhra

2022

Forensic Sci Med Pathol

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The persistence and infectivity of SARS-CoV-2 in different postmortem COVID-19 specimens remain unclear despite numerous published studies. This information is essential to improve corpses management related to clinical biosafety and viral transmission in medical staff and the public community. We aim to understand SARS-CoV-2 persistence and infectivity in COVID-19 corpses. We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocols. A systematic literature search was performed in PubMed, Science Direct Scopus, and Google Scholar databases using specific keywords. We critically reviewed the collected studies and selected the articles that met the criteria. We included 33 scientific papers that involved 491 COVID-19 corpses. The persistence rate and maximum postmortem interval (PMI) range of the SARS-CoV-2 findings were reported in the lungs (138/155, 89.0%; 4 months), followed by the vitreous humor (7/37, 18.9%; 3 months), nasopharynx/oropharynx (156/248, 62.9%; 41 days), abdominal organs (67/110, 60.9%; 17 days), skin (14/24, 58.3%; 17 days), brain (14/31, 45.2%; 17 days), bone marrow (2/2, 100%; 12 days), heart (31/69, 44.9%; 6 days), muscle tissues (9/83, 10.8%; 6 days), trachea (9/20, 45.0%; 5 days), and perioral tissues (21/24, 87.5%; 3.5 days). SARS-CoV-2 infectivity rates in viral culture studies were detected in the lungs (9/15, 60%), trachea (2/4, 50%), oropharynx (1/4, 25%), and perioral (1/4, 25%) at a maximum PMI range of 17 days. The SARS-CoV-2 persists in the human body months after death and should be infectious for weeks. This data should be helpful for postmortem COVID-19 management and viral transmission preventive strategy.

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COVID-19 Autopsy in India: Protocols, Procedures, and Experiences

Cited by 6 publications

References 13 publications

A Retrospective Study of Findings and Challenges in Conduction of Covid-19-Positive Autopsies

A Retrospective Study of Findings and Challenges in Conduction of Covid-19-Positive Autopsies

Organ Involvement in COVID-19: A Molecular Investigation of Autopsied Patients

SARS-CoV-2 persistence and infectivity in COVID-19 corpses: a systematic review

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