Dying of VOC-202012/01 — multimodal investigations in a death case of the SARS-CoV-2 variant

Abstract

The current pandemic with Severe acute respiratory syndrome-coronavirus-2 has been taking on new dynamics since the emergence of new variants last fall, some of them spreading more rapidly. Many countries currently find themselves in a race to ramp up vaccination strategies that have been initiated and a possible third wave of the pandemic from new variants, such as the Variant of Concern-202012/01 from the B.1.1.7 lineage. Until today, many investigations in death cases of Coronavirus-disease-19 have been conducted, revealing pulmonary damage to be the predominant feature of the disease. Thereby, different degrees of macroscopic and microscopic lung damage have been reported, most of them resembling an Acute Respiratory Distress Syndrome. Far more, systemic complications of the disease such as pulmonary embolisms have been described. However, neither morphologic nor virologic findings of patients dying of the new variants have yet been reported. Here, we report on a comprehensive analysis of radiologic, morphologic, and virologic findings in a fatal case of this variant.

New Postmortem Perspective on Emerging SARS-CoV-2 Variants of Concern, Germany

“…All corpses admitted to the Institute of Legal Medicine (n = 8,578) and crematoria (n = 1,705) in Hamburg, Germany, during March 3, 2020–March 31, 2022, were screened for SARS-CoV-2 mRNA by quantitative reverse transcription PCR ( 3 ). We found a total of 808 SARS-CoV-2 RNA-positive corpses; median monthly prevalence was 6.54% in 2020, 5.28% in 2021, and 12.50% in 2022 ( Figure , panel A).…”

“…We included 23/49 consecutive deceased persons infected with non-VOC lineages and 26/49 consecutive deceased persons infected with VOCs (B.1.1.7, n = 7; B.1.617.2, n = 4; and B.1.1.529, n = 15) ( Table ). We processed formalin-fixed paraffin-embedded tissue for histologic and immunohistochemical staining and cryopreserved tissue for molecular analysis as previously described ( 3 , 6 ).…”

Multiorgan tropism of SARS-CoV-2 lineage B.1.1.7

“…Organ tropism thereby correlated with the presence of comorbidities including chronic kidney disease and diabetes [ 5 ]. The first case report on autopsy results of a B.1.1.7 fatality was published recently in Int J Legal Med [ 6 ].…”

“…Forensic aspects of no. 1 have been published as case report [ 6 ] No Sex Age PMI Place of death Comorbidities ( n ) Airway ( n ) Cardiovascular ( n ) Kidney ( n ) Brain ( n ) Metabolism ( n ) Other ( n ) 1 f 70 6 OH 4 1 2 1 0 0 0 2 m 76 2 NW 4 0 3 0 0 0 0 3 f 78 6 OH 4 1 2 0 0 1 0 4 m 85 4 ICU 4 0 3 0 0 0 1 5 m 45 2 ICU 2 0 ...…”