Infectivity of deceased COVID-19 patients

Plenzig, Stefanie; Bojkova, Denisa; Held, Hannelore; Berger, Annemarie; Holz, Franziska; Cinatl, Jindrich; Gradhand, Elise; Kettner, Mattias; Pfeiffer, Annika; Verhoff, Marcel A.; Ciesek, Sandra

doi:10.1007/s00414-021-02546-7

Cited by 34 publications

(46 citation statements)

References 14 publications

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“…It is routinely performed in all cases admitted to our Institute. Given occupational safety concerns about the potential of infection of mortuary staff and pathologists [12], it has been suggested that PMCT with an appropriate clinical history, could be a useful alternative to autopsy in the absence of nasopharyngeal swab for SARS-CoV-2 RT-PCR testing. This concept of chest CT being used as screening test in CoVID-19 has been explored in the clinical environment but in general has been rejected by multiple eminent societies on the basis of non-specificity of CT, the potential burden on radiology departments and challenges for infection control [13][14][15][16] although there are advocates.…”

Section: Discussionmentioning

confidence: 99%

Post-mortem CT lung findings at a medicolegal institute in SARS-CoV-2 RT-PCR positive cases with autopsy correlation

O’Donnell

Iles

Woodford

2021

Forensic Sci Med Pathol

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CoVID-19 is a novel viral infection with now well-established clinical radiological findings. There is limited data on post-mortem imaging. We explore the proposition that PMCT could be used as screening test. In an 11-week period, 39 deceased persons were referred for medicolegal investigation with pre-existing or subsequent nasopharyngeal swabs showing positivity on SARS-CoV-2 RT-PCR testing. All 39 had routine whole-body CT scans on admission and 12 underwent medicolegal autopsy. These cases were contrasted with 4 others which were negative on nasopharyngeal swabs despite PMCT findings suggestive of CoVID-19 pneumonia (designated false positive). Nine of the 12 autopsies showed lung histology consistent with those reported in CoVID-19 pneumonia. Typical clinical CoVID-19 lung findings on PMCT were only detected in 5 (42%). In 3 of the 4 false positive cases, lung findings showed non-COVID-19 histology but in 1, findings were identical. PMCT CoVID-19 findings in the lungs are therefore not specific and may not be detected in all cases due to obscuration by expected agonal CT findings or other pathologies that pre-dated SARS-CoV-2 infection. PMCT findings may otherwise be subtle. Although PMCT may hint at CoVID-19, we believe that nasopharyngeal swabs are still required for definitive diagnosis. Even with positive swabs, clinical CoVID-19 lung findings on PMCT are often not detected. PMCT findings can be subtle, extreme or obscured by agonal changes. Given this range of PMCT changes, the challenge for pathologists is to determine whether death has been caused by, or merely associated with, SARS-CoV-2 infection.

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Section: Discussionmentioning

confidence: 99%

Post-mortem CT lung findings at a medicolegal institute in SARS-CoV-2 RT-PCR positive cases with autopsy correlation

O’Donnell

Iles

Woodford

2021

Forensic Sci Med Pathol

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“…In case 1 of our study, the first symptoms occurred 15 days and in case 2, 19 days before death, so it is possible that both patients were no longer infectious due to the duration of the disease at the time of death. Studies on postmortem changes in COVID-19 patients have produced evidence that moderate signs of decay in a corpse will not have a major influence on the infectivity of the virus [ 12 ]. In their study with samples of living patients, La Scola et al showed that infectivity in cell culture correlates with the level of viral RNA load, with CPE being observed at low C t values rather than at higher ones [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…: ACC 169) seeded in 5.5 cm 2 culture tubes. Cells were incubated in a CO 2 -incubator at 37 °C for up to seven days and assessed microscopically every day for virus specific cytopathogenic effects (CPE) [ 12 , 14 ]. After seven days or earlier in the case of cell lysis occurred as a sign of cell culture infection by the added virus, cell culture supernatants were tested for the presence and amount of viral RNA by RT-PCR using cobas® SARS-CoV-2 (Roche Diagnostics), to verify that CPE were attributable to SARS-CoV-2 infection.…”

Section: Methodsmentioning

confidence: 99%

Detection and infectivity of SARS-CoV-2 in exhumated corpses

et al. 2021

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Postmortem detection of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) after the exhumation of a corpse can become important, e.g. in the case of subsequent medical malpractice allegations. To date, data on possible detection periods [e.g. by reverse transcription polymerase chain reaction (RT-PCR)] or on the potential infectivity of the virus after an exhumation are rare. In the present study, these parameters were examined in two cases with a time span of approximately 4 months between day of death and exhumation. Using SARS-CoV-2 RT-PCR on swabs of both lungs and the oropharynx detection was possible with cycle threshold (Ct) values of about 30 despite signs of beginning decay. RT-PCR testing of perioral and perinasal swabs and swabs collected from the inside of the body bag, taken to estimate the risk of infection of those involved in the exhumation, was negative. Cell culture-based infectivity testing was negative for both, lung and oropharyngeal swabs. In one case, RT-PCR testing at the day of death of an oropharyngeal swab showed almost identical Ct values as postmortem testing of an oropharyngeal swab, impressively demonstrating the stability of viral RNA in the intact corpse. However, favorable climatic conditions in the grave have to be taken into account, as it was wintertime with constant low temperatures. Nevertheless, it was possible to demonstrate successful postmortem detection of SARS-CoV-2 infection following exhumation even after months in an earth grave.

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“…There was no correlation between successful virus isolation and PMI. Also Plenzig et al reported the isolation of viable viruses from lungs in two out of four cases independent from PMI (10).…”

Section: Discussionmentioning

confidence: 98%

“…These five centers represent four different geographic regions (north, south, east, and west), two different medical disciplines (pathology and legal medicine), and two different techniques (conventional complete autopsies and minimally invasive autopsies). Swabs were chosen as the method for generating samples for RT-qPCR and infectivity assessment in cell culture experiments, as used by others recently (10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

Contamination of personal protective equipment during COVID-19 autopsies

Brandner

Borcherding²,

Edler

et al. 2021

Preprint

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Confronted with an emerging infectious disease, the medical community faced relevant concerns regarding the performance of autopsies of COVID-19 deceased at the beginning of the pandemic. This attitude has changed, and autopsies are now recognized as indispensable tools for elucidating COVID-19; despite this, the true risk of infection for autopsy staff is still debated. To elucidate the rate of SARS-CoV-2 contamination in personal protective equipment (PPE), swabs were taken at nine locations of the PPE of one physician and an assistant each from 11 full autopsies performed at four different centers. Further samples were obtained for three minimally invasive autopsies (MIA) conducted at a fifth center. Lung/bronchus swabs of the deceased served as positive controls. SARS-CoV-2 RNA was detected by RT-qPCR. In 9/11 full autopsies PPE samples were tested RNA positive with PCR, in total 21% of all PPE samples taken. The main contaminated parts of the PPE were the gloves (64% positive), the aprons (50% positive), and the upper sides of shoes (36% positive) while for example the fronts of safety goggles were only positive in 4.5% of the samples and all face masks were negative. In MIA, viral RNA was observed in one sample from a glove, but not in other swabs. Infectious virus isolation in cell culture was performed in RNA positive swabs from full autopsies. Of all RNA positive PPE samples, 21% of the glove samples were positive for infectious virus taken in 3/11 full autopsies. In conclusion, in >80% of autopsies, PPE was contaminated with viral RNA. In >25% of autopsies, PPE was found to be even contaminated with infectious virus, signifying a potential risk of infection among autopsy staff. Adequate PPE and hygiene measures, including appropriate waste deposition, are therefore mandatory to enable safe work environment.

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Infectivity of deceased COVID-19 patients

Cited by 34 publications

References 14 publications

Post-mortem CT lung findings at a medicolegal institute in SARS-CoV-2 RT-PCR positive cases with autopsy correlation

Post-mortem CT lung findings at a medicolegal institute in SARS-CoV-2 RT-PCR positive cases with autopsy correlation

Detection and infectivity of SARS-CoV-2 in exhumated corpses

Contamination of personal protective equipment during COVID-19 autopsies

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