Proposal for a harmonized protocol for COVID-19 screening and necropsy in forensic sciences facilities

Abstract

On 31 December 2019, health authorities in the People's Republic of China informed the World Health Organization of a then limited outbreak of interstitial viral pneumonia, identified at a laboratory in the city of Wuhan. In mid-April 2020 this outbreak of COVID-19 (as the disease has been called) has aggravated and spread worldwide, causing more than 200,000 deaths and affecting especially the United States, Spain, Italy, France and the United Kingdom. Despite the severity of the outbreak, the pathological findings have not been described in detail and there are very few guidelines or protocols for conducting autopsy studies on patients who have died from COVID-19. There are currently very few histopathological case series studies on this disease. In addition, some of these studies have been performed on biopsies or surgical resection pieces from patients in whom disease was subsequently demonstrated or through minimally invasive autopsy protocols. None of the studies offer a detailed necropsy protocol. This document proposes a protocol of action for the institutes of Forensic Medicine facing the current SARS-CoV2 pandemic, which combines protection of worker safety with optimization of tissue collection.

Microbiology in minimally invasive autopsy: best techniques to detect infection. ESGFOR (ESCMID study group of forensic and post-mortem microbiology) guidelines

“…While MIA can reduce the need to undertake invasive autopsies in patients with known or suspected Hazard Group 3 infections such as HIV or COVID-19 [31,[35][36][37], very few recent articles detail the collection of samples for microbiological examination in adults during MIA. Previous studies have focused on the collection of biopsies for histopathological examination [38,39].…”

Clinicopathologic characteristics of severe COVID-19 patients in Mexico City: A post-mortem analysis using a minimally invasive autopsy approach

“…This approach has been validated and protocolized in low-income countries, particularly in the setting of biohazard concerns and highly contagious diseases (tuberculosis, yellow fever, and Nipah virus) [ 15 – 19 ]. Even though complete open autopsy remains the gold standard for multi-organic post-mortem diagnosis, the unique challenges posed by the COVID-19 pandemic regarding biosafety precautions (particularly in low-income countries) made this technique unavailable [ 20 ]. An ultrasound-guided approach for MIA (MIA-US) has been described yielding similar findings to those reported in open autopsies.…”