Proposal of the Autopsy Guideline for Infectious Diseases: Preparation for the Post-COVID-19 Era (abridged translation)

Abstract

With the rapidly spreading coronavirus disease 2019 (COVID-19) pandemic over the past few months, the world is facing an unprecedented crisis. Innumerable lives have been lost to this novel infectious disease, the nature of which supersedes conventional medical understanding. The COVID-19 pandemic is not just a global health crisis, several aspects of life in the post-COVID-19 era are also being contemplated. Experts in unison are warning that the upcoming changes in all areas of life could potentially be far more drastic than ever experienced in the entire human civilization. The medical community is no exception, and therefore, personnel involved in forensic medicine also need to be adequately prepared for the future. Forensic medicine is a branch of medicine dedicated to one of the most important stages of the human lifecycle and has always been at the forefront in times of unprecedented social change. The autopsy, one of the most important tools of forensic medicine, is also useful to infectious diseases because it identifies the causal relationship between death and infection, reveals medical and epidemiological knowledge, and provides objective evidence for legal disputes. We present new autopsy guidelines in forensic medicine, formulated based on the various infectious diseases that we presently live with and may encounter in the future. In formulation of these guidelines several considerations have been taken into account, namely, the role forensic pathologists should play in the post-COVID-19 era and the necessary preparations as well as the support needed from society to fulfill that role. The present COVID-19 outbreak should be a starting point for formulating improvements in current practices in forensic science, including autopsy biosafety practices and the medicolegal death investigation system.

Minimally Invasive Autopsy Practice in COVID-19 Cases: Biosafety and Findings

“…The recommended measures for COVID-19 autopsy are highly variable [ 7 , 8 , 10 , 25 , 26 , 27 , 28 , 29 , 30 ]. Several guidelines recommend at least a BSL-3 autopsy facility to perform a complete autopsy safely in COVID-19 cases [ 10 , 29 ], whereas other guidelines alternatively recommend a negative pressure room [ 31 ] or whole room ventilation [ 32 ] with proper air filtration. Notably, evidence on the safety of performing MIA in COVID-19 cases is limited.…”

COVID-19 autopsies: Procedure, technical aspects and cause of fatal course. Experiences from a single-center

“…Initially, there was a wide reluctance in performing autopsies in many countries, caused by a shortage of resources, staggering amounts of casualties but also an uncertain risk of infection for the autopsy team. During the last months, experience reports [ 7 , 10 , 15 , 25 ], examples of good practice [ 4 ] as well as autopsy procedure proposals have been published [ 6 , 27 ] underlining the importance of strict safety measures and a well-designed autopsy protocol [ 3 , 6 , 12 , 17 ]. In addition, the current literature offers little information on appropriate processing of COVID-19 samples.…”

A Comprehensive Review of Pathological Examination in Forensic Medicine: Past, Present, and Future

“…Association for European Cardiovascular Pathology (AECVP) produced a guideline for the post-mortem investigation of patients who die suddenly from cardiac diseases [ 56 ]. Apart from this, there are protocols for clinical autopsy, which direct the PE [ 57 ]. Failure to adhere to the guidelines will create a high chance of missing the COD.…”