Safe management of bodies of deceased persons with suspected or confirmed COVID-19: a rapid systematic review

Yaacoub, Sally; Schünemann, Holger J.; Khabsa, Joanne; El‐Harakeh, Amena; Khamis, Assem M.; Chamseddine, Fatimah; Khoury, Rayane El; Saad, Zahra; Hneiny, Layal; Cuello-Garcia, Carlos A.; Muti-Schünemann, Giovanna; Bognanni, Antonio; Chen, Chen; Chen, Guang; Zhang, Yuan; Zhao, Hong; Hanna, Pierre Abi; Loeb, Mark; Piggott, Thomas; Reinap, Marge; Rizk, Nesrine; Stalteri, Rosa; Duda, Stephanie; Solo, Karla; Chu, Derek K.; Akl, Elie A.

doi:10.1136/bmjgh-2020-002650

Cited by 46 publications

(32 citation statements)

References 11 publications

(8 reference statements)

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“…This study reports two cases of death from COVID-19, comparing the obtained data with those of a Control case, a newborn who died from pneumonia not due to COVID-19. Considering that COVID-19 infection is new, the main findings of the present study confirm that autopsy represents a very important tool to clarify the mechanisms of infection [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ].…”

Section: Discussionsupporting

confidence: 74%

Preliminary Post-Mortem COVID-19 Evidence of Endothelial Injury and Factor VIII Hyperexpression

et al. 2020

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(1) Background: The current outbreak of COVID-19 infection is an ongoing challenge and a major threat to public health that requires surveillance, prompt diagnosis, as well as research efforts to understand the viral pathogenesis. Despite this, to date, very few studies have been performed concerning autoptic specimens. Therefore, this study aimed: (i) to reiterate the importance of the autoptic examination, the only method able to precisely define the cause of death; (ii) to provide a complete post-mortem histological and immunohistochemical investigation pattern capable of diagnosing death from COVID-19 infection. (2) Methods: In this paper, the lung examination of two subjects who died from COVID-19 are discussed, comparing the obtained data with those of the control, a newborn who died from pneumonia in the same pandemic period. (3) Results: The results of the present study suggest that COVID-19 infection can cause different forms of acute respiratory distress syndrome (ARDS), due to diffuse alveolar damage and diffuse endothelial damage. Nevertheless, different patterns of cellular and cytokine expression are associated with anti-COVID-19 antibody positivity, compared to the control case. Moreover, in both case studies, it is interesting to note that COVID-19, ACE2 and FVIII positivity was detected in the same fields. (4) Conclusions: COVID-19 infection has been initially classified as exclusively interstitial pneumonia with varying degrees of severity. Subsequently, vascular biomarkers showed that it can also be considered a vascular disease. The data on Factor VIII discussed in this paper, although preliminary and limited in number, seem to suggest that the thrombogenicity of Sars-CoV2 infection might be linked to widespread endothelial damage. In this way, it would be very important to investigate the pro-coagulative substrate both in all subjects who died and in COVID-19 survivors. This is because it may be hypothesized that the different patterns with which the pathology is expressed could depend on different individual susceptibility to infection or a different personal genetic-clinical background. In light of these findings, it would be important to perform more post-mortem investigations in order to clarify all aspects of the vascular hypothesis in the COVID-19 infection.

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Section: Discussionsupporting

confidence: 74%

Preliminary Post-Mortem COVID-19 Evidence of Endothelial Injury and Factor VIII Hyperexpression

et al. 2020

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“…In this scenario there are several important concerns about the management of corpses who died “from” or “with” COVID-19 or the management of corpses who died in the period of the outbreak, particularly in the red zone of the infection. The main organizations, such as the World Health Organization (WHO) [ 11 ], Centers for Disease Control and Prevention (CDC) [ 12 ], have published documents reporting recommendations and safety strategies to adopt during confirmed and suspected COVID-19 autopsies and the safe management of corpses at the epicenter of the outbreak, however, many scientific committees’ protocols were put on hold thus stopping both clinical and forensic autopsies from being performed [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Each country has chosen to respond to this emergency with its own decisions; on the one hand, countries such as Italy have chosen not to perform clinical autopsies [ 20 , 21 ], even if recommendations to carry out autopsies had been made by the Italian scientific organization of forensic scientists [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical-Forensic Autopsy Findings to Defeat COVID-19 Disease: A Literature Review

Sessa

Bertozzi

Cipolloni

et al. 2020

JCM

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The severe acute respiratory syndrome (SARS)-CoV-2 was identified for the first time in China, in December 2019. Confirmed cases of COVID-19 have been reported around the world; indeed, this infection has been declared a pandemic. Consequently, the scientific community is working hard to gain useful information about the history of this virus, its transmission, diagnosis, clinical features, radiological findings, research and development of candidate therapeutics as well as vaccines. This review aims to analyze the diagnostic techniques used to ascertain the COVID-19 infection, critically reviewing positive points and criticism for forensic implications, obviously including autopsy. Finally, this review proposes a practical workflow to be applied in the management of corpses during this outbreak of the COVID-19 infection, which could be useful in cases of future infectious disease emergencies. Analyzing the diagnostic methods, to date, virus nucleic acid RT-PCR represents the standard method used to ascertain the COVID-19 infection in living subjects and corpses, even if this technique has several criticisms: mainly, the staff should be highly specialized, working in high-throughput settings, able to handle high workloads and aware of health risks and the importance of the results. Thus, IgG/IgM serological tests have been developed, overcoming RT-qPCR duration, costs, and management, not requiring highly trained personnel. Nevertheless, serological tests present problems; the WHO recommends the use of these new point-of-care immunodiagnostic tests only in research settings. Furthermore, nothing has yet been published regarding the possibility of applying these methods during post-mortem investigations. In light of this scenario, in this review, we suggest a flow chart for the pathologist called on to ascertain the cause of death of a subject with historical and clinical findings of COVID-19 status or without any anamnestic, diagnostic, or exposure information. Indeed, the literature data confirmed the analytical vulnerabilities of the kits used for laboratory diagnosis of COVID-19, particularly during postmortem examinations. For these reasons, autopsy remains the gold standard method to ascertain the exact cause of death (from or with COVID-19 infection, or other causes), to consequently provide real data for statistical evaluations and to take necessary measures to contain the risks of the infection. Moreover, performing autopsies could provide information on the pathogenesis of the COVID-19 infection with obvious therapeutic implications.

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“…The need for new strategies for the proper and safe management of anatomic specimens that tested positive or suspect for COVID-19 is evident in the absence of specific studies on the effectiveness of biosafety standards in this condition ( Yaacoub et al, 2020 ). Therefore, these rules must be rethought and expanded, aiming at the safety of all users, especially the technical professionals and professors responsible for embalming new corpses.…”

Section: Resultsmentioning

confidence: 99%

Human anatomy education and management of anatomic specimens during and after COVID-19 pandemic: Ethical, legal and biosafety aspects

Lemos

Araújo²,

Lima³

et al. 2021

Annals of Anatomy - Anatomischer Anzeiger

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COVID-19 is an infection caused by the SARS-CoV-2 virus, initially identified in the city of Wuhan, China, in December 2019. Since then, the virus has spread to the continents, causing a major pandemic. The impacts of this pandemic on the education of human anatomy interfere in at least two aspects: (1) receiving and managing anatomical specimens in anatomy laboratories and (2) adaptations for classes on remote virtual teaching. Therefore, this study reviewed and discussed the legal and bioethical aspects, considering the scenario of a South American Country, aiming to stimulate the debate on these two relevant themes in the international community. Because of the COVID-19 pandemic and the impossibility of mass testing, anatomists and other workers in the field must deal with the risk of receiving bodies infected with SARS-CoV-2. In this situation, additional care measures in biosafety practices are essential to protect the staff. Such measures are: the bodies must be preserved by the perfusion of formaldehyde or other fixative solutions; embalming must be performed in ventilated rooms with a good air exhaust system; to avoid excessive manipulation of bodies and procedures such as pulmonary insufflation or craniotomy; and proper use of personal protective equipment, including lab coat, gloves and masks. As for exposure of body images in online classes, this review showed that there are no legal impediments to this end. However, anatomists must adopt measures aimed at protecting the memory of the deceased, such as using secure digital platforms with restricted access; family authorization/consent and student awareness.

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Safe management of bodies of deceased persons with suspected or confirmed COVID-19: a rapid systematic review

Cited by 46 publications

References 11 publications

Preliminary Post-Mortem COVID-19 Evidence of Endothelial Injury and Factor VIII Hyperexpression

Preliminary Post-Mortem COVID-19 Evidence of Endothelial Injury and Factor VIII Hyperexpression

Clinical-Forensic Autopsy Findings to Defeat COVID-19 Disease: A Literature Review

Human anatomy education and management of anatomic specimens during and after COVID-19 pandemic: Ethical, legal and biosafety aspects

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