SARS-CoV-2 persistence and infectivity in COVID-19 corpses: a systematic review

Abstract

The persistence and infectivity of SARS-CoV-2 in different postmortem COVID-19 specimens remain unclear despite numerous published studies. This information is essential to improve corpses management related to clinical biosafety and viral transmission in medical staff and the public community. We aim to understand SARS-CoV-2 persistence and infectivity in COVID-19 corpses. We conducted a systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) protocols. A systematic literature search was performed in PubMed, Science Direct Scopus, and Google Scholar databases using specific keywords. We critically reviewed the collected studies and selected the articles that met the criteria. We included 33 scientific papers that involved 491 COVID-19 corpses. The persistence rate and maximum postmortem interval (PMI) range of the SARS-CoV-2 findings were reported in the lungs (138/155, 89.0%; 4 months), followed by the vitreous humor (7/37, 18.9%; 3 months), nasopharynx/oropharynx (156/248, 62.9%; 41 days), abdominal organs (67/110, 60.9%; 17 days), skin (14/24, 58.3%; 17 days), brain (14/31, 45.2%; 17 days), bone marrow (2/2, 100%; 12 days), heart (31/69, 44.9%; 6 days), muscle tissues (9/83, 10.8%; 6 days), trachea (9/20, 45.0%; 5 days), and perioral tissues (21/24, 87.5%; 3.5 days). SARS-CoV-2 infectivity rates in viral culture studies were detected in the lungs (9/15, 60%), trachea (2/4, 50%), oropharynx (1/4, 25%), and perioral (1/4, 25%) at a maximum PMI range of 17 days. The SARS-CoV-2 persists in the human body months after death and should be infectious for weeks. This data should be helpful for postmortem COVID-19 management and viral transmission preventive strategy.

A Year of Deaths Due to or With COVID-19 Under Universal Postmortem Testing in San Francisco

“…This concern, voiced by representatives of these groups, was the genesis of the universal decedent testing mandate in San Francisco. We believe that our data add to the literature on the low likelihood of transmission to persons handling decedents under recommended precautions 21–31 . During our peak COVID-19 mortality period, at most 1 in 35 decedents had otherwise undocumented COVID-19 infection.…”

“…We believe that our data add to the literature on the low likelihood of transmission to persons handling decedents under recommended precautions. [21][22][23][24][25][26][27][28][29][30][31] During our peak COVID-19 mortality period, at most 1 in 35 decedents had otherwise undocumented COVID-19 infection. We further believe that it unlikely that any delay in postmortem testing would have missed additional cases.…”

“…Our average time from death to specimen collection was less than 1 day for the DTU and less than 3 days for the OCME, with an outlier of 53 days. Multiple studies and a systematic review place the detection time out to 29 days or more but viable virus and infectivity are low 28–31 . Case reports extend the detection of COVID-19 RNA in cadavers to 4 months, although without cell culture-based evidence of infectivity 29,30 …”

Death from COVID-19 in a Fully Vaccinated Subject: A Complete Autopsy Report

“…In deaths due to the COVID-19 vaccine, it is necessary to report myocarditis, and again vaccine-induced immune thrombotic thrombocytopenia syndrome (VITT/ VIPIT), with rosary-like systemic thrombosis, especially of the encephalic and gastro-intestinal systems [ 29 , 30 , 31 , 32 ].…”

Quantification and persistence of COVID‐19 virus in recently deceased individuals before and after embalming

“…While infectivity and persistence of COVID‐19 virus in fresh samples extracted from postmortem tissues has been shown even up to 230 days (Aquila et al, 2021; Plenzig et al, 2021; Putra et al, 2022; Stein et al, 2022) the possibility that embalming might eliminate or reduce this effect is still under investigation.…”