The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview

Abstract

During the COVID-19 pandemic, forensic sciences, on the one hand, contributed to gaining knowledge about different aspects of the pandemic, while on the other hand, forensic professionals were called on to quickly adapt their activities to respond adequately to the changes imposed by the pandemic. This review aims to clarify the state of the art in forensic medicine at the time of COVID-19, discussing the following: the influence of external factors on forensic activities, the impact of autopsy practice on COVID-19 and vice-versa, the persistence of SARS-CoV-2 RNA in post-mortem samples, forensic personnel activities during the SARS-CoV-2 pandemic, the global vaccination program and forensic sciences, forensic undergraduate education during and after the imposed COVID-19 lockdown, and the medico-legal implications in medical malpractice claims during the COVID-19 pandemic. The COVID-19 pandemic has greatly influenced different aspects of human life, and, accordingly, the practical activities of forensic sciences that are defined as multidisciplinary, involving different expertise. Indeed, the activities are very different, including crime scene investigation (CSI), external examination, autopsy, and genetic and toxicological examinations of tissues and/or biological fluids. At the same time, forensic professionals may have direct contact with subjects in life, such as in the case of abuse victims (in some cases involving children), collecting biological samples from suspects, or visiting subjects in the case of physical examinations. In this scenario, forensic professionals are called on to implement methods to prevent the SARS-CoV-2 infection risk, wearing adequate PPE, and working in environments with a reduced risk of infection. Consequently, in the pandemic era, the costs involved for forensic sciences were substantially increased.

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

“…During the autopsy, Letulle’s block was performed with subsequent organ fixation in formalin. Consistent with the studies of subjects who died from COVID-19 [ 28 , 34 ], on H&E staining, the lungs showed massive interstitial pneumonia, areas of inflammation with interstitial lympho-plasma cell infiltrate, and an interstitial edema. The liver showed granulocytes within the liver parenchyma.…”

“…Autopsies conducted on subjects who died of COVID-19 showed pulmonary embolism, diffuse alveolar damage (DAD), hyaline membranes, thromboembolism, and interstitial edema with heterogeneous inflammatory tissue. Centrilobular necrosis and moderate portal or lobular inflammation are described in the liver [ 28 ].…”

Exploring the Role of Serology Testing to Strengthen Vaccination Initiatives and Policies for COVID-19 in Asia Pacific Countries and Territories: A Discussion Paper

“…With multiple COVID-19 vaccines being introduced across the globe to a widely diverse population, people have become increasingly concerned about the risks associated with vaccines. Efforts to surveille, identify and report adverse events following immunization (AEFIs) are particularly important for preserving and restoring confidence in vaccination programs and combating vaccine hesitancy [106,107]. In this context, AEFI post-mortem investigations have been instrumental in establishing the causality relationship between vaccine administration and fatal adverse events, as well as identifying the cause of death in such cases [106][107][108].…”

“…Efforts to surveille, identify and report adverse events following immunization (AEFIs) are particularly important for preserving and restoring confidence in vaccination programs and combating vaccine hesitancy [106,107]. In this context, AEFI post-mortem investigations have been instrumental in establishing the causality relationship between vaccine administration and fatal adverse events, as well as identifying the cause of death in such cases [106][107][108]. Concerns due to the persistence of high viral loads in exhumed corpses after a long post-mortem interval in spite of appropriate burial practices [109] highlight the importance of implementing shared guidelines for the safety of handling of COVID-19-positive and potentially infectious corpses during autopsy practices [106,109,110].…”

Long Term Cell Immune Response to COVID-19 Vaccines Assessment Using a Delayed-Type Hypersensitivity (DTH) Cutaneous Test

“…Knowing the state of our immune system with traditional methods of measuring cellular and humoral immunity in a pandemic situation is complex [ 3 ], expensive, and invasive, so we need simple tools that give us an immediate response to our current needs and thus distribute the doses of vaccines to those who really need them [ 4 ]. In this brief report, we tried to assess with a simple, cheap, and easy-to-interpret test, a first step to study the immune response in vaccinated individuals 6 months after the start of the immunization scheme with 2 doses of an mRNA vaccine [ 5 ].…”