Although many clinical reports have been published, little is known about the pathological post-mortem findings from people who have died of the novel coronavirus disease. The need for postmortem information is urgent to improve patient management of mild and severe illness, and treatment strategies. The present systematic review was carried out according to the Preferred Reporting Items for Systematic Review (PRISMA) standards. A systematic literature search and a critical review of the collected studies were conducted. An electronic search of PubMed, Science Direct Scopus, Google Scholar, and Excerpta Medica Database (EMBASE) from database inception to June 2020 was performed. We found 28 scientific papers; the total amount of cases is 341. The major histological feature in the lung is diffuse alveolar damage with hyaline membrane formation, alongside microthrombi in small pulmonary vessels. It appears that there is a high incidence of deep vein thrombosis and pulmonary embolism among COVID-19 decedents, suggesting endothelial involvement, but more studies are needed. A uniform COVID-19 post-mortem diagnostic protocol has not yet been developed. In a time in which international collaboration is essential, standardized diagnostic criteria are fundamental requirements.

/pdf/autopsy-findings-in-covid-19-related-deaths-a-literature-l45uf3edrp.pdf

Autopsy findings in COVID-19-related deaths: a literature review

The pandemic of COVID-19 caused by 2019-nCoV outbreaks in most of the countries, has subsequently spread rapidly and become a pandemic worldwide. Due to the strong infectivity of COVID-19 and lack of experience of performing an autopsy in infectious disease-induced death, the pandemic created some challenges for forensic practitioners. In this article, we summarize the experience of how we handle the confirmed or suspected infectious cases and give some perspectives for the future.

Perspectives on the death investigation during the COVID-19 pandemic

Persistence of SARS-CoV-2 RNA in post-mortem swab 35 days after death: A case report.

Modern technologies enable the exchange of information about the expansion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the continually increasing number of the coronavirus disease 2019 (COVID-19) cases almost in real time. The gravity of a current epidemiological situation is represented by the mortality rates, which are scrupulously updated daily. Performing autopsies on patients with either suspected or confirmed COVID-19 is of high importance since these might not only improve clinical management but also reduce the risk of SARS-CoV-2 infection expansion. The following paper aimed to present the most crucial aspects of SARS-CoV-2 infection from the point of view of forensic experts and pathologists, recommendations and safety precautions regarding autopsies, autopsy room requirements, possible techniques, examinations used for effective viral detection, recommendations regarding burials, and gross and microscopic pathological findings of the deceased who died due to SARS-CoV-2 infection. Autopsies remain the gold standard for determining the cause of death. Therefore, it would be beneficial to perform autopsies on patients with both suspected and confirmed COVID-19, especially those with coexisting comorbidities.

/pdf/covid-19-in-the-autopsy-room-requirements-safety-4qca56dxs2.pdf

COVID-19 in the autopsy room-requirements, safety, recommendations and pathological findings.

Postmortem studies are crucial for providing insight into emergent diseases However, a complete autopsy is frequently not feasible in highly transmissible diseases due to biohazard challenges Minimally invasive autopsy (MIA) is a needle-based approach aimed at collecting samples of key organs without opening the body, which may be a valid alternative in these cases We aimed to: (a) provide biosafety guidelines for conducting MIAs in COVID-19 cases, (b) compare the performance of MIA versus complete autopsy, and (c) evaluate the safety of the procedure Between October and December 2020, MIAs were conducted in six deceased patients with PCR-confirmed COVID-19, in a basic autopsy room, with reinforced personal protective equipment Samples from the lungs and key organs were successfully obtained in all cases A complete autopsy was performed on the same body immediately after the MIA The diagnoses of the MIA matched those of the complete autopsy In four patients, COVID-19 was the main cause of death, being responsible for the different stages of diffuse alveolar damage No COVID-19 infection was detected in the personnel performing the MIAs or complete autopsies In conclusion, MIA might be a feasible, adequate and safe alternative for cause of death investigation in COVID-19 cases

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

Autopsy is of great significance for elucidating the pathological changes, pathogenesis and cause of death of Coronavirus Disease 2019 (COVID-19) and can provide a theoretical basis for scientific and accurate prevention and control of its outbreak. Based on related laws and regulations, such as the Law of the People's Republic of China on Prevention and Control of Infectious Diseases, clinical manifestations and epidemiological characteristics of COVID-19 and guidelines on the prevention and control of this epidemic, combined with the practical work of forensic pathology examinations, we developed the Guide to Forensic Pathology Practice for Death Cases Related to Coronavirus Disease 2019 (COVID-19) (Trial Draft). This guide describes the background investigation of the death cases, autopsy room requirements, personal prevention and protections, external examinations, autopsy practices and auxiliary examinations, and thus offers a reference for forensic and pathological examination institutions and staff.

Guide to forensic pathology practice for death cases related to coronavirus disease 2019 (COVID-19) (Trial draft)‡

Autopsy is of great significance to the elucidation of the pathological changes, pathogenesis and cause of death of corona virus disease 2019 (COVID-19) and can provide theoretical basis for more scientific and accurate prevention and control of the outbreak. Based on related laws and regulations, such as Law of the People’s Republic of China on Prevention and Control of Infectious Diseases, the clinical manifestations and epidemiological characteristics of COVID-19, and the related guidelines on the prevention and control of the outbreak, combined with the practical work of forensic pathology examination, the Guide to the Forensic Pathology Practice on Death Cases Related to Corona Virus Disease 2019 (COVID-19) (Trial Draft) has been developed. This guide includes information on the background investigation of the cases, autopsy room requirements, personal prevention and protections, external examinations, autopsy, auxiliary examinations, and so on. This guide can be used as a reference by forensic and pathological examination institutions, as well as examination staff.

Key words: 
forensic pathology; autopsy; SARS-CoV-2; corona virus disease 2019 (COVID-19); guide

Guide to the Forensic Pathology Practice on Death Cases Related to Corona Virus Disease 2019 （COVID-19） （Trial Draft）

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Guide to forensic pathology practice for death cases related to coronavirus disease 2019 (COVID-19) (Trial draft)‡

Guide to the Forensic Pathology Practice on Death Cases Related to Corona Virus Disease 2019 （COVID-19）（Trial Draft）

Bin Luo

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Papers

Guide to forensic pathology practice for death cases related to coronavirus disease 2019 (COVID-19) (Trial draft)‡

Guide to the Forensic Pathology Practice on Death Cases Related to Corona Virus Disease 2019 （COVID-19） （Trial Draft）

Guide to the Forensic Pathology Practice on Death Cases Related to Corona Virus Disease 2019 （COVID-19）（Trial Draft）