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Retrospective Post-mortem SARS-CoV-2 RT-PCR of Autopsies with COVID-19-Suggestive Pathology Supports the Absence of
Jasmin Dionne Haslbauer1, Valeria Perrina1, Matthias Matter1
1Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland.
Insights
This study found no evidence of early lethal COVID-19 spread in Basel, Switzerland, before March 2020. Analysis of deaths and autopsy results did not detect SARS-CoV-2, suggesting community transmission began later.
Area of Science:
- Epidemiology
- Infectious Diseases
- Public Health
Background:
- The global spread of COVID-19 (Coronavirus Disease 2019) caused by SARS-CoV-2 raises questions about its earliest introduction into new regions.
- The potential for early, undetected community transmission of SARS-CoV-2 before official reports is a significant concern, particularly in Europe.
Purpose of the Study:
- To investigate the potential for early lethal community spread of COVID-19 in Basel, Switzerland, prior to its officially reported emergence.
- To analyze mortality data and histopathological findings for evidence of SARS-CoV-2 infection in late 2019 and early 2020.
Main Methods:
- Retrospective analysis of deaths (n=310) at University Hospital Basel from October 2019 to February 2020, compared with March 2020 (n=72).
- Evaluation of clinical causes of death, focusing on COVID-19-suggestive sequelae like bronchopneumonia, ARDS, and PE.
- SARS-CoV-2 RT-PCR testing on autopsy cases (n=71) with suggestive clinical history and histopathology.
Main Results:
- A statistically significant increase in pulmonary deaths was observed in March 2020, aligning with reported COVID-19 emergence.
- Lethal bronchopneumonia showed a seasonal increase from December 2019 to January 2020.
- Incidence of lethal ARDS and PE remained low, and all autopsy cases tested negative for SARS-CoV-2.
Conclusions:
- The study's findings suggest that lethal community transmission of COVID-19 was absent in Basel before March 2020.
- No evidence supports early SARS-CoV-2 spread in Switzerland prior to the officially recognized outbreak.
Introduction:
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread around the world. While the first case was recorded in Hubei in December 2019, the extent of early community spread in Central Europe before this period is unknown. A high proportion of asymptomatic cases and undocumented infections, high transmissibility, and phylogenetic genomic diversity have engendered the controversial possibility of early international community spread of SARS-CoV-2 before its emergence in China.
Methods:
To assess the early presence of lethal COVID-19 in Switzerland, we retrospectively performed an analysis of deaths at University Hospital Basel between October 2019 and February 2020 (n = 310), comparing the incidence of clinical causes of death with March 2020 (n = 72), the month during which the first lethal COVID-19 cases in Basel were reported. Trends of COVID-19-suggestive sequelae, such as bronchopneumonia with organization, acute respiratory distress syndrome (ARDS), or pulmonary embolisms (PE) were evaluated. In cases where autopsy was performed (n = 71), analogous analyses were conducted on the cause of death and pulmonary histological findings. Eight cases with a COVID-19-suggestive clinical history and histopathology between October 2019 and February 2020, and 3 cases before October 2019, were selected for SARS-CoV-2 RT-PCR.
Results:
A statistically significant rise in pulmonary causes of death was observed in March 2020 (p = 0.03), consistent with the reported emergence of lethal COVID-19 in Switzerland. A rise in lethal bronchopneumonia was observed between December 2019 and January 2020, which was likely seasonal. The incidence of lethal ARDS and PE was uniformly low between October 2019 and February 2020. All autopsy cases analyzed by means of SARS-CoV-2 RT-PCR yielded negative results.
Conclusion:
Our data suggest the absence of early lethal community spread of COVID-19 in Basel before its initial reported emergence in Switzerland in March 2020.
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