Prospective postmortem evaluation of 735 consecutive SARS-CoV-2-associated death cases.

Area of Science:

• Forensic Pathology
• Infectious Diseases
• Public Health

Background:

• The COVID-19 pandemic caused by SARS-CoV-2 has led to significant global mortality.
• Distinguishing deaths directly from COVID-19 versus those with COVID-19 is crucial for accurate mortality data.
• Limited information exists regarding the specific circumstances and causes of death in COVID-19 patients.

Purpose of the Study:

• To systematically review SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020.
• To differentiate between deaths caused by COVID-19 and non-COVID-19 deaths.
• To analyze the causes of death and patient demographics in COVID-19 fatalities.

Main Methods:

• Systematic review of 735 SARS-CoV-2-associated deaths.
• Utilized conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography, and medical records.
• Employed statistical analyses, including multiple logistic regression, for cohort comparison.

Main Results:

• 84.1% of deaths were classified as COVID-19 deaths, 6.4% as non-COVID-19, and 9.5% remained unclear.
• The median age of COVID-19 deaths was 83.0 years, with 54.4% being male.
• In autopsy cases, pneumonia and diffuse alveolar damage were common (73.6%), with thromboses (39.2%) and pulmonary embolism (22.1%) also noted.

Conclusions:

• The majority of individuals who died directly from SARS-CoV-2 infection were elderly with multiple comorbidities.
• The study underscores the importance of mortality surveillance and postmortem examinations for understanding pandemic impacts.
• Hamburg experienced a 5.5% increase in annual mortality in 2020, with COVID-19 deaths accounting for 3.4%.