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COVID-19 Autopsy in India: Protocols, Procedures, and Experiences
Jayanthi Yadav1, Brinda Patel1, Mahaluxmi S1
1Forensic Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND.
Insights
Conducting autopsies for COVID-19 cases is vital for understanding disease progression. This study outlines essential protocols for safe and effective post-mortem examinations, even in resource-limited settings, ensuring the safety of the autopsy team.
Area of Science:
- Pathology
- Infectious Diseases
- Public Health
Background:
- Coronavirus disease 2019 (COVID-19) presents a global health crisis, necessitating autopsy studies for understanding its pathophysiology.
- Autopsy data is crucial for disease comprehension, yet such studies are scarce, particularly in developing nations.
- Conducting autopsies on infectious cases requires specialized infrastructure and stringent safety protocols.
Purpose of the Study:
- To conduct a complete pathological autopsy on a COVID-19 patient to identify histopathological changes.
- To correlate autopsy findings with clinical data, including hospitalization duration, mechanical ventilation, comorbidities, and biochemical parameters.
- To establish protocols for safe and effective autopsies in infectious cases, especially in resource-limited settings.
Main Methods:
- A complete pathological autopsy was performed on a COVID-19 patient following institutional ethical approval and family consent.
- Histopathological examination (HPE) and real-time polymerase chain reaction (RT-PCR) were conducted on collected tissues.
- Clinical and biomedical data were collected and correlated with autopsy findings.
Main Results:
- Consent was a limiting factor, obtained in only 15.3% of cases.
- Gross findings indicated viral infection and comorbidities across all organs.
- Developed and implemented protocols enabled successful completion of autopsies with good sample collection, ensuring no infection spread to the autopsy team.
Conclusions:
- Experience from 21 COVID-19 autopsies provides insights into minimal requirements for infectious case autopsies.
- Guidelines are proposed for conducting autopsies in challenging conditions, particularly relevant for developing countries.
- Successful execution of autopsies in infectious cases is achievable with appropriate protocols and precautions.
Background:
Coronavirus disease 2019 (COVID-19) has besieged mankind because of its novelty, causing a global health crisis. The autopsy-based studies provide a crucial role in understanding the pathophysiology and the behavior of the disease. But there is a paucity of such studies in the world especially so from developing nations. Conducting a complete autopsy on infectious bodies like COVID-19 requires conducive infrastructural setup and protocols suited to the needs, and precautions are to be taken meticulously.
Methods:
A complete pathological autopsy was conducted on a known case of a COVID-19-hospitalized patient, who died in our institution, with the aim to look for histopathological changes in each organ and to compare these findings with clinical findings such as duration of hospitalization, mechanical ventilation, comorbidities, biochemical parameters, and the result of real-time polymerase chain reaction (RT-PCR) of the tissues. The complete autopsy was performed after obtaining consent from the family, and the study was approved by the Institutional Ethics Committee. Histopathological examination (HPE) and RT-PCR were conducted on the tissue collected during autopsy. Clinical and biomedical data were collected and correlated.
Result:
The written informed consent from the family could be obtained in only 15.3% of cases, which was a limiting factor. The post-mortem interval ranged from 3.5 to 19.5 hours. The gross findings revealed pathologic features of viral infection as well as existing comorbidities in all the organs. The development of protocols and new innovations to limit the spread of infection, taking into consideration the limited facilities, which are described in this article, resulted in the successful completion of all the autopsies with a good sample collection, and nobody in the autopsy team was tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
Conclusions:
The experience gained from these 21 COVID-19 autopsies helps to outline the basic or minimal requirements for conducting autopsies in highly infectious cases even in not-so-ideal conditions and also provides guidelines to be used while conducting such autopsies, especially in developing countries.
