Coronial postmortem reports and indirect COVID-19 pandemic-related mortality

Area of Science:

• Public Health
• Forensic Pathology
• Epidemiology

Background:

• The first COVID-19 lockdown (March-May 2020) caused significant healthcare disruption and excess mortality.
• Non-COVID-19 deaths and indirect mortality impacts require thorough investigation beyond death certification.

Purpose of the Study:

• To analyze coroners' autopsy reports before and during the initial COVID-19 lockdown in the UK.
• To assess the role of delayed healthcare access and behavioral changes in excess mortality during the pandemic.

Main Methods:

• A multicentre review of non-forensic coroners' autopsies from 2018 and 2020.
• Categorization of deaths into natural non-COVID-19, COVID-19-related, and non-natural causes.
• Evaluation of lockdown's potential contribution to mortality.

Main Results:

• A significant increase in deaths where delayed medical care was a contributing factor (10 in 2018 vs. 44 in 2020).
• COVID-19 was directly attributed in only 9% of 2020 autopsies.
• Lockdown contributed to 24% of suicides and 12% of drug/alcohol-related deaths.

Conclusions:

• Coroners' autopsy reports are crucial for understanding excess mortality from pandemic-related healthcare disruption.
• Individual case-level data from autopsies offer insights not found in death certification.
• Enhanced evaluation of autopsy reports and maintained healthcare access are vital for future pandemic preparedness.