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Related Experiment Video

Updated: Oct 5, 2025

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SARS-CoV-2 viral load and replication in postmortem examinations.

Simone Grassi1, Vincenzo Arena2, Paola Cattani3

  • 1Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy. simone.grassi@unicatt.it.

International Journal of Legal Medicine
|January 24, 2022
PubMed
Summary

Autopsy SARS-CoV-2 RNA was detected in hospitalized and non-hospitalized cases. Non-hospitalized cases showed higher viral loads, emphasizing strict biosafety protocols during autopsies of infected individuals.

Keywords:
COVID-19Clinical autopsyForensic autopsySARS-CoV-2Viral loadViral replication

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Area of Science:

  • Forensic Pathology
  • Virology
  • Infectious Diseases

Background:

  • Postmortem detection of SARS-CoV-2 RNA is crucial for understanding viral persistence.
  • Hospitalization status may influence viral load and replication indicators in deceased individuals.

Purpose of the Study:

  • To investigate SARS-CoV-2 RNA levels and replication in autopsy samples from hospitalized and non-hospitalized cases.
  • To assess the correlation between hospitalization, viral load, and active viral replication.

Main Methods:

  • Analysis of 29 autopsy cases with postmortem SARS-CoV-2 positive swabs.
  • Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for total and replicative SARS-CoV-2 RNA.
  • Comparison of viral loads and replication indicators between hospitalized (H) and non-hospitalized (NH) groups.

Main Results:

  • Higher mean viral load (2.53 × 10^11 copies/mL) observed in NH cases compared to H cases (9.31 × 10^8 copies/mL).
  • Active SARS-CoV-2 replication indicators found in 13/29 cases (6 NH, 7 H).
  • Statistically significant association between replicative mRNA and death without hospitalization (P=0.013).

Conclusions:

  • Non-hospitalized individuals may harbor higher SARS-CoV-2 viral loads postmortem.
  • Active viral replication can occur in deceased individuals, irrespective of hospitalization status.
  • Stringent biological safety measures are imperative during autopsies of SARS-CoV-2 infected cases, particularly for non-hospitalized individuals.