Safe autopsy procedures for COVID-19: Experience of one research center

In the early days of the 2019 coronavirus disease (COVID-19) pandemic, there were few published guidelines for safely performing autopsies of infected individuals. To limit the risk to autopsy personnel, major changes to our autopsy protocol were initiated. Between January 26, 2020 and February 28, 2022, the Arizona Study of Aging and Neurodegenerative Disorders and its Brain and Body Donation Program performed autopsies on 162 subjects; of these, 36 tested positive for SARS-CoV-2 on FDA-certified PCR tests; 2 were undiagnosed. A key protocol change was the use a heavy-duty clear polyethylene bag sealed at the subject's neck and saw handle for containment of bone saw-generated aerosols during skullcap removal. During this time period, there were 94 COVID-19 autopsy exposures involving 19 staff members with only 2 occurrences of a single autopsy team member testing positive for SARS-CoV-2 within 7 days of participation in a SARS-CoV-2-positive autopsy. During the same period, 9 autopsy personnel without temporal proximity to autopsy participation tested positive. This suggests that our revised protocols reduced any enhanced risk of SARS-CoV-2 infection to autopsy personnel beyond the risk within the community. Therefore, we recommend the use of our protocol for performing autopsies on subjects with health-threatening communicable conditions.