[The first COVID-19 hotspot in a retirement home in Hamburg]. / Der erste COVID-19-Hotspot in einer Hamburger Senioreneinrichtung: Präventionskonzept, Letalität und Obduktionsbefunde.

Background: Coronavirus disease 2019 (COVID-19), a disease caused by the new coronavirus (SARS-CoV-2), is a particular threat to old people. At the end of March 2020, the first and so far largest outbreak of the disease occurred in a retirement home in Hamburg. Methods: Analysis of procedures in dealing with a residential unit affected by SARS-CoV­2, accommodating a risk group of 60 seniors with dementia is presented as well as a detailed presentation of post-mortem examination results of all 8 deceased tested positive for SARS-CoV­2. Results: Out of 60 residents, 39 were infected by SARS-CoV­2. Due to preventive procedures it was possible to stop further spreading of the infection to other residential areas. In all 8 fatal cases, the autopsy diagnosis was death due to COVID-19. Autopsies revealed all COVID-19 patients to have a fatal (broncho)pneumonia and signs of relevant pre-existing cardiac, renal and pulmonary conditions in all cases. In 75% (n = 6) of the cases a fresh venous thrombosis was found. In 66.7% (n = 4) of the cases thrombotic events were combined with peripheral pulmonary artery thromboembolisms. Conclusion: The cohort of SARS-CoV­2 infected residents of a nursing home is characteristic for clinical and epidemiological features of the new coronavirus disease. Due to a centralized evaluation of all fatalities at the Institute of Legal Medicine in Hamburg, a detailed examination of all deceased positive for SARS-CoV­2 was possible. Thereby, increased case fatality rates of approximately 20% could in all cases be assigned to a relevant number of pre-existing comorbidities of multiple organ systems, which was consistent with the clinical data available.

[SARS-CoV-2-associated deaths in adult persons up to 50 years of age]. / SARS-CoV-2-assoziierte Todesfälle von erwachsenen Personen bis 50 Jahre: Eine retrospektive Auswertung der COVID-19-assoziierten Todesfälle im Jahr 2020 im Institut für Rechtsmedizin Hamburg, Deutschland.

INTRODUCTION: Several evaluations of deaths in persons of advanced age associated with SARS-CoV­2 can be found in the international literature. The aim of this work was the evaluation of deaths associated with SARS-CoV­2 of persons of younger or middle age (up to 50 years) at the Institute of Legal Medicine in Hamburg, Germany, with presentation of frequency, comorbidities and disease courses. MATERIAL AND METHODS: A total of 735 SARS-CoV-2-associated cases of decedents with registered addresses in Hamburg were evaluated in 2020 at the Institute of Legal Medicine in Hamburg, Germany, using various examination methods. The selection and performance of the respective methods was based on the consent given by the relatives. In addition, more autopsies of decedents with a registered address outside Hamburg and positive SARS-CoV­2 detection were performed. RESULTS AND CONCLUSION: Of the 735 decedents 9 with a registered Hamburg address and 3 of the deaths studied with an external registered address (n = 12; 7 men and 5 women) were aged 50 years or younger, with an average age of 39.8 years. Essentially, there were cardiovascular, neurological, and malignant pre-existing diseases, as well as obesity. The SARS-CoV­2 was detected post-mortem for the first time in two cases; these were found to have a virus-independent cause of death. Of the individuals 7 died from COVID-19 pneumonia, 3 individuals from the consequences of the necessary intensive medical treatment.Several studies have demonstrated an association between obesity and severe SARS-CoV-2-related disease progression, particularly in younger patients and this was confirmed in the legal medicine study population.

COVID-19 lungs in post-mortem computed tomography.

Post-mortem computed tomography (PMCT) is a rapid and noninvasive diagnostic tool for important contributions to the identification of pulmonary findings in the deceased with pneumonia, including cases of coronavirus disease 2019 (COVID-19). Although computed tomography (CT) shows a high sensitivity for pneumonia in living persons, it is relatively unspecific for COVID-19 pneumonia clinically. Typical CT findings for viral pneumonia therefore require confirmation by PCR tests (polymerase chain reaction tests), even if lung infections with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) show characteristic patterns, most frequently ground glass opacities (GGO) and a combination of GGO and air space consolidations. In the consecutive autopsy series of SARS-CoV­2 deaths from Hamburg, Germany, the most frequent cause of death was and still is COVID-19 pneumonia. Typical findings were frequently found in the PMCT in SARS-CoV-2-associated deaths, which were taken into account when classifying the death as COVID-19.

[Postmortem imaging of the lung in cases of COVID-19 deaths]. / Postmortale Bildgebung der Lunge bei COVID-19-Todesfällen.

CLINICAL/METHODOLOGICAL ISSUE: COVID-19 is a new viral disease that is associated with inflammatory pulmonary changes which can be detected in computed tomography (CT). So far postmortem CT (PMCT) has not been used as a screening instrument for the evaluation of deaths with and without autopsy. In this respect, its validity has to be proved in comparison to clinical-radiological experiences. STANDARD RADIOLOGICAL METHODS: Postmortem CT METHODICAL INNOVATIONS: So far, PMCT can be regarded as a methodological innovation that has not yet been sufficiently evaluated for pneumonia. PERFORMANCE: CT in clinical routine has a high sensitivity for pneumonia. However, to what extent postmortem artifacts are relevant to PMCT still has to be determined. ACHIEVEMENTS: There is still no standard procedure for the postmortem radiological diagnosis of COVID-19 disease. Despite postmortem artifacts, PMCT can provide valuable information about the presence of pneumonia with interstitial character, especially without autopsy. PRACTICAL RECOMMENDATIONS: PMCT is particularly useful in the assessment of suspected cases of COVID-19 pneumonia for morphological assessment in the context of monitoring deaths in the current pandemic situation.

Evidence for systematic autopsies in COVID-19 positive deceased: Case report of the first German investigated COVID-19 death.

Forensic medicine and pathology involve specific health risks, whereby health workers are dealing with microorganisms, cells or parasites, which are referred to as biological agents. Biological agents are divided into four categories according to § 3 of the Biological Agents Ordinance. The newly identified coronavirus, severe acute respiratory syndrome, coronavirus 2 (SARS-CoV-2) that has spread rapidly around the world is placed into category 3 of the Biological Agents Ordinance, meaning pathogens that can cause serious illnesses in humans and may pose a risk to workers. The Robert Koch Institute, the German government's central scientific institution in the field of biomedicine issued the announcement, that aerosol-producing measures (including autopsies) of SARS-CoV­2 infected bodies should be avoided, despite the fact that autopsies are an important source of understanding the pathomorphological course of new diseases. The first German case of death due to a proven SARS-CoV­2 infection is presented with global multifocal reticular consolidation in the post-mortem computed tomography (CT) scan, a macroscopic and microscopic viral pneumonia and viral RNA of SARS-CoV­2 in pharyngeal mucosa and lung tissue.