Vision of the causes of death by COVID-19 with the experiences of autopsies

On January 30, 2020, the World Health Organization (WHO) declared SARS-CoV-2 infection an international public health emergency. The autopsy, considered the best method of studying the patient and the disease, corroborates that patients can die from the direct action of the virus (who died from COVID-19), while others positive for SARS-CoV-2 did not show morphological lung changes attributed to the action of the virus. It is proposed to establish the morphological diagnostic criteria in the context of the SARS-CoV-2 and COVID-19 epidemic in the deceased in Cuba based on the systematic study of autopsies. The morphological patterns that are established in the lungs of patients who died under the effect of COVID-19 have been identified. The pulmonary edema of permeability with the widening of the pulmonary septum, the deposit of the disorganized hyaline membrane inside the alveoli, the detachment of epithelial cells (pneumocytes and bronchial and bronchiolar cells), followed by epithelial hyperplasia with sometimes the presence of metaplastic changes and atypia, and finally, fibrosis. When autopsies are performed, it is possible to locate each disease in its place, in chronopathogram, which allows death certificates repair to be carried out to assess the place that COVID-19 has occupied as a cause of death in the population studied. In the opinion of the group, identifying morphological alterations is essential to prepare the chronopathogram of the deceased and the adequate clinical-pathological evaluation of the patient. © 2022, Editorial Ciencias Medicas. All rights reserved.

Autopsy experiences of deceased by COVID-19

Introduction: A case of a patient who died from COVID-19 is presented, which the authors consider to be the prototype of most of those who died from this condition, which was performed at autopsy. Objective: Disseminate the experiences in the study of the autopsy of this type of patients and contribute to its application in clinical and scientific practice. Clinical case: A 78-year-old male patient is presented, with arterial hypertension, diabetes mellitus and obesity, who began with cough, fever, runny nose, who was admitted with a diagnosis of COVID-19, progressed to severity and died 10 days later. of his admittance. The fundamental elements of the clinical history, the diagnoses of causes of death pre-mortem and post-mortem are presented. Autopsy diagnoses and quality assessment results of clinical cause of death diagnoses are specified. Conclusions: The experiences of the study of this autopsy as a prototype, reaffirm the damage caused by SARS-CoV-2 and contribute to the knowledge of this field. © 2022, Editorial Ciencias Medicas. All rights reserved.

Autopsy and medical death certificates in deaths related to COVID-19

Introduction: The COVID-19 pandemic has been the largest in the current century and the reason for numerous scientific works. In Cuba, the Temporary Group of Pathological Anatomy has been established to study the autopsies of those who died from COVID-19 (more than 400). The medical death certificates, documents of inestimable value, in Cuba are repaired according to the results of the autopsies, to raise their quality. Objectives: To evaluate the results of autopsies with COVID-19 diagnoses, compared to medical death certificates. Methods: The diagnoses of causes of death of 65 autopsies of the year 2020 were evaluated with their medical death certificates. The diagnoses were processed in the Automated System for the Registration and Control of Pathology. Direct causes of death, basic causes of death, intermediate causes of death, and contributing causes of death were analyzed. The total agreement of both diagnoses was defined, partial agreement, diagnostic mismatch or discrepancy, and insufficient data. Results: Diagnostic discrepancies of basic and direct cause of death are 46.2 % and 60.0 % of all cases and 19.4 % and 64.5 % when COVID-19 was basic cause of death. The high figures for diagnostic discrepancies correspond to those reported in previous studies, both in clinical diagnoses and in medical death certificates. Conclusions: There are high numbers of diagnostic discrepancies compared with the results of autopsies with COVID-19 diagnoses, compared to medical death certificates. © 2021, Editorial Ciencias Medicas. All rights reserved.