New Mexico's COVID-19 Experience.

ABSTRACT: The 2019 novel coronavirus disease (COVID-19) has spread worldwide, infiltrating, infecting, and devastating communities in all locations of varying demographics. An overwhelming majority of published literature on the pathologic findings associated with COVID-19 is either from living clinical cohorts or from autopsy findings of those who died in a medical care setting, which can confound pure disease pathology. A relatively low initial infection rate paired with a high biosafety level enabled the New Mexico Office of the Medical Investigator to conduct full autopsy examinations on suspected COVID-19-related deaths. Full autopsy examination on the first 20 severe acute respiratory syndrome coronavirus 2-positive decedents revealed that some extent of diffuse alveolar damage in every death due to COVID-19 played some role. The average decedent was middle-aged, male, American Indian, and overweight with comorbidities that included diabetes, ethanolism, and atherosclerotic and/or hypertensive cardiovascular disease. Macroscopic thrombotic events were seen in 35% of cases consisting of pulmonary thromboemboli and coronary artery thrombi. In 2 cases, severe bacterial coinfections were seen in the lungs. Those determined to die with but not of severe acute respiratory syndrome coronavirus 2 infection had unremarkable lung findings.

POSTMORTEM CT LUNG FINDINGS IN DECEDENTS WITH COVID-19: A REVIEW OF 14 DECEDENTS AND POTENTIAL TRIAGE IMPLICATIONS

ABSTRACT OBJECTIVE Computed tomography has significant utility as a diagnostic tool for coronavirus disease 2019 (COVID-19) in the clinical setting COVID-19 deaths are sometimes examined by forensic pathologists, often in the setting of an unknown diagnosis We assessed the utility of postmortem computed tomography (PMCT) for use as a triage tool for these autopsy examinations MATERIALS AND METHODS We reviewed PMCT findings in 14 and histopathology in 11 decedents who were positive for COVID-19 RESULTS The predominant imaging findings were bilateral mixed densities, in either a diffuse or peripheral distribution, with traction bronchiectasis, and/or crazy paving In particular, traction bronchiectasis, ill-defined rounded consolidations, and reverse halo sign are useful when distinguishing from other postmortem changes CONCLUSION We conclude that triage with a PMCT may aid the forensic pathologist in diagnosing possible COVID-19 infection prior to autopsy examination

COVID-19: Postmortem Diagnostic and Biosafety Considerations.

As a result of the 2019 novel human coronavirus (COVID-19) global spread, medical examiner/coroner offices will inevitably encounter increased numbers of COVID-19-infected decedents at autopsy. While in some cases a history of fever and/or respiratory distress (eg, cough or shortness of breath) may suggest the diagnosis, epidemiologic studies indicate that the majority of individuals infected with COVID-19 develop mild to no symptoms. Those dying with-but not of-COVID-19 may still be infectious, however. While multiple guidelines have been issued regarding autopsy protocol in cases of suspected COVID-19 deaths, there is some variability in the recommendations. Additionally, limited recommendations to date have been issued regarding scene investigative protocol, and there is a paucity of publications characterizing COVID-19 postmortem gross and histologic findings. A case of sudden unexpected death due to COVID-19 is presented as a means of illustrating common autopsy findings, as well as diagnostic and biosafety considerations. We also review and summarize the current COVID-19 literature in an effort to provide practical evidence-based biosafety guidance for medical examiner-coroner offices encountering COVID-19 at autopsy.