ABSTRACT
Pathology Autopsy and Mortuary Services have been front and center in the severe acute respiratory syndrome coronavirus 2 (SARS-Co-V-2) pandemic. The sheer number of fatalities from the pandemic have been unlike any other in recent memory and needed the rapid creation of new protocols and paradigms to manage the situation. This required rapidly escalating mortuary capacity to manage the increased fatalities from the pandemic with the establishment of lines of communication and networking with governmental entities, institution of new policies for patient flow, and implementation of worker infection control and well-being plans. Autopsies also assumed a crucial role, both to provide insight into the pathomechanisms of a novel disease and to allow tissue retrieval necessary to power research directed towards finding a vaccine. We here outline the plan adopted by the Yale Autopsy and Mortuary Services, in alignment with the institutional mission of high-quality patient care, education, research and health care worker safety and well-being, as the Corona Virus Disease of 2019 (COVID-19) pandemic surged in Connecticut. In the early response phase, ensuring sufficient mortuary capacity necessarily took center stage. As we enter the recovery and plateau phase of the pandemic, setting up a process for a rapid and safe autopsy, that will meet educational and research needs while ensuring the safety of our workforce is being implemented.
Subject(s)
Autopsy/methods , Coronavirus Infections , Emergencies , Mortuary Practice/methods , Pandemics , Pathology, Clinical/methods , Pneumonia, Viral , Autopsy/standards , Betacoronavirus , COVID-19 , Humans , Mortuary Practice/standards , Occupational Exposure/prevention & control , Occupational Health/standards , Pathology, Clinical/standards , Public Health/methods , Public Health/standards , SARS-CoV-2ABSTRACT
INTRODUCTION: Countries around the world are confronted with a rising count of patients that die from COVID-19. Up to this date, there is no scientific evidence that proves that a COVID-19 corpse is still infectious. Different guidelines are being followed worldwide on how to deal with a COVID-19 positive corpse. The aim of this review is to compare different guidelines and literature on best practice for handling a COVID-19 positive corpse. RESULTS: The guidelines vary greatly in the use of PPE's and other safety measures especially during autopsy. There is great variation in the use of disinfectant and its concentration. Also recommended funeral services and contact with relatives vary greatly. CONCLUSION: In conclusion, there is very limited scientific evidence on which the researched guidelines are based. It is unclear why some guidelines propose a "business as usual" attitude and others a "code-red" attitude. More scientific evidence is needed to substantiate the handling of COVID-19 positive corpses to make an educated decision on how to safely handle a COVID-19 positive corpse.
Subject(s)
Autopsy , Betacoronavirus , Cadaver , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic/standards , Autopsy/methods , Autopsy/standards , Autopsy/trends , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , COVID-19 , Coronavirus Infections/transmission , Disinfectants/administration & dosage , Disinfection/methods , Disinfection/standards , Funeral Rites , Humans , Morgue/standards , Mortuary Practice/methods , Mortuary Practice/standards , Mortuary Practice/trends , Personal Protective Equipment/standards , Personal Protective Equipment/trends , Pneumonia, Viral/transmission , SARS-CoV-2Subject(s)
Anatomy/education , Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Education, Medical/organization & administration , Mortuary Practice/standards , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , COVID-19 , Cadaver , Computer-Assisted Instruction/methods , Computer-Assisted Instruction/trends , Coronavirus Infections/transmission , Dissection/statistics & numerical data , Education, Distance/methods , Education, Distance/organization & administration , Education, Distance/trends , Education, Medical/methods , Education, Medical/statistics & numerical data , Education, Medical/trends , Humans , India/epidemiology , Mortuary Practice/legislation & jurisprudence , Mortuary Practice/trends , Pneumonia, Viral/transmission , SARS-CoV-2 , Schools, Medical/organization & administration , Schools, Medical/supply & distribution , Schools, Medical/trends , Tissue and Organ Procurement/legislation & jurisprudence , Tissue and Organ Procurement/organization & administration , Tissue and Organ Procurement/standards , Video RecordingABSTRACT
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.