The forensic pathologist's public health role

While historically some have viewed the work of medical examiners/coroners (ME/C) and death investigators as predominantly serving the criminal justice system, in fact, the act of certifying a death is—in and of itself—a public health endeavor. The purpose of the death certificate is to track how and why individuals die as a means of helping others survive. Death certificates do save lives. In addition to generating these vital statistics, which guide public health policy, ME/C also perform a public health service in a variety of other ways. For instance, autopsy pathologists report unsafe consumer products, warn of recreational hazards (e.g., the dangers of snowmobile or all-terrain vehicle use), publicize and report occupational hazards (e.g., falls and electrocution risks), identify toxic exposures (e.g., carbon monoxide from defective heating units), and evaluate the safety of medical therapies. At autopsy, ME/C perform infectious disease surveillance, diagnosing and reporting communicable diseases such as bacterial meningitis, tuberculosis, and Legionella, thereby helping to mitigate disease spread in the community. They identify and characterize emerging infectious threats, such as COVID-19. They track violent deaths, including homicides, suicides, accidents, child and domestic abuse deaths, maternal mortality, and overdose deaths—to name a few—and participate as members of death review teams that attempt to identify systemic issues and prevent further such deaths. © 2023 Elsevier Inc. All rights reserved.

Pandemic Autopsy Biosafety Considerations

At autopsy, prosectors have always risked exposure to a wide array of infectious agents. With the recent advent of the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic, such exposure concerns have increased dramatically. Careful assessment of facility infrastructure and appropriate biosafety training, however, can minimize risks and allow for safe autopsy performance. As with other disease outbreaks, the living have much to learn from the dead. To date, autopsy studies have been critical in elucidating the mechanisms by which COVID-19 (coronavirus disease 2019) may critically compromise not only pulmonary but also cerebral, cardiac, and renal function. Much remains unknown, though, and further tissue-based research is called for. The following review is intended to detail best practices and principles for autopsy biosafety, with a focus on issues specific to the current pandemic. Copyright © Wolters Kluwer Health, Inc. All rights reserved.

SARS-CoV-2-Associated Myocarditis at Autopsy

The COVID-19 pandemic has been a major cause of mortality worldwide. While respiratory pathology seems to be the major mechanism of disease, cardiovascular pathology has increasingly been reported to play a role in adverse outcomes. A variety of different cardiovascular histopathologies have been reported at postmortem examination including myocarditis. Because of limited autopsy numbers and lack of standardized reporting of such cases, however, the prevalence of COVID-19 (2019 coronavirus disease)-associated myocarditis is unknown. The current autopsy case report illustrates how COVID-19 pulmonary pathology can be accompanied by right ventricular myocarditis. The discussion reviews the pathophysiology of myocarditis, as well as diagnostic strategies, adding to the growing body of literature describing myocarditis in association with COVID-19 disease.