First Confirmed SARS-CoV-2 Related Deceased in Ethiopia on Post-mortem Examination and the Context Confronted in Limited Forensic Pathology Centre: case report. (preprint)

ABSTRACT

A 55-year-old male was found dead in the church of Kefa Zone, Southern Nation and Nationality People Region, the local area of Ethiopia about 500 km away from the only available national forensic centre in Addis Ababa, Ethiopia. He had no medical history of comorbidity or medicine prescribed previously as well as no contact history with COVID-19 cases. Also, no travel history to Addis Ababa, which has an epicenter of COVID- 19 high burden cases, and no living individuals reported cases of COVID-19 patients in local residence of the deceased. The National COVID-19 emergency operating team already decided to do postmortem surveillance and collect nasopharyngeal or oropharyngeal swabs for SARS-CoV-2 on all the dead bodies submitted to the mortuary for postmortem examination. For this case and other cases on that day postmortem nasopharyngeal swabs collected and sent for RT-PCR COVID19. Test confirmed COVID-19 positive for this deceased one day after the body handed over to family and transported back to residence of the deceased. The external post-mortem examination revealed an emaciated middle-age adult male with rigor mortis on lower extremity and non- blanching livor mortis on the back of the body. There was no evidence of recent injury. On internal examination pleural adhesions were present on anterior and posterior aspect of left lung. The left lung extensively necrotized, collapsed and weighs about 280grams. Right lung was dark red in color, consolidated, weighs 450 grams, patchy petechial hemorrhages on the pleural surface. No viscera preserved for microbiology, virology, histopathology, or immunohistochemistry tests as these facilities are not available in our set up. With the pandemic impact of SARS-COV-2, a range of issues unfolds, also during autopsies, as we report the first Ethiopian case of fatal SARS-COV-2 pneumonia confirmed on post-mortem examination.