Practical aspects of COVID-19 autopsies

Background. The COVID-19 pandemic represents a so far unknown challenge for the medical community. Autopsies are important for studying this disease, but their safety was challenged at the beginning of the pandemic. Objectives. To determine whether COVID-19 autopsies can be performed under existing legal conditions and which safety standards are required. Materials and methods. The autopsy procedure undertaken in five institutions in Germany, Austria, and Switzerland is detailed with respect to legal and safety standards. Results. In all institutions the autopsies were performed in technically feasible rooms. The personal equipment consisted of functional clothing including a disposable gown and apron, a surgical cap, eye protection, FFP-3 masks, and two pairs of gloves. In four institutions, complete autopsies were performed; in one institution the ultrasound-guided biopsy within the postmortal imaging and biopsy program. The latter does not allow the appreciation of gross organ pathology; however, it is able to retrieve standardized biopsies for diagnostic and research purposes. Several scientific articles in highly ranked journals resulted from these autopsies and allowed deep insights into organ damage and conclusions to better understand the pathomechanisms. Viral RNA was frequently detectable in the COVID-19 deceased, but the issue of infectivity remains unresolved and it is questionable if Ct values are greater than 30. Conclusions. With appropriate safeguards, autopsies of people who have died from COVID-19 can be performed safely and are highly relevant to medical research.

Automated summary

This study demonstrates that with appropriate safeguards, autopsies of people who have died from COVID-19 can be performed safely and are highly relevant to medical research. Insights into organ damage and conclusions to better understand the pathomechanisms have been made through these autopsies. However, the issue of infectivity in COVID-19 deceased individuals remains unresolved.