Covid19 dead: what post-mortem reveals about the virus

In fact, the dead hardly play a role in the everyday life of pathologists. Opening corpses, examining what a person suffered and died from has faded into the background. Instead, pathologists, today diagnose whether a tumor is benign or malignant, for example.

Mostly tissue that was removed during surgery. “The technique of autopsy, on the other hand, seems antiquated,” says Andreas Rosenwald, director of the Pathological Institute at the University of Wurzburg. At his institute, 50 autopsies would face 50,000 examinations on living patients in a normal year. But this year is not a normal year, and the findings from post-mortem examinations are taking on a new weight since medical professionals worldwide are trying to understand how dangerous the coronavirus really is for humans. “Apart from the symptoms treated, we still don’t know enough about what the virus actually does in the body,” says Rosenwald.

However, the Robert Koch Institute (RKI) recommended in March to avoid post-mortems. This is because pathologists and medical personnel could become infected with the coronavirus through air particles, so-called aerosols when the bodies were opened. The German Society for Pathology and the Federal Association of German Pathologists disagreed with this assessment and demanded “as many autopsies as possible from corona deceased” in order to derive therapy options from it in the best case.

The majority of the patients were very overweight, says the expert

In Switzerland, pathologists, depending on the equipment of the autopsy halls and “depending on the courage”, have so far autopsied, as Alexandar Tzankov says, head of the autopsy department at the university hospital in Basel. So far 20 people who died of COVID 19 have been autopsied there, and Tzankov already wants to recognize patterns in the diagnoses. “All those examined had high blood pressure,” says the professor, “a large proportion of the patients were also severely obese, ie clearly overweight.” And it was mainly men. More than two-thirds had previously damaged coronary arteries, a third had diabetes.

In addition to clarifying the previous illnesses, the doctors around Tzankov also examined the damage to the lung tissue of the deceased. “Few patients had pneumonia,” he says, “but what we saw under the microscope was a serious disruption to the lung’s microcirculation.” That means that the oxygen exchange no longer works, and explain the difficulties in ventilating COVID-19 patients in the intensive care units: “You can give the patient as much oxygen as you want, and he will simply not be transported any further. ” It is unclear whether the findings could have been taken into account earlier in the treatment of intensive care patients.

The RKI has now withdrawn its recommendation to avoid post-mortems. RKI Vice President Lars Schaade said on Tuesday: “The original recommendation was not to not autopsy but to limit it to the bare minimum. Of course, it is correct, especially if the disease is new, to do as much as possible under the appropriate safety precautions. ” The president of the Federal Association of German Pathologists, Karl-Friedrich Burrig, says about the withdrawn recommendation: “That was a lapsus.” His association has now asked all pathologists in a letter to perform autopsies on COVID-19 dead.

A register was also set up at the Technical University of Aachen last week to collect the results. The public is watching “with a certain curiosity, perhaps also hope for the subject”, says a letter from Aachen. Ideally, you can answer a few questions from clinical physicians through autopsy and thus contribute to dealing with the patient. But pathologist president Burrig does not expect any quick insights from the register: “A good six months will surely pass before someone summarizes the first results,” says Burrig. “Anything else would not be serious.” You don’t want to be too quick with a publication and then get criticism.

Regardless of the RKI’s recommendation and the establishment of the registry, the Hamburg legal doctor Klaus Puschel went a special way. Between March 22nd and April 11th, he autopsied 65 COVID-19 deceased at the University Medical Center Hamburg-Eppendorf. Eastern Herald Newspaper, NDR and WDR have received a report on these cases, which was sent to the Hamburg health authority last week. The professor confirmed the authenticity of the report on request but did not want to answer any questions. Only the number of autopsies in Hamburg is now more than 100 and “none without previous illness”, said Klaus Puschel. The report does not claim to be complete. No other clinic in Germany has so far examined nearly as many COVID 19 deceased.

People who do not have to be ventilated also die

The report also coincides with some of the findings from Basel. For example, that the majority of the dead had heart diseases. According to the report, 55 out of 61 of those examined in Hamburg had a “previous cardiovascular disease”, ie high blood pressure, a heart attack, arteriosclerosis or other heart weakness. 46 autopsies had previous lung disease.

28 had damage to other organs such as kidneys, liver or transplant organs. 16 were suffering from dementia, others already had cancer, severe overweight or diabetes.

To date, there are only a few systematic studies on the autopsies of COVID-19 dead worldwide. Doctors at Beijing University Hospital presented findings from 29 post-mortem tests at the end of March. They stressed that the virus not only attacked the lungs but also the immune system and other organs. In the trade magazine, Lancet Pathologists from the University of Zurich reported that the virus triggered severe vascular inflammation in various organs. They had examined two deceased and one survivor. This could explain why patients who did not have to be ventilated also died.

In Italy, the health agency published a report listing the pre-existing conditions of 1738 deceased patients. However, the report does not refer to post-mortems, but only to information from the medical records. Hypertension, diabetes and coronary artery disease were also most common there.

The much-debated question of whether the patients die with or from the virus is only being attempted by the report by the Hamburg forensic doctor Klaus Puschel. Covid-19 was noted as the cause of death in 61 of 65 deceased. In the remaining four, the viral disease was not the cause of death.

The Basel pathologist Tzankov considers this distinction to be “academic” https://www.sueddeutsche.de/. “If I have cancer and live for half a year and drive over a car, it doesn’t reduce the driver’s fault “, he says. The life expectancy of the deceased with many previous illnesses was certainly shorter than that of healthy people. “But all of these patients would probably have lived longer without COVID-19, maybe an hour, maybe a day, a week, or a year.”