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Case Reports
. 2020 Sep;41(3):143-151.
doi: 10.1097/PAF.0000000000000567.

COVID-19: Postmortem Diagnostic and Biosafety Considerations

J Matthew Lacy  1 , Erin G Brooks, Joshua Akers  2 , Danielle Armstrong  2 , Lauren Decker  2 , Adam Gonzalez  2 , William Humphrey  2 , Romana Mayer  2 , Matthew Miller  2 , Catherine Perez  2 , Jose Antonio Ruiz Arango  2 , Lakshmanan Sathyavagiswaran  2 , Wendy Stroh  2 , Suzanne Utley  2
Affiliations
Case Reports

COVID-19: Postmortem Diagnostic and Biosafety Considerations

J Matthew Lacy et al. Am J Forensic Med Pathol. 2020 Sep.

Abstract

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.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

FIGURE 1
FIGURE 1
A and B, Isolation cooler “airlock” entrance from body receiving area (A) and access to the isolation suite (B); note that full PPE required for entry into the airlock.
FIGURE 2
FIGURE 2
Autopsy PPE on left with a full face-shield PAPR and liquid impervious gown; scene investigation PPE on right with disposable facemask respirator (shown with N95, but current requirements are for surgical mask only), fluid resistant gown, and eye protection.
FIGURE 3
FIGURE 3
Unfixed moderately heavy, edematous, and relatively firm lungs with areas of hemorrhage in the right upper/middle lobes and left lower lobe.
FIGURE 4
FIGURE 4
A–F, Hematoxylin-eosin–stained sections at original magnification of 100× (A, B) and 400× (C–F). Lung parenchyma exhibits inflamed septae, hyaline membranes, and pneumocyte hyperplasia (A); septal and perivascular mononuclear inflammation (B); hyaline membranes and alveolar fibrin (C); intra-alveolar macrophages and reactive pneumocytes (D); marked pneumocyte hyperplasia (E); with sporadic multinucleated cells (F).
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