Is it COVID-19? The value of medicolegal autopsies during the first year of the COVID-19 pandemic

• Type of Material: Article
• Authors: Rachel Geller, Emory University; Jenna L Aungst, DeKalb County Medical Examiner’s Office; Anna Newton-Levinson, Emory University; Geoffrey Smith, Emory University; Marina Mosunjac, Emory University; Mario Mosunjac, Emory University; Christy S Cunningham, DeKalb County Medical Examiner’s Office; Gerald T Gowitt, DeKalb County Medical Examiner’s Office
• Language: English
• Date: 2021-11-23
• Publisher: ELSEVIER IRELAND LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2021 Elsevier B.V. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.forsciint.2021.111106
• Title of Journal or Parent Work: FORENSIC SCIENCE INTERNATIONAL
• Volume: 330
• Start Page: 111106
• End Page: 111106
• Keywords: COVID-19; Retrospective; SARS-COV-2; Medicine, Legal; Life Sciences & Biomedicine; UNITED-STATES; Science & Technology; Mortality; Legal Medicine; SARS-CoV-2; Autopsy
• Research Categories: Health Sciences, Public Health

Abstract

Objectives: We describe the experience of a busy metropolitan medical examiner's office in the United States and share our navigation of the COVID-19 autopsy decision-making process. We describe key gross and microscopic findings that, with appropriate laboratory testing, should direct a pathologist towards a COVID-19-related cause of death. Material and methods: We performed a retrospective review of 258 suspected and/or confirmed COVID-19 associated deaths that occurred between March 5, 2020, and March 4, 2021. Results: A total of 62 cases due to fatal COVID-19 were identified; autopsy findings included diffuse alveolar damage, acute bronchopneumonia and lobar pneumonia, and pulmonary thromboemboli. Nine additional decedents had a nasopharyngeal swab positive for SARS-CoV-2 and a cause of death unrelated to COVID-19. Forty-seven cases with COVID-19-like symptoms showed no laboratory or histopathologic evidence of SARS-CoV-2 infection; the most common causes of death in this group were hypertensive or atherosclerotic cardiovascular disease, complications of chronic alcoholism, and pulmonary thromboemboli unrelated to infection. Conclusions: The clinical findings associated with COVID-19 are not specific; a broad differential diagnosis should be embraced when decedents present with cough or shortness of breath. An autopsy may be indicated to identify a cause of death unrelated to COVID-19.