Autopsy for pneumonia (COVID-19, SARS-CoV-2)

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How are you handling autopsies (especially for pneumonia), in the context of COVID-19 / SARS-CoV-2? I worry about infected patients without a diagnosis of COVID-19.

Of note, here are CDC's guidelines:


Postmortem activities should be conducted with a focus on avoiding aerosol generating procedures, and ensuring that if aerosol generation is likely (e.g., when using an oscillating saw) that appropriate engineering controls and personal protective equipment (PPE) are used. These precautions and the use of Standard Precautions should ensure that appropriate work practices are used to prevent direct contact with infectious material, percutaneous injury, and hazards related to moving heavy remains and handling embalming chemicals.

If an autopsy is performed, collection of the following postmortem specimens is recommended:

Postmortem clinical specimens for testing for SARS-CoV-2, the virus that causes COVID-19:
Upper respiratory tract swabs: Nasopharyngeal Swab AND Oropharyngeal Swab (NP swab and OP swab)
Lower respiratory tract swab: Lung swab from each lung
Separate clinical specimens for testing of other respiratory pathogens and other postmortem testing as indicated
Formalin-fixed autopsy tissues from lung, upper airway, and other major organs

If an autopsy is NOT performed, collection of the following postmortem specimens is recommended:

Postmortem clinical specimens for testing for SARS-CoV-2, the virus that causes COVID-19, to include only upper respiratory tract swabs: Nasopharyngeal Swab AND Oropharyngeal Swab (NP swab and OP swab)
Separate NP swab and OP swab specimens for testing of other respiratory pathogens

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Screw that. Too much work
 
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TELL THEM TO SCREW OFF. I WOULDN'T GO NEAR THAT AUTOPSY (or any autopsy) UNLESS I WAS PAID AT LEAST 10K.
 
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How are you handling autopsies (especially for pneumonia), in the context of COVID-19 / SARS-CoV-2? I worry about infected patients without a diagnosis of COVID-19.

Of note, here are CDC's guidelines:


Postmortem activities should be conducted with a focus on avoiding aerosol generating procedures, and ensuring that if aerosol generation is likely (e.g., when using an oscillating saw) that appropriate engineering controls and personal protective equipment (PPE) are used. These precautions and the use of Standard Precautions should ensure that appropriate work practices are used to prevent direct contact with infectious material, percutaneous injury, and hazards related to moving heavy remains and handling embalming chemicals.

If an autopsy is performed, collection of the following postmortem specimens is recommended:

Postmortem clinical specimens for testing for SARS-CoV-2, the virus that causes COVID-19:
Upper respiratory tract swabs: Nasopharyngeal Swab AND Oropharyngeal Swab (NP swab and OP swab)
Lower respiratory tract swab: Lung swab from each lung
Separate clinical specimens for testing of other respiratory pathogens and other postmortem testing as indicated
Formalin-fixed autopsy tissues from lung, upper airway, and other major organs

If an autopsy is NOT performed, collection of the following postmortem specimens is recommended:

Postmortem clinical specimens for testing for SARS-CoV-2, the virus that causes COVID-19, to include only upper respiratory tract swabs: Nasopharyngeal Swab AND Oropharyngeal Swab (NP swab and OP swab)
Separate NP swab and OP swab specimens for testing of other respiratory pathogens
Sounds like it should be referred to the ME office. That's not hospital-level autopsy procedure at all. Let the ME's handle that nonsense.
 
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Sounds like it should be referred to the ME office. That's not hospital-level autopsy procedure at all. Let the ME's handle that nonsense.

Sounds like some people have no clue what is the function of an ME office.
What is the basis for such a referral?
If the patient died at the hospital and there is no suspicion for unnatural death good luck with that.
 
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Sounds like some people have no clue what is the function of an ME office.
What is the basis for such a referral?
If the patient died at the hospital and there is no suspicion for unnatural death good luck with that.

No way the ME office will do that autopsy. If necessary for death certificate completion, the case will be signed based on hospital records review.
 
No way the ME office will do that autopsy. If necessary for death certificate completion, the case will be signed based on hospital records review.

We would bounce them back when i was a medical examiner for 2 years in the late 80’s.


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I am in a unique position to comment, although I cant say exactly why.

The MEs will not do these cases pretty much unless they are insane.

You should unequivocally refuse to do them as well.

If pushed, tell them you would like a per suspected case hazard differential to match rule out Ebola or CJD post mortems: like 10-20K per.

Actually, personally I would refuse to do all post mortem exams until this situation is under control.
 
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I suspect anyone sick with anything that might be Coronavirus will be tested ante-Morten moving forward. Thus virtually all deaths from covid will be known before they die and autopsy should not be needed to establish the diagnosis.

So the purpose of any autopsy in this setting will really only be to document the autopsy finding in Patients who died of Covid. A few groups did this for SARS. The findings were more or less expected (hyaline change in lung /DAD). I imagine there will be posts done in this setting - but only at academic centers.
 
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