Abstract
There is still a lack of knowledge concerning the pathophysiology of death among COVID-19-deceased patients, and the question of whether a patient has died with or due to COVID-19 is still very much debated. In Italy, all deaths of patients who tested positive for SARS-CoV-2 are defined as COVID-19-related, without considering pre-existing diseases that may either contribute to or even cause death. Our study included nine subjects from two different nursing homes (Cases 1–4, Group A; Cases 5–9, Group B). The latter included patients who presumably died from CO poisoning due to a heating system malfunction. All subjects tested positive for COVID-19 both ante- and post-mortem and were examined using post-mortem computed tomography prior to autopsy. COVID-19 was determined to be a contributing cause in the deaths of four out of nine subjects (death due to COVID-19; i.e., pneumonia and sudden cardiac death). In the other five cases, for which CO poisoning was identified as the cause of death, the infection presumably had no role in exitus (death with COVID-19). In our attempt to classify our patients as dying with or due to COVID-19, we found the use of complete assessments (both histological analyses and computed tomography examination) fundamental.
Highlights
All corpses from Group A displayed findings of interstitial pneumonia, ischemic heart disease, and some degree of cardiac hypertrophy
The difficulties encountered when trying to differentiate between deaths with COVID19 and deaths due to COVID-19 represent a substantial problem, especially considering the fact that the concept of causality is fundamental in legal medicine
It would be advisable to perform nasopharyngeal swabs and PMCT scans in all suspected cases in order to distinguish those in which SARS-CoV-2 infection caused the death from those where COVID-19 was only part of the causal link
Summary
In December 2019, an outbreak of lower respiratory tract infection cases was detected in Wuhan City in the Hubei Province of China. In the absence of a known etiological agent, the first cases were classified as “pneumonia of unknown etiology.”. Following careful investigations by the local CDC (Center for Disease Control and Prevention), the etiology of the disease was attributed to severe acute respiratory syndrome coronavirus. The novel coronavirus disease was named “coronavirus disease 19”
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