Abstract

Clinical observations indicate that COVID-19 is a systemic disease. An investigation of the viral distribution within the human body and its correlation with tissue damage can aid in understanding the pathophysiology of SARS-CoV-2 infection. We present a detailed mapping of the viral RNA in 61 tissues and organs of 11 deceased patients with COVID-19. The autopsies were performed within the early postmortem interval (between 1.5 and 15 hr, mean: 5.6 hr) to minimize the bias due to viral RNA and tissue degradation. Very high viral loads (>104copies/ml) were detected in most patients' lungs, and the presence of intact viral particles in the lung tissue could be verified by transmission electron microscopy. Interestingly, viral RNA was detected throughout various extrapulmonary tissues and organs without visible tissue damage. The dissemination of SARS-CoV-2-RNA throughout the body supports the hypothesis that there is a maladaptive host response with viremia and multiorgan dysfunction.

Highlights

  • In December 2019, several cases of pneumonia caused by a novel Betacoronavirus called SARS-CoV2 were first described in the city of Wuhan in China (Zhu et al, 2020); the disease was thereafter named ‘coronavirus disease 2019’ (COVID-19) (Lu et al, 2020)

  • The investigation of COVID-19 patients included a full characterization of the clinical characteristics and parameters (Table 1)

  • Our results show that patients 1–10 died of COVID-19, whereas patient 11 suffered from a metastasized squamous cell carcinoma of the cervix and died of an ileus following peritoneal carcinosis (Table 2 provides an overview of the macro- and micromorphological autopsy findings)

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Summary

Introduction

In December 2019, several cases of pneumonia caused by a novel Betacoronavirus called SARS-CoV2 were first described in the city of Wuhan in China (Zhu et al, 2020); the disease was thereafter named ‘coronavirus disease 2019’ (COVID-19) (Lu et al, 2020). More than 121 million SARS-CoV-2 infections have been reported (Dong et al, 2020). The number of deaths attributed to COVID-19 has exceeded 2.6 million worldwide (Dong et al, 2020). COVID-19 occurs with varying degrees of severity. While approximately 81% of COVID-19 patients experience mild symptoms, 14% suffer from respiratory distress, and 5% have to be hospitalized (Wu and McGoogan, 2020; Wiersinga et al, 2020). 20% enter a critical condition with respiratory failure, endovascular complications, or multiple organ dysfunction

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