Abstract
To date, there is poor evidence on the transmission of infection in individuals handling the bodies of deceased persons infected with SARS-CoV-2 and in particular, during autopsies. The aim of this study was to demonstrate that when appropriate strategies are adopted autopsy is a safe procedure with a minimal infection risk for all subjects involved (pathologists, technical personnel, and others) when proper strategies are adopted. We performed 16 autopsies on cadavers of persons who had died with confirmed COVID-19 with different post-mortem intervals (PMI). To confirm the presence of SARS-CoV-2 RNA, for each autopsy, 2 swabs were sampled from lungs, while to evaluate environmental contamination, 11 swabs were taken at three different times: T0 (before autopsy), T1 (at the end of the autopsy, without removing the corpse), and T2 (after cleaning and disinfecting the autopsy room). Specifically, 2 swabs were sampled on face shields used by each pathologist, and 4 swabs were collected on the autopsy table; 4 swabs were also collected from walls and 1 from floor. Lung swabs confirmed the presence of SARS-CoV-2 RNA in all cases. Environmental swabs, collected at T0 and T2 were all negative, while swabs sampled at T1 were shown to be positive. Interestingly, no association was shown between PMI length and environmental contamination. Infection control strategies for safe management of clinical forensic autopsies of bodies with suspected or confirmed COVID-19 are also described.
Highlights
The aim of this study was to demonstrate that when appropriate strategies during post-mortem investigation concerning handling the bodies of deceased persons infected with COVID-19 are adopted, autopsy is a safe procedure with a minimal infection risk for all involved subjects
The molecular test for SARS-CoV-2-RNA using quantitative reverse transcriptasepolymerase chain reaction (rRT-PCR) was performed on all samples of low respiratory airways collected at time T1
The positive results were not influenced by the period of time elapsed between the ante-mortem COVID-19 diagnostic test and the post-mortem swabs (COVID-19 rRT-PCR assay performed on post-mortem swab)
Summary
The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pandemic is associated with a broad spectrum of clinical manifestations, mainly characterized by an acute respiratory syndrome associated with a multi-organ syndrome, causing more than. The pathophysiological mechanisms causing death and the therapeutic strategies to counteract them remain elusive. A significant contribution has come from autopsy studies, cadaveric studies are still limited despite the fact that autopsies represent the gold standard to identify the cause of death. Autopsy is a valuable tool to obtain accurate mortality statistics, which could become essential for public health and health service planning [2]. One of the reasons for the poor use of autopsy is undoubtedly linked to the uncertainty of safety when handling the corpses of patients who died following
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