Abstract
The body of a deceased with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is considered infectious. In this study, we present the results of infectivity testing of the body and testing of mortuary staff for SARS-CoV-2. We performed real-time quantitative polymerase chain reaction (RT-qPCR) for SARS-CoV-2 on 33 decedents with ante mortem confirmed SARS-CoV-2 infection. Swabs of the body surface from five different body regions and from the body bag or coffin were examined. A subset of the swabs was brought into cell culture. In addition, screening of 25 Institute of Legal Medicine (ILM) personnel for ongoing or past SARS-CoV-2 infection was performed at two different time points during the pandemic. Swabs from all locations of the body surface and the body environment were negative in cases of negative post mortem nasopharyngeal testing (n=9). When the post mortem nasopharyngeal swab tested positive (n=24), between 0 and 5 of the body surface swabs were also positive, primarily the perioral region. In six of the cases, the body bag also yielded a positive result. The longest postmortem interval with positive SARS-CoV-2 RT-qPCR at the body surface was nine days. In no case viable SARS-CoV-2 was found on the skin of the bodies or the body bags. One employee (autopsy technician) had possible occupational infection with SARS-CoV-2; all other employees were tested negative for SARS-CoV-2 RNA or antibody twice. Our data indicate that with adequate management of general safety precautions, transmission of SARS-CoV-2 through autopsies and handling of bodies is unlikely.
Highlights
The body of a deceased person with ante mortem confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered contagious
Since the beginning of the pandemic, the potential infectivity of the body has led to widespread adoption of a restrictive approach to deaths associated with coronavirus disease 2019 (COVID-19), avoiding any contact with the body
Between June 2, 2020, and November 15, 2020, 33 decedents who were tested positive for SARS-CoV-2 ante mortem and who were clinically considered to have died of COVID-19 were examined post mortem at the Institute of Legal Medicine (ILM)
Summary
The body of a deceased person with ante mortem confirmed infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered contagious. Ann Sophie Schröder and Carolin Edler share first authorship. Antonia Fitzek and Jan-Peter Sperhake share last authorship. Autopsies and ablutions of SARS-CoV-2 decedents may produce infectious droplets or aerosols. We are not aware of any safely confirmed occupational SARS-CoV-2 infections of autopsy teams during autopsies of SARS-CoV-2 positive decedents [7,8,9,10]. Since the beginning of the pandemic, the potential infectivity of the body has led to widespread adoption of a restrictive approach to deaths associated with coronavirus disease 2019 (COVID-19), avoiding any contact with the body. Dijkhuizen et al provide an overview of various recommendations in the management of SARS-CoV-2 associated deaths [11]
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