Autopsies onCOVID-19 patients reveals a lot of information on the virus. There have been no reports of COVID-19 transmission between a corpse and a pathologist.
Highlights:
Coronavirus autopsies reveal important facts about SARS-CoV-2 during the COVID-19 pandemic. - COVID-19 autopsies reveal important information about the infection
- Obesity is related to severe coronavirus illness
- COVID-19 primarily targets type II pneumocytes in the lungs
- COVID-19 cell death linked to clotting rather than myocarditis and vascular thrombosis is widely observed in COVID-19 patients
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‘COVID-19 autopsies have revealed a lot of information on the infection. Autopsies have helped discover important information related to the infections as it affects pretty much every organ in the body. Autopsies have clarified common myths about the novel coronavirus.’
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COVID-19
COVID-19 affects pretty much every organ in the body. COVID-19 autopsies are compared to a police line up where the perpetrator cannot be definitively identified, but unlikely suspects can be eliminated.No direct tissue pathology, which accounts for acute symptoms in the heart, kidney and brain are seen in the autopsies.
Pathologists have hypothesized causes of extensive organ damage in COVID-19. Hypoxia due to compromised lung function may be causing secondary injuries.
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Obesity and COVID-19
Obesity in COVID-19 patients worsens morbidity and mortality.Obesity is a pathological state which is responsible for many conditions such as increased clotting, atherosclerosis, fatty liver disease, enlarged hearts and other conditions.
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COVID-19 Affects Lungs
COVID-19 shows selectivity for the lungs. In one case, bone marrow response with several myeloid precursors in the peripheral blood vessels, which is seen in an overwhelming infection. The virus targets type II pneumocytes.Lung surface cells secrete a fatty substance to keep the lobes pliable. That precipitates the diffuse alveolar damage and acute respiratory failure.
Viral tropism for pulmonary II pneumocytes was confirmed with immunohistochemistry testing and electron microscope.
The viral antigen of SARS-CoV-2 in the lung tissue was higher when compared with SARS or MERS.
Highly pathogenic coronaviruses are detected in the epithelial cells of the upper respiratory tract.
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Myocarditis and COVID-19
Myocarditis is typical of viral diseases but is inconsistent in COVID-19.Only a very few have reported very little inflammation of the heart muscle.
At least one death has been attributed directly to COVID-19 induced lympho-histiocytic and eosinophilic myocarditis. Lympho-histiocytic myocarditis is a rare type of myocarditis.
Autopsy studies haven’t found typical myocarditis in nearly every case. German researchers have reported that around 60 of 100 COVID-19 recovered patients had ongoing myocardial inflammation as measured by cardiovascular magnetic resonance imaging (MRI).
Richard S.Vander Heide suspects that the researchers do not see true myocarditis but something else in the MRI.
Vander Heide and his colleagues found that around 6 out of the 22 autopsies had a history of heart disease.
All of them had diffuse alveolar damage in addition to pulmonary thrombi and microangiopathy.
Alveolar damage is a histopathologic marker of Acute Respiratory Distress Syndrome (ARDS).
In all cases, there was no evidence of typical lymphocytic myocarditis. Vander Heide believes that myocarditis is not responsible for heart cells dying. He thinks that clotting results in cell death due to ischemia.
Vascular Changes in COVID-19
Vascular changes are among the distinctive features of COVID-19. Increased clotting due to COVID-19 has been confirmed from autopsies.The virus may infiltrate the endothelium and cause injury to the blood vessels.
Pathologists compared lungs of 7 patients who died from COVID-19 with 7 patients who died from ARDS secondary to influenza and with 10 age-matched uninfected patients.
The severe endothelial injury was seen in COVID-19 affected lungs. Widespread vascular thrombosis with microangiopathy and occlusion of alveolar capillaries was seen. Significant new vessel growth of an unusual form of angiogenesis called intussusceptive angiogenesis was also observed.
Intussusceptive angiogenesis is a reactive formation of new blood vessels where one vessel splits into two vessels.
Venous thromboembolism was also observed in patients at the University Medical Center Hamburg-Eppendorf in Germany.
Several potential mechanisms that coronavirus triggers venous thromboembolism are endothelial dysfunction, systemic inflammation and a pro-coagulatory state.
Researchers from Hospital Graz II in Graz, Austria found thrombosis in all the 11 autopsies they had conducted.
COVID-19 Autopsies
Pathologists were initially reluctant to perform autopsies related to COVID-19, as they involve aerosol-generating procedures.The College of American Pathologists provided guidelines that recommended techniques to minimize aerosol-generating procedures.
Hand shears and other alternatives could be used instead of an oscillating bone saw or a vacuum shroud with the bone saw can be used.
According to Williamson, there have been no reports of COVID-19 transmission between a corpse and a pathologist, morgue technician or assistant.
Williamson found that the number of pathologists conducting autopsies was less. Only 6 of the 50 respondents were conducting autopsies in March. The number increased to 30 in a month.
The Center for Disease Control (CDC) recommends autopsies to be performed in a negative pressure suite.
In summary, a lot of information on SARS-CoV-2 infection have been gained from autopsies. Facts need to confirmed as there are many myths about the novel coronavirus.
Reference:
- 192 CMAAO CORONA FACTS and MYTH COVID : Autopsy reports of COVID 19 patients-
Source-Medindia
