What is revealed during the autopsy of victims of coronavirus

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What is revealed during the autopsy of victims of coronavirus
What is revealed during the autopsy of victims of coronavirus
Anonim

In Germany, it was allowed to dissect the bodies of those who died from the coronavirus, concluding that the scientific benefit outweighs the danger of infecting doctors. Several unexpected discoveries have already been made: for example, not everyone has pneumonia. Pathologists report that most of the victims have in common.

- At the beginning of the pandemic, the Robert Koch Institute (RKI) warned against autopsy of people who died from coronavirus in order to protect doctors from infection.

- Scientists in Hamburg and Basel are nevertheless doing this and have already come to the first conclusions: people with problem lungs are in particular danger.

“The KFM has now dropped its autopsy recommendation, as the data obtained can be very valuable.

In principle, dead bodies practically no longer play a special role in the daily practice of pathologists. The autopsy in order to determine what the person was ill with and from what he died, receded into the background. Today, pathologists are primarily concerned with finding out whether, for example, a tumor is benign or malignant. Studies are carried out on the basis of tissues obtained during operations. “But the autopsy method is now perceived as outdated,” says Andreas Rosenwald, director of the Institute for General Pathology at the University of Würzburg. By comparison, his institute performs 50 autopsies and 50,000 studies of diseases in living patients in a typical year.

But this year is unusual, and the data obtained during the autopsies take on new meaning: doctors around the world are trying to understand how dangerous the coronavirus is for humans in reality. “Beyond the primary symptoms, we know too little about the damage the virus actually does to the body,” says Rosenwald.

But back in March, the Robert Koch Institute (RKI) recommended that autopsies be avoided whenever possible. Pathologists and medical personnel are at risk of contracting coronavirus through airborne particles, the so-called aerosols. With this point of view, the German Society of General Pathology and the Federal Union of German Pathologists did not agree - they insisted "on the maximum possible number of autopsies of coronavirus deaths" in order to develop the best therapy methods based on the data obtained.

Expert: most patients were obese

In Switzerland, pathologists perform autopsies with the proper equipment in the dissecting rooms and “with the proper courage,” says Alexandar Tzankov, head of the autopsy department at the University Hospital Basel. To date, there have been autopsies on 20 deaths from Covid-19, and Tsankov believes that he has identified certain diagnostic signs.

"All those examined had high blood pressure," says the professor, "and most of the patients were significantly overweight." In addition, they were predominantly men, two-thirds of the patients had coronary artery injuries, and a third of the patients suffered from diabetes.

In addition to identifying previous diseases, doctors from Tsankov's group also examined lung tissue damage in the deceased. “Pneumonia was found in a minimal number of patients,” he says. “What we saw under the microscope was a severe impairment of microcirculation in the lungs.” According to Tsankov, this means that oxygen exchange was impaired, which explains the difficulty in breathing in patients with Covid-19 in intensive care units: "You can give a patient as much oxygen as you want, but he simply will not move through the body." It is unclear whether these findings have previously been taken into account when treating patients in intensive care units.

In the meantime, the Robert Koch Institute withdrew its recommendation against autopsies. IRC President Lars Schaade said on Tuesday: “The original recommendation did not say that autopsies should not be performed at all, they should only be performed in exceptional cases. It is, of course, true that it is in the case of a new disease that as many autopsies as possible should be carried out, taking appropriate precautions."

Karl-Friedrich Bürrig, President of the Federal Union of German Pathologists, considers the previous recommendation a lapse. He says his union sent a letter to all pathologists urging them to perform autopsies on Covid 19 deaths.

The Rhine-Westphalian University of Technology Aachen set up a register last week to summarize research results. According to a report from Aachen, the public is following "with a certain curiosity, and perhaps even hope, in our area of expertise." It also says that, ideally, with the help of autopsies, it will be possible to answer some of the questions of clinicians and thereby contribute to the correct treatment of patients.

However, pathologist president Burrig does not expect to jump quickly from the register data. “At least six months must pass before the first results can be generalized,” says Burrig. "Otherwise it wouldn't be serious." According to him, one should not rush to publish so as not to run into criticism.

Hamburg forensic physician Klaus Püschel, regardless of the recommendation of the KFM and the formation of the register, went his own way. Between March 22 and April 11, at the University Hospital Hamburg-Eppendorf, he performed autopsies on 65 patients who had died from coronavirus. The newspaper Süddeutsche and the television and radio companies NDR and WDR have an autopsy report. The same report was sent last week to the Hamburg Health Office.

Upon inquiry, the professor confirmed the authenticity of the report, but declined to answer any questions. In the meantime, the number of autopsies performed in Hamburg has exceeded 100, and in none of the cases has there been “without previous illnesses,” as Klaus Puchel said. His report does not claim to be complete. But no other German clinic has even come close to examining so many deaths from Covid-19.

People who have not received mechanical ventilation also die

The data from the report is consistent with some of the research findings from Basel. For example, the fact that most of the deceased had heart disease. 55 out of 61 patients examined in Hamburg, according to the report, suffered from "cardiovascular disease", that is, high blood pressure, heart attack, atherosclerosis or other heart failure. The 46 autopsy patients had a history of lung disease. In 28 patients, diseases of other organs - kidneys, liver or organs after transplantation - were found. 16 patients suffered from dementia, others had cancer, severe obesity or diabetes.

So far, only a small amount of systematic research has been carried out around the world based on the autopsy results of deaths from Covid-19. At the end of March, doctors at the Peking University Hospital released 29 autopsies. They stressed that the virus affects not only the lungs, but also the immune system and other organs.

In the specialized journal Lancet, pathologists at the University of Zurich report signs that the virus is causing severe vascular inflammation in various organs. They examined two deceased and one survivor. This may explain why patients who did not require mechanical ventilation also die.

In Italy, the Ministry of Health published a report listing the previous illnesses of 1,739 patients who died. True, the report is not based on autopsy results, but only on data from medical records. The most commonly mentioned are high blood pressure, diabetes and coronary artery disease.

The often debated question of whether patients die from the virus itself or from the virus itself is trying to answer the Hamburg forensic physician Klaus Puschel. In 61 of the 65 deaths, the Covid-19 virus was named the cause of death. In the four remaining cases, death was not caused by a virus.

The Basel pathologist Tsankov called this conclusion "academic." “If I have cancer, I have six months to live and a car runs over me, the driver’s guilt does not diminish,” he says. According to him, the life expectancy of those who died with many previous diseases was in any case less than that of healthy people. "But all of these patients without Covid-19 would probably live longer - maybe an hour, maybe a day, a week, or a whole year."

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