Hospital autopsy, practice of decline reveals the secret of COVID-19

The COVID-19 pandemic helped revive the autopsy.

When the virus first arrived in a US hospital, doctors could only guess the cause of its strange set of symptoms: the patient lost his sense of smell and taste, developed a skin rash, and had difficulty breathing. What can explain why you reported amnesia? Cough or pain like the flu?

In a hospital morgue, which has been steadily prominent and losing money for decades, pathologists have been busy dissecting the first victims of the disease and finding some answers.

“We received an email from the clinician desperately asking,’What are you looking at?'” Said Dr. Amy Rapkievich of NYU Langone. The “autopsy” she points out means to see for yourself. “That’s exactly what we had to do.”

Early autopsy of the deceased patient confirmed that the coronavirus not only causes respiratory illness, but can also attack other important organs. They also led doctors to try anticoagulants in some COVID-19 patients and rethink how long others use ventilators.

“You can’t cure what you don’t know,” said Dr. Alex Williamson, a pathologist at Northwell Health in New York. “By watching someone’s death carefully, many lives were saved.”

Autopsy has been informing medicine for centuries — recently helping to uncover the extent of opioid epidemics, improve cancer treatments, and unravel the mysteries of AIDS and anthrax. Hospitals were once judged by the number of autopsies performed.

However, they have lost their height for years as the medical community turned to lab tests and image scans instead. In 1950, about half of the inpatients who died were treated. Today, these rates are shrinking somewhere between 5% and 11%.

“This is really like a lost tool,” said Dr. Richard Vander Heide, a pathologist at Louisiana State University.

At some hospitals, this year felt even more difficult. Safety concerns about infection forced many hospital managers to discontinue or significantly curb autopsy in 2020. The pandemic also reduced the total number of patients in many hospitals overall and reduced autopsy rates in some places. Large hospitals across the country report that few autopsies will be performed in 2020.

“Overall, our numbers have declined significantly,” said Dr. Alesia Wilson, director of autopsy and forensic services in Ann Arbor.

At the University of Washington in Seattle, pathologist Dr. Desiree Marshall performed an autopsy of COVID-19 in a regular suite due to lack of adequate ventilation for safe surgery as it is one of the oldest facilities in the hospital. Couldn’t do it. Marshall has been working at the school’s animal research facility since April, renting a county coroner’s office early in some cases.

Other hospitals went in the opposite direction, performing far more autopsies even in difficult circumstances, better understanding the pandemic, and a surge in deaths that resulted in at least 400,000 more US deaths than usual. I tried to correspond to.

At the University of New Orleans Medical Center, where Vanderheide works, pathologists perform about 50% more autopsies than in recent years. Other hospitals in Alabama, California, Tennessee, New York, and Virginia also say they are above normal annual tally.

Their results shape our understanding of what COVID-19 does to the body and how it fights.

For example, in spring and early summer, seriously ill coronavirus patients used mechanical ventilation for several weeks at a time. Later, pathologists discovered that such prolonged ventilation could cause widespread lung damage, and doctors began to rethink how to use ventilators during a pandemic. It was.

Doctors are currently investigating whether anticoagulants can prevent the fine blood clots found in patients early in the pandemic.

Autopsy studies have also shown that the virus can travel through the bloodstream and ride on infected cells, spreading and affecting human blood vessels, heart, brain, liver, kidneys, and colon. Shown. This finding helped explain the wide range of symptoms of the virus.

Pathologists store coronavirus-infected organs and tissues collected during autopsy in a freezer to help researchers study illnesses and possible treatments and treatments. Future autopsy will also help to understand the illness victims of long-distance transporters who suffer from symptoms for weeks or months after infection.

Despite these life-saving discoveries made during the pandemic, economic reality and labor force declines mean that ancient medical practices are unlikely to fully recover when outbreaks decline. To do.

Hospitals do not need to provide autopsy services, and at hospitals that do so, the cost of the procedure is not directly covered by most private insurance or Medicare.

“Given that there is no reimbursement for this, it’s almost an altruistic practice,” said Dr. Billy Fife Kirschner, a pathologist at Rutgers University. “It’s very important, but we don’t have to fund it.”

Add to mix: Very few specialists can actually perform an autopsy. It is estimated that there are only hundreds of forensic pathologists in the United States, but it could use thousands. Each year, less than one in 100 medical graduates is in this profession.

According to Williamson of Northwell, some hope that the 2020s pandemic will drive field adoption, as in the “CSI boom” of the early 2000s.

Wilson of Michigan Medicine is more skeptical, but she still can’t imagine her job going completely out of date. Learn to treat the living from the dead — she said it was a pillar of medicine.

It helped doctors understand the mystery of the 1918 influenza epidemic, just now over a century later they helped understand the mystery of COVID-19.

“They were in the same situation. The only way to know what was happening was to open up and look,” Vanderheide said in 1918 about a doctor trying to save his life.