Post-mortem examination reveals “last responders” are a pandemic epidemic

May 19, 2020 | 6:25 am

The pandemic of the coronavirus caused all attention to health workers and criminals of public health illness Frontline battle -And sometimes give them life-to put the coronavirus under control.

However, due to ongoing efforts to screen for coronaviruses and to track cases, health checkers and coroners play an important role. These “last responders” are usually called upon to investigate and determine the cause of unexpected or unnatural mortality, including deaths that occur at home.

In the early stages of outbreaks, lack of testing often hampered their efforts. Now, as the device becomes increasingly widely available, these experts will be able to fill in answers about how people died and whether their death was related to coronaviruses. May be. In addition, these confirmed cases help track down the contacts who may be infected.

According to experts, these changes do not occur all at once or uniformly across the country. In addition, the increase in post-mortem examinations could lead autopsies and medical examiners to the point of debate about the true number of COVID-19 casualties.

Identifying the number of people killed by the virus is Ongoing controversial bones.. Some defenders of the Trump administration argue that death estimates are inflated, as they often include people who were presumed dead but were not examined. Is. Administrative critics argue that the disorderly deployment of tests and treatments has resulted in thousands of unnecessary deaths, not included in the official death toll.

Even months after the introduction of COVID-19 in the United States, access to test materials such as test kits and nasal swabs remains poor in many places. Public health experts agree that extensive testing is important for people to safely escape lockdown and for companies and other institutions to safely resume.

“In some areas, we prioritize testing sick people over the dead. If there are limited tests available to them, that’s probably a good decision,” Washington, chairman of the American Society, said. Dr. Sally Aiken, a medical doctor in Spokane County, Oregon, says. Medical inspector.

But as availability increases, strengthening the post-mortem COVID-19 test may reveal important clues to the spread of the virus, experts say.

Many sick people have during a pandemic Stayed home and died Rather than asking for help in a hospital overwhelmed by patients with coronavirus.

For example, in New York City in April, Every day 200 residents died at homeIn comparison with 20 such deaths before the pandemic, the city’s medical examiner spokesperson spoke to a local public radio station, WNYC.

Many of those instances were untestable. But with more testing, such cases are now noticeable.

“Most of the things we test are individuals who die at home,” says Gary Watts, a coroner in Richland County, South Carolina, chairman of the International Association of Autopsy Doctors.

If a family member or friend tells the person that they have symptoms consistent with COVID-19, the coroner’s office usually uses a nasal swab to test for the virus. If the test is positive and the office can determine the cause of death without autopsy, it is not usually done.

The coroner and the medical examiner have similar responsibilities, Backgrounds are often different.. Coroners are usually elected officials, regardless of whether they have a medical degree. The medical examiner is usually a doctor and may be an expert in forensic pathology.

Like Watts, Dr. Kent Hirschberger, a coroner in Montgomery County, Ohio, including the city of Dayton, was sufficient to determine whether COVID-19 was involved in suspected death, unlike in the early days of the pandemic. Said that a good test was done.

By increasing the number of post-mortem tests, “we can better track contacts,” he says.

Aiken said several medical checkups and coroners have significantly enhanced the test and are conducting it on all bodies brought in.

“They are surprised by some of the positive people, such as suicides and car crashes,” she says.

One of the reasons for increasing testing is to protect the staff handling the bodies. Dr. Judy Merynek, San Francisco Area Forensic Pathologist and CEO of Pathology Expert.

“ We want to avoid autopsy unless absolutely necessary, ” if the body of the morgue is positive for COVID-19, because it exposes them to the virus through aerosolized particles and blood, Merinec said. Says Mr. In addition, the Department of Occupational Safety and Health recommends that no autopsy be performed for COVID-19 deaths, she said.

It has been pointed out that even if a coroner or a medical examiner does not perform a comprehensive nasal swab test on a recently deceased person, he or she may be able to provide important information later.

It is standard practice to take blood samples from patients sent to the morgue, and coroners and medical examiners usually keep blood samples for up to one year. Testing these blood samples for antibodies to the coronavirus shows a previous infection, so public health professionals can get a clearer picture of when the virus arrived in the United States and the extent of its spread.

It is not possible to identify all undiagnosed infections as they will not be diagnosed until antibodies appear 1-3 weeks after infection, According to the Federal Centers for Disease Control and Prevention. Before that, people may die. Nevertheless, experts say that postmortem antibody testing can provide useful information.

“When [the virus] Having arrived in the US, we can find out more about how this virus was not detected, “says Melinek.

In the future, the public health experts and politicians are considering the decision to reopen the country’s business and the possibility of the virus reoccurring, so the more detailed information is better, the expert said. I will.

“Post-mortem testing is useful and important when it is balanced with the feasibility of the logistics that do it,” he says. Lorna Soap, Professor of Epidemiology at Grossman School of Medicine, New York University. “When politics enters this realm, it’s great to see the case so it’s not criticized.”