Letters to CAPTODAY

Two articles about autopsies appeared in CAPTODAY’s  May  Suiting up for COVID-19 autopsies, sharing findings” and June Autopsies Show many Faces of COVID-19 issues. The articles are remarkable as a reflection of current state of declining autopsies as teaching tool for medicine. During the COVID-19 epidemic outbreak this tendency became especially visible. OSHA and hospital’s administration with the silent node of College of American Pathologists actually put autopsies on a hold just in time when the epidemic required the opposite.

However, before I am placing a post, which analyzes some points of June 15, 2020 Interim Guidance for Collection and Submission of Postmortem Specimens from Deceased Persons with Known or Suspected COVID-19. This documents sheds some light on the reasons for pathology community confusion regarding autopsy performance during the COVID-19 epidemic.

I responded to both articles with two letters to the Editor. The letters were not published in this College of American Pathologists magazine. Both letters are below. I’m going to make more expanded analysis both letters in a separate post with the concentration on organizational and technical issue rather on medical part for understandable reasons.

The letter on 6/11/20

To the Editor:

The May issue’s “Suiting up for COVID-19 autopsies, sharing findings” article shows that postmortem examinations are returning to their main goal of a teaching tool. Hopefully, College of American Pathologists encourages broader autopsy performance and coordinates the autopsy data collection.

There is no reliable scientific data that COVID-19 is different from other respiratory infections initiated by coronaviruses as far as transmission is concerned. The aerosol component in transmission is still disputed. For understandable reasons, SARS-CoV-2 virus transmission through sneezing or speaking droplet nuclei cannot be taken into account during an autopsy.  The aerosolization is quite preventable by proper autopsy technique and air flow engineering controls.

The use of personal protective equipment (PPE) is obligatory in every autopsy. It is reckless to do an autopsy without double gloves or a face shield, especially during evisceration or bone cutting. The layers of protective equipment mentioned in the article (even a biohazard-type suit) do not assure safety if the rules of donning and especially doffing are not followed. An autopsy requires hours of work. A reflection of unsubstantiated fears, the suggested in the article PPE does not provide conditions for comfortable performance of the multiple tasks during the procedure. The work without comfort is the way to mistakes and trauma. The grossing-technology.com website’s COVID-19 blog discusses in detail protective equipment and autopsy room/table maintenance during the procedure.

Just friendly remarks on the LSU School of Medicine pathology department’s honorable efforts to collect invaluable data in the midst of the COVID-19 epidemic. Unfortunately, this is not the last epidemic that the anatomic pathology will encounter.

Izak B. Dimenstein, MD, PhD, HT (ASCP)    

The letter on 6/24/20

To the Editor:

The article Autopsies show many faces of COVID-19 is evidence that postmortem examinations are returning as a teaching tool for clinicians and the resource for the scientific comprehension of COVID-19 anatomic pathology data. Unfortunately, precious material has been lost by OSHA’s confusing regulations and administrative restrictions, including two autopsies per week limitation. Administrative decisions are often marred by self-preservation, especially in current pandemic of fear. It is hard to believe that OSHA issued the regulatory restrictions without consultation with pathologists. LISTSERV communications and the CAP Autopsy Committee’s involvement are very useful.

Dr. Rapkiewitz is right that that COVID autopsy is not different from an influenza autopsy. There is no reliable scientific data that COVID-19 is different from other infections initiated by coronaviruses as far as transmission during an autopsy is concerned. In contrast to clinical work, for understandable reasons, SARS-CoV-2 virus transmission through sneezing or speaking droplet nuclei cannot be taken into account during an autopsy.  Strict adherence to OSHA standard PPE can provide safe and comfortable work. An autopsy requires hours of work with performance of multiple tasks. The grossing-technology.com website’s COVID-19 blog discusses in detail protective equipment with attention to donning, especially donoff, as well as some additional measures to prevent aerolization potentially infectious material during the procedure.

An autopsy, which is performed under relatively tranquil condition in contrast to the patient’s ward, should use all array of modern laboratory tests, including for Disseminated Intravascular Coagulation (DIC) diagnosis. Also, the reliability of the molecular rRT-PCR test can be checked. The test is assumed as impeccable, as the final verdict.

Izak Dimenstein

                                                                                                                                                                                         

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