Autopsy Blog
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Did the Decedent Actually Die of COVID-19 or Merely with COVID-19?
by Nemanja Rodic, M.D., PH.D., FACP, FASCP, FACMG
While to casual observer the cause of death may seem obvious in some individuals who were tested for COVID-19 antemortem, or suspected of having COVID-19; not all cases fit a stereotype. Since many patients had underlying chronic medical conditions prior to death, other possibilities must be considered. When individuals die with unusual clinical symptoms, unknown clinical symptoms, or without clinical symptoms, an autopsy is a useful tool to investigate and diagnose the actual cause of death.
For instance, decedents with suspected COVID-19 as a primary, or contributing, cause of death, may have tested positive for SARS-CoV-2 (also known as “COVID-19”) antemortem. However, a positive COVID-19 test result prior to death merely informs us that the decedent has had COVID-19 infection at some point in life, but does not inform as to whether death was actually caused by COVID-19. To address the question of whether death was caused by COVID-19, an autopsy procedure must be performed.
Embalming does not interfere with COVID-19 testing and diagnosis postmortem. Therefore, an autopsy to address cause of death may still be performed even after embalming.
From Our Case Files:
We recently submitted for publication a medical case report on this issue. The decedent was a 82-year-old man with fever and cough for five days prior to death. His body had been embalmed prior to autopsy. At the time of the autopsy, a postmortem nasopharyngeal swab and lung swab were performed, both of which were positive for COVID-19. Testing for influenza was negative. The autopsy revealed microscopic findings in keeping with marked viral infection. This along with other microscopic and macroscopic observations during the autopsy procedure help secure the diagnosis and led us to conclude that the cause of death was COVID-19. This was relayed to the family, who found useful the further details regarding decedent’s cause of death.