Did the Decedent Actually Die of COVID-19 or with COVID-19?
Understanding Cause of Death in the Context of COVID-19
Throughout the COVID-19 pandemic, families, clinicians, and public health officials alike have grappled with an important and often difficult question: when a decedent tests positive for COVID-19, did they die of COVID-19, or merely with COVID-19?
While to a 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. Many patients had underlying chronic medical conditions, complicating the determination of the true cause of death. In these situations, clinical impressions alone are insufficient. An autopsy remains the gold standard to investigate, diagnose, and clarify the actual cause of death.
The Role of Autopsy in COVID-19 Death Investigations
For instance, some individuals suspected of having COVID-19 may have tested positive for SARS-CoV-2 (the virus that causes COVID-19) antemortem. However, a positive test result only confirms that the decedent had a COVID-19 infection at some point; it does not prove that COVID-19 caused their death.
Determining whether COVID-19 was the direct cause requires a detailed postmortem examination, including:
Careful review of clinical history
Gross and microscopic examination of tissues
Additional laboratory testing if needed
It is also important to note that embalming does not interfere with postmortem COVID-19 testing or with the ability to reach a reliable diagnosis. Thus, even after embalming, an autopsy can provide vital answers.
From Our Case Files: An Illustrative Example
We recently submitted for publication a case report on this very topic. The case involved an 82-year-old man who had experienced fever and cough for five days before his passing. His body had been embalmed prior to autopsy.
At autopsy, postmortem nasopharyngeal and lung swabs tested positive for COVID-19. Testing for influenza and other respiratory viruses was negative. Microscopically, lung tissues showed marked findings consistent with severe viral infection, including widespread alveolar damage typical of COVID-19-related pneumonia.
Based on the clinical history, laboratory results, and detailed pathological findings, we concluded that the primary cause of death was indeed COVID-19. This diagnosis, shared with the family, provided important closure and a better understanding of the decedent’s final illness.
Why Accurate Determination Matters
Accurate cause-of-death determination is not merely a technical exercise. It has profound implications:
For families, it provides clarity and peace of mind during a period of deep grief.
For public health officials, it ensures that mortality statistics reflect reality, which is critical for resource planning and epidemiologic understanding.
For the broader medical community, it contributes to our collective knowledge about COVID-19 and its true impact across diverse patient populations.
While COVID-19 profoundly altered the landscape of global health, the fundamental importance of autopsy remains unchanged. In complex cases, it is an irreplaceable tool to separate assumption from fact, and to honor the truth of each individual life and death.
When a decedent has tested positive for COVID-19, only through a thorough autopsy can we determine whether they truly died of the virus, or merely with it. In the pursuit of medical truth and compassion for grieving families, this distinction matters, now more than ever.
For more information about our autopsy services or for questions regarding postmortem evaluations, please contact us at:
📞 +1 (202) 795-7109 (East Coast)
📞 +1 (415) 365-0040 (West Coast)