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No Autopsies on COVID-19 Deaths: A Missed Opportunity and the Lockdown of Science

Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy
Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
Department of Law, Forensic Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
Department of General surgery and medical-surgical specialties, University of Catania, 95121 Catania, Italy
Department of Biomedical and Biotechnological Sciences, University of Catania, 95121 Catania, Italy
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
J. Clin. Med. 2020, 9(5), 1472;
Received: 12 March 2020 / Revised: 11 May 2020 / Accepted: 13 May 2020 / Published: 14 May 2020
Background: The current outbreak of COVID-19 infection, which started in Wuhan, Hubei province, China, in December 2019, is an ongoing challenge and a significant threat to public health requiring surveillance, prompt diagnosis, and research efforts to understand a new, emergent, and unknown pathogen and to develop effective therapies. Despite the increasing number of published studies on COVID-19, in all the examined studies the lack of a well-defined pathophysiology of death among patients who died following COVID-19 infection is evident. Autopsy should be considered mandatory to define the exact cause of death, thus providing useful clinical and epidemiologic information as well as pathophysiological insights to further provide therapeutic tools. Methods: A literature review was performed on PubMed database, using the key terms: “COVID-19”, “nCov 19”, and “Sars Cov 2”. 9709 articles were retrieved; by excluding all duplicated articles, additional criteria were then applied: articles or abstracts in English and articles containing one of the following words: “death”, “died”, “comorbidity”, “cause of death”, “biopsy”, “autopsy”, or “pathological”. Results: A total of 50 articles met the inclusion criteria. However, only 7 of these studies reported autopsy-based data. Discussion: The analysis of the main data from the selected studies concerns the complete analysis of 12,954 patients, of whom 2269 died (with a mortality rate of 17.52%). Laboratory confirmation of COVID-19 infection was obtained in all cases and comorbidities were fully reported in 46 studies. The most common comorbidities were: cardiovascular diseases (hypertension and coronary artery disease), metabolic disorders (diabetes, overweight, or obesity), respiratory disorders (chronic obstructive pulmonary disease), and cancer. The most common reported complications were: acute respiratory distress syndrome (ARDS), acute kidney injury, cardiac injury, liver insufficiency, and septic shock. Only 7 papers reported histological investigations. Nevertheless, only two complete autopsies are described and the cause of death was listed as COVID-19 in only one of them. The lack of postmortem investigation did not allow a definition of the exact cause of death to determine the pathways of this infection. Based on the few histopathological findings reported in the analyzed studies, it seems to be a clear alteration of the coagulation system: frequently prothrombotic activity with consequent thromboembolism was described in COVID-19 patients. As a scientific community, we are called on to face this global threat, and to defeat it with all the available tools necessary. Despite the improvement and reinforcement of any method of study in every field of medicine and science, encouraging the autopsy practice as a tool of investigation could also therefore, help physicians to define an effective treatment to reduce mortality. View Full-Text
Keywords: COVID-19; infectious diseases; autopsy; diagnosis COVID-19; infectious diseases; autopsy; diagnosis
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MDPI and ACS Style

Salerno, M.; Sessa, F.; Piscopo, A.; Montana, A.; Torrisi, M.; Patanè, F.; Murabito, P.; Li Volti, G.; Pomara, C. No Autopsies on COVID-19 Deaths: A Missed Opportunity and the Lockdown of Science. J. Clin. Med. 2020, 9, 1472.

AMA Style

Salerno M, Sessa F, Piscopo A, Montana A, Torrisi M, Patanè F, Murabito P, Li Volti G, Pomara C. No Autopsies on COVID-19 Deaths: A Missed Opportunity and the Lockdown of Science. Journal of Clinical Medicine. 2020; 9(5):1472.

Chicago/Turabian Style

Salerno, Monica, Francesco Sessa, Amalia Piscopo, Angelo Montana, Marco Torrisi, Federico Patanè, Paolo Murabito, Giovanni Li Volti, and Cristoforo Pomara. 2020. "No Autopsies on COVID-19 Deaths: A Missed Opportunity and the Lockdown of Science" Journal of Clinical Medicine 9, no. 5: 1472.

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