J Matthew Lacy, Snohomish County Medical Examiner's Office, Everett, WA
Erin G. Brooks, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
Joshua Akers, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
Danielle Armstrong, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
Lauren Decker, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
Adam Gonzalez, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
William Humphrey, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
Romana Mayer, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
Matthew Miller, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
Catherine Perez, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
Jose Antonio Ruiz Arango, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
Lakshmanan Sathyavagiswaran, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
Wendy Stroh, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO
Suzanne Utley, National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO

Document Type

Article

Publication Date

9-1-2020

Abstract

As a result of the 2019 novel human coronavirus (COVID-19) global spread, medical examiner/coroner offices will inevitably encounter increased numbers of COVID-19-infected decedents at autopsy. While in some cases a history of fever and/or respiratory distress (eg, cough or shortness of breath) may suggest the diagnosis, epidemiologic studies indicate that the majority of individuals infected with COVID-19 develop mild to no symptoms. Those dying with-but not of-COVID-19 may still be infectious, however. While multiple guidelines have been issued regarding autopsy protocol in cases of suspected COVID-19 deaths, there is some variability in the recommendations. Additionally, limited recommendations to date have been issued regarding scene investigative protocol, and there is a paucity of publications characterizing COVID-19 postmortem gross and histologic findings. A case of sudden unexpected death due to COVID-19 is presented as a means of illustrating common autopsy findings, as well as diagnostic and biosafety considerations. We also review and summarize the current COVID-19 literature in an effort to provide practical evidence-based biosafety guidance for medical examiner-coroner offices encountering COVID-19 at autopsy.

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