COVID-19: Autopsies extremely important in death cases, say experts

A man gets tested at a camp organised by the BMC in ward no. 90, Kalina, under the guidance of Municipal Councillor Adv Tulip Brian Miranda, on Wednesday. PIC/Pradeep Dhivar

AS the number of COVID-19 cases rise again, health experts and medical academicians have tagged this as phase 3 of the pandemic (community spread). The need of the hour according to them, is to have a two-fold solution: a) clinical and pathological autopsies should be a must to ascertain the exact reason for death and also to have collective data for medical students and research and b) introduction of epidemic management in medical text books, from undergraduate levels, which can be very useful for better training and handling of pandemics in future.

The National Working Committee of the Indian Medical Association formed to make recommendations for the formation of the Indian Medical Services (IMS), a separate cadre on the lines of the IAS, IPS, IFS, and IRS, has already submitted its 40-pages detailed report to the Central Health Ministry for better COVID management.

Dr. Vedprakash Mishra, national head of the Academic Programme (Indian Programme), UNESCO Chair in Bioethics (Haifa), who heads the committee said, "Apart from having raised serious concerns, the pandemic has also brought into focus the limitations of manpower, especially in regard to expertise for the management of an epidemic of such magnitude. The limitations are both in terms of required numbers as well as the level of expertise. One of the important lessons that must be learned is that a venture must be initiated for the training and orientation of a generation of trained health manpower in the form of specialists to manage epidemics."

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Dr. Mishra further added, "Likewise, there is a need for the structuring of the required operational details in regard to epidemic management in the Undergraduate Medical Education Curriculum in the form of stipulated competencies, so that the limitations are tackled."

'Poor judgment'

"Some countries are paying a big price for their scientific slackness. While several responses to this pandemic such as shutdowns were done appropriately and at the right time by countries like India, South Korea, Taiwan, Japan, and Cambodia, many countries delayed their responses such as the use of the mask to prevent transmission. That includes the US, UK, Italy, India, Brazil, etc. which are now paying a high price for the poor judgment of their scientists" said Dr Subhash Hira, professor of Global Health at the University of Washington-Seattle, USA and health advisor to several UN, Indian and African health agencies.

"In the milieu of disaster management protocols, several areas such as the female COVID warriors requiring properly fitting PPEs, selected autopsies to proactively study and generate medical knowledge that is subsequently published, handling of dead bodies with appropriate protection of the environment, etc. were missed out in
several countries," he said.

'Autopsies a must'

Dr. Wiqar Shaikh, the senior allergy and asthma specialist, said, "Although the SARS-CoV2, is primarily a respiratory virus, it has come to light that it has adverse impacts on multiple organs other than lungs. This has been proved by several pathological autopsies studies conducted in the USA, UK, China and several other countries. It is also important to bring on record, that not a single autopsy on a COVID-19 death has been done in India even after 81,000 deaths."

Dr. Shaikh added, "One of the most common autopsy findings is an increase in coagulation (blood clotting) which damages multiple organs, the brain, causes a paralytic attack, heart attack, and kidney failures. Patients have been found to have cirrhosis and in the pancreas, the swelling has been observed. Several autopsies have found secondary fungal infections internally and externally."

"Therefore, it is extremely important, that we begin to conduct autopsies in COVID-19 death cases so that we could have a database of afflictions of various organs. As India is a tropical country, and our genetic makeup is different from western countries, it is obvious that our findings may be different from western nations. This is important because it will help us to investigate and treat COVID-19 patients," he said.

Forensic surgeon speak

"Clinco-pathological autopsies help us understand how the patient has died of the disease and the impact on the various organs or systems of the body. A detailed microscopic study aided by immune-histological and molecular techniques may reveal the pathogenic activity of the infection. It is a known fact that around 20 percent to 30 percent of infections in hospital patients remain undetected until a postmortem is performed," said Dr Indrajit Khandekar, professor, Department of Forensic Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha.

Dr Indrajit Khandekar from Mahatma Gandhi Institute of Medical Sciences, Wardha

Dr. Khandekar added, "In an autopsy, multiple viruses and bacteria are detected. Attributing all changes to COVID without testing for other viruses will be highly unscientific and will mislead the public at large. An autopsy will also help identify the role of comorbid conditions in causing death. If we do such a detailed autopsy, then it will definitely help to identify whether the person has 'died with COVID, or 'died of COVID."

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