Lacy J Matthew, Brooks Erin G, Akers Joshua, Armstrong Danielle, Decker Lauren, Gonzalez Adam, Humphrey William, Mayer Romana, Miller Matthew, Perez Catherine, Arango Jose Antonio Ruiz, Sathyavagiswaran Lakshmanan, Stroh Wendy, Utley Suzanne
From the Snohomish County Medical Examiner's Office, Everett, WA.
National Association of Medical Examiners Ad Hoc Bioterrorism and Infectious Disease Committee, Savannah, MO.
Am J Forensic Med Pathol. 2020 Sep;41(3):143-151. doi: 10.1097/PAF.0000000000000567.
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.
由于2019新型人类冠状病毒（COVID-19）的全球传播，法医/验尸官办公室在尸检时不可避免地会遇到数量增加的COVID-19感染死者。虽然在某些情况下，发热和/或呼吸窘迫史（如咳嗽或呼吸急促）可能提示诊断，但流行病学研究表明，大多数感染COVID-19的个体症状轻微或无症状。然而，死于COVID-19但并非因COVID-19死亡的人仍可能具有传染性。虽然已经发布了多项关于疑似COVID-19死亡病例尸检方案的指南，但这些建议存在一些差异。此外，迄今为止，关于现场调查方案的建议有限，而且关于COVID-19死后大体和组织学发现的出版物也很少。本文介绍了一例因COVID-19导致的意外猝死病例，以说明常见的尸检结果以及诊断和生物安全方面的考虑。我们还回顾和总结了当前关于COVID-19的文献，以便为在尸检时遇到COVID-19的法医-验尸官办公室提供基于证据的实用生物安全指导。
