回顾性尸检 SARS-CoV-2 RT-PCR 与 COVID-19 提示性病理支持 2020 年 2 月前瑞士巴塞尔不存在致命的社区传播。
Retrospective Post-mortem SARS-CoV-2 RT-PCR of Autopsies with COVID-19-Suggestive Pathology Supports the Absence of Lethal Community Spread in Basel, Switzerland, before February 2020.
机构信息
Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland.
Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
出版信息
Pathobiology. 2021;88(1):95-105. doi: 10.1159/000512563. Epub 2020 Nov 6.
INTRODUCTION
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread around the world. While the first case was recorded in Hubei in December 2019, the extent of early community spread in Central Europe before this period is unknown. A high proportion of asymptomatic cases and undocumented infections, high transmissibility, and phylogenetic genomic diversity have engendered the controversial possibility of early international community spread of SARS-CoV-2 before its emergence in China.
METHODS
To assess the early presence of lethal COVID-19 in Switzerland, we retrospectively performed an analysis of deaths at University Hospital Basel between October 2019 and February 2020 (n = 310), comparing the incidence of clinical causes of death with March 2020 (n = 72), the month during which the first lethal COVID-19 cases in Basel were reported. Trends of COVID-19-suggestive sequelae, such as bronchopneumonia with organization, acute respiratory distress syndrome (ARDS), or pulmonary embolisms (PE) were evaluated. In cases where autopsy was performed (n = 71), analogous analyses were conducted on the cause of death and pulmonary histological findings. Eight cases with a COVID-19-suggestive clinical history and histopathology between October 2019 and February 2020, and 3 cases before October 2019, were selected for SARS-CoV-2 RT-PCR.
RESULTS
A statistically significant rise in pulmonary causes of death was observed in March 2020 (p = 0.03), consistent with the reported emergence of lethal COVID-19 in Switzerland. A rise in lethal bronchopneumonia was observed between December 2019 and January 2020, which was likely seasonal. The incidence of lethal ARDS and PE was uniformly low between October 2019 and February 2020. All autopsy cases analyzed by means of SARS-CoV-2 RT-PCR yielded negative results.
CONCLUSION
Our data suggest the absence of early lethal community spread of COVID-19 in Basel before its initial reported emergence in Switzerland in March 2020.
简介
由严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引起的 2019 年冠状病毒病（COVID-19）已在全球迅速蔓延。虽然首例病例于 2019 年 12 月在湖北记录，但在此之前，中欧早期社区传播的程度尚不清楚。高比例的无症状病例和未记录的感染、高传染性以及系统基因组的多样性使得 SARS-CoV-2 在其在中国出现之前，国际社会早期传播的可能性存在争议。
方法
为了评估 SARS-CoV-2 在瑞士的早期致死性 COVID-19 的存在，我们回顾性地分析了巴塞尔大学医院 2019 年 10 月至 2020 年 2 月（n=310）之间的死亡病例，将临床死因的发生率与 2020 年 3 月（n=72）进行比较，3 月是巴塞尔首次报告致命 COVID-19 病例的月份。评估了 COVID-19 提示性后遗症的趋势，如机化性支气管肺炎、急性呼吸窘迫综合征（ARDS）或肺栓塞（PE）。对进行尸检的病例（n=71）进行了类似的死因和肺组织病理学分析。在 2019 年 10 月至 2020 年 2 月期间，有 8 例具有 COVID-19 提示性临床病史和组织病理学的病例，以及 3 例发生在 2019 年 10 月之前的病例，被选择进行 SARS-CoV-2 RT-PCR。
结果
2020 年 3 月观察到肺部死因的统计学显著上升（p=0.03），与瑞士报告的致死性 COVID-19 的出现一致。2019 年 12 月至 2020 年 1 月期间，致命性支气管肺炎的发生率上升，可能与季节性有关。2019 年 10 月至 2020 年 2 月期间，致命性 ARDS 和 PE 的发生率均较低。通过 SARS-CoV-2 RT-PCR 分析的所有尸检病例均产生阴性结果。
结论
我们的数据表明，在 2020 年 3 月瑞士首次报告 COVID-19 出现之前，巴塞尔不存在 COVID-19 的早期致命性社区传播。
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