CONTRARY VIEW Association of Pathologists and Cytologists of FBiH: Autopsy in COVID-19 Cases Does Not Reveal Cause of Death

SARAJEVO, (Patria) - SARS-CoV-2 is classified in the Hazard Grade 3 (HG3) group of pathogens, together with high-risk viruses such as rabies virus, poliovirus, yellow fever virus, HIV, hepatitis B, and others [1,2,3]. HG3 pathogens cause severe diseases in humans and pose a high risk to medical staff, with potential spread to other people [2], states the announcement from the Association of Pathologists and Cytologists of FBiH regarding contradictory media reports on autopsies of deceased persons with suspected or confirmed COVID-19 disease, aimed at communicating correct and evidence-based facts.

"Leading authoritative international institutions such as the World Health Organization [3], the European Centre for Disease Prevention and Control [6], the US Centers for Disease Control and Prevention [7], the Royal College of Pathologists of the United Kingdom [1], and regional institutions such as the Croatian Institute of Public Health [4], do not recommend autopsies of deceased persons with suspected or confirmed COVID-19 disease, except in cases where there is an absolute forensic medical indication, e.g., homicide, etc. [4]. Such recommendations were made for the following reasons: • COVID-19 is a highly contagious disease with potentially great dangers to the health of personnel involved in the autopsy process, as well as cleaning and decontamination of the premises after the autopsy. There is also a risk to public health due to the spread of infection from infected personnel to other people [1]", say the Association of Pathologists and Cytologists of FBiH.

They add that among the reasons are also "SARS-CoV-2 is undoubtedly persistent and infectious in bodily fluids and organs of the deceased [3], and it has been additionally proven to be infectious on various external surfaces for up to 72 hours under experimental conditions [5]. Performing such autopsies requires specific rooms with natural air ventilation of at least 160 L/s per deceased, or rooms with negative pressure and air exchange at least 12 times per hour. In addition, all other personal protective equipment for personnel, appropriate to the risk of HG3 pathogens, is necessary [2,3,6,7]. • COVID-19 can be the main cause of death, or a contributing cause, if the deceased at the time of infection also suffered from other acute or chronic diseases. • Finally, using available clinical, radiological, and laboratory methods pre- and post-mortem, the presence or absence of SARS-CoV-2 can be determined, and from the latest clinical experiences and studies, the consequences of such infection in the form of failure of lung, kidney, and other organ functions are known".

In such cases, autopsy does not provide any new data on the cause of death, and the risk to personal and public health is much greater than the benefit. 

Taking into account the positions of international institutions, as well as our personal experiences and expertise, the Association holds a unified stance that performing an autopsy on a deceased person with suspected or confirmed COVID-19 disease, in conditions where the cause of death is clear, does not provide additional useful information, while simultaneously representing an unjustified risk to personal and public health.

"In suspected cases, post-mortem radiological and laboratory diagnostics have equal informative value, but carry much less risk to human health and costs for the healthcare system. The Association will continue to carefully monitor new information, experiences, and recommendations from international bodies that arrive daily, and will align its positions with new knowledge and best practices. In a situation where we, as an entire society, are subjecting ourselves to rigorous measures to reduce the risk of infection spread, acting contrary to best practices and recommendations would constitute irresponsible behavior", conclude the Association.