The autopsy, a fading practice, revealed the secrets of COVID-19

NEW YORK (AP) – The COVID-19 pandemic has helped revive the autopsy.

When the virus first arrived in US hospitals, doctors could only guess what caused its strange composition of symptoms: what could explain why patients lost their sense of smell and taste, developed skin rashes, struggled to breathe and reported memory loss on top of flu-like coughs and pain?

In the mornings of the hospital, which has steadily lost prominence and funding for decades, pathologists dissected the first victims of the disease – and found some answers.

“We got emails from clinicians, a little desperate and asked, ‘What do you see?’ ”” Said NYU Langones Dr. Amy Rapkiewicz. ‘Autopsy,’ she pointed out, means to see for yourself. “That was exactly what we were going to do.”

Early autopsies of deceased patients confirmed that coronavirus not only causes respiratory diseases but can also attack other vital organs. They also got doctors to try blood thinners in some COVID-19 patients and reconsider how long others should be in ventilators.

“You can’t treat what you do not know about,” said Dr. Alex Williamson, a pathologist at Northwell Health in New York. “Many lives have been saved by looking closely at someone’s death.”

Autopsies have been informing medicine for centuries – most recently helping to uncover the scale of the opioid epidemic, improve cancer care and demystify AIDS and anthrax. Hospitals were once judged by how many autopsies they performed.

But they have lost stature over the years as the medical world instead turned to laboratory tests and image scans. In 1950, practice was performed on about half of deceased hospital patients. Today, these rates have dropped to somewhere between 5% and 11%.

“It really is a lost tool,” said Louisiana State University pathologist Dr. Richard Vander Heide.

Some hospitals found it even harder this year. Security concerns over transmission forced many hospital administrators to stop or severely curb autopsies by 2020. The pandemic also led to a general decline in the total number of patients in many hospitals, sometimes reducing the number of autopsies. Large hospitals around the country have reported that they will perform fewer autopsies in 2020.

“Overall, our number is down, quite marked,” from 270 autopsies in recent years to about 200 so far this year, said Dr. Allecia Wilson, director of autopsies and forensic services at Michigan Medicine in Ann Arbor.

At the University of Washington in Seattle, pathologist Dr. Desiree Marshall did not perform the autopsy of COVID-19 in her usual suite because, as one of the hospital’s oldest facilities, it lacked the proper ventilation to perform the procedure safely. Marshall ended up borrowing the county’s medical examination offices in a few cases early and has been working out of the school’s animal research facilities since April.

Other hospitals went the opposite way and performed far more autopsies, even in difficult circumstances to try to better understand the pandemic and keep up with a wave of deaths that has resulted in at least 400,000 more American deaths than usual.

At New Orleans University Medical Center, where Vander Heide works, pathologists have performed approx. 50% more autopsies than they have done in recent years. Other hospitals in Alabama, California, Tennessee, New York and Virginia say they will also exceed their usual annual figures for the procedure.

Their results have shaped our understanding of what COVID-19 does to the body and how we can combat it.

In the spring and early summer, for example, some seriously ill coronavirus patients were in ventilators for several weeks at a time. Later, pathologists discovered that such extended ventilation could cause extensive lung damage, prompting physicians to reconsider how to use ventilators during the pandemic.

Doctors are now investigating whether blood thinners can prevent microscopic blood clots that had been detected in patients early in the pandemic.

Autopsy studies also showed that the virus can travel through the bloodstream or pull on infected cells and spread to and affect a person’s blood vessels, heart, brain, liver, kidneys and colon. This finding helped explain the virus’ wide range of symptoms.

More findings will certainly come: Pathologists have stored freezers with coronavirus-infected organs and tissues collected during autopsies, which will help researchers investigate the disease as well as possible cures and treatments. Future autopsies will also help them understand the toll of the disease on long-distance transportationthose who suffer from symptoms for weeks or months after infection.

Despite these life-saving discoveries made during the pandemic, the economic reality and a dwindling workforce mean that the old medical practice is unlikely to fully recover as the outbreak subsides.

Hospitals are not required to provide autopsy services, and for those who perform them, the cost of the procedure is not directly covered by most private insurance policies or by Medicare.

“Considering that there is no reimbursement for this, it is almost an altruistic practice,” said Rutgers University pathologist Dr. Billie Fyfe-Kirschner. “It’s very important, but we do not have to finance it.”

Added to the mix: The number of experts who can actually perform autopsies is critically low. Estimates suggest that the United States has only a few hundred forensic pathologists, but could spend thousands – and less than one in 100 medical students enter the profession each year.

Some in the field are hoping that the pandemic in 2020 could increase recruitment to the field – like the “CSI boom” of the early 2000s, Northwell’s Williamson said.

Michigan Medicine’s Wilson is more skeptical, but even still she can not imagine her work becoming totally obsolete. Learning from the dead to treat the living – that’s a pillar in medicine, she said.

It helped doctors understand the mysteries of the 1918 flu pandemic, right now it helps them understand the mysteries of COVID-19 more than a century later.

“They were in the same situation,” Vander Heide said of the doctors who tried to save lives in 1918. “The only way to learn what was going on was to open the body and see.”


The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. AP is solely responsible for all content.