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In principle, corpses no longer play a particular role in the daily practice of pathologists. An autopsy to determine what a sick person is and what he died of disappeared in the background. Today, pathologists are primarily concerned with determining whether a tumor, for example, is benign or malignant. The studies are based on tissues obtained during surgery. “But the autopsy method is now perceived as obsolete,” says Andreas Rosenwald, director of the Institute of General Pathology at the University of Würzburg. By way of comparison, in his institute, in the typical year, 50 autopsies and 50 thousand examinations of diseases of living patients are carried out, writes the authoritative German edition Suddeutsche Zeitung in material presented without FOCUS editorial intervention.
But this year is unusual, and the autopsy data takes on new meaning: Doctors around the world are trying to figure out how dangerous it is. the coronavirus in fact “Besides the basic symptoms, we know very little about the damage the virus does to the body,” says Rosenwald.
But in March, the Robert Koch Institute (IRC) recommended that an autopsy not be performed if possible. Pathologists and medical personnel are at risk of infecting the coronavirus with airborne particles, so-called aerosols. The German Society for General Pathology and the Federal Union of German Pathologists disagreed with this view: they demanded “as many autopsies as possible of a deceased coronavirus” to develop the best treatment methods based on the data obtained .
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In Switzerland, pathologists perform an autopsy if they have the proper equipment and “courage,” says Alexander Tsankov, head of the autopsy unit at the University Hospital of Basel. To date, 20 Covid-19 autopsies have been performed, and Tsankov believes he has identified certain diagnostic features.
“All the patients examined had high blood pressure,” said the professor, “and most of the patients were significantly overweight.” In addition, they were predominantly male, two thirds showed damage to the coronary artery, one third of the patients had diabetes.
In addition to identifying previous illnesses, doctors in the Tsankov group also examined lung tissue damage in the dead. “In a minimal number of patients, pneumonia is detected. What we saw under the microscope was a severe disturbance of the microcirculation in the lungs.” According to the specialist, this means that the oxygen metabolism is altered, which explains the difficulty of breathing in patients with Covid-19 in intensive care units: “You can give the patient as much oxygen as necessary, but he simply will not move for the body”. . It is not clear whether these data could have been taken into account in the treatment of patients in intensive care units.
Meanwhile, the IAC withdrew its recommendation not to perform autopsies. Institute President Lars Shaadee said Tuesday: “The initial recommendation did not mean that autopsies should not be done at all, but should have been done in exceptional cases.” Of course, it is true that in the case of a new disease, it is necessary to perform as many autopsies as possible, subject to appropriate precautions. ”
Karl-Friedrich Bürg, President of the Federal Union of German Pathologists, considers the prior recommendation for a lapus. As he says, his union sent a letter to all pathologists urging them to have an autopsy on the late Covid 19.
Last week, a registry was created at the Technical University of Rhine-Westphalia in Aachen to summarize the results of the studies. According to Aachen’s message, the public is looking “with some curiosity and possibly luck at our area of expertise.” He also says that, ideally, the use of autopsies can answer some questions from doctors and thus contribute to correct treatment to the patients
However, the president of pathologists Burig does not expect quick conclusions from the registry data. “It must be at least six months before the first results are summarized,” says Burig. “Otherwise it would be frivolous.” According to him, one should not rush to the publications to avoid serious criticism.
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Despite his recommendation from the IRA and the establishment of the registry, Hamburg court physician Klaus Psychel went his own way. Between March 22 and April 11, at the Hamburg-Eppendorf University Hospital, he performed an autopsy on 65 patients who died of coronavirus. Suddeutsche newspaper, as well as radio and television companies, NDR and WDR have autopsy reports. The same report was sent to the health department in Hamburg last week.
In response, the professor confirmed the authenticity of the report, but declined to answer any questions. Meanwhile, the number of autopsies performed in Hamburg exceeded 100 and in no case was the patient without previous disease, as Klaus Psychel said. Your report is not intended to be exhaustive. But no other German clinic has examined so many people who died from Covid-19.
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The data in the report is in line with some of the results of the Basel studies. For example, most of the dead had heart disease. According to the report, 55 of the 61 patients examined in Hamburg suffer from ‘cardiovascular disease’ – that is, high blood pressure, heart attack, atherosclerosis or other heart failure. 46 autopsy patients had prior lung disease. 28 patients were diagnosed with diseases of other organs: kidney, liver or organs after transplantation. 16 patients had dementia, others had cancer, severe obesity, or diabetes.
So far, only a small number of systematic autopsy studies have been conducted on the autopsy of the dead by Covid-19. In late March, doctors at the Beijing University Clinic published the results of 29 autopsies. They stressed that the virus affects not only the lungs but also the immune system and other organs.
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Pathologists at the University of Zurich reported in the Lancet journal that the virus is causing severe vascular inflammation in various organs. They examined two dead and one survivor. This may explain why patients who did not need artificial ventilation also die.
In Italy, the Ministry of Health publishes a report that lists previous illnesses of 1,739 deaths. patients. Admittedly, the report is not based on autopsy results, but only on medical records. The most commonly mentioned are high blood pressure, diabetes, and coronary heart disease.
Klaus Psychel addresses the commonly discussed question of whether patients die from the virus itself, or whether they include the virus itself. In 61 of 65 deaths, the Covid-19 virus was identified as the cause of death. In the other four cases, death was not caused by the virus.
Basel pathologist Tsankov regards this conclusion as “academic”. “If I have cancer and am half a year old, I can be hit by a car and the driver’s fault is no less,” he says. According to him, the life expectancy of the deceased with many previous illnesses would be, in any case, less than that of healthy people. “But all of these patients would probably live longer without Covid-19, maybe an hour, a day, a week, or a whole year.”
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