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It is in circular 11285 of the Ministry of Health that weighs one of the most disturbing questions that the government has not yet wanted to unravel. It was issued on April 1 (in the middle of “phase 1”, therefore) and provides provisions on the funeral sector, cemetery and cremation. In paragraph “c”, however, he also discusses autopsy tests and agnostic findings (read here). And so it states: “During the entire period of the emergency phase, autopsies or diagnostic findings should not be performed on complete Covid-19 cases, whether they died while hospitalized in a hospital ward or died at home.”. Not only. In a constitutional short-circuit, the judicial authority “grants” the right to “limit the evaluation to an external inspection of the body”. How was it possible that in Italy, in the twenty-first second, what a group of forensic doctors did not have too much trouble defining “scientific block”?
The importance of autopsies
“The lack of post-mortem research – reads an article published at the end of May in the Journal of Clinical Medicine – did not allow a definition of the exact cause of death, useful to determine the pathways of this infection”. Not everyone bows to the dictates of the Ministry of Health. In the Papa Giovanni XXII hospital, for example, rebuilt in Coronavirus Black Book (click here), the director of the Department of Laboratory Medicine and Pathological Anatomy, Andrea Gianatti, decides to do his thing. And, together with Aurelio Sonzogni, he begins to perform autopsies as of March 23. “It became clear early on that this disease was manifesting itself in different ways.”. To understand the behavior of the virus, some pieces were still missing. The need to understand leads him to break the rules and discover the usefulness of heparin against thrombosis. “The idea of intervening in coagulation at the empirical level reveals a QN Gianatti: left after seeing the thromboembolic picture and using cortisone in the inflammatory vascular gyrus “. However, when clinical evidence, backed by autopsy evidence, begins to show that the sick are dying “not so much for severe pulmonary failure as for massive pulmonary embolism or other serious thromboembolic phenomena”, now its too late. Deaths already number in the thousands and the shock wave of the pandemic has hit Italy inexorably.
Doubts about the circular
Although the government has repeatedly accused the mass of mistakes made during “phase 1”, Health Minister Roberto Speranza has never motivated the content of circular 11285. Now, however, lawyer Giancarlo Cipolla is trying to see clearly about delays and omissions in the executive’s fight against the coronavirus. On November 5, the Brescia prosecutor’s office carried out the investigation itself, which in the previous months, however, had already been closed by the judges of Cremona. The crime hypotheses (for now against unknown persons) range from the guilty epidemic to homicide and negligent injuries, to the abuse of power and the omission of official acts. In the statement of the lawyer, who assists Giovanna Muscetti, Milanese manager, the prohibition of performing autopsies on the corpses of Covid-19 victims and the prohibition of performing oropharyngeal swabs to confirm whether the dead had been infected or less. “Based on the opinions of the doctors cited in our statement – explains Cipolla – the main problem of deaths is not the virus, but the immune reaction that destroys cells infected by the virus”. Many patients, in fact, end up in resuscitation for generalized venous thromboembolism, especially pulmonary, so intubation is of little use if thromboembolism is not prevented. “If you ventilate a lung where the blood does not reach, it is useless – explains Professor Sandro Giannini from the Rizzoli Clinic in Bologna – the problem is cardiovascular, not respiratory. Venous microthrombosis, not pneumonia, determines death”.
Critical points
Points one and two of paragraph “c” of circular number 11285 are intended to discourage short any analysis that could, instead, help science to progress in the knowledge of COVID-19 and therefore in the study of an effective cure. In point one it is clearly established that “During the entire period of the emergency phase, autopsies or diagnostic findings should not be performed on complete Covid-19 cases, whether they died during hospitalization in a hospital ward or died at home.”. As if that were not enough in point two, the judicial authority has the right to “to evaluate, in its own autonomy, the possibility of limiting the assessment to the only external inspection of the corpse in all cases in which the autopsy is not strictly necessary”. In the same way, as for the health departments of each region, it is said that they will be given “Indications aimed at limiting the execution of diagnostic tests only to cases intended to diagnose the cause of death, limiting to what is strictly necessary those that must be carried out for reasons of study and in-depth analysis”. In this way, the ministry inaugurates the concession season with a dubious interpretation (as many scholars point out) of the constitutional principles relating to the separation of powers (judicial, executive and legislative) and the autonomy and independence of the judiciary.
It is difficult to say whether the investigation by the Brescia prosecutor will lead to indictments and convictions. We’ll see. But the question remains: why in the 21st century prevent autopsy examination? There must be an answer. And someone will have to provide it sooner or later.
