The doctor who studied those killed by COVID-19 told how the disease affects the body: one thing is particularly surprising

The first victim of the coronavirus in Lithuania was an 83-year-old Ukrainian woman, whose life passed away on March 20 in the Admission-Emergency Department of Ukmergė Hospital. Subsequently, the number of deaths increased. Initially, most of the deaths were of honorable age, after which the coronavirus also claimed the lives of increasingly young people.

Data from the Department of Statistics shows that a total of 4.4 thousand people have died from coronavirus in Lithuania since the beginning of the pandemic. individuals, eight of whom were under the age of 30.

The new virus has raised many questions: from how to protect against it, how to treat the sick, to studying deaths from COVID-19. Autopsies of people who have died from this disease have been entrusted to forensic doctors-experts from the State Service of Forensic Medicine.

We spoke with Sigitas Chmieliauskas, an expert forensic physician with the State Service of Forensic Medicine and a doctor of medical sciences, about how the first victims of COVID-19 were studied, how they are doing now, and how COVID-19 affects people’s bodies. who gets it.

– Perhaps you remember the beginning of the pandemic in Lithuania: how were the investigations of the first deaths carried out?

– The beginning was full of uncertainty: there was a lack of global knowledge about the appearance of the virus, its threat and a tremendous lack of tools for all doctors. However, the procedure was quickly established and, in compliance with all safety requirements, forensic doctors, the only ones in Lithuania, successfully performed autopsies on corpses infected with COVID-19.

All necrosis is preceded by routine COVID-19 nasopharyngeal swabs and, if established from the beginning of the pandemic, all coroners will examine the dead COVID-19 in accordance with all safety requirements.

– How is it decided that COVID-19 victims will be examined by forensic experts?

– A forensic medical examination is mandatory for all those who die suddenly, without a clear cause of death, in case of violence, accidents and homicide, whether or not the victim has COVID-19.

Even up to 70 percent. Cases come to us dead suddenly and only after a forensic medical examination can we say what the cause of death is, if there were signs of violence that led to death. And in both accidents and homicides, the dead are also infected with COVID-19, so our forensic medical examination is very important and mandatory.

– Is it true that pathologists had to fight for protective measures in the first deaths from coronavirus? How did you feel about examining the dead for an infection that was still considered mysterious at the time? Did you feel scared? Were there colleagues who refused to investigate these dead?

– At the beginning of the pandemic, there was a lack of medical protection for all doctors, including us, but this problem was later resolved and we were able to feel safe examining the dead COVID-19.

It should be noted that performing an autopsy on the dead who have been infected with the coronavirus presents a significant risk of infection for the investigating forensic physician. Therefore, proper workplace safety measures are very important. At that time, there were very few scientific publications around the world on the emergence of this coronavirus, which posed new challenges for forensic doctors not only in Lithuania. Characteristic signs of COVID-19 have been searched around the world.

All of these challenges did not scare the forensic doctors but, on the contrary, sparked more interest.

– What has changed in those years and a half? How is the autopsy of the people who died of COVID-19 happening now?

– Since the beginning of the pandemic, all autopsies have been carried out with the maximum use of all labor protection measures, regardless of whether the deceased was infected with the virus or not. Examining COVID-19 patients has become a daily part of the medical examiner’s job.

COPID-19 infected lungs are more likely to be affected at autopsy, with disease complications, secondary infection, pneumonia, and acute respiratory failure.

Today we already know what protection measures are effective to prevent COVID-19 infection: wear special suits with legs and headdresses, protective masks, masks and gloves. Of course, doctors and support personnel in special protective suits are extremely overheated all the time, wet face shields and goggles cause problems at work, but we adapt to that.

– Did you have to calculate how many deaths from COVID-19 had been investigated during the entire pandemic? What percentage of respondents do they make up?

– Each coroner examines one or three cases of COVID-19 in the dead per week, but these figures are not uniform and vary greatly over time.

It is important to note that not all cases of COVID-19 infection are caused by coronavirus or its complications. It is rare for a deceased person to become infected with COVID-19 but die as a result of an accident, murder, or another cause that is not related to COVID-19 at all. It is possible that some of the deaths from COVID-19 and complications from this disease are not included in the general statistics because the coroner initially issues a provisional death certificate with a diagnosis of “unspecified cardiac arrest” and then issues a final report. death certificate with additional test answers, revised diagnosis. In such cases, we only see the number of deaths from COVID-19 later in the general statistics.

– Are you investigating COVID-19 for every person who dies in unclear circumstances?

– So far, 100 percent. for all the dead, we took swabs from the nasopharynx to detect COVID-19. After performing an autopsy on the deceased, we evaluate the changes in the internal organs. If a coroner detects macromorphological changes in lung tissue or other organs, these changes are evaluated microscopically, responses to additional tests are evaluated, and only then is the diagnosis of COVID-19 based.

In the unclear circumstances of the deceased, a forensic medical autopsy is performed in all cases. It is a gold standard that cannot be replaced by any other study: radiological, ultrasonic, or magnetic resonance imaging.

– What do forensic experts notice when they do autopsies on people who have died of COVID-19? How does this disease affect the lungs and other organs?

– An autopsy on a deceased person infected with COVID-19 may not show any specific signs of the disease to the naked eye, but additional microscopic examinations may reveal certain changes in the tissues.

What we observe in our practice and what the authors of scientific articles point out are the most vulnerable and most severely lungs of those infected with COVID-19. The authors point out some observable signs: the lungs throughout the area are mottled, stained, with reduced dignity, interpreted as areas of microinfarction of the lung tissue, where then a secondary infection occurs in these sites of the lung tissue, pneumonia and even later is develops acute respiratory failure.

The surprising thing so far in my forensic practice is that they find dead people in their home without going to a medical facility, and at autopsy we found extremely pronounced advanced pneumonia spreading throughout the entire lung area.

– Among those who died from COVID-19 were young people under 40 years of age. What comorbidities or conditions caused such a severe course of infection? Overall, do you notice the most common comorbidities in COVID-19 deaths?

– The average age of deaths from COVID-19 is usually around 60-80 years, mostly men. It is understood that in this age group, the most commonly observed cardiovascular comorbidities, cardiovascular atherosclerotic lesions, heart muscle lesions.

Deaths from COVID-19 in young people are less common, but it is important to note that this coronavirus infection is also dangerous for younger groups, and the general public is urged to get vaccinated immediately.

– What is the difference between the examination of deaths from coronavirus and deaths from other diseases? Do you have to follow special procedures?

– The main difference since the beginning of the pandemic is that all forensic examinations – autopsies are performed in compliance with all the maximum measures of labor protection, regardless of whether we obtain a positive or negative result of the COVID-19 test. Another important change that did not exist before the pandemic is that it is 100% until now. all the dead are stained from the nasopharynx for COVID-19.

The methodology and principles of the forensic medical examination of a person who dies from coronavirus have not changed compared to those who have died from other illnesses or injuries. In all cases, the skull, chest and abdominal cavity are opened and changes in internal organs are evaluated, fractures and other injuries are evaluated. In all cases, samples will be taken for additional laboratory tests.

– Initially, nasopharynx samples were taken from the dead for PCR testing prior to testing, resulting in test sequences. Is it still like that now? Do studies of such dead take longer than others?

– So far nasopharyngeal samples have been taken from all the dead for PCR tests, but we were waiting for the answers to this test at the beginning of the pandemic and only then was the medical examination of the deceased performed. In this way, huge lines formed, the relatives were not able to remove the corpse for a week or two.

Current practice is that we do not wait for the response of a deceased nasopharyngeal PCR test prior to a forensic medical examination, and all autopsies are performed with the maximum use of all occupational protection measures, whether the deceased was infected with it. virus or not. In this way, we ensure a faster investigation of the deceased.

– Now that a delta variety is spreading, the actual number of deaths from coronavirus is not very high at the moment. But have you noticed the exceptional effects of this variety on the body?

– We are pleased that the number of deaths from coronavirus is much lower than in the heat of the pandemic itself, which could be explained by the increasing number of people vaccinated with COVID-19. Since the appearance of this coronavirus continues to be a new challenge for scientists, it will be possible to talk about differences in its strains in the future.