Writing in the Journal of Forensic and Legal Medicine, a pathologist from Thailand and one from China say they have observed the first fatal case of COVID-19 transferring from a deceased patient to a medical examiner.
Given that the virus is “novel,” not much was known as it began spreading from China across the globe. Researchers rushed to study the underlying mechanisms of the disease, including its transmission methods, symptoms and treatment options. However, transmission modes post-mortem were not readily examined, leaving forensic pathologists and medical examiners with more questions than answers.
While it has not been conclusively proven that COVID-19 can spread from a deceased body, the authors report their observations of a forensic practitioner in Bangkok contracting the disease during post-mortem examination. At the time of death nearly a month ago, on March 20, the total number of COVID-19 cases in Thailand was 272, a comparatively low number. Due to this, as well as minimal community spreading and infection, the authors, Won Sriwijitalai and Viroj Wiwanitkit, say it unlikely the forensic practitioner contracted the disease outside of work.
“Although patients may get the infection from workplace exposure or through spreading in the community, at the period of the occurrence of this case, the patients in Thailand are mostly imported cases and recording of local spreading in the community is limited. There is low chance of forensic medicine professionals coming into contact with infected patients, but they can have contact with biological samples and corpses,” the authors write.
Last week, Ahmad Samarji, professor of forensic science at Phoenicia University in Lebanon, said the likelihood that human remains are infectious is “high.” As he pointed out, during the 2014/2015 Ebola epidemic, handling of the dead was one of the main modes of transmission.
In response to COVID-19 and how much is unknown, governments have restricted viewing and handling of deceased after post-mortem examination is complete. In the United States, the Centers for Disease and Control (CDC) issued special guidance for the collection and submission of post-mortem specimens from deceased known or suspected COVID-19 cases, as well as recommendations for biosafety and infection control. The agency now recommends conducting autopsies in Airborne Infection Isolation Rooms that have a minimum of 6 air changes per hour (ACH) for existing structures and 12 ACH for renovated or new structures, and have air exhausted directly outside or through a HEPA filter. In addition to the usual autopsy PPE of gloves, gown, apron and goggles, the CDC recommends a disposable N-95 respirator or higher to protect the health of medical examiners.