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COVID-19 - cause of death or co-morbidity: the answer of pathologists

Patients with COVID-19 are dying “from” or “from” the coronavirus. The pathologists who performed the autopsies on such victims were divided. Writes about it DW.

Photo: Shutterstock

Every evening, as in regular reports from the front, viewers are told how many currently infected with the SARS-CoV-2 coronavirus in their country, how many have recovered and how many have died.

But doctors in many countries affected by the pandemic argue about whether people infected with it are dying “from” or “with” COVID-19, or whether this disease is simply concomitant, and the cause of death is chronic ailments. The answers, in theory, should give the results of autopsies.

The Koch Institute was initially against autopsies

At the initial stage of the coronavirus epidemic in Germany, the Robert Koch State Institute (RKI), which coordinates the fight against infectious diseases in the country, for safety reasons, did not recommend performing autopsies on dead patients with SARS-CoV-2 in the body. Back in early April, the RKI on its website strongly recommended “to avoid examining internal organs, not performing autopsies or other actions that cause aerosol leakage”.

Then the institute changed its mind, and its deputy director Lars Schaade at a press conference in Berlin even specifically pointed out the importance of opening autopsies as often as possible.

This is the only way to establish, he added, that coronavirus infects a lot more internal organs than it was possible to judge from the first data received from China.

However, from the very beginning, German morgues did not heed the RKI's recommendation, which Karl Friedrich Bürrig, chairman of the federal union of German pathologists, called "an unfortunate mistake." With all modern infectious diseases, autopsies are very important to clarify the course of the disease, including COVID-19, Burrig recalled.

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Hamburg forensic expert database

The most extensive database on this subject was compiled by Professor Klaus Püschel - Director of the Institute for Forensic Medicine at the University Hospital Hamburg.

"From the dead," the professor is sure, "you can learn a lot to heal the living."

From March 22 to April 11, he performed autopsies on 65 deceased patients diagnosed with COVID-19. All without exception, apart from this disease, suffered from others. Thus, 46 people were still "pulmonary" during their lifetime, 28 had diseases of other internal organs or transplanted organs, 10 suffered from diabetes or obesity, 10 had cancer, 16 had dementia (the total number is more than 65, since some patients had several diseases. - Ed.).

Now in the Puchel database, information is already based on the results of more than 100 autopsies, which confirm his initial conclusion: none of the deceased was sick exclusively with COVID-19. All had other ailments - cardiovascular diseases (in particular, suffered heart attacks), high blood pressure, atherosclerosis, diabetes, cancer, pulmonary or renal failure, cirrhosis of the liver.

Therefore, Klaus Puchel considers the fear of coronavirus exaggerated and says that COVID-19 "is not a particularly dangerous viral disease." According to him, this virus should be taken seriously, but the excitement around it, according to the professor, has caused unfounded fears of the population. Among the unjustified measures, he considers the ban on the farewell of relatives to the dead.

“Although you shouldn't kiss the dead,” says Püchel, “you can look at them and even touch them with your hands if you wash them afterwards.”

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Post-mortem studies in Italy and Switzerland

The data that Puchel received in Hamburg roughly corresponds to the report of the Italian Ministry of Health, compiled not from the autopsy results, but from the case histories of 1 patients who died. 738% of them had at least one other disease in addition to COVID-96,4. Most often it was high blood pressure (19%), diabetes (70%) and cardiovascular disease (32%). The average age of the deceased in Italy was 28 years, in Hamburg - 79.

All 20 patients were also hypertensive, after death they were opened by the chief pathologist of the Swiss university clinic in Basel, Alexander Tzankov. In addition, most of them were overweight, two-thirds had heart and vascular problems, and a third had diabetes.

But unlike Professor Klaus Puschel, Tsankov is not inclined to call COVID-19 a relatively harmless disease. If they had not become infected with a coronavirus, Tsankov recalled, these people would most likely be still alive now.

“Without COVID-19, these patients would have lived longer: maybe an hour, maybe a day, maybe a week, or maybe a year,” Tsankov said.

David Horst, the chief pathologist of the Berlin Charite University Hospital, draws attention to this circumstance. The average age of dead patients with COVID-19 opened by him is 69 years old, but among them was one 45-year-old woman.

In an interview with the Berliner Zeitung newspaper, he confirmed that all the dead people he examined had chronic diseases during their lifetime: cardiovascular, hypertension, pulmonary insufficiency, some were obese. But, Horst recalled, “such diseases are very common in Germany among people over 65 years old, one in three suffers from them”.

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The Berlin pathologist notes that in most cases, these chronic diseases alone do not pose a serious threat to life. But in combination with coronavirus, they become extremely dangerous, especially for the elderly.

Answering the question of Berliner Zeitung about the most common complications caused by coronavirus, the expert named three. First, damage to the lungs, which begin to fill with fluid and as a result cease to enrich the body with oxygen. Secondly, bacteria quickly multiply in the affected lungs, which often leads to inflammatory processes and sepsis. Thirdly, this is a violation of the blood coagulation process, as a result of which blood clots form, causing a collapse of the cardiovascular system.

Regarding the debate about whether patients died “from” or “from” COVID-19, Horst insists on the wording “from”. He confirms that all the dead had some kind of chronic illness, but not so serious that they would die from it.

“I think it’s very important to prevent the perception that the coronavirus is not dangerous because these people, they say, would die anyway,” Horst said. "Without the coronavirus, they would be alive right now."

As ForumDaily wrote earlier:

Miscellaneous медицина research pandemic World coronavirus death from coronavirus

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