CHAPTER 14: Clinical Autopsy in COVID-19

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak started in December 2019 and was declared a pandemic on 11 March 2020. In severely affected individuals, infection results in a massive release of pro-inflammatory cytokines and leads to the development of acute respiratory distress syndrome. The clinical course evolves into a hypercoagulable state and multi-organ dysfunction. Autopsy findings provide an opportunity to gain a better knowledge of the disease and increase our understandings of the disease. Autopsy in coronavirus disease 2019 (COVID-19) deaths need to be conducted with standard safety precautions, keeping the exposure to the prosectors and other healthcare personnel to a minimum. The lungs face the major brunt of the disease and show features of diffuse alveolar damage on histopathological analysis. The presence of microthrombi in small pulmonary vessels has also been documented, which points towards the hypercoagulable state associated with the disease. A spectrum of histopathological findings are noted in extra-pulmonary organs. Most of these changes are attributed to the systemic effects of elevated cytokine levels, ischemia, and shock. However, different orthogonal approaches (using immunohistochemistry, in situ hybridization, electron microscopy, and molecular testing) have been used to detect the presence of viral particles in pulmonary as well as extra-pulmonary organs.