NEW YORK – The COVID-19 pandemic helped revive the autopsy.
When the virus first arrived in US hospitals, doctors could only guess what was causing its strange constellation of symptoms: What could explain why patients lose their sense of smell and taste, develop rashes, struggle to breathe and report flu-like memory loss and flu-like pain?
In hospitals that have consistently lost prominence and funding over several decades, pathologists carefully dissected the first victims of the disease – and found some answers.
“We received e-mails from clinics, a bit desperate, asking, ‘What do you see?’ “Said Dr. Amy Rapkiewicz of NYU Langone. “An autopsy,” she said, “means seeing yourself.” “That’s exactly what we had to do.”
Early autopsies of deceased patients confirmed that coronavirus not only causes respiratory diseases, but can also attack other vital organs. They also led doctors to try blood thinners in some patients with COVID-19 and reconsider how long others should have on the ventilators.
“You can’t treat what you don’t know,” said Dr. Alex Williamson, a pathologist at Northwell Health in New York. “Many lives have been saved by watching someone’s death carefully.”
Autopsies have informed the drug for centuries – most recently helping to reveal the scale of the opioid epidemic, improving cancer care and demystifying AIDS and anthrax. Hospitals were once tried after autopsies.
But they have lost their stature over the years, while the medical world has turned to laboratory tests and imaging scans. In 1950, the practice was performed on about half of the patients who died in the hospital. Today, these rates have dropped to somewhere between 5% and 11%.
“It’s really a lost instrument,” said Louisiana State University pathologist Dr. Richard Vander Heide.
Some hospitals have found it even harder this year. Transmission safety concerns have forced many hospital administrators to stop or severely limit autopsies in 2020. The pandemic has also led to a general decline in the total number of patients in many hospitals, which has lowered autopsy rates. in some places. Large hospitals across the country reported fewer autopsies in 2020.
“Overall, our numbers have dropped quite significantly, from 270 autopsies in recent years to about 200 so far this year,” said Dr. Allecia Wilson, director of autopsies and forensic services at Michigan Medicine in Ann. Arbor.
At the University of Washington in Seattle, pathologist Dr. Desiree Marshall was unable to perform COVID-19 autopsies in her usual suite because, being one of the hospital’s oldest facilities, she did not have adequate ventilation to safely perform the procedure. Marshall ended up borrowing the county doctor’s offices for a few cases in the beginning and has been working on the school’s animal research facilities since April.
Other hospitals have gone the opposite way, performing far more autopsies even in difficult circumstances to try to better understand the pandemic and keep up with an increase in deaths that has led to at least 400,000 deaths in the U.S. than in normal mode.
At New Orleans University Medical Center, where Vander Heide works, pathologists performed 50 percent more autopsies than they did in recent years. Other hospitals in Alabama, California, Tennessee, New York and Virginia say they will also exceed the usual annual accounts for the procedure.
Their results shaped our understanding of what COVID-19 does to the body and how we could combat it.
In the spring and early summer, for example, some seriously ill coronavirus patients were in ventilators for weeks on end. Later, pathologists discovered that such extensive ventilation could cause extensive lung damage, prompting doctors to rethink how they use ventilators during a pandemic.
Doctors are now exploring whether blood thinners can prevent the formation of microscopic blood clots that were discovered in patients at the beginning of the pandemic.
Autopsy studies have also shown that the virus can travel through the bloodstream or cause a walk on infected cells, spreading to a person’s blood vessels, heart, brain, liver, kidneys and colon. This finding helped explain the wide range of symptoms of the virus.
There are sure to be more findings: pathologists have stored freezers with coronavirus-infected organs and tissues collected during autopsies, which will help researchers study the disease, as well as possible remedies and treatments. Future autopsies will also help them understand the impact of the disease on long-term carriers, those who suffer from symptoms weeks or months after infection.
Despite these life-saving discoveries made during the pandemic, financial realities and a declining workforce mean that the old medical practice is unlikely to fully return when the outbreak subsides.
Hospitals are not required to provide autopsy services, and in those that do, the costs of the procedure are not covered directly by most private or Medicare insurance.
“When you consider that there is no reimbursement for this, it is almost an altruistic practice,” said Dr. Billie Fyfe-Kirschner, a pathologist at Rutgers University. “It’s extremely important, but we don’t have to fund it.”
Added to the mix: the number of experts who can perform autopsies is extremely low. Estimates suggest that the United States has only a few hundred forensic pathologists, but could use a few thousand – and less than one in 100 medical school graduates enter the profession each year.
Some in the industry hope that the 2020 pandemic could increase field recruitment – just like the “CIS boom” of the early 2000s, said Williamson of Northwell.
Wilson of Michigan Medicine is more skeptical, but not even she can imagine her work becoming completely outdated. Learning from the dead to treat the living – is a pillar of medicine, she said.
It helped doctors understand the mysteries of the 1918 flu pandemic, right now it helps them understand the mysteries of COVID-19 more than a century later.
“They were in the same situation,” Vander Heide said of doctors trying to save lives in 1918. “The only way to find out was to open your body and see.”