New York, AP.
The COVID-19 pandemic helped revive the autopsy.
When the virus first reached American hospitals, doctors could only guess why a strange constellation of symptoms appeared: What could explain why patients lost their sense of smell and taste, developed a rash, had difficulty breathing and reported memory loss over a flu-like cough and aches?
In hospital morgues, which have steadily lost their prominence and funding over several decades, pathologists have been busy dissecting disease early victims – and finding some answers.
“We were getting emails from the doctors, kind of desperate, asking, ‘What are you seeing? She noted that “autopsy” means you can see for yourself. “That’s exactly what we had to do.”
Early autopsies of deceased patients confirmed that the Coronavirus not only causes respiratory diseases, but can also attack other vital organs. They have also led doctors to try blood thinners in some COVID-19 patients and to reconsider how long others should spend on ventilators.
“You can’t treat what you don’t know about,” said Dr. Alex Williamson, a pathologist at Northwell Health in New York. “Many lives were saved by looking closely at someone’s death.”
Autopsies have helped medicine for centuries – recently helping to reveal the scale of the opioid epidemic, improving cancer care and demystifying AIDS and anthrax. Hospitals were once judged by the number of autopsies they performed.
But they lost their status over the years as the medical world turned instead to lab tests and x-rays. In 1950, this practice was performed on about half of deceased hospital patients. Today, these rates have shrunk to between 5% and 11%.
“It’s really a kind of missing tool,” said Dr. Richard Vander Hyde, a pathologist at Louisiana State University.
Some hospitals found it more difficult this year. Safety concerns about transmission have forced many hospital officials to halt or seriously reduce autopsies in 2020. The pandemic has also led to a general decline in the total number of patients in many hospitals, which has reduced autopsy rates in some places. Large hospitals across the country are reporting fewer autopsies in 2020.
“Overall, our numbers have decreased significantly” from 270 autopsies in recent years to about 200 autopsies so far this year, said Dr. Alicia Wilson, director of anatomy and forensic services at Michigan Medicine in Ann Arbor.
At the University of Washington in Seattle, pathologist Dr. Desiree Marshall was unable to perform an autopsy for COVID-19 in her regular ward, as it is one of the oldest hospital facilities, and she lacks proper ventilation to safely perform the operation. Marshall ended up loaning county medical examination offices for a few cases early on, and he’s been working outside the school’s animal research facilities since April.
Other hospitals have gone in the opposite direction, performing far more autopsies even under difficult conditions to try to better understand the epidemic and keep up with the wave of deaths that have led to at least 400,000 more deaths in the United States than usual.
At the University of New Orleans Medical Center, where Vander Hyde works, pathologists have performed 50% more autopsies than they have in recent years. Other hospitals in Alabama, California, Tennessee, New York and Virginia say they will also exceed their usual annual count for the procedure.
Their findings shaped our understanding of what COVID-19 does to the body and how we can combat it.
In the spring and early summer, for example, some critically ill coronavirus patients have been on ventilators for weeks at a time. Later, pathologists discovered that such extended ventilation could cause widespread lung injury, leading doctors to rethink how they used ventilators during the pandemic.
Doctors are now exploring whether blood thinners can prevent the microscopic blood clots that were discovered in patients early in the epidemic.
Autopsy studies also indicated that the virus may be transmitted through the bloodstream or superimposed on infected cells and spread and affect blood vessels, heart, brain, liver, kidneys and colon. This finding helped explain a wide range of symptoms of the virus.
More results are sure to come: Pathologists have stored freezing devices in organs and tissues infected with the coronavirus collected during autopsies, which will help researchers study the disease as well as possible treatments and treatments. Future autopsies will also help them understand the impact of the disease on people who travel long distances, and who experience symptoms for weeks or months after being infected.
Despite these life-saving discoveries made during the pandemic, the financial realities and a dwindling workforce mean that ancient medical practice is unlikely to fully recover when the outbreak recedes.
Hospitals are not required to provide autopsy services, and in the ones that do, the costs of the procedure are not covered directly by most private insurance companies or by Medicare.
“When you think that there is no compensation for this, it is almost an altruistic exercise,” said Dr. Billy Five Kirchner, a pathologist at Rutgers University. “It’s very important but we don’t have to fund it.”
Added to the mix: the number of experts who can actually perform autopsies is extremely low. It is estimated that the United States has only a few hundred forensic pathologists, but it can employ several thousand – and less than one in 100 medical school graduates enter the profession each year.
Some in the field are hoping the 2020 pandemic will boost employment in the field – just like the “CSI boom” of the early 2000s, says Williamson of Northwell.
Wilson of Michigan Medicine is more skeptical, but she still can’t imagine her business is completely out of date. She said that learning from the dead to heal the living – it is a pillar of medicine.
It helped clinicians understand the mysteries of the 1918 influenza pandemic, as it is now helping them understand the mysteries of COVID-19 more than a century later.
Vander Hyde said of the doctors trying to save lives in 1918: “They were in the same position. The only way to know what was going on was to open the body and see.”