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Autopsy Findings in COVID-19 Patients

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Autopsy Findings in COVID-19 Patients

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Read this article to know the significant details of autopsy obtained through postmortem of COVID-affected people.

Medically reviewed by

Dr. Kaushal Bhavsar

Published At November 3, 2020
Reviewed AtFebruary 13, 2024


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the death of millions of people all over the world. Many countries were successful in bringing down the COVID cases by lockdowns, strict social distancing rules, and vaccination. However, SARS-CoV-2 that causes COVID-19 (the coronavirus disease 2019), has significantly impacted people's health and lives.

For a more thorough understanding of the disease process and treatment, scientists have conducted autopsies on the victims, which has provided a more detailed understanding of the histopathological and anatomical findings of the disease. It has also given a rough idea about the mechanism of action and disease pathology, but more remains unclear. We have included the significant findings obtained through postmortem and how the virus affects multiple systems in the body.

What Do We Know About SARS-CoV-2 So Far?

SARS-CoV-2 is a novel RNA (ribonucleic acid) virus. It has a similar genomic sequence, clinical presentation, and behavior to SARS-CoV, the virus that caused SARS in 2003. The virus has a surface spike glycoprotein that binds to the protein angiotensin-converting enzyme 2 (ACE2) which is located in the tissues of the lungs, heart, digestive tract, lymph nodes, brain, etc. SARS-CoV-2 is more virulent and affects multiple systems in the human body.

Clinical Presentation:

The severity of clinical manifestations of COVID-19 ranges from asymptomatic forms to severe respiratory failure. Based on the following categories, the clinical manifestations include-

  1. Asymptomatic - Such patients do not exhibit any symptoms but might still spread the infection to others.

  2. Mild - Mild fever, headache, tiredness, dry cough, nasal congestion, sore throat, and muscle pain. Some people also experience shallow breathing and shortness of breath. Almost 81 % of all patients exhibit mild to moderate symptoms.

  3. Severe - Shortness of breath, oxygen saturation less than 93 %, and rapid breathing. Around 14 % of the cases have these symptoms. The patient can have pneumonia, sepsis, or acute respiratory distress syndrome.

  4. Critical - Critically ill patients exhibit cardiac symptoms, respiratory failure, septic shock, and multiple organ failure (MOF). Only 5 % of patients show critical symptoms.

Other symptoms of COVID-19 include,

Causes of Death From COVID-19:

The following are the main causes of death from COVID-19-

  1. Acute respiratory distress syndrome (ARDS) - The small air sacs in the lungs fill with fluid, depriving the organs in the body of oxygen.

  2. Sepsis - It is a life-threatening and extreme response of the body’s immune system to an infection.

  3. Acute cardiac injury - Results in elevated cardiac markers, such as troponin. It is considered equivalent to myocardial infarction (MI).

  4. Type I respiratory failure - Lung damage results in a lack of oxygen.

  5. Heart failure - The heart muscles do not pump sufficient blood.

  6. Alkalosis - Increased bicarbonate in the blood increases the alkalinity and decreases acid in the blood.

  7. Acute kidney injury - Kidney damage or kidney failure due to infection.

  8. Hypoxic encephalopathy - Brain injury due to a lack of oxygen supply.

  9. Hyperkalemia - Higher potassium levels in the blood.

Various studies have shown hyperinflammatory response to the virus is the main cause of death as it affects the heart vessels, kidney, liver, and other vital organs.

What Are the Postmortem Findings in COVID-19 Victims?

1) Lung Findings:

  • Pulmonary Capillary Congestion - Accumulation of fluid in the lung capillaries, affecting the exchange of oxygen and carbon dioxide.

  • DAD - Diffuse alveolar damage (DAD) is damage to the gas-exchange surfaces (alveoli) in the lungs. This leads to edema (swelling), fibrosis (scarring), and impaired oxygen exchange.

  • Bronchopneumonia - A type of pneumonia that results in inflammation of the small air sacs in the lungs (alveoli).

  • Emphysema - Here, alveoli get damaged, resulting in shortness of breath.

  • Pulmonary Embolism - Blood clots block the arteries present in the lungs.

  • Pulmonary Hemorrhage - Bleeding from the upper or lower respiratory tract.

  • Amyloidosis of Vessels - Abnormal protein called amyloid starts depositing in different parts of the lungs and its vessels.

  • Pulmonary Vasculitis - Inflammation and destruction of blood vessels present in the lungs.

2) Heart Findings:

  • Myocardial Hypertrophy - The thickening of heart muscles.

  • Senile Amyloidosis - Deposition of abnormal protein in heart muscles.

  • Pericarditis - Inflammation of the pericardium, which is the fibrous connective tissue surrounding the heart.

  • Cardiac Fibrosis - Abnormal thickening of heart muscles or heart valves.

  • Acute Myocardial Infarction - Blockage in one or more arteries of the heart.

  • Myocardial Necrosis - Cell death (necrosis) of heart muscles.

3) Liver Findings:

  • Fatty Liver - Abnormal fat deposition in the liver.

  • NASH - Nonalcoholic fatty acid disease (NASH) is an advanced stage of fatty liver.

  • Hepatic Necrosis - Lack of oxygen supply to the liver results in shock and cell death.

4) Lymph Node Findings:

  • Lymphatic Congestion - The lymph nodes get blocked or clogged.

  • Increased Plasmablasts - Plasmablasts are immature plasma cells that secrete antibodies.

5) Spleen Findings:

  • Splenitis - Inflammation of the spleen.

6) Kidney Findings:

  • Acute Tubular Necrosis - Low blood flow to the kidneys damages the cells present in renal tubules.

  • Glomerulosclerosis - Scarring or hardening of the tiny blood vessels (glomeruli) in the kidney.

  • Disseminated Intravascular Coagulation - Here, blood clots block small blood vessels of the kidneys, resulting in acute kidney injury.

  • Hypertensive Nephropathy - Kidney failure.

Live SARS-CoV-2 Virus Found During Autopsy:

During the first autopsy conducted in India, doctors were able to isolate the live SARS-CoV-2 virus 18 hours after the patient’s death. This 62-year-old COVID-19 patient died after 14 days of treatment and had active viruses in the mouth, throat, and nasal area. The various swabs that the doctors took from the mouth, throat, and nose all tested positive in the RT-PCR test. But, there was no trace of the virus on the skin or the surface of internal organs like the lungs.

Similarly, a forensic practitioner most likely was infected by a deceased patient in Thailand. This is why it is not surprising to find live SARS-CoV-2 virus for up to hours or days after death. The virus can be present in the nasal secretions and can also be replicating in the cells of the body that have not yet died. Though the duration till which the coronavirus could stay alive in human corpses is inconclusive and unclear, scientists assert that the viral genome persists in the corpse’s tissues for more than 30 days. Hence, it can be hypothesized that disease transmission from the deceased can occur until a certain period after death, even after disinfecting the corpse.

Frequently Asked Questions


How Is the Coronavirus Related to SARS-CoV-2?

A disease outbreak in China was linked to a novel coronavirus in 2019. The infection is called coronavirus two severe acute respiratory syndromes (SARS-CoV-2). In addition, it creates a condition known as coronavirus disease (COVID-19).


What Distinguishes SARS-CoV From SARS-CoV-2?

SARS-CoV is no longer a threat from a pandemic, but SARS-CoV-2 is now actively spreading. Because many persons with SARS-CoV-2 have minor or no symptoms, it is more difficult to detect and track the virus's spread and later to contain it.


What Type of Organism Is SARS, Virus, or Bacteria?

A class of viruses known as coronaviruses is responsible for some strains of the common cold and Severe Acute Respiratory Syndrome (SARS). The COVID19 virus is a novel coronavirus that causes the illness COVID-19 (or SARS-CoV-2 virus).


Why Does the SARS-CoV-2 Virus Have Variants?

When modifications to the genetic code (either from genetic mutations or viral recombination) occur during genome replication, viruses like SARS-CoV-2 continue to evolve. A lineage is a collection of genetically distinct viral strains with a common ancestor.


Does COVID Resemble SARS?

The human SARS-coronavirus-2 (CoV), which caused the 2003 SARS pandemic and is known as SARS-CoV-2, shares 82% of its genome with the coronavirus producing COVID-19.


Is There a Vaccination for SARS?

COVOVAX and Nuvaxovid are SARS-CoV-2 Protein (COVID-19) Nanoparticle Vaccines produced by Serum Institute of India Pvt Ltd and Novavax, respectively.


How Does the Body Respond to SARS?

Regarding SARS, infected immune cells such as monocyte-macrophages and hematopoietic cells secrete more pro-inflammatory cytokines like TNF-, IL-6, and IFN-/-, while fewer pro-inflammatory cytokines are produced.


Is SARS More Harmful Than COVID?

SARS was far less contagious than COVID-19 but much more lethal. Since 2003, there haven't been any SARS outbreaks anywhere worldwide. However, if a person has signs of COVID-19 (particularly coughing) or is caring for someone who may have COVID-19, they should only use a mask.


How Was SARS Eliminated?

Syndromic surveillance, early patient isolation, stringent contact quarantine enforcement, and in some places, top-down community quarantine enforcement were all used to contain SARS successfully. However, all human-to-human transmission had to be stopped to eradicate SARS.


Is SARS-CoV a Flu?

COVID-19 and influenza are contagious respiratory diseases, although distinct viruses bring them on. The coronavirus (SARS-CoV-2) that infected COVID-19 was first discovered in 2019. A flu virus infection (influenza virus) is what causes the flu.


How Is SARS Transmitted?

25 Virus particles can then be transferred from a vulnerable person's hands to their eyes, mouth, or nose by a subsequent touch. 26 Direct contact with an infected person who has contaminated their fingers from their nose or mouth is one possible variant on these routes.


Who Is Most Susceptible to SARS?

Infection prevalence was less than 5% in individuals under 18, but it was nearly four times higher in those 40 years or older.


Was Pfizer Applied for SARS?

The Pfizer substance was created to obstruct a protease enzyme. However, the molecule has been revived, and it only reacts with the coronavirus proteases that caused COVID-19 and SARS in 2003, respectively.


Is There a Mutation Of SARS?

Genes that are required for a virus to cause disease but are not necessary for the virus to survive are deleted. All known coronaviruses, including the SARS virus, appear to share these genes. Therefore, if they were eliminated, the SARS virus would be difficult to change back into a deadly form.


Is PCR and SARS-CoV-2 Equivalent?

Real-time RT PCR is used to find SARS-CoV-2. Poor outcomes do not rule out COVID-19 and shouldn't be the only factor considered when making patient treatment decisions. The clinical observations, patient history, and epidemiological data must be integrated with negative results.
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Dr. Kaushal Bhavsar
Dr. Kaushal Bhavsar

Pulmonology (Asthma Doctors)


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