NEW YORK – The COVID-19 pandemic helped revive the autopsy.
When the virus first arrived in U.S. hospitals, doctors could only speculate what caused its strange constellation of symptoms: Which could explain why patients lose their sense of smell and taste, develop skin rashes, struggle to breathe, and report memory loss on top of coughing and flu-like pain?
In hospital morgues, which have been constantly losing importance and funding for several decades, pathologists hastily dissected the first victims of the disease – and found some answers.
“We were getting an email from a clinician, kind of desperate, asking,‘ What do you see? ’” Dr. Amy Rapkiewicz of NYU Langone. “An autopsy,” she pointed out, 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 also instructed doctors to try blood thinners in some patients with COVID-19 and to reconsider how long others should be on ventilators.
“You can’t treat what you don’t know about,” said Dr. Alex Williamson, a pathologist from Northwell Health in New York City. “Many lives have been saved by careful observation of someone’s death.”
Autopsies have been informing about medicine for centuries – they have recently helped detect the scale of the opioid epidemic, improve cancer care and demystify AIDS and anthrax. In the past, hospitals evaluated how many autopsies they performed.
But over the years, they lost their stature because the medical world turned instead to laboratory tests and imaging. In 1950, the practice was conducted on about half of the deceased hospital patients. Today, those rates have dropped to somewhere between 5% and 11%.
“It’s a really lost tool,” said Louisiana State University pathologist Dr. Richard Vander Heide.
It has been even harder for some hospitals this year. Concerns about safety transfers have forced many hospital administrators to stop or severely curb autopsies by 2020. The pandemic has also led to a general decline in the total number of patients in many hospitals, which has reduced the autopsy rate in some places. Large hospitals across the country reported conducting fewer autopsies in 2020.
“Overall, our number is declining, quite significant,” from 270 autopsies in recent years to about 200 so far this year, said Dr. Allecia Wilson, director of autopsy and forensic services at Michigan Medicine in Ann Arbor.
At the University of Washington in Seattle, pathologist Dr. Desiree Marshall was unable to perform a COVID-19 autopsy in her usual apartment because, as one of the oldest facilities in the hospital, it does not have adequate ventilation to safely perform the procedure. Marshall eventually borrowed county medical examination offices early on and has been working at school animal research facilities since April.
Other hospitals have taken the opposite path, performing many more autopsies even under difficult circumstances to try to better understand the pandemic and track the sudden number of deaths that resulted in at least 400,000 deaths in the U.S. more than normal.
At the University of New Orleans Medical Center, where Vander Heide works, pathologists performed about 50% more autopsies than in recent years. Other hospitals in Alabama, California, Tennessee, New York and Virginia say they will also exceed their usual annual sum for the procedure.
Their results have shaped our understanding of what COVID-19 does to the body and how we can fight it.
For example, in the spring and early summer, some seriously ill coronavirus patients have been on ventilators for weeks. Later, pathologists discovered that such prolonged ventilation could cause extensive lung injuries, which led doctors to reconsider the way they use ventilators during a pandemic.
Doctors are now investigating whether blood thinners can prevent microscopic blood clots that are detected in patients early in a pandemic.
Autopsy studies have also shown that the virus can travel through the bloodstream or travel through infected cells, spreading and affecting a person’s blood vessels, heart, brain, liver, kidneys and colon. This finding helped explain a wide range of virus symptoms.
More knowledge is sure to come: Pathologists have supplied freezers to organs and tissues infected with coronavirus collected during autopsies, which will help researchers study the disease, as well as possible cures and treatments. Future autopsies will also help them understand the tribute to the disease on long carriers, those who suffer from symptoms for weeks or months after infection.
Despite these life-saving discoveries made during the pandemic, financial reality and a shrinking workforce mean it is unlikely that ancient medical practice will fully recover when the epidemic subsides.
Hospitals are not required to provide autopsy services, and for those who perform them the costs of the procedure are not covered directly by most private insurance or Medicare.
“When you think there is no compensation for that, it is almost an altruistic practice,” said a pathologist from Rutgers University, Dr. Billie Fyfe-Kirschner. “It’s vital, but we don’t have to fund it.”
Added to the combination: The number of professionals who can actually perform autopsies is critically low. Estimates suggest that the United States has only a few hundred forensic pathologists, but that it could be used by several thousand – and less than one in 100 medical school graduates enter the profession each year.
Some on the ground are hoping the 2020 pandemic could boost job recruitment – just like the “CSI boom” of the early 2000s, Northwell’s Williamson said.
Wilson of Michigan Medicine is more skeptical, but he still can’t imagine her work becoming completely outdated. Learning from the dead how to treat the living is a pillar of medicine, she said.
Helping doctors understand the mysteries of the 1918 flu pandemic, it is now helping them understand the secrets 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 what was going on was to open the body and see.”
The Department of Health and Science of the Associated Press receives support from the Department of Scientific Education of the Howard Hughes Medical Institute. The AP is solely responsible for all content.