Dr. Amy Rapkiewicz, pathology department chair at NYU Langone Hospital - Long Island, looks at slides from a biopsy in her office in Mineola, N.Y., Wednesday, Dec. 16, 2020. Experts say the COVID-19 pandemic has helped revive the autopsy at many hospitals. The procedure has helped doctors this year understand what coronavirus does to patients’ organs and how they might better treat some of the disease’s more baffling symptoms. (AP Photo/Seth Wenig)

Dr. Amy Rapkiewicz, pathology department chair at NYU Langone Hospital - Long Island, looks at slides from a biopsy in her office in Mineola, N.Y., Wednesday, Dec. 16, 2020. Experts say the COVID-19 pandemic has helped revive the autopsy at many hospitals. The procedure has helped doctors this year understand what coronavirus does to patients’ organs and how they might better treat some of the disease’s more baffling symptoms. (AP Photo/Seth Wenig)

The autopsy, a fading practice, revealed secrets of COVID-19

Early autopsies confirmed COVID does not just cause respiratory disease, but can also attack other vital organs

The COVID-19 pandemic has helped revive the autopsy.

When the virus first arrived in U.S. hospitals, doctors could only guess what was causing its strange constellation of symptoms: What could explain why patients were losing their sense of smell and taste, developing skin rashes, struggling to breathe and reporting memory loss on top of flu-like coughs and aches?

At hospital morgues, which have been steadily losing prominence and funding over several decades, pathologists were busily dissecting the disease’s first victims — and finding some answers.

“We were getting emails from clinicians, kind of desperate, asking, ‘What are you seeing?’” said NYU Langone’s Dr. Amy Rapkiewicz. ‘Autopsy,’ she pointed out, means to see for yourself. “That’s exactly what we had to do.”

Early autopsies of deceased patients confirmed the coronavirus does not just cause respiratory disease, but can also attack other vital organs. They also led doctors to try blood thinners in some COVID-19 patients and reconsider how long others should be 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 have been saved by looking closely at someone’s death.”

Autopsies have informed medicine for centuries — most recently helping to reveal the extent of the opioid epidemic, improve cancer care and demystify AIDS and anthrax. Hospitals were once judged by how many autopsies they performed.

But they’ve lost stature over the years as the medical world instead turned to lab tests and imaging scans. In 1950, the practice was conducted on about half of deceased hospital patients. Today, those rates have shrunk to somewhere between 5% and 11%.

“It’s really kind of a lost tool,” said Louisiana State University pathologist Dr. Richard Vander Heide.

Some hospitals found it even harder this year. Safety concerns about transmission forced many hospital administrators to stop or seriously curb autopsies in 2020. The pandemic also led to a general dip in the total number patients at many hospitals, which drove down autopsy rates in some places. Large hospitals around the country have reported conducting fewer autopsies in 2020.

“Overall, our numbers are down, pretty 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 couldn’t conduct COVID-19 autopsies in her usual suite because, as one of the hospital’s oldest facilities, it lacks the proper ventilation to safely conduct the procedure. Marshall ended up borrowing the county medical examiner offices for a few cases early on, and has been working out of the school’s animal research facilities since April.

Other hospitals went the opposite way, performing far more autopsies even under difficult circumstances to try to better understand the pandemic and keep up with a surge of deaths that has resulted in at least 400,000 more U.S. deaths than normal.

At New Orleans University Medical Center, where Vander Heide works, pathologists have performed about 50% more autopsies than they have in recent years. Other hospitals in Alabama, California, Tennessee, New York and Virginia say they’ll also surpass their usual annual tally for the procedure.

Their results have shaped our understanding of what COVID-19 does to the body and how we might combat it.

In spring and early summer, for example, some seriously sick coronavirus patients were on ventilators for weeks at a time. Later, pathologists discovered such extended ventilation could cause extensive lung injury, leading doctors to rethink how they use ventilators during the pandemic.

Doctors are now exploring whether blood thinners can prevent microscopic blood clots that had been discovered in patients early in the pandemic.

Autopsy studies also indicated the virus may travel through the blood stream or hitch a ride on infected cells, spreading to and impacting a person’s blood vessels, heart, brain, liver, kidneys and colon. This finding helped explain the virus’s wide range of symptoms.

More findings are sure to come: Pathologists have stocked freezers with coronavirus-infected organs and tissues 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 disease’s toll on long haulers, those who suffer symptoms for weeks or months after infection.

Despite these life-saving discoveries being made during the pandemic, financial realities and a dwindling workforce mean it’s unlikely that the ancient medical practice will fully rebound when the outbreak wanes.

Hospitals are not required to provide autopsy services, and in those that do perform them, the procedure’s costs are not directly covered by most private insurance or by Medicare.

“When you consider there’s no reimbursement for this, it’s almost an altruistic practice,” said Rutgers University pathologist Dr. Billie Fyfe-Kirschner. “It’s vitally important but we don’t have to fund it.”

Added into the mix: The number of experts who can actually perform autopsies is critically low. Estimates suggest the U.S. has only a few hundred forensic pathologists but could use several thousand — and less than one in 100 graduating medical school students enters the profession each year.

Some in the field hope the 2020 pandemic could boost recruitment to the field — just like the “CSI boom” of the early 2000s, Northwell’s Williamson said.

Michigan Medicine’s Wilson is more skeptical, but even still she can’t imagine her work becoming totally obsolete. Learning from the dead to treat the living — it’s a pillar of medicine, she said.

It helped doctors understand the mysteries of 1918’s influenza pandemic, just at is now helping them understand the mysteries of COVID-19 more than a century later.

“They were in the same situation,” Vander Heide said of the doctors trying to save lives in 1918. “The only way to learn what was going on was to open up the body and see.”

Marion Renault, The Associated Press

Like us on Facebook and follow us on Twitter.

Want to support local journalism? Make a donation here.

Coronavirus

Just Posted

A single motorcycle parked outside of the Kelowna Hells Angels clubhouse at 837 Ellis Street on July 9, 2020. (Michael Rodriguez - Capital News)
Kelowna Hells Angels prospect sentenced to 9 months in jail for aggravated assault

Colin Michael Bayley pleaded guilty to the downtown Kelowna assault earlier this month

Rescue crews search for a missing diver in Okanagan Lake at Hot Sands Beach by the William R. Bennett Bridge on Sunday, May 16. (Michael Rodriguez/Capital News)
Missing Okanagan Lake diver presumed drowned, recovery efforts continue

Boaters are asked to stay away from the area as crews continue the search

(Lindsey Roche/Contributed)
Kelowna children enjoy drive-in movie thanks to support from the community

A daycare in the Mission area gets creative during the COVID-19 pandemic

File photo (Aaron Hemens/Capital News)
Overturned kayak in Mission Creek prompts police response

Kelowna RCMP is looking to speak with anyone who may know the individual associated with the kayak

A drug bust on Government Street in Duncan on Tuesday, March 30, led to a "substantial seizure" according to the North Cowichan/Duncan RCMP. (File photo)
Search continues for diver who went missing in Okanagan Lake

Search and rescue, RCMP underwater recovery team looking for diver missing since Saturday afternoon

An avalanche near Highway 1 in Glacier National Park. Avalanche Canada will benefit from a $10 million grant from the B.C. government. (Photo by Parks Canada)
Avalanche Canada receives $10 million grant from B.C. government

Long sought-after funds to bolster organization’s important work

Fate, an American cocker spaniel bred at Lavington’s Aladdin Cockers by Carol and Robin Edwards, is currently the No. 1 ranked cocker spaniel in the U.S. and has drawn an invitation to the world’s most famous dog show, the Westminster Kennel Club event in New York, next month. (Photo submitted)
Okanagan-bred cocker spaniel to strut stuff at Westminster Kennel Club

Fate, an American cocker spaniel bred by Lavington’s Aladdin Cockers, is ranked No. 1 in the U.S.

KCR Migrant Support Worker, Javier, had an exciting day escorting his son Ian with him during ‘Take your Child to Work Day’!
KCR: Volunteering is being part of a whole

KCR Community Resources shares stories of its volunteers in a weekly column

Conservation Service Officer Kyle Bueckert holds a gold eagle that was revived from acute rodent poisoning Monday, May 12. Photo: Submitted
‘Obviously, he’s a fighter’: Golden eagle, recovered from poisoning, back in Kootenay wild

CSO Kyle Bueckert released the eagle into the wild Thursday, May 13

A fledgling white raven was spotted near the end of Winchester Road in Coombs. (Mike Yip photo)
Legend continues as iconic white raven spotted once again on Vancouver Island

Sightings rare everywhere in world except for central Vancouver Island location

Capt. Jenn Casey died in a crash just outside of Kamloops, B.C., on May 17, 2020. (CF Snowbirds)
Snowbirds to honour Capt. Casey, who died in B.C. crash, in 2021 tour

Tour will kick off in Ontario in June before heading west

Cannabis bought in British Columbia (Ashley Wadhwani/Black Press Media)
Is it time to start thinking about greener ways to package cannabis?

Packaging suppliers are still figuring eco-friendly and affordable packaging options that fit the mandates of Cannabis Regulations

This bird box at the Salmon Arm Foreshore lies broken on May 14, 2021 after someone pulled the pole out of the ground and smashed the formerly occupied nest. It was one of more than 30 that have been wrecked. (Martha Wickett-Salmon Arm Observer)
Destruction of nests, birds at Salmon Arm foreshore described as horrifying

More than 30 bird boxes made by community destroyed, just one was not occupied

Ranchero resident Cody Krabbendam proudly displays the Lifesaving Society awards he recently received for a rescuing another boy while swimming at Sicamous Beach in July 2020. (Contributed)
Shuswap boy receives medal of bravery, scholarship for rescue at Sicamous beach

Last summer Cody Krabbendam jumped into the lake to save another boy from drowning

Most Read