As a result of the 2019 novel human coronavirus (COVID-19) global spread, medical examiner/coroner offices will inevitably encounter increased numbers of COVID-19-infected decedents at autopsy. While in some cases a history of fever and/or respiratory distress (eg, cough or shortness of breath) may suggest the diagnosis, epidemiologic studies indicate that the majority of individuals infected with COVID-19 develop mild to no symptoms. Those dying with-but not of-COVID-19 may still be infectious, however. While multiple guidelines have been issued regarding autopsy protocol in cases of suspected COVID-19 deaths, there is some variability in the recommendations. Additionally, limited recommendations to date have been issued regarding scene investigative protocol, and there is a paucity of publications characterizing COVID-19 postmortem gross and histologic findings. A case of sudden unexpected death due to COVID-19 is presented as a means of illustrating common autopsy findings, as well as diagnostic and biosafety considerations. We also review and summarize the current COVID-19 literature in an effort to provide practical evidence-based biosafety guidance for medical examiner-coroner offices encountering COVID-19 at autopsy.

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Pasteurella multocida, a gram-negative bacillus, is present in the oropharyngeal secretions of livestock, wild animals, and domesticated pets and can cause infection in humans. The most common route of entry has been shown to be via an animal bite, but a significant portion of cases of human infection lack evidence of such a wound. Review of the literature reveals that patients with a history of an animal bite tend to have a less aggressive clinical course than patients without an animal source of infection.  We present a case, however, of Pasteurella multocida bacteremia which resulted in the death of an immunocompromised 80-year old woman in which the route of infection was found at autopsy to be a cat bite. This case highlights the importance of educating patients, particularly those with underlying immunocompromised conditions, of the possible lethal complications that can result from animal inflicted wounds and the importance of seeking medical assistance should a bite occur.

Training in autopsy encompasses the acquisition of skills and knowledge beyond the Y-shaped incision. In addition to learning basic tissue examination and processing skills, the autopsy service provides education in teamwork, professionalism and leadership, communication, public health, research, and self-reflection. Regardless of future specialization or practice setting, education provided by the autopsy has the potential to influence both the professional and personal lives of the trainees. Despite widespread agreement that autopsy education improves patient care, challenges to building and maintaining a dynamic and educational autopsy service exist and include factors that are both intrinsic and extrinsic to the practice of autopsy itself. Challenges including adequate volume of cases, knowledge of the procedure and skill in obtaining consent for autopsies, inclusion of an autopsy experience in medical school curriculums, competition for resident time, lack of subspecialists such as pediatric/perinatal and cardiac pathologists, and political action to gain support from regulatory bodies are addressed. Finally, we explore the way forward in autopsy education. Solutions such as the standardization of the educational autopsy, valuing the quality of competence over quantity of cases, and benefits of the Office of Decedent Affairs are discussed. By rededicating ourselves to the education of trainees via experiences on the autopsy service, we empower them to harness the many opportunities offered by the postmortem examination and ensure autopsy's seat at the table in 21st-century medicine.

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