Biosafety Requirements for Autopsies of Patients with COVID-19: Example of a BSL-3 Autopsy Facility Designed for Highly Pathogenic Agents

Abstract

Information obtained from autopsies of patients infected with high-risk pathogens is an important pillar in managing a proper response to pandemics, particular in the early phase. This is due to the fact that autopsy allows efficient evaluation of comorbidities for risk assessment, as well as identification of key pathophysiological and molecular mechanisms in organs driving the severity of disease which might be important targets for therapeutic interventions. In the case of patients who have died of infection with unknown pathogens, isolation and culture of pathogens from the affected organs is another important opportunity for a proper response to (re)emerging infectious diseases. However, the situation of COVID-19 demonstrated that there were concerns about performing autopsies because of biosafety risks. In this review we compare requirements for biosafety level 3 (BSL-3) laboratories from the European Commission and the World Health Organization and summarize specific recommendations for postmortem analysis of COVID-19-deceased patients from the Centers for Disease Control and Prevention. Furthermore, we describe in detail a BSL-3 facility with enhanced protection of personnel and an environment that has been designed for performing autopsies, biobanking of collected tissue specimens, and culture of pathogens in cases of high-risk pathogen infections and report on the experience obtained in operating this facility in the context of COVID-19.

Rapid Antigen Test for Postmortem Evaluation of SARS-CoV-2 Carriage

“…when qRT-PCR is not readily available, RAT might be useful in selecting the most hazardous corpses that should be examined under special conditions (e.g., Biosafety Level 3 [9]). RAT could therefore be a valuable adjunct tool in guiding autopsy practice.…”

“…In conclusion, RAT should not be seen as a potential replacement for but rather as an addition to current postmortem testing strategies. Especially when qRT-PCR is not readily available, RAT might be useful in selecting the most hazardous corpses that should be examined under special conditions (e.g., Biosafety Level 3 [ 9 ]). RAT could therefore be a valuable adjunct tool in guiding autopsy practice.…”

SARS-CoV2 neutralizing activity of ozone on porous and non-porous materials

“…All experimental procedures with SARS-CoV-2 were performed in a biosafety level (BSL)-3 laboratory at room temperature (RT, 22−24 °C) and 45 % relative humidity [ 26 ]. The experimental series were performed using a SARS-CoV-2 virus isolate (Human 2019-nCoV Isolate ex China Strain: BavPat1/2020) originated in the city of Wuhan (Hubei province, China).…”

Considerations for Maintaining Safety in Biobanks during the COVID-19 Pandemic: A Systematic Review

“…In the COVID-19 context, SOPs are required for the safe handling of biological samples obtained from individuals who may or may not be positive cases of COVID-19 [3,[17][18][19] . Clarity on these SOPs is however required by biobank staff to protect themselves against SARS-CoV-2 or prevent the transmission of COVID-19 to others [10] . The World Health Organization has developed a collection of guidance to support the safety of healthcare workers; in many instances, underestimation of the biosafety requirements is the norm [7] .…”

“…Building on these, biosafety guidelines have been developed by the government of many countries for COVID-19 biobanks [8][9] . The guidelines require observance of good laboratory practices and standard safety precautions while working with infectious samples [10] . Many COVID-19 biobanks are currently working under these recommended safety guidelines; however, others are defaulting in complete compliance to the safety recommendations.…”