COVID-19 and Sudden Unexpected Community Deaths in Lusaka, Zambia, Africa - A Medico-Legal Whole-Body Autopsy Case Series

Abstract

Background Data from Africa of sudden and unexpected COVID-19 community deaths, and underlying pathological, demographic and co-morbidity features require definition. Methods We performed a descriptive case series of COVID-19 related deaths seen at Forensic Post-Mortem autopsy examination of sudden and unexpected Community Deaths in Lusaka, Zambia, Africa. Post-Mortem gross and histopathological examinations of all organs were performed according to Standard Operating Procedures. . Patient demographics, history, co-morbidities, pathological gross and microscopic findings, and cause(s) of death were recorded. Variables were grouped as frequencies and percentages. Comparison of data was made with autopsy findings of hospital COVID-19 deaths. Findings Of 21 COVID-19 decedents, 14/21 (66.2%) were male. 18/21, (85%) were below 55 years of age, (mean age, 40 ± 12.3; range, 20-73). Median duration of symptoms was 1 day (range 0-2). 9/21 (42.9%) had comorbidities, with hypertension and obesity being the most common. Main post-mortem findings were diffuse alveolar damage (DAD) (80.9%), saddle and shower emboli (38.1% respectively), and pneumonia (14.3%). Pulmonary thromboembolism (76.2%), DAD (14.3%) and SARS-CoV-2 pneumonia (9.5%) were common causes of death. Conclusions COVID-19 as cause of death in medico-legal death (forensic) investigation of sudden and unexpected community deaths Risk factors for the younger age of COVID-19 deaths and thromboembolism need to be identified.

Prevalence of Acute Pulmonary Embolism at Autopsy in Patients With COVID-19

“…After excluding duplicates and preliminary screening, 155 full-text articles were assessed for eligibility, and 141 studies were excluded for not meeting the inclusion criteria, leaving 13 studies fulfilling the inclusion criteria ( Figure 1 , Supplementary File 2 ). 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19

Figure 1 Flow diagram of selected studies for the meta-analysis according to the PRISMA. PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

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“…At autopsy, histopathologic findings of deep vein thrombosis were observed in 16.6% of cases in 4 studies (mean age 56.0 years). 7 , 9 , 14 , 17 The administration of anticoagulant treatment was not systematically performed in the reviewed studies. Quality assessment showed that all studies were of moderate-high quality according to the Newcastle-Ottawa quality assessment scale ( Table 2 ).…”

“… 8 China 26 69.8 (10.3) 13 (50 %) 9 (34.6 %) NR 4 (15.4 %) NR 2 (7.7 %) NR Mucheleng'anga et al. 9 Zambia 21 40 (12.3) 14 (66.2 %) 3 (14.3 %) 3 (14.3 %) 1 (4.8 %) NR NR 3 (14.2 %) Dal Ferro et al. 10 Italy 40 79 (11) 22 (55 %) NR 15 (37 %) 10 (24 %) NR NR NR Romanova et al.…”

“…Autopsy findings reported that the cumulative prevalence of acute PE as an underlying cause of death in patients with COVID-19 ranged between 3.8% and 66.2% reviewing 9 studies based on 303 subjects (mean age 64.0 years). 6 , 7 , 8 , 9 , 11 , 13 , 16 , 17 Using a random-effect model, the pooled prevalence of acute PE, as an underlying cause of death was 19.9% (95% CI 11.0 to 33.3%, I 2 83.3%) ( Figure 3 ). Because of the low number of the included studies (<10), Egger's test cannot be performed; however, the visual inspection of the relative funnel plot ( Supplementary File 3 ) did not reveal significant evidence of publication bias.…”

SARS-CoV-2 seroprevalence and associated risk factors in periurban Zambia: a population-based study

“…Several studies have shown that individuals with co-morbidities are at increased risk of severe COVID-19 disease and death (Dustan, 1990;Edler et al, 2020;Mucheleng'anga et al, 2021;Mwananyanda et al, 2021). In other studies, risk of infection in HIV-positives or in previous TB patients was not more than 1.5-2 times higher than for HIV-negatives or non-TB patients (Chanda D et al;Mulenga et al, 2021).…”