Do We Really Need Hazard Prevention at the Expense of Safeguarding Death Dignity in COVID-19?

Abstract

To date, little is known regarding the transmission risks of SARS-CoV-2 infection for subjects involved in handling, transporting, and examining deceased persons with known or suspected COVID-19 positivity at the time of death. This experimental study aims to define if and/or how long SARS-CoV-2 persists with replication capacity in the tissues of individuals who died with/from COVID-19, thereby generating infectious hazards. Sixteen patients who died with/from COVID-19 who underwent autopsy between April 2020 and April 2021 were included in this study. Based on PMI, all samples were subdivided into two groups: ‘short PMI’ group (eight subjects who were autopsied between 12 to 72 h after death); ‘long PMI’ (eight subjects who were autopsied between 24 to 78 days after death). All patients tested positive for RT-PCR at nasopharyngeal swab both before death and on samples collected during post-mortem investigation. Moreover, a lung specimen was collected and frozen at −80 °C in order to perform viral culture. The result was defined based on the cytopathic effect (subjective reading) combined with the positivity of the RT-PCR test (objective reading) in the supernatant. Only in one sample (PMI 12 h), virus vitality was demonstrated. This study, supported by a literature review, suggests that the risk of cadaveric infection in cases of a person who died from/with COVID-19 is extremely low in the first hours after death, becoming null after 12 h after death, confirming the World Health Organization (WHO) assumed in March 2020 and suggesting that the corpse of a subject who died from/with COVID-19 should be generally considered not infectious.

The Impact of the COVID-19 Pandemic on the Practice of Forensic Medicine: An Overview

“…As previously discussed, based on a very recent study, the COVID-19 corpse may be considered safe a few hours after death. These data seem to be confirmed by the absence of evidence of infection from cadavers, also in consideration of the great number of COVID-19 deaths worldwide [ 90 ]. Another important aspect that supports this theory is related to corpse management of those who died from other causes (road accidents, suicides, deaths at work), because they may be asymptomatic individuals.…”

“…This category includes individuals who are SARS-CoV-2 positive but have no clinical or radiological manifestations of COVID-19 [ 127 ]. Personnel involved in corpse management (mortuary staff, first aid personnel, pathologists) did not always apply the measures prescribed for handling COVID-19 corpses; despite this, no cases of infection related to this type of practice have been reported [ 90 ]. This aspect is strictly related to forensic personnel activities: all investigations should be considered at high risk of infection, taking the right countermeasures [ 89 ].…”

“…Despite many articles demonstrating the persistence of SARS-CoV-2 RNA in post-mortem specimens, the possibility that the virus retains replicative capacity remains to be proven. To date, only a few studies have been conducted concerning the viability of the virus and the infectivity hazard to the personnel involved in COVID-19 corpse management [ 90 , 91 ]. Recent data demonstrated that a few hours (12 h) after death, the corpses of subjects who died with/from COVID-19 may be considered noninfectious.…”

The Risk of COVID-19 Infection in Prisons and Prevention Strategies: A Systematic Review and a New Strategic Protocol of Prevention

“…However, this measure dramatically reduced prisoners’ human rights and only slightly slowed the progression of COVID-19 within prisons [ 66 , 67 ]. Italy also adopted other types of maneuvers to prevent COVID-19 infection within prisons, such as the possibility of home detention in cases of prisoners with less than 18 months of sentence to serve [ 68 , 69 , 70 ]. However, the release of prisoners is a highly debated topic: on the one hand, it could reduce overcrowding in prisons, but on the other hand, it would put prisoners on probation who may not have a home to live in.…”

Post-mortem Findings of Inflammatory Cells and the Association of 4-Hydroxynonenal with Systemic Vascular and Oxidative Stress in Lethal COVID-19

“…The autopsies were carried out by pathologists experienced in BSL3 autopsies, who conducted postmortem evaluations by an in situ evaluation of the body cavities and organs, but a post-mortem swab of the lower airways was not taken because the patients has tested daily and were SARS-CoV-2 positive until death. All autopsies were performed between 17 and 28 h after death, assuring the accuracy of the evaluation and a sufficiently safe autopsy procedure [27,28].…”