The contribution of autopsy in COVID-19 pandemic: Missed opportunity in Sub-Saharan Africa

Abstract

‘Autopsy studies are for the living and not the dead!’ This statement underlines the central role of autopsy studies in refining and informing the medical and forensic science body of knowledge. Significant outbreaks, like the ongoing COVID-19 pandemic, have continued to reveal the capacity gap in autopsy practice, especially in Sub-Saharan Africa (SSA). Despite the importance of autopsy in investigating previous infectious disease outbreaks, health systems in SSA still assign a lesser priority to autopsy and forensic practice. Some of the critical factors hindering routine clinical autopsy are the lack of experts and facilities, and a health system that focuses less on postmortem examination. Societal traditions and cultural beliefs against the practice of autopsy and manipulation of the dead body are also significant barriers. Nevertheless, strengthening the role of autopsy in clinical practice may help clinicians to more quickly address clinical questions associated with highly infectious outbreaks.

Post-mortem examination of Hospital Inpatient COVID-19 Deaths in Lusaka, Zambia - A Descriptive Whole-body Autopsy Series

“…However, our study illustrates that autopsies during the COVID-19 era are possible to conduct on SARS-CoV-2 infected subjects in Zambia. There is a need to revive clinical and research autopsies througout sub-Saharan African countries ( Mawalla, 2020 , Mucheleng’anga and Himwaze, 2020 , Bruce-Brand et al, 2020 , Mudenda et al, 2020 , Rampatige and Gilks, 2015 , Barth et al, 2020 , Yi et al, 2020 ) to add to the provisional information provided by our study. Further autopsies with accurate data are required to conjure a more comprehensive picture of the pathogenesis and impact of COVID-19 in SSA.…”

“…An area of continuing neglect and missed opportunities for COVID-19 research in SSA is that of accurately defining the pathological features of COVID-19 and ascertaining the underlying cause(s) of death from COVID-19 in hospitals ( Bamgboye et al, 2020 , Mawalla, 2020 , Mucheleng’anga and Himwaze, 2020 ). Whilst several reports of whole body autopsy case series and organ specific pathology have been published from China, Europe and USA ( Maiese et al, 2020 ), there is little information on post-mortem examination and the pathology of COVID-19 in SSA.…”

“…There are only two individual case reports of whole body autopsies and lung biopsy studies of four South African ICU patients obtained after death ( Mulale et al, 2021 , Khaba et al, 2020 , Bruce-Brand et al, 2020 ). Several reports have emphasized the need for rekindling and revamping autopsy and post-mortem studies in SSA ( Mawalla, 2020 , Mucheleng’anga and Himwaze, 2020 , Maiese et al, 2020 , Mulale et al, 2021 , Khaba et al, 2020 , Bruce-Brand et al, 2020 , Mudenda et al, 2020 ), to determine the underlying pathology and causes of COVID-19 deaths occurring in hospital inpatients.…”

“…Whole-body autopsies in general, and on confirmed or suspected SARS-CoV-2 cases in Africa have not been forthcoming due to scarcity of pathologists, inadequate infrastructure, and difficulties in obtaining consent for autopsies ( Mawalla, 2020 , Mucheleng’anga and Himwaze, 2020 , Khaba et al, 2020 , Rampatige and Gilks, 2015 ). In addition, performing autopsies in environments where infectious pathogens such as SARS-CoV-2 are suspected or confirmed, requires optimal biosafety facilities ( World Health Organization, 2020 , Baj et al, 2021 , Liang et al, 2020 ), which are unavailable in most African countries.…”

Substance Use Disorder and COVID-19; Forensic Medicine and Pharmacology Perspectives: A Concise Narrative Review

“…Leaving the possibilities for criminal offences higher than usual. Therefore, the lack of autopsy data prevents the cycle of information that helps connect clinical care to forensic pathology practices in forensic medicine [22].…”