Following in the footsteps of states like Madhya Pradesh and Gujarat, the Maharashtra government is now going to conduct a study on deceased Covid-19 patients through pathological autopsy to raise understanding of SARS-CoV-2’s disease-causing ability (pathology) and its impact on organs. For this, the Directorate of Medical Education and Research (DMER) is planning to seek permission from the Indian Council of Medical Research (ICMR). However, the forensic experts are concerned as aerosol produced during autopsy can expose them to the virus.
According to the experts, the pathological autopsy will help them to understand the critical insights into the pathogenesis of Covid-19 in humans. It can help in finding answers about the changes in tissues and examinations of organs and examine the physiology behind inflammation and blood-clotting, which are characteristic Covid-19 complications. The analysis can help in determining if the therapy was proper and reasonable.
Dr. TP Lahane, director of DMER, said they are keen on a limited study on the impact of Covid-19 on the human body through pathological autopsies. The procedures are going to be administered at three state-run medical colleges that are attached to hospitals. Moreover, the research through pathological autopsies also needs approval from the ICMR, which oversees all medical research in the country. “Currently it is in the initial stage of discussion where we are planning to start the pathological autopsy in some medical colleges in the state. However we will begin our work once we have sought ICMR’s approval,” he said.
The All Indian Institute of Medical Sciences (AIIMS) in Bhopal (Madhya Pradesh) had administered the primary pathological autopsy of a Covid-19 patient on August 16. The Rajkot Civil hospital in Gujarat conducted its Covid autopsy on September 7.
As per the rules of ICMR, if a suspected patient dies before reaching the hospital, it is levelled as a medico-legal case. Only in such incidences, the hospitals are authorised to conduct autopsies. Moreover, to conduct a pathological autopsy, the hospitals will have to seek the official consent of the families.
“It is seen that the virus mainly affects the lungs but the Sars-Cov-2– the virus also damages multiple organs in patients like brains, kidneys, hearts among others. Even if a patient survives, he/she can sustain long term health problems,” said Dr. Lancelot Pinto, an epidemiologist from Hinduja Hospital.
A study—The pathological autopsy of coronavirus disease 2019 (COVID-2019) in China: a review published in Oxford academic in June laid emphasis on pathological autopsy to explore the pathogenicity and lethality of Covid-19. “The issue of whether a person died from COVID-2019 infection or not is always an ambiguous problem in some cases. we urgently need to obtain the relevant pathological knowledge of COVID-2019 through autopsy…” reads the report.
However, the forensic experts are concerned as aerosol produced during autopsy can expose them to the virus. “Whether the virus can infect people from a body remains scientifically inconclusive. So, if the state wants us to conduct pathological autopsies, then they should not only provide us with good quality personal protective equipment (PPE) but also with machinery,” said a forensic expert from JJ Hospital.