Dr. Amy Rapkiewicz, pathology department chair at NYU Langone Hospital - Long Island, looks at slides from a biopsy in her office in Mineola, N.Y., Wednesday, Dec. 16, 2020. Experts say the COVID-19 pandemic has helped revive the autopsy at many hospitals. The procedure has helped doctors this year understand what coronavirus does to patients’ organs and how they might better treat some of the disease’s more baffling symptoms. (AP Photo/Seth Wenig)

Dr. Amy Rapkiewicz, pathology department chair at NYU Langone Hospital - Long Island, looks at slides from a biopsy in her office in Mineola, N.Y., Wednesday, Dec. 16, 2020. Experts say the COVID-19 pandemic has helped revive the autopsy at many hospitals. The procedure has helped doctors this year understand what coronavirus does to patients’ organs and how they might better treat some of the disease’s more baffling symptoms. (AP Photo/Seth Wenig)

The autopsy, a fading practice, revealed secrets of COVID-19

Early autopsies confirmed COVID does not just cause respiratory disease, but can also attack other vital organs

The COVID-19 pandemic has helped revive the autopsy.

When the virus first arrived in U.S. hospitals, doctors could only guess what was causing its strange constellation of symptoms: What could explain why patients were losing their sense of smell and taste, developing skin rashes, struggling to breathe and reporting memory loss on top of flu-like coughs and aches?

At hospital morgues, which have been steadily losing prominence and funding over several decades, pathologists were busily dissecting the disease’s first victims — and finding some answers.

“We were getting emails from clinicians, kind of desperate, asking, ‘What are you seeing?’” said NYU Langone’s Dr. Amy Rapkiewicz. ‘Autopsy,’ she pointed out, means to see for yourself. “That’s exactly what we had to do.”

Early autopsies of deceased patients confirmed the coronavirus does not just cause respiratory disease, but can also attack other vital organs. They also led doctors to try blood thinners in some COVID-19 patients and reconsider how long others should be on ventilators.

“You can’t treat what you don’t know about,” said Dr. Alex Williamson, a pathologist at Northwell Health in New York. “Many lives have been saved by looking closely at someone’s death.”

Autopsies have informed medicine for centuries — most recently helping to reveal the extent of the opioid epidemic, improve cancer care and demystify AIDS and anthrax. Hospitals were once judged by how many autopsies they performed.

But they’ve lost stature over the years as the medical world instead turned to lab tests and imaging scans. In 1950, the practice was conducted on about half of deceased hospital patients. Today, those rates have shrunk to somewhere between 5% and 11%.

“It’s really kind of a lost tool,” said Louisiana State University pathologist Dr. Richard Vander Heide.

Some hospitals found it even harder this year. Safety concerns about transmission forced many hospital administrators to stop or seriously curb autopsies in 2020. The pandemic also led to a general dip in the total number patients at many hospitals, which drove down autopsy rates in some places. Large hospitals around the country have reported conducting fewer autopsies in 2020.

“Overall, our numbers are down, pretty significantly,” from 270 autopsies in recent years to about 200 so far this year, said Dr. Allecia Wilson, director of autopsies and forensic services at Michigan Medicine in Ann Arbor.

At the University of Washington in Seattle, pathologist Dr. Desiree Marshall couldn’t conduct COVID-19 autopsies in her usual suite because, as one of the hospital’s oldest facilities, it lacks the proper ventilation to safely conduct the procedure. Marshall ended up borrowing the county medical examiner offices for a few cases early on, and has been working out of the school’s animal research facilities since April.

Other hospitals went the opposite way, performing far more autopsies even under difficult circumstances to try to better understand the pandemic and keep up with a surge of deaths that has resulted in at least 400,000 more U.S. deaths than normal.

At New Orleans University Medical Center, where Vander Heide works, pathologists have performed about 50% more autopsies than they have in recent years. Other hospitals in Alabama, California, Tennessee, New York and Virginia say they’ll also surpass their usual annual tally for the procedure.

Their results have shaped our understanding of what COVID-19 does to the body and how we might combat it.

In spring and early summer, for example, some seriously sick coronavirus patients were on ventilators for weeks at a time. Later, pathologists discovered such extended ventilation could cause extensive lung injury, leading doctors to rethink how they use ventilators during the pandemic.

Doctors are now exploring whether blood thinners can prevent microscopic blood clots that had been discovered in patients early in the pandemic.

Autopsy studies also indicated the virus may travel through the blood stream or hitch a ride on infected cells, spreading to and impacting a person’s blood vessels, heart, brain, liver, kidneys and colon. This finding helped explain the virus’s wide range of symptoms.

More findings are sure to come: Pathologists have stocked freezers with coronavirus-infected organs and tissues collected during autopsies, which will help researchers study the disease as well as possible cures and treatments. Future autopsies will also help them understand the disease’s toll on long haulers, those who suffer symptoms for weeks or months after infection.

Despite these life-saving discoveries being made during the pandemic, financial realities and a dwindling workforce mean it’s unlikely that the ancient medical practice will fully rebound when the outbreak wanes.

Hospitals are not required to provide autopsy services, and in those that do perform them, the procedure’s costs are not directly covered by most private insurance or by Medicare.

“When you consider there’s no reimbursement for this, it’s almost an altruistic practice,” said Rutgers University pathologist Dr. Billie Fyfe-Kirschner. “It’s vitally important but we don’t have to fund it.”

Added into the mix: The number of experts who can actually perform autopsies is critically low. Estimates suggest the U.S. has only a few hundred forensic pathologists but could use several thousand — and less than one in 100 graduating medical school students enters the profession each year.

Some in the field hope the 2020 pandemic could boost recruitment to the field — just like the “CSI boom” of the early 2000s, Northwell’s Williamson said.

Michigan Medicine’s Wilson is more skeptical, but even still she can’t imagine her work becoming totally obsolete. Learning from the dead to treat the living — it’s a pillar of medicine, she said.

It helped doctors understand the mysteries of 1918’s influenza pandemic, just at is now helping them understand the mysteries of COVID-19 more than a century later.

“They were in the same situation,” Vander Heide said of the doctors trying to save lives in 1918. “The only way to learn what was going on was to open up the body and see.”

Marion Renault, The Associated Press

Like us on Facebook and follow us on Twitter.

Want to support local journalism? Make a donation here.

Coronavirus

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Alberta Health reported two new COVID-19 deaths in Red Deer Friday. (Image courtesy CDC)
Two more deaths linked to Olymel outbreak in Red Deer

Province reported 356 additional COVID-19 cases Friday

Alberta Premier Jason Kenney speaks during a news conference in Edmonton on Feb. 24, 2020. It’s budget day in the province, and Kenney’s United Conservative government is promising more help in the fight against COVID, but more red ink on the bottom line. THE CANADIAN PRESS/Jason Franson
Alberta’s budget promises more help for COVID-19 with a hard deficit

Annual spending on debt interest is closing in on $3 billion

Alberta reported an additional 399 cases of COVID-19 Thursday, on 9,217 tests, for a test positivity rate of 4.3 per cent. (Image courtesy CDC)
Red Deer down to 562 active COVID-19 cases

8 new COVID-19 deaths, 399 additional COVID-19 cases

Mike Ammeter (Photo by Rebecca Hadfield)
Sylvan Lake man elected chair of Canadian Canola Growers Association

Mike Ammeter is a local farmer located near the Town of Sylvan Lake

City of Red Deer has nearly doubled its active COVID-19 case count since Feb. 10 and has 75.6 per cent of the Central zone’s active cases. (File photo)
Another new high: Red Deer hits 574 active COVID-19 cases

Province reports 13 new COVID-19 deaths, 430 new cases

Bookings for COVID-19 vaccines for people age 75 or older start Wednesday. (File photo by THE CANADIAN PRESS)
Updated: Delays for seniors booking for vaccine appointments

By 9:20 a.m. Wednesday, 4,500 seniors had booked their appointments

A helicopter flies past a mountain near McBride, B.C., on Saturday January 30, 2016. THE CANADIAN PRESS/Darryl Dyck
Avalanche warning for backcountry users in North and South Rockies

Avalanche Canada is urging backcountry users to always check their regional avalanche forecasts

Supporters pray outside court in Stony Plain, Alta., on Wednesday, Feb. 24, 2021, as a trial date was set for Pastor James Coates of GraceLife Church. He is charged with holding Sunday services in violation of Alberta’s COVID-19 rules and with breaking conditions of his bail release. THE CANADIAN PRESS/Jason Franson
Trial date for jailed Alberta pastor charged with breaking COVID-19 health orders

The court says it will reconvene with lawyers on March 5 for a case management plan by teleconference

A pharmacist prepares a COVID-19 vaccine at Village Green Retirement Campus in Federal Way on Jan. 26. (Olivia Sullivan/Sound Publishing)
Canada approves use of AstraZeneca’s COVID-19 vaccine

The country joins more than a dozen others in giving the shot the green light

Emily Keeping of Wetaskiwin, Alta., was last seen at 4:20 p.m. on Feb. 25, 2021 at the FasGas on 49 St and 50 Ave in Wetaskiwin. Supplied/ Wetaskiwin RCMP.
UPDATE: Wetaskiwin RCMP seek assistance in locating missing 11-year-old

Emily Keeping was last seen on Feb. 25, 2021 at the FasGas on 49 St and 50 Ave in Wetaskiwin.

Sylvan Lake's Winter Village lured many visitors to the town this winter. The town has launched a new contest to attract a new business.
(Black Press file photo)
Sylvan Lake offering rent-free storefront space to lure new businesses

Winning business proposal will get a storefront space rent-free for a year

Alberta premier Jason Kenney, right and Doug Schweitzer, Minister of Justice and Solicitor General, provide details about Bill 13, the Alberta Senate Election Act., in Edmonton Alta, on Wednesday June 26, 2019. THE CANADIAN PRESS/Jason Franson
Minister Doug Schweitzer talks on Enhanced COVID-19 Business Benefit

Provincial government rolling out new benefit this April to better help small businesses.

NDP leader Jagmeet Singh holds a press conference on Parliament Hill in Ottawa on Wednesday, Feb. 24, 2021. THE CANADIAN PRESS/Sean Kilpatrick
NDP will not trigger election as long as pandemic continues: Singh

‘“We will vote to keep the government going’

Most Read