Scientists are turning to the pandemic’s dead to help heal the living. In a recent Bloomberg podcast, Senior Editor Jason Gale spoke with several physicians and pathologists who are striving to solve the mysteries of long-hauler syndrome by studying the remains of people who have died from COVID-19.

Why Study the Dead?

While studying the deceased to help the living may seem anachronistic, says Gale, it makes sense if you think of the forensic pathologists as detectives who are trying to identify and understand a killer’s (virus’) M.O. before the next crime. To do this, scientists first need to understand the cellular distribution of the virus across the brain and body. They seek answers to such questions as:

• Where does the virus go when it enters the body?
• What is it doing while it’s there?
• What cell types does it affect?
• How long does the virus stay in each area?

In answering each of these and similar questions, says Dan Chertow, a critical-care physician, they can “put the pieces together to tell a cohesive story about the mechanisms that are contributing to severe acute illness in some, asymptomatic infection in others, and long-term symptoms in a reasonable portion of survivors that are really distressing.”

The Decline of Autopsy-Based Research Today

According to Gale, autopsies have been “the bedrock of medical science since at least the 1500s” but have waned in popularity and use as research tools in recent years. Autopsies are expensive procedures, explains pathologist Linda Isles, because facilities cost a lot to maintain at a safe standard. With all the imaging and other technological advances in recent decades, clinicians have been under-valuing autopsies. 

Today, many pathology trainees aren’t required to do autopsies. Less training leads to less confidence in performing autopsies, which leads to less use of autopsy facilities, resulting in a lack of maintenance of those facilities. This development is both unwise and incredibly unfortunate, she says.

The Challenges of COVID-19 Autopsy-Based Research

Doing autopsies on COVID-19 victims for the purpose of research has additional challenges, says Chertow. He and his team have only about 24 hours to study a body before the tissues die, taking critical information and answers with them. 

Obtaining bodies in the first place, he adds, is a “massive logistical undertaking” that includes speaking with family to get approval for the autopsy and coordinating with a funeral home to pick up the body and bring it to the research facility. He has a 24/7 call arrangement with a partner funeral home for just this purpose, in order to ensure that tissue samples will still be viable when the autopsy begins. 

Timing is crucial. “With every autopsy,” says Gale, “the picture gets clearer of what COVID is capable of doing across [patients’] bodies, and what impact it may have on them in the long run.” 

The Risks of COVID-19 Autopsies

Though “detailed post-mortem investigations are picking up now,” in the early months of the pandemic, only a few hundred autopsies were done–and not all results published–delaying critical answers for both researchers and physicians. 

The shortage of appropriate facilities was not the only reason for this. Pathologists’ fear of getting COVID while performing them was another, due to the aerosols that are released during the process, such as when the brain is removed from the skull. 

Staying Safe During an Autopsy

Determined pathologists like Chertow, however, have found a way to properly address these safety concerns. COVID-19 autopsies are done in a secure, air-locked chamber. The pathologists wear multiple layers of protective equipment, including a plastic apron over a surgical gown over an impermeable coverall over surgical scrubs. 

They also wear three pairs of gloves and two pairs of shoe coverings. Instead of N95 masks, they breathe through controlled, air-purifying respirators located under a hood that fits over their head and shoulders.

Chertow is not new to dangerous working conditions. He was in Liberia in 2014 during the region’s Ebola crisis and performed many autopsies on AIDS victims, as well. He’s brought the lessons he learned to bear on his COVID research.

How Do COVID Autopsies and Regular Autopsies Differ?

Chertow says that his team analyzes samples from almost 100 different areas of the brain and body, far beyond what is sampled in a regular autopsy. Each COVID autopsy takes approximately three hours to complete, and the tissue analysis can take weeks. They’re working as quickly as possible, though, says Chertow, because “the sooner we have answers from this work, the sooner we’ll be able to better address the long-term effects of COVID-19.”

*Gale, J. (2021, Oct. 26). U.S. Scientists Study the Pandemic’s Dead to Crack ‘Long Covid’ [Podcast]. Bloomberg. https://www.bloomberg.com/news/articles/2021-10-26/u-s-scientists-study-the-dead-for-insights-into-treating-long-covid 

Much about the novel coronavirus, i.e., COVID-19, is still not fully understood. As research progresses and our knowledge of the virus increases, information can change rapidly. We strive to update all of our articles as quickly as possible, but there may occasionally be some lag between scientific developments and our revisions.