To the Editor.—I am writing to commend many members of the autopsy pathology community (including hospital and forensic practitioners) who have come together to help shape and deliver quality postmortem care during the initial wave of the novel coronavirus disease 2019 (COVID-19) pandemic. In March 2020, as new cases were rapidly escalating in New York City and around the world, most autopsy pathologists likely appreciated that decedent management and autopsy practice would have to quickly and adeptly evolve in response to the pandemic. Staff questioned where to put increasing numbers of decedents who were incessantly arriving in morgue spaces. Attending and resident pathologists were concerned about the potential infectivity of COVID-19 at autopsy. I realized I did not have sufficient information with which to effectively navigate the unfamiliar territory into which postmortem care was rapidly transitioning amid the evolving pandemic.
So, on March 20, 2020 I drafted an email to a group of colleagues around the country asking their opinions on managing COVID-19 at autopsy and in the morgue. I also encouraged them to spread the word about this fledgling “COVID Autopsy Listserve (the “listserve”—really just an email distribution list) to anyone involved with postmortem care. That day ended with 55 inaugural participants, and by the end of March more than 100 people from around the United States and some international locations were engaging on the listserve. Today, there are nearly 200 members on the listserve, mostly autopsy pathologists but also some researchers and clinicians. All are welcome, and new people join each week. The goal of the listserve is to disseminate knowledge and experience so we can safely and effectively expand medical knowledge through autopsy, while compassionately caring for decedents and their families.
The members of the listserve have addressed and continue to deal with myriad issues relating to COVID-19 in the postmortem realm. However, one of its most rewarding successes was its empowering pathologists who have appropriate facilities, supplies, and experience to autopsy COVID-19 decedents. I developed and disseminated through the listserve 2 surveys, 1 each at the end of March and April 2020. Around 50 pathologists responded to each survey (51 in March, 49 in April). Interesting perspectives and practice trends documented in these surveys over the initial weeks of the pandemic include the following:
Most respondents felt that existing guidelines1 allow for the safe performance of COVID-19 autopsies (84% March and 92% April);
More institutions performed or were preparing to perform COVID-19 autopsies in April (63%) than in March (35%);
More respondents had autopsied a COVID-19 decedent in April (51%) than had in March (6%); and
Respondents' support for resident involvement in COVID-19 autopsies increased from March (55%) to April (82%).
“Experientia docet” (experience teaches) and through the COVID Autopsy Listserve we continue to educate and reassure each other, collaborate on research, and optimize our aggregate response to the COVID-19 pandemic. If you are involved with or interested in autopsy and/or decedent management then please join us (email the author at firstname.lastname@example.org).
Stay safe, and keep fighting the good fight!
The author has no relevant financial interest in the products or companies described in this article.