The first case of coronavirus disease 2019 (COVID-19) in the United States (U.S.) was confirmed in January 2020. Initially, little was known about the epidemiology and clinical course of the disease and diagnostic testing was limited in the U.S. until March/April 2020. Since then, many studies have speculated that SARS-CoV-2 may have pre-existed undiagnosed outside China before the known outbreak.


To evaluate the prevalence of SARS-CoV-2 in adult autopsy cases performed just before and during the beginning of the pandemic at our institution, where autopsy was not performed on known COVID-19 cases.


We included adult autopsies performed in our institution from 6/1/2019–6/30/2020. Cases were divided into groups based on the likelihood of cause of death being related to COVID-19, presence of a clinical respiratory illness, and histologic findings of pneumonia. Archived formalin-fixed-paraffin-embedded lung tissue of all COVID-possible cases and COVID-unlikely cases with pneumonia were tested for the SARS-CoV-2 RNA, using Centers for Disease Control and Prevention 2019-nCoV-Real-Time Reverse Transcription polymerase chain reaction (qRT-PCR).


Eighty-eight cases were identified, and among those, 42/88 (48%) cases were considered COVID-possible cause of death with 24/42 (57%) showing respiratory illness and/or pneumonia. COVID-19 as cause of death was considered unlikely in 46/88 (52%) with 34/46 (74%) showing no respiratory illness or pneumonia. SARS-CoV-2 qRT-PCR was performed on a total of 49 cases; 42 COVID-possible and seven COVID-unlikely with pneumonia, and all cases were negative (0/49).


Our data suggests that autopsied patients in our community who died between 6/1/2019–6/30/2020 without known COVID-19 were unlikely to have had subclinical and/or undiagnosed COVID-19 infection.

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