Unlocking the lockdown of science and demystifying COVID-19: how autopsies contribute to our understanding of a deadly pandemic

Excerpt

A rapidly evolving sweeping pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to coronavirus disease 2019 (COVID-19) has dominated the first half of 2020 and continues to do so. Cases of COVID-19 were first described in late 2019, when a series of previously unidentified pneumonia-related deaths emerged in Hubei province, China [1]. COVID-19, subsequently spread to almost all countries with a current count of > 11.5 million cases and > 535,000 confirmed deaths worldwide (https://​www.​worldometers.​info/​coronavirus/​). Although virus’ origin, cellular entry and epidemiology [2‐4] have rapidly been clarified, in situ observations of the actual viral interactions within human organs and tissues in patients suffering from COVID-19 have for a long time been addressed at the level of case reports or small series of ≤ 4 cases, as reviewed by Calabrese et al. [5] in the current issue of Virchows Archiv. Indeed, by the end of April 2020 when 150,000 patients had already died of COVID-19, only 16 autopsy cases had been reported in the peer-reviewed literature, with nine publications presenting limited autopsies, assessment of postmortem core-needle or incisional collections of tissue. In the absence of reliable data regarding the degree of SARS-CoV-2 infectivity in dead individuals, various authorities discouraged the conduction of autopsies. This, combined with the ill-adjusted attitudes of pathologists, clinicians and societies towards autopsies, locked down scientific activities to elucidate the actual underlying mechanisms of COVID-19 [6]. This seems incomprehensible, given the fundamental and time-proven role of autopsies in re-emerging, emerging or unknown diseases [e.g., 7]. Only after 170,000 reported COVID-19 deaths and 4 months of pandemic, the first autopsy series of > 10 patients (n = 21) was put forward published [8], and only after another 280,000 deaths and one more month, finally a series of > 50 patients (n = 80) was released [9]. …