tetano
Editor, Senior Moderator
Front Med (Lausanne)
. 2022 Apr 14;9:868954.
doi: 10.3389/fmed.2022.868954. eCollection 2022.
COVID-19 Autopsies Reveal Underreporting of SARS-CoV-2 Infection and Scarcity of Co-infections
Nathalie Schwab[SUP] 1 [/SUP], Ronny Nienhold[SUP] 1 [/SUP], Maurice Henkel[SUP] 1 2 [/SUP], Albert Baschong[SUP] 1 [/SUP], Anne Graber[SUP] 1 [/SUP], Angela Frank[SUP] 1 [/SUP], Nadine Mensah[SUP] 1 [/SUP], Jacqueline Koike[SUP] 1 [/SUP], Claudia Hernach[SUP] 1 [/SUP], Melanie Sachs[SUP] 1 [/SUP], Till Daun[SUP] 1 [/SUP], Veronika Zsikla[SUP] 1 [/SUP], Niels Willi[SUP] 1 [/SUP], Tobias Junt[SUP] 3 [/SUP], Kirsten D Mertz[SUP] 1 4 [/SUP]
Affiliations
Abstract
Coronavirus disease 2019 (COVID-19) mortality can be estimated based on reliable mortality data. Variable testing procedures and heterogeneous disease course suggest that a substantial number of COVID-19 deaths is undetected. To address this question, we screened an unselected autopsy cohort for the presence of SARS-CoV-2 and a panel of common respiratory pathogens. Lung tissues from 62 consecutive autopsies, conducted during the first and second COVID-19 pandemic waves in Switzerland, were analyzed for bacterial, viral and fungal respiratory pathogens including SARS-CoV-2. SARS-CoV-2 was detected in 28 lungs of 62 deceased patients (45%), although only 18 patients (29%) were reported to have COVID-19 at the time of death. In 23 patients (37% of all), the clinical cause of death and/or autopsy findings together with the presence of SARS-CoV-2 suggested death due to COVID-19. Our autopsy results reveal a 16% higher SARS-CoV-2 infection rate and an 8% higher SARS-CoV-2 related mortality rate than reported by clinicians before death. The majority of SARS-CoV-2 infected patients (75%) did not suffer from respiratory co-infections, as long as they were treated with antibiotics. In the lungs of 5 patients (8% of all), SARS-CoV-2 was found, yet without typical clinical and/or autopsy findings. Our findings suggest that underreporting of COVID-19 contributes substantially to excess mortality. The small percentage of co-infections in SARS-CoV-2 positive patients who died with typical COVID-19 symptoms strongly suggests that the majority of SARS-CoV-2 infected patients died from and not with the virus.
Keywords: COVID-19; SARS-CoV-2; autopsy; bacterial co-infection; infection; mortality; respiratory failure.
. 2022 Apr 14;9:868954.
doi: 10.3389/fmed.2022.868954. eCollection 2022.
COVID-19 Autopsies Reveal Underreporting of SARS-CoV-2 Infection and Scarcity of Co-infections
Nathalie Schwab[SUP] 1 [/SUP], Ronny Nienhold[SUP] 1 [/SUP], Maurice Henkel[SUP] 1 2 [/SUP], Albert Baschong[SUP] 1 [/SUP], Anne Graber[SUP] 1 [/SUP], Angela Frank[SUP] 1 [/SUP], Nadine Mensah[SUP] 1 [/SUP], Jacqueline Koike[SUP] 1 [/SUP], Claudia Hernach[SUP] 1 [/SUP], Melanie Sachs[SUP] 1 [/SUP], Till Daun[SUP] 1 [/SUP], Veronika Zsikla[SUP] 1 [/SUP], Niels Willi[SUP] 1 [/SUP], Tobias Junt[SUP] 3 [/SUP], Kirsten D Mertz[SUP] 1 4 [/SUP]
Affiliations
- PMID: 35492342
- PMCID: PMC9046787
- DOI: 10.3389/fmed.2022.868954
Abstract
Coronavirus disease 2019 (COVID-19) mortality can be estimated based on reliable mortality data. Variable testing procedures and heterogeneous disease course suggest that a substantial number of COVID-19 deaths is undetected. To address this question, we screened an unselected autopsy cohort for the presence of SARS-CoV-2 and a panel of common respiratory pathogens. Lung tissues from 62 consecutive autopsies, conducted during the first and second COVID-19 pandemic waves in Switzerland, were analyzed for bacterial, viral and fungal respiratory pathogens including SARS-CoV-2. SARS-CoV-2 was detected in 28 lungs of 62 deceased patients (45%), although only 18 patients (29%) were reported to have COVID-19 at the time of death. In 23 patients (37% of all), the clinical cause of death and/or autopsy findings together with the presence of SARS-CoV-2 suggested death due to COVID-19. Our autopsy results reveal a 16% higher SARS-CoV-2 infection rate and an 8% higher SARS-CoV-2 related mortality rate than reported by clinicians before death. The majority of SARS-CoV-2 infected patients (75%) did not suffer from respiratory co-infections, as long as they were treated with antibiotics. In the lungs of 5 patients (8% of all), SARS-CoV-2 was found, yet without typical clinical and/or autopsy findings. Our findings suggest that underreporting of COVID-19 contributes substantially to excess mortality. The small percentage of co-infections in SARS-CoV-2 positive patients who died with typical COVID-19 symptoms strongly suggests that the majority of SARS-CoV-2 infected patients died from and not with the virus.
Keywords: COVID-19; SARS-CoV-2; autopsy; bacterial co-infection; infection; mortality; respiratory failure.