"The story of 38 brains, 87 lungs and 42 hearts": what autopsies of Covid patients say
In the Washington Post, the testimonies of some pathologists who performed autopsies on the bodies of people missing due to the coronavirus
03/07/2020 11:40am CEST | Updated July 8, 2020
"The story of 38 brains, 87 lungs and 42 hearts: how death can help us live." So the Washington Post titrates an article dedicated to the testimony of some pathologists who in recent months have been responsible for performing autopsies on the bodies of people who have disappeared because of the coronavirus.
The newspaper first reports the words of Dr. Amy Rapkiewicz, a pathologist at NYU Langone Health academic medical center who says she found damage to the lungs, kidneys and liver, noting that some organs had particular cells rarely found at those sites. "Yet some of the evidence, never before found, seemed familiar," she says. Flipping back through her books, she says she found reference to a medical report from the 1960s about a patient suffering from dengue fever," it says.
In dengue, a tropical mosquito-borne disease, the virus appeared to destroy platelet-producing cells, causing hemorrhaging. The coronavirus seemed to amplify the effect, causing dangerous disruption of coagulation
The pathologist states, "Covid-19 and dengue are different, but in this aspect they are similar."
Autopsies have always been a source of discovery for understanding new diseases: from HIV/AIDS, through Ebola, to Covid-19. On WP, we read that "thanks to autopsy examinations conducted on Covid patients, it has been confirmed that the lungs are the organs most affected by the virus. But damage has also been found in the brain, kidneys, liver, gastrointestinal tract, spleen and endothelial cells that line blood vessels. As mentioned above, the researchers would also find widespread alteration in coagulation
As for the heart, many physicians pointed to a cardiac complication that they suspected could be traced to a form of myocarditis (inflammation of the heart muscle), but in that case autopsies did not confirm it. Dr. Rapkiewicz of NYU Langone, who studied seven hearts, was struck by the abundance of cells called megakaryocytes, which produce platelets that control clotting and are typically found only in bone marrow and the lungs.
Dr. Richard Vander Heide of LSU in New Orleans, moreover, says he has performed autopsies on patients who had suffered cardiac arrest in the hospital but who, when examined, had no primary damage to the heart but to the lungs. One of the first U.S. investigations made public, on April 10, involved a 44-year-old patient who had been treated at LSU Health. Vander Heide, who has been in practice since 1994, recalls in the pages of the WP that he dissected the lung and discovered probably hundreds or thousands of microclots: "I'll never forget the day. I had never seen anything like it." Autopsy after autopsy, Vander Heide says he found the same troubling picture.
"The findings had gotten the attention of many hospitals, prompting physicians to give anticoagulants
to Covid patients. This is now common practice," the American Journal points out. Other pulmonary autopsy examinations - including those described in studies of 38 Italian patients - have shown the same picture.
The Washington Post then cites a study published in June in the Lancet's eClinicalMedicine, in which the alteration of coagulation
in the heart, kidney and liver is highlighted. Such evidence led the authors to suggest that this could be a major cause of multi-organ failure in Covid-19 patients.
As for neurological damage, the Washington Post article points out that among the most common complaints were altered sense of smell and taste, altered mental status, stroke, seizures and even delirium. It reads, "A preliminary study conducted in China, published in the BMJ's Journal of Neurology, Neurosurgery & Psychiatry in March, found that 22% of 113 patients experienced neurological problems ranging from excessive sleepiness to coma." In June, the WP points out, French researchers reported that "84% of ICU patients had neurological problems and that, at the time of discharge, one-third were confused or disoriented."
Isaac Solomon, a neuropathologist at Brigham and Women's Hospital in Boston, conducted 18 autopsies, examining particular areas of the brain: "the cerebral cortex (the gray matter responsible for processing information), the thalamus (which modulates sensory input), the basal ganglia (responsible for motor control), etc.". The expert pointed out that he found only small pockets of inflammation, while there were signs of the damage caused by lack of oxygen.
"When the brain doesn't get enough oxygen, neurons die, and that death is permanent: to some extent, people's brains can compensate, but at some point the damage is so extensive that several functions are compromised," reads the Washington Post. Another key aspect would therefore be represented by the early administration of a supplementary amount of oxygen in Covid patients, in order to avoid severe brain damage.
In conclusion - given the altered coagulation
found in many patients - the American newspaper states that "autopsies suggest that anti-platelet drugs, in addition to anticoagulants
, may be useful in curbing the effects and complications brought on by Covid-19," specifying, however, that it is "just one piece of a much larger puzzle." "We still have a lot to learn," they conclude.
https://www.washingtonpost.com/health/2 ... -findings/