NEW YORK (AP) – The COVID-19 pandemic has helped revive the autopsy.
When the virus first hit U.S. hospitals, doctors could only guess what was causing its strange constellation of symptoms: what could explain why patients lost their sense of smell and taste, developed rashes, struggled with breathe and reported flu-like cough and memory loss?
In the morgues of hospitals, which have been steadily losing prominence and funding for several decades, pathologists were busy dissecting the first victims of the disease and found some answers.
“We were getting emails from doctors, a little desperate, asking us,‘ What are you seeing? Said Dr. Amy Rapkiewicz of NYU Langone. “The autopsy,” she pointed out, means see for yourself. “That’s exactly what we had to do.”
Early autopsies of dead patients confirmed that coronavirus not only causes respiratory disease, but can also attack other vital organs. They also took doctors to try anticoagulants in some patients with COVID-19 and reconsider how long others should be in ventilators.
“You can’t treat what you don’t know,” said Dr. Alex Williamson, a pathologist at Northwell Health in New York. “Many lives have been saved by watching someone’s death closely.”
Autopsies have informed medicine for centuries, and more recently have helped reveal the extent of the opioid epidemic, improve cancer care, and demystify AIDS and anthracite. Hospitals were once judged by the number of autopsies they performed.
But they have lost stature over the years, as the medical world devoted itself to laboratory testing and imaging. In 1950, the practice was conducted in about half of the hospitalized patients who died. Today, these rates have been reduced to between 5% and 11%.
“It’s really a lost tool,” said Dr. Richard Vander Heide, a pathologist at Louisiana State University.
Some hospitals found it even more difficult this year. Transmission safety concerns forced many hospital administrators to halt or severely curb autopsies in 2020. The pandemic also led to a general decline in the total number of patients in many hospitals, leading to lower rates of autopsy. autopsy in some places. Large hospitals across the country have reported fewer autopsies by 2020.
“Overall, our numbers have declined, quite significantly,” from 270 autopsies in recent years to about 200 so far this year, said Dr. Allecia Wilson, director of autopsies and forensic services at Michigan Medicine. and Ann Arbor.
At the University of Washington in Seattle, pathologist Dr. Desiree Marshall was unable to perform COVID-19 autopsies in her usual suite because, as one of the hospital’s oldest facilities, she does not have adequate ventilation to conduct the procedure safely. Marshall ended up lending the county medical examiner offices for a few cases at first, and since April he has been working at the school’s animal research facilities.
Other hospitals followed the opposite path, performing many more autopsies even in difficult circumstances to try to better understand the pandemic and keep up with an increase in deaths that has caused at least 400,000 more. Deaths in the United States than usual.
At the University of New Orleans Medical Center, where Vander Heide works, pathologists have performed approximately 50% more autopsies than in recent years. Other hospitals in Alabama, California, Tennessee, New York and Virginia say they will also exceed their usual annual bill for the procedure.
Their results have shaped our understanding of what COVID-19 does to the body and how we can combat it.
In the spring and early summer, for example, some severely ill coronavirus patients were ventilators for weeks. Later, pathologists discovered that this extended ventilation could cause extensive lung injury, which led doctors to rethink how fans use them during the pandemic.
Doctors are now exploring whether anticoagulants can prevent microscopic blood clots that had been discovered in patients early in the pandemic.
Autopsy studies also indicated that the virus can travel through the bloodstream or trap infected cells, spreading and affecting the blood vessels, heart, brain, liver, kidneys and colon. ‘a person. This finding helped explain the wide range of symptoms of the virus.
More discoveries are sure to come: Pathologists have freezers with coronavirus-infected organs and tissues collected during autopsies, which will help researchers study the disease, as well as possible cures and treatments. Future autopsies will also help them understand the weight of the disease on long-distance carriers., those who suffer symptoms for weeks or months after infection.
Despite these life-saving discoveries during the pandemic, financial realities and declining workforce mean the old medical practice is unlikely to fully recover when the outbreak subsides.
Hospitals are not required to provide autopsy services, and in those that do, the costs of the procedure are not covered directly by most private insurance or Medicare.
“When you consider that there is no reimbursement for that, it’s almost an altruistic practice,” said Dr. Billie Fyfe-Kirschner, a pathologist at Rutgers University. “It’s vital, but we don’t have to fund it.”
Added to the mix: The number of experts who can actually perform autopsies is very low. Estimates suggest that the US only has a few hundred forensic pathologists, but could use a few thousand and less than one in every 100 medical school graduates enters the profession each year.
Some professionals in the field hope the 2020 pandemic could increase field recruitment, as did the “CSI boom” of the early 2000s, said Williamson of Northwell.
Wilson of Michigan Medicine is more skeptical, but he still can’t imagine his work being totally obsolete. Learning from the dead to treat the living: It is a pillar of medicine, he said.
He helped doctors understand the mysteries of the 1918 flu pandemic, right now he helps them understand the mysteries of COVID-19 more than a century later.
“They were in the same situation,” Vander Heide said of doctors trying to save lives in 1918. “The only way to learn what was going on was to open your body and see.”
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The Associated Press Health and Science Department is supported by the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.