COVID-19: What the Autopsies Reveal

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Gibbs reports on how pathologists are starting to get a much closer look at the damage that covert nineteen does to the body by carefully examining the lungs hearts kidneys and other organs of people who have died while infected with the novel Corona Virus. Wait spoke with experts at the Cleveland Clinic. And the University of Washington who have performed these high risk autopsies very few of which have been done so far in the United States. Covert nineteen is a new disease and doctors have been struggling to figure out how best to treat it putting people on ventilators as always a last resort for other diseases typically about half the patients who go onto a ventilator do not survive but Kobe nineteen patients seemed to do even worse on mechanical ventilation a study in the UK found that only about a third of corona virus patients survived that experience and in a report published on April Twenty second in the Journal of the American Medical Association. Researchers found even more alarming outcomes recently in New York City analyzing data from twelve large New York hospitals during March. They found that out of three hundred twenty patients on ventilators. Two hundred and eighty two died so only about one in nine survived mechanical ventilation. We know this. New Corona virus damages the lungs. But how exactly does it differ in important ways from influenza and other VIRAL INFECTIONS? Some experts have suggested that the virus can infect and damage the heart as well and maybe the kidneys or even the brain when people are seriously ill with Cova nineteen. They seem to be at higher. Risk of blood clots. But it's really hard to determine from lab tests and fuzzy medical images whether it's the virus damaging these other organs or whether the body's own immune system fouling up the works as it generates massive inflammatory response to combat the corona virus. Any kind of lung injury can result in acute respiratory distress syndromes. This is a disease process that we've known about for a long. It's a very typical pattern of injury that we see in the lungs when they're injured for many many different kinds of reasons. That's disarray Marshall. A pathologist at the University of Washington. She says that it's often the cascading organ failure triggered by acute respiratory distress syndrome or A. Rds The causes elderly people to die from influenza and firefighters to die from smoke inhalation and cancer patients to die from reactions to chemotherapy. The pressing question. We need to answer for Kobe. Nineteen is whether it's just a rds that makes the disease deadly or whether this new diseases different and even more complicated to treat them what doctors have seen before well if you watch TV you know what medical examiners do when they want to figure out what killed somebody. There's just no substitute for a thorough and detailed autopsy earlier this month researchers published the first English language autopsy results on people who died after becoming infected with the novel Corona Virus. The paper appeared in the American Journal of Clinical Pathology on April tenth. It describes to interesting cases both from Oklahoma case one was seventy seven year old man who had cycled between fever and chills for six days before finally calling for an ambulance on March twentieth. He had high blood pressure and some other health issues but no cough on the trip to the hospital. He was gasping for air and his heart stopped by the time they arrived at the emergency room. It was too late. The gentleman had not seen a doctor for his fever. He had not been tested for Kobe. Nineteen so it wasn't clear what had caused the heart attack taking his life. The Medical Examiner's team in Oklahoma City decided that it was important to find out they swabbed the man's nasal passages and also his lungs both swabs tested positive for the SARS. Kobe virus and chest xrays showed what they described as complete white out in. What would normally be dark empty lung? Cavities doing an autopsy on a Kobe. Positive body is risky but they had the special protective equipment and high containment room. They needed to do it and maybe they could learn something that would help save some of the hundreds of thousands of people around the world who will fight cove in nineteen for their lives in the months to come so they laid his body on the dissecting table and they opened them up. The team contacted a well-known lung pathologist at the Cleveland Clinic to help them interpret what they saw especially as they examined tissue samples from bears organs under the microscope. My name is Sanjay Mukhopadhyay. I'm director of pathology at the Cleveland Clinic. Autopsies give you another deeper look into tissue. That is actually several layers of resolution higher than what you can get from a history a physical examination routine laptops even the highest resolution CD. Scans none of them. Even approach the resolution that you can get from an autopsy. The medical examiner had noticed that. This man's lungs were two to three times heavier than usual. A Common Consequence of AIDS pathologist actually referred to that syndrome by a different name. One that describes the end result of the disease lung cells. They call it diffuse. Lv alert damage in that gentleman. We found diffuse Alveoli damage under the microscope. When you take a breath and it goes down your windpipe. The windpipe actually branches and to do and when goes into the left lung and one goes into the right and then those branches of the windpipe branch like the branches of a tree. You know they get smarter than sponsored smaller as you go. Further and further away and the end point of the branch is what we call an Lvn Louis or colloquially you can call it an air sac and what that is just a very tiny balloon. You need a microscope to see it. And they're just cows and thousands of those little balloons in the lung. That's what makes up the lamp so each time. You inhale you inflate thousands of microscopic Vealy as the ED enters into that little balloon with oxygen in it. The point of the balloon is to take that oxygen into the bloodstream. The wall of the balloon has little blood vessels in it so in the normal language. Dicap- breath the oxygen goes from the middle of the balloon into the one of the balloon. And that's where the arteries are and the oxygen goes into your blood cells. Red Blood Cells. We call them. And then that Dixit back to the heart and the heart center the oxygen to the rest of the body for this exchange of oxygen and carbon dioxide to work properly. The thin lining of the air SAC has to be very close to the walls of the blood vessels. Now what happens in in actually in any severe viral infection is that the virus starts causing damage reading a digest. I which is the back of the throat and then all the way down so all the way down the windpipe down the branches to the smallest branches and then into the air sex and when it gets into the AIR SACS. Call that a viral pneumonia. What's happening is actually. The virus is damaging the walls of the those little webs of capillaries that surround the walls of the air. Sacs start to leak proteins fluids white blood cells and debris from destroyed lung seep into the air sacs the debris clogs the balloons. But maybe even more important it also thickens the walls of the air sacs. Literally it's making a barrier for the oxygen to go from the middle of the relates to the bloodstream and so this is the reason that oxygen levels are so low in these patients who are very sick from ovid. The researchers concluded that case won the seventy seven year old man had died from Kobe. Nineteen even though he had never been diagnosed with it. Mukhopadhyay said he was struck by similar. The pattern of organ damage was to what he's used to seeing from autopsies on people who died from other viral infections. It's actually very similar to what happens in influenza and at just to mention a few other examples. Sars you know the SARS from two thousand to two thousand three identical merced Middle Eastern disparaties syndrome identical findings. I did autopsies and deported them on H. One and one when that happened the swine flu identical findings and I give you one more example. You know the when the vaping thing happened just recently and many people were getting sick from the most sick patients but actually developing diffuse. Lbj damage case too was different. This man had to the hospital a day earlier on March nineteenth. He was only forty two but had myo tonic. Muscular dystrophy a hereditary disease that causes muscles to weaken or atrophy. Sometimes so much that food can back up from the stomach. Go down the wrong tube into the lungs where causes bacterial pneumonia? He felt sharp abdominal pains and went to the hospital where a cat scan showed fluid in his lungs just hours later his heart gave out any passed away although he was labelled as community acquired pneumonia and died and was found to be covert positive. The microscopic examination. This patient does not support the idea that he died of Gobert so there was no damage instead. They found food particles and bacterial infection in the airway clear signs of aspirational pneumonia. So case to died with cove in nineteen but he did not die of covert nineteen. Which makes it very interesting because it brings up the issue of. How often is this happening? How often are people who are PAS? Different went on a nasal swab dying of things other than Kobe. I put that question to Desert Marshall whom we heard from earlier. I'm the director of autopsy after De Services at the University of Washington Medical Center since early. March Marshall has performed more than a dozen autopsies of people who died after testing positive for corona virus infection. She says the results of those autopsies have been submitted to a Medical Journal for publication but are still undergoing peer review. Marshall says that the risk of infection that this fires poses has changed how they perform all autopsies regardless of whether the person was suspected to have covert nineteen. Or not so. We've actually started to swab all of our students and get those results before will perform an autopsy in our facility. That isn't the negative pressure sweet so his Marshall also found that like case to in Oklahoma some patients are dying of something else but turning out to have corona virus infection as well we have not. We have not had any unexpected positive results yet. It's still a limited number but of the probably fifteen that we've done. We have not had a positive comeback where we weren't expecting it. And what about the finding from case one in Oklahoma here in Washington are most of the Kobe? Nineteen patients dying from more or less standard AIDS or the autopsies revealing evidence of the virus infecting and damaging other organs as well hearing concerns of the clinicians and folks on the front lines there's the virus infecting the heart or is it just kind of secondary affects related to the critical illness. Is there excess? Clotting related to this disease. Different things like that. It looks like it's helping us to see that Cova did is actually causing typical acute respiratory distress syndrome. Initially there were thoughts that it was behaving a bit differently. But I think as we get more numbers of people and there's less of the individual variability the vast majority of these cases are showing the typical pathologic features of acute respiratory distress and Which we call a diffuse Alveoli damage. Pathology it does look like it. Is that phenomenon and there's not something Speaking out pathologically. That's different in a way that will inform them that you know. They should probably continue to use. The evidence based tried and true therapies for areas in particular marshal says. They aren't seeing an unusual number of small blockages and blood vessels. That would require treatment beyond the usual blood thinners such as Heparin nor has her group or other. She has heard from around. The country found the corona virus causing serious heart infections in the autopsies. They

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