Why Autopsies Are Proving Crucial During Covid-19

Why Autopsies Are Proving Crucial During Covid-19 Advances in medical imaging have reduced the need for the procedure, but it is leading to discoveries that may help with better treatments Emma Yasinski Undark Smithsonian Magazine

Normally, when James Stone, a pathologist at Massachusetts General Hospital, does autopsies, he has an audience — a dozen or so students, pathology fellows, assistants, and even attending physicians, hoping to learn from his work.

But since the Covid-19 pandemic began, Stone has done autopsies on Covid-19 victims with just one or two other colleagues in the room. Instead of the usual gloves, mask, goggles, apron and other gear that pathologists don during autopsies, he wears what he calls “full-hazmat-style gear” as he makes a Y-shaped incision in the deceased patient’s body, slicing from each shoulder toward the sternum and then straight down to the belly button. Stone or a technician then peels back the skin, ribs, and chest plate to see the organs inside.

Sometimes, Stone can tell organs are damaged just by looking at them. But the most useful insights come when he places pieces of tissue under the microscope, searching for the effects of Covid-19.

In past generations, Stone would have had more colleagues in other hospitals investigating the consequences of a mysterious new virus. But these days, his setup is less common. After years of nationwide cuts, Massachusetts General is one of a limited number of hospitals left in the U.S. that has its own dedicated autopsy suite. And, early in the pandemic, Stone was one of the few pathologists willing to risk performing autopsies on Covid-19 patients amid concerns that doing so would transmit SARS-CoV-2, the virus that causes the disease.

Still, Stone and other pathologists willing and able to examine Covid-19 victims have made discoveries that may lead to better treatments for current patients. In the process, their work has helped illuminate the effects of a sometimes mystifying virus — even as it highlights longstanding declines in autopsy rates.

Indeed, since 1950, pathologists in the U.S. have gone from conducting autopsies on nearly half of all patients who died in hospitals to less than 5 percent of them. In part, that’s because advances in imaging technology have given physicians more confidence in their diagnoses. But “our ability to determine the cause of death is pretty bad unless you do an autopsy,” says Mary Fowkes, a pathologist at Mount Sinai Hospital in New York. She says about a quarter of autopsies reveal something the clinician did not know about the patient’s cause of death. ..