Study aims at finding impact of virus on organs.

The All India Institute of Medical Sciences (AIIMS), Bhopal, has begun researching on COVID-19 by conducting autopsies on bodies of positive patients to figure out the virus’ impact on organs and correlate autopsy findings with clinicopathological ones and similar studies worldwide.

“This is the first deliberate attempt in the country to study in detail COVID-19 positive deaths,” said Arneet Arora, Dean and Head of Department, Forensic Medicine and Toxicology, at the institute.

As an integrated research intramural project, Microbiology, Pathology and Lab Medicine, Forensic Medicine and Toxicology, and Anaesthesiology departments are involved in conducting autopsies on 10 deceased COVID-19 positive patients after approval from the Institution Human Ethics Committee of the AIIMS.

Family consent

“The consent of the families of the patients is the most important and securing it has been a challenge. We tell them the procedure might help us define treatment better,” said Dr. Arora. The research team could approach families of the eight of the 12 deceased since July 31, of which just one consented. The first autopsy was conducted on August 16.

The study’s objectives are to report autopsy findings in deaths due to COVID-19, look for pathological changes in different organs of patients, correlate autopsy findings with clinicopathological ones, compare autopsy findings with similar studies worldwide and detect the presence of virus in all samples retrieved during procedures.

Microbiological analysis

The team would conduct microscopic examination of all organs and microbiological analysis, that is the virus analysis and examine possible clotting of blood in the body. “We will take out samples, but assimilate from all departments reports and then analyse the cases,” said Dr. Arora.

Further, in a bid to reduce the possible exposure to infection, only five than the usual 10 specialists are conducting procedures wearing personal protective equipment at an isolation room having an HVAC (heating, ventilation, and air-conditioning) system which changes the air cycle several times an hour through high-efficiency particulate air (HEPA) filters.

As the institute began conducting autopsies on bodies of COVID-19 suspects from March 17, it noticed several bodies, categorised as COVID status unknown as their samples couldn’t be tested before death, showed histopathological and microscopic findings resembling that of confirmed cases. “So we thought we might as well conduct the procedures on bodies of positive patients,” explained Dr. Arora.

Fear of infection

The fear of infection among doctors during autopsies on positive patients looms with aerosol generation during the procedure, the reason why the Indian Council of Medical Research has not recommended it. Therefore, the team is adopting low-aerosol generating techniques such as using the conventional hammer-chisel technique instead of the oscillating electric saw to open a skull. “Using the saw may release aerosol from bones and marrow thereby posing a risk,” said Dr. Arora.

Further, as advised by the Royal College of Pathologists, London, senior specialists with experience are conducting the procedures as they may follow safety protocols more strictly.

“Our research comes after autopsies in China and Italy, but more elaborate and comprehensive,” she added.

Dr. Arora admitted it was still unclear whether bodies of COVID-19 positive patients were more infectious than the living ones. “There is risk involved. While conducting the procedure, you are basically cutting open the source of the breath which carries aerosol — the lungs,” she said.

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