The autopsy, a fading practice, revealed secrets of COVID-19

NEW YORK (AP) - The COVID-19 pandemic has helped revive the autopsy.
When the virus first hit US hospitals, doctors could only guess what was causing its strange set of symptoms: What could explain why patients lost their sense of smell and taste, developed rashes, had difficulty breathing, and also reported memory loss more like flu Cough and pain?
In morgues in hospitals that have steadily lost importance and funding over several decades, pathologists eagerly dissected the first victims of the disease - and found some answers.
"We got emails from clinicians who were desperate and asked, 'What are you seeing? "Said NYU Langone's Dr. Amy Rapkiewicz." Autopsy, "she pointed out, means to see for yourself." That is exactly what we had to do.
Early autopsies of deceased patients confirmed that the coronavirus not only causes respiratory disease, but can also attack other vital organs. They also prompted doctors to try blood thinners on some COVID-19 patients and reconsider how long other ventilators should be on.
"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 looking closely at someone's death."
Autopsies have informed medicine for centuries - most recently helping to uncover the scale of the opioid epidemic, improve cancer treatment, and demystify AIDS and anthrax. Hospitals were judged once by how many autopsies they performed.
But they have lost stature over the years as the medical world turned to laboratory testing and imaging scans instead. In 1950 the practice was carried out on about half of the hospital patients who died. Today those rates have dropped to 5% to 11%.
"It's kind of a lost tool, really," said Louisiana State University pathologist Dr. Richard Vander Heath.
Some hospitals found it even more difficult this year. Safety concerns about the transmission forced many hospital administrators to stop or seriously contain autopsies in 2020. The pandemic also resulted in an overall decline in the total number of patients in many hospitals, which in some places resulted in a decrease in autopsy rates. Large hospitals across the country have reported having fewer autopsies in 2020.
"Overall, our numbers are down pretty much," said Dr. Allecia Wilson, director of autopsies and forensic services at Michigan Medicine in Ann Arbor, increased from 270 autopsies in recent years to about 200 this year.
At the University of Washington in Seattle, the pathologist Dr. Desiree Marshall does not perform COVID-19 autopsies in her usual suite as one of the oldest facilities in the hospital lacks adequate ventilation to safely perform the procedure. Marshall early borrowed the County Medical Examiner's offices on a few occasions, and has been working in the school's animal research facilities since April.
Other hospitals have gone the opposite way, performing far more autopsies even in difficult circumstances, to better understand the pandemic and keep pace with an increase in deaths that has resulted in at least 400,000 more deaths than normal in the U.S.
At New Orleans University Medical Center, where Vander Heide works, pathologists have performed about 50% more autopsies than in recent years. Other hospitals in Alabama, California, Tennessee, New York, and Virginia say they will also top their usual annual numbers for the procedure.
Your results have shaped our understanding of what COVID-19 does to the body and how we could fight it.
In spring and early summer, for example, some seriously ill coronavirus patients were ventilated for weeks. Pathologists later discovered that such expanded ventilation can lead to extensive lung injuries, which prompted doctors to rethink ventilator use during the pandemic.
Doctors are currently investigating whether blood thinners can prevent microscopic blood clots, which were discovered in patients at the beginning of the pandemic.
Autopsy studies also showed that the virus can travel through the bloodstream or dock a ride on infected cells and spread to and affect a person's blood vessels, heart, brain, liver, kidneys, and colon. This finding helped explain the wide range of symptoms associated with the virus.
More insights are sure to come: Pathologists have filled freezers with coronavirus-infected organs and tissues removed during autopsies to help researchers study the disease and possible cures and treatments. Future autopsies will also help them understand the consequences of the disease for long-distance drivers who experience symptoms weeks or months after the infection.
Despite these life-saving discoveries made during the pandemic, given financial realities and the dwindling workforce, it is unlikely that old medical practice will fully recover once the outbreak subsides.
Hospitals are not required to provide autopsy services, and those who perform the procedure are not directly covered by most private insurance companies or Medicare.
"This is almost an altruistic practice considering this is non-reimbursable," said Rutgers University pathologist Dr. Billie Fyfe-Kirschner. "It is vital, but we don't have to fund it."
In addition, the number of experts who can actually perform autopsies is critically small. It is estimated that the US has only a few hundred forensic pathologists but could employ several thousand - and less than one in 100 medical students joins the profession each year.
Some in the area are hoping the 2020 pandemic could boost recruitment in this area - just like the "CSI boom" in the early 2000s, said Northwell's Williamson.
Michigan Medicine's Wilson is more skeptical, but she can't imagine her work being completely out of date. Learning from the dead to treat the living is a pillar of medicine, she said.
It helped doctors understand the secrets of the 1918 pandemic influenza and is now helping them understand the secrets of COVID-19 more than a century later.
"They were in the same situation," said Vander Heide of the doctors who tried to save lives in 1918. "The only way to learn what was going on was to open the body and see."
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The Associated Press Department of Health and Science is supported by the Department of Science Education of the Howard Hughes Medical Institute. The AP is solely responsible for all content.

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