Test deceased for Covid-19 before postmortems, say new guidelines

Postmortems should not be carried out on bodies without first testing them for Covid-19, according to newly published recommendations from the Royal College of Physicians in Ireland (RCPI).

No “open cavity” postmortem examination should be performed on bodies if their disease status is unknown, the guidelines from the RCPI’s faculty of pathology advise.

Staff are at “substantial risk” of infection through carrying out postmortems, the guidelines say, and examinations of deceased Covid-19 patients should therefore be restricted to the two locations where these risks can be mitigated – mortuaries in Dublin and Cork.

“Each death must be assessed in great detail and in the context of clinical, radiologic and laboratory findings to ensure that an accurate cause of death is ascribed, with the consideration of the need for a postmortem examination for this determination.”

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Just five postmortems have been carried out on Covid-19-positive patients, The Irish Times reported earlier this month. The overall number of postmortems carried out in the first four months of the year was substantially down.

Multidisciplinary team conference

The guidelines say hospital and mortuary staff should hold a multidisciplinary team conference with the local coroner in relation to deaths. The decision on whether to go ahead with a postmortem is made by the coroner.

Where a patient is assumed to be negative for the virus, but a swab produces a positive result, a second meeting should be convened with the coroner, pathologists and GP. This meeting will decide whether a postmortem is required, or whether the death can be ascribed to Covid-19 based on other investigations such as CT scans, an external examination or toxicology tests.

The aim of the system is to deal with Covid-19 deaths in a quick and effective way, thus ensuring remains are returned to families for burial as rapidly as possible, according to Dr Clive Gilgallen, chair of the faculty working group that produced the guidelines.

The number of postmortems being carried out “is on the way up again”, he said, as the rate of negative tests increases.

It is not know how long coronavirus lasts in the body after death, according to Dr Kilgallen, though the related Sars virus survived several days.