Bengaluru doctor who did COVID-19 patient's autopsy says lungs were leathery

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The first autopsy conducted on a victim of coronavirus in Bengaluru, has revealed that the virus is active even 18 hours after death. The clinical autopsy was done after a 62-year-old patient in Bengaluru died after two weeks of treatment. 

Forensic expert Dinesh Rao, who heads the Department of Forensic Medicine in Oxford Medical College and Research Institute, took the virus samples from the deceased’s nose, throat and mouth, lung surface, respiratory passages, face and neck. An RT-PCR test, which is the gold standard for COVID-19 testing, showed that the nose and throat samples tested positive for the novel coronavirus.

Dr Rao said he took up the autopsy to understand how the disease affects the human body and to evaluate if there was a need to update the treatment protocol of patients. He said in the case of the 62-year-old patient, the lungs were majorly affected by bacterial infections. With the effect of the virus, Dr Rao said the patient’s lungs had turned leathery and gained in weight significantly. While lungs normally weigh around 700 grams, for the victim it weighed more than 2.1 kg and had turned into a leather ball which otherwise should be like a rubber balloon. 

Dr Rao added that the deceased’s lungs had blood clots and the air sacs were damaged, which meant that the patient needed thrombolytic therapy before being put on a ventilator. He said that the lungs turning inconsistent and leathery was contrary to the usual effects of acute respiratory distress.

“As a forensic expert, I have done more than 60,000 autopsies and I have seen shock lung features in around 300-400 cases. The damages in the areolar tissues in those cases and those in corona patients are very different. This is one of the most important findings. Even with this damage, the lung size has not increased in size but it has become hard. Other infections in the lungs will cause the lungs to increase in size but not hard,” Dr Rao told TNM.

He added that there were many inflammatory changes in the heart. “The whole respiratory passage was also inflamed. Other than that the kidney had reduced in size, so there needs to be a study on this. The presence of the virus has to be done in a periodic analysis and that will also give us better understanding of how to handle the dead bodies,” he said.

Dr Rao believes that such autopsies and greater research is needed to understand how the disease affects the human body and accordingly treatment protocols should be modified.

“I can only say that merely giving antiviral drugs or connecting patients with respiratory distress to ventilator usage is of no use. We should always do CT scan and pinpoint where exactly is the thrombolysis and if there are plenty in number, then better to give thrombolytic drugs along with oxygen,” he said.

The autopsy was done with the consent of the patient's family and all of his kin were in home isolation at that time. However, others from this department were skeptical to be a part of it.

“We have a very small window period of getting permission from the family and setting up the facility. I had hardly 2-3 hours. The staff who were available in my department, they expressed fear and we can't really involve other specialists. It is also not possible to set up a panel of experts from different institutes in such a short period of time. The reason for fear is understandable,” he said.

Dr Rao says that his findings are a bit different from studies in Italy and the US and wants to do more autopsies before coming to conclusions. “There they observed hyaline changes in the lungs but we did not observe that there. (Hyaline change is any change that results in a glassy, pink homogenous staining of the tissue) What we say was a lot of inflammatory cells in the interstitial space, the alveolar was raptured and there were small clots in the blood vessels of the lungs which led to destruction of the lung tissue. We call his coagulative necrosis,” he says.

He adds that though results of one autopy cannot be deemed as conclusive evidence, the post-mortem has opened a big pandora’s box. “Any new disease can be understood better only through such post mortems. This is the only way to derive clinical modalities to treat patients. This has been done with all other diseases in the world,” he says.

Dr Rao said that he wants to publish his findings in a peer-reviewed medical journal.