LAUSR

In December 2019, the spread of the novel coronavirus SARS-CoV-2 began in Hubei, China, and since then, a worldwide devastating pandemic has developed, which is affecting public and social life to a very high degree and overtaxing the medical systems of many countries. The first COVID-19 death of a German citizen occurred in Egypt. For a 59-year-old firefighter from Hamburg, the longedfor-holiday trip to Luxor-Assuan-Hurghada turned out to be a deadly mission. Theman died on 08March 2020 in the intensive care unit of a hospital in Hurghada on the Red Sea. In Hamburg itself, the first case of a corona infection was also registered in March at the University Medical Center Hamburg-Eppendorf. The patient had returned shortly before from a skiing holiday in Austria; since then, the number of infected persons has increased rapidly. TheWorldHealth Organization declared COVID-19 aworldwidemedical problem on 30 January and declared the spread of a pandemic on 11March. In Europe, there have been serious medical consequences in many countries (especially Italy, Spain, France, Great Britain). Most deaths occurred in the USA. No country in the world was spared. A more or less consistent ban on public activities was ordered by the governments. So far (as of 22May), almost all registered so-called corona deaths have been documented and evaluated in Hamburg. In a few cases, these were legal autopsies according to § 87 StPO (Code of Criminal Procedure); in most cases, the autopsies were ordered by the responsible health authority according to § 25 (4) InfSchG (German Infection Protection Act). From the beginning of the pandemic, we deliberately did not follow the recommendation of the official website of the Robert Koch Institute (RKI –German healthmonitoring agency) to avoid autopsies. This recommendation has been made repeatedly in the literature, but it has also been criticised [3, 4]. It is, however, not acceptable for scientific research into this new viral infection with regard to the pathogenesis and clinical course of COVID19. It should be remembered that hygiene and adapted organisational procedures in infectious diseases such as COVID-19 are part of daily routine with regard to protective measures when handling the cadaver and during dissection. The situation is comparable with other infectious cadavers (e.g. influenza, hepatitis, AIDS, EHEC, tuberculosis)—this was underlined by recommendations of the German Society for Forensic Medicine! The reluctant attitude towards autopsies reminds experienced forensic doctors of the situation at the beginning of the spread of AIDS, when initially only extraordinary autopsies were performed [7]. On the other hand, autopsies have made a significant progress in understanding the disease AIDS, in its spread in special risk groups and with regard to concomitant diseases. Our own experience with the autopsies performed in Hamburg to date shows very different disease courses and correspondingly diverse morphological and virological findings. Details were presented by Edler et al. [2], Casagrande et al. [1], Puelles et al. [6], and Wichmann et al. [9]. The viral infection of the respiratory tract and the lungs has so far proven to be central to the fatal course of the disease.However, the typical full picture of a viral pneumonia is not always given. In addition, changes are caused by bacterial superinfections or other nosocomial infections, therapy in intensive care units with long-term ventilation, occasional aspiration events, various pre-existing respiratory diseases and concomitant multimorbidity. In particular, we found an unusually high number of ubiquitous thromboses and recurrent pulmonary embolisms (including pulmonary infarctions)—findings with particular relevance for diagnostics and therapy! * Klaus Püschel [email protected]