LAUSR

A rapidly evolving sweeping pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) leading to coronavirus disease 2019 (COVID-19) has dominated the first half of 2020 and continues to do so. Cases of COVID-19 were first described in late 2019, when a series of previously unidentified pneumonia-related deaths emerged in Hubei province, China [1]. COVID-19, subsequently spread to almost all countries with a current count of > 11.5 million cases and > 535,000 confirmed deaths worldwide (https://www. worldometers.info/coronavirus/). Although virus’ origin, cellular entry and epidemiology [2–4] have rapidly been clarified, in situ observations of the actual viral interactions within human organs and tissues in patients suffering from COVID-19 have for a long time been addressed at the level of case reports or small series of ≤ 4 cases, as reviewed byCalabrese et al. [5] in the current issue of Virchows Archiv. Indeed, by the end of April 2020 when 150,000 patients had already died of COVID-19, only 16 autopsy cases had been reported in the peerreviewed literature, with nine publications presenting limited autopsies, assessment of postmortem core-needle or incisional collections of tissue. In the absence of reliable data regarding the degree of SARS-CoV-2 infectivity in dead individuals, various authorities discouraged the conduction of autopsies. This, combinedwith the ill-adjusted attitudes of pathologists, clinicians and societies towards autopsies, locked down scientific activities to elucidate the actual underlying mechanisms of COVID-19 [6]. This seems incomprehensible, given the fundamental and timeproven role of autopsies in re-emerging, emerging or unknown diseases [e.g., 7]. Only after 170,000 reported COVID-19 deaths and 4 months of pandemic, the first autopsy series of > 10 patients (n = 21) was put forward published [8], and only after another 280,000 deaths and one more month, finally a series of > 50 patients (n = 80) was released [9]. The paper by Heinrich et al. in this volume [10] very fittingly illustrates the overcoming of the above mentioned hindrance of autopsies from the German perspective, reporting the systematic postmortem examination, including CT scan, autopsy, histology, and virology assessments, of the first (German) patient to die from COVID-19. As suggested by the fact that the deceased had to be transported to Hamburg within 12 days of death and examined at the Department of Legal Medicine, the overcoming of the blocked position regarding COVID-19 autopsies, at least in Germany, was largely due to the personal commitment and professional conviction of the involved authors. They detected a rather characteristic [5, 8] morphologic pattern with deep-red, slightly nodular, hyperemic, and very heavy lungs with prominent diffuse alveolar damage (DAD), microvascular thrombosis, capillary congestion, and acute hemorrhagic tracheo-bronchitis. In the light of absence of sound evidences regarding the degree of infectivity of COVID-19 cadavers, various labs adjusted their autopsy practices [e.g., 8] in order to ensure safety precaution against infection. In the current issue of Virchows Archiv, Basso et al. [11] describe and nicely illustrate the procedure, which has been used to perform the first series of postmortem examinations at Padua University Hospital, Italy, to minimize the risk of infection for pathologists and technicians. The paper clearly shows that if autopsies of COVID-19 patients are performed under well thought-out conditions, they are indeed feasible and at minimal risk, even if an oscillator saw with special suction device instead of a handsaw is utilized to open the neurocranium. Moreover, the authors report a very important finding that helps clarification whether patients who died on COVID-19 are still infectious: cultures demonstrated vital viruses in lung samples obtained even 6 days after death. * Alexandar Tzankov [email protected]