LAUSR

Background Data from Africa of sudden and unexpected COVID-19 community deaths, and underlying pathological, demographic and co-morbidity features require definition. Methods We performed a descriptive case series of COVID-19 related deaths seen at Forensic Post-Mortem autopsy examination of sudden and unexpected Community Deaths in Lusaka, Zambia, Africa. Post-Mortem gross and histopathological examinations of all organs were performed according to Standard Operating Procedures. . Patient demographics, history, co-morbidities, pathological gross and microscopic findings, and cause(s) of death were recorded. Variables were grouped as frequencies and percentages. Comparison of data was made with autopsy findings of hospital COVID-19 deaths. Findings Of 21 COVID-19 decedents, 14/21 (66.2%) were male. 18/21, (85%) were below 55 years of age, (mean age, 40 ± 12.3; range, 20-73). Median duration of symptoms was 1 day (range 0-2). 9/21 (42.9%) had comorbidities, with hypertension and obesity being the most common. Main post-mortem findings were diffuse alveolar damage (DAD) (80.9%), saddle and shower emboli (38.1% respectively), and pneumonia (14.3%). Pulmonary thromboembolism (76.2%), DAD (14.3%) and SARS-CoV-2 pneumonia (9.5%) were common causes of death. Conclusions COVID-19 as cause of death in medico-legal death (forensic) investigation of sudden and unexpected community deaths Risk factors for the younger age of COVID-19 deaths and thromboembolism need to be identified.