The Centers for Disease Control (CDC) says “autopsies on decedents with known or suspected COVID-19 should be conducted in Airborne Infection Isolation Rooms,” in a guidance released to medical professionals on February 20.
In addition, the CDC guidance says Aerosol Generating Procedures (AGP) ” such as use of an oscillating bone saw should be avoided for confirmed or suspected cases of COVID-19.”
“If an oscillating saw is used, attach a vacuum shroud to contain aerosols,” the CDC cautions.
The Washington State Department of Health issued its own guidance last week to funeral homes handling deceased cases of COVID-19 that elaborated on the earlier CDC guidance. Washington has seen at least 68 deaths from COVID-19 as of Thursday, the highest of any state in the country:
This document is to provide guidance for preventing infection in mortuary and funeral home workers who handle deceased persons with coronavirus disease 2019 (COVID-19), the illness caused by SARS-coronavirus-2 (SARS-CoV-2).
SARS-CoV-2 is most often spread by respiratory droplets when an infected person coughs or sneezes, similar to how influenza and other respiratory infections spread. Transmission from respiratory droplets is not a concern when handling human remains or performing postmortem procedures. However, mortuary and funeral home workers should take precautions to avoid contact with potentially infectious body fluids.
In addition to following “standard precautions,” the State of Washington guidance advises medical professionals that:
COVID-19 could potentially be transmitted by infectious aerosols generated by using an oscillating saw, suctioning body fluids, or other aerosol generating procedure. If aerosol
generating procedures are anticipated, refer to US Centers for Disease Control and Prevention’s guidance for postmortem specimens from deceased persons under investigation for COVID-19 for information on procedures that should be avoided, additional safety precautions, ventilation requirements, and respiratory protection.
In Snohomish County, Washington, where four people have died from COVID-19 as of Thursday, the County Medical Examiner’s office issued the following guidance:
If a decedent meets any of the [COVID-19] criteria, the Snohomish Health District is notified and a SCMEO medical investigator responds to the scene and transports the decedent to the SCMEO for further examination/testing. Upon arriving to the SCMEO, the decedents are placed in a special isolation refrigerator. The decision to perform an autopsy or test for the COVID-19 virus, or other viruses such as influenza, is made on a case-by-case basis in consultation with public health authorities.
If an autopsy is performed, the pathologist and autopsy technicians performing the examination use the same standard personal protective equipment (PPE) that is used during routine autopsies. The exams are conducted in an isolated, negative pressure, autopsy suite utilizing airborne precautions. The suite is disinfected thoroughly following each exam.
The pathologist and autopsy technicians performing the exam follow Centers for Disease Control (CDC) guidelines when collecting swab and tissue specimens in addition to those collected during routine autopsies. Following the exam, the specimens collected are transported to the Washington State Department of Health Public Health Laboratory in Shoreline, WA for testing.
Though these precautionary guidelines for the conducting of autopsies on victims of COVID-19 have not been widely reported, it comes as little surprise that the CDC, several state departments of health, and local county health departments have been quick to provide them to medical professionals who may be at risk.