Defeat Pandemics – Autopsies for infection control

ESTABLISHMENT OF A GERMANY-WIDE AUTOPSY NETWORK

The DEFEAT PANDEMIcs collaborative project, funded with seven million euros and in which the IMR has been involved since August 2020, aims to establish a Germany-wide autopsy network and develop a national COVID-19 autopsy registry. In the autopsy register, data, biomaterials and findings are to be systematically and regularly recorded, compiled and digitally retrievable. A total of 27 university hospitals and numerous other institutions such as the Robert Koch Institute are participating in the project.

AUTOPSIES PROVIDE IMPORTANT INSIGHTS INTO COVID-19

In a press release, Professor Martin Aepfelbacher, MD, network spokesperson and Dean of Research at the University Medical Center Eppendorf (UKE), emphasized the relevance of autopsies in the fight against the pandemic: "Autopsies can quickly provide important insights that decisively improve risk identification, diagnostics and treatment of patients."

At the beginning of May 2020, the Institute of Forensic Medicine of the UKE, headed at the time by Professor Klaus Püschel, MD, was able to provide evidence that performing autopsies on patients who had died of COVID-19 could play a key role in managing the pandemic. For example, Püschel's team found that there was a significantly higher risk of thrombosis as a result of the COVID-19 disease and, in the process, was able to improve treatment by administering blood thinners. Postmortem examination of the organs also makes it possible to determine the extent to which the disease can lead to permanent organ and health damage.

STUDY ON THE HANDLING OF SECTIONAL ORDERS IN GERMANY

The autopsies performed by Dr. Püschel at the UKE in Hamburg, during the first pandemic wave, were ordered by the city in cooperation with the health authorities. This was done almost exclusively on the basis of the Infection Protection Act (IfSG). To begin the process, an empirical study by the UKE will investigate the extent to which autopsy orders were used in other German states. The IMR will provide legal support for the study.

"By means of a survey, data will first be collected from all German public health authorities on the extent to which dissections have been ordered, on what legal basis and, above all, with what justification," explains John Heidemann, who is intensively involved in the research, being a research associate himself at the IMR. "In addition, we will conduct expert interviews at the highest state authorities responsible for infection control to find out to what extent a nationwide strategy for section arrangements has been pursued," adds Heidemann.

The study should provide a better estimate of pandemic-related mortality, i.e., the number of patients who died directly from the pathogen. In addition, it will show whether non-clinical deaths were also autopsied.

PANDEMIC RAISES NEW LEGAL QUESTIONS

The COVID-19 pandemic, which has put the Infection Protection Act to the test in many respects, also raises unrecognized legal questions about autopsies. Professor Gaede, describing the main goal of the IMR, adds "We need to subject the current bases for ordering autopsies to an examination in order to raise potentials for an overall proportionate protection against infection that have been undeveloped so far. For example, we will address the question of how legal certainty can be ensured for the pathologists carrying out the work." If the authorization for the dissection order do not meet the requirements of efficient and proportionate infection prevention, Gaede and Heidemann intend to draw up what they consider to be the necessary proposals for change.

The first results and recommendations are expected to be published in March 2021.