Question

Provide a comprehensive summary on the article "Perspectives on the death investigation during the COVID-19 pandemic" by Ye Xue et al.

Answer 1

COVID-19 Pandemic:

New pneumonia called COVID-19, which is caused by a novel coronavirus (2019-nCoV), has broken out around the world.

The pandemic of COVID-19 caused by 2019-nCoV outbreaks in most of the countries, has subsequently spread rapidly and become a pandemic worldwide.

Due to the strong infectivity of COVID-19 and lack of experience of performing an autopsy in infectious disease-induced death, the pandemic created some challenges for forensic practitioners. In this article, we summarize the experience of how we handle the confirmed or suspected infectious cases and give some perspectives for the future.

1.Potential risks facing by forensic practitioners

Forensic practitioners may not know the victim's accurate health condition, travel history in a pandemic area or the contact history with possibly infected persons immediately. So, they face Potential risks during death scene investigations. The use of personal protective equipment by all personnel at a death scene is recommended.

2. Potential risks during autopsy

2019-nCoV has strong survivability and resistance to cold environments [[6], [7]]. It indicates that the 2019-nCoV can survive in a corpse for a period of time after the infected person has died. The remains of patients who have died of COVID-19 may have a large amount of the virus.

Currently, known routes of transmission of 2019-nCoV are mainly respiratory droplets, aerosols, and contact with viral secretions. During an autopsy, forensic practitioners need to perform tissue segmentation, organ extraction, organ incision and other procedures, during which the virus can be passively released and increase the risk of inhaling the virus due to the timeframe of the autopsy and close proximity to the body.

3. Measures we have taken in forensic practice

A thorough investigation of the history of victims

Protection measures for the death scene and autopsy

Forensic practitioners should wear one-piece protective clothing, N95 mask, protective goggles face shield, protective shoe covers, and at least two layers of medical latex gloves; they should also be aware of the proper order of putting on and taking off protective equipment. Autopsies should be performed in a special autopsy laboratory in strict accordance with a process of three areas and two buffer zones, which consist of:

1.Clean area,

2.One first-level buffer zone,

3.Semi-contaminated areas,

4.A second level buffer zone and

5.Contaminated area.

4. Future improvement

• Establish a multi-department joint control system

The joint control system should coordinate with multiple departments, such as the Center for Disease Control, Civil Administration Department, Health Commission and Environmental Protection Authorities for death investigation, as soon as possible. All departments should unite together and share information about the pandemic situation.

• Improvement of the forensic autopsy laboratory construction

For dealing with infected cases, autopsy laboratories should be constructed in the future to be qualified at certain biological safety levels. The P3 autopsy laboratory would satisfy the requirements for most of the infectious diseases, with the special requirements in terms of floor layout, maintenance structure, ventilation and air conditioning system, water supply and air supply system, sewage disposal, and disinfection system.

• Forensic radiology requires progress

Clinical diagnostic criteria for COVID-19 are the nucleic acid test and radiology examination by CT scan. Virtual autopsy based on forensic radiology technology could play a significant role in the autopsy of infectious diseases. CT scan of the cadaver before autopsy provides an initial assessment of a possible cause of death and also prevent forensic practitioners from directly contacting an infected but asymptomatic body. Forensic practitioners could make a preliminary judgment on whether the deceased may be infected or not and take appropriate protective measures during subsequent autopsy.