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Just like everywhere else, the coronavirus is upending normal procedures at the San Diego County Medical Examiner’s Office.
When it comes to the coronavirus pandemic, even the dead are dangerous. At the San Diego County Medical Examiner’s office, pathologists are donning respirators and diverting potential COVID-19 cases to a rarely used autopsy room designed to protect against airborne pathogens. And they’ve rented 53-foot refrigerated trucks to store bodies if the death toll skyrockets.
So far, though, pathologists have seen only about a dozen of the more than 240 reported deaths from COVID-19 in the county. That’s because the medical examiner’s office only steps in when a death is unexpected or unexplained. In those cases – 3,232 of 22,000 deaths in San Diego County in 2018 – officials launch investigations and may perform autopsies to determine why and how people died.
In an interview, chief deputy medical examiner Dr. Steven Campman explained how he and his colleagues are adjusting to a new era.
Campman: Only about 10 percent of cases we’ve tested have been positive. We have had 11 deaths at the ME’s Office with COVID-19 as the primary cause of death or a contributing condition. Only one required an autopsy to determine the cause of death.
Of the deaths that the medical examiner has seen related to COVID, most had symptoms like fever and cough at home and either died at home or in the emergency room before the diagnosis was made. A few deaths occurred in care facilities when people were debilitated, recovering from trauma and were known to become symptomatic/COVID positive. They were medical examiner’s cases because of having the trauma.
We generally test by collecting nasopharyngeal swabs, like in live people. In some cases, lung tissue or other swabs may be collected. We are watching for potential COVID-related deaths and are testing when indicated for diagnosis. However, do not generally test for COVID-19 when, for instance, someone dies of a drug overdose, gunshot or injuries in a car crash.
It is routine to wear standard, full personal protective equipment for all autopsies, which for most includes a standard surgical mask. For known or suspected deaths with a novel infectious disease, like COVID or H1N1 influenza, or an aerosol transmissible disease, we wear an N-95 respirator or powered air-purifying respirators, which have a hood into which filtered air is passed.
If death is known to be COVID-related and due to natural disease, we often perform just an external examination without opening the body. If we know a death is COVID-positive, and we have to perform an autopsy, we have used our Airborne Isolation Room instead of the main autopsy room.
It’s a separate autopsy room equipped to perform one autopsy at a time, separate from the main autopsy room in which multiple autopsies can be performed at the same time. The isolation room has negative air pressure so that airflow from that room does not leak into the rest of the building when its door is opened. We use it in deaths known or suspected to represent a novel infectious disease, like COVID-19 or H1N1 influenza, or an aerosol transmissible disease. It has been used three times in recent weeks, and usually goes many months or even a year or more between uses.
We have already acquired extra refrigerated storage, not just for our department but to be made available for regional hospitals, through the Office of Emergency Services.
Two of the 53-foot trucks are at the medical examiner’s facility, ready but unused. The other three are on county property awaiting deployment where needed.
Our normal facility can handle around 300 bodies, and we’ve been steady at our usual capacity of approximately 50 percent. We can handle hundreds more with the additional storage.
We have had planned, graded responses for handling bodies from just a small number into the thousands from various situations, including pandemics, terrorist attacks, plane crashes and earthquakes.