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. 2021 Aug 22;18(16):8851.
doi: 10.3390/ijerph18168851.

Dying "from" or "with" COVID-19 during the Pandemic: Medico-Legal Issues According to a Population Perspective

Fabio De-Giorgio  1   2 , Vincenzo M Grassi  1   2 , Eva Bergamin  1   2 , Alessandro Cina  2   3 , Franca Del Nonno  4 , Daniele Colombo  4 , Roberta Nardacci  5 , Laura Falasca  5 , Celeste Conte  1   2 , Ernesto d'Aloja  6 , Gianfranco Damiani  2   7 , Giuseppe Vetrugno  1   2
Affiliations

Dying "from" or "with" COVID-19 during the Pandemic: Medico-Legal Issues According to a Population Perspective

Fabio De-Giorgio et al. Int J Environ Res Public Health. .

Abstract

There is still a lack of knowledge concerning the pathophysiology of death among COVID-19-deceased patients, and the question of whether a patient has died with or due to COVID-19 is still very much debated. In Italy, all deaths of patients who tested positive for SARS-CoV-2 are defined as COVID-19-related, without considering pre-existing diseases that may either contribute to or even cause death. Our study included nine subjects from two different nursing homes (Cases 1-4, Group A; Cases 5-9, Group B). The latter included patients who presumably died from CO poisoning due to a heating system malfunction. All subjects tested positive for COVID-19 both ante- and post-mortem and were examined using post-mortem computed tomography prior to autopsy. COVID-19 was determined to be a contributing cause in the deaths of four out of nine subjects (death due to COVID-19; i.e., pneumonia and sudden cardiac death). In the other five cases, for which CO poisoning was identified as the cause of death, the infection presumably had no role in exitus (death with COVID-19). In our attempt to classify our patients as dying with or due to COVID-19, we found the use of complete assessments (both histological analyses and computed tomography examination) fundamental.

Keywords: CO intoxication; COVID-19; causality; pneumonia; post-mortem computed tomography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Group A: lung macroscopic and microscopic findings: (A,B) cut surface showing the consolidation of lobes and red congested areas, with thickening of the interstitial septa and pulmonary edema; (C) interstitial fibrosis H&E, 200×; (D) numerous inflammatory cells consisting mostly of lymphocytes infiltrating into alveolar septa and clustering around capillary vessels, H&E, 200×.
Figure 2
Figure 2
Group B: pulmonary macroscopic and microscopic findings: (A,B) cherry-red coloration, pulmonary edema, and congestion; compact basal parenchyma; (C) desquamative necrosis of the bronchial epithelium, H&E, 400×; (D) bronchi surrounded by inflammatory cells, H&E, 400×.
Figure 3
Figure 3
Post-mortem lung CT (parenchymal window) showing “ground glass” opacities in a subject of group A (A) and in one of group B (B). In A, the distribution of opacities was bilateral, peripheral, and without gravitational gradient. This pattern is considered typical in COVID-19 pulmonary infection. In B, the “ground glass” opacities showed a more central and gravitational distribution, as seen in post-mortem CT lung changes.
See this image and copyright information in PMC

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