Author’s reply: Letter to the Editor in response to Guerriero “Restriction of autopsies during the COVID-19 epidemic in Italy: prudence or fear?”
I appreciated the letter by Guerriero 1, that gives us the chance to consider the COVID-19 situation and the effects on our activity. First of all, I think it is important to consider the urgency of the specific moment, at the time we produced the document with the society of forensic medicine. The intent was to secure our activities and the respect of our profession, so that the authorities governing our hospitals could be alerted that pathologists could do autopsies even during COVID-19 but at certain conditions. The document gave all the criteria on “how to equip the pathology sector room to the highest levels of bio-safety and how to equip and educate the operators with the best PPE and how to use it, and it was not conceived to lockdown the pathology departments in all Italian hospitals – even in those equipped and ready to deal with Coronavirus-2”2.
We did not want to stop autopsy, but in particular, we tried to help pathologists of those regions highly affected by the virus to obtain what they deserved: security and respect 3. The goal of our society is to improve the level of biosafety of the pathology units, for autopsies, histology, cytology and molecular biology 4,5. Some of the colleagues used the document as it was intended and obtained the level of security and organization of the autopsy room that allowed them to perform this “medical activity” as it should be independently from COVID-19.
We specified that autopsy should not be used for COVID-19 first diagnosis and I still think that this is the fact. If the diagnosis of COVID-19 was clear cut the autopsy should be performed in specific structural setting to guarantee the safety of operators. Colleagues of the most affected regions were able to perform a high number of autopsies of selected cases (e.g., young persons or subjects without any co-morbidity, or with atypical therapeutic response), adopting a minimally invasive protocol and they are hopefully going to publish their results.