SA experts probe victims’ lungs to work out why Covid-19 is ...

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SA experts probe victims’ lungs to work out why Covid-19 is lethal

Researchers at UCT and Wits hope the autopsies will crack the worldwide mystery of why the virus kills so many

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Forensic pathologist Prof Lorna Martin at Salt River Mortuary in Cape Town.
Natural cause Forensic pathologist Prof Lorna Martin at Salt River Mortuary in Cape Town.
Image: Ruvan Boshoff

Top SA lung experts are performing autopsies on Covid-19 victims as part of a global effort to understand why the virus is so deadly in certain patients.

Even though Covid-19 has claimed more than 300,000 lives, there is no definitive understanding of the precise ways in which it kills.

While autopsies are normally done only on people who have died of unnatural causes, it is hoped the SA study will help doctors to save the lives of patients who experience severe illness.

Prof Shabir Madhi.
Prof Shabir Madhi.
Image: National Research Foundation

The surveillance study has already begun, under the leadership of  Prof Shabir Madhi from the Respiratory and Meningeal Pathogens Research Unit at Wits University. Madhi is a member of SA’s ministerial advisory committee on Covid-19.

The study, due to end in December, comes as many countries have experienced “hampered efforts to collect tissue from patients” because of “strained healthcare systems, lockdowns and safety requirements”, according to the scientific journal Nature.

Wits and the University of Cape Town are involved in the research, and there are plans to add a site in KwaZulu-Natal.

“We are investigating SARS-CoV-2 [the virus that causes Covid-19] and other respiratory pathogens in adults hospitalised for SARI [severe acute respiratory infection] who then died, in major provinces in SA,” said Madhi.

Samples of lung tissue were being extracted in fatal cases of Covid-19 “and from a sample of fatal pneumonia cases” in which SARS-CoV-2 “was not identified” before death.

The team also wants to “establish a repository of whole blood samples” to explore possible genetic markers that predispose an individual to severe Covid-19 disease.

Prof Keertan Dheda
Prof Keertan Dheda
Image: University of Cape Town

Prof Keertan Dheda, who heads the Lung Institute at UCT, said: “The study, funded by the South African Medical Research Council and approved by the ethics committee, has already begun at Groote Schuur Hospital.”

It includes looking at the “underlying lung immunopathology, and whether this is different in diabetics and HIV-infected persons”.

Prof Lorna Martin, head of the Western Cape forensic pathology service, said academic autopsies had become rare worldwide, leading to a decline in research.

“In the case of unnatural deaths, forensic autopsies are done for medico-legal purposes as guided by the National Health Act, and are done by the state,” she said.

“Covid-19 is deemed a natural cause of death just like Ebola, a heart attack, or cancer, for example,” and forensic autopsies were not done.

She said that research autopsies on those who had died naturally had declined exponentially in the past decade because of the exhaustive administrative process involved.

“It is expensive and there is much red tape,” she said, adding that research autopsies require ethics approval and clearance, family consent, and strict protocols that must be followed by a reputable institution that is given permission to perform them.

'I am much more safe here than if I go to the supermarket,' says Prof Lorna Martin at the Salt River Mortuary.
Cold facts 'I am much more safe here than if I go to the supermarket,' says Prof Lorna Martin at the Salt River Mortuary.
Image: Ruvan Boshoff

Martin said the decline of research autopsies had led to a “lack of cases with which to teach registrars” as well as a gap in the way such autopsies could “feed back information into the public health system”.

She was not worried by the risk of infection when performing autopsies on Covid-19 patients. “If you’ve got your personal protection equipment on and follow procedure, it’s the safest place to be,” she said. “I am much more safe here than if I go to the supermarket.”

A bigger concern was the number of bodies that would need to be stored before burial or cremation when the disease peaked. “With natural deaths, the body is normally the family’s responsibility and that’s what the private undertaker industry is about,” she said.

But at some point in a pandemic, bodies “must become the duty of the state because everybody is going to be overwhelmed”.

Fatality management planning meetings were looking at options including “field mortuaries next to field hospitals”.

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