COVID-19 as Viewed by The Pathologist: A Rapid Literature Review
Francesco Callea, MD. PhD.
The current coronavirus outbreak represents a severe threat to public health worldwide. Finding measures to properly manage and prevent the epidemic is ongoing, right now practitioners and public health authorities need immediate, actionable information. Basic science and medical scientific disciplines have quickly produced a quantity of publications never seen with other emergencies, with a risk of exaggerated information and non-evidence-based measures.
This rapid literature review of PubMed®/MEDLINE publications from January 20 to April 20, 2020 using COVID-19 as main key-word resulted in over 6.000 articles, with around 600 reviews. The contributions were subsequently clustered in subgroups according to journal sources and preselected areas of reference.
Results were aggregated into 4 categories: supported, promising controversial and critical data.
This Review has revealed a major criticality: only seven pathology articles were based on post-mortem material (minimally invasive autopsies/biopsies) . Dealing with an unknown disease, autopsies are indispensable to understand pathogenetic mechanisms, in order to rationalize therapeutic interventions. Even more important is to adopt a dedicated protocol aimed at correlating pathological findings with disease duration, patient location (home, hospital ward, ICU), and, for each period, symptoms, and treatment. Autopsy reports should not be released before a multidisciplinary discussion by hospital Root Cause Analysis or Morbidity/Mortality conferences. Telepathology is not a suitable means for such studies.