Dead hold clue to Gujarat’s high mortality mystery

High-powered committee seeks recommendations of SOPs and guidelines to set up facilities for clinical autopsies of deceased Covid-19 patients as corona deaths skyrocket in the State

Gujarat may soon be the first state in India to facilitate research into the pathology and disease progression of Covid-19 as its mortality skyrockets, especially in Ahmedabad.

The state’s highpowered research committee led by Deputy CM Nitin Patel has commissioned senior doctors to form protocols, standard operating procedures (SOPs) and precautionary measures as well as send a list of infrastructural facilities required to begin clinical or pathological autopsies of deceased Covid-19 patients.

A senior health department official confirmed the development stating that the decision had been taken after more than a month of deliberations on the topic due to differing views of some doctors over such research in the time of the pandemic. Senior doctors of B J Medical College in Ahmedabad have been tasked with setting up of guidelines for such autopsies in Gujarat.

Dr Hansa Goswami, HoD of Pathology at B J Medical College told Mirror, “We have been asked to prepare SOPs and be ready to carry out autopsies of Covid-19 patients which have not been carried out in Gujarat so far. We are preparing the guidelines now.”



What is clinical or pathological autopsy?

While the forensic medicine departments of medical colleges carry out post-mortems of medico-legal cases (MLCs) to help in police investigation of natural and unnatural deaths, the study of the progression of any disease is carried out by pathologists who carry out what is known as a pathological or clinical autopsy of those who have died due to the disease.

Concerns about getting adequate staff members to perform autopsies during the Covid-19 pandemic have been rubbished as the treatment of Covid-19 patients is mostly with doctors and staff of medicine, emergency medicine, pulmonology and related departments while autopsies will be conducted by doctors of pathology and forensic medicine departments.

Record deaths demand research into disease

How do Covid-19 patients die? According to the Gujarat government, either they die of co-morbidities such as diabetes, hypertension or they die without any underlying medical conditions and just due to cytosine storm and pulmonary embolism caused by the SARS-CoV-2 virus.

The first week of May has been the deadliest so far for Gujarat, with half of all Covid-19 deaths in state being reported from May 1 to 7. Of the 425 deaths reported till May 7, 211 deaths took place in just one week (May 1-7), and this accounted for 50 per cent of the death toll in Gujarat.



Senior doctors weigh in on need to study the disease

Dr D N Lanjewar, who retired as HoD of Pathology at Grant Medical College in Mumbai and is now professor at Gujarat Adani Institute of Medical Sciences (GAIMS) in Kutch, said, “Clinical or pathological autopsies are required to know progression of diseases and even as literature is coming in from China and the US, pathology differs over geography and so we need to conduct our own research.” Dr Lanjewar has conducted over 236 clinical autopsies of AIDS patients during his time in Mumbai.



Speaking in support of research into Covid-19 deaths, Dr Dileep Mavalankar, director of IIPH-G said, “For any new disease which kills people autopsy should be done to understand which organs are damaged and how. Microscopic examination may give clues to improve therapy to save future patients. Of course for Covid deaths it should be done with utmost care and full protective measures so that the staff is not infected.”

However, Kidney disease expert Dr Pranjal Modi of IKDRC said, “Autopsies are usually done when the cause of death is not known and if it must be done for research purposes, consent from family is required. Secondly, we need highly specialised protection for those doctors conducting it as they can be infected. In the US, researchers have found some patients have suffered from inflammation of the heart while others have suffered from pneumonia. So the progression of the disease has not been completely tracked. However, if necessary, a central lab must be given for this where the autopsies can be carried out.”

One of the doctors conducting a nationwide clinical trial in Ahmedabad, told Mirror, “We are unable to find suitable recruits for our trials due to the fast progression of the disease and the rapid deterioration of chosen subject which is taking them out of the stringent protocols set by ICMR. If autopsies are conducted on a random group of deceased patients, it may help us understand the effect on the human body better.”

The doctor is also worried about the large number of deaths among Covid-19 patients with no co-morbidities, especially in the young and middle aged group.

However, according to Principal Secretary, health, Jayanti Ravi, “We will be carrying out a very limited number of clinical autopsies of deceased Covid-19 patients for research purposes as per ICMR guidelines. We are hoping it will help in the understanding of this new disease and help us in treatment of patients.”

Medicos cite central guidelines to avoid research

DGHS Union health ministry guidelines on Covid-19 dead body management and autopsy as of March 15, 2020, state that autopsies of deceased Covid-19 patients should be ‘avoided’. However, the document also makes clear guidelines on protection in case autopsies are needed.

During the meeting of the highpowered committee, some members raised questions as to going against the central guidelines. However, the committee made the decision to at least facilitate the process of research for those willing to take the risk posed by carrying out autopsies of Covid-19 deceased patients. A source informed that the state government wished to carry out its own research on Covid-19 due to huge deaths in Gujarat rather than relying on studies carried out in the US, China, Italy or Sweden.