Best practice for forensic autopsy in suspected SARS-COV-2 infected bodies. An update from the task force of the Italian Group of Forensic Pathology.

In light of the global spread of the new human coronavirus SARS-CoV-2, identified for the first time during an outbreak of pneumonia cases in Wuhan, China, a number of forensic autopsies will be performed on potentially infected corpses. The main aim of this document is to provide safety recommendations to perform forensic autopsies. Moreover, the forensic pathologist sometimes is the first physician facing to the death of a SARSCOV-2 infected subject. In this case, a comprehensive knowledge of SARS-COV-2 clinical and pathological features, may be of the utmost importance not only to timely pose the suspect of infection but also to timely provide safety measures and adequate post-mortem sampling. After summarizing clinical and pathological features of SARSCOV- 2 infection, information about the related health and safety issues will be provided. The autopsy facility must be Biosafety Level 3 and negative pressure with 6-12 air changes per hour should be provided in the autopsy room. Moreover, personal protective equipment for individual protection must guarantee protection both from direct contact and aerosol transmission. Furthermore, clinical information, relevant to pose the suspect of infection before and during the autopsy, will be focused in a dedicated section. Finally, the autopsy procedure will be illustrated together with the microbiological and histopathological sampling activity, recommended not only for diagnostic purposes but also for scientific studies. SARS-CoV-2 recommendations dedicated to the forensic setting seem of the utmost importance. Indeed, the forensic pathologist might be claimed not only to establish the cause of death, but also to solve a number of further issues, such as: the assessment of malpractice and medical liability, complicated by the rapid evolution of the state of the art; the potential contributory role of SARS-CoV-2 infection in the manner of death, for example, cases of suicide have been reported in infected patients; to reconstruct retrospectively the time and transmission modality of the infection in a specific subject, aimed for example to evaluate the liability to third parties especially for infections occurred in fragile patients living in nursing homes for elderly or disabled people.