++SOUNDBITES PARTIALLY OR FULLY COVERED BY VIDEO++
Mineola, New York - 16 December 2020
1. Close of sign reading, (English): "Entrance to Morgue Here"
2. Various of pathologist Dr. Amy Rapkiewicz inside a cold storage unit of the morgue
3. SOUNDBITE (English) Amy Rapkiewicz (RAP-co-WITZ), MD, Pathologist at NYU Langone:
"Historically, thinking about pandemics – Influenza, Sars-CoV-1 – any pandemic, really, autopsy allows played a role in learning about the disease process."
4. SOUNDBITE (English) Amy Rapkiewicz (RAP-co-WITZ), MD, Pathologist at NYU Langone:
"And I think when coronavirus was first starting to be described, at least COVID-19, not coronavirus in general, we knew that it affected the lungs. Obviously, patients came in with respiratory illness, but it was only really through autopsy that we started to see the spectrum of disease manifestations that the coronavirus can cause – COVID-19 can cause."
5. Rapkiewicz opening up cold storage trailer outside of the morgue
6. Walking shot showing rows of shelves used to store corpses inside cold storage trailer
7. Rapkiewicz going through hospital mortuary record book and various of book, UPSOUND (English): "This book would normally take, maybe, over a year to fill and we are nearly through it. And this one is only a couple months' old."
8. SOUNDBITE (English) Amy Rapkiewicz (RAP-co-WITZ), MD, Pathologist at NYU Langone:
"When we started to do the autopsies of the COVID-19 patients, one of the main findings that we found was that there was clotting in various organs throughout the body – the heart, the lungs, the liver, the kidneys. And that was really under recognized clinically as a source of as sort of a process within the disease."
9. Various of Rapkiewicz looking through a microscope at a non-COVID-19 tissue sample
10. Various of Rapkiewicz and an assistant examining tissue from a non-COVID-19 autopsy ++GRAPHIC WARNING++
11. SOUNDBITE (English) Amy Rapkiewicz (RAP-co-WITZ), MD, Pathologist at NYU Langone
"In many of my cases, of the patients that died in the ICU, they had very advanced scarring in their lungs that I wouldn't expect to see in someone who comes in with, let's say, influenza. And I think that we will learn that the damage that coronavirus does is quite dramatic."
12. Rapkiewicz examining a lung from a COVID-19 autopsy ++GRAPHIC WARNING++
When it first arrived in U.S. hospitals, doctors could only guess what was causing COVID-19's strange constellation of symptoms: In addition to cold-like coughs and aches, some patients lost their sense of taste, got skin rashes, struggled to breathe, or reported memory loss.
But at hospital morgues, pathologists were busily dissecting the disease's first victims. Their findings quickly became key to understanding how coronavirus ravages the body.
"It was only really through autopsy that we started to see the spectrum of disease manifestations that the coronavirus can cause, COVID-19 can cause," NYU Langone pathologist Dr. Amy Rapkiewicz said.
Around the country, the pandemic is helping revive the use of autopsies, which have lost stature over the years as the medical world instead turned to lab tests and imaging scans.
Early dissections of deceased COVID-19 patients, for example, confirmed the novel virus is not just a respiratory disease, but can also attack heart, brain, liver, kidney, colon and other vital organ tissue. During some of those autopsies, the discovery of microscopic blood clots led to the use of blood thinners for treating coronavirus.
"That was really under recognized clinically as a source of as sort of a process within the disease," Rapkiewicz said.
But at many hospitals, short supplies of equipment, funding and personnel prevented the service from taking place at all — even when pathologists were certain of its value during an infectious disease outbreak.
"Historically, thinking about pandemics, influenza, Sars-CoV-1, any pandemic really, autopsy allows played a role in learning about the disease process," Rapkiewicz said.
Autopsies have informed medicine for more centuries — most recently playing a critical role in detecting the opioid epidemic, demystifying AIDS and anthrax, and improving painful cancer treatments such as radiation and chemotherapy.
Facilities across the country have also been able to stock freezers with coronavirus-infected organs and tissues collected during autopsies. These biobanks will help researchers study the disease as well as possible cures and treatments.
"In many of my cases, of the patients that died in the ICU, they had very advanced scarring in their lungs that I wouldn't expect to see in someone who comes in with, let's say, influenza," Rapkiewicz said.
And during the current, deadly COVID-19 surge, pathologists will pay special attention to the effects of coronavirus treatments and the disease's physical toll on long haulers.
"I think that we will learn that the damage that coronavirus does is is quite dramatic," Rapkiewicz said.
The number of experts who can actually perform autopsies is critically low. Estimates suggest the U.S. has only a few hundred forensic pathologists but needs several thousand to keep up with demand.
Only about 1% of accredited medical specialty programs are in pathology, and many of them go unfilled each year. About one in 100 of graduating medical school students go into the field. Meanwhile, experts have predicted, the number of retiring pathologists could peak as soon as 2021.
Once in the field, burnout and low pay can make it hard to commit to a long career.
Despite the resurgence of autopsies in some hospitals this year, experts don't expect the ancient medical practice to fully rebound.
For one, due to safety concerns about the transmission risk of autopsies, many teaching hospitals decided to stop or seriously curb the practice
It's been decades since the federal government required hospitals provide a certain rate of autopsies. In 2019, it stopped asking hospitals to offer access to autopsies at all. In addition, the country's largest health insurer, Centers for Medicare and Medicaid, no longer covers the practice.