Spain pathologists help build virus understanding

When it first arrived in hospitals across Spain, much like the rest of the world, COVID-19’s strange constellation of symptoms perplexed doctors. In addition to cold-like symptoms, many patients also lost their sense of taste or developed skin rashes. Others reported memory loss and brain fog. Some struggled to breathe, even on ventilators.

At best, a lab test could confirm whether someone was infected with the coronavirus. Beyond that, doctors could only guess at what was raging inside their bodies. However, in few hospital morgues, pathologists were the ones to fill in the first details of COVID-19’s internal toll by dissecting and inspecting the disease’s first victims.

Through autopsies conducted by pathologists like Virginia de Lucas in Madrid, we now know far more about how the coronavirus infects and ravages the human body than we did nine months ago. De Lucas and her colleagues at the "Fundación Jiménez Díaz" hospital in Madrid started taking autopsy samples in April, from patients who lost their lives to COVID-19. A total of 50 autopsies were performed nationwide, of which about 10 were performed by Fundación Jiménez Díaz hospital.

"Everything was unknown. We didn't know how to organize ourselves; how can I pass you this container? We were afraid to touch each other, so yes, I admit that doing the first (autopsy) I was concerned," said the 28-year-old de Lucas who is the supervisor of the anatomical pathology department.

Early studies of deceased patients, for example, confirmed that COVID-19 was not just a respiratory disease. In addition to attacking the lungs, the coronavirus can also infect heart, brain, liver, kidney, colon and other vital organ tissue. Emilia Barrera, in charge of performing the first autopsies said they quickly realized how the virus can damage certain organs of COVID-19 patients. The lungs were one of the main organs affected, a loss of sponginess and functional capacity was observed.

The lungs of virus patients exhibited significant post-mortem stiffness, said Barrera. The results of some of those autopsies have shaped our understanding of what COVID-19 does to the body and how we might treat it. Despite the resurgence of autopsies in some hospitals this year, experts do not expect the ancient medical practice to fully rebound. "This space (room) which is not that old was constructed specifically for biosecurity activities but we have very few of them in Spain, that's why very few hospitals were able to do this type of autopsies," said de Lucas.