WHO has correctly warned about an Infodemic with COVID. The biggest challenge for us as the medical community is to deal with distinguishing the scientific information from the unscientific (and possibly anecdotal) information.

I read this information floating on WhatsUp University (WA Univ.) almost 5-6 days back and did not pay much credence. However, since the creation of this group, I see this for the third time. That mandates me from researching this on Pubmed Central and Google Scholar. Pubmed Central gave zero results to “COVID and Autopsy” Whereas, Google Scholar pulled few results. I have cited references along with the full text as well.

I found a total of three publications related to Autopsy. One was a single case report from China, another 12 cases from New Orleans, and the remaining report of 2 cases from Oklahoma. I searched for an autopsy study for 50 cases and I found none. Also, I saw no doctor with this background who would have not disclosed his name or published this autopsy study of 50 cases, since it would have been well acclaimed. The WA Univ. author has not discussed the autopsy finding but is driving the readers to his preset conclusions.

My Concern:

1. If the author has truly done a study of 50 cases, why has he/she not published this?
2. Often submissions are accepted as advanced publications subject to review, he/she could have resorted to this option?
3. The name of the author is Dr. Fikry, a Google search does not indicate any such doctor.
4. Why does he want to stay anonymous? Select reasons that come to my mind are – either the work cannot be substantiated or he/she has not followed the Helsinki guidelines for research.
5. Research Style – Ideally, research has to follow a methodology, and a paper is written in order. I did not see that order but a direct jumping to evidence.
6. Should we rely on WhatsUp University for these conclusions?

References: 

1. Interesting read on Autopsy findings in COVID-19 from Dr. Sanjay Mukhopadhyay, Director of Pulmonary Pathology at the Cleveland Clinic. https://www.scientificamerican.com/podcast/episode/covid-19-what-the-autopsies-reveal/
2. https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa062/5818922
3. The above can also be accessed from https://www.unboundmedicine.com/medline/citation/32275742/COVID-19_Autopsies,_Oklahoma,_USA.

I am also including the full text of the “False Autopsy Finding of 50 cases” below along with my comments in parenthesis

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Full text of the Unsubstantiated (Possibly false) WhatsUp University version (author anonymous). 

Thanks to 50 autopsies carried out on patients who died from COVID-19, they found that it is NOT PNEUMONIA, strictly speaking, because the virus does not kill pneumocytes of its type only but uses an inflammatory storm to create an endothelial vascular thrombosis, with the corresponding diffuse thrombosis the lung is the most affected because it is the most inflamed, but also, it produces a heart attack or stroke, and many other thrombotic diseases. Infact the protocols have left the useless antiviral therapies and have concentrated on the inflammatory and anti-clotting. (Ideally, gross findings are shared substantiated by microscopic finding, not the pathophysiology or mechanism)

These therapies must be done immediately, even at home, where the treatment responds very well to the patients. Later they are less effective. In resuscitation, they are almost useless. If the Chinese had reported it, they would have invested in-home therapy, not Intensive Care! It is a case of DISSEMINATED INTRAVASCUAL COAGUALATION THROMBOSIS (see the spelling, this is typical of WhatsUp University). So, the way to combat it is with antibiotics, anti-inflammatories and anticoagulates. (Not sure if we subscribe to antibiotics in the absence of bacterial infection, a report from New Orleans emphasizes that there was no bacterial infection).

An Italian anatomical pathologist reports that the Pergamo (I never visited Italy so I searched for Pergamo, I found no Pergamo City, but one as Bergami, Milan) hospital made a total of 50 autopsies, Milan 20; the Chinese have only made 3, which seems to fully confirm the information. Success is determined by a disseminated intravascular coagulation activated by the virus, so interstitial pneumonia would have nothing to do with this, it would have been just a big diagnostic error. In retrospect, I have to rethink these chest radiographs that were discussed a month ago as interstitial pneumonia, it could actually be fully consistent with a disseminated interstitial coagulation DICA (earlier, I shared a report of the different CT findings in COVID, those images can be reviewed by clicking the links).

People go to ICUs for thrombus, generalized venous embolism; generally, lupus. If this were the case, intubations and resuscitations would be useless if thromboembolism is not resolved first. Ventilating a lung where blood does not reach is useless. In fact, nine out of ten die because the problem is cardiovascular not respiratory. It is venous micro-thrombosis and not pneumonia that determines mortality.

Why do thrombi form? Because inflammation according to the school text induces thrombosis through a complex but well-known pathophysiological mechanism. So what the scientific literature said especially from China until the middle of March was that anti-inflammatories should not be used. Now the therapy that is being used in Italy is with anti-inflammatories and antibiotics as in influenzas, and the number of hospitalized patients has been reduced. Many deaths even in their 40s had a history of fever for 10 to 15 days, which were not adequately treated here (the history is intentionally purported to mimic COVID, check the spellings, a scientific report goes through spell check, a WhatsUp University report does not) the readers to believe this is COVID-19). The inflammation destroyed everything and created the ground for the formation of thrombi, because the main problem is not the virus, but the immune reaction that destroys the cell where the virus enters. In fact, patients with rheumatoid arthritis have never been admitted to the covid departments, because they are on cortisone therapy, which is a great anti-inflammatory. That is the main reason why hospitalizations in Italy are decreasing and it is becoming a treatable disease at home. By treating it well at home, not only hospitalization is avoided but also the risk of thrombosis. It was not easy to understand, because the signs of micro-embolism have faded even in the echocardiogram.

This weekend the comparison was made of the data of 50 patients between those who breathe badly and those who do not and the situation seems very clear (Once again, to repeat, I saw no such autopsy report of 50 cases on Pubmed Central, or Google Scholar or Google, neither did I see a city by the name of Pergamo).

With this important finding, it would be possible to return to normal life and open the businesses closed by the quarantine, not immediately, but it is time to publish these data so that the health authorities of each country make their respective analysis of this information and avoid more useless deaths and the vaccine may come later.

In Italy, from today the protocols are changing. According to valuable information from Italian pathologists, ventilators and Intensive Care Units are not required. So we must rethink investments to adequately address this disease (Do we want to jump to a conclusion without sufficient evidence?).

References:

Pathological findings of COVID-19 associated with acute respiratory distress syndrome (Link here)

COVID-19 Autopsies, Oklahoma, USA (Link here)

Pulmonary and Cardiac Pathology in Covid-19: The First Autopsy Series from New Orleans (Click here)

https://academic.oup.com/ajcp/advance-article/doi/10.1093/ajcp/aqaa062/5818922

https://www.unboundmedicine.com/medline/citation/32275742/COVID-19_Autopsies,_Oklahoma,_USA.

https://www.scientificamerican.com/podcast/episode/covid-19-what-the-autopsies-reveal/