BREAKING COVID-19 News! Swiss Autopsy Study Exposes Massive Underreporting Of COVID-19 Deaths!

COVID-19 News: As the world grappled with the unprecedented challenges posed by the COVID-19 pandemic, the accuracy of reported cases and mortality rates remained under constant scrutiny. A recent autopsy study, conducted by researchers from the Cantonal Hospital Baselland, University Hospital Basel, Novartis Institutes for BioMedical Research, and the University of Basel-Switzerland, has shed light on a significant aspect of the pandemic - the potential underreporting of SARS-CoV-2 infections and related deaths.


Massive Underreporting Of COVID-19 Deaths In Swiitzerland,
Across Europe And Elsewhere Discoverd Via Autopsy Study.
 
The Global Impact of COVID-19
The COVID-19 pandemic, declared by the World Health Organization in March 2020, has been a major global health crisis, causing substantial excess mortality across various regions. In Europe, two distinct waves of excess mortality mirrored the pandemic waves, with the first occurring between March and May 2020 and the second from August 2020 to February 2021. During these periods, excess mortality rates reached 25.1% in April 2020 and 40.6% in November 2020, emphasizing the severity and impact of the pandemic on human lives.
 
The Challenge of Determining Cause of Death
A recurring question throughout the pandemic was whether individuals with fatal outcomes genuinely died from COVID-19 or with SARS-CoV-2. The Swiss autopsy study covered in this COVID-19 News report aimed to address this issue by scrutinizing an unselected autopsy cohort for the presence of SARS-CoV-2 and common respiratory pathogens, providing valuable insights into the accurate estimation of COVID-19 mortality.
 
Study Design and Patient Characteristics
The study involved the analysis of lung tissues from 62 consecutive autopsies conducted during the first and second waves of the pandemic in Switzerland. The autopsy cohort consisted of 65% males and 35% females, with a median age of 76.5 years. Notably, none of the patients had received a COVID-19 vaccination, as the vaccination campaign in Switzerland had only commenced in early January 2021.
 
Common comorbidities among the deceased patients included chronic cardiovascular disease, hypertension, chronic respiratory disease, chronic renal disease, cognitive impairment, diabetes mellitus, and malignancies. The majority of the patients succumbed to respiratory failure due to pneumonia or acute cardiovascular events.
 
Underreported COVID-19 Cases
The crucial findings of the study revealed a substantial discrepancy between reported COVID-19 cases during the patients' lifetimes and post-mortem detection of SARS-CoV-2 in their lung tissues. Among the 62 autopsy cases, 18 patients were clinically diagnosed with COVID-19 before death, representing 29% of the cohort.
 
However, post-mortem analysis detected SARS-CoV-2 in the lung tissues of 28 patients, indicating an underreporting rate of 16%.
 
Additionally, five patients who were unexpectedly SARS-CoV-2 positive exhibited typical COVID-19 symptoms and autopsy findings consistent with the disease. These cases highlighted the challenges in accurately diagnosing COVID-19 during patients' lifetimes, contributing to the underreporting phenomenon.
 
The Impact on Mortality Rates
The autopsy results unveiled an 8% higher SARS-CoV-2-related mortality rate than officially reported. While clinicians reported COVID-19 in 29% of cases, the autopsy findings suggested that 37% of all cases had a cause of death directly related to SARS-CoV-2 infection. This difference emphasized the potential contribution of underreporting to excess mortality rates observed during the pandemic.
 
Respiratory Co-Infections and Antibiotic Treatment
Further analysis of the autopsy data revealed that only 25% of COVID-19 deaths had bacterial co-infections in the lungs. Interestingly, the majority of SARS-CoV-2 positive patients (75%) did not suffer from respiratory co-infections when treated with antibiotics. This finding emphasized the importance of understanding the incidence of superinfections in critically ill patients and the effectiveness of antibiotic therapy.
 
Autopsy Findings and Other Respiratory Pathogens
The study explored the histomorphological appearance of autopsy lungs in clinically known COVID-19 patients and those identified post-mortem. Strikingly, none of the unexpectedly SARS-CoV-2 positive patients showed the characteristic diffuse alveolar damage (DAD) observed in clinically known cases. Instead, their lung tissues exhibited unspecific morphological changes, such as emphysema. This discrepancy highlighted the challenges in histopathological diagnosis during patients' lifetimes.
 
Post-mortem detection of SARS-CoV-2 revealed the virus in various organs outside the lungs, including the heart, thyroid, kidney, adrenal gland, pancreas, and liver. The study identified higher viral copy numbers in the lungs, emphasizing the organ's primary involvement in COVID-19 pathogenesis.
 
Discussion and Implications
The retrospective nature of the study allowed for the analysis of a large cohort of consecutive autopsies during the first and second waves of the pandemic in Switzerland. The findings indicated that 82% of SARS-CoV-2 infected patients and 37% of all cases had a cause of death related to SARS-CoV-2 infection. The majority of deaths occurred due to respiratory failure, with co-infections playing a minor role in fatal COVID-19 cases.
 
The study's revelations regarding underreported COVID-19 cases and deaths underscore the complexity of accurately assessing the true impact of the virus on mortality rates. The potential reasons for underreporting included low viral copy numbers in the nose, atypical or asymptomatic courses of infection, insufficient testing capacities, and analytical vulnerabilities in SARS-CoV-2 diagnostic testing.
 
The Implications for Global Understanding of COVID-19
The Swiss autopsy study contributes significantly to the global understanding of the COVID-19 pandemic's impact on mortality rates. The findings emphasize the importance of post-mortem testing to track the presence of the virus accurately. The study's conclusion that most COVID-19 patients in Switzerland had not been clinically diagnosed before death further challenges the existing narrative surrounding the attribution of deaths to COVID-19. It suggests that a considerable portion of individuals who succumbed to the virus might not have been identified during their lifetime, potentially leading to an underestimation of the true burden of the disease.
 
Excess Mortality Rates in Europe and the Global Context
To contextualize these findings, it is imperative to delve deeper into the excess mortality rates observed during the waves of the pandemic in Europe. Excess mortality, defined as the difference between observed and expected mortality, provides a comprehensive measure of the overall impact of the pandemic on mortality, encompassing both reported and unreported COVID-19 deaths.

During the first wave in Europe, from March to May 2020, excess mortality rates surged dramatically. In April 2020 alone, several European countries witnessed excess mortality rates ranging from 23.7% in Spain to a staggering 115.7% in Belgium. These figures underscore the severity of the pandemic's impact on mortality, extending beyond officially reported COVID-19 deaths.
 
Similarly, the second wave, spanning from October 2020 to January 2021, saw a resurgence of excess mortality rates across Europe. Countries like the United Kingdom, Italy, and France experienced excess mortality rates of 37.4%, 49.4%, and 53.7%, respectively, during the peak months of November and December 2020.
 
The Swiss autopsy study aligns with the global trend of underreported COVID-19 cases and deaths, contributing to the incomplete picture presented by official statistics. The implications of such underreporting extend beyond scientific curiosity, impacting public health policies, resource allocation, and the overall understanding of the pandemic's true toll.
 
Factors Contributing to Underreporting
The study's identification of factors contributing to the underreporting of COVID-19 cases sheds light on the challenges faced by healthcare systems during the early stages of the pandemic. Low viral copy numbers in nasopharyngeal swabs, atypical or asymptomatic infection courses, and insufficient testing capacities were among the primary factors influencing underdiagnosis.
 
The analytical vulnerabilities of SARS-CoV-2 diagnostic RT-PCR, especially in cases with low viral loads, emerged as a critical concern. The study's findings underscore the need for ongoing improvements in diagnostic techniques to enhance the accuracy of COVID-19 case identification, particularly in individuals with mild or atypical symptoms.
 
Moreover, the possibility of nosocomial spread within hospitals contributing to the underreporting highlights the challenges healthcare facilities faced in preventing infections among patients and healthcare workers. Strengthening infection prevention measures within healthcare settings becomes crucial to mitigate the risk of nosocomial transmission and subsequent underreporting.
 
The Broader Implications for Public Health
The Swiss autopsy study carries significant implications for public health strategies and policies aimed at managing the ongoing and future waves of the pandemic. Accurate data on COVID-19 cases and deaths are fundamental for formulating effective public health interventions, allocating resources efficiently, and assessing the overall impact of the virus.
 
The study advocates for the continued utilization of autopsies in understanding the pathogenesis and epidemiology of infectious diseases, particularly during pandemics. Post-mortem testing emerges as a valuable tool not only for confirming COVID-19-related deaths but also for uncovering cases that remained undiagnosed during patients' lifetimes.
 
In light of the findings, public health authorities may need to reassess the methodologies employed for tracking and reporting COVID-19 cases. The study calls for a reevaluation of testing strategies, emphasizing the importance of post-mortem testing in providing a more comprehensive and accurate representation of the true prevalence of SARS-CoV-2 within populations.
 
Conclusion
The Swiss COVID-19 autopsy study serves as a significant contribution to the global discourse on the true impact of the virus, challenging assumptions about the completeness of reported cases and deaths. The revelations regarding underreported infections and deaths underscore the need for a nuanced approach in understanding the dynamics of the pandemic.
 
As the world continues to navigate the challenges posed by COVID-19, the study emphasizes the crucial role of autopsies in unraveling the mysteries of infectious diseases. It calls for a reevaluation of diagnostic approaches, testing capacities, and reporting mechanisms to ensure a more accurate representation of the pandemic's toll on human lives.
 
The lessons learned from the Swiss autopsy study extend beyond borders, prompting a global reflection on the adequacy of existing surveillance and reporting systems. Ultimately, a comprehensive understanding of the true impact of COVID-19 is essential for shaping effective public health responses, fostering resilience in healthcare systems, and preparing for future pandemics.
 
The study findings were published in the peer reviewed journal: Frontiers In Medicine.
https://www.frontiersin.org/articles/10.3389/fmed.2022.868954/full
 
For the latest COVID-19 News, keep on logging to Thailand Medical News.