The role of the forensic pathologist during a pandemic

Frontline healthcare workers across the world are working around the clock to help save lives during the COVID-19 crisis, while those in the field of forensic pathology focus on the deceased. Many individuals assume that dealing with the deceased does not require the same urgency as working with a critically ill patient, however, , in a pandemic like COVID-19, large numbers of the deceased can swiftly exceed local capacities if not managed effectively and in a timeous manner. The Western Cape Government Health’s (WCGH’s) Forensic Pathologists may be faced with extraordinary challenges but are constantly adapting to effective solutions in preparation for the unknown and to successfully carry out their daily duties.

One of the WCGH’s Forensic Pathologists, Dr Mandy Date-Chong, became a Medical Officer stationed at the Tygerberg Forensic Pathology Laboratory in 2007 and completed her specialisation as a Forensic Pathologist in 2012. Dr Date-Chong has been employed as a Consultant Forensic Pathologist for the University of Cape Town and Forensic Pathology Services (FPS) in Salt River, since 2013. As a result of COVID-19, Dr Date-Chong and her colleagues have had to adapt to various changes in a short period of time. As in all healthcare facilities, the general flow of people and personnel in FPS facilities have been restricted to prevent possible contamination from one area of the mortuary to the other.

When FPS is contacted from a death scene regarding a case of sudden death in the community, Forensic Pathologists are required to answer questions on their Covid-19 checklist.  Should any of those questions indicate a possibility of Covid-19 then precautions need to be taken during the retrieval of the body from the scene, during the identification of the deceased by a family member at the mortuary and during the autopsy, and when the body is handed over to the undertaker at the end of the autopsy process. If the deceased is known to have COVID-19 and the death is attributed to COVID-19, then the death is classified as natural and does not require a forensic post-mortem examination. As a result, the deceased will not be admitted to the FPS mortuary. At the scene, social distancing must be maintained when questioning family members or witnesses.  The body will be bagged, and the bag will be sprayed with a sodium hypochlorite solution. All equipment used to retrieve the deceased must be decontaminated after.

During autopsies, Forensic Pathologists are accustomed to wearing full PPE, however there are extra precautions that are taken during this time. Certain procedures are considered aerosol generating and pose a risk to doctors and forensic pathology officers who are considered risk level 4 – the same as the clinicians working in the hospital COVID-19 wards. When dealing with a decedent with known COVID-19, the protocol states that Forensic Pathologists cannot, after autopsy hand over the body to an undertaker who is unable to manage that individual with COVID-19.  The body is then placed within the body bags, directly into the coffin.

The WCGH’s FPS have taken the uncertainty of the virus and its impact into account and Forensic Pathologists have therefore adopted a preparatory stance in ensuring that they are in a position to overcome potential operational and occupational challenges in the case of a future pandemic.

“In the early stages of lockdown when movement and the sale of alcohol was restricted, our number of unnatural deaths plummeted.  Now with the easing of restrictions, homicides have soared. What is happening at the hospitals with staff members is also happening to us at FPS. We’ve also had personnel who’ve had to isolate due to COVID-19 with areas at the mortuary and in our offices needing deep cleaning.  There is no ‘new normal’ because every day there are new regulations. One may become used to doing something a certain way and the rules may change. Although the past few months have been surreal and stressful, I am grateful to have the support of my husband and children, relatives and friends,” says Dr Date-Chong.