Review Article: PDF OnlyCOVID-19 POSTMORTEM DIAGNOSTIC AND BIOSAFETY CONSIDERATIONSLacy, J. Matthew MD (member NAME Ad-hoc Bioterrorism and Infectious Disease Committee); Brooks, Erin G. MD (Chair, NAME Ad-hoc Bioterrorism and Infectious Disease Committee); Akers, Joshua MD; Armstrong, Danielle DO; Decker, Lauren MD; Gonzalez, Adam MD; Humphrey, William MD; Mayer, Romana MD; Miller, Matthew MD; Perez, Catherine MD; Arango, Jose Antonio Ruiz MD; Sathyavagiswaran, Lakshmanan MD; Stroh, Wendy DO; Utley, Suzanne MDAuthor Information Chief Medical Examiner, Snohomish County Medical Examiner’s Office, 9509 29th Ave W, Everett, WA 98204 Associate Professor of Pathology, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792 National Association of Medical Examiners (NAME) Ad-hoc Bioterrorism and Infectious Disease Committee Members Manuscript received April 1, 2020; accepted April 9, 2020. Disclosures: None Corresponding author: J. Matthew Lacy, MD (member NAME Ad-hoc Bioterrorism and Infectious Disease Committee), Chief Medical Examiner, Snohomish County Medical Examiner’s Office, 9509 29th Ave W, Everett, WA 98204, Phone 425-438-6205, Fax 425-438-6222, John.Lacy@co.snohomish.wa.us This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections. The American Journal of Forensic Medicine and Pathology: April 24, 2020 - Volume Publish Ahead of Print - Issue - doi: 10.1097/PAF.0000000000000567 Open PAP Metrics Abstract As a result of the 2019 novel human coronavirus (COVID-19) global spread, medical examiner/coroner offices will inevitably encounter increased numbers of COVID-19-infected decedents at autopsy. While in some cases a history of fever and/or respiratory distress (e.g. cough or shortness of breath) may suggest the diagnosis, epidemiologic studies indicate that the majority of individuals infected with COVID-19 develop mild to no symptoms. Those dying with—but not of—COVID-19 may still be infectious, however. While multiple guidelines have been issued regarding autopsy protocol in cases of suspected COVID-19 deaths, there is some variability in the recommendations. Additionally, limited recommendations to date have been issued regarding scene investigative protocol, and there are a paucity of publications characterizing COVID-19 postmortem gross and histologic findings. A case of sudden unexpected death due to COVID-19 is presented as a means of illustrating common autopsy findings, as well as diagnostic and biosafety considerations. We also review and summarize the current COVID-19 literature in an effort to provide practical evidence-based biosafety guidance for ME/C offices encountering COVID-19 at autopsy. © 2020 by Lippincott Williams & Wilkins.