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Mass obduction in Hamburg hospital
What causes covid 19 deaths
Hamburg forensic pathologists performed autopsies on more than 600 Covid-19 deaths to understand the course and cause of death. They found out what people with severe courses die of and what can prevent death in some cases.
Most Covid 19 patients with a severe course die from the viral infection due to pre-existing conditions and because of their advanced age. This is the result of an evaluation by the Institute of Forensic Medicine at the University Medical Center Hamburg-Eppendorf (UKE). The physicians performed 735 autopsies last year. Of these, 618 died from Covid-19. In seven percent, however, another cause was responsible for the death, they said.

Overall, 88 percent of those who died from Covid-19 had at least three to four pre-existing conditions, he said, and the vast majority of all deaths were older than 76. Some deaths with the new Covid-19 mutations have also been autopsied, UKE scientists said. However, the causes of death were the same as with the conventional virus variant.

But the forensic scientists also had some good news: the number of Covid-19 deaths from pulmonary embolism has dropped noticeably. "Among the first hundred deaths in the spring of last year, more than half still died from pulmonary embolisms," said forensic pathologist Benjamin Ondruschka when asked by SPIEGEL. In the meantime, he said, the number has declined noticeably.

The chances of survival for seriously ill Covid 19 patients could be increased by anticoagulants. This was also confirmed by the autopsy of the more than 600 cases, Ondruschka said. The anticoagulants - or blood thinners - reduce thrombosis and pulmonary embolism. As the study of the deceased showed, life was prolonged by the blood thinners, yet the patients could not always be saved.

Already in May, researchers at the UKE had warned that blood clotting often becomes extremely unbalanced due to Sars-CoV-2. In many Covid-19 patients, the blood clots, they said at the time.

The German Society for Thrombosis and Hemostasis Research also recommended at the time that every hospitalized patient be treated with the drug heparin in high doses, unless there was something to the contrary.

"The anticoagulants help, but cannot prevent fatal pulmonary embolisms in every case," said study author Ondruschka. Nevertheless, he said, physicians have had a "learning curve" since the first wave a year ago. "We have reduced the absolute number of thromboses and prolonged the phase of survival for the final deceased," the forensic physician said at the presentation of the study in Hamburg.

Causes of death: Age, pre-existing conditions and obesity
Most corona patients with severe courses die of multiple organ failure or sepsis in addition to pulmonary emboli.

Often, these causes of death are favored by a number of pre-existing conditions, which are particularly prevalent in people of advanced age, the UKE scientists said. People with severe courses usually suffered from high blood pressure, renal insufficiency, diabetes, tumors or chronic obstructive pulmonary disease (COPD). Only one percent of those who died had no previous illness - here, more detailed research is needed into the causes.

An unhealthy lifestyle is often an aggravating factor: 20 percent of those who died were morbidly overweight, he said. "Obesity is a decisive factor in severe courses," Ondruschka said.

The youngest Corona deceased autopsied by medical examiners was 29 years old, he said, and the oldest deceased was 100. Seven people died as a result of the infection before reaching the age of 50. The men who died were statistically slightly younger than the women, and more men died than women. Children or adolescents were not among the deaths studied.

Only one effective drug
Despite intensive research, there are still too few effective drugs against covid-19, says Stefan Kluge, head of the hospital's intensive care clinic. "Dexamethasone is the only drug that has been shown to reduce mortality," Kluge says. With remdesivir, on the other hand, high hopes would have been disappointed. "Large studies have shown that remdesivir has little effect on severely ill patients," Kluge said.

Currently, 400 drugs are being studied worldwide, but there are also extremely many setbacks, he said. "We know, for example, that vitamin D does not protect against severe courses, despite all the announcements," Kluge said.
sug/dpa

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