TOKYO -- A Japanese Society for Forensic Pathology survey has found that pathologists' requests for postmortem coronavirus tests were refused by public health centers or other institutions in more than half the cases studied.
The society queried university forensic medicine departments and medical examiners in mid-April on how public health centers and other parties reacted to requests for polymerase chain reaction (PCR) tests on recently deceased patients who had had fevers or other symptoms consistent with COVID-19. The requests were turned down in 12 of 23 cases filed between January and mid-April by 26 organizations.
"To get a proper understanding of the coronavirus death rate, the tests must be done more widely," the society stated. It is also asking for postmortem testing for people suspected of having had the novel coronavirus to prevent infections from spreading among bereaved families and pathologists.
Among the cases tested were a man in his 40s who had come back from China in February, and a man in his 20s, both of whom had postmortem CT scans revealing evidence of pneumonia.
In one of the cases where testing was refused, the deceased was a boy under 10 who was found during an autopsy to have signs of respiratory infection. A sample taken when doctors were trying to resuscitate him was tested but came out negative. However, a second test was requested in part to protect pathologists from catching the virus, but was refused.
There was also a case of a person living alone who had a slight fever in the days before their death. When they consulted a public health center, it was decided they were exempt from testing on the grounds that it was unclear whether they had had close physical contact with an infected person, and an infection route could not be clearly established.
One medical institution, which had all three of its postmortem PCR test requests made between February and April rejected, said in the pathology society survey it believed that "a perception that in general 'corpses cannot be tested' is spreading."
Another doctor working in a university forensic pathology department in eastern Japan's Kanto region also had two requests for PCR tests refused in February. The first case concerned a man who died in hospital after his breathing worsened suddenly. He had reportedly made trips out of the house before hospitalization, and had a fever. The other was a man living alone who died at home. He'd also reportedly had a fever.
In both instances, postmortem examinations concluded that they had died from causes other than COVID-19. But the public health center carrying out the checks reportedly did not clarify why it had refused to administer PCR tests on both men before the examinations.
The doctor reporting both refusals said, "At the time, even in clinical situations the use of PCR tests was being limited. Because the deceased men's cases did not conform to the decision-making route required to carry out a PCR test, perhaps they couldn't do them."
Due to continual rejections, the doctor's laboratory has reportedly put its own money into antibody tests to try to prevent infections. He said, "It's not just about deciding the cause of death for someone using a PCR test. I want people to understand it also has implications for stopping the further transmissions among family members who lived with the deceased."
The association says that there are no guidelines from the government or other doctors' organizations on how to examine the body of someone suspected of dying from the novel coronavirus, and that decisions on whether to request PCR tests are left entirely up to the doctors and public health centers involved in the cases.
Toshikazu Kondo, director of the association, said, "I think it's a matter of course that public health centers are putting care priorities on the living. But if a deceased person is found to have been infected with the novel coronavirus, then people who have been in close contact with them can be traced, and further infections prevented."
The funeral industry has also taken an interest in testing the deceased, with both the All Japan Funeral Directors Co-operation and Japan Hearse Association asking for the release of information on infections along with greater testing.
The Ministry of Health, Labor and Welfare has jurisdiction over PCR testing. In response to a request for comment, its Tuberculosis and Infectious Diseases Control Division said that because "as a rule, tests should be conducted on all deceased patients whom doctors suspect of being infected with the coronavirus," it was "deeply regrettable if there are cases of tests not going ahead (despite suspicions of infection)." But it added, "If the public health center is having issues with capacity, it may be difficult for tests to be done on all deceased patients suspected of having the novel coronavirus."
Because PCR tests are not being carried out sufficiently on deceased patients, there are concerns that the number of people who have died from COVID-19 is actually higher than reported. Kondo said, "If a cause of death cannot be ascertained, then accurate coronavirus death rates cannot be obtained."
The doctor at the university pathology department referred to news reports of infections being discovered in the corpses of people police were treating as having died of unnatural causes, saying, "It suggests that there may actually have been infections among cases across the country which couldn't be tested up to now. I feel quite acutely that a system for smoother postmortem testing is needed."
But the ministry of health's Tuberculosis and Infectious Diseases Control Division stated, "We are already counting people who tested positive after death. Under the current system, we don't think there would be large discrepancies in the overall figures."
(Japanese original by Harumi Kimoto, Integrated Digital News Center)