High titers of infectious SARS-CoV-2 in corpses of patients with COVID-19

Hisako Saitoh; Yuko Sakai-Tagawa; Sayaka Nagasawa; Suguru Torimitsu; Kazumi Kubota; Yuichiro Hirata; Kiyoko Iwatsuki-Horimoto; Ayumi Motomura; Namiko Ishii; Keisuke Okaba; Kie Horioka; Hiroyuki Abe; Masako Ikemura; Hirofumi Rokutan; Munetoshi Hinata; Akiko Iwasaki; Yoichi Yasunaga; Makoto Nakajima; Rutsuko Yamaguchi; Shigeki Tsuneya; Kei Kira; Susumu Kobayashi; Go Inokuchi; Fumiko Chiba; Yumi Hoshioka; Aika Mori; Isao Yamamoto; Kimiko Nakagawa; Harutaka Katano; Shun Iida; Tadaki Suzuki; Shinji Akitomi; Iwao Hasegawa; Tetsuo Ushiku; Daisuke Yajima; Hirotaro Iwase; Yohsuke Makino; Yoshihiro Kawaoka

doi:10.1016/j.ijid.2023.01.046

High titers of infectious SARS-CoV-2 in corpses of patients with COVID-19

Int J Infect Dis. 2023 Apr:129:103-109. doi: 10.1016/j.ijid.2023.01.046. Epub 2023 Feb 7.

Authors

Hisako Saitoh¹, Yuko Sakai-Tagawa², Sayaka Nagasawa³, Suguru Torimitsu⁴, Kazumi Kubota⁵, Yuichiro Hirata⁶, Kiyoko Iwatsuki-Horimoto², Ayumi Motomura⁷, Namiko Ishii⁷, Keisuke Okaba⁷, Kie Horioka⁸, Hiroyuki Abe⁹, Masako Ikemura⁹, Hirofumi Rokutan⁹, Munetoshi Hinata⁹, Akiko Iwasaki⁹, Yoichi Yasunaga⁹, Makoto Nakajima¹⁰, Rutsuko Yamaguchi⁴, Shigeki Tsuneya⁴, Kei Kira⁴, Susumu Kobayashi⁴, Go Inokuchi⁴, Fumiko Chiba⁴, Yumi Hoshioka³, Aika Mori³, Isao Yamamoto¹¹, Kimiko Nakagawa¹¹, Harutaka Katano¹², Shun Iida¹², Tadaki Suzuki¹², Shinji Akitomi¹³, Iwao Hasegawa¹¹, Tetsuo Ushiku⁹, Daisuke Yajima⁷, Hirotaro Iwase⁴, Yohsuke Makino⁴, Yoshihiro Kawaoka¹⁴

Affiliations

¹ Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: hms1466@faculty.chiba-u.jp.
² Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
³ Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
⁴ Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁵ Department of Healthcare Information Management, The University of Tokyo Hospital, Tokyo, Japan.
⁶ Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan.
⁷ Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Legal Medicine, International University of Health and Welfare, Tokyo, Japan.
⁸ Department of Legal Medicine, International University of Health and Welfare, Tokyo, Japan.
⁹ Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
¹⁰ Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
¹¹ Department of Forensic Medicine, Kanagawa Dental University, Yokosuka, Japan; Public Interest Incorporated Association Nihon Kousei-Kyoukai, Yokosuka, Japan.
¹² Department of Pathology, National Institute of Infectious Diseases, Tokyo, Japan.
¹³ Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Japan Medical Association Research Institute, Tokyo, Japan.
¹⁴ Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo, Japan; Center for Global Viral Diseases, National Center for Global Health and Medicine, Tokyo, Japan; Influenza Research Institute, Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, USA.

Abstract

Objectives: The prolonged presence of infectious SARS-CoV-2 in deceased patients with COVID-19 has been reported. However, infectious virus titers have not been determined. Such information is important for public health, death investigation, and handling corpses. The aim of this study was to assess the level of SARS-CoV-2 infectivity in the corpses of patients with COVID-19.

Methods: We collected 11 nasopharyngeal swabs and 19 lung tissue specimens from 11 autopsy cases with COVID-19 in 2021. We then investigated the viral genomic copy number by real-time reverse transcription-polymerase chain reaction and infectious titers by cell culture and virus isolation.

Results: Infectious virus was present in six of 11 (55%) cases, four of 11 (36%) nasopharyngeal swabs, and nine of 19 (47%) lung specimens. The virus titers ranged from 6.00E + 01 plaque-forming units/ml to 2.09E + 06 plaque-forming units/g. In all cases in which an infectious virus was found, the time from death to discovery was within 1 day and the longest postmortem interval was 13 days.

Conclusion: The corpses of patients with COVID-19 may have high titers of infectious virus after a long postmortem interval (up to 13 days). Therefore, appropriate infection control measures must be taken when handling corpses.

Keywords: Autopsy; COVID-19; Infectious titer; Postmortem interval; SARS-CoV-2; Virus isolation.

MeSH terms

COVID-19 Testing
COVID-19* / diagnosis
Cadaver
Communicable Diseases*
Humans
Lung
SARS-CoV-2