The persistence of SARS-CoV-2 after death of infected individuals is unclear. The aim of this study was to investigate the presence of SARS-CoV-2 RNA in different organs in correlation with tissue damage and post-mortem viral dynamics in COVID-19 deceased. Twenty-eight patients (17 males, 11 females; age 66–96 years; mean 82.9, median 82.5 years) diagnosed with COVID-19 were studied. Swabs were taken post-mortem during autopsy (N = 19) from the throat, both lungs, intestine, gallbladder, and brain or without autopsy (N = 9) only from the throat. Selective amplification of target nucleic acid from the samples was achieved by using primers for ORF1a/b non-structural region and the structural protein envelope E-gene of the virus. The results of 125 post-mortem and 47 ante-mortem swabs were presented as cycle threshold (Ct) values and categorized as strong, moderate, and weak. Viral RNA was detected more frequently in the lungs and throat than in the intestine. Blood, bile, and the brain were negative. Consecutive throat swabs were positive up to 128 h after death without significant increase of Ct values. All lungs showed diffuse alveolar damage, thrombosis, and infarction and less frequently bronchopneumonia irrespective of Ct values. In 30% the intestine revealed focal ischemic changes. Nucleocapsid protein of SARS-CoV-2 was detected by immunohistochemistry in bronchial and intestinal epithelium, bronchial glands, and pneumocytes. In conclusion, viral RNA is still present several days after death, most frequently in the respiratory tract and associated with severe and fatal organ damage. Potential infectivity cannot be ruled out post-mortem.

感染者死亡后 SARS-CoV-2 的持续存在尚不清楚。本研究的目的是调查 COVID-19 死者不同器官中 SARS-CoV-2 RNA 的存在与组织损伤和死后病毒动态的相关性。对 28 名被诊断患有 COVID-19 的患者（17 名男性，11 名女性；年龄 66-96 岁；平均 82.9 岁，中位数 82.5 岁）进行了研究。尸检期间（ N = 19）从喉咙、肺、肠、胆囊和大脑采集拭子，或者在没有尸检的情况下（ N = 9）仅从喉咙采集拭子。通过使用病毒 ORF1a/b 非结构区和结构蛋白包膜 E 基因的引物，实现了样品中靶核酸的选择性扩增。 125 份死后和 47 份死前拭子的结果以周期阈值 (Ct) 形式呈现，并分为强、中和弱。与肠道相比，肺部和咽喉中检测到病毒 RNA 的频率更高。血液、胆汁和大脑均为阴性。死后 128 小时内连续咽拭子呈阳性，Ct 值没有显着增加。无论 Ct 值如何，所有肺部均显示弥漫性肺泡损伤、血栓形成和梗死，且较少发生支气管肺炎。 30% 的患者肠道出现局部缺血性变化。通过免疫组织化学方法在支气管和肠上皮、支气管腺和肺细胞中检测到 SARS-CoV-2 的核衣壳蛋白。总之，病毒 RNA 在死后几天仍然存在，最常见于呼吸道，并与严重和致命的器官损伤有关。死后不能排除潜在的传染性。