Information obtained from autopsies of patients infected with high-risk pathogens is an important pillar in managing a proper response to pandemics, particular in the early phase. This is due to the fact that autopsy allows efficient evaluation of comorbidities for risk assessment, as well as identification of key pathophysiological and molecular mechanisms in organs driving the severity of disease which might be important targets for therapeutic interventions. In the case of patients who have died of infection with unknown pathogens, isolation and culture of pathogens from the affected organs is another important opportunity for a proper response to (re)emerging infectious diseases. However, the situation of COVID-19 demonstrated that there were concerns about performing autopsies because of biosafety risks. In this review we compare requirements for biosafety level 3 (BSL-3) laboratories from the European Commission and the World Health Organization and summarize specific recommendations for postmortem analysis of COVID-19-deceased patients from the Centers for Disease Control and Prevention. Furthermore, we describe in detail a BSL-3 facility with enhanced protection of personnel and an environment that has been designed for performing autopsies, biobanking of collected tissue specimens, and culture of pathogens in cases of high-risk pathogen infections and report on the experience obtained in operating this facility in the context of COVID-19.

中文翻译：

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COVID-19 患者尸检的生物安全要求：为高致病性病原体设计的 BSL-3 尸检设施示例

从感染高危病原体的患者的尸体解剖中获得的信息是管理对大流行做出适当反应的重要支柱，尤其是在早期阶段。这是因为尸检允许有效评估合并症以进行风险评估，以及确定导致疾病严重程度的器官中的关键病理生理学和分子机制，这可能是治疗干预的重要目标。对于死于未知病原体感染的患者，从受影响器官中分离和培养病原体是对（重新）出现的传染病做出适当反应的另一个重要机会。但是，COVID-19 的情况表明，由于存在生物安全风险，人们对进行尸体解剖存在担忧。在本次审查中，我们比较了欧盟委员会和世界卫生组织对生物安全 3 级 (BSL-3) 实验室的要求，并总结了疾病控制和预防中心对 COVID-19 死者死后分析的具体建议。此外，我们详细描述了一个 BSL-3 设施，该设施具有增强的人员保护和环境，该设施旨在进行尸检、收集的组织标本的生物样本库以及在高风险病原体感染的情况下进行病原体培养，并报告经验在 COVID-19 的背景下运营该设施时获得的。