Embalming (EM) reduces residual SARS-CoV-2 in tissues, but its effectiveness on the external body surfaces of corpses infected with coronavirus disease 2019(COVID-19) remains unclear. We therefore examined the presence of SARS-CoV-2 in the pharynx, anus, and on external body surfaces following EM in nine COVID-19-infected corpses, including four full autopsy cases and five minimally invasive autopsy (MIA) cases. Antigen testing and viral quantification using real-time PCR were performed. Nasopharyngeal antigen tests were positive prior to EM and negative thereafter in all nine cases. Among the four autopsy cases, SARS-CoV-2 RNA was detected in all nasopharyngeal samples (100%), in two oropharyngeal samples (50%), and at seven sites (41%) across 17 external body surfaces, three or more days after EM. No viral RNA was detected in anal samples. Among the five MIA cases, viral RNA was detected in two nasopharyngeal samples (40%), one oropharyngeal sample (20%), and at four sites (44%) across nine external body surfaces, three or more days after EM. The reduction in viral load before and after EM exceeded 99%in nasopharynx and oropharyngeal samples in both autopsy and MIA cases, and exceeded 94% on external body surfaces in MIA cases. Moreover, viral reduction was greater several days after EM than immediately following the procedure. These findings suggest that the combination of MIA and EM effectively reduces the detectableSARS-CoV-2 RNA in COVID-19-infected corpses. Additionally, maintaining the body for several days after EM appears to reduce the viral levels. In autopsy and MIA cases, nasopharyngeal antigen tests were positive before EM but negative after EM. In four autopsy cases, SARS-CoV-2 was detected in the nasopharynx in all (100%) and in the oropharynx in two cases (50%) after EM. Among the 17 external surface sites, the virus was detected in six (35%) 1 d and in seven (41%) 3 d after EM. Anal swabs were negative before and after EM in all cases. In five MIA cases, SARS-CoV-2 was detected in the nasopharynx of three (60%) immediately after EM and in two (40%) 3 d thereafter. In the oropharynx, the virus was detected in one case (20%) both immediately and 3 d after EM. In nine external surface sites, the virus was detected in one (11%) immediately after EM and in four sites (44%) 3 d thereafter The amount of SARS-CoV-2 decreased by 99% in the nasopharynx and oropharynx and by 94% on external surfaces after EM. In many cases, EM appeared more effective several days after treatment.
Saitoh et al. (Fri,) studied this question.