![]() Due to legitimate concerns about infection risk and limited personal protective equipment (PPE), early postmortem studies were initially either gross examination only, postmortem biopsies, restricted to certain organs, or case reports, with a few comprehensive series and some reviews emerging more recently. Despite an explosion of literature addressing the clinical impact and molecular microbiology of SARS-CoV-2, autopsy studies remain underrepresented. Postmortem examinations, or autopsies, are the gold standard for the elucidation of the underlying pathophysiology of disease. In New York State alone, 1,279,811 cases and 41,587 deaths are documented. As of 21 January, 2021, there have been 97.4 million confirmed cases globally including over 2 million deaths. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the infective agent behind COVID-19, has rapidly spread around the globe resulting in substantial morbidity and mortality. Targeting of these multisystemic pathways could lead to new treatment avenues as well as combination therapies against SARS-CoV-2 infection. Our autopsy series of COVID-19-positive patients reveals that this disease, often conceptualized as a primarily respiratory viral illness, has widespread effects in the body including hypercoagulability, a hyperinflammatory state, and endothelial dysfunction. Laboratory results of our COVID-19 cohort disclose elevated inflammatory markers, abnormal coagulation values, and elevated cytokines IL-6, IL-8, and TNFα. We additionally provide electron microscopic evidence of the presence of the virus in our samples. We also report microthrombi in multiple organ systems including the brain, as well as hemophagocytosis. Diffuse alveolar damage was present in over 90% of cases. Autopsies revealed large pulmonary emboli in six cases. Here, we report on the first 100 COVID-19-positive autopsies performed at the Mount Sinai Hospital in New York City. ![]() Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated clinical syndrome COVID-19 are causing overwhelming morbidity and mortality around the globe and disproportionately affected New York City between March and May 2020. Modern Pathology volume 34, pages 1456–1467 ( 2021) Cite this article Pathophysiology of SARS-CoV-2: the Mount Sinai COVID-19 autopsy experience
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