New York Will Check the Lifeless Extra Usually for Coronavirus and Flu

New York Will Test the Dead More Often for Coronavirus and Flu

Cough, fever, chills – in the case of a rapid fall, symptoms alone are not helpful in distinguishing Covid-19 from similar-looking flu cases. That means routine testing for both viruses is crucial – possibly even after some patients have died.

That will at least be the case in New York, where officials recently announced an increase in post mortem tests for the coronavirus and flu. Respiratory disease-related deaths that have not been confirmed prior to a person's death must be tested for both viruses within 48 hours under the new regulation.

"These regulations will ensure we have the most accurate death dates possible as we continue to administer Covid-19 as we prepare for flu season," said Dr. Howard Zucker, the state's health commissioner, in a statement last week.

Deceased hospital patients and residents of nursing homes, as well as facilities looked after by undertakers or medical examiners, will be included in the follow-up exams. If experts at a local facility cannot do the test themselves, they can ask the state to do the test for them in their public health laboratory.

Although the results of these tests are too late to change the course of treatment for the deceased, they can still help health officials track the prevalence of both types of infections and indicate whether close contacts should be warned about the deceased being quarantined.

"People need to know who has been sick around them," said Dr. Valerie Fitzhugh, a pathologist at Rutgers New Jersey Medical School. "If someone cannot be tested in life, why not test shortly after death?"

Adopting regulations early will also encourage counties to improve their testing readiness before fall and winter, when seasonal viruses like flu and respiratory syncytial virus [RSV] tend to thrive, said Dr. Mary Fowkes, a clinical pathologist at Mount Sinai Hospital in New York. Coronavirus cases are still occurring on a daily basis in many parts of the country – and they become harder to track when similar diseases mess up the picture.

"I think this is important to prepare for," said Dr. Fowkes.

In the early days of the pandemic, New York, like the rest of the country, struggled to contain the virus. Many diseases went untested, including that of several thousand people whose deaths were later classified as suspected but unconfirmed cases of Covid-19.

Much has changed since the spring, said Gareth Rhodes, assistant superintendent and special adviser to the New York Treasury and a member of Governor Andrew M. Cuomo's virus response team. After sputtering began in March, New York is currently running around 100,000 coronavirus tests a day, with positivity rates of 1 percent or less. With hundreds being hospitalized across the state, daily deaths from Covid-19 have been in the single digits since late August.

The new regulations also stipulate that live patients with flulike symptoms or known exposure to the coronavirus or a flu virus should be tested for both pathogens. This makes it less likely that a case will be overlooked at all.

"We are closely monitoring deaths," said Rhodes. At this point in time, the New York coronavirus testing regimes in medical facilities are fairly consistent. "You can't be a hospital in New York right now without tests," he said.

The ordinance does not apply to all deaths – only those suspected to be related to a respiratory disease.

That means the new rules for post-mortem testing are unlikely to change the number of coronavirus cases significantly, if at all. The state laboratory in Wadsworth has not received a request to perform an autopsy test since the announcement last Sunday, Rhodes said.

However, the regulation can be useful if, for example, a death occurs on the way to the hospital or shortly after arrival, or if an emergency causes the laboratory to be temporarily closed so that tests cannot be performed immediately. Others may die at home or elsewhere outside the care of a hospital or nursing home without easy access to testing.

"This is supposed to catch anything that fell through the cracks," said Dr. Rosemary She, a pathologist at the University of Southern California's Keck School of Medicine.

Thorough testing can also have an impact on which bodies will be autopsied in medical examiners' offices where resources and staff are strained, said Dr. Erin Brooks, a pathologist at the University of Wisconsin-Madison. Someone whose cause of death can be confirmed by testing positive for the coronavirus, for example, may not need further investigation.

A number of pathologists noted that while coronavirus testing for sick patients is nearly ubiquitous in medical facilities in other states, combination tests that include the flu, including post-mortem testing, are not as common and may be considered have to.

More laboratories will most likely need to invest in tests that can detect multiple types of pathogens at the same time. For example, one of the tests carried out in Wadsworth is a so-called breathing panel from a company called BioFire, which simultaneously looks for genetic material from more than 20 types of bacteria and viruses, including the coronavirus and several types of flu viruses.

Some experts have postulated that proactive measures such as continued physical distancing and vigilant mask wear could mitigate the blow of this year's flu season, as it appears to have been in the southern hemisphere.

"However, it is in our best interests to prepare for the worst," said Dr. Fitzhugh, "and to hope for the best."


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