CAUSES OF DEATH IN MEDICAL PRACTICE Guide to Thanatogenesis in the COVID-19 Disease

Establishing the causes of death is one of the least addressed aspects in the medical literature both in of clinical practice and in the prosectural, anatomopathological or forensics fields.While, at first sight, the physio-pathological processes leading to death are always evident, it is not uncommon that both the clinician and the pathologist find it difficult to establish the sequence of biological processes that have led to a patient's death.Traditionally, the area of causality of death belongs to forensic medicine, but lately it has become increasingly obvious to treating physicians that accurately establishing the causes of death may be not only a method to confirm the clinical diagnosis and the correctness of treatment, but also a measure of legal self-protection.The ultimate novelty of COVID-19, caused by the SARS-CoV-2 coronavirus, and the global effects of the pandemic have been accompanied by an outburst of medical communications, sometimes the published data having, different conclusions or even being contradictory.Depending on the characteristics of the analyzed patient cohorts, as well as on the previous experience and the cultural and professional particularities of the affected hospitals and geographical regions, the medical data provided on an open-source basis by hundreds or, maybe even, thousands of doctors who have diagnosed and treated COVID-19 patients required a process of synthetization and multidisciplinary interpretation of the diagnostic elements originating directly from clinicians, imaging technicians, pathologists or epidemiologists, as well as from prestigious public sources quoting famous specialists.The medical information has been reviewed based on my personal experience with casework and thanatogenerator patterns encountered during 25 years of forensic practice and more than 5,000 autopsies and forensic medical reports related to cases with complex causal processes, to provide a logical summary of the situations that may occur in general medical practice and in relation to COVID-19, using the scientific evidence available as of october 2020.During the months and years to come there shall undoubtedly appear new studies and communications on the mechanisms of action of the coronavirus, which has permanently changed human civilization and which will continue to change part of the current diagnostic and therapeutic medical concepts.Hoping that this guide will help further a better understanding of the morpho-physio-pathological processes leading to death under various circumstances of the human biology, this book aims, first and foremost, at providing the gathered experience in the forensic thanatogenesis field to doctors who endeavor to save the patients' lives.Professor Cristian STAN, MD, PhD Senior Forensic Pathologist crististn@gmail.com