Prospective postmortem evaluation of 735 consecutive SARS-CoV-2-associated death cases.

Coronavirus disease 19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic with significant mortality. Accurate information on the specific circumstances of death and whether patients died from or with SARS-CoV-2 is scarce. To distinguish COVID-19 from non-COVID-19 deaths, we performed a systematic review of 735 SARS-CoV-2-associated deaths in Hamburg, Germany, from March to December 2020, using conventional autopsy, ultrasound-guided minimally invasive autopsy, postmortem computed tomography and medical records. Statistical analyses including multiple logistic regression were used to compare both cohorts. 84.1% (n = 618) were classified as COVID-19 deaths, 6.4% (n = 47) as non-COVID-19 deaths, 9.5% (n = 70) remained unclear. Median age of COVID-19 deaths was 83.0 years, 54.4% were male. In the autopsy group (n = 283), the majority died of pneumonia and/or diffuse alveolar damage (73.6%; n = 187). Thromboses were found in 39.2% (n = 62/158 cases), pulmonary embolism in 22.1% (n = 56/253 cases). In 2020, annual mortality in Hamburg was about 5.5% higher than in the previous 20 years, of which 3.4% (n = 618) represented COVID-19 deaths. Our study highlights the need for mortality surveillance and postmortem examinations. The vast majority of individuals who died directly from SARS-CoV-2 infection were of advanced age and had multiple comorbidities.

Loneliness among Homeless Individuals during the First Wave of the COVID-19 Pandemic.

The feeling of loneliness is a major public health concern associated with multiple somatic and psychiatric illnesses. Studies have shown increasing incidence of loneliness in the general population during the first wave of the COVID-19 pandemic. Homeless individuals are a particularly vulnerable group; however, little is known about loneliness among homeless individuals. We therefore aimed to examine the prevalence of loneliness among homeless individuals during the pandemic. Furthermore, we estimated the association between loneliness and sociodemographic and lifestyle factors, as well as the self-perceived risk of contracting COVID-19. Data from the Hamburg survey of homeless individuals were used, including 151 homeless individuals that were recruited in spring of 2020. Loneliness was measured by the 3- item version of the UCLA-3 Loneliness Scale. To summarize, 48.5% of the participants experienced loneliness. Multiple linear regressions showed increased loneliness to be associated with male gender (ß = 1.07, p = 0.01), being single (ß = 1.33, p = 0.00), originating from Germany (ß = 1.48, p = 0.00), high frequency of sharing a sleeping space with more than three people (ß = 0.42, p = 0.02) and a higher self-perceived risk of contracting COVID-19 (ß = 0.41, p = 0.02). On the contrary, there was no association of loneliness with age, educational level, chronic alcohol consumption or frequently sharing a sleeping space. In conclusion, the magnitude of loneliness among homeless individuals during the pandemic was highlighted. Description of factors determining loneliness may help to identify homeless individuals at risk.

[Peranal exenteration of the intestine during a homicide]. / Peranale Darmextraktion in Rahmen eines Tötungsdeliktes.

A 66-year-old female alcoholic was killed in a sexually motivated homicide. After peranal insertion of the hand large parts of the intestine were torn from the mesentery and pulled out through the anus. The findings are discussed and compared with the pertinent literature.

[Myiasis because of neglect]. / Fliegenmadenkrankheit (Myiasis) bei Verwahrlosung alter/kranker Menschen.

Myiasis is known as the infestation of living organisms with maggots. It is often caused by (self-) neglect. Eight cases of myiasis have been examined at the Institute of Legal Medicine in Hamburg between 2002 and 2014. It is important that the medical examiner compares the maggots' stage of development with the alleged time of death. Especially in cases of home care, myiasis and neglect are suspicious and deserve special attention.