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Review Article

Facing COVID‑19: Forensic Doctors of Public Security

Departments Should Improve Infected Cadaver Identification
and Personal Protection Procedures
Jian‑Bin Fu1, Jian Wang2
1
Forensic Identification Center of Yinchuan Bureau of Public Security, Ningxia, China, 2Institute of Forensic Science, Ministry of Public Security, Beijing, China

Abstract
Because of the nature of the human identification system, forensic doctors working in public security departments are responsible for cadaver
examination and conducting crime scene investigations. These processes contain inherent risks, which often include various injury, poisoning
hazards, and probable exposure risks with virus such as COVID‑19. This paper discusses the occupational protections used for forensic doctors,
such as crime scene corpse identification, autopsy building construction, risk assessment, and protective measures. Finally, we suggest the
introduction of relevant rules and regulations that could guarantee the stability and safety of crime scene investigations and cadaver examinations.
These measures may be helpful for forensic institutes and doctors working in public security departments.

Keywords: Cadaver identification, coronavirus disease 2019, forensic doctors, personal protection

Introduction Current Postmortem Examination of a Deceased

Because of the nature of the public security system, forensic
doctors working in these departments face occupation‑related
hazards when performing crime scene investigations and
cadaver examinations. Some experts have begun to address
the safety of forensic doctors during such work. These risks
include human factors such as overworking, health concerns,
psychological abnormalities, monitoring errors, and other
personnel‑related hazards. Material factors are also relevant.
These include machinery, equipment, facilities, materials,
and other hazards that can be pose a physical, chemical, or
biological threat to an individual through their respiratory
tract, digestive tract, skin, or mucous membranes. In addition,
significant environmental and management factors must
also be considered.[1] Despite these risks, there are few
discussions about personal protection for forensic doctors
conducting high‑risk autopsies. During the coronavirus disease
2019 (COVID‑19) pandemic, adequate personal protection to
prevent occupational exposure to this virus is a serious need for
these professionals. Here, we discuss how to properly identify
infectious cadavers and implement appropriate personal
Individual with Confirmed or Probable Exposure
to an Infectious Disease Such as COVID‑19
In the 21st century, public security bureaus have gradually
increased investments into autopsy room construction
and personal protection. In some places, autopsy facilities
specifically for decomposed or infectious corpses have been
developed and constructed. These measures have improved
the safety of forensic examinations and autopsies. However,
autopsies of deceased individuals with a severely infectious
disease, such as COVID‑19, still pose a challenge.
According to governmental laws, autopsies and examinations
of deceased individuals who have been positively diagnosed
with or are suspected to have an infectious disease should be
Address for correspondence: Dr. Jian Wang,
No. 17, Muxidi South District, Beijing 100038, China.
E‑mail: 13641268837@qq.com
Submitted: 30-April-2020  Revised: 02-Jun-2020
Accepted: 09-Jun-2020  Published: 09-Jul-2020

protective measures.
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How to cite this article: Fu JB, Wang J. Facing COVID‑19: Forensic

DOI: doctors of public security departments should improve infected cadaver
10.4103/jfsm.jfsm_35_20 identification and personal protection procedures. J  Forensic Sci Med
2020;6:65-8.

© 2020 Journal of Forensic Science and Medicine | Published by Wolters Kluwer ‑ Medknow 65

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Fu and Wang: Suggestions for forensic doctors of public security departments facing COVID-19
held in independent autopsy rooms and auxiliary facilities that
have adequate lighting, proper air conditioning, fewer people
present, and a sufficient amount of supplies. In addition, public
security organizations have formulated a series of standards for
autopsy procedures. However, detailed and specific operation
steps for forensic doctors still urgently need to be developed.
Risk Assessment of a Deceased Individual with
Confirmed or Probable Exposure to an Infectious
Disease Such as COVID‑19
After summarizing 30 years of practical experience in forensic
medicine, we have determined that the following cases
should be carefully considered during the current COVID‑19
pandemic:
Four types of notable cases that currently need extremely
strict requirements to prevent infection
1. The murdered individual had been infected with
COVID‑19
2. The murdered individual was most likely infected with
COVID‑19, such as a person who lived in or traveled
throughout an epidemic area or had close contact with an
infected patient
3. The deceased individual was diagnosed with COVID‑19
but died of another cause
4. An unidentified deceased individual who was suspected
of having COVID‑19.
If one of the abovementioned cases occurs, forensic doctors
should ensure that the autopsy facilities and staff are
qualified through national trainings. The forensic doctors
should cooperate with the Centers for Disease Control and
Prevention (CDC) and request support from local government
to sufficiently prepare for forensic examinations. Performing
autopsies on infectious corpses without detailed protective
measures may lead to dangerous outcomes that could be fatal.
Five types of special cases that currently have sufficient
preparations
1. The deceased individual is a local citizen who has never
lived in nor traveled throughout an epidemic area
2. The deceased individual never had close contact with any
person who had or was suspected of having COVID‑19
3. The deceased individual had traveled or lived in an
epidemic area but was not infected with COVID‑19
4. The deceased individual had close contact with a
COVID‑19 patient but was not infected with COVID‑19
5. The deceased individual’s family members or relatives
are COVID‑19 patients and are being medically treated.
Because a virus has a specific amount of time, it can survive
in a corpse; forensic doctors should conduct autopsies after
this period. This would greatly minimize the infection risk
and protect the health of the forensic doctors by preventing
occupational exposure. Currently, there is no systematic
research report describing the survival time of the novel
66 Journal of Forensic Science and Medicine  ¦  Volume 6  ¦  Issue 2  ¦  April-June 2020
coronavirus in vitro or in a cadaver. However, relevant studies
of other coronaviruses may provide valuable information
for evaluating the survival time of the novel coronavirus. In
2004, a study on the resistance of the severe acute respiratory
syndrome (SARS) coronavirus[2] found its survival time in vitro
varied with temperature. Under no‑light conditions at 20°C,
it could survive 2 days in hospital sewage, domestic sewage,
and dechlorinated water, 3 days in feces, 14 days in normal
saline, and 17 days in urine. At 4°C, the virus could survive
for more than 14 days in the various types of water mentioned
above and for more than 17 days in feces and urine. A study
on the resistance of Hendra virus[3] showed that it can infect
both humans and horses, resulting in acute respiratory disease.
Its survival ability in winter was stronger than that in summer
and was greatly affected by ambient temperature. In a case
report where the death was caused by a Middle East respiratory
syndrome coronavirus (MERS‑CoV) infection,[4] MERS‑CoV
was still detected in nasal secretions 3 days after death. The
abovementioned studies suggest that it is necessary to extract
samples from the corpse and perform viral nucleic acid testing
as an effective method for personal protection.
Assessment and identification of infectious disease risk
factors
The World Health Organization (WHO) Laboratory Biosafety
Manual uses biosafety level (BSL)‑1 to BSL‑4 to indicate
the corresponding biosafety protection level of laboratories
engaged in in vitro operations. Similarly, it uses animal
biosafety level (ABSL)‑1 to ABSL‑4 to indicate the
corresponding biosafety protection level of laboratories
conducting animal operations. [5] The UK’s Control of
Substances at Risk to Health Regulations 2002 (COSHH)[6]
protects professionals from exposure to biologically harmful
factors including bacteria, viruses, parasites, and fungi. These
biological agents are divided into four hazard groups. This
grouping system is a useful reference tool for forensic doctors
to evaluate biological hazards in crime scene investigations and
cadaver examinations during an infectious disease outbreak
such as the COVID‑19 pandemic.
Protective Measures during an Autopsy of a
Deceased Individual with Confirmed or Probable
Exposure to an Infectious Disease such as
COVID‑19
Personal protective measures that are suitable during
crime scene investigations
During crime scene investigations, forensic scientists
must strictly follow the related laws and standardization
requirements to properly complete disinfections, protections,
investigations, examinations, and other procedures. They
should wear appropriate personal protective equipment,
establish a safe environment, and generate a plan before
examining the corpse. Photos should be taken before deciding
whether extraction of any samples is necessary. Method of
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Fu and Wang: Suggestions for forensic doctors of public security departments facing COVID-19
sample extraction should be based on the different situations
described above in Section 2. For the four types of cases that
need strict requirements (Section 2.1), it is better to extract
material evidence from the corpse in the laboratory unless it
could be lost during transport of the body. During examination
of a deceased individual infected with COVID‑19, forensic
doctors should prevent excretions from the oral and nasal
cavities and also be cautious of the stomach contents and urine.
The corpse should be wrapped in a plastic bag and packaged
securely. For the five types of special cases that currently
have sufficient preparations (Section 2.2), it is recommended
to conduct body examinations and material evidence in the
laboratory to avoid cross contamination.
Personal protective measures during autopsies
Laws such as Regulations on Autopsy and Examination of
Patients with Infectious Diseases or Suspected Infectious
Diseases clearly regulate the diagnosis and treatment process,
surgery protection, and preventive measures necessary for
patients with (or suspected of having) an infectious disease
during hospitalization. However, strict regulations and
protective measures for autopsy facilities and workers need
improvement, and specific emphasis should be placed on
handling of corpses with infectious diseases or suspected
infections.
Personal protective measures for forensic doctors
The novel coronavirus is known to have latent or asymptomatic
infections.[7] Because of the COVID‑19 pandemic, patients
and their close relatives may resort to judicial proceedings
because of a death or dispute pertaining to COVID‑19
prevention, infection, diagnosis, or treatment. In this situation,
judicial organizations and other relevant departments
would initiate investigation procedures, which would
include forensic pathological autopsies, histopathological
examinations, biochemical laboratory examinations, etc.
Considering severely infectious diseases such as COVID‑19,
the investigation departments, as well as the forensic doctors,
should pay more attention to protections needed for these
investigational activities.
Autopsy precautions for deceased individuals who
presumptively died of COVID‑19
In the Practical Guidelines for Infection Control in Health
Care Facilities, the WHO recommended the following autopsy
precautions for decedents of SARS:
1. Prevent the production of aerosols by: avoiding the use
of power saws, conducting procedures underwater if
there is a chance of aerosolization, avoiding splashing
when removing any organs, and placing a clear plastic
bag over the cadaver’s head while eviscerating the
brain (some facilities are equipped with special tents for
this procedure)
2. Use a minimal amount of equipment during the autopsy
3. Avoid using scalpels and scissors with pointed ends
4. Never pass instruments and equipment by hand – always
use a tray
Journal of Forensic Science and Medicine  ¦  Volume 6  ¦  Issue 2  ¦  April-June 2020
5. If possible, use disposable instruments and equipment
6. Keep the number of staffs present to a minimum.[8]
COVID‑19 is similar to SARS in that both have displayed
droplet, contact, and airborne transmission routes. Therefore,
the practical guidelines suggested by the WHO for SARS
should also be followed for COVID‑19 to avoid infection or
transmission during investigations and examinations.
Countermeasures and Suggestions
For case investigations, comprehensive analysis, and personal
protection, we believe that forensic doctors of the public
security departments should follow the instructions we have
described here. First, nucleic acid testing and other diagnostic
measures should be performed to confirm or rule out any
suspected infections. Next, the inspection steps described
above should be followed during extractions of any blood,
urine, sputum, secretions, or feces from a body. In addition,
public security organizations should strive to obtain the support
of the local government and cooperate with the CDC to build
a standardized laboratory that meets the requirements of
occupational protections for forensic doctors.
Local departments should initiate the construction of specific
laboratories dedicated to potentially infectious autopsies to
provide safe and comfortable facilities for forensic doctors.
This mission is an important component of forensic science
development.
In addition, we suggest that the leading department of forensic
science develops a handbook on occupational protection
in forensics for investigations and examinations related to
infectious diseases, including COVID‑19. We believe that
this handbook should be published as both a paper edition
and a mobile phone application and includes risk assessment
methods, classifications of potential hazards, and effective
protective measures.
Acknowledgments
This article was originally released in Chinese language in
Chinese Journal of Forensic Medicine.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Jiao-Yong L. Occupational safety of forensic medical in crime scene
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4. Mahallawi WH. Case report: Detection of the Middle East respiratory
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68 Journal of Forensic Science and Medicine  ¦  Volume 6  ¦  Issue 2  ¦  April-June 2020