Why does the RKI want to prevent autopsies on COVID-19 in Germany?
*Robert Gorter, MD, PhD.
23 October 2020
In a recommendation by the Robert Koch Institute (RKI), an equivalent of the CDC in the USA, on how to deal with Covid 19 deceased, many see an attempt to disguise the true extent of the corona epidemic: to increase the number of victims very sharply. What is it?
It is a handout for doctors and undertakers: In the “Recommendations for dealing with Covid-19 deceased”, the Robert Koch Institute (RKI) in Berlin points out the risk of infection and safety measures.
Among other things, it says: An internal exam, autopsies, or other aerosol-producing measures should be avoided or even not performed. If these are absolutely necessary, they should be kept to a minimum.
For some critics of the institute it is clear: The RKI wants to avoid that the true cause of death is found out in alleged Covid-19 victims – although the text explains how such examinations can be carried out safely.
A paramedic in Rome wears complete protective equipment including glasses, a suit and a breathing mask against the corona virus. ANGELO CARCONI / EPA-EFE / Shutterst
Many Pathologists disagree with RKI
The President of the Federal Association of German Pathologists, Karl-Friedrich Bürrig, and the Chairman of the German Society for Pathology, Gustavo Baretton, also expressed their criticism of the RKI recommendation – however, in order to increase knowledge about Covid-19:
“At the moment, autopsies of these deceased should not be avoided, but on the contrary carried out as often as possible, also to shed light on the connection with other underlying diseases of the deceased. There is a high level of public interest in this,” they wrote in a joint letter to the RKI, which is available from www.tagesschau.de. “
RKI specifies the recommendation
In the meantime, the RKI has finally responded to the criticism and changed the controversial formulation. “Currently there are still numerous unanswered questions about the disease process of a Covid-19 infection and what leads to death. Therefore, autopsies are to be carried out with the aim of better understanding the clinical picture and possible therapy options in a targeted manner and with adequate protection of the staff,” said an RKI recently -Speaker of the Robert Koch Institute.
In individual cases, the RKI was informed of difficulties in balancing the need for an autopsy and protecting the staff, the spokeswoman said. The original wording had been agreed with the federal states. However, RKI President Lothar Wieler already emphasized the importance of the autopsy for clarifying Covid-19 deaths at the institute’s press conference on Tuesday. Together with the pathologist associations, the institute is now working on a guide to autopsies and sampling from the Sars-CoV-2 infected deceased.
Complex legal situation
But who can even decide whether an autopsy can be performed? That depends initially on the type of autopsy, explains Wolfgang Eisenmenger, the former director of the Institute for Forensic Medicine at the Ludwig Maximilians University in Munich, to tagesschau.de.
First of all, there are autopsies that are ordered by the court or public prosecutor’s office if the cause of death is unclear or if a criminal offense is suspected. In the case of an anatomic-pathological autopsy or a corpse opening as part of medical training, a declaration of consent from the relatives or a corresponding decree from the deceased is required.
Health authorities can enforce autopsies
Health authorities can also order autopsies for disease control reasons. The legal basis for this is provided by the nationwide Infection Protection Act: It allows doctors from the health department and its agents to conduct an after-mortgage inspection if it is deemed necessary to protect against infection – even without consent. However, these were an absolute exception, says Eisenmenger. “In my forty years as a forensic scientist, this has happened maybe once or twice.”
It would therefore be entirely possible for health authorities to order autopsies – as clinical autopsies, so not as judicial opening of bodies or “administrative sections”. The capacities for such autopsies would be available in Germany, said Association President Bürrig to tagesschau.de. However, it remains to be seen whether all suspected cases should be autopsied.
An employee looks at cell cultures in a pathology laboratory at the Charite in Berlin gallery The cause of death from Covid 19 disease can only be determined on an interdisciplinary basis.
Cause of death not clear
But how is a “Covid-19 dead” defined?
Karl-Friedrich Bürrig explains:
“The public health department will classify every death with a virologically proven Covid-19 infection / positive (but unreliable with many false positive results) PCR test as a Covid-19 death in the cause of death statistics.” He himself sees it differently: “This results in huge inflated numbers of Covid-19 deaths. In my opinion, the deceased as a result of a Covid-19 infection should be whoever succumbed to the direct consequences of this infectious disease. “
“An example would be infection – pneumonia – COPD – heart failure,” says Bürrig. However, many other conditions such as previous illnesses or risk factors will play a big role. The final statement about the cause of death could only be made if the virological findings and clinical course were unambiguous and an autopsy confirmed the causal relationships and that is an interdisciplinary task that is rarely carried out. “
How dangerous is COVID-19 really? There is currently almost no differentiation between whether someone died “from” or “with” the infection – mainly because the Robert Koch Institute (RKI) urgently advises against autopsies.
The professional associations of pathologists and forensic doctors, however, consider this to be urgently necessary, because it can clarify to what extent internal organs are affected by the infection and which risk factors play a role on closer inspection.
Kathrin Grimmer, spokeswoman for the Bavarian State Office for Health and Food Safety (LGL), is behind the RKI, which lists all deceased with proven SARS-CoV-2 infection in the statistics of corona deaths.
The RKI points out “that an internal investigation, autopsies or other aerosol-producing measures should be avoided,” said Grimmer. When publishing the Bavarian case numbers, the LGL therefore makes it clear that both people who have died of Corona and those who have died with Corona are included in the count according to the Infection Protection Act.
The Baden-Württemberg State Health Office reports the same procedure. As spokesman Markus Jox explains, examinations are usually carried out by a resident doctor or a hospital doctor. In the case of cremations, a medical certificate must also be obtained in Baden-Württemberg.
“The LGA itself is not involved in the inquiries; The local health authorities in the country are responsible, and they are responsible for a crematorium, ”said Jox. Most offices would have delegated the second post-mortem examination to forensic institutes, pathologists or forensic doctors in the catchment area. “To the best of our knowledge, the results of the second inquest are not systematically recorded.”
The State Center for Health in North Rhine-Westphalia is also following the RKI’s approach, said Axel Birkenkämper, spokesman for the Ministry of Health and Social Affairs there. “The cases are also counted in which, according to the doctor’s assessment, the SARS-CoV-2 infection contributed to the death, but other factors also played a role.”
In general, it is often difficult to determine the cause of death even after a carefully carried out post-mortem examination, according to Birkenkämper, so that the specific cause of death often remains unclear. To make matters worse: “Autopsies are not carried out on all deceased.”
Forensic doctors criticize RKI requirements
Reinhard Dettmeyer, President of the Professional Association of German Forensic Doctors, on the other hand, insists that clarity is only possible through autopsies. The fact that more elderly people die from corona infection shows that previous illnesses play a major role.
“So there are rather younger people who have not had a previous illness and who die after developing pneumonia from‘ or due to ‘the infection,” says the forensic doctor. Depending on the severity of the previous illnesses, there are also people who, for example, die of a heart attack or a stroke with a SARS-CoV-2 infection. The infection is then referred to as a “triggering occasional cause”.
Hamburg has set out to create more clarity here. In the Hanseatic city “all deaths with a positive PCR test are assessed by the Institute for Forensic Medicine,” says Jessica Kratt, spokeswoman for the authority for health and consumer protection. “This provides medically differentiated evidence of who died not only with but causally from a Covid 19 disease.” The Hanseatic City of Hamburg expressly opposes the recommendations of the RKI, according to which autopsies of people infected with corona should be kept to a minimum.
In Austria and Switzerland, too, the actual number of deaths would have to be well below the official current number of people who died from COVID-19, since no autopsies were carried out. However, the actual number is lower. At least the autopsy results of the Hamburg forensic doctor Klaus Püschel but also recently published studies by other experts suggest this. With his team, he has autopsied all previous COVID-19 deaths in Hamburg. The result: All of the deceased were seriously ill before that. And: “There are quite a few in whom the viral disease had little or no impact on the fatal outcome,” says Püschel.
Because of these results, the official figures of the deceased of the Robert Koch Institute (RKI) differ from the Hamburg census. The latter listed eight “COVID-19 deaths” in Hamburg on Wednesday, but in the official statistics of the RKI it was against it. “Our research results show that, from a medical point of view, ‘ordinary people’ need not have any fear or panic about COVID-19,” says Püschel.
Died with or from the virus?
In Austria, too, the question of how many people really died from the virus and how many have been raised again and again. The statistics of corona deaths include all deceased who previously tested positive for COVID-19. Regardless of whether they died directly as a result of the viral disease itself or “with the virus” (another cause of death). This means that even a young accident victim would potentially appear in the statistics – in the unlikely event that they would even be tested for the virus.
The Austrian oncologist Stefan Wöhrer tells of a patient who died of pancreatic cancer – and who tested positive for the virus. Wöhrer is convinced that the man would have succumbed to his cancer without the virus and that this case is not an isolated case. He will never be certain because the man was not autopsied. Conversely, it could just as well happen that a person dies of COVID-19 without being tested.
Autopsies could clear up many ambiguities. A recommendation from the German Robert Koch Institute met with a lack of understanding among many doctors. This recommendation stated: “An internal examination, autopsies or other aerosol-producing measures should be avoided.” This recommendation was withdrawn after objections from the umbrella association of pathologists in Germany. In Austria, however, the Ministry of Social Affairs still recommends pathologists not to perform routine autopsies.
The Situation in The Netherlands is the same with numbers of COVID-19 deaths without autopsies. The Dutch population is increasing asking each other and the health authorities (RIVM) but there were never clear answers why no autopsies had ever been performed.\
The actual cause of death from Covid 19 disease can only be determined on an interdisciplinary basis
The recommendation of the Robert Koch Institute “I don’t understand either”, says the head of the pathology department of an Austrian hospital, who does not want to be named (sic). While autopsies of COVID-19 deaths could run the risk of infectious liquids being flushed into the sewage and the viruses surviving there for weeks, this is not a real risk in Germany and Austria. In Austria, he says, at least some COVID-19 deaths are autopsied. “But: If I don’t have a clinical question, I don’t need to do an autopsy.”
One who has already autopsied several people who have died of COVID-19 is the Graz pathologist Sigurd Lax. The dead he examined died of severe lung damage, but had significant previous illnesses such as diabetes or chronic heart disease or COPD.
The University of Aachen started an autopsy registry
The managing director of the umbrella association of pathologists in Germany, Gisela Kempny, also wants to take a closer look: “The cause of deaths in statistics is important and certainly an interesting aspect, but pathologists want to save the living.” She, too, wants to gain knowledge about the course of the disease with autopsies, above all in order to understand unusual courses, such as those of younger deceased.
At the University of Aachen, the corona crisis has led to a new register: In the future, all COVID-19 autopsy results will be collected anonymously and made available to other pathologists. “We’re only just getting started, but we want to exchange ideas with the autopsy registry in Aachen as soon as possible via video conferences and share our results,” says Kempny. Ideally, autopsy results from several countries could be brought together and made available for research. In Austria there have not yet been any efforts to bring together the autopsy results that are already available.
The renowned Hamburg forensic doctor Klaus Püschel considers the fear of Corona to be exaggerated. With his team he autopsied the dead in Hamburg, and he discovers:
“In these cases, the virus was only the last drop.”
The Hamburg forensic doctor Klaus Püschel and his team are examining the corona victims in the Hanseatic city, and he considers the fear of the virus to be exaggerated. In Hamburg not a single person not previously ill has died from the virus, Püschel told the “Hamburger Morgenpost”. “The fear of this virus affects our lives in a completely exaggerated way. That bears no relation to the danger posed by the virus” says the renowned forensic doctor. “I am convinced that the corona mortality will not even make itself felt as a peak in the annual mortality.” There is no reason for fear of death in connection with the spread of the disease in the Hamburg region.
“Everyone we have examined so far had cancer, a chronic lung disease, were heavy smokers or seriously obese, suffered from diabetes, cancer, COPD or had cardiovascular disease.” In these cases, the virus was the last drop that broke the barrel. His team had just examined the body of the first 100-year-old who died with Covid-19. Here it was the very last drop.
Now what’s the bottom line?
The only reliable way to determine whether COVID-19 was the primary and immediate cause of death is an autopsy.
Numerous studies document that the average age of patients who died of Corona was (is) 83 years of age.
All deceased patients had significant co-morbidity: severe underlying chronic disease like COPD, Diabetes, heart disease and cancer
All experts in the field agree that the number of patients who were officially documented as COVID-19 deaths are therefore severely overestimated.
COVID-19 epidemic seems to be an average flu epidemic with week by week deaths and compared to the previous 4 years are extremely alike and in several European nations there is even a lower-than-average number of deaths.
this infection with COVID-19 was the last straw that broke the camel’s back
Robert Gorter, MD, PhD.
Among many other things, Dr. Robert Gorter served simultaneously 6 major universities in 3 contents as faculty member over his 50+ year’s career as a practicing physician, researcher and lecturer.
From the early 1980’s on, he was one of the very first doctors at the AIDS clinic of the University of California San Francisco Medical School (UCSF) and became the medical director of the Department of AIDS Epidemiology and Biostatistics at UCSF and lectured Public Health at the University of California Berkeley, etc. His interests and knowledge about retroviruses is tremendous and his team and he studied the seroincidence and seroprevalence not only of HIV but also of HTLV-1 and HTLV-2 in the Drug Using and the Homeless Population in the San Francisco Bay Area. Therefore, Robert Gorter has great concerns about using retroviruses as vectors in the current vaccine manufacturing. Using retroviruses might turn out to become a Box of Pandora.
He was (principal) clinical investigator of several studies and served on a few commissions of the FDA to approve (or disapprove) of new drug applications. Already at the time, out of his own observations, Robert Gorter was very concerned by the corruption at the FDA and the CDC.
From the mid 1980’s on, Robert Gorter knows Dr. Anthony Fauci and Dr. Judy Gerberding personally.