This document provides specific interim recommendations for the collection and submission of postmortem specimens from deceased persons with confirmed or suspected COVID-19. This interim guidance is based on what is currently known about coronavirus disease 2019 (COVID-19), including what is known regarding how SARS-CoV-2 spreads.
Medical examiners, coroners, and other healthcare professionals should use professional judgment to determine if a decedent had signs and symptoms compatible with COVID-19 during life and whether postmortem testing is necessary. Many patients with confirmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g., fever, cough, difficulty breathing). There are epidemiologic factors that may also help guide decisions about testing for SARS-CoV-2, such as documented COVID-19 in a jurisdiction, known community transmission, contact with a known COVID-19 patient, or being a part of a cluster of respiratory illness in a closed setting (e.g., a long-term care facility). Testing for other causes of respiratory illness (e.g., influenza) is strongly encouraged, see Information for Clinicians on Influenza Virus Testing.
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In addition to postmortem specimens, any remaining specimens (e.g., NP swab, sputum, bronchoalveolar lavage) that were collected prior to death should be retained. Please refer to Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens for COVID-19 for more information.
If a postmortem NP swab is being collected, only those personnel who are obtaining the specimen should be in the room. Personnel should follow Standard Precautions. In addition to Standard Precautions, the following are recommended:
For suspected COVID-19 cases, CDC recommends collecting and testing postmortem NP swabs and if an autopsy is performed, lower respiratory specimens (lung swabs). If the diagnosis of COVID-19 was established before death, collection of these specimens for COVID-19 testing may not be necessary. Medical examiners, coroners, and pathologists should work with public health or clinical laboratories to determine capacity for testing postmortem swab specimens.
There are limited data available to estimate the frequency of detection of SARS-CoV-2 by RT-PCR by swabs collected at different intervals postmortem. If SARS-CoV-2 testing on postmortem swab specimens is being considered for a suspected COVID-19 case, SARS-CoV-2 RNA may still be detected up to several days postmortem and possibly longer, based on limited available data for SARS-CoV-2 and from experiences with MERS-CoV and SARS-CoV. Sensitivity may be reduced with a longer postmortem interval or embalming. Duration of illness prior to death should be considered when interpreting a negative result.
Studies that evaluate the detection of SARS-CoV-2 by antigen testing on postmortem swabs are being reported in the literature. The sensitivity of rapid antigen tests is generally lower than NAAT. Please refer to Interim Guidance for Rapid Antigen Testing for SARS-CoV-2 for more information.
If multiplex assays for the simultaneous detection of SARS-CoV-2, influenza viruses and other respiratory pathogens are not available, separate postmortem specimens (e.g., NP or lung swabs) should be collected for routine testing of respiratory pathogens at either clinical or public health labs. Note that laboratories should NOT attempt viral isolation from specimens collected from confirmed or suspected COVID-19 cases unless this is performed in a BSL-3 laboratory.
No data are currently available on performance of SARS-CoV-2 serologic testing on postmortem samples. Serologic tests for SARS-CoV-2 look for the presence of antibodies. In general, a positive antibody test is presumed to mean a person was infected with SARS-CoV-2, the virus that causes COVID-19, at some point in the past or developed antibodies from receiving a COVID-19 vaccine. It does not mean they are currently infected. Antibody tests can detect the presence of these antibodies in serum within days to weeks following acute infection. Depending on when someone was infected and the timing of the test, the test may not find antibodies in someone with COVID-19 at the time of death. Antibody test results should not be used to diagnose someone who is suspected to have an active, current SARS-CoV-2 infection. For more information, see: Interim Guidelines for COVID-19 Antibody Testing.
If necessary and with advance approval, postmortem swab specimens may be shipped to CDC for SARS-CoV-2 RT-PCR testing if testing is not available at public health or clinical laboratories in a jurisdiction, or if repeated testing results remain inconclusive, or if other unusual results are obtained. State or local health departments should contact CDC at respvirus@cdc.gov prior to submitting samples to confirm.
Standard body bagging procedures should be followed, consistent with procedures used for deaths when there is no confirmed or suspected COVID-19. Given the varying weights of decedents and variety, construction, and conditions of body bag materials, postmortem care workers should use prudent judgement determining if risks for puncture, tearing, or failure of body bags could occur and whether a second body bag or a body bag of thicker, stronger material (e.g., minimum of 6 mil thickness) is necessary. Risk factors include:
However, failure is multifactorial, with macro trends serving as just one piece of a much larger puzzle. Additional contributing factors can be hard to uncover, but the obituaries written by founders, investors, and journalists offer plenty of clues.
Vietnam-based Propzy, a proptech startup, initiated its shutdown in mid-September. CEO John Le stated that the company had been hit hard by the pandemic and ultimately proved unable to recoup its losses in the face of continued lockdowns. Propzy had previously laid off 50% of its staff in June, but announced that it was still on track to raise fresh capital. This did not pan out, and its inability to raise new funding in conjunction with macro turbulence pressured the company to close its doors for good.
Several of the companies in this update stated they shut down because they were unable to raise funding (GoBear) or find a viable revenue model (Loon). Some were hit especially hard by pandemic shutdowns and changing consumer behaviors (Brideside). Others, meanwhile, allegedly mismanaged their spending (AWOK) or faced problems unrelated to the pandemic (TenX) that led to their failure.
In this update, the hospitality industry was hit especially hard, with several short-term rental and travel startups forced to wind down operations. Fashion and media companies also lost customers and dollars they needed as consumer spending pulled back and investor appetite waned.
Consumer hardware startup Essential closed down in February 2020, following the flop of its Essential Phone launched in 2017 and other unfinished projects. Founded by Andy Rubin, the creator of Android, the startup drew significant interest, raising over $330M. However, after a 2018 New York Times report revealed that Rubin had allegedly left Google due to sexual misconduct allegations, attention to the startup cooled. According to The Verge,
Apartment rental startup Stay Alfred was hit hard by the pandemic, as shutdowns forced the company to close its properties and investor interest dried up. The startup, which had raised $62M in funding, announced it would permanently cease operations in May 2020. According to Short Term Rentalz, CEO Jordan Allen said in an interview with the Spokane Journal,
Reach Robotics, the startup behind gaming robot MekaMon, shut down after being unable to make it in the hypercompetitive consumer hardware industry. Both co-founders weighed in with their thoughts around the life and challenges of Reach Robotics.
History has taught us how hard it can be to call the timing of a market transition. We have seen this play out first hand in the commercial drone marketplace. We were the pioneers in this market and one of the first to see the power drones could have in the commercial sector. Unfortunately, the market took longer to mature than we expected. As we worked through the various required pivots to position ourselves for long term success, we ran out of financial runway. As a result, it is with a heavy heart that we notified our team, customers, and partners that we will wind down the business.
This was a hard decision given that, over the past three years, Manilla has won many awards and has been well supported by its valued user base but was unable to achieve the scale necessary to make the economics of the business viable.
While I know there might be a possibility I could hustle incredibly hard and try to set up partnerships, the time investment required far outweighed the already incredibly slim chances of generating revenue.
Finances were just one part of the story. The other part was that we failed to execute our own plans. Both external factors (e.g. the hardware ecosystem in India) and internal reasons (e.g. the expertise of the team) played a role. With money it would have lasted a bit more longer.
Bush: There were times when I would look at him and say, \u201cThis isn\u2019t the guy.\u201d And I remember some of the senior agents saying, \u201cAre you sure this isn\u2019t the guy?\u201d And I said, \u201cIf our guy\u2019s got all loops, this guy\u2019s got all whorls.\u201d And they would look at you, give you that hard stare, but you know, that was a decision point. We\u2019d let the guy go.
Based on the monitoring data from the service owner and their own monitoring, the platform team can write their postmortem following the standard practices and our postmortem template. This results in an internally reviewed document that has the canonical view of the incident timeline, the scope and magnitude of impact, and a set of prioritized actions to reduce the probability of occurrence of the situation (increased Mean Time Between Failures), reduce the expected impact, improve detection (reduced Mean Time To Detect) and/or recover from the incident more quickly (reduced Mean Time To Recover). 2ff7e9595c
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