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Coronial postmortem reports and indirect COVID-19 pandemic-related mortality
  1. Robert Pell1,
  2. S Kim Suvarna2,
  3. Nigel Cooper3,
  4. Guy Rutty4,
  5. Anna Green5,
  6. Michael Osborn6,
  7. Peter Johnson7,
  8. Alison Hayward8,
  9. Justine Durno6,
  10. Theodore Estrin-Serlui9,
  11. Marion Mafham10,
  12. Ian S D Roberts1
  1. 1 Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Department of Histopathology, Northern General Hospital, The University of Sheffield, Sheffield, UK
  3. 3 School of Medical Education, Newcastle University School of Clinical Medical Sciences, Newcastle upon Tyne, UK
  4. 4 East Midlands Forensic Pathology Unit, University of Leicester, Leicester, UK
  5. 5 Department of Cellular Pathology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  6. 6 Department of Cellular Pathology, Imperial College Healthcare NHS Foundation Trust, London, UK
  7. 7 Department of Cellular Pathology, Buckinghamshire Healthcare NHS Trust, High Wycombe, UK
  8. 8 Department of Cellular Pathology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes, UK
  9. 9 Department of Cellular Pathology, West Hertfordshire Hospitals NHS Trust, Watford, UK
  10. 10 Nuffield Department of Population Health, University of Oxford, Oxford, UK
  1. Correspondence to Professor Ian S D Roberts, Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK; Ian.Roberts{at}


Aims Widespread disruption of healthcare services and excess mortality not directly attributed to COVID-19 occurred between March and May 2020. We undertook the first UK multicentre study of coroners’ autopsies before and during this period using postmortem reports.

Methods We reviewed reports of non-forensic coroners’ autopsies performed during the first COVID-19 lockdown (23 March to 8 May 2020), and the same period in 2018. Deaths were categorised as natural non-COVID-19, COVID-19-related, non-natural (suicide, drug and alcohol-related, traumatic, other). We provided opinion regarding whether delayed access to medical care or changes in behaviour due to lockdown were a potential factor in deaths.

Results Seven centres covering nine coronial jurisdictions submitted a total of 1100 coroners’ autopsies (498 in 2018, 602 in 2020). In only 54 autopsies was death attributed to COVID-19 (9%). We identified a significant increase in cases where delays in accessing medical care potentially contributed to death (10 in 2018, 44 in 2020). Lockdown was a contributing factor in a proportion of suicides (24%) and drug and alcohol-related deaths (12%).

Conclusions Postmortem reports have considerable utility in evaluating excess mortality due to healthcare and wider societal disruption during a pandemic. They provide information at an individual case level that is not available from assessment of death certification data. Detailed evaluation of coroners’ autopsy reports, supported by appropriate regulatory oversight, is recommended to mitigate disruption and indirect causes of mortality in future pandemics. Maintaining access to healthcare, including substance misuse and mental health services, is an important consideration.

  • reports
  • autopsy
  • COVID-19
  • death
  • epidemiology

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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  • Handling editor Runjan Chetty.

  • Contributors ISDR, RP, SKS, NC, GR, AG, MO undertook planning of the study. ISDR, SKS, NC, GR, AG, MO, PJ were responsible for the conduct of the study within participating centres. ISDR, RP, SKS, NC, GR, AG, MO, PJ, AH, JD, TE-S collected data from participating centres. ISDR, RP undertook analysis and interpretation of the data. ISDR and RP wrote the manuscript. ISDR, RP, SKS, NC, GR, AG, MO, PJ, AH, JD, TE-S, MM reviewed and revised the manuscript. ISDR is responsible for the overall content as guarantor, accepting fill responsibility for the finished work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests ISDR, NC, SKS, AG, PJ, MO received payment from HM Coroner for undertaking non-forensic Coronial Post Mortem work during the period of the study. GR holds a patent on the ‘Cadatheter’, a catheter designed specifically for postmortem computed tomography angiography (PI/GB2012/050359). MM has received Research Grant funding from Novartis and Novo Nordisk, and a Fellowship Grant from the British Heart Foundation Oxford Centre for Research Excellence.

  • Provenance and peer review Not commissioned; internally peer reviewed.