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A viral post on autopsies, Italy and the new coronavirus has many inaccuracies

11 JUNE 2020

A viral post on Facebook has made a number of claims about Italy's handling of the Covid-19 pandemic.

"Well! Well! Well! People are Waking up! Italy went against the WHO, saying no autopies [sic] on Covid-19, (wonder why?) Italy Did 50 autopsies and here's something you all need to read, before the nonexpert experts from FB delete it!"

The post claims, amongst other things, that Italy went against the WHO to perform post-mortems on Covid-19 patients, and found the disease is caused by a bacteria that causes blood clotting, not a virus.

Almost all of the claims it makes are incorrect.

"Italy went against the WHO, saying no autopies [sic] on Covid-19"

The World Health Organisation (WHO) did not say that post mortems shouldn't be performed on people who died with Covid-19. The WHO released guidance on 24 March on safety measures for managing bodies and performing post-mortems on patients who had died of Covid-19. This guidance does not say autopsies should not take place.

Italy did perform post mortems on patients who had died of Covid-19, though on 1 April the Ministry of Health recommended against doing autopsies on patients who clearly had the disease. Post-mortems are also allowed to take place on Covid-19 patients in other countries, including the UK and China.

"Italy has allegedly discovered covid is not a virus, but a bacterium. It clots the blood and reduces the oxygen saturation from dispersing throughout the body."

Covid-19 is caused by a virus called SARS-CoV-2, not a bacteria. Scientists have been studying the disease and its cause for several months now, and have sequenced the genetic material of the virus. (However, it is the case that people with Covid-19 can get secondary infections caused by bacteria, which can be very dangerous.)

As we've written before, severe Covid-19 can cause blood clotting problems.

"[Italy] started using aspirin 100mg and a coagulant medication. And have had immense success. 14,000 people were released from the hospital as healthy and covid free."

The Italian Medicines Agency makes no mention of aspirin on its page about drugs being used outside of clinical trials to treat patients with Covid-19. The agency's list of clinical trials in Italy on potential treatments for Covid-19 does not explicitly mention aspirin either. There is at least one study into using aspirin to treat Covid-19, although that's not taking place in Italy.

It's true that an anticoagulant called heparin, which is normally used to prevent blood clots, has been given to Covid-19 patients in Italy in certain circumstances.

It's not clear what the post means when it mentions 14,000 having been released from hospital healthy in Italy. At the time of writing just under 170,000 people in Italy had recovered from Covid-19.

"Italy is demanding Bill Gates and the World health Organization be held accountable for crimes against humanity for misleading, misdirecting, and withholding life saving information from the world, which cost the lives of thousands."

This seems to be referring to the case of an Italian MP, Sara Cunial, making a speech in which she told the Italian Prime Minister to send Bill Gates to the International Criminal Court for crimes against humanity. Ms Cunial is not currently a member of any political party, and her speech was not endorsed by the Italian government.

"Autopsies performed by the Italian pathologists has shown that it is not pneumonia but it is Disseminated Intravascular Coagulation (Thrombosis) which ought to be fought with antibiotics, antivirals, anti-inflammatories and anticoagulants."

As we have written before, it is incorrect to say that Covid-19 patients have been misdiagnosed with pneumonia when they have disseminated intravascular coagulation.

Pneumonia is a common complication of severe Covid-19, and disseminated intravascular coagulation can also be present in Covid-19 pneumonia patients.

As for the treatments, there is not yet a specific cure for Covid-19 that has been proved to be effective.

Antibiotics are not used to directly treat viruses, so are not used for Covid-19, although in some cases are given to patients if they are also suffering from bacterial infections. Some antivirals are being tested to see how effective they might be at treating Covid-19, and one, remdesivir, is being given to certain patients in the UK.

The anti-inflammatory drug ibuprofen is being tested to see whether it can help Covid-19 patients, and the anticoagulant heparin has been used in some cases to treat Covid-19 illness.

"[There was] a Mexican family in the United States who claimed they were cured with a home remedy was documented: three 500 mg aspirins dissolved in lemon juice boiled with honey, taken hot."

This has no basis in fact. Home remedies, including those involving lemon and honey, have no power to cure Covid-19 or prevent it. Hot water with lemon and honey can soothe a cough, but has no power to cure the new coronavirus. Aspirin can be used for pain relief in adults if they have a cough or cold, but you should not take as many as three 500mg in one go. Tablets are usually 300mg and the usual dose is one or two every four to six hours.

We could find no record of a family in Mexico claiming to have been cured in this way. Other posts claim the home remedy is an Italian or Cuban invention.

"An Italian pathologist reports that the hospital in Bergamo did a total of 50 autopsies and one in Milan, 20, that is, the Italian series is the highest in the world, the Chinese did only 3".

We can't find a specific report describing 50 autopsies being done on Covid-19 patients at a hospital in Bergamo. One study, published in the Lancet, looked at 38 samples from Covid-19 patients who died at hospitals in Bergamo and Milan.

Contrary to what the post claims, there have been more than three autopsies of Covid-19 patients in China.

"According to the Italian pathologist, treatment in ICUs is useless if thromboembolism is not resolved first. "If we ventilate a lung where blood does not circulate, it is useless, in fact, nine (9) patients out of ten (10) will die because the problem is cardiovascular, not respiratory.""

Thromboembolism, which is a type of blood clot, is one of several potential complications that can arise in severely ill Covid-19 patients. It's not known exactly how many Covid-19 patients die of this, as opposed to respiratory failure, or organ failure. Several of these can also occur at once in the same patient.

Whether or not a Covid-19 hospital patient goes into ICU depends not just on what complications they have, but how ill they are, how closely they need to be monitored, as well as the capacity and policy of the hospital they're in.

"Unfortunately, what the scientific literature said, especially Chinese, until mid-March was that anti-inflammatory drugs should not be used."

We could not find peer-reviewed studies that questioned the safety of ibuprofen in Covid-19 patients, or any specifically that came from China.

However, it's correct that there has been some debate over whether anti-inflammatory drugs, like ibuprofen, should be used in patients with Covid-19.

In the UK, initially, the NHS said that those self-isolating with symptoms could take painkillers such as ibuprofen and paracetamol, except those who have been specifically told by their doctors not to.

In mid-March, the NHS changed its guidance, and stopped advising people to use ibuprofen. It said that although there was "currently no strong evidence that ibuprofen can make coronavirus (Covid-19) worse", it recommended using paracetamol to treat the symptoms "until we have more information".

Now, the NHS says that ibuprofen is fine to use if you have symptoms, although it advises that people should try paracetamol first, as it is "the safer choice for most people".

"The main problem is not the virus, but the immune hyperreaction that destroys the cell where the virus is installed."

It's true that in some patients, the immune system can overreact to the infection, and cause inflammation that can lead to organ failure. This is known as a cytokine storm. But not all the evidence points to this being present, or the cause of death, in all critically ill patients.