Spread of COVID-19 Infection in Long-Term Care Facilities of Trieste (Italy) during the Pre-Vaccination Era. Integrating Findings of 41 Forensic Autopsies with Geriatric Comorbidity Index as a Valid Option for the Assessment of Strength of Causation

Background: in 2020 a new form of coronavirus spread around the world starting from China. The older people were the population most affected by the virus worldwide, in particular in Ita-ly where more than 90% of deaths were people over 65 years. In these people, the definition of the cause of death is tricky due to the presence of numerous comorbidities. Objective: to deter-mine whether Covid-19 was the cause of death in a series of older adults residents of nursing care homes. Methods: 41 autopsies were performed from May to June 2020. External examina-tion, swabs, macroscopic and microscopic examination were performed. Results: the case series consisted of nursing home guests; 15 men and 26 women, with a mean age of 87 years. The av-erage number of comorbidities was 4. Based only on the autopsy results the defined cause of death was in 8% of the cases respiratory failure in subjects with histological signs of diffuse al-veolar damageCovid-19 in 8% of the cases, 31% died of acute respiratory failure due to bron-chopneumonia, 37% died of acute cardiac failure with one or more positive swabs for Covid-19SARS-CoV-2, 10% died of acute cardiac failure in patients without signs of SARS-CoV-2 infectionCovid-19, 3 cases of septic shock, 2 cases from malignant neoplastic disease and 1 case of massive digestive bleeding. Conclusions: The combined evaluation of the Geriatric Index of Comorbidity, swab result and autopsy results showed that only in 5 cases death was due to Covid-19, in the remaining 36 cases Covid-19 was not acknowledged as cause of death