Pathophysiology of SARS-CoV-2: the Mount Sinai COVID-19 autopsy experience

Clare Bryce, Zachary Grimes, Elisabet Pujadas, Sadhna Ahuja, Mary Beth Beasley, Randy Albrecht, Tahyna Hernandez, Aryeh Stock, Zhen Zhao, Mohamed Rizwan AlRasheed, Joyce Chen, Li Li, Diane Wang, Adriana Corben, G. Kenneth Haines, William H. Westra, Melissa Umphlett, Ronald E. Gordon, Jason Reidy, Bruce PetersenFadi Salem, Maria Isabel Fiel, Siraj M. El Jamal, Nadejda M. Tsankova, Jane Houldsworth, Zarmeen Mussa, Brandon Veremis, Emilia Sordillo, Melissa R. Gitman, Michael Nowak, Rachel Brody, Noam Harpaz, Miriam Merad, Sacha Gnjatic, Wen Chun Liu, Michael Schotsaert, Lisa Miorin, Teresa A. Aydillo Gomez, Irene Ramos-Lopez, Adolfo Garcia-Sastre, Ryan Donnelly, Patricia Seigler, Calvin Keys, Jennifer Cameron, Isaiah Moultrie, Kae Lynn Washington, Jacquelyn Treatman, Robert Sebra, Jeffrey Jhang, Adolfo Firpo, John Lednicky, Alberto Paniz-Mondolfi, Carlos Cordon-Cardo, Mary E. Fowkes

Research output: Contribution to journalArticlepeer-review

143 Scopus citations


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated clinical syndrome COVID-19 are causing overwhelming morbidity and mortality around the globe and disproportionately affected New York City between March and May 2020. Here, we report on the first 100 COVID-19-positive autopsies performed at the Mount Sinai Hospital in New York City. Autopsies revealed large pulmonary emboli in six cases. Diffuse alveolar damage was present in over 90% of cases. We also report microthrombi in multiple organ systems including the brain, as well as hemophagocytosis. We additionally provide electron microscopic evidence of the presence of the virus in our samples. Laboratory results of our COVID-19 cohort disclose elevated inflammatory markers, abnormal coagulation values, and elevated cytokines IL-6, IL-8, and TNFα. Our autopsy series of COVID-19-positive patients reveals that this disease, often conceptualized as a primarily respiratory viral illness, has widespread effects in the body including hypercoagulability, a hyperinflammatory state, and endothelial dysfunction. Targeting of these multisystemic pathways could lead to new treatment avenues as well as combination therapies against SARS-CoV-2 infection.

Original languageEnglish
Pages (from-to)1456-1467
Number of pages12
JournalModern Pathology
Issue number8
StatePublished - Aug 2021


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