Chief Forensic Pathologist’s report

In March 2020, the province, country and world were thrown into a state of emergency due to the COVID-19 pandemic. Since then, the way we work together and practise forensic pathology has had to pivot and adapt to the evolving crisis. While this report covers the period of April 2019 to March 2020, I would like to take this opportunity to reflect on our response to COVID-19, as well as the leadership role of our team.

During the early phase of COVID-19, the Ontario Forensic Pathology Service (OFPS) focused on maintaining ‘essential’ medicolegal autopsies for public death investigations. The paramount consideration was the protection of frontline staff through social distancing, the procurement and conservation of personal protective equipment and the promotion of wellness.  Where an autopsy was required to answer medicolegal questions, procedures were modified to limit the possibility of viral particles in the air. The application of forensic imaging at the Provincial Forensic Pathology Unit (PFPU) in Toronto has allowed us to target procedures and dissections. The OFPS’ modified guidelines were shared widely to inform best practices, and we have worked closely with the Canadian and Ontario Associations of Pathologists and international partners to translate timely knowledge.

Initially, because COVID-19 deaths were natural and, therefore, not reportable under the Coroners Act, very few autopsies were conducted. However, in some cases where medicolegal issues necessitated investigation by a coroner, autopsies were conducted. I performed the first COVID-19 positive autopsy on March 17, 2020 at the PFPU. The first cases were referred for autopsy for various reasons, including to support death investigations in long-term care facilities. By June 2021, more than 160 COVID-19 cases have been examined at the PFPU.

The OFPS, through its autopsy practice, is well positioned to gain first-hand insight into COVID-19. The PFPU has partnered with coroners and public health to support viral testing and contribute to public health.

Autopsies play an important role in understanding the pathological spectrum of COVID-19 and its effects on the human body. The OFPS is assisting with pre-clinical research by microbiologists and immunologists at the University of Toronto to contribute to vaccine development. Based on this work, Health Canada approved a phase one clinical trial that commenced in January 2021 for a new vaccine that has been developed by a Canadian biotech company in Toronto. The OFPS is in a unique position to collaborate on this vaccine project because of our direct experience with the effects of the SARS-CoV-2 virus. This project shows how the OFPS’ expertise can safeguard public health in a way beyond its traditional role of providing medical expertise to the criminal justice system.

This activity is happening at a time of an unprecedented high sustained autopsy caseload across Ontario, including a surge in opioid related deaths. Since the beginning of the pandemic, the PFPU is performing an average 120 medicolegal autopsies per week. Other Forensic Pathology Units across the province have also seen increased caseloads. Despite challenging operational pressures, including managing an increased number of bodies, the OFPS remains committed to a knowledge-based approach to COVID-19.

During this uncertainty, it is important to pause and remember what we stand for: Integrity, Responsiveness, Excellence, Accountability and Diversity. I believe that our team has exemplified these core values in their herculean efforts to provide critical and evidence-based answers to families and to our death investigation, criminal justice and public health partners. I am very proud and thankful to work with such a great team of professionals.

Michael S. Pollanen, MD PhD FRCPath DMJ (Path) FRCPC Founder, forensic pathology
Chief Forensic Pathologist of Ontario and Deputy Chief Coroner
Professor, Department of Laboratory Medicine & Pathobiology, University of Toronto
June 2021