Table 1.
The roles of pathology (all disciplines) in a pandemic severe infection
| Early phase | Identification and characterisation of the infectious agent |
| Generation and evaluation of diagnostic tests for the infection | |
| Drafting simple clinico-pathological case definitions or indicators of the new infectious disease | |
| Advising on health & safety issues around the treatment of patients with the disease | |
| Middle phase | Roll-out and performance of diagnostic tests |
| Detailed description of the clinical pathology, ie what the infection does to tissues, organ and how it results in disease and mortality | |
| Research into the pathogenesis of the disease | |
| Advising on health & safety issues around the post-mortem examination of patients who die with the disease | |
| Providing guidelines on how to perform autopsy examinations on those who die of and with the infection, recommending what diagnostic samples to take | |
| Advising on safe practices for those who remove and dispose of cadavers that contain the infectiona | |
| Diagnosing through autopsy who has died because of the infection versus with the infection; evaluating the impact of co-morbidities on the outcome of infection | |
| Contributing to vaccine development, including safety studies in animals and humans | |
| Late phase | Monitoring, through autopsy, adverse effects of treatments and vaccines against the infection |
| Monitoring through the autopsy the potential excess deaths from other causes as the pandemic impacts on normal diagnostic and life-saving therapeutic procedures | |
| Veterinary pathology study of possible sources of the infection in the wild and how they transmitted to humans | |
| Eternal population surveillance for the infection, in the living and the dead |
a
In 2007, the author attended a meeting of doctors, coroners, nurses, undertakers, religious leaders, and Home Office and public health officials to discuss what might happen if H5N1 influenza virus was introduced into the UK and became epidemic. The most memorable talking point was how to dispose of large numbers of bodies, of those dying with H5N1. A historian described how in both World Wars, mass graves were used to bury the dead, without apparent controversy, and queried whether this would be acceptable in the 21st century? Most participants at the meeting, particularly the religious leaders, were adamantly opposed to the idea