![A computer rendering of a positive covid test leaning on a spherical flag of New Zealand](http:http://assets.medpagetoday.net/media/images/100xxx/100339.jpg?width=0.8)
Well, the 'rona got us. After 2 years of having successfully dodged COVID-19 here in Wellington, New Zealand, the bug has entered our household. It came in either through our daughter's school or her after-school activities. Of course it did. At work I can remain masked in all my interactions with colleagues, and I don full personal protective equipment, including an N95 respirator, while doing autopsy death investigation. My husband is a writer who works alone, and his typical activity outside the house is mountain biking, also alone. Both of us always wear our N95s when shopping or otherwise going into any space where we would be swapping our aerosols with those emitted by strangers.
When the government allowed schools to stop mandating masks, our daughter's school made masking "encouraged." The following week, the case numbers -- for both students and staff -- spiked. In the weeks that followed, there were so many sick and isolating teachers that the administration had to rotate some afternoon classes to home study, and the school returned to a temporary mask mandate. At first, our daughter, who is double vaccinated and boosted, managed to avoid COVID-19 by keeping her N95 on. But she is an actor, and for performances she needed her mask off. Last week, that fateful faint pink line appeared on her rapid test.
I will admit to feeling a bit defeated. I knew it would eventually get us, and I am grateful that we are vaccinated and boosted and that we have the tests and masks and a HEPA air purifier at home. We're going to try to mitigate transmission from our daughter to us, but I know that the odds are not in our favor now that the bug is under our roof. spiked way up, then dropped, then coasted for weeks on a plateau, then spiked again, and has now dropped back to the plateau numbers. Will it keep dropping or spike again? I won't even hazard a guess, and I don't really trust the infection numbers anymore -- most people now test positive by rapid test, never get a PCR, and don't necessarily report their infection to the government.
The Ministry of Health, meanwhile, has changed how they count COVID-19 deaths, distinguishing who is dying of COVID-19 and who is dying with COVID-19. I'm a professional who has to make legally-mandated decisions about these kind of things, and even I am struggling to parse that policy. Here's a hypothetical example drawn from several cases I've done recently. A young adult man comes to my autopsy table. He had been apparently healthy and died suddenly. When I open him up, there's nothing inside -- no gross anatomic findings on autopsy that would explain his death. Under the microscope, however, I do find evidence of scarring in the heart tissue. When the body came to the hospital and then into our mortuary, he had two COVID-19 PCR swabs; one came back positive and one came back negative. So, we can surmise that this dead guy is harboring a low viral load -- but is that an indication of a recent, healing infection or a "historic," remote one? And how does it play into the cause of death?
What about the opposite type of case, one with an undeniable anatomic finding? I open up this hypothetical decedent and find that the wall of the heart has ruptured. Okay, check please. But, wait -- I also find that this patient had both rip-roaring COVID-19 myocarditis and advanced heart disease. So, which of those ailments is the cause of death and which one is the contributing cause? What if their PCR swab came back fully negative because they had "recovered" from the flu-like symptoms they had the other week, but the microscopic pathology shows continued immune damage to the heart? Is it from COVID-19? Is it from the booster they received a few weeks ago? Or is it all just a consequence of the underlying atherosclerotic heart disease?
Too many what-ifs. In my field, we don't like what-ifs. We're supposed to provide final answers to coroners and to the decedents' families. Knowing that what I write on the death certificate becomes part of the public record and actually influences the numbers our national health authorities generate makes me super cautious. I show the case to other pathologists. I schedule a peer review. I do extra stains and tests for viral PCR on the tissue -- tests I would not have had to run 2 years ago -- and I agonize over every word in the opinion on my autopsy report. Even routine cases for a forensic pathologist, like motor vehicle accidents and drug overdoses, get extra scrutiny if they test positive for COVID-19, or if they received a vaccination and the family or coroner wants me to answer whether the death had something to do with that.
I wish I had an easy answer. I don't. I hate the 'rona with the fire of a thousand suns. It has defined our lives for the last 2 years and it will continue to do so for the foreseeable future. While I hope to hear that new technology will deliver a vaccine that proves effective against multiple variants and also stops viral transmission, I know that such a breakthrough likely won't come for quite some time. And over that time, all we can do if we want to dodge the bug is to keep up our household protocol: staying masked, washing hands, dining outdoors, and streaming movies at home. I can't afford to miss work and our daughter can't afford to miss more school. We're muddling through.
is an American forensic pathologist and the CEO of PathologyExpert Inc. She is currently working as a contract pathologist in Wellington, New Zealand. She is the co-author with her husband, writer T.J. Mitchell, of the New York Times bestselling memoir , and two novels, and , in the Jessie Teska forensic detective series. You can follow her on Twitter () and .