Pathologist criticises failure to do more postmortem examinations on victims The failure to conduct postmortem examinations on all 299 people who died of Sars has robbed Hong Kong of the chance to learn more about how the virus kills, a leading pathologist says. Philip Beh Swan-lip said this would also have cleared confusion about how patients died, at a time when the government was revising the number of Sars cases. Dr Beh, clinical assistant professor in forensic pathology at the University of Hong Kong, criticised health officials for not conducting autopsies on all the victims. He said he made such an appeal before but the Hospital Authority had not taken him seriously. Dr Beh said it would be a 'joke' to revise the Sars death toll without any autopsy evidence. 'If autopsies had been done to establish cause of death, we would not be in the present situation of guessing if the 299 deaths officially registered are all Sars deaths.' According to information he has gathered from public hospitals, postmortem examinations were carried out on about 60 Sars patients. But only half were complete investigations. In most of the other cases, doctors just removed lung tissue from the bodies. Dr Beh, a former senior government forensic scientist, said even if a patient tested positive for Sars in a laboratory, it did not necessarily mean he died of Sars, especially if he had other diseases. His team conducted six autopsies, on two 'probable' and four 'suspected' Sars patients, at Queen Mary Hospital. One probable case and one suspected case were confirmed as Sars deaths. According to Dr Beh, at least 41 autopsies of suspected and probable Sars patients were performed in Singapore. Seven were confirmed as Sars deaths. Dr Beh revealed that in April, when Sars was still spreading, he and his university colleagues had contacted the authority and e-mailed all the pathology departments of public hospitals, appealing for more autopsies to be done. 'At that time, some pathologists feared that they could be infected during an autopsy. We volunteered ... to do the cases. But eventually, only one case was referred from Tuen Mun Hospital,' he said. 'An autopsy can provide us with very valuable information on how the coronavirus attacks organs. We have missed the chance. 'The human race, unfortunately, did not take advantage of these unfortunate deaths and we did not gain as much as we could have. It is frustrating. We should look at this aspect if Sars returns.' Dr Beh said the authority should have had a policy to ask frontline doctors to conduct autopsies on all the Sars victims. The authority could have reached such a decision with the Department of Health and the coroner. Doctors could have put in 'unknown cause' on the death certificates of Sars patients. The case would then be referred to the coroner to order an autopsy. Dr Beh said although about 30 full autopsies of Sars patients were done in Hong Kong, the sample size was still too small. 'All these patients could be different in age and may have presented differently, as such they may have had different treatment, some with anti-viral agents and some with both anti-viral agents and steroids. The information may not help us very much because we do not know the effects of the virus in a bigger spectrum of cases.' In a reply to the South China Morning Post, a World Health Organisation spokeswoman said it did not have the numbers of Sars patients for whom autopsies had been done. 'The WHO also does not have any policy on whether autopsies should be conducted for Sars-related deaths. This is a local decision for which circumstances, both legal and medical, must be considered, and isn't necessarily an issue of public health.' She said blood tests were usually done 21 to 28 days after a patient recovered to verify the illness.