Objective.To establish morphological features of lung and other internal organs lesion in the deceased with COVID-19.

Materials and methods. The morphological study results in 44 deceased patients with COVID-19 performed in Minsk regional pathoanatomical bureau were analyzed. Macroscopic and microscopic changes in the internal organs (lungs, heart, liver, kidneys and adrenal glands) were estimated.

Results.Cardiovascular diseases were detected in 100 % (n=44), obesity in 47.7 % (n=21), diabetes mellitus in 25 % (n=11) of the deceased. Coronary heart disease was recognized as a combined disease in 29.5 % (n=13) of the deceased, arterial hypertension and diabetes mellitus were a background disease in 70.5 (n=31) and 20.5 % (n=9) of the deceased respectively.

In 100 % (n=44)of the deceased with COVID-19  diffuse alveolar damage (DAP) was revealed. Signs of exudative (hyaline membranes), proliferative (type 2 pneumocyte hyperplasia) and fibroplastic (fibroblast proliferation with fibrosis phenomena) stages were simultaneously detected in the lungs. In the myocardium focal necrosis of cardiomyocytes was more often observed, mainly due to cytolysis, but there were no large draining regions of necrosis and there were no signs of demarcation inflammation. The signs of acute kidney injury were reported in 43.2 % (n=19) of the deceased.

Conclusion. Cardiovascular diseases, obesity and diabetes mellitus had the greatest impact on the development and outcome of COVID-19 in the deceased. DAP in COVID-19-associated lung injury occurs with a violation of the classical staging. Classic myocarditis matching the 2016 Dallas Morphological Criteria was rare in patients with COVID-19.