Our observations add further information on the pathology examination findings of COVID-19. An initial report from China described histopathological findings in 2 cancer patients with COVID-19, which showed several nonspecific histological changes, edema, fibrinous, proteinaceous exudates, hyperplastic pneumocytes, patchy inflammation, and multinucleated giant cells [4]. A case report, also from China, described findings in a postmortem biopsy specimen which showed diffuse alveolar damage and interstitial mononuclear inflammatory infiltrates [5]. In our autopsy study, we found that COVID-19 predominantly causes acute lung injury and diffuse alveolar damage, which is associated with multisystem involvement and significant pathology across most body organs in patients with and without comorbid disease. All deaths were due to cardiorespiratory failure and all cases had extrapulmonary manifestations. Microvascular injury and thrombosis were also detected. The 4 younger patients without preexisting medical conditions also had similar findings despite absence of comorbidities and displayed all the histopathological hallmarks of widespread vascular injury, including liver, kidney, spleen, and bone marrow involvement.