The Covid-19 Pandemic has affected every citizen of this world. It has been a highly contagious and highly virulent virus that has a mortality rate up to 10 times greater than the typical flu! In this post, we aim to highlight lessons we can learn from Covid-19 and how we can take protective measures for ourselves, our families, and our communities.
As of early October 2020, there have been more than 7 Million Americans infected with COVID-19, and over 200,000 deaths. This shocking death rate has disproportionately affected people with diabetes and obesity, and people of color, and people of advanced age. Respiratory droplets are the main cause of transmission of the SARS-CoV-2 virus. These droplets are released with talking, coughing, sneezing, and singing. Respiratory droplets usually reach the ground within 3 to 6 feet of the person of origin. There is likely some component of aerosolized spread indoors with limited ventilation, such that the virus may hang in the air for a period of time prior to dropping to the ground. Contact surface spread is another mode of transmission. The virus can be spread by asymptomatic, pre-symptomatic, and symptomatic individuals. The average time from exposure to symptoms is 5 days, with almost all people developing symptoms within 12 days of exposure. There is a great range of symptoms for infected individuals from no symptoms to respiratory failure, and multi-organ failure and death. For hospitalized patients, 20% will need intensive care. The most common symptoms are fever, dry cough, shortness of breath, fatigue, and muscle aches; and additionally, there can be symptoms of nausea/vomiting or diarrhea, headache, weakness, runny nose, and loss of smell or taste. Complications may include pneumonia, acute respiratory distress, liver injury, cardiac injury, kidney injury, clotting events, impaired consciousness, and shock. The diagnosis is made by PCR testing of a nasopharyngeal swab for the SARS-CoV-2 virus. As the false negative rate of the test can be 20% or more depending on the timing of the test with symptoms, it is possible to also make the diagnosis clinically. Antibody testing may be done to confirm previous infection. However, a positive antibody test does not necessarily provide protection against future exposures.
Treatment has been primarily supportive: supplemental oxygen, rest, symptom reduction. There have been recent randomized controlled studies that have shown benefit for Dexamethasone (a steroid, and immunosuppressant), and for Ramdesivir (an anti-viral). There are many studies that are ongoing to determine the possible effectiveness of convalescent serum (anti-SARS-CoV-2 Antibodies); anticoagulants; modulators of the immune system; monoclonal antibodies; and other anti-virals.
We continue to gather data on the potential impact of Covid-19 upon pregnant women and their fetuses, as well any potential impact upon fertility. Here is what we currently know as of early October 2020. For pregnant women with COVID-19, there is almost a two-fold greater chance of an ICU admission; with an overall ICU admission rate of 1 per 68 infected pregnant women. Keep in mind that the overall infection rate in pregnant women is low. Transmission of the virus to the fetus through the placenta appears rare by current data. There does seem to be a higher risk of pre-eclampsia, prematurity, and cesarean delivery. One mechanism of disease of the SARS-CoV-2 virus is by causing micro-clotting. Given the vascular nature of the placenta, complications related to placenta dysfunction are understandable and need further study. There are data registries to try to gather more information over time. It is reasonable to postpone conception until there is a safe and effective vaccine; if age and other factors are favorable for an individual or couple to make this choice.
For patients undergoing fertility treatment, information from a recent basic science study concluded that the SARS-CoV-2 virus was not present in the semen or testicular tissue of infected men. The same research group had scare human ovarian tissue to study; and studied the ovarian tissue of primates with results showing a lack of receptors for the virus, suggesting that long term impact on ovarian function is unlikely.
Measures to prevent COVID-19 are highly encouraged for all individuals; and especially for pregnant women:
- Wear a mask in public
- Wash hands frequently and thoroughly
- Maintain social distancing of 6 feet or more.
- Limit contact with other individuals; avoid medium or large crowds
- Avoid indoor activities, such as restaurants, and the arts until proven very safe
- Maintain prenatal appointments
- Maintain a supply of preparedness resources including medications
- Avail yourself to a vaccine; when it is available and confirmed safe in pregnancy
- Wear personal protective equipment if there is potential for occupational exposure
Preventing disease is an individual goal and a community public health goal. Vaccine trials are in phase 3 to test efficacy and safety. During these trials, there is ongoing independent scientific review that cannot be influenced by the pharmaceutical company or by politicians. Good to know. While vaccination does not prevent every potential case of the disease, it is associated with markedly reduced cases of the virus, less severe cases of the virus and therefore substantially lower rates of hospitalizations and deaths. This is the benefit to individuals as well as to the health care system and to society.
Through this pandemic, we have learned cough and cold etiquette, mask wearing, along with social distancing, and isolation of infected individuals, as simple and effective measures that can actually control the pandemic and save lives. We have a greater respect for the value of vaccines in preventing the burden of diseases. We have all learned to greatly respect the germ theory. We have also concluded that the real heroes of society are the healthcare workers, first responders, and other frontline workers. We applaud each and every one of them!
Wiersinga, W.J. et al., “Pathophysiology, Transmission, Diagnosis, and Treatment of the Coronavirus Disease 2019 (COVID-19), A Review”, JAMA, online, 2020.12839, July 10, 2020.
Novel Coronavirus 2019 (COVID-19), American College of Obstetricians and Gynecologists, Practice Advisory, July 1, 2020.
Stanley, K, et al, “Coronavirus disease-19 and fertility: Viral host entry protein expression in male and female reproductive tissues”, Fertil Steril, July 2020.