18 August More on pregnancy, lingering viruses, mental health, collateral damage and children

1. Editorial and Podcast in Science  on pregnancy and COVID: Some quotes:

• Protect your pregnant patients. The first ones who need the masks are pregnant women. The first to avoid social contact should be pregnant women.
• According to CDC database on > 8000 COVID + pregnancy: ….  50% more likely to end up in intensive care units (ICUs) than their nonpregnant peers. Pregnant women were also 70% more likely to need ventilators, although they were no more likely to die.
• Also in the postpartum: 3 X more risk on complications.
• But  no indication of birth defects in newborns: although placental circulation isq sometimes disturbed by COVID: SARES-CoV-2 is essentially non- blood borne, hence apparently no (or much less?) risk than e.g. rubella or CMV (which are blood-borne).

2. Lingering viruses: the story of a young lady, Natalie Forouzad, caught in her parent’s basement, because of persistent COVID-19 PCR positivity is the background to remind us that other viruses, which usually have an acute self-limiting course (Flu, ZIKA, EBOLA, measles…) sometimes stay in the body for a long time. In some cases, they have been shown to elicit complications (e.g. subacute sclerosing panencephalitis in case of measles) or can still be infectable (e.g. ZIKA or EBOLA from a semen “sanctuary”).  A low grade persistence (e.g. in association with foilicular dendritic cells in the lymph nodes) may also continuously stimulate specific immune responses , resulting in permanent re-infection immunity.  In the case of SARS-CoV-2, the debate whether or not infectious virus could be “shedded” is ongoing.  So not clear if people should remain in isolation. As discussed last week, measurement of subgenomic RNA (as a signh of replication-competent virus) could be a solution? 

3. Mental problems by COVID: read the experience from a colleague in Boston in the Annals: she had a “mild” COVID…. For those who believe we should stop emphasizing COVID, “because it just kills people who would die soon anyway”

4. On the other hand there is collateral damage: because the COVID pandemic has absorbed most medical capacity in North and South for many months….

-  In the North: more and more reports of negative effects on the care for non-communicable diseases, raising morbidity and mortality of cardiovascular diseases and cancer

- In the South  (Nature 12 August) : COVID-19 has turned the clock back years, if not decades, in the fight against infectious diseases. AIDS TB and malaria deaths could double due to COVID

5. And another review (provided by a colleague) that children are not so “innocent” after all…. See the practical advice for reopening schools on p.14 and 15….

Best wishes,

Guido