Coronavirus in Context: A Look Back, A Look Ahead

    Coronavirus in Context: A Look Back, A Look Ahead

    09/04/2020

    As the COVID-19 pandemic continues to disrupt our daily lives inside and outside of the hospital, questions remain about the virus and its ramifications for pregnancy, birth, postpartum, and newborn care. Still, we know far more about the novel coronavirus than we did earlier this year. And new research is ongoing around the world, so we're learning more all the time.

    Now that we're more than six months into the pandemic, it's a good time to take a look back at how we got here and a look ahead at the emerging science, especially as it relates to expecting and new parents.

    Looking Back at the Birth of a Pandemic

    On January 30, the World Health Organization (WHO) called attention to an outbreak of a new respiratory illness, calling it a public health emergency of international concern. At the end of February, the WHO gave the novel coronavirus the name COVID-19. And on March 11, it declared the outbreak a pandemic. Since then, the virus, which originated in Wuhan, China, has spread rapidly around the world, including to every state in the U.S.

    By mid-March, hospitals across the country were canceling in-person childbirth, breastfeeding, newborn care, and grandparenting classes due to concerns about COVID-19. These developments continue to affect how educators deliver vital pregnancy, birth, and parenting instruction. For more about the evolution of patient education during a pandemic and how our clients have risen to the challenge, check out our blog post.

    The Origins of COVID-19

    SARS-CoV-2 is the novel coronavirus responsible for the COVID-19 pandemic of 2020. It's among seven types of coronaviruses that infect humans. Four of these viruses are relatively mild in nature – they cause the common cold. Three others, however, cause acute and severe illnesses:

    • MERS-CoV causes Middle Eastern Respiratory Syndrome (MERS)
    • SARS-CoV causes Severe Acute Respiratory Syndrome (SARS)
    • SARS-CoV-2 causes COVID-19

    According to the Centers for Disease Control and Prevention (CDC), MERS represents a very low risk to the general public in the U.S. To date, all MERS cases have been linked to travel to or residence in countries around the Arabian Peninsula. As for SARS, only eight people in the U.S. have been diagnosed with the infection, and all had traveled to other parts of the world where a SARS outbreak was occurring. The number of COVID-19 cases in the U.S., on the other hand, continues to rise with each passing day.

    For an updated count of confirmed cases and number of deaths, you can access the John Hopkins Coronavirus Resource Center.

    What to Look for Now: COVID-19 Symptoms

    We now know that while some people with laboratory diagnoses of COVID-19 remain asymptomatic, many experience severe multisystem symptoms. Furthermore, it's still unclear what the long-term manifestations of this virus will turn out to be. But some common symptoms have emerged.

    Common symptoms of COVID-19

    • Cough, congestion, runny nose
    • Fever, chills, sore throat
    • Shortness of breath or difficulty breathing
    • New loss of taste or smell
    • Diarrhea, nausea, vomiting
    • Headache, muscle/body aches, fatigue

    These symptoms usually develop within 2-14 days of exposure to the virus. But some patients have reported other uncommon symptoms, and some of those require emergency care. 

    Emergency symptoms of COVID-19

    • Difficulty breathing
    • Persistent pain or pressure in the chest
    • New confusion
    • Inability to wake or stay awake
    • Bluish-colored face or lips

    As health care providers, patients look to you for accurate information about COVID-19 prevention. To help you educate them, our medical team has put together a flyer based on the latest COVID-19 research that provides general safety and prevention guidance. We encourage you to share it with your patients. You can find it here.

    Pregnancy Considerations During the Pandemic

    Currently, data and information are limited regarding the impact of underlying medical conditions on COVID-19 and whether they increase the risk for severe illness. But according to the CDC, people experience immunologic and physiologic changes during pregnancy that could increase their risk for more severe illness from respiratory infections such as COVID-19.

    So it's important to encourage your pregnant patients to keep all prenatal appointments and to consistently follow guidance for prevention of the virus. It's especially important for them to assess their level of risk before going out in public. If they cannot maintain a social distance of a least 6 feet, it's best that they stay home. Whenever possible, they should use telehealth. And if they take any medications, they should keep a 30-day supply on hand. 

    A vaccine for COVID-19 is not yet available, but routine vaccinations to prevent other diseases and illnesses are important. During pregnancy, getting vaccinations such as influenza and Tdap can offer important protections for parents and babies. 

    For those who are pregnant and positive for COVID-19, there may be an increased risk of negative pregnancy outcomes, including but not limited to preterm birth. And pregnant women with comorbidities such as heart disease, diabetes, obesity, or others, may be at increased risk of severe illness compared with people in the general population with similar conditions. 

    Breastfeeding Best Practices and COVID-19

    The WHO and CDC have differing opinions on the safety of breastfeeding for people with the virus. Ultimately, parents should make the decision on whether to breastfeed in consultation with their health care providers. 

    The WHO recommends breastfeeding and rooming-in for infants and young children whose mothers have suspected or confirmed COVID-19 infection. The WHO stresses that the "benefits of breastfeeding and nurturing mother-infant interaction to prevent infection and promote health and development are especially important when health and other community services are themselves disrupted or limited."

    The CDC, on the other hand, says health care providers and parents should discuss the risks and benefits of temporary separation in the hospital to potentially prevent the transmission of the virus to the baby. The CDC recognizes that the ideal setting for the care of a healthy, full-term newborn during the hospital stay is in the parent's room. But it is not known if the virus can spread to a baby in breast milk, although the data currently available suggests that it's unlikely.

    Research Studies on Pregnancy and COVID-19

    Research is continuing all over the world, but there's still much we do not know. And as new information emerges, guidance can change, so it's important to stay updated from credible sources. There's a critical need for further data, analysis, and peer-reviewed literature on COVID-19 infection during pregnancy. 

    Some of the latest COVID-19 research findings related to pregnancy:

    • In June, the CDC reported pregnant women may be at higher risk for severe illness from COVID-19 when compared with non-pregnant women. Current data demonstrates that pregnant women have an increased risk of intensive care unit (ICU) admission and mechanical ventilation during COVID illness. The risk of dying, however, is no greater for pregnant women than the general population of the same age, according to the study.
    • In July, physicians in France published a case study that suggests a newborn caught the coronavirus before birth from his mother via the placenta. This has demonstrated that transplacental transmission of SARS-CoV-2 infection is possible during the last weeks of pregnancy, but it's uncommon.
    • Emerging data show higher rates of COVID-19 infection in some communities of color, especially in Black, Latinx and Native American people.
    • A study published in The Lancet on July 23 found that it's unlikely for perinatal transmission of COVID-19 to occur from mother to baby when correct hygiene measures are consistently used. In view of those findings and the benefits of early parent/infant bonding and breastfeeding, the study suggests that rooming-in and direct breastfeeding are safe and should be promoted but must be paired with effective parental education on how to protect the baby, including the use of surgical masks and frequent hand washing.

    How Pregnant Patients Can Advance COVID-19 Research

    The American College of Obstetricians and Gynecologists (ACOG) has asked its members to encourage pregnant patients who test positive for COVID-19 to consider enrolling in research studies that will help the health care community better understand prengnacy issues related to the virus. The organization is concerned that pregnant and lactating patients may have been excluded from coronavirus vaccine clinical trials. 

    If you have patients who are interested in participating in research studies, encourage them to contact their health care provider and local health department for information.

    Looking Ahead: Where Do We Go from Here?

    We still have lots of work to do. But look how far we've come. We'd love to hear from you. Join us on Facebook at CCI Hub to share your personal stories about caring for new and expecting families during the pandemic. What do you think the future holds? Will we have a vaccine by the end of the year? Let's keep this conversation going.