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What Pregnant Women Should Know About Coronavirus What Pregnant Women Should Know About Coronavirus
(about 11 hours later)
[This article is part of the developing coronavirus coverage, and was updated on March 26. Go here for the latest on the coronavirus.][This article is part of the developing coronavirus coverage, and was updated on March 26. Go here for the latest on the coronavirus.]
Pregnant women are often particularly susceptible to respiratory infections and, once infected, can become seriously ill, with long-lasting consequences for both mother and baby.Pregnant women are often particularly susceptible to respiratory infections and, once infected, can become seriously ill, with long-lasting consequences for both mother and baby.
Is that true for the new coronavirus?Is that true for the new coronavirus?
The information available so far is thin, but it appears that pregnant women are no more likely than anyone else to have severe symptoms from the coronavirus. In an analysis of 147 women, only 8 percent had severe disease and 1 percent were in critical condition, according to a report published on Feb. 28 by the World Health Organization.The information available so far is thin, but it appears that pregnant women are no more likely than anyone else to have severe symptoms from the coronavirus. In an analysis of 147 women, only 8 percent had severe disease and 1 percent were in critical condition, according to a report published on Feb. 28 by the World Health Organization.
It is too soon to know the consequences for these women’s babies. But so far at least, infants born to women with an infection seemed free of the virus and appeared healthy at birth, according to a study of nine pregnant women and their babies published in February in The Lancet.It is too soon to know the consequences for these women’s babies. But so far at least, infants born to women with an infection seemed free of the virus and appeared healthy at birth, according to a study of nine pregnant women and their babies published in February in The Lancet.
“Fortunately, there was no evidence of vertical transmission from mother to child,” said Dr. Wei Zhang, an epidemiologist at Northwestern University and one of the Lancet study’s authors.“Fortunately, there was no evidence of vertical transmission from mother to child,” said Dr. Wei Zhang, an epidemiologist at Northwestern University and one of the Lancet study’s authors.
A study published in March in JAMA offered more reassurance: Of 33 newborns born at the Wuhan Children’s Hospital, only three had any signs of the virus, and even their symptoms were mild, the researchers reported.A study published in March in JAMA offered more reassurance: Of 33 newborns born at the Wuhan Children’s Hospital, only three had any signs of the virus, and even their symptoms were mild, the researchers reported.
The researchers were uncertain of the source of the infection in the three newborns, however, and recommended that pregnant women be carefully monitored.The researchers were uncertain of the source of the infection in the three newborns, however, and recommended that pregnant women be carefully monitored.
Both studies are small. And they do not offer any clues to the infection’s effect on women in earlier stages of pregnancy.Both studies are small. And they do not offer any clues to the infection’s effect on women in earlier stages of pregnancy.
Fevers in early pregnancy are associated with birth defects and with some developmental conditions. And some viruses can have devastating consequences for the fetus. Zika, for example, can lead to an unusually small head, and Ebola can be lethal.Fevers in early pregnancy are associated with birth defects and with some developmental conditions. And some viruses can have devastating consequences for the fetus. Zika, for example, can lead to an unusually small head, and Ebola can be lethal.
The 1918 and 1957 flu pandemics had death rates of between 30 and 50 percent among pregnant women. The trend in pregnant women infected with SARS, the closest relative of the new coronavirus, is no more reassuring: In one small study of 12 pregnant women in Hong Kong who developed SARS during the 2003 outbreak, three died, and four of the seven women who were in their first trimester had a spontaneous miscarriage.The 1918 and 1957 flu pandemics had death rates of between 30 and 50 percent among pregnant women. The trend in pregnant women infected with SARS, the closest relative of the new coronavirus, is no more reassuring: In one small study of 12 pregnant women in Hong Kong who developed SARS during the 2003 outbreak, three died, and four of the seven women who were in their first trimester had a spontaneous miscarriage.
The WHO’s statistics for the new coronavirus and Dr. Zhang’s study both offer reason for optimism, but data from bigger numbers is crucial, experts said.The WHO’s statistics for the new coronavirus and Dr. Zhang’s study both offer reason for optimism, but data from bigger numbers is crucial, experts said.
“We do know that we’re going to have lots of pregnant women with coronavirus, just given the number of cases,” said Dr. Denise Jamieson, chair of gynecology and obstetrics at Emory University. “It’s going to be critical that surveillance systems collect information on pregnancy status.”“We do know that we’re going to have lots of pregnant women with coronavirus, just given the number of cases,” said Dr. Denise Jamieson, chair of gynecology and obstetrics at Emory University. “It’s going to be critical that surveillance systems collect information on pregnancy status.”
Dr. Jamieson is one of three experts who crafted the American College of Obstetricians and Gynecologists’ guidelines for treating pregnant women infected with the coronavirus. Among other best practices, the guidelines ask doctors’ offices to screen pregnant women even before their appointment — so that women with symptoms can wait in a separate area from other patients — and to take a detailed travel history.Dr. Jamieson is one of three experts who crafted the American College of Obstetricians and Gynecologists’ guidelines for treating pregnant women infected with the coronavirus. Among other best practices, the guidelines ask doctors’ offices to screen pregnant women even before their appointment — so that women with symptoms can wait in a separate area from other patients — and to take a detailed travel history.
For their part, pregnant women should take the same precautions as everyone else but let their doctors know immediately if they are experiencing any symptoms, Dr. Jamieson said.For their part, pregnant women should take the same precautions as everyone else but let their doctors know immediately if they are experiencing any symptoms, Dr. Jamieson said.
Pregnant women might also want to obtain copies of their health records in advance, “so that if there is some disruption in services, they have a record of their prenatal care,” she said.Pregnant women might also want to obtain copies of their health records in advance, “so that if there is some disruption in services, they have a record of their prenatal care,” she said.
Dr. Jamieson was at the Centers for Disease Control and Prevention at the time of the 2009 H1N1 pandemic. About one in three pregnant women infected with that virus were hospitalized.Dr. Jamieson was at the Centers for Disease Control and Prevention at the time of the 2009 H1N1 pandemic. About one in three pregnant women infected with that virus were hospitalized.
The C.D.C. recommended then that pregnant women who gave birth be separated from their infants until they were no longer infectious. The women were also encouraged to continue to express their breast milk but then discard it until they were illness-free, Dr. Jamieson said.The C.D.C. recommended then that pregnant women who gave birth be separated from their infants until they were no longer infectious. The women were also encouraged to continue to express their breast milk but then discard it until they were illness-free, Dr. Jamieson said.
Similar measures may be necessary with the coronavirus, she said: “Separating moms and babies is obviously a difficult issue.”Similar measures may be necessary with the coronavirus, she said: “Separating moms and babies is obviously a difficult issue.”
Updated June 16, 2020Updated June 16, 2020
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
The infected mothers in Dr. Zhang’s Lancet study were isolated from their infants. All nine women gave birth by cesarean section to minimize the newborns’ exposure to the virus. Dr. Zhang’s collaborators in Wuhan, the epicenter of the epidemic, tested cord blood, throat swabs from the infants, breast milk and amniotic fluid.The infected mothers in Dr. Zhang’s Lancet study were isolated from their infants. All nine women gave birth by cesarean section to minimize the newborns’ exposure to the virus. Dr. Zhang’s collaborators in Wuhan, the epicenter of the epidemic, tested cord blood, throat swabs from the infants, breast milk and amniotic fluid.
“We did not see any evidence for the virus,” Dr. Zhang said.“We did not see any evidence for the virus,” Dr. Zhang said.
In other reports of infected babies, including a study of 10 newborns with serious complications, the infants were either tested hours after they were born or may have had direct contact with the infected mothers because the women were not diagnosed before delivery, Dr. Zhang said.In other reports of infected babies, including a study of 10 newborns with serious complications, the infants were either tested hours after they were born or may have had direct contact with the infected mothers because the women were not diagnosed before delivery, Dr. Zhang said.
“If we have proper isolation and strict protocol, there should be good chance to have a healthy baby,” he said.“If we have proper isolation and strict protocol, there should be good chance to have a healthy baby,” he said.
Dr. Zhang was careful to emphasize that his study offers “good news” only to women in late pregnancy. “We should be very careful not to mislead other group of pregnant women,” he said. “We don’t know the real effect of the virus on women in early pregnancy.”Dr. Zhang was careful to emphasize that his study offers “good news” only to women in late pregnancy. “We should be very careful not to mislead other group of pregnant women,” he said. “We don’t know the real effect of the virus on women in early pregnancy.”
If women in earlier stages of pregnancy do turn out to be at risk, they will be prime candidates for a vaccine. The first trial for a vaccine is expected to begin later this month, but its criteria exclude pregnant women.If women in earlier stages of pregnancy do turn out to be at risk, they will be prime candidates for a vaccine. The first trial for a vaccine is expected to begin later this month, but its criteria exclude pregnant women.
Their exclusion is appropriate for this stage of vaccine development, said Dr. Ruth Karron, a vaccinologist at Johns Hopkins University and one of the co-leaders of the PREVENT guidance for including pregnant women in clinical trials.Their exclusion is appropriate for this stage of vaccine development, said Dr. Ruth Karron, a vaccinologist at Johns Hopkins University and one of the co-leaders of the PREVENT guidance for including pregnant women in clinical trials.
For a vaccine to be offered to pregnant women, scientists must first balance the risks and benefits; in this case, she said, both are unknown. The researchers would need to know the nature and prevalence of the disease in pregnant women, as well as any potentially dangerous side effects from the vaccine, such as fever.For a vaccine to be offered to pregnant women, scientists must first balance the risks and benefits; in this case, she said, both are unknown. The researchers would need to know the nature and prevalence of the disease in pregnant women, as well as any potentially dangerous side effects from the vaccine, such as fever.
But as researchers learn more, researchers should plan to include pregnant women in later iterations of the trial, Dr. Karron said: “This first trial is just that — it’s a first trial.”But as researchers learn more, researchers should plan to include pregnant women in later iterations of the trial, Dr. Karron said: “This first trial is just that — it’s a first trial.”
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