COVID Transmissions for 9-30-2021
Pregnant people need to get vaccinated.
Greetings from an undisclosed location in my apartment. Welcome to COVID Transmissions.
It has been 683 days since the first documented human case of COVID-19. In 683, Monmu, future Emperor of Japan, was born.
Today’s issue will focus on birth and pregnancy. As you’ll see in comments in the text and the Pandemic Life section, this is a timely theme on a personal level.
Next week, we will be back to our regular Monday/Wednesday/Friday schedule.
Bolded terms are linked to the running newsletter glossary.
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Now, let’s talk COVID.
97% of hospitalized pregnant people have not been vaccinated
The CDC recently issued an advisory urging pregnant people to become vaccinated. I could not agree more. The advisory is here: https://emergency.cdc.gov/han/2021/han00453.asp
One eye-popping statistic here is that 97% of pregnant people with SARS-CoV-2 infection in hospitals are not vaccinated. That’s not 97% of pregnant people in hospitals for COVID-19; that’s people who are there for illness or for labor and delivery. If you’ve walked in the door of a hospital recently while pregnant and tested positive for SARS-CoV-2 infection, there is a 97% chance you weren’t vaccinated. Only 3% of pregnant people in hospitals with SARS-CoV-2 positivity were vaccinated.
This really ought to tell you how amazing and effective vaccination is, but I don’t think the question here is whether the vaccines work in pregnant people. In fact there really isn’t a question here, but a matter for great concern—why are there so many unvaccinated pregnant people? This statistic alone doesn’t tell us how many there actually are, but it does tell us that there are enough for the number to be meaningfully tracked with percentages. This means there are too many pregnant people in hospitals with SARS-CoV-2 infections, bottom line.
The CDC goes further, however: Over the course of the pandemic, 125,000 laboratory-confirmed COVID-19 cases have been observed in pregnant people in the US, with 22,000 hospitalizations and 161 deaths. It is nice to see that the death rate is so low, but the hospitalization rate is alarmingly high. When you are a pregnant person, getting an illness that sends you to the hospital is not even close to a routine thing. It is dangerous for you and for your baby. Pregnant people are mildly immunosuppressed and can be at serious risk for complications or even additional infections acquired in hospitals. And then there is the fact that COVID-19 itself can cause very serious complications—it doesn’t have to kill a person to do bad things to them or their baby.
And, I’m afraid, the death rate does not tell us the whole story. Pregnant people are generally not by definition otherwise high-risk, so we need to consider what their risk would be if they were not pregnant. Compared to similar, non-pregnant people, those who are pregnant are at elevated risk of severe illness and death from COVID-19. The fetus is also at elevated risk of serious outcomes, including that of ICU admission and preterm birth. Some data also suggest elevated risk of pregnancy complications that can be hazardous to both the patient and their fetus, such as preeclampsia.
With regard to COVID-19 disease parameters, many of the hallmarks of severe disease—like the need for hospitalization, ICU admission, and potentially mechanical ventilation or ECMO1—also have elevated risk in the recently pregnant.
Despite all of this, it is thought that only 31% of pregnant people overall have been vaccinated either before or during their pregnancies. This is partly due to persistent false beliefs about vaccination, such as the idea that pregnant people are at higher risk of safety outcomes on vaccination (all evidence indicates they are not) or that people who are young and healthy enough to be pregnant are not at great risk from COVID-19 (they very much are).
The beliefs on this matter need to change because they are not in line with reality. The reality is that pregnant people are at huge risk from COVID-19 and vaccination is the only viable way to protect both the pregnant patient and their fetus. We’ve discussed the data that underlie this before in the newsletter, and I encourage you to go back and review it. People need to get out there and communicate this to every pregnant person they know. I’m sitting here in a maternal health unit room, writing this newsletter, wondering who isn’t vaccinated and whether they are putting my newborn daughter and recovering wife at risk. I shouldn’t have to worry about this, and the unvaccinated patients on this floor shouldn’t have been misled into avoiding vaccination. We have to fix this—for everyone’s sake.
Protective antibodies against COVID-19 are passed to infants
If you’re not convinced by what I’ve said above, I think maybe you’ll be interested to hear that getting vaccinated also seems to be able to protected infants from COVID-19. We know well that parents can transfer antibodies to infants though a variety of mechanisms—transfer of parental antibodies through the placenta takes place and is demonstrated as protective for the purposes of immunity to many diseases.
Additionally, it is possible to secrete antibodies in breast milk. This has been documented for COVID-19, though it is not totally clear if this confers protection: https://www.theguardian.com/lifeandstyle/2021/sep/27/antibodies-in-breast-milk-remain-for-10-months-after-covid-infection-study
Recently, however, we learned that in a small study, protective antibodies generated by parental vaccination for COVID-19 were passed to 100% of 36 studied infants at birth: https://www.sciencedirect.com/science/article/pii/S2589933321001762
That latter story shows you the incredible value of vaccination of a pregnant person. It protects that person, and it also protects their eventual infant, who cannot be vaccinated under current regulatory approvals. Protecting two (eventual) people with one vaccination course is incredible, especially since one of these hypothetical people could not otherwise be given a vaccine. If, eventually, vaccines are approved in infants, it is likely it will not cover infants younger than 6 months. This passive transfer of antibodies could protect infants in that first 6 months of life, ensuring a potential lifetime of protection from COVID-19.
That’s the kind of news I like to hear.
What am I doing to cope with the pandemic? This:
Welcoming our daughter
Since I last wrote to you, my wife and I welcomed our daughter, our first child, to the world:
Mother and baby are both doing excellently.
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No corrections since last issue.
See you all next time. And don’t forget to share the newsletter if you liked it.
Always,
JS
Ironically, many people only know what ECMO is from its application in neonatal care, where it can help supplement the function of lungs that have not fully developed yet. It is now also used in adult COVID-19 care, where it can supplement the function of lungs that are too damaged to be compatible with survival.
Mazel tov!