Mother to child transmission of COVID-19 during pregnancy is uncommon

Shreya Sharma
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Mother to child transmission of COVID-19 during pregnancy is uncommon

Vertical transmission of COVID-19 infection from mother to baby during pregnancy is as low as 2-5%

Transmission of COVID-19 from mother to baby during pregnancy is uncommon, and the rate of infection is no greater than 2-5%, finds a new study. 

The research also found that babies that did test positive for COVID-19, were mostly asymptomatic. There was also no difference whether the baby is born vaginally, breastfed or allowed contact with the mother.

Many early reports on COVID-19 in pregnancy suggested that in order to reduce the risk of transmission of COVID-19 from mother to baby, it was safer to have a caesarean, to isolate the baby from the mother at birth and to formula feed, but there was very little evidence to support these guidelines.

This systematic review of 49 studies analyzed the rates of vertical transmission of COVID-19 infection from mother to baby during pregnancy and also risks associated with birth.  

The studies reviewed included 666 neonates (newborn babies) and 655 women (as some women delivered twins). Of the COVID-19 infected women who delivered their babies vaginally, only eight out of 292 (2.7%) had a baby which tested positive for COVID-19.

findings show that neonatal COVID-19 infection is uncommon, and also commonly asymptomatic in those babies who are affected

Of the 364 women who had a caesarean, 20 (5.3%) of those had a baby which tested positive for COVID-19.

These findings show that neonatal COVID-19 infection is uncommon, and also commonly asymptomatic in those babies who are affected.

The data also showed that the infection rates to be no higher when the baby was born vaginally, breast fed or allowed contact with the mother immediately after birth.

Dr Kate Walker, Clinical Associate Professor in Obstetrics from the University of Nottingham and a lead author of the study said, “There has been a lot of concern around whether pregnant women should be concerned for the health of their babies if they contract COVID-19.

“We wanted to look at the outcome for babies whose mothers contracted the virus and see if the route of birth, method of infant feeding and mother/baby interaction increased the risk of babies contracting the virus. From our results, we are satisfied that the chance of newborn infection with COVID-19 is low.

“We would also stress that a vaginal birth and breast feeding are safe for mothers who find themselves in these circumstances.”

The findings were published in BJOG: An International Journal of Obstetrics and Gynaecology.

Engage with the private sector on COVID care, Centre tells states

Medibulletin Desk
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Engage with the private sector on COVID care, Centre tells states

Health secretary Preeti Sudan writes to states to engage with the private sector to ensure quality care for patients at reasonable rates

 

There have been several reports indicating an emerging shortage of healthcare infrastructure including hospitals with ICU beds, ventilators, oxygen supported beds etc., for management of COVID-19 patients. There have also been reports of overcharging by healthcare providers for COVID-19 treatment.

In order to ensure that patients receive prompt, good quality and care at reasonable rates, it has been suggested to States to have consultations with the local private healthcare providers

Being seized of the emerging scenario, Ministry of Health & Family Welfare has addressed the States/UTs to engage with the private healthcare providers to facilitate enhanced bed availability and critical care health facilities as well as to ensure fair and transparent charges for services provided. In this regard, some States have already taken initiative. They have reached an agreement with the private sector on reasonable rates and arrangements to provide critical care for in-patient admissions. PMJAY package (available at website and CGHS package rates are already available with the States. The latter rates are fixed area wise.

In order to ensure that patients receive prompt, good quality and care at reasonable rates, it has been suggested to States to have consultations with the local private healthcare providers and arrive at reasonable rates, while factoring in cost elements for personal safety equipments for healthcare providers. It has been suggested that the rates, once fixed, must be widely publicized so that both the patients and service providers are fully aware and capacities are used optimally. States have also been asked to proactively engage with the private sector health providers and consider pooling in public and private healthcare facilities, as this will help in providing prompt, good quality and reasonable health care to COVID-19 patients.

Face masks most effective tool to prevent the spread of COVID-19

Medibulletin Desk
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Face masks most effective tool to prevent the spread of COVID-19

Wearing a face mask dramatically reduced the chances of person-to-person spread of the virus

Want to avoid being infected by the SARS-CoV-2 virus, then always wear a face mask when outside home. 

Not wearing a face mask dramatically increases a person’s chances of being infected by the COVID-19 virus, finds a new study.

Findings were published in the current issue of PNAS (Proceedings of the National Academy of Sciences).

Researchers analyzed the chances of COVID-19 infection and how the virus is easily passed from person to person. From trends and mitigation procedures in China, Italy and New York City, the team found that using a face mask reduced the number of infections by more than 78,000 in Italy from April 6-May 9 and by over 66,000 in New York City from April 17-May 9.

“Our results clearly show that airborne transmission via respiratory aerosols represents the dominant route for the spread of COVID-19,” said Renyi Zhang, Texas A&M Distinguished Professor of Atmospheric Sciences and an author of the paper. “By analyzing the pandemic trends without face-covering using the statistical method and by projecting the trend, we calculated that over 66,000 infections were prevented by using a face mask in little over a month in New York City. 

“This inexpensive practice, in conjunction with social distancing and other procedures, is the most likely opportunity to stop the COVID-19 pandemic.”

Wearing a face mask as well as practicing good hand hygiene and social distancing will greatly reduce the chances of anyone contracting the COVID-19 virus

“Our study establishes very clearly that using a face mask is not only useful to prevent infected coughing droplets from reaching uninfected persons, but is also crucial for these uninfected persons to avoid breathing the minute atmospheric particles (aerosols) that infected people emit when talking and that can remain in the atmosphere tens of minutes and can travel tens of feet,” said co-author, Mario Molina, a professor at the University of California-San Diego and a co-recipient of the 1995 Nobel Prize in Chemistry.

“Our work suggests that the failure in containing the propagation of COVID-19 pandemic worldwide is largely attributed to the unrecognized importance of airborne virus transmission,” he said. “Social-distancing and washing our hands must continue, but that’s not sufficient enough protection. Wearing a face mask as well as practicing good hand hygiene and social distancing will greatly reduce the chances of anyone contracting the COVID-19 virus.”

Many states in India have made it compulsory to wear face masks while stepping outside homes and people violating the order are punishable with fines and jail term as well.

Nearly half of all SARS-CoV-2 infections may be asymptomatic

Medibulletin Desk
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Nearly half of all SARS-CoV-2 infections may be asymptomatic

Analysis of data from 16 groups of COVID-19 patients from around the world suggest number of ‘silent’ carriers’ may be as high as 45%

A large percentage of people infected by the COVID-19 virus never show symptoms of the disease, according to the results of a new analysis of public datasets on asymptomatic infections.

An asymptomatic individual is someone who is infected with SARS-CoV-2, but never develops symptoms of COVID-19, while a presymptomatic person is similarly infected, but will eventually develop symptoms. Longitudinal testing, which refers to repeated testing of individuals over time, would help differentiate between the two.

The findings, published in Annals of Internal Medicine, suggest that asymptomatic infections may account for as much as 45 percent of all COVID-19 cases, playing a significant role in the early and ongoing spread of COVID-19. The report highlights the need for expansive testing and contact tracing to mitigate the pandemic.

Our review really highlights the importance of testing. It’s clear that with such a high asymptomatic rate, we need to cast a very wide net, otherwise the virus will continue to evade us

“The silent spread of the virus makes it all the more challenging to control,” said Eric Topol, MD, founder and director of the Scripps Research Translational Institute and professor of Molecular Medicine at Scripps Research. “Our review really highlights the importance of testing. It’s clear that with such a high asymptomatic rate, we need to cast a very wide net, otherwise the virus will continue to evade us.”

Data collected information from testing studies on 16 diverse cohorts from around the world, including data on nursing home residents, cruise ship passengers, prison inmates and various other groups.

“What virtually all of them had in common was that a very large proportion of infected individuals had no symptoms,” said behavioral scientist and co-author Daniel Oran. “Among more than 3,000 prison inmates in four states who tested positive for the coronavirus, the figure was astronomical: 96 percent asymptomatic.”

The review further suggests that asymptomatic individuals are able to transmit the virus for an extended period of time, perhaps longer than 14 days. The viral loads are very similar in people with or without symptoms, but it remains unclear whether their infectiousness is of the same magnitude. Further evaluation with large-scale studies that include sufficient numbers of asymptomatic people is required, added Oran.

The authors also conclude that the absence of symptoms may not imply an absence of harm. CT scans conducted on 54 percent of 76 asymptomatic individuals on the Diamond Princess cruise ship, appear to show significant subclinical lung abnormalities raising the possibility of SARS-CoV-2 infection impacting lung function that might not be immediately apparent. 

India allows use of Remdesivir in COVID 19; loss of smell in symptoms list

Medibulletin Desk
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India allows use of Remdesivir in COVID 19; loss of smell in symptoms list

Ministry of health issues revised clinical management protocol for COVID19 allowing use of Remdesivir, Tocilizumab; loss of smell and taste are symptoms

 

India has allowed use of repurposed drug Remdesivir that is making waves the world over, to be used for COVID19. It has also allowed restricted use of tocilizumab and convalescent plasma therapy for the disease, while revising the list of symptoms. The new list of COVID19 symptoms includes loss of smell and taste.

The revised clinical management protocol released by the ministry of health on Saturday says: As per data from Integrated Health Information Platform (IHIP)/ Integrated Disease Surveillance Programme (IDSP) portal case investigation forms for COVID 19 (n=15,366), the details on the signs and symptoms reported are (as on 11.06.2020), fever (27%), cough (21%), sore throat (10%), breathlessness (8%), Weakness (7%), running nose (3%) and others 24%.

While remdesivir a drug originally developed for Ebola is being repurposed for COVID19, tocilizumab is used in autoimmune disorders

While remdesivir a drug originally developed for Ebola is being repurposed for COVID19, tocilizumab is used in autoimmune disorders. Convalescent plasma therapy n(CPT) involves transfusion of the blood plasma of a recovered patient into another patient. It has been used for many other diseases but its efficacy for COVID19 is still under investigation. Hydroxychloroquine will continue to be used but the antibiotic azithromycin is no longer a part of the treatment protocol.

The median incubation period, it lays down is 5.1 days (range 2–14 days). “The precise interval during which an individual with COVID-19 is infectious is uncertain. As per the current evidence, the period of infectivity starts 2 days prior to onset of symptoms and lasts up to 8 days. The extent and role played by pre-clinical/ asymptomatic infections in transmission still remain under investigation,” says the protocol document.

 

Reusable masks could offset N95 mask shortage for health care workers

Medibulletin Desk
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Reusable masks could offset N95 mask shortage for health care workers

Use of elastomeric masks could reduces the number of N95 masks needed by nearly 95 percent in one month

A cost-effective strategy for health care systems to offset N95 mask shortages due to the COVID-19 pandemic is to switch to reusable elastomeric respirator masks, according to a new study. 

These long-lasting masks, often used in industry and construction, cost at least 10 times less per month than disinfecting and reusing N95 masks meant to be for single use, said authors of the study, published in the Journal of the American College of Surgeons.

The study evaluated the cost-effectiveness of using elastomeric masks in a health care setting during the COVID-19 pandemic, said Sricharan Chalikonda, MD, MHA, FACS, lead study author and chief medical operations officer for Pittsburgh-based Allegheny Health Network (AHN), where the study took place.

elastomeric masks offer health care workers equal or better protection from airborne infectious substances compared with N95 masks

Disposable N95 masks are the standard face covering when health care providers require high-level respiratory protection, but during the pandemic, providers experienced widespread supply chain shortages and price increases.

Elastomeric masks are made of a tight-fitting, flexible, rubber-like material that can adjust to nearly all individuals’ faces and can withstand multiple cleanings, Dr. Chalikonda said. These devices, which resemble gas masks, use a replaceable filter. 

According to the Centers for Disease Control and Prevention (CDC), elastomeric masks offer health care workers equal or better protection from airborne infectious substances compared with N95 masks.

At the end of March, AHN began a one-month trial of a half-facepiece elastomeric mask covering the nose and mouth. The mask holds a P100-rated cartridge filter, meaning it filters out almost 100 percent of airborne particles. The first to receive the new masks were respiratory therapists, anesthesia providers, and emergency department and intensive care unit (ICU) doctors and nurses. Initially, providers shared the reusable masks with workers on other shifts, and the masks underwent decontamination between shifts using vaporized hydrogen peroxide similar to the technique used to sterilize disposable N95 masks.

Although an elastomeric mask costs about $20 and the filter costs $10 compared with only $3 for an N95 mask, the research team found the elastomeric masks were “conservatively” 10 times less expensive.

Authors explained that the monthly cost is lower because they can disinfect elastomeric masks much more often, multiple caregivers can share the same mask, and, unlike N95s masks, they do not need to waste the mask after a failed fit test. It does not require any additional hospital resources to implement if the hospital already has an N95 mask reuse and resterilization program.

Only 0.73% Indians exposed to COVID19, finds ICMR survey

Medibulletin Desk
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Only 0.73% Indians exposed to COVID19, finds ICMR survey

The first phase of antibody tests by ICMR show that less than 1% people in 65 districts of the country have been exposed to the virus

Even as the number of deaths and fresh cases in the last 24 hours touched daily highs of 10956 and 396 respectively, taking the total to 297535 cases, very few Indians it seems have been exposed to the virus.

A sero-surveillance study conducted by ICMR has revealed that 0.73% of the population surveyed showed evidence of past exposure to SARS-CoV-2. ICMR conducted the first sero-survey for COVID19 in May 2020 in collaboration with state health departments, NCDC and WHO India.

The study was conducted in 83 districts covering 28,595 households and 26,400 individuals. The study has two parts out of which the primary task of estimating the fraction of population who has been infected with SARS-CoV-2 in general population has been completed. The results are for only 65 districts for which the data have been analysed.

During the last 24 hours, a total of 5,823 COVID-19 patients have been cured. Thus, so far, a total of 1,41,028 patients have been cured of COVID-19

The second objective of estimating fraction of population who has been infected with SARS-CoV-2 in containment zones of hotspot cities is in the process of completion.

The study also clearly points out that the measures taken during the lockdown have been successful in keeping the transmission low and in preventing rapid spread of COVID-19. ICMR has calculated that compared to rural areas, risk of spread is 1.09 times higher in urban areas and 1.89 times higher in urban slums. The infection fatality rate is very low at 0.08%.

This only means that a large portion of the population must continue following COVID appropriate behaviour suggested by from time to time.

During the last 24 hours, a total of 5,823 COVID-19 patients have been cured. Thus, so far, a total of 1,41,028 patients have been cured of COVID-19. The recovery rate amongst COVID-19 patients is 49.21%. India currently has 1,37,448 active cases which are all under active medical supervision.

At present, the number of patients recovered exceeds the number of active patients.

Why is the spread of COVID-19 more in New York than Singapore?

Medibulletin Desk
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Why is the spread of COVID-19 more in New York than Singapore?

Drying time of COVID-19 virus respiratory droplets plays a major role in infectivity of COVID-19 

In a new research, investigators examined the drying time of respiratory droplets from COVID-19 infected subjects and inferred that temperature, humidity and surface play vital roles in the infectivity of COVID-19.

How long the coronavirus causing the disease remains alive after someone infected with it coughs or sneezes has been a major query in the scientific community. Once the droplets carrying the virus evaporate, the residual virus dies quickly, so the survival and transmission of COVID-19 are directly impacted by how long the droplets remain intact. The droplet size is of the order of human hair width, and the researchers examined frequently touched surfaces, such as door handles and smartphone touchscreens.

Findings were published in Physics of Fluids, by AIP Publishing.

Using a mathematical model well established in the field of interface science, researchers compared the drying time of COVID-19 virus infected respiratory droplets on various surfaces in six cities – New York, Chicago, Los Angeles, Miami, Sydney and Singapore. Results showed higher ambient temperature helped to dry out the droplet faster and drastically reduced the chances of virus survival. In places with greater humidity, the droplet stayed on surfaces longer, and the virus survival chances improved. In the cities with a larger growth rate of the pandemic, the drying time was longer.

 

(left) A droplet on a surface. (right) Comparison of the growth rate of the infection of different cities/regions (bars) with respective drying times (squares) of a 5-nanoliter droplet. The error bar represents the variability in outdoor weather. CREDIT : Rajneesh Bhardwaj and Amit Agrawal

“In a way, that could explain a slow or fast growth of the infection in a particular city. This may not be the sole factor, but definitely, the outdoor weather matters in the growth rate of the infection,” said Rajneesh Bhardwaj, one of the authors.

The study suggests that surfaces, such as smartphone screens, cotton and wood, should be cleaned more often than glass and steel surfaces, because the latter surfaces are relatively hydrophilic, and the droplets evaporate faster on these surfaces.

 

First time in India, more recovered COVID19 cases than active cases

MediBulletin Bureau
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First time in India, more recovered COVID19 cases than active cases

India for the first time since the start of the pandemic, has more recovered cases than active cases

For the first time since the start of the pandemic, the number of recovered COVID19 patients in India have crossed the number of active cases.

As many as 5,991 patients were cured of COVID-19 in the last 24 hours. This takes the total number of recovered patients to 1,35,205, while the total number of active cases is now 1,33,632. For the first time, the total number of recovered patients has exceeded the active cases.  The recovery rate now stands at 48.88%. The total number of COVID cases in India is now 276583 with 9985 new cases and 274 deaths being reported in the last one day.

Central Teams are being deputed to provide technical support and handhold the State Health Departments in six cities of Mumbai, Ahmedabad, Chennai Kolkata, Delhi and Bengaluru.

Also, the number of tests conducted by ICMR has exceeded 50 lakhs; it stands at 50,61,332 today. In the last 24 hours, ICMR has tested 1,45,216 samples. ICMR has continued to ramp up the testing capacity for detecting the Novel Coronavirus in the infected persons. The number of government labs has been increased to 590 and private labs has been increased to 233 (a total of 823).

Central Teams are being deputed to provide technical support and handhold the State Health Departments and Municipal Health Officials to review public health measures being undertaken for COVID-19 in six cities of Mumbai, Ahmedabad, Chennai Kolkata, Delhi and Bengaluru.

The teams will undertake visit to the cities mentioned within the next one week to review public health measures being undertaken for COVID-19. The teams will submit daily report of activities undertaken to State Health Department and the Union Ministry of Health & Family Welfare. They will inform them regarding any issue of urgent importance and also submit a report of its observations and suggestions before concluding the visit.

Widespread facemask use could dramatically reduce COVID-19

Shreya Sharma
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Widespread facemask use could dramatically reduce COVID-19

Population-wide facemask use could reduce transmission of COVID-19 and prevent a second wave of the disease

Population-wide use of facemasks keeps the coronavirus ‘reproduction number’ under 1.0, and prevents further waves of the virus when combined with lockdowns, suggests a modelling study.

The research suggests that lockdowns alone will not stop the resurgence of SARS-CoV-2, and that even homemade masks with limited effectiveness can dramatically reduce transmission rates if worn by enough people, regardless of whether they show symptoms. The findings were published in the Proceedings of the Royal Society A.

“Our analyses support the immediate and universal adoption of facemasks by the public. “If widespread facemask use by the public is combined with physical distancing and some lockdown, it may offer an acceptable way of managing the pandemic and re-opening economic activity long before there is a working vaccine,” said lead author, Dr Richard Stutt, from the University of Cambridge.

routine facemask use by 50% or more of the population reduced COVID-19 spread to an R less than 1.0, flattening future disease waves

The new coronavirus is transmitted through airborne droplets loaded with SARS-CoV-2 particles that get exhaled by infectious people, particularly when talking, coughing or sneezing.

For the study, researchers worked to link the dynamics of spread between individuals with population-level models, to assess different scenarios of facemask adoption combined with periods of lockdown.

The study found that if people wear masks whenever they are in public it is twice as effective at reducing ‘R’ than if masks are only worn after symptoms appear. The reproduction or ‘R’ number is the number of people the virus is passed onto by an infected individual. 

In all modelling scenarios, routine facemask use by 50% or more of the population reduced COVID-19 spread to an R less than 1.0, flattening future disease waves and allowing less-stringent lockdowns.

The team investigated the varying effectiveness of facemasks. Previous research shows that even homemade masks made from cotton t-shirts or dishcloths can prove 90% effective at preventing transmission.

The study suggests that an entire population wearing masks of just 75% effectiveness can bring a very high ‘R’ number of 4.0 to all the way down to under 1.0, even without aid of lockdowns. In fact, masks that only capture a mere 50% of exhaled droplets would still provide a “population-level benefit”.

Cultural and even political issues should not stop people wearing facemasks, so the message needs to be clear: my mask protects you, your mask protects me, added the researchers.

Prof Chris Gilligan, coauthor from Cambridge’s Epidemiology and Modelling Group, added: “These messages will be vital if the disease takes hold in the developing world, where large numbers of people are resource poor, but homemade masks are a cheap and effective technology.”

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