COVID-19 Update: 19 August 2020

Do you remember way back in April (ages ago)? Casting your mind to the distant recesses of COVD-19, you may remember a Columbia University report (in NEJM Journal Watch ) that 15% of pregnant women were already infected with the coronavirus. Most of these had no symptoms. My supposition at the time was that these pregnant women had been in close and frequent contact with healthcare providers, prior to distancing and masking, making them more at risk of viral acquisition.

Now in August, there is some good news for women seeking prenatal care. Researchers in Boston have shown no difference in the average number of in-person visits between 90 pregnant women who tested positive for COVID-19 and 370 pregnant controls who did not contract the virus. The researchers say the findings “suggest in-person health care visits were not likely to be an important risk factor for infection and that necessary, in-person care can be safely performed.” Their paper is published in JAMA Network Open.

This findings fits as well with what we are discovering about COVID-19 transmission patterns. Unsurprisingly, household exposure to COVID-19 confers the greatest risk for transmission, while being outdoors is least risky. A recent publication in Annals of Internal Medicine studied 3400 close contacts of nearly 400 COVID-19 patients in Guangzhou, China. Overall, nearly 4% of all contacts became infected. Of these, 10% of household contacts were infected versus 1% of those exposed in healthcare settings and 0.1% of those exposed on public transportation. Interestingly, the risk for transmission increased with the severity of symptoms in the original (index) case increased. I found this to be somewhat counter intuitive given the recent emphasis on asymptomatic and presympatic spread of the virus.

Lastly, a study in The Lancet has calculated the risk of diabetes & COVID-19 mortality. Between March and May, the unadjusted rate of in-hospital death with COVID-19 among U.K. patients was 138 per 100,000 for those with type 1 diabetes and 260 per 100,000 with type 2 diabetes — compared with 27 per 100,000 for those without diabetes. An adjusted risk of death from COVID-19 was 2.9-fold higher for those with type 1 diabetes and 1.8-fold higher for those with type 2 diabetes.

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