Coronavirus Chronicles — Orphanhood and Other Knock-On Effects

The thing is, it’s not just that people are dying from COVID-19. There is a lot of spillover, an enormous amount of chain reaction, a huge pile of consequences that result from so many illnesses and deaths, and so much societal disruption.

Hospitals have reported turning away patients with urgent medical needs, including women in labor, because there was just nowhere to put them. In Austin, when a man with two guns was arrested outside a school, local residents speculated on what would have happened if he had not been apprehended.

A mass casualty event is not a farfetched possibility. Nationwide, more than 1,000 children and teens have been killed by guns this year so far. Plenty of thoughts and prayers are available — just nowhere near enough medical care. In Austin on that day, there were no emergency room beds, no intensive care beds, indeed no empty hospital beds of any kind, within miles.

To the point

This post is about dead parents, who are not just COVID patients. They are mothers and fathers with other medical emergencies, who in many places have been unable to get treatment because COVID patients absorb all the resources.

The stories become more specific, like the one Newsweek published last month, of a California couple, both in their late 30s, who died within two weeks of each other. They were survived by five children under the age of seven, and the sixth was delivered while her mother was being treated for the virus. The woman’s brother told a reporter that his sister had been reluctant to be vaccinated because she was pregnant. The most recent Childhood Obesity News post, by the way, is about the benefits and safety, for mothers and babies, of vaccination against COVID-19.

We hear one horrendous story after another, like that of a Tennessee mother of three who was hospitalized for months; who went deaf and had to have her hands and feet amputated because of COVID. A nurse’s social media account mentions a friend who is on oxygen because of COVID, and who is also taking care of the three children her sister left behind. The grandparents are unable to offer help, because they died too. So many of these deaths hurt children, and while all are tragic, some are tinged with painful irony, like the Georgia nurse and anti-vaxxer who died in August leaving five kids.

Seth Flaxman, co-lead author of a recent paper about children orphaned by the plague, says, “Out of control COVID-19 epidemics abruptly and permanently alter the lives of the children who are left behind.” Journalist Katie Camero elaborates on the theme:

Based on what researchers have learned from the Ebola and HIV epidemics, orphaned children face high risks of short- and long-term negative effects on their health, safety and well-being after losing caregivers. Consequences include poverty, mental health problems, sexual violence, teenage pregnancy and higher risks of suicide, heart disease, diabetes, cancer or stroke.

Each and every one of those physical and psychological problems can lead to obesity.

(To be continued…)

Your responses and feedback are welcome!

Source: “Parents of 5 Children Including Newborn Die 2 Weeks Apart From COVID,” Newsweek.com., 09/12/21
Source: “US is No. 4 in the world with most orphaned children by COVID deaths, study finds,” MiamiHerald.com, 07/21/21
Image by Marco Verch/CC BY 2.0

Coronavirus Chronicles — COVID-19 and Pregnant People

In June, the Equal Employment Opportunity Commission issued guidance to American employers confirming that they can require both existing workers and new hires to be vaccinated against COVID-19. At the same time, employers must comply with provisions of the Americans with Disabilities Act, and of Title VII of the Civil Rights Act of 1964. But, says journalist Elizabeth Nolan Brown,

In some circumstances, Title VII and the ADA require an employer to provide reasonable accommodations for employees who, because of a disability or a sincerely held religious belief, practice, or observance, do not get vaccinated for COVID-19 [… ] ncluding pregnancy-related conditions that constitute a disability.

What do medical authorities say? In August, Israel approved booster shots for people over 40 and pregnant women over 18. In the United States, the Centers for Disease Control, having found that there is no increased risk of miscarriage, recommended vaccination for pregnant women, and for women trying to conceive, and also for breastfeeding mothers.

Journalist Katie Kerwin McCrimmon interviewed family medicine practitioner Dr. Molly Hoss, who has delivered hundreds of babies, and learned that concern is natural because pregnant women are more likely to have a severe case of COVID-19, and the disease also makes preterm birth more likely. Dr. Hoss firmly believes in vaccination for all. Vaccination is not only safe for mother and child, but antibodies are passed along through breastfeeding.

Backing up a step

The specter of infertility has spooked a lot of people, but the American College of Obstetricians and Gynecologists says that such fears are not supported by scientific evidence. The Centers for Disease Control and Prevention position is,

There is currently no evidence that any vaccines, including COVID-19 vaccines, cause female or male fertility problems or problems getting pregnant.

Their experts have confirmed that in men, being vaccinated does not influence sperm counts, and scientists have “tested ovarian reserves and function before and after the vaccine and they also showed no difference.”

In September, another study, published by the American Journal of Obstetrics & Gynecology, confirmed that “Pregnant women who get mRNA vaccines pass high levels of antibodies to their babies.” Further studies are underway to determine how long into a baby’s life this advantage lasts.

Sadly, according to the CDC’s September numbers, among pregnant women ages 18 to 49, only 30% have been vaccinated. Study co-author Dr. Ashley Roman told reporter Anushree Dave, “Right now we’re recommending all pregnant women receive the vaccine for maternal benefit.”

Professor Linda Eckert, who teaches obstetrics and gynecology at the University of Washington, says research is finding “very encouraging levels of antibody in cord blood,” referring to the umbilical cord through which a fetus receives nourishment. She says,

This is another reason pregnant women should get vaccinated, as we are seeing more disease in younger infants and this is a proactive choice pregnant individuals can make to protect their infants.

Your responses and feedback are welcome!

Source: “Employers Can Require Workers To Get COVID-19 Vaccine, Says EEOC,” Reason.com, 06/03/21
Source: “In world first, Health Ministry approves COVID boosters to all Israelis over 40,” TimesOfIsrael.com, 08/20/21
Source: “Infertility and COVID-19 vaccines: Get the facts,” UCHealth.org, 08/10/21
Source: “Vaccinated Pregnant Women Pass Protection to Babies in Study,” Bloomberg.com, 09/22/21
Image by Julita B.C./CC BY-SA 2.0

Coronavirus Chronicles — More About Mothers, Babies, and COVID-19

The conditions of pregnancy, which dictate how a child is formed and given a start in life, are also connected with obesity in major ways. As if that were not enough of a problem for medical science to deal with, now we have the coronavirus in the mix, complicating things even more. Prospective mothers are horrified by the idea that they might contract the virus and transmit it to their children

By February of this year, it was known that while maternal COVID accounted for a small increase in ICU admissions and in preterm labor, there was more good news than bad. OB-GYN specialist Dr. Jeff Livingston wrote,

Two new independent studies reveal highly encouraging results showing pregnant people with Covid-19 pass protective antibodies to their babies. This finding indicates that pregnant people with Covid-19 are passing protective antibodies through the placenta to their babies.

Interestingly, the severity of maternal illness seems irrelevant, and even mothers who are asymptomatic will pass antibodies to the developing fetuses. Generally, the earlier in pregnancy the infection happened, the more antibodies would be transferred. In that particular study, no babies were born with active SARS-CoV-2. However, it was not clear whether they would henceforth be immune.

Here and there

In the U.S., the Delta variant is creating havoc. In Brazil, the Gamma (P.1) variant is causing health authorities to advise women not to embark on pregnancy just yet (presuming they have a choice), which may be good advice almost anywhere.

In May, The New York Times quoted Dr. Fátima Marinho, who estimated that among children younger than five, more than 2,200 had died since the pandemic began. Of these, more than 1,600 were under a year old. Another expert, Dr. Ribas Freitas said,

We can already affirm that the P.1 variant is much more severe in pregnant women. And, oftentimes, if the pregnant woman has the virus, the baby might not survive or they might both die.

For both to expire is an extreme case, yet it happens. A study of 2,100 pregnant women in 18 countries around the world showed that…

[…] those who contracted COVID-19 during pregnancy were 20 times more likely to die than those who did not contract the virus.
Aside from an increased risk of death, women and their newborns were also more likely to experience preterm birth, pre-eclampsia, and admission to the intensive care unit or intubation. Of mothers who tested positive for the disease, 11·5% of their babies also tested positive.

In August of this year, it was reported that Mississippi had counted 72 fetal deaths in unvaccinated pregnant women, which also translated to a doubling of the usual number of stillbirths. In Alabama, an unvaccinated nurse died along with the fetus in her womb.

The American Journal of Obstetrics & Gynecology reported that in Washington state, pregnant women caught the virus at a 70% higher rate than their age-mates, with non-white women accounting for a disproportionate segment of that population.

Your responses and feedback are welcome!

Source: “Moms Pass Protective Antibodies to Baby After Coronavirus Infection,” Medium.com, 02/04/21
Source: “Covid: C.D.C. Director Says Choice Is to ‘Get Vaccinated or Continue to Wear Your Mask’,” NYTimes.com, 05/16/21
Source: “Pregnancy and COVID-19,” June 2021
Source: “In world first, Health Ministry approves COVID boosters to all Israelis over 40,” TimesOfIsrael.com, 08/20/21
Source: “Pregnancy tied to estimated 70% higher COVID-19 rate,” UMN.edu, 02/17/21
Image by oddharmonic/CC BY-SA 2.0

Coronavirus Chronicles — The Hazards of Reproduction

One of the many ways in which the pandemic affects children is by preventing them from having a chance to be born. There is great potential for harm in being pregnant and ill with coronavirus at the same time. One reason why this matters is because maternal fever can affect the fetus. COVID-19 also increases the likelihood that even babies who are successfully delivered might lose their mothers within their first days or weeks of life.

Not only the virus itself, but the mere threat of it is dangerous when patients are constrained from making in-person office visits. A large proportion of expectant mothers have been having their checkups via telemedicine, which is unsatisfactory in itself and increases the chance that asymptomatic women will not be diagnosed with the virus.

A Scientific American article mentioned some typical cases, like where a pregnant woman ill with the virus had to have a C-section to deliver her baby two months early. More than a month later this mother was still in the intensive care unit and had not yet held her child, and the doctors were thinking she would need a double lung transplant in order to continue living.

A quickly worsening situation

Since the Delta variant arrived on the scene, the danger to pregnant women and their babies has seen a horrifying increase. Lately, new cases in the United States involving pregnant women have increased to 1,000 per week. Of 22,000 pregnant women who have been hospitalized, 161 have died. Carolyn Barber wrote,

Simply put, pregnant people have been avoiding the vaccine, and the toll may be enormous… The road to this point is filled with misinformation but also with fears and concerns about the COVID vaccines’ impact on fertility and pregnancy, which many physicians find understandable, if mostly unsupported.

At the University of Birmingham’s hospital, researchers documented the cases of 39 unvaccinated pregnant women, where nine babies did not survive, and two of the women died. A Centers for Disease Control study of 400,000 pregnant women with symptomatic COVID-19 indicated that their risk of severe illness and/or death was higher than that of non-pregnant people. It gets worse:

Likewise, a study of about 870,000 women found that, compared with those who did not give birth with COVID-19, those who did so had a nearly one-and-a-half-fold increase in preterm births, a sixfold increase in ICU admissions, a 14-fold increase in mechanical ventilation and a 15-fold increase in death.

The news is not all bad. A study was done of 1,200 women who received positive COVID-19 test results before vaccines were available, and around three-quarters of them escaped with either a mild case or no symptoms at all. And after mRNA vaccines became available, it was discovered that high levels of protective antibodies are passed on to fetuses.

Jeanne Sheffield, M.D., an expert in maternal-fetal medicine at Johns Hopkins, also wrote about the possibilities, which are not uniformly grim. She tells parents,

We can provide treatment for COVID-19 in pregnancy. Several of the medications currently in use are also being used for our pregnant women, and early studies have shown they can provide some benefit.

Your responses and feedback are welcome!

Source: “Pregnant and Unvaccinated: Delta’s Deadly Toll,” ScientificAmerican.com, 10/01/21
Source: “Coronavirus and Pregnancy: What You Should Know,” HopkinsMedicine.org, undated
Image by Omer Ziv/CC BY-ND 2.0

Coronavirus Chronicles — Another Set of Specialized Victims

In terms of reproductive news, February of 2021 was a bad month. The Center for Infectious Disease Research and Policy published an article titled “Pregnancy tied to estimated 70% higher COVID-19 rate.” What does that mean exactly? Journalist Mary Van Beusekom reported that…

[…] population-based estimates of coronavirus infections in pregnancy are unreliable due to incomplete recording of pregnancy status or inclusion of only hospitalized patients.

Still, it appeared that in the state of Washington, pregnant women “were infected with COVID-19 at a 70% higher rate than others of similar ages,” and it was becoming more obvious that pregnancy combined with coronavirus is a recipe for severe illness and maternal mortality.

Another significant factor is that most of these expectant mothers were non-white. Since this group includes many women classified demographically as Hispanic, American Indian/Alaska Native, and Native Hawaiian/Pacific Islander, a great many of them prefer to receive care in non-English languages. It is easy to empathize with the importance of that, in medical settings where stress is high and people are masked.

In spite of the difficulties with acquiring and collating data from many different sources, a University of Washington research team assembled numbers that pleased no one and spurred discussion of the importance of prioritizing vaccination in pregnant patients. Kristina Adams Waldorf, M.D., one of the study’s co-authors, told the press that pregnant women were being ignored when it came to the plans for vaccine prioritization. She said,

Many states are not even linking their COVID-19 vaccine allocation plans with the high-risk medical conditions listed by the [Centers for Disease Control and Prevention] — which include pregnancy.

Why are pregnant women so likely to catch the virus? Nobody quite understood, but some contributing factors are “exposures from children in daycare, their role as a caregiver within an extended family, residence in larger households.” Also, lead author Erica Lokken, Ph.D., had a suspicion:

Higher infection rates in pregnant patients may be due to the overrepresentation of women in many professions and industries considered essential during the COVID-19 pandemic — including healthcare, education, service sectors…

Another journalist, Kellee Azar, also wrote about this trend of pregnant women with higher infection rates than others in their age group. Part of the problem is that they are likely to have additional medical issues like high blood pressure, diabetes, and, of course, weight gain — that do not mix well with COVID-19.

Obstetrics and gynecology professor Dr. Kristina Adams Waldorf said that one out of 10 pregnant women suffering from the virus were being hospitalized. Aside from the possibility of maternal mortality, pre-term birth is another potential result.

This is bad news for already existing children, too, because many of them have mothers who are likely to become pregnant again, and when those mothers and new babies are ensnared in illness and hospitalization, it poses tremendous problems for whole families in terms of child care, finances, and even the prospect of children being orphaned.

All of this creates another set of knock-on or sequential problems stemming from the COVID infection. Children in families disrupted in these ways are likely to experience many of the conditions and difficulties that are known to exacerbate childhood obesity, thus supplying another group of prospective victims for the virus that has already demonstrated its affinity for body fat.

Your responses and feedback are welcome!

Source: “Pregnancy tied to estimated 70% higher COVID-19 rate,” UMN.edu, 02/17/21
Source: “Pregnant women should be considered high risk for COVID-19, study finds,” KATU.com, 02/19/21
Image by Andrew Seaman/CC BY-ND 2.0