Supervisor Elham AbolFateh
Editor in Chief Mohamed Wadie

The New Coronavirus … By Dr Magdy Badran

Mon 17 Feb 2020 | 12:40 PM
Ahmad El-Assasy

Since December, 2019, the outbreak of the 2019 novel coronavirus disease (COVID-19) infection has become a major epidemic threat in China. There are currently 71,336 confirmed cases from the coronavirus COVID-19 outbreak as of February 17, 2020.

New Coronavirus in Pregnant Women

It is too early yet to explicitly determine the effects of the COVID-19 on pregnant women and their fetuses. Members of the coronavirus family, which have been responsible for previous outbreaks of severe acute respiratory syndrome (SARS-CoV) and the Middle East respiratory syndrome (MERS-CoV), have demonstrated their ability to cause severe complications during pregnancy.

In general, the transmission of viruses can occur through two pathways: horizontal and vertical transmission. In horizontal transmission, viruses are transmitted among inpiduals of the same generation, while vertical transmission refers to generational transmission of viruses from parents to their offspring. HIV-1, e.g., can be acquired inside the uterus, during delivery, or via breastfeeding.

The important infections acquired through the placenta are toxoplasmosis caused by Toxoplasma gondii, congenital rubella syndrome caused by German measles, cytomegalic inclusion disease caused by Cytomegalovirus, hepatitis caused by Hepatitis B virus, AIDS caused by HIV virus and congenital syphilis caused by Treponema pallidum. They cause intrauterine growth retardation and several congenital anomalies.

The risk of vertical transmission of COVID-19 might be as low as that of SARS. No reliable evidence is as yet available to support the possibility of vertical transmission of COVID-19 infection from the mother to the baby. Previous studies have shown that SARS during pregnancy is associated with a high incidence of adverse maternal and neonatal complications, such as spontaneous miscarriage, preterm delivery, intrauterine growth restriction, application of endotracheal intubation, admission to the intensive care unit, renal failure, and disseminated intravascular coagulopathy.

Pregnant women are susceptible to respiratory pathogens and to the development of severe pneumonia, which possibly makes them more susceptible to COVID-19 infection than the general population, especially if they have chronic diseases or maternal complications.

Pregnant women and newborn babies should be considered key at-risk populations in strategies focusing on the prevention and management of COVID-19 infection. Neonates of pregnant women with suspected or confirmed COVID-19 infection should be isolated in a designated unit for at least 14 days after birth and should not be breastfed, to avoid close contact with the mother while she has suspected or confirmed COVID-19 infection.

We’re still in the deep learning curve about this virus. There’s more we don’t know than we do know about the new coronavirus.

If a baby does get infected with coronavirus a few days after birth we currently cannot tell if the baby was infected in the womb or during birth. Coronaviruses (which include MERS and SARS) are more likely to increase the risk of a miscarriage than being passed on in the womb.

A Chinese newborn has been diagnosed with the new coronavirus just 30 hours after birth, the youngest case recorded so far. The baby was born on 2 February in Wuhan, the epicenter of the virus. The baby's mother tested positive before she gave birth. It is unclear how the disease was transmitted - in the womb, or after birth. Only a handful of children have come down with the virus. The baby, who weighed 3.25kg at birth, was in a stable condition and under observation. It's quite possible that the baby picked it up very conventionally - by inhaling virus droplets that came from the mother coughing.

Youth Protects Against COVID-19

So far, it seems that youth protects against the worst effects of COVID-19. The outbreak of a new coronavirus in China has killed more than 1,676 people, but one group has escaped with minimal damage: children.

Few children are among those sick enough to be diagnosed with the coronavirus.

The median age of patients skews older, between 49 and 56 years old. It's not entirely clear why children seem to be escaping the worst effects of the virus. But a similar pattern holds for SARS and MERS.

It may be because of differences in the immune responses of children compared to adults. The innate immune response, that is the early response that is aimed broadly at groups of pathogens, tends to be more active in children.

The innate immune system is the first line of defense against pathogens. If the innate immune response is stronger in children exposed to COVID-19 they may fight off infection more readily than adults, suffering only mild symptoms. Other coronaviruses, including SARS and MERS, also show this pattern.

Children are actually having viral pneumonia. But because their immune systems are so robust, it doesn't lay them out the way it would as an adult. Seasonal flu death rates in adults are 10 times that of death rates in children. Similarly, adults are 25 times more likely to die from chickenpox than children are. And though influenza can be devastating for infants, older children usually make it through with more ease than adults.

It seems most likely that children are catching the infection but recovering more easily than their parents and grandparents. Kids might have healthier respiratory tracts because they've been exposed to less cigarette smoke and air pollution than adults. Another factor seems to be that kids are healthier in general, with fewer chronic health conditions.

In both the SARS outbreak of 2003 and the MERS outbreak of 2012, adults with chronic health conditions were at a higher risk of death than adults without co-occurring conditions. These conditions could include anything from diabetes to autoimmune disorders to cardiovascular disease, or even simple obesity.

Acute Respiratory Distress Syndrome

Adults are also more susceptible to a detrimental immune response that causes a condition called acute respiratory distress syndrome (ARDS). A complicated imbalance of immune cell activity sends inflammation in the lungs into overdrive, ultimately causing fluid to fill the alveoli. The red blood cells flow into these alveoli to pick up new oxygen. When they sacs flood, they stop working. The person can no longer breathe. About 40% of people with ARDS die. The death rate is higher in the elderly and in patients who have chronic diseases.

ARDS was frequently fatal in adults with the SARS coronavirus. Whereas even though children with SARS had pneumonia, they didn't get the immunologic complications that adults have.

Infants Diagnosed with COVID-19 Infection

A  recent retrospective study identified all hospitalized infants diagnosed with COVID-19 infection between December 8, 2019, and February 6, 2020, in China. The age of the infants ranged between 28 days to 1 year . Nine infected infants were identified between December 8, 2019, and February 6, 2020. All patients were hospitalized. Seven patients were female. The youngest was aged 1 month and the oldest was 11 months.

Four patients were reported to have a fever, 2 had mild upper respiratory tract symptoms, 1 had no symptoms but tested positive for COVID-19 in a designated screening because of exposure to infected family members, and 2 had no information on symptoms available. The time between admission and diagnosis was 1 to 3 days.

Families of all 9 infants had at least 1 infected family member, with the infant’s infection occurring after the family members’ infection. Seven infants were reported to be either living in Wuhan or having family members who visited Wuhan, 1 had no direct linkage to Wuhan, and 1 had no information available. None of the 9 infants required intensive care or mechanical ventilation or had any severe complications.

Given the number of infections reported, the number of infected infants identified was small. This may be due to a lower risk of exposure or incomplete identification due to mild or asymptomatic disease, rather than resistance to infection. However, this study showed that infants can be infected by COVID-19; the earlier stage of the COVID-19 epidemic primarily involved adults older than 15 years. Family clustering occurred for all infected infants. Infants who have infected family members should be monitored or evaluated and family clustering should be reported to ensure a timely diagnosis.

Seven of the 9 infant patients were female. Previous studies found higher percentages of infection in men than women.

Because infants younger than 1 year cannot wear masks, they require specific protective measures. Adult caretakers should wear masks, wash hands before close contact with infants, and sterilize the infants’ toys and tableware regularly.