Speaking of antibody testing, the MD I talked to says the doctors are very reluctant to send people for Covid Ab testing because to some it might give a sense of false security if the rest comes back positive. Doctors here have to provide extensive counseling regarding what a positive result might mean before they order one.
So many false negatives and depends on what test is used. It almost makes no sense to get them.
So for the sad pregnancy losses, is the theory that blood clots are involved?
Serious doubts are being raised about the recent Lancet study against HCQ, something about the data collection, an organization called Surgisphere.
Interestingly, these are the same authors who put together the report that showed good results for ivermectin, likewise not a profitable drug, although that report (linked upthread) never actually got published. Things that make you go hmm.
And so we wait for actual trial data. There are 16 clinical trials now for ivermectin at clinicaltrials.gov (two in the US), plus a few more in Europe. Waiting for data = watching paint dry. If I recall, a couple of the studies have end points in June/July.
A little bit of data out of India: â104 patients were given medicine in Kanpur Medical College. Test of 94 came negative in 4 days of giving medicine. Kanpur Medical is writing a research paper on this medicine.â https://news.digitalseolife.com/deworming-medicine-ivermectin-effective-in-coronavirus-treatment-%e0%a4%a1%e0%a5%80-%e0%a4%b5%e0%a4%b0%e0%a5%8d%e0%a4%ae%e0%a4%bf%e0%a4%82%e0%a4%97-%e0%a4%95%e0%a5%80-%e0%a4%a6%e0%a4%b5%e0%a4%be/ (though Iâm having a little trouble getting google translate to work here)
Ivermectin is among treatments being tested in North Dakota though itâs not clear whether this is merely part of an existing trial or their own thing. https://www.jamestownsun.com/newsmd/coronavirus/6506357-Sanford-Essentia-join-quest-for-better-treatments-for-COVID-19.
Ivermectin might be another ionophore? âIvermectin, antiviral properties and COVID-19: a possible new mechanism of actionâ https://link.springer.com/article/10.1007/s00210-020-01902-5
On HCQ, some focus on the difference between outpatient and inpatient treatment: âEarly Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisisâ (out of Yale, American Journal of Epidemiology)
https://academic.oup.com/aje/advance-article/doi/10.1093/aje/kwaa093/5847586
Re: Pregnancy outcomes. There was one miscarriage in a positive woman with no symptoms. The rest of the newborns were born healthy. The placenta is âoverbuiltâ to handle damage to parts of it.
On the pregnancy angle, perhaps this points toward prophylactic anticoagulants for at least some COVID-infected pregnant patients. (Anticoagulants are commonly prescribed in pregnancy, though that may involve perinatologist visits; had my own share of heparin and lovenox in pregnancy back in the day.)
For those who want to get into the T-cell weeds again: âDifferent pattern of pre-existing SARS-COV-2 specific T cell immunity in SARS-recovered and uninfected individualsâ https://www.biorxiv.org/content/10.1101/2020.05.26.115832v1
Iâm much more concerned about the false positives. Does anyone know the statistics on those?
Thatâs not what @WayOutWestMom said. She said European medical journals were reporting cases of fetal deaths from covid. A fetal death is after 4 months gestation.
She further said that her own daughter had seen a sad case of a fetal death at 34 weeks of gestation. The mother had had symptoms and tested positive.
There was a case in JAMA: a woman in her 19th week of gestation miscarried. She was symptomatic for covid and tested positive.
It looks like there is a risk that a pregnant woman who gets covid will get a placental infection and lose the baby. We donât as of now know what that risk is. Itâs not zero.
https://www.sciencedaily.com/releases/2020/05/200522113714.htm
The report of the study out of Northwestern is the one to which I was referring.
Thanks for the link, @TatinG. The reports are early but alarming. They studied the placentas of sixteen pregnant women who tested positive for covid and who either gave birth or miscarried.
One of the women miscarried in the second trimester. The other fifteen delivered apparently healthy babies. The study compared the placentas of those women with control placentas from 2018. Thereâs a condition called maternal vascular malperfusion (MVM); it causes altered blood flow in the motherâs side of the placenta. Two of the 15 covid women had a formal diagnosis of MVM; 1 of the 215 controls did. Eleven of the 15 covid women (73%) had features of MVM; 27% of the controls did.
We know that covid causes blot clots and vascular problems. Now we discover that a high percentage of pregnant women who have covid get vascular problems in the placenta. This is worrisome.
Thatâs one theory, but itâs far from certain. There are just too many unknowns at this time. Placentas of infected women also appeared to have multiple abnormally formed blood vessels that restrict the blood flow between the mother and the fetus. (A hallmark of eclampsia, but occurring without any other symptoms of eclampsia like maternal hypertension.) Some placentas were necrotic.
A pre-print of a systematic review study of Covid-19 pregnancy outcomes in China, US, South Korea, and Honduras, showed that women infected with Covid-19 (total 441) had 21% rate of pre-term births (vs 10% for non-infected mothers). Additionally 3% of full term births resulted in infant who were abnormally small for gestation age (a sign of inadequate blood flow to the fetus).
There were similar results from a study done in Wuhan China in 2019â99 pregnant women-- 21 had a pre-term birth (any birth before 36 weeks), including 6 who delivered before 32 weeks. Of the 8 who were in their second trimester, one had a spontaneous miscarriage.
Lots of issues and lots of unknowns.
The New England Journal of Medicine just ran an opinion piece on speeding up drug discovery of new/repurposed drugs to treat the coronavirus. Iâm not impressed with their arguments, but I did like Derek Lowesâs commentary about the shortcomings of computer modeling and virtual screening.
I donât know if we can link to his blog, but google âIn the Pipeline.â
Every time we think we know all the bad things covid does, we find another one. I wasnât too worried about Kawasaki because itâs bad but rare. But these pregnancy problems appear to be bad and common. If covid means the fetus is getting less blood flow than it should, thatâs bad for every fetus of an infected mother, not just the ones where the injury is bad enough that the fetus is small for gestational age.
What are we going to see from the babies born to covid+ mothers in June, July and August?
The different symptoms that manifest in people with this virus is definitely very concerning. I donât think we know yet all the things this virus effects.
There are 3 young women in my family who are all about 4 months pregnant (they do always seem to come in bunches.) It is very worrisome.
It is worrisome. My older D is 4 month pregnant with a high risk pregnancy. Sheâs also a EM doctor in hard hit area (New England). She is very concernedâeven more so about the potential impact on neonates.
At her hospital, there has been a steady stream of newborns with coronavirus pneumonia. At one time there were as many as 8 in the NICU with CV-19 pneumonia.
CV seems to be particularly serious for infants under 3 months of age because they donât have a fully developed immune system and cannot successfully fight off the disease.
One consideration re: the impact of covid-19 on pregnant womenâpregnancy itself has all sort of systematic health impacts on a womanâincluding depressing their innate immune response and increasing cardiac and renal risk factorsâeven in an otherwise healthy mother during a normal pregnancy.
Yikes, I have a relative who is pregnant in Bay Area. Sheâs a podiatrist, married to pathologist. Hope they stay healthy!
The SF Bay Area has a low rate of covid. Hopefully your pregnant relative will not be infected.
Not a lot of news stories on this yet, but significant allegations have been raised about the big Lancet retrospective study on HCQ that caused WHO to pull some trials. A lot of internet chatter.
https://www.bloomberg.com/news/articles/2020-05-29/scientists-question-study-linking-malaria-drugs-to-covid-risks
I get the sense that thereâs a back story that weâll never fully know. E.g., why did the same authors of the Lancet piece write up their ivermectin retrospective last month but then not publish it - was it not accepted (and if so, why not) or not submitted.
(and a bit of contrast with the article from the American Journal of Epidemiology)