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DOCTOR'S NOTE
Features|Doctor's Note
Will catching COVID in pregnancy affect your baby’s development?
COVID infection can increase the risk of preterm labour and the associated long-term complications for babies. Plus, how severe COVID affects life expectancy, and a pill to ease the effects of long COVID.
[Jawahir Al-Naimi/Al Jazeera]
By Dr Amir Khan
6 Dec 2021
The more we learn about COVID-19, the more we understand that it is a multisystem disorder, meaning it is not simply an infection of the respiratory system – its effects are far wider than that.
Much has been said about the importance of getting pregnant women vaccinated; we have seen unvaccinated pregnant women in ICUs as well as higher numbers suffering from stillbirths and premature deliveries as a result of catching the virus. But what of the babies who are lucky enough to survive their mothers catching COVID; how does it affect them?
The SARS-CoV-2 virus enters the body through the nasal passage and infects lung cells by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. From there it can move to infect other parts of the body where ACE2 receptors are also found, including on the placenta, the organ that connects a pregnant mother with her unborn baby.
The placenta’s job is, among other things, to protect the unborn child from infections that the mother may get, although there are some infections – like cytomegalovirus (CMV), Zika virus and the herpes simplex virus – that have managed to get past this barrier and infect babies, with devastating outcomes.
It remains unclear if SARS-CoV-2 can break through the placental barrier, and we are unsure whether newborn babies who test positive for COVID soon after birth caught it from their mother before or during delivery. But there is good evidence of mothers being able to pass on antibodies against COVID to their unborn babies during pregnancy.
Furthermore, vaccination of pregnant women has been shown to result in maternal IgG production five days after the first jab. IgG, an important antibody that helps fight COVID, was found to transfer across the placenta and help protect the baby 16 days after the first dose of the vaccine.
In mothers hospitalised with COVID, preterm birth – a baby born before 37 weeks of pregnancy – is the most common adverse pregnancy outcome. For mothers infected at some point in their pregnancy, the risk of giving birth at less than 37 weeks was 40 percent higher, while the risk of very preterm birth – which occurs at less than 32 weeks of gestation – was 60 percent higher. For those who also had hypertension, diabetes and/or obesity, the risk of preterm birth rose 160 percent.
Any illness that causes stress to a pregnant woman’s lungs, immune system or circulatory system can affect blood and oxygen flow to the womb where the baby is developing, increasing the risk of preterm delivery. COVID not only causes respiratory and cardiovascular stress but also induces a strong immune response which can cause widespread inflammation. It is this combination that can increase the risk of a pregnant woman infected with COVID going into preterm labour.
Being born prematurely carries significant risk to babies, potentially leading to long-term intellectual and developmental disabilities.
A number of studies have found that being born prematurely is a major risk factor for cerebral palsy. The risk is especially high for babies born earlier than 32 weeks. Cerebral palsy is the name for a group of lifelong conditions that affect movement and coordination; it is caused by a problem with the brain that develops before, during or soon after birth.
Several studies have found that preterm infants are at higher risk of autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), anxiety, depression, and motor and sensory abnormalities, including problems related to vestibular balance, pain processing and deafness. These are all things that have long-lasting effects well into adulthood.
Although it remains unclear as to whether a mother can pass on COVID to her unborn child, it is becoming increasingly clear that COVID increases the risk of preterm delivery and the long-term complications that come with this. We have strong and clear data showing that pregnant women can safely be vaccinated against the virus and that the antibodies generated by vaccines may offer some protection to newborn babies. The safest and most effective way to protect yourself and your baby from the effects of COVID-19 is to get vaccinated.
Progress report: Can severe COVID increase your risk of dying in the next year?
A study from the United States has found that people who suffered from severe COVID-19 and required hospital admission were more than twice as likely to die in the 12 months after recovering than those who had no infection or even mild disease.
We are yet to fully understand the long-term sequelae of COVID-19, with symptoms of long COVID, in particular, being widespread and far reaching. But the study that followed 13,638 patients (178 of whom had experienced severe COVID symptoms, 246 of whom had mild or moderate COVID symptoms and the remainder of whom had tested negative) found that the risk of death from all causes was significantly higher in patients who had severe COVID.
None of those who contracted COVID died from the acute phase of the disease; they made full recoveries, and were then followed up on to see if there were any adverse outcomes from having had the illness at all.
[Jawahir Al-Naimi/Al Jazeera]
Those under 65 years old who had had severe COVID were most at risk. We would expect to see an increased risk of death in those who had severe COVID and were hospitalised from coronavirus-related illnesses such as pneumonia or respiratory failure, but this was only true for 20 percent of this group. The vast majority of deaths (79.5 percent) were for causes other than respiratory or cardiovascular conditions. Many of these deaths occurred months after the initial COVID infection and were not easily linked to the coronavirus by the clinicians caring for the patients.
This study is supported by others that came before it, with one claiming that COVID infection carries an increased six-month mortality risk, and another showing that people who had severe COVID and were hospitalised were far more likely to end up in hospital in the following months compared with those who had mild or no illness.
But this is the first study to look specifically at deaths (with a follow up of 12 months) of those who had differing degrees of COVID compared with those who remained negative. This study provides evidence that the increased risk of death from COVID is not limited to the initial episode of infection and illness, but a severe episode of COVID carries with it a substantially increased risk of death in the coming year. In fact, the risk of 12-month mortality among adults under 65 who are hospitalised with COVID-19 is increased by 233 percent over those who are COVID negative.
This study and those that came before it add to the theory that COVID is a complex infection that affects multiple organs with long-lasting effects, especially in those who suffer severe illness in the acute phase. The disease is likely to leave those who recover from it physically vulnerable and susceptible to future illnesses, though the mechanism for this remains unclear. But evidence is building that an increased risk of death in the future after recovery is a possible complication of COVID, and this is even more reason to remain vigilant against it. Wear a mask indoors, ventilate schools and workplaces, and get vaccinated.
Good news: Trials start for new drug to manage symptoms of long COVID
The post-COVID syndrome, long COVID, is thought to affect millions of people worldwide. It is defined as “signs and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis”. The definition says the condition usually presents with clusters of symptoms, often overlapping, which may change over time and can affect any system within the body.
Two of the most common symptoms reported are fatigue and muscle pain. These symptoms are thought to be brought on by a dysfunction in mitochondria found within human cells; these are the energy or powerhouses of each cell. Mitochondria play an important role in turning the energy from the food we eat to chemical energy that cells need to do their jobs. It is thought that the SARS-CoV-2 virus interferes with mitochondria and their ability to make this energy, leading to fatigue.
Now the University of Oxford is leading a new phase 2a clinical trial to investigate whether a drug could treat the fatigue and muscle weakness experienced by patients who have recovered from COVID. The drug, AXA1125, is developed by the US-based biotechnology company Axcella Therapeutics. In two previous clinical studies and in preclinical models, it demonstrated the ability to reverse mitochondrial dysfunction and improve energetic efficiency.
The Oxford study will include 40 volunteers and half will be given AXA1125 and half a placebo. The research team will be using magnetic resonance spectroscopy to assess any improvements in mitochondrial function within the skeletal muscle in long COVID patients. If the trials are successful it may then pave the way for similar studies looking at those suffering from other post-viral symptoms like chronic fatigue syndrome and myalgic encephalomyelitis (ME).
Personal account: COVID misinformation and my family
Misinformation about the COVID vaccines is rife. It is part of the reason why many choose not to get vaccinated and it is also part of the reason the pandemic will carry on longer than it needs to. I, rather naively, assumed my family – having three doctors in it – would not fall victim to the deliberate tactics of those spreading misinformation about the vaccines; but last week I was proved wrong.
It was our weekly Saturday night family meal at my mum’s house. She cooks up a big feast, we all descend on our old family home to eat and spend time together, while the kids play around and the adults have rather boring conversations trying to put the world to rights.
Surprisingly, we have managed to avoid talking about the COVID vaccines (outside of declaring that we have had them and noting any mild side effects we had), but this week my brother-in-law was keen to discuss the need for boosters. Now to be clear, I get on very well with my brother-in-law, he is the first person I call when I need something, but on the subject of boosters we disagreed.
The conversation started in a fairly benign way.
“Have you had your booster yet?” my sister asked the room. Everyone nodded, they had either had it or were waiting to have it. Then a brief silence.
“I am not going to have mine,” my brother-in-law said, matter of factly. More silence followed.
“What do you mean you are not going to have it?” I asked.
“Well, my friend told me that they now want us to have boosters every year, and I just don’t think we need them,” he said.
“And does your friend have any medical qualifications?” my other sister, who is a doctor, chimed in.
“No, but he has done his research,” my brother-in-law said.
Ah, the research of the medically unqualified, I thought to myself. Since the pandemic began, it seems as though everyone has suddenly attained a medical degree and has expert opinions on the vaccine or the virus. Despite having years of training on how to critically analyse research papers at medical school and interpret large studies, my medical opinion carries the same weight as Susan down the road who has had a read of Facebook.
“But you’ve had your first two jabs, right?” I asked.
“Yes, I have but I wish I hadn’t, to be honest.”
“What do you mean?” I asked, horrified.
“Well, I felt I had to get them for travel or going into venues, but until they say I can’t do those things without a booster then I am holding off.” He took a sip from his teacup and went back to watching the television as if what he had said did not warrant further discussion.
“What about the boosters worries you?” my sister asked again. She was far more diplomatic than me.
“You know, it’s hard to know what to believe. On one hand, you have all the doctors saying you need them to protect you and then on YouTube you see people turning magnetic after having had them.”
“Turning magnetic?” I nearly spat out my tea, surely this was a joke.
“Yes, after they had the vaccine, they put a piece of metal on their arm and it stuck to them like something magnetic had been injected into them, you can see for yourself just put in a search.” He tried to offer me his phone which was already playing one of the videos.
“No thanks, I am pretty sure that’s fake,” I retorted.
“See, you’re not prepared to listen to the other side,” he said, putting his phone back into his pocket.
This is when I decided to end the conversation. In a way he was right, I was not prepared to listen to the other side; I had spent too long caring for those dying from COVID to watch a video of a man sticking a spoon to the side of his arm.
[Jawahir Al-Naimi/Al Jazeera]
Here was the problem: the debate about vaccines has become so polarised that there no longer appears to be a middle ground. I am, of course, willing to listen to sensible factual debate steeped in evidence. What I will not entertain are conversations about population control, 5G, magnets and the New World Order. I don’t have time, too many people have died and we have an effective vaccine that has already saved millions of lives worldwide.
If someone wants to talk to me about the side effects of the vaccines, then I am all ears. I know there are side effects. The common ones are mild and self-limiting, the serious ones are rare, and the benefits of taking the vaccines outweigh the risks of these very rare serious side effects.
We probably all have family members that hold differing views on the vaccines to ourselves. It doesn’t mean we like it, but it may allow some of us to open up a healthy debate and correct misinformation where we can. An “us versus them” mentality is unhelpful, the pandemic has shown us we are stronger when we come together and much weaker when we are apart.
Reader’s question: What is the difference between a variant and a strain?
As we move through this pandemic, previously unfamiliar words have entered everyday vernacular. “Variant” is certainly one of them. It is a word that is being thrown around more now with the Omicron variant dominating the news.
Some people have used the terms “variants” and “strains” interchangeably when talking about COVID-19, but is there a difference between the two?
The answer is yes.
To date, there has only ever been one strain of the SARS-CoV-2 virus that causes COVID-19. For a new strain to occur, enough mutations have to take place in the virus to make it look and behave differently.
We have of course seen mutations of the SARS-CoV-2 COVID-19 virus but not enough to make the virus behave differently; all the variants still infect people in the same way and cause a similar illness.
Generally speaking, variants occur when mutations within the virus happen. Usually, these have little or minimal effects on the virus. But if lots of mutations occur that cause the virus to behave differently then this would be a new strain.
SOURCE: AL JAZEERA
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