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COVID-19: What we know so far about treatment options and conception

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We are living in unprecedented times, at least all of us younger than a hundred years old. That being said, pandemic or no, the cycle of life continues.

Conception, pregnancy, labour, and delivery have neither paused nor stopped for a lot of people. What we do know is that there have to be modifications in how these come about. This article is an update on earlier ones written on the COVID-9 (SARS-CoV2) Pandemic.

In different parts of the world, lockdown measures are in effect to ensure people stay home and maintain physical distancing to stop the spread of the coronavirus SARS-CoV-2. Nigeria is not an exception, and indeed many parts of the country have instituted various degrees of the lockdown.

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Anecdotal increase in sexual activity, which could potentially lead to conception, will, therefore, come as no surprise, especially in a country like ours where according to the 2018 National Demographic Health Survey (NDHS) report, the total fertility rate is 5.3 children per woman and the contraceptive prevalence rate is 17 per cent.

In patients undergoing fertility, relevant global associations have proposed that providers and clients exercise caution. Explore individual exigent circumstances such as urgent sperm or oocyte freezing for cancer patients whose cancer treatment cannot be put on hold and come to an informed agreement with affected clients.

Infertility is a serious disease that requires treatment promptly. Over time, an increasing number of patients whose care has been delayed are now in a situation that has become more urgent. The majority of organizations from WHO, IFFS, ICMART, ASRM, and our Nigerian AFRH recommend meticulous protocols for patients and staff of a fertility clinic necessary to commence and reactivate the treatment of infertility using Assisted Laboratory Technologies. The primary recommendation by most of the organizations is that practices must ensure that they adequately prepare to provide patient care in a manner that limits the risk to patients, staff, and physicians, and other healthcare providers. It includes substantial self-education and staying up to date as new information emerges; on the risk of disease transmission by symptomatic and asymptomatic individuals.

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Additionally, practices must ensure that they are prepared to perform a formal risk assessment of practice activities and the physical plant by the practice leadership team using publicly available resources or with the assistance of experts. Practices should create or adapt existing written risk mitigation policies and procedures that include having an adequate supply of necessary resources and training for all staff. The protocols that include the use of a pre-visit questionnaire, the measurement of temperature for patients and staff, and the use of protective equipment.

In the light of on-going pregnancy, Guidance from the SOGON, RCOG, ACOG, and FIGO have stated that despite this being a novel disease, pregnant women are not at a higher risk of infection than the general public. Provided they comply with the same measures of physical, social distancing, regular hand washing, and practicing respiratory hygiene.

Concerning the conduct of antenatal check-up services, the necessity they say is the mother of invention. Health care providers now offer telemedicine in a much more robust format than in yesteryears. It enables them to reduce the number of people in direct contact while ensuring no pregnant woman and her baby are in jeopardy.

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Labour and delivery are being conducted with adherence to universal precautions in addition to the use of personal protective equipment, more than ever before.

A few cases of newborns being positive for Covid-19 born to women who also had the disease reported in the United Kingdom. All three babies survived and discharged after testing negative. On a comforting note, too, the virus has not been found in the amniotic fluid of pregnant women nor breast milk of lactating women as of today.

The search for a specific treatment or cure or vaccine is the hottest topic in the scientific community and not only as it affects conception and pregnancy.

So far, the options explored include: Chloroquine/hydroxychloroquine phosphate, a drug which is famous for its treatment of malaria. According to a study in China by Gao, Tian, and Yang, the drug showed apparent efficacy and acceptable safety against Covid-19 associated pneumonia. An on-going case-control study conducted in Turkey used hydroxychloroquine and Zinc as a precaution. To frontline workers and their close associates, may be able to provide us with further information into the role of hydroxychloroquine. They reported improvement in those infected with COVID-19. Several other experts from Germany, the United States of America, and South Korea are making Clinical trials on Chloroquine. I am happy that Nigeria would attempt similar clinical trials with Chloroquine. Hopefully, the trials would include Chloroquine, and Zinc reported to give better success with SAR-CoV2.

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Remdesivir, a drug initially created to treat Ebola, is also being explored for its efficacy.

Yes, the vitamins and minerals are not left out- Zinc (Antiviral and antibacterial supplement), Vitamin C, and Vitamin D.

According to researchers at the Northwestern University, Vitamin D strengthens the person’s innate immunity (just like Zinc does) and prevents overactive response from the system that protects the body against infections.

Further yet-to-be-proven claims are the efficacy of Artemisinin (Wormwood), another anti-malarial drug, which is being used extensively in Madagascar. Some doctors in Ghana have reported success with the use of a tea from another anti-malaria plant Neem tea (Dongo Yaro in Hausa), Azadirachta indica for COVID-19 patients. A few Nigerians in London with COVID-19 said they were successful with the use of a tea mixture of raw garlic, ginger, lemon, and tea made from the bark of the Enantia chlorantha plant (Awopa in Yoruba).

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A few others have used black seed (Nigella sativa). Also, among the naturally occurring substances in Nigeria is bitter Kola nut, which has antibacterial, anti-malaria functions in addition to the ability to improve immunity and lung function. Several people have reported improvement with eating one or two bitter kola nut daily. Some recent studies have shown that the post mortem evaluation of patients who dies from COVID-19 displayed the occurrence of progressive inflammatory factor storm and coagulation dysfunction in severe and fatal cases. They confirmed that the antiviral effect and anticoagulant action of Aspirin 100mg daily helped reduced the severity of the infection. The World Health Organisation (WHO) warned against the use of a high dose of 500mg Aspirin. However, the use of 75mg dispersible aspirin(baby Aspirin) is recommended for several medical conditions.

We remain hopeful that in the not distant future, we will have answers from these various studies to help us combat the Covid-19 disease. However, until a vaccine is available, and experts say it could be up to 18 months, the crisis of survival dictate prevention by staying at home, social distancing with the mask, frequent hand washing, building up immunity, and the use of currently tested medication under a doctor’s supervision.

In general, it can be concluded that for one’s body immune build-up, and defense, the use of Zinc capsules, Vitamin C, and D can be used daily without and adverse consequences.

*Oladapo A. Ashiru is a Professor of Anatomy and Consultant Reproductive Endocrinologist and Chief Medical Director, Medical Art Center and Mart-Life Detox Clinic Ikeja, Lagos. +2348033347231, www.medicalartcenter.com.

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