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Coronavirus diary – Part 16

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Since the pandemic began, there have been isolated cases of newborns who have tested positive for the coronavirus, but there has not been enough evidence to rule out the possibility that the infants became infected by the mother after they were born, experts said — Pam Belluck

I have discussed at considerable length modes of transmission of the COVID-19. The common routes known to the public are human-to-human transmission, respiratory secretions, faeces, sex, and fomites. But I am yet to focus on transmission from mother to her baby during pregnancy that medical experts call antenatal transmission. The fact that I did not discuss it is understandable. A while ago, experts affirmed that the effect of COVID-19 on pregnancy had not been fully understood due to the paucity of data. However, recent developments are throwing more light on the subject. Indeed, available data had indicated a rare occurrence of vertical transmission during the third trimester of pregnancy with no data yet on early pregnancy.

It is pertinent to present the uncertainty of the research community about antenatal transmission. In Wuhan, the epicentre of the virus in China, a baby born on February 2, was diagnosed with the COVID-19 just 30 hours after birth. It was reckoned to be the youngest case as at then. The baby’s mother had tested positive before she gave birth. However, there was no useful explanation on how the disease was transmitted whether in the womb or after birth. Thus medical experts could only hazard a guess on the contraction of the in the womb. The possibility of infection in immediate post-birth contact with mother was not factored out. The development engendered the need to pay attention to the mother-to-child route of transmission.

In Cali, Colombia, Diana Angola who fought for her own life gave birth to son Jefferson. The 36-year-old was put into a coma as COVID-19 patient and doctors had to perform a caesarian section and Jefferson was born prematurely without the coronavirus but struggled to breathe warranting clinical intervention.

On April 27, in Nigeria, a 40-year-old woman, who tested positive for the coronavirus, gave birth to a healthy baby girl at the Lagos University Teaching Hospital (LUTH. Between April and May 19, three other deliveries by COVID-19 patients took place without hitches. On April 1, Angela Primachenko, a Vancouver-resident, Washington, delivered her baby without being infected with the virus while medically induced into a coma over her corona infection.

In a report by Colleen Shalby in Los Angeles Times, 134 pregnant women in L.A. tested positive for coronavirus, but none of their babies. The results indicated that it was unlikely for a pregnant mother to pass the virus to her baby during pregnancy. A newborn, however, could be susceptible to person-to-person spread. Reassuringly then, the virus was yet to be found in amniotic fluid and breast milk among others. A related study by Mehreen Zaigham and Ola Anderson on Studies on clinical manifestations and maternal and perinatal outcomes of COVID‐19 during pregnancy involving a systematic review of 108 pregnancies, the majority of mothers were discharged without any major complications, severe maternal morbidity as a result of COVID‐19 and perinatal deaths were reported. Vertical transmission of the COVID‐19 could not be ruled out. They advised careful monitoring of pregnancies with COVID‐19 and on measures to prevent neonatal infection.

Two related developments seem to point to the fact there is a mother-to-child transmission, thereby erasing the atmosphere of uncertainty in the research community. In June, a published article Pediatric Infectious Disease Journal, titled, “Probable Vertical Transmission of SARS-CoV-2 Infection” by Alicia Demirjian et al indicated a vertical transmission of COVID-19 from mother to foetus in the perinatal cycle. They described in the article the likelihood of vertical transmission of COVID-19 in a neonate born to a mother with coronavirus. Following the cesarean section, the neonate was kept in strict isolation. They found that Molecular tests for COVID-19 on respiratory samples, blood, and meconium were initially negative, but became “positive on a nasopharyngeal aspirate on the third day of life. On day 5, the neonate developed fever and coryza, which spontaneously resolved. Viral genomic analysis from the mother and neonate showed identical sequences except for 1 nucleotide.”

Also, in an article, published July 14 in the journal Nature Communications, French doctors have reported first baby born with COVID-19 at a hospital near Paris being infected in utero with COVID-19 and then being born with the disease. The mother was infected with COVID-19 during the last trimester of her pregnancy. The child who was delivered by caesarean section, showed symptoms of the virus, namely, severe rigidity, damage to the white matter in the brain, and acute petulance, immediately after birth. The good news is that both the child and the mother survived. While the article doubted the transmission route, it however, pointed to umbilical cord route. The baby which developed a fever and some mild breathing difficulty, tested positive for SARS-CoV-2 administered 24 hours after her birth came up positive for SARS-CoV-2, so also with a second test 24 hours later. Further tests of the placenta revealed the presence of coronavirus particles and a protein that is believed to be specific to the virus. Because of these results, the researchers concluded that COVID-19 was passed on to the baby in the womb, not during or after her birth. What is more, evidence of SARS-CoV-2 on PCR testing of the placenta, amniotic fluid, cord blood, or breast milk samples abound.

Akhaine is a Professor of Political Science, Lagos State University.

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