In this webinar, Dr. Anna Galindo Trias, Medical Director at Gravida International Center of Assisted Human Reproduction of Barcelona, explains COVID-19 and pregnancy topic.
We don’t have any data as we stopped treatments as soon as we knew that this infection spread all over the world. What I’m going to tell you is my guess. I guess that this virus has a very concrete target, which is the receptors that are located in the respiratory tract or intestinal tract, so my guess is that this virus might not affect the embryo implantation directly by being there. On the other hand, if a woman is infected, if the system of a woman is in an ongoing infection, of course, it’s going to be less receptive for this implantation. This is another thing, it is the general status of a woman that may impact the implantation, but I doubt this is going a be directly the virus.
I think and it’s my impression, it’s not something based on facts, it’s just a feeling again, I think that probably COVID won’t have receptors to attach to the egg because comet these little spikes that it has are very picky when they get attached to the membrane of one cell and they are dedicated to the respiratory tract and the intestinal tract, so I doubt that the egg will have these specific receptors for COVID. As far as we don’t know, all the clinics probably from now on, we are going to make sure that our donors are not in active infection when they donate the eggs. When we start treatments again. What this means, is testing these donors for immunity and doing PCR, which is the direct tests of these donors to make sure that they are not infected during stimulation or pickup. Probably it’s going to be different sampling at different stages of the donation to make sure that these donors are healthy at the moment of the process. That they donate healthy eggs. I don’t know about the eggs that are stored already, but I can tell you these are probably all the resources that are going to be put in the future protocols.
If you are right now in our clinics we take very special care of separating patients who are not infected from patients that are confirmed as infected. And also in the delivery rooms, that are not infected, clean delivery rooms, we perform a really thorough clean up after every delivery in case a patient didn’t know she had the virus so it would not spread. It doesn’t stay on the surfaces because we clean all the surfaces and these are the protocols that are taken in all the hospitals to ensure the safety of the patients.
If you don’t meet these terms you have been reported as positive these special precautions are just being with your baby nothing else. If you are positive for COVID then you deliver in a special delivery room, and we take special measures to protect the baby too. It could get to this horizontal transmission, not the vertical inside of the uterus, but the horizontal which is transmitted through droplets or surfaces. So cleaning your hands very very often for patients who are positive, wearing a special mask. And very specifically not touching the surfaces and everything that contacts the baby is the best way to go.
The baby is another vulnerable individual in society. Nowadays I would say for the moment to stay at home with your baby and protect your baby. The baby while it is breastfed is getting antibodies also from the mother and is being protected. But I would put all the general isolation measurements until this baby is at least six months old or a little older. But this is just an opinion. Right now, babies have to stay at home and should not have contact with friends or family.
Medications that are used in pregnant women are medication that is considered safe considering risk and benefit. This means that are medications that don’t have evidence of malformations so we can use them in pregnant women. They are accepted, of course, they are not the A classification. The medications are classified from A to X, considering the risk on the baby. A is the safest medication X is the forbidden one during pregnancy. Usually, they are B or C class medication, so these medications are considered beneficial compared with the risk. Just give it to the mother. That’s why they are not used in mild or cases.
We don’t really know when we are going to start because we are waiting for the government and society’s recommendations. We are facing a plateau and a little drop in the number of cases so we are happy about it. We are looking forward to these recommendations, hopefully, it will be either late May or June. But this is a hope, it’s nothing official. And what are we going to do, probably, we are going to start building testing protocols for patients and practitioners, for cleaning staff. It is important to know which patients that the patient is safe. When it comes to the patient who comes to the clinic, we want to know the status of the workers. Which one has been infected and already cured. Which one has not been infected and is at risk but not infected, or which one can’t work because it’s in an infective phase of the sickness. As to the workers, we are going to recommend them to stay home if they are infective and the other ones we will take strict measures or less strict depending on their status. For patients, it is going to be the same probably. If the patient is one of the thirty percent of the population that already had the COVID infection and is already cured, theoretically, it would be safe to go through treatment if PCR is negative.
IgG, which is the marker for pure is positive and IgM for the SARS is negative if the patient is susceptible to get the infection. That would be the thing just informing the patient and probably recommending specific preventive measures. For these patients it would be the way to go and also if they are infected at this time, we would recommend not to start and wait.
Well, that’s a tricky question yeah. We’re building our protocols. Probably the key point is going to be how often we will test the susceptible population of patients and staff. Because the already immune staff or patient are individuals we do not need to worry about. The susceptible ones are the ones who are going to be really the key point. In terms of staff, we have still to figure it out. In terms of patients, we have more or less figured it out testing them right when they start testing for the final test for treatment when they start treatment and right before going for pickup and right before the transfer if it’s the aim of treatment in cryo transfers or IVF treatment. When it comes to donors, it is going to be done a little bit more often to make sure that the donors are healthy. We are working on our protocols. That’s what we are working on right now to ensure safety for patients, for donors and also for the staff.
Well, we know that rhinoviruses, in general, are pretty unstable individuals. Such little spots when they copy themselves they make mistakes pretty often so these give these viruses a lot of variability in the copies. Every X copies they have a little variable. An example of this is influenza, which is the flu virus and the cause of the flu. Every year we have to build new vaccines because of these little variations. Mainly it is the same virus, but these little variations make people sick, so probably COVID or SARS is going to act similarly. We know that there are little variations detected in different areas of Europe. In the SARS’ main variations somebody that has been in contact with one of the cousins of this virus can react better, that’s my opinion. What we also know in general, is that this minimum variation you have been in contact with, the cousin, the next generation of the virus probably is going to affect you less severely, but this has to be confirmed. We need to know more about this virus, but probably this virus is going to have little mutations that are going to make us make vaccines and change the vaccines once in a while to be updated to these little changes.