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  • Writer's pictureDr. Speir

Testing of asymptomatic patients on L&D & MIS-C (not miscellaneous)

Updated: Jul 23, 2020

So, some good news as far as testing goes. Hoag will be offering COVID-19 testing via a rapid test to all women coming into labor starting on Tuesday 7/21/2020. A lot of the hospitals in Orange County and around the country are already doing this. Everyone should be wearing a mask as much as possible, if patients are in labor and having trouble breathing due to contractions or pushing that would of course be an exception.

Data for pregnant patients is sparse but this 10 week study is from across the US and shows that 58% were asymptomatic at the time of diagnosis and had presented for obstetrical reasons. In this data set you can see in symptomatic patients there was a much higher rate of <27 week deliveries compared to the asymptomatic which is really important but the authors don't make many conclusions about this.

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Here's why I think you should do it:

#1 If you are a asymptomatic positive person, coming into the hospital and potentially infecting multiple other health care workers who could then spread it to other health care workers and patients would be very detrimental to the health care system. There is still very limited PPE ( personal protective equipment) for health care workers and most are only wearing complete PPE for known positive patients. So, if we don't know you are positive and you don't know --how would we know to wear the additional recommended PPE. All around the country people are complaining about wearing cloth masks, I will tell you a properly fitted N95 (not the kinds people are wearing around the community) is about 100 x worse. Big props to all the frontline workers who have been doing this from the beginning of the pandemic. A lot of pregnant health care workers are already avoiding patient contact and if the remaining people start getting sick we are going to be continually short of staff.

#2 If you are positive, the recommendation is that you are separated from your baby for 10 days and someone else take care of the baby to avoid spread to the newborn. Now, you don't have to do that. You can do whatever you want, it is your baby. However, keeping 6 feet apart, wearing a mask and gloves, cleaning your breasts before feeding the baby, washing your hands often and before pumping are going to minimize spread.

#3 We need to data and research to better understand this virus and pregnancy. Normally it takes decades, but hopefully we can start getting meaningful data soon. Pregnant women and women in general are usually the last to be studied and this leaves a big gap in knowledge for patients and providers to be able to counsel them appropriately. There was a paper in Nature that reported vertical transmission of COVID from mother to infant, but this was only one patient and in other reports the transmission to fetuses appears to be unlikely so there is still a lot of learn. I wouldn't freak out over one paper despite the headlines.

Again please wear your mask and encourage everyone you know to do so. This virus is going to be here a while and we might as well try to change our behavior so we can start doing more. If everyone wears a mask and socially distances we could have this under control in a few months and then we would safely be able to open schools. Which I think most parents really want. We want all the benefits of school but we have to do it in a safe way. I don't want to potentially give my kids a virus that would give them life long health issues or give them a risk of hospitalization due to respiratory issues or MIS-C (Multisystem Inflammatory syndrome in children). You know what traumatizes kids more than not getting to play with their friends, getting hospitalized and almost dying. To say that we are going to open schools no matter what is just blatantly immature and uneducated (ironic, right).

A little more about data : as of 7/15/2020 the CDC

(don't even get me started on the White House's attempt to avoid the CDC getting data from hospitals)

342 cases of MIS-C which presents about 2-4 weeks post COVID-19 infection with severe inflammation and fever requiring hospitalization, 6 kids died. Cases occurred from < 1 year old to 20, average age was 8.

Per the AAP as of 7/9/2020- total number of cases in children were 200,184 which 7.6% of total. But there was a 45% increase in child cases between 6/25-7/9!

0.7-9% required hospitalization, seems small, but that is between 1,401 - 18,000 kids needing to be in a hospital! To put this in perspective - per the American Cancer society 11,050 kids will be diagnosed with any type of cancer in all of 2020. So, don't listen to all those people (including the OC Board of Supervisors) who are saying this is not a serious disease in children!

So let's see 342/200,184 = .17% risk of getting MIS-C. So the risk is low but if we have more numbers will this change? And as always with numbers, if you are the parents of those .17% of kids, population numbers don't matter, your kid is 100%.

These numbers are kind of blowing my mind right now (I am by no means a data analyst but I did pass statistics in college) but we need these numbers crunched and crunched well before we make any decisions about schools! We also need the data to be reliable and well tracked and we need to trust our leaders will take the health and safety of our children as the first priority.

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