Maternal and neonatal outcomes of COVID-19 in a high-risk pregnant cohort with and without HIV.

BACKGROUND: The impact of SARS-CoV-2 infection in pregnant women living with HIV (PLHIV) has not been described previously. OBJECTIVES: To describe the clinical presentation and outcomes of a cohort of women with high-risk pregnancies with confirmed COVID-19 to determine whether risk factors for disease severity and adverse outcomes of COVID-19 differed in pregnant women without HIV compared with PLHIV. METHODS: We prospectively enrolled pregnant women with COVID-19 attending the high-risk obstetric service at Tygerberg Hospital, Cape Town, South Africa, from 1 May to 31 July 2020, with follow-up until 31 October 2020. Women were considered high risk if they required specialist care for maternal, neonatal and/or anaesthetic conditions. Common maternal or obstetric conditions included hypertensive disorders, morbid obesity (body mass index (BMI) ≥40 kg/m2) and diabetes. Information on demographics, clinical features, and maternal and neonatal outcomes was collected and compared for PLHIV v. pregnant women without HIV. RESULTS: One hundred women (72 without HIV and 28 PLHIV) with high-risk pregnancies had laboratory-confirmed COVID-19. Among the 28 PLHIV, the median (interquartile range) CD4 count was 441 (317 - 603) cells/µL, and 19/26 (73%) were virologically suppressed. COVID-19 was diagnosed predominantly in the third trimester (81%). Obesity (BMI ≥30 in n=61/81; 75%) and hypertensive disorders were frequent comorbidities. Of the 100 women, 40% developed severe or critical COVID-19, 15% required intensive care unit admission and 6% needed invasive ventilation. Eight women died, 1 from advanced HIV disease complicated by bacteraemia and urosepsis. The crude maternal mortality rate was substantially higher in women with COVID-19 compared with all other deliveries at our institution during this period (8/91 (9%) v. 7/4 058 (0.2%); p<0.001). Neonatal outcomes were favourable. No significant differences in COVID-19 risk factors, disease severity, and maternal/neonatal outcome were noted for PLHIV v. those without HIV. CONCLUSIONS: In this cohort of high-risk pregnant women, the impact of COVID-19 was severe, significantly increasing maternal mortality risk compared with baseline rates. Virally suppressed HIV infection was not associated with worse COVID-19 outcomes in pregnancy.

COVID-19 infection in high-risk south african pregnancies with and without HIV

Background: Data from Africa reporting the outcomes of COVID-19 infection in pregnancy are limited, particularly for women with high-risk pregnancies (hypertension, diabetes and obesity) and pregnant women living with HIV (PLHIV). We describe the clinical features, maternal and birth outcomes of COVID-19 high-risk pregnancies at a South African tertiary care referral hospital with a 24% antenatal HIV prevalence. Methods: We prospectively collected data from COVID-19 infected pregnant women attending the high-risk obstetric service at Tygerberg Hospital, Cape Town, between 1 May 2020 and 31 July 2020, and documented pregnancy and birth outcomes until 30 October 2020. Laboratory testing for SARS-CoV-2 infection was performed only in symptomatic pregnant women. Descriptive analysis was performed for all COVID-19 infected women with high-risk pregnancies;demographic and outcome variables were compared for PLHIV versus pregnant women without HIV. Results: One hundred pregnant women (72 without HIV and 28 PLHIV) had laboratory-confirmed COVID-19 infection (Table 1). Obesity, hypertensive disorders and gestational diabetes were frequent comorbidities. Among 28 PLHIV, the majority received antiretroviral treatment 27 (96%);median CD4 count was 441 (14-838) cell/mm3 for 21 (75%) and 19 (73%) were virologically suppressed. COVID-19 infection was diagnosed predominantly in the 3rd trimester (81%);50% of women delivered within 2 weeks of infection onset. Forty women developed pneumonia;13 developed adult respiratory distress syndrome (ARDS) and 6 required invasive ventilation. Eight women died, 7 from ARDS and 1 from advanced HIV disease with bacteraemia. Pregnancy outcomes included 91 live births (including 5 sets of twins), 5 stillbirths, 4 miscarriages, 2 mothers who died with the fetus in situ and 1 medical termination of pregnancy. Birth outcomes for 2 women were unknown. Outcome for the 91 liveborn neonates were good except for one who died from complications related to perinatal asphyxia. No significant differences for COVID-19 infection impact and outcome were noted for PLHIV versus those without HIV. Conclusion: In this cohort of high-risk pregnant women with COVID-19 infection, no clinical differences in outcome attributable to HIV-infection were noted, however the majority of PLHIV were virally suppressed. The impact of COVID-19 infection in pregnancy was severe (40% complicated by pneumonia;8% crude mortality rate);neonatal outcomes were favourable.

Personal protective equipment (PPE) in a pandemic: Approaches to PPE preservation for South African healthcare facilities.

Personal protective equipment (PPE) is key to protecting healthcare workers from COVID-19 infection, but the pandemic has disrupted supply chains globally and necessitated rapid review of the scientific evidence for PPE re-use. In South Africa, where the COVID-19 epidemic is still developing, healthcare facilities have a short window of opportunity to improve PPE supply chains, train staff on prudent PPE use, and devise plans to track and manage the inevitable increases in PPE demand. This article discusses the available PPE preservation strategies and addresses the issue of decontamination and re-use of N95 respirators as a last-resort strategy for critical shortages during the pandemic.