ABSTRACT
Background and Purpose: Effects of COVID-19 in pregnancy are controversial.1-3 Some studies have found that a high viral load (VL) yields more symptoms,3,4 while others have found no significant differences.5 Some studies have shown pregnant women are not more likely to have a serious illness,2,6,7 while others say pregnancy is at risk for severe disease. 8,9 The purpose of our study is to compare VL values of polymerase chain reaction (PCR) tests between COVID-19 positive pregnant and nonpregnant women. Our secondary aim is to compare the asymptomatic rates among these two groups. Method(s): This case-control study identified women with COVID-19 confirmed by PCR between April-November, 2020. Cycle threshold (Ct), the number of cycles run on PCR to detect COVID-19, is inversely proportional to VL. Each pregnant woman was matched, by BMI and age, to two nonpregnant controls. Statistical analyses included Independent T-Test, Cochran's Q test and repeated measures ANOVA. Result(s): Sixty-four pregnant women were matched to 128 nonpregnant female controls. Race did not differ between the two groups. Ct in asymptomatic cases (Ct=24.1, SD=5.9) was higher (lower viral load) than symptomatic cases (Ct=12.5, SD=7.3) (p<0.001). Ct did not differ between pregnant and non-pregnant females, regardless of symptoms. Symptomatic infection among pregnant women was 54% compared to 87.7% in nonpregnant women (p<0.001). Fever, cough and fatigue were less common in pregnancy, at rates of 20.3% vs 40.7% (p=0.03), 39.1% vs 61.7% (p=0.02), and 4.7% vs 19.6% (p=0.02), respectively. Rates of shortness of breath, loss of taste and/or smell were similar in the two groups. Conclusion(s): Pregnancy did not yield higher viral load than nonpregnancy. VL is higher in symptomatic women than asymptomatic women, which holds true in pregnancy as well. Of all hospital admissions, pregnant women were less symptomatic than nonpregnant women. Correlation between VL and severity of disease needs further investigation.
ABSTRACT
Background/Case Studies: CCP is a new product emergently approved by the FDA for treatment of COVID-19 based on clinical indications. The rationale is that CCP provides anti-SARS-CoV-2 antibodiesimproving the recipient's immune response. Ideally, transfusion decisions should be based on the clinical status in conjunction with the patient's blood component level requiring supplementation. Thus, we measured the antibody levels of the donors and recipients. Study Design/Methods: Between 4/16 and 5/9/2020, 18 CCPs were transfused based on clinical indication. CCP was purchased from a regional blood product provider. Qualitative determination of anti-Spike protein IgG was performed in the recipient's pretransfusion plasma and in the CCP using the EuroImmun ELISA (Luebeck, Germany) for 16 of the patients. Results/Findings: Of the 16 patients, 11 were positive for IgG prior to the transfusion, questioning the utility of CCP administration. Patients 1-7, 10 and 11 are deceased. All other patients have been discharged. All patients receiving CCP were critically ill and on ventilation support, although the disease progressed at different paces. The patients who died showed a more rapid decline during the disease, thus there were a higher number of seronegative patients amongst those who died (3/7 of expired vs. 2/9 of living patients). There was no statistically significant difference between the surviving versus the deceased group regarding the time from admission to CCP transfusion but there was a statistically significant difference related to the total length of stay (mean of 39 surviving vs. 10 days expired group). Overall survival in our cohort was 50%. Two patients developed fever and hypotension during transfusion, raising the question of a transfusion reaction. Conclusions: Developing transfusion guidelines will help manage utilization and may reduce the risk to the patients and optimize outcomes. Based on these limited observations and the unknown therapeutic effect of the CCP, we propose to restrict CCP to IgG negative patients considering that the presence of IgG in the recipient indicates an active immune response, especially since the amount of IgG provided by the CCP is minimal compared to the total amount of patient IgG due to the high difference in volume between the CCP (200 ml) and the patient's plasma volume (3000 ml or more). The IgG detection is qualitative. The inhibitory capacity of the IgG was not assessed, although it is recognized that the anti-Spike protein antibodies have neutralization capacity. In our cohort rapid clinical decline within 5-6 days of symptom onset was associated with seronegativity.