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It seems that things are calming down with SARS-Cov-2, as there are no longer daily reports and notes of findings of new variants and subvariants of the virus, as well as clinical changes in symptomatology, hospitalizations, severity, and deaths due to COVID-19. We do not know how we should guard against viral infection during the impending endemic phase of the disease, knowing the complex health problems of prolonged COVID if we contract the virus. In this article we describe the latest known coronavirus mutations, how they affect certain organs and systems, the advantage of a better response to infection in people with healthy lifestyle, the rebound of symptomatology, reinfections at the time of the vaccine, prolonged COVID, excess mortality of physicians who attended the first waves without vaccine, and some news and knowledge about COVID in the pregnant woman and her fetus and newborn;the future of the newborn born to a mother with COVID remains unknown. In the COVID endemic, should we continue to protect ourselves? How?Copyright © Peruvian Society of Obstetrics and Gynecology. All Rights Reserved.
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At the end of the second year of the COVID-19 pandemic, it seems that the enigmatic coronavirus is giving us some respite. However, the number of people infected has started to rise in the northern hemisphere, where a strong winter with snowfall is approaching. But this new increase is also observed in the southern hemisphere, as in Peru, when we are in spring. SARS-CoV-2 continues to differentiate into a multitude of variants and subvariants, some of which are more easily able to evade human immunity and that achieved with mRNA vaccines, and also may not respond to monoclonal antibody treatments. Current clinical information is oriented to the expectation that existing vaccines could at least reduce hospitalizations, intensive care admission and deaths. Learning about the clinical effects of SARS-CoV-2 infection, the occurrence of reinfection, and long-term physical and mental harm continues, with prevention of infection, reinfection, and prolonged COVID being sought.
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WHO Director-General Tedros Adhanom Ghebreyesus has recently said that 'The end of the pandemic is near. We are not there yet, but the end is in sight'. And U.S. President Joe Biden, with about 400 deaths per day in the U.S., has repeated that assertion. From what we can read in the literature, we are not there yet and there may be a long way to go. Although more is known about the virus and its ability to transform into variants and subvariants in order to enter the host more easily, some of these transformations are cause for concern. We make a brief review of what we have learned about morbidity and mortality due to SARS-CoV-2, how women's health has worsened, some alterations in sperm, defenses against the virus, reinfections, its unhealthy action on the pregnant woman, the fetus and the newborn, vaccines and boosters, and a vision of what lies ahead. Copyright © The Author(s) 2022.
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Since the late 2020's it was anticipated that the SARS-CoV-2 coronavirus would stay with us indefinitely, but there was hope that we would be able to combat it at some point effectively so that it would not produce the severe illness and death that we were seeing at that time. The pandemic has continued with this coronavirus continually modifying itself to enter the human body more easily. The Omicron variant preferentially infects the upper respiratory tract. And some of its mutations appear to affect parts of the spike protein that bind to ACE2. One of the latest subvariants of the variants, BA.212.1, infects more people more rapidly, although cases of severe infection and deaths have declined considerably. The following is a summary of what has been known in this first quarter of the year 2022 about the particularities of the virus, how it infects and its consequences, the protection of vaccination, what's new about the pregnant woman and her newborn, and whether there is any good side to the occurrence of the COVID-19 pandemic.
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A brief overview of the evolution of gynecology in Peru in the last 200 years is done. Following the medicine and surgery practiced by the inhabitants in the pre-Hispanic era, known through their huacos and archeological sites, and after the development of diagnostic and operative gynecology with the systematic use of the speculum in the 19th century, which made possible interventions such as uterine curettage and posterior colpotomy for the drainage of pelvic abscesses, the history of Peruvian gynecology would begin in 1878, when Lino Alarco performed the first gynecological surgery by laparotomy to remove an ovarian tumor. Néstor Corpancho, in his service at the Hospital de Santa Ana, was the first to perform myomectomies by laparotomy, as well as hysterectomies. In 1879, the Chair of Gynecology was created in the Faculty of Medicine of the Universidad Nacional Mayor de San Marcos, and later the first modern operating room was installed in Peru. In 1898, Constantino T. Carvallo initiated the training of brilliant gynecologists, which was later continued with the schooling of specialists and access to updated medical information. Current COVID-19 pandemic requires monitoring of women's short and long term health, their gestations and newborns' lives, greater investment in health, trained professionals in emergency and person-centered health, research on diseases and their prevention, learn more about genetics, immunology, metabolic syndrome and related comorbidities (obesity, hypertension, diabetes mellitus), how to prolong healthy life, use nanotechnology, artificial intelligence, robotics, and more.
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The SARS-CoV-2 virus continues to reproduce rapidly and is showing more infectious variants. The second wave of the pandemic is subsiding in Europe and the United States of North America, but not in South America. In Peru, the number of deaths has more than doubled, with a higher mortality rate in men and in those over 70 years of age. It has been corroborated worldwide that pregnant women suffer a more severe disease-sometimes with a process similar to preeclampsia-with a greater possibility of death than non-pregnant women and greater fetal death and prematurity. Initial vaccines developed in the USA and Europe are proving effective in reducing infections, hospitalizations and deaths in countries where vaccination has advanced more rapidly. It is being administered in pregnant women without major side effects, and they are recommended to be vaccinated to avoid severe infection. As of now, the duration of immunity given by COVID-19 infection and by the vaccine is not known. A third booster dose and rebranding of vaccinees is being considered. And a third wave of infections is expected due to the emergence of the Brazilian and Indian (Delta) variants.
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In late 2020, vaccines developed in the Western world against the SARS-CoV-2 virus were approved and are currently being inoculated, together with Chinese and Russian vaccines. In the meantime, we are in a second wave of the disease and the new coronavirus has been transforming to allow for better propagation, harboring and replication in humans. The disease now manifests itself with new symptoms, greater contagiousness, severity and variation in the number of deaths. Coronavirus infection of pregnant women is occurring with harshness and maternal and perinatal consequences. Vaccination has been initiated in pregnant women and nursing mothers, after discussion with their gynecologists about risks and benefits. This article provides a brief account of the events that took place during the transition from 2020 to 2021.
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The new coronavirus pandemic continues with us and will do so for a long time. It has brought a new way of life, with isolation, confinement, personal protection, distancing, use of virtuality and others. The diagnosis of the infected and its management has been improved;there is no cure yet, although there are vaccines approved in haste. The health crisis has exposed the lack of preparation of our health systems, resulting in political and economic crises, with impoverishment, death, and emotional and psychological complications. In these pages we continue writing in a summarized way the new knowledge about SARS-CoV-2 and the COVID-19 disease, its diagnosis, pathophysiology, symptomatic management and the severe disease, re-infection, its sequelae and lethality. But mainly how it affects the infected woman during pregnancy, childbirth and the puerperium, as well as aspects of rooming in and breastfeeding. And what happens when the infection affects the newborn. The future of the mothers and children who suffered the infection remains to be known.
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When COVID-19 appeared, we did not expect its rapid expansion throughout the world nor the serious consequences it would bring. We currently understand more about the virus' morphology and its activity in the environment and within the human body, as well as its greater predisposition to affect vulnerable populations, such as the elderly and persons with comorbidities like obesity, diabetes, hypertension and immunosuppression. This virus shows a predilection for men, and a higher prevalence in countries with greater poverty, promiscuity and economically depressed areas, among others. Various treatments have been tested and discarded in patients with moderate and severe disease. The frequency of deaths is decreasing due to personal protection measures, social distancing, emergency quarantine, and combination of medications and supplemental oxygen. However, there is still no cure, and we are waiting for the appearance of the vaccine. Women are less frequently and less severely affected;however, they should follow preventive measures, especially if frail with comorbidities. Preventive medical consultations and non-emergency surgical procedures have been temporarily postponed. Pregnant women are experiencing an increase in prematurity, fetal deaths, placental lesions and presence of the virus in placental adnexa, with cases of severe morbidity and maternal death. This article is an update on the situation of COVID-19 in the world and in Peru, emphasizing the care of women and pregnant women.
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Several western countries have initiated the return to pre-pandemic life with the reduction in the number of severe infections and deaths despite of the high infectivity of the Omicron B2 variant. This is occurring amid complaints from the population tired of the restrictions due to COVID-19, the consequent economic and labor problems and with an antivaccine sector with an important presence. SARS-CoV-2 will not disappear, new variants will emerge, and it will be necessary to be alert to its threats and design new vaccines. However, human beings are learning the measures to prevent infection, the importance of self-protection and of the family, and the surveillance of the virus. Imperfect vaccines have been developed that require boosters at relatively short intervals. However, many countries are not yet prepared to face the pandemic - now endemic - due to overconfidence in the eventual disappearance of the virus, lack of human and economic resources for better health care, and corruption. Women are more sensitive to viral infection and is getting vaccinated to avoid serious infection and death. Evidence finds that pregnant women with COVID-19 suffer more miscarriages, preterm deliveries, and intrauterine and perinatal death. The placenta is the unit most compromised in its defense of the fetus. The resulting placentitis causes placental insufficiency and fetal hypoxic-ischemic injury. Newborns are protected by the passage of maternal antibodies, with a longer duration of those originated by vaccines. Much remains to be known about the future of SARS-CoV-2 infection. But a complex and shocking problem resulting from the infection is already a reality - the prolongation of multi-organ damage, even with mild disease, mainly in the cardiovascular, pulmonary, and cerebral systems, as well as the alteration of mental health and shortening of life.
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Eighteen months have passed since the COVID-19 infection caused by SARS-CoV-2 was declared a pandemic. There is still no treatment for the virus other than symptomatic and recuperative. The rapid recognition of the novel coronavirus allowed the development of vaccines that are being used on an emergency basis and have led to a decrease in severe cases, hospitalizations, use of intensive care units, mechanical ventilation and deaths. But there are still unknowns about the genetic modifications and variants that the virus uses for better invasion and adaptation to human defenses, as well as about its immediate and long-term consequences in men, women and their children. Herd immunization seems distant to achieve, because we do not know the immunity provided by the infection and vaccines, as well as its duration, and because a large part of the population that does not want to be vaccinated. In addition, there is insufficient vaccine supply capacity, limited accessibility to health services, unfavorable economic situation, increased poverty and its consequences, temporary decrease in life expectancy and other complications secondary to infection by the virus. The present review is a brief account of recent advances in the knowledge and management of COVID-19, at a time when Peru is celebrating the Bicentennial of the country's Independence from Spanish rule, on July 28, 1821, and when Peruvians find themselves in the midst of an aggressive, elusive and deadly pandemic, with human, population, economic and political issues to be resolved.
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The teaching of obstetrics and surgery in Peru began at the beginning of the 19th century, at the initiative of Hipólito Unanue. Cayetano Heredia and others structured it academically when the Faculty of Medicine of the Universidad Nacional Mayor de San Marcos was created in 1856. The chair of clinical gynecology was created at the end of the 19th century, appointing Constantino T. Carvallo as professor. In 1947, the Peruvian Society of Obstetrics and Gynecology (SPOG) was founded with the purpose of developing the science and continuous training of specialists in gynecology and obstetrics. Since 1955, The Peruvian Journal of Gynecology and Obstetrics is the scientific communication media of the SPOG, which publishes experiences and research in the specialty. The residency in Obstetrics dates back to 1958 at the Maternity Hospital of Lima and, between 1961 and 1962, Abraham Ludmir began the schooled residency in obstetrics and gynecology at the Hospital Materno Infantil San Bartolomé. The continuous and rapid progress given by scientific research, information and modernization of technology in the specialty has caused the emergence of several branches related to the pathology of women and perinates, integrated in medical institutions that advance at different speed and importance. The current SARS-CoV-2 coronavirus pandemic has highlighted the problems in national health care, resulting in hospital congestion, insufficient equipment, drugs and human resources, unfavorable indicators of surveillance, infections and deaths, which will require a change in health management. Teaching in medicine was also affected, with the conversion from classroom to virtual education, prohibition of onsite care for students and senior teachers, who will be returning to the hospitals. Medical education, scientific and technological advances and the vision of a rapidly changing world must give rise to new curricular plans for medical students and residents in the specialty, for appropriate health care.
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It has been two years since the appearance of SARS-CoV-2, coronavirus which has spread rapidly throughout the world, causing more than 270 million infected people and more than 5 million deaths. This coronavirus has had many variants and mutations, which is its way of getting into humans more easily and producing COVID-19 disease. The result has been a trail of infections and deaths, with lethality around 1%, and has affected the way of life, work, education, the economy of the countries, increased poverty and violence, among others. We still do not have a cure for the disease, but vaccines have reduced the number of severely infected people and deaths. And antiviral drugs are emerging that could prevent severity and death from COVID-19, if used at the onset of infection. In this article we include some of the news and outcomes occurred in the last trimester and what it has meant for women's and pregnant women's health.