Coronavirus disease 2019 in pregnancy.

OBJECTIVES: This study aimed to compare clinical courses and outcomes between pregnant and reproductive-aged non-pregnant women with COVID-19, and to assess the vertical transmission potential of COVID-19 in pregnancy. METHODS: Medical records of pregnant and reproductive-aged non-pregnant women hospitalized with COVID-19 from January 15 to March 15, 2020 were retrospectively reviewed. The severity of disease, virus clearance time, and length of hospital stay were measured as the primary objective, while the vertical transmission potential of COVID-19 was also assessed. RESULTS: Eighty-two patients (28 pregnant women, 54 reproductive-aged non-pregnant women) with laboratory-confirmed COVID-19 were enrolled in this study. Univariate regression indicated no association between pregnancy and severity of disease (OR 0.73, 95% CI 0.08-5.15; p=0.76), virus clearance time (HR 1.16, 95% CI 0.65-2.01; p=0.62), and length of hospital stay (HR 1.10, 95% CI 0.66-1.84; p=0.71). Of the pregnant women, 22 delivered 23 live births, either by cesarean section (17, 60.7%) or vaginal delivery (5, 17.9%), and no neonate was infected with SARS-CoV-2. CONCLUSIONS: Pregnant women have comparable clinical courses and outcomes with reproductive-aged non-pregnant women when infected with SARS-CoV-2. No evidence supported vertical transmission of COVID-19 in the late stage of pregnancy, including vaginal delivery.

Early Epidemiological Features and Trends of the COVID-19 Outbreak in Southeast Asia: a Population-Level Observational Study (preprint)

Background: The global outbreak of coronavirus disease 2019 (COVID-19) has been ongoing in Southeast Asia since 13 January 2020. We conducted an observational study to investigate underlying disease patterns of COVID-19 in Southeast Asia, and consequently to guide intervention strategies against the pandemic.Methods: In this population-level observational study set in Southeast Asia, we compiled a list of patients with COVID-19 (n = 925) and daily country-level case counts (n = 1346) from 13 January 2020 through 16 March 2020. All epidemiological data were extracted from official websites of the WHO and health authorities of each Southeast Asian country. Relevant spatiotemporal distributions, demographic characteristics, and short-term trends were assessed.Results: A total of 1,346 confirmed cases of COVID-19, with 217 (16.1%) recoveries and 18 (1.3%) deaths, were reported in Southeast Asia as of 16 March 2020. Early transmission dynamics were examined with an exponential regression model: y=0.30e0.13x (p<0·01, adjusted R2 = 0.96).  Using this model, we predicted that the cumulative number of reported COVID-19 cases in Southeast Asia would exceed 10,000 by early April 2020. A total of 74 cities across eight countries in Southeast Asia were affected by COVID-19. Most of the confirmed cases were located in five international metropolitan areas. Demographic analyses of the 925 confirmed cases indicated a median age of 44 years and a sex ratio of 1.25. The median age of the local patient population was significantly higher than that of the corresponding country’s general population (p<0·01), whereas the sex ratio did not significantly differ.Conclusions: The COVID-19 situation in Southeast Asia is unevenly geographically distributed and pessimistic in the short term. Age may play a significant role in both the susceptibility to and outcome of infection. Real-time active surveillance and targeted intervention strategies are urgently needed to contain the pandemic.

Children are less affected by COVID-19: a family case study (preprint)

Background: Family clustering has facilitated the transmission of SARS-CoV-2, and the outflows of people from Wuhan to their hometown has become the most important transmission channel in China. The study aimed to investigate the SARS-CoV-2 infection of an entire family, especially children. Methods: This family case study was conducted in General Mountain Hospital, Guizhou Province. In January 2020, we recruited a family of 13 members, including three children and nine adults, at different stages, from admission screening to discharge. We used standardized case report forms to collect clinical data between January 16, 2020 and March 1, 2020. These data included temperature, contact history, incubation period, laboratory test results, imaging results, length of hospital stay, and treatment outcomes. Results: Eight cases had confirmed diagnoses of SARS-CoV-2 infection, including three mild cases (37.5%) and five common cases (62.5%). The child patient had the shortest length of hospital stay and less obvious symptoms. There was no significant difference between the laboratory test results and CT scans. Conclusions: Children are not susceptible to virus infection in their families. Compared with adult patients, pediatric patients have milder symptoms, shorter hospital stays, and lower risk of lung infections. As this cannot confirm whether their nucleic acid amplification tests are negative or positive after discharge, the management and control of discharged patients should therefore be paid additional attention.