COVID-19 is Associated with Increased Severity in Pregnant Women

Background: COVID-19 pandemic originated in China in late 2019, the number of cases are increasing with 2,104,346 cases and 116,140 deaths in the United States, as of June 16, 2020. Pregnant women are a vulnerable population in epidemics or Pandemics. This Review is designed to look in detail the severity of COVID-19 in pregnant women in comparison to non-pregnant women of reproductive age. Methods: Literature search on PubMed, Google Scholar, Lancet, and Web of Science were conducted. Results: We have found the evidence of increased risk for severe disease and distinctive symptoms among pregnant women diagnosed with COVID-19 as compared to non-pregnant women. Conclusions: COVID-19 presents in an atypical fashion in pregnant women with comparatively increased severity of symptoms, compared to COVID-19 positive non pregnant women of reproductive age. These findings can help clinicians to recognize the risk posed by COVID-19 in pregnant women

COVID-19 & Pregnancy Complication During Early Pandemic: A Narrative Review

Background: Coronaviruses have caused 3 outbreaks in the past 2 decades. The novel one is SARS-COV-2, which causes COVID-19. Pregnant women have somewhat altered immune state, which may make them more vulnerable to COVID-19 and its complications. Extensive research is needed to better understand the clinical course of COVID-19 in this population. Objective: This review article discusses the comparison of previous coronaviruses’ outbreaks, clinical presentations, and complications in pregnant women and newborns. Study Design: We conducted literature search for case series and case reports about pregnancy outcomes in pregnant women with COVID-19 during the early phase of pandemic. Results: In case series, 37 of 129(28.6%) pregnant women with COVID-19 disease had preterm delivery and 14 of 67 pregnant women had fetal distress. The rate of preterm labor in normal pregnant women who are healthy and not infected with any virus worldwide is approximately 11%. Conclusion: Based on the articles reviewed, preterm delivery appears to be the most common complication in COVID-19 pregnant patients. Other complications include fetal distress, stillbirth, ICU admission and severe disease leading to fetal demise and maternal mortality. Pregnancy outcomes seem to be better with Covid-19 compared to SARs and MERS. However, most of these publications are from the early part of the pandemic when protocols for care for pregnant women were being worked out and comprehensive knowledge of the disease process in pregnant women was still in developing stage

Anesthesia Services in the Time of COVID

Our hospital is a 400-bed Level-1 trauma center with 78 ICU beds serving the greater Louisville metropolitan area. The COVID-19 pandemic forced our hospital to re-evaluate our core business operations and to develop a coherent response to a fluid situation. Between March 15 and May 15, 2020, the University of Louisville Hospital admitted more than 100 COVID-19 inpatients, approximately 30 were admitted to the intensive care unit (ICU) and most required endotracheal intubation. The following review describes our Department of Anesthesiology & Perioperative Medicine foci, actions and rationale during the COVID-19 pandemic. While we hope not to experience another pandemic in the near future, this review may be a helpful starting point for preparing for future respiratory spread pandemics

Characteristics and Outcomes of Adults Hospitalized with SARS-CoV-2 Community-Acquired Pneumonia in Louisville, Kentucky

Background: Patients infected with the novel coronavirus SARS-CoV-2 are frequently hospitalized with community-acquired pneumonia (CAP). The objective of this study was to define the clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 CAP in the city of Louisville, KY. Methods: This was a retrospective observational study of 700 patients with SARS-CoV-2 infection hospitalized to eight of the adult hospitals in the city of Louisville. Patients with 1) a positive RT-PCR for SARS-CoV-2, 2) fever, cough, or shortness of breath, and 3) an infiltrate at chest imaging were defined as having SARS-CoV-2 CAP. Demographic characteristics of the study population were compared with census data from the city of Louisville. For each patient more than 500 variables were abstracted from electronic medical records and recorded using Research Electronic Data Capture software. Data was analyzed by descriptive and inferential statistics using R version 3.4.0. Results: SARS-CoV-2 CAP was identified in 632 (90%) patients hospitalized with COVID-19. The median age of the patients was 63 years, 53% were females, 31% were black and 12% Hispanic. The most frequent comorbidities were hypertension (56%), obesity (50%), and diabetes (33%). Mortality was 17% for the total population and 34% for the 249 patients admitted to ICU. For each category of race, ethnicity and comorbidities, the proportion of hospitalized patients with SARS-CoV-2 CAP was significantly different when compared to the Louisville population (p \u3c 0.001). Conclusion: Patients of black race, Hispanic ethnicity, and patients with history of hypertension, obesity or diabetes are overrepresented among hospitalized patients with SARS-CoV-2 CAP when compared to the Louisville population. Hospitalized patients with SARS-CoV-2 CAP are likely to require ICU care, with death occurring in approximately one of six hospitalizations

No difference in clinical outcomes for African American and White patients hospitalized with SARS-CoV-2 pneumonia in Louisville, Kentucky

Introduction: Current literature indicates that African American individuals are at increased risk of becoming infected with the SARS-CoV-2 virus and suffer higher SARS-CoV-2-related mortality rates. However, there is a lack of consensus as to how the clinical outcomes of African American patients differ from those of other groups. The objective of this study was to define the clinical outcomes of African American and White hospitalized patients with SARS-CoV-2 community-acquired pneumonia (CAP) in Louisville, Kentucky. Methods: This was a retrospective cohort study of hospitalized patients with SARS-CoV-2 CAP at eight hospitals in Louisville, Kentucky. Severity of CAP at time of hospitalization was evaluated using the pneumonia severity index (PSI), CURB-65 score and SARS-CoV-2 viral load. The following thirteen clinical outcomes were compared: discharge alive to home, time to home discharge, admission to the ICU, length of ICU stay, need for invasive mechanical ventilation (IMV), duration of IMV, development of acute respiratory distress syndrome (ARDS), development of septic shock, need for vasopressors, development of cardiovascular events, time to cardiovascular events, in-hospital mortality, and time to death. Results: A total of 541 patients were eligible for this study, 343 White (63%) and 198 African American (37%). None of the thirteen clinical outcomes were statistically significantly different between the two groups. Conclusions: This study indicates that African American and White patients do not have different clinical outcomes after the point of hospitalization due to SARS-CoV-2 CAP