What you need to know about COVID-19 if you are pregnant

Hot off the press the world talking about COIVD-19, the pneumonia-causing virus that was first reported as an outbreak in WuHan China at the end of 2019.

Viruses are thought of as ‘molecular pirates or wizards’, as they are cunning and sneaky in the way they replicate and hijack the host’s cells.

COVID-19 is a disease that has mutated and evolved over time to be able to infect humans.  Viruses have no properties of normal cells, such as a nucleus, or ribosomes, meaning that they are intracellular parasites that depend completely on their host.

What we need to remember at this point in time, is that we have overcome HIV, Hepatitis, Zika and SARS-CoV-2 (2002), when it comes to pregnancy, IVF and the human race. 

There is one plus for pregnant women with COVID-19. Unlike Zika, it has not yet been proven that the virus crosses the membrane barrier to the baby causing any issues to a pregnancy. So far babies born have not been infected.

The Science

The protein structure from SARS-CoV-2 and SARS-CoV-19 are both a three-prong structure for attachment to the hosts’ cells derived from an animal virus that show 77.5% identical in the amino acid sequence.  But to show how sneaky these viruses are, the COVID-19 virus has changed its protein receptor at its three-prong attachment so that it is only 46% identical to SARS-CoV-2.

What does this mean?  This means that people who were previously infected by SARS-CoV-2 in 2002, their antibodies will not attack the new virus, leaving them vulnerable to infection.

How does COVID-19 impact IVF?

The good news is, that Covid-19 is unlikely to replicate during IVF procedures, the scientist uses the same techniques used in the lab for HIV patients. This involves a unique process of washing out the viral load from the sperm, use single-use items per patient, stringent cleaning procedures, and correct personal protective equipment for all staff involved.

An interesting note, Covid-19 lasts for up to 3 hours in the air from a cough or sneeze, up to 4 hours on copper, and 24 hours on cardboard and up to 2 to 3 days on plastic and stainless steel.  Whereas hepatitis is stable in dried blood for up to 4 months!

It has been discussed that using the normal dilution process for washing and cleaning embryos would allow for very low risk of the virus being attached to the embryo in the lab during procedures and during the freezing-thawing process. It has been discussed that all potential patients at this stage may need to use the ICSI procedure to make sure they are minimizing risk.  The precautions would need to be taken when coming in close distance to patients for embryo transfer, and making sure it is not passed from aerosols or vaginal fluid at this time.

The bottom line is that all human tissue should be considered as potentially infectious, meaning that a strong quality control policy is essential for all IVF laboratories. 

References:

1. Chen, S., Liao, E., Shao, Y., 2020.  Clinical analysis of pregnant women with 2019 novel coronavirus pneumonia ‘Medical Virology’ 1-19
2. Dashraath, P., Jing Lin Jeslyn, W., Mei Xian Karen, L., Li Min, L., Biswas, A., Ariandas Choolani, M., Matter, C., Lin S, L., 2020. Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy ‘American Journal of Obstetrics and Gynecology’ 1-47
3. Hamming, I., Timens, W., Bulthuis, M, L., Lely, A, T., Navis, G., van Goor, H., 2004. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis ‘Journal of Pathology’ 203(2): 631-7
4. Karimi-Zacrchi, M., Neamatzadeh, H., Dastgheib, S, A., Abbasi, H., Mirjalili, R., Behforouz, A., Ferdosian, F., Bahrami, R., 2020. Vertical Transmission of Coronavirus Disease 10 (COVID-19) from infected Pregnant Mothers to Neonates: A Review ‘Fetal and Pediatric Pathology’ 1551-3823 (online).
5. Vankadari, N and Wilce, J, A., 2020. Emerging WhuHan (COVID-19) coronavirus: glycan shield and structure prediction of spike glycoprotein and its interaction with human CD26 ‘Emerging Microbes and Infections’ 9(1): 601-604