Has everyone lost their minds?

I just want to start off by saying WHOAH people! What is happening to everybody? Where did logic go? Where did common sense and understanding go? In just the past 24 hours I have seen people finger pointing, yelling at each other, shouting about conspiracy theories, threatening others, protesting, and panicking. That is a ton of unfriendly verbs right there. There is nothing good that is going to come from any of it. What’s simmering underneath all of it? : the pandemic and the politics swirling swirling around it. Let me take a minute and give you my honest perspective on it. Let me also be clear that what I am going to say is based on facts and personal observations. I am not here to sway you, convince you or otherwise change your direction. I just want to give you something to consider. If it happens to help you press pause on panic and anger, fantastic! If it doesn’t, it needs to be said anyway.

Ok here goes. I am here to tell you that Covid 19 is a real virus in the Corona virus family, which is the same family of viruses that cause the common cold. As you know, there is an infinite variety of viral mutations that can cause a cold and thus, we will probably never have a vaccine for it. Some of us will go down like a wildabeast for weeks with congestion, trouble breathing, coughing and even fevers. Some of us will get a little runny nose for a few days to a week and that’s the end of it. A small group of high risk people may even die from it. Now here comes Covid 19, a corona virus. It can mutate like other Corona viruses. It is ridiculously contagious like a cold. The vast majority of people that get it will have bad cold symptoms. Some people will be completely symptom free. A small subset will get seriously ill and may even die. This is crazy scary right? Of course it is. That’s a natural response. But, let’s put it in perspective. There is a certain subset of unfortunate people that are more at risk for everything due to comorbid conditions. These are the folks that need to always be careful, whether there is a pandemic going on or not. When you do the actual math on the covid thing, with verifiable numbers, the death rate is extremely small. I get it, even one death is too many. Of course it is. I am just saying that it is my opinion that our reaction and response to Covid perhaps should be in better proportion to the actual statistical risk it poses. We deal with many infectious and terrible things that can kill people every single year and they have not instigated a world mess of this proportion. I seem to recall complaining about the “latest shitty upper respiratory illness” as it blows through the world every year. In my lifetime alone we have had AIDS, H1N1, SARS, ebola, and the year round outbreaks of flu. I have news for you. AIDS and the flu have not miraculously disappeared, just because we are not talking about them. They are not the cool kids anymore, but I can remember being inundated with all kinds of bits of information each time one of these outbreaks started and feeling momentarily overwhelmed, but then we all went on. We didn’t shut down the economy and add financial despair to the shoulder weight of an already distressed country. We didn’t wipe out all other news and saturate all of our overwhelmed receptors relentlessly for months.

Let me be clear. I know this virus is real. I work in three different hospital systems. I have seen everything from the icu patients to the asymptomatic patients and everyone in between. Half of my family has had it….all have survived thank goodness but other people I know haven’t. One of my favorite people in the world died of Covid. But guess what, every time I have found myself scratching my head on why someone died, I realized after investigation that they actually had a comorbid condition that adversely affected their Covid path. It just makes sense. These cases we hear about in which someone died unexpectedly, I am willing to bet that the vast majority of the time there was an underlying condition as well. Just because we don’t hear about it or the person didn’t know, doesn’t make it not true. I think in the case of Covid, it’s all the things we don’t know or feel sure of that get to us the most. We hope a vaccine is coming, but it won’t be universally available for awhile yet. When it is, I am sure that some people will refuse it like they refuse everything else, even though we have all been clamoring for one for months. How does that make sense? It’s like we want to be able to control a decision about something, anything, just to say that we did whether it is good for us or not since we all feel so out of control.

So what am I really saying is that I think the whole pandemic has provided us with a view into how quickly everything can go wrong with misleading information. It has showed us how forced panic is not the way to go to convince people to follow guidelines. It has showed us that leaving people to their own devices without clear communication leads to nothing but chaos. It has showed us that when we come at people from all sides with negative and oppressive tactics, we don’t even allow them the opportunity to make good decisions. We have got to get it together and do things and think things based on actual facts and reintroduce common sense into this global scenario. Otherwise, we are just not going to make it through this.

Hang in there.

Dr. Katz

Is It Time To Be Thankful Yet?

So, Thanksgiving just passed. Did we all remember to be thankful, or did we get mired down in complaining about not seeing the usual volume of family members and bemoan the current status of the COVID pandemic? I think that a lot of people fell into the second category, if they are being honest. I admit that, even though I have realized all of my current blessings, I still fall prey to the diffuse and sometimes oppressive fatigue of depression that has followed me around for the last 9 months, despite all my best efforts. This begs the question then, when is it time to be thankful? The answer is: RIGHT NOW! For a lot of us, things aren’t really going our way and haven’t for a long time. The economy is tough. Family relations are strained. Family members have been lost. People are fed up and spend a little too much time like little powder kegs ready to blow at the slightest opportunity for conflict. On top of that, the capacity for empathy is not so great right now. I have to admit that, even my standards for thankfulness have had to be lowered a bit just to keep things in perspective and convince myself that I am not “reaching too high.” …lol. Still, I am above ground, I have a family to miss, I have my health ( most days), and I still get to do what I love and take care of people. Essentially, it is all I really need so you betcha I am thankful. Don’t let me kid you. I have ” days” like everyone else. I am still human. We are all feeling the struggle right now. It’s a normal human response to the sense of loss of control and freedom. But, just when you feel that whine coming on I urge you to think twice before you do it. There is always the possibility that someone is worse off than you.

Dr. Katz

Here We Go Again!

Greetings from Michigan, where the shutdowns are back, viral cases are surging, morale is down and the economy is heaving along, the best that it can. Whew! That is both a mouthful and yet another heavy set of burdens for us to bear. What are we going to do? What can we do?…that we aren’t doing already? How are they deciding what to shut down? which schools to close? In the midst of the new resurgence of information overload, in combination with the overwhelming sense of loss of control, everything starts to merge together and nothing really makes sense anymore. With a sense of frustration and a deep need for answers and assertion of control, we start pointing fingers and making enemies and burning bridges right and left. We forget what’s really important anymore because we are so distracted by our unhappiness, our loss of freedoms, and our fog of depression that never seems to lift anymore. What we don’t realize, is that by launching our own attacks and tossing aside what’s familiar and devaluing those around us, we are just perpetuating our own isolation further. We are actually making things worse! If it is community that we truly crave, why fight amongst ourselves and elevate our level of pettiness to historic levels? What is that really doing? How is that supposed to make us feel any better? I have news for you: it isn’t and it won’t. So….stop already! Please! I get that it completely sucks to not be able to see the people you want to see all the time. I get it that we can’t frolic at concerts right now and family gatherings have become but a blip in the rearview. Businesses are struggling and people are at risk of losing their livelihood. I know. I am one of them. Big stuff is at stake. It all seems out of proportion to the actual death rate of this virus, but you and I both now, that we are not privy to all of the information. Therefore I have to believe that the “experts” aren’t just trying to screw us. I just can’t go on thinking like that. I am not talking about being lemmings or sheep, but, we just can’t afford to give in to hate and despair like we are. Nothing good will come of it. I am still hopeful that it is not forever. One thing IS clear in my mind: I know for sure that any of my own potential methods for self-destruction will not make things get any better any faster. I know how hard it is to be positive right now. I am struggling just like everybody else, but you will not see me giving up just yet and I am hoping against hope that you will join me.

Dr. Katz

Physician Burnout

Being a good doctor has been especially tough lately. It seems like there are so many obstacles to being able to provide quality care without completely sacrificing your own mental and physical health. Fortunately for me, I consider myself to be very strong of mind and body and my love for my patients and my job still far outweighs all the negative impact of the obstacles. I am very grateful for that, but, some are not so lucky.

You ask yourself, what kind of obstacles could doctors really have? Don’t they have it made? I mean, don’t they just make a ton of money off of the rest of us and live these amazing extravagant lives? Don’t they just get to direct us like sheep with all of their recommendations, procedures, and prescriptions etc? I hate to burst your bubble, but it is not like that at all, at least not for me.

Did you know that the rate of physician burnout is set to hit and all time high this year? The final numbers are not in yet, but it doesn’t look good. On top of that, Ob Gyn as a specialty has the fourth highest rate of burnout among all the specialties. 46% of Ob Gyn physicians report feeling burnout. So, what is burnout anyway? Physician burnout is classified as a psychological syndrome that is a prolonged response to chronic occupational stressors. Heh? What? It means that the stresses of the job potentially get so overwhelming and so stressful that you kind of break down and just don’t want to do it anymore. Yikes! Sounds awful doesn’t it? I mean anything with the word burn in it can’t be good right?

So, what are the symptoms of burnout? 1) Feeling tired and drained all the time is one of them. 2) Fatigue that does not budge no matter how much sleep you get is another. 3) Feeling sick all the time is yet another. 4) Changes in appetite or sleeping habits 5) Drop in libido or sexual desire 6) frequent back pain, muscle aches, headaches with no other apparent cause.

What do physicians have to be so stressed out about you ask? There are a ton of potential stressors. Let’s start off with the fact that your incredibly high medical school loans offset by the lower average salaries for most physicians means that your debt is not paid off until you are nearing 50. How about the fact that reimbursements for physicians, particularly in my specialty continue to drop, regardless of manhours spent or level of difficulty to the point that I find myself wondering if I am going to be the one paying to do procedures on patients instead of the patients…lol. Let’s think about the hours for a minute. For me, a solo practicing obgyn, I am essentially on call 24 hours a day and 7 days a week. My ability to do anything with my family completely depends on what is happening with patients. I find myself getting coverage if I decide to go to the bathroom in a town that’s greater than 30 miles away, much less if I am going on an actual vacation. I just can’t risk missing a call. For those of you with 9 to 5 jobs, most of you get to be done when you go home. I am never really done. I am always responsible for my patients. I am not complaining. I chose this life and this specialty. I am just clarifying.

Another stressor is the fact that there has been a huge breakdown in the concept of the doctor patient team relationship. Patients are now viewed as consumers rather than patients and as such, this wave of consumer-oriented thinking has brought a wave of bossy, entitled, demanding behavior that is often hard to stomach. I am extremely fortunate that I do not have a lot of these patients, but when I do, it is very exhausting. I have spent too much time invested in my education and have worked too hard and too long to have patients shake their finger at me, dictating their own care without listening as if I am their secretary or sales rep, rather than their doctor. It’s just not right.

One of the biggest stressors is the fact that doctors, even with all of their training and medical knowledge, do not really have the final say in what they can recommend for patients. The insurance companies do. The expenses do. The patient’s ability to pay does. I cannot tell you how many thousands of times in the last 25 years that I have had to change the optimum management, prescription, procedure, etc for a patient because of insurance and cost. Most of the time, my poor patients have to go through multiple treatment failures, medication side effects, extra office visits, etc before I am allowed to finally do the right thing for them because of some insurance criteria. To make it worse, most of them do not understand that I am not the one dictating these delays. They are under the impression that I am just “nickel and diming” them. Nothing could be further from the truth, yet I bear the brunt of their frustration and mine anyway.

Last but not least, let’s touch on the impact of COVID 19 for a minute. Wow talk about a stressor! Now we have to worry about exposure, like the rest of the world. We can’t hug our patients, hold their hand or comfort them in any way except with words, which is just not enough for some patients. If you thought insurance companies were bad about dictating care, they have nothing on COVID. We are being told when we can do procedures. I didn’t operate for months. We are being told what care is essential and what care isn’t. (Apparently vaginas fell in the isn’t category for awhile, unless a baby was coming out.) Our businesses are shut down and employees are sent home because there weren’t enough patients to keep them. Employees are afraid to come to work even when we have enough patients. We are told to do virtual consults instead of bringing patients to the office. How exactly are you supposed to do that with ObGyn patients? Hold their vaginas up to the screen? Generalization and conformity rules over sense and applicability. Even now when we are allowed to see patients, fear keeps most of them home anyway, crippling my ability to adequately care for them. I can say 100 times that it has never been safer to go to the office with all the precautions and prescreening, but I cannot force them to come in.

Long story short, physician burnout is a real thing. It affects nearly half the physicians in a lot of different specialties, and obgyn is no exception. I just want everyone to keep in mind that we doctors realize that everyone is struggling right now, but we need you to realize that we are right there with you.

Have a thoughtful day.

Dr. Katz

Corona doesn’t just invade bodies. It invades conversations too.

Wow this is so true! I am finding that there is no situation or conversation setting that is risk free of the corona topic. It just creeps in somehow no matter what. I am willing to bet that part of the culprit there is that people realize that I am a physician, but I cannot change that. It’s just that I need a break from talking about it every now and then. It comes up in the most bizarre situations though. It even came up when our farrier was over working on our horses and the llama guys were over shearing the llamas. Heh? Llama corona? Corona and horse feet? Although I also have to admit that I seem to wait with baited breath in every conversation for the corona lead in and on the rare times that it doesn’t present itself, I find myself bringing it up. I seem to have a multitude of strategies pre-prepared just in case. So, I guess I have to embrace a lion’s share of blame in that regard. I am not sure why I do that. I think part of it is that I am determined to share a logical, fact-based viewpoint about the whole situation, as opposed to the barrage of half-truths and conspiracy theories that I hear everyday. I also sense that people just need to hash it over and talk about it still until life resumes some sense of normality so why fight it? I have to admit tho, I do wax poetic, dreaming about the days when I used to talk about something else: books, tv shows, kids, pets, politics( yuck, rarely), and even OTHER world events. Those were the days weren’t they? In the spirit of the return to normal life, let’s make a pact: Have at least one conversation a day without discussing corona virus. Come on! Who’s with me? Cheers to talking about……anything else! Have a fantastic day everybody!

Dr. Katz

Isn’t it strange that it’s ok that I’m human now, but it wasn’t ok before?

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Traditionally, it seems that most patients do not view their physicians as actual, potentially flawed human beings. It’s just too uncomfortable a concept. If patients viewed their doctors as humans, that would mean that they would have to acknowledge the fact that they can make mistakes, have emotions, have physical ailments, and emergencies as well. To most patients, that is an untenable thought. Their doctors need to be superhuman, infallible, and infinitely available at a moment’s notice. This kind of thinking allows patients to engage in demanding, unreasonable, and entitled behavior at times and puts a significant burden on the doctor patient relationship.

Interestingly, this seems to have turned around somewhat now in the time of COVID. Now it seems like patients are attaching themselves more to doctors who are showing their human side. The videos I post of myself at home in regular clothes or talking about how I finally figured out how to do my nails by myself get tons of views. Patients are listening with baited breath to see how I might be struggling with all of these changes. It’s as if listening to me is giving them tacit consent that it’s ok not to be ok right now. I feel like giving them a glimpse into me as a person is actually helpful right now. I can potentially help guide them through the proverbial tunnel to the other side of this thing. I get excited when I post my Facebook live daily video in the morning and all those people tune in. Knowing that I am able to reach all those people in a positive way helps me too. Personally I am loving it. If I can be myself with patients and still help them at the same time, I am all in! I would prefer to be that way all the time, within reason of course. I still stand by what I have said in previous blogs. Patients who are suffering or have just been given a terrible diagnosis do not necessarily care how I am feeling at the moment. Common sense still has to reign supreme here. I guess what I am really saying is that I hope the compassion doesn’t die out when the pandemic does. Have a great day everybody!

Dr. Katz

Umm….since when are vaginas NOT essential?

I saw a meme the other day with a woman straddling a lap top computer and it read: The new face of gynecology. At first I totally laughed out loud, carefully distancing myself safely into the ” That’s so ridiculous.” response category. Then, I stopped and realized whoa? Are we that far off from that right now? The struggle to get on the list of essential businesses right now is real and we all want to get there, but who decides what is essential and what isn’t? There are some things that are black and white in regards to this decision…..or are they? Ice cream shops are not essential, unless you have that sudden, overwhelming craving or you are a pregnant woman and nothing else will do to go with your pickles. Paint shops are not essential, unless you were trying to finish painting your wall and ran out just prior to reaching the last quarter panel. Movie theaters are not essential, unless you are on your last nerve with multiple bored children and seeing a movie is literally the only thing that they are able to reach a consensus on. I realize that these examples are somewhat facetious, but you get what I mean about perspective right? I totally agree with social distancing and restricting interactions to essential ones to help flatten the curve and decrease the spread of this awful virus. I am just not sure that we are all on the same page regarding what is essential and what isn’t.

I hear lately that gynecology is not essential and that obgyns should only be seeing ob patients or patients with infections. WHAT?! HEH?! I guess that seeing ob patients is more of a black and white call since there are two humans involved and we cannot monitor them over the phone or perform ultrasounds…..or c sections, but why isn’t gynecology essential? Why aren’t vaginas important? I am living in fear of fines or getting reported right now as I continue to see gynecology patients( with a zillion precautions of course) that I deem to be essential. It’s all I know how to do. Gynecology patients still need care, COVID or no COVID. The key to the relatively high success rate of cure in gynecology is timely, proactive, and preventative diagnosis and we are removing that advantage all together by denoting gynecology as non-essential.

I have heard patients say that they were turned down by other offices when they called to make an appointment because they were having abnormal bleeding. I confess, I got them right in! To me, bleeding is essential! I have had to turn down multiple patients whose incontinence I am treating with our awesome in-office options because that is not considered essential. I am sorry, but not peeing on yourself uncontrollably seems very essential to me. I am not allowed to do gyn surgeries for right now unless life or limb is imminently threatened or cancer staging is affected. Well, how am I supposed to know if cancer staging is going to be affected if I can’t go in and look with hysteroscopy in the first place? I can’t make that call without all the information. What if doing that surgery would make a life or death difference and I just don’t realize it? In addition to that, if I wait until someone is bleeding to death( life or limb risk), it may be kinda too late to do anything about it. Just sayin. If we get a bad outcome in the end because of delay in care due to COVID, are we going to be able to use the COVID-19 defense in court? Do we think that patients will care that we had to hide behind COVID restrictions if they lose their own lives or the life of a loved one? I feel confident that the answer is no when this is all said and done. I feel like all of these delays are just a tiny sample of the reality of the socialized healthcare that people think they want because it sounds good on paper. Just something to think about. Have a great day everybody.

Dr. Katz

Is anyone else getting maskne lately?

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The struggle is real! I have discovered yet another snarky perk of the war against COVID 19: chronic mask-wearing acne! It is a beast that is not likely to be tamed any time soon…lol Our skin is under attack from chronic suffocation, bacteria and the extra dry environment under our masks. Who knew we would be fighting a blemish war too! I did not sign up for this. Having said that, would I rather battle a pimple than a life-threatening respiratory infection? Yes ma’am I would. There are things we can do to try to save our skin for now. There is nothing we can do if we die from COVID 19 so, in terms of the big picture, the war on acne is decidedly less important. However, I just don’t need one more thing to frustrate me when I look in the mirror in the morning and neither do you so here are a few tips. Personally, I have stepped up my skin regimen to include three times a day face washing with my Neutrogena Cooling Gel Scrub: once in the morning before I put the mask on, the second I take it off when I get home, and again before bed. I have also added cleocin wipes twice per day for the bacteria that are now allowed to lay on my face all day. To combat the additional dryness, I am adding a little bit of Neutrogena Oil Free Moisturizer. Now, if you are not experiencing dryness, please don’t add the moisturizer. It will only make things worse.

Now that I am done complaining about my skin, let me start out by saying that I believe in almost all of the precautions that we are taking lately to help prevent the spread of COVID. Or, at least let me say that I understand them all, but I still have mixed feelings about some of them. We need to wear the masks when we are around people and patients and have to go to the store. We need to practice social distancing of at least six feet. Yup I get it. I have to admit that I am still not sure about the limiting going between two houses and the not being able to paint or plant part. I understand that if you are going to your cottage you probably also have to go to the gas station and grocery store, but if you want people to distance, what better place to do that than their cabin in the woods? The same kind of goes with painting and planting…..unless people are throwing plant and paint group events. So, the store is open, but the parts of the store that people could use to stay at home and do home projects to keep themselves busy is not. Hmm. I can understand people’s frustration with that one. I think that if you are asking people to do necessary self-quarantine and social distancing, why not facilitate it being easier to do so? But, keep in mind that the government is just trying to keep us safe and that restrictions are necessary. Also keep in mind that some people would take these extra allowances and run with them and forget social distancing all together and put us all at risk. I guess it is a balancing game: potentially over calling restrictions to balance out risk for the people that would abuse the extra allowances and cost thousands of extra lives. It is an incredibly difficult game to play and I do not envy the government officials at all. The responsibility of just caring for my family and my patients is a lot to take on at times. The responsibility for a whole nation must be overwhelming to say the least. I don’t think I could handle it. Could you?

Dr. Katz

It was still a good Easter.

Yes I said it. Easter was still good. I saw everybody posting in despair about not being able to see family members. Umm. Unless you live alone, you still saw some family members right? Or, even if you do live alone, there is still skype, facetime, zoom, etc. You can still see people that way. Yes, you can’t hug or touch them, but we are not supposed to right now anyway remember? It’s a saving lives thing? So, even if you were able to get close enough to see them, it would still be like a tease because you couldn’t go up an grab ’em like you want so what would be the point?

Anyway, moving on. Like I said, Easter was still good. We still had good food. We still enjoyed the company of just the four of us: my husband, myself, and our two daughters. We ate at the dining room table with no cell phones. My husband did all the cooking! We formed a group chat with the relatives. We still had an Easter egg hunt. I still left baskets out for my teenagers with chocolate and goodies….and autographed pictures of the Easter Bunny of course. We still decorated eggs. We still stopped to remember what the day is really about and gave appropriate thanks. No, we did not attend a live church service. No, we did not go to a big family party. We just laid low. It was a great excuse to not wear a bra and stay in pajamas all day. I don’t think I even showered as a matter of fact, not because I was depressed about COVID or angry at the Governor, but because I just didn’t have anywhere to go. The pressure was off. That’s a plus in my book.

On a side note, we groomed the dogs out of desperation. That really just reminded me of how indispensable our groomer really is and how much I respect her for keeping safety in mind and also laying low right now. Both are dogs now look like a five year old took the kindergarten scissors to them with no supervision. Hey I tried ok? I mean, they don’t seem upset about it. I didn’t cut anything I wasn’t supposed to. There was no biting, blood, or whining. As a matter of fact, at one point they just laid down and surrendered because I think they realize that all other options had been exhausted. So, I am gonna take that as a win…for now. But the second the groomer is back in business I will be begging at her door and bringing bribes…lol.

I think the thing that I enjoyed the most is that the four of us were together all day long. My 16 year old even made an appearance instead of lurking in her room. We had great conversations. We admired our own handiwork in literally every room of the house that is now organized and purged for the first time in like seven years. Whoo! I took the time to just look at my kids and my husband and listen to them and soak up every minute. These things seem so small and trivial, but I treasured every one of them. They all remind me of how precious and wonderful life is and how we should never take even the smallest thing for granted. Hope everyone had a meaningful and happy Easter!

Dr. Katz

COVID-19 and Pregnancy

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Hi everybody! We have been doing so many updates about all aspects of this virus and it’s effects lately. It seems to be all we can talk about. However, I feel like we have forgotten about the preggies. It’s time to review a little bit about what we know about COVID and pregnancy. Please keep in mind that whatever I explain right now this minute could still change tomorrow. The following is a break down of the recent commentary about COVID and pregnancy in the journal Obstetrics and Gynecology.

First, let’s keep in mind that the WHO only declared a global pandemic as of March 11th, so there hasn’t been a ton of time or pregnant women to study since then. Let’s go over what we do know and what we have seen. Keep in mind that this situation is changing rapidly. As of March 17th, more than 189,000 people have been diagnosed with COVID globally with more than 7,500 deaths and more than 150 countries involved. Realistically, this is probably just the tip of the iceberg because of the limitations of testing so far. We know the common symptoms of dry cough, fever, and fatigue. We know that the incubation period is up to two weeks. We know some of the findings on chest x-ray and in lab tests that can occur with COVID and we are working on a serum test instead of the nasal swab. We also know that there are multiple very similar coronaviruses that have been around since the 1980s! Hmm. How new is this thing really? I am asking for purely academic interest only I promise. Has it really been around all this time in bats like the other viruses and somebody just finally ate the right/wrong bat in a soup so it could make the jump to humans?

Ok. I am getting distracted. I was supposed to talk about COVID and pregnancy. So, what do we know about the preggies anyway? So far, there have been three case series for a total of 31 pregnancies affected by COVID that have been published. We also have a WHO report from China with some limited information on 147 pregnancies. We also have reviews looking at features of other coronaviruses like SARS(Severe Acute Respiratory Syndrome-Associated Coronavirus) and MERS( Middle East Respiratory Syndrome-Related Coronavirus) in pregnancy. The American College of Obgyn has already published guidelines for pregnancy and the CDC has posted answers to frequently asked questions about COVID and pregnancy, but there is still a lot we do not know for sure right now.

So, what are the answers and what are the questions? One of the biggest questions is the case-related fatality of the disease in pregnancy. It is hard to sort through the data on the fatalities because the fatality rate really depends on the co-morbidities of the patients, the quality of the health care provided and the age and health of the patients affected. It’s not just straight numbers. So far, rates around the world have been reported in a range from .9% to 9%. But remember, these rates are overall rates, not adjusted for the variables mentioned above. Plus, mild or asymptomatic cases can be missed so the fatality numbers can actually be overestimated. We don’t fully know the fatality rate in the United States yet and as of yesterday, we do not have any fatalities reported in pregnant women that I am aware of.

We still have questions about all the routes of transmission of COVID as well. We are still looking at how long the virus survives on surfaces. So far, 9 days is the magic number, depending on the surface and the particular coronavirus. We are still looking at whether asymptomatic people can transmit the virus. For a pregnant woman, the biggest question if there is vertical transmission of the virus. Vertical transmission refers to transmission of the virus from a pregnant woman to her fetus. We really haven’t had enough pregnant women yet to compare to nonpregnant women of similar age. There was a small study comparing SARS in similar aged pregnant and non-pregnant women that suggested that pregnant women may have a greater incidence of severe disease and death, but we are not seeing that so far with COVID.

As far as vertical transmission, we really don’t know the answer yet. SO FAR, we have not seen it yet in the small number of COVID pregnancies reported up until this point. This sounds great, but I don’t think we can count on this just yet. I am going to hang on to this bit of potential good news anyway for now. I will say that the in the group of pregnancies studied so far, the vast majority of women were infected in the third trimester and most of them had delivery by c section. We don’t really have any pregnancies to refer to at this point where the women were infected in the first or second trimester.

There is a question about pregnant health care workers and COVID. Should they be given special consideration? In the past, the CDC has recommend different guidelines for different viruses. For H1N1, they recommended that pregnant workers follow the same precautions as other workers, but maybe avoid any procedures that could generate aerosols( infected respiratory droplets). A different systemic review of 1862 publications rated the following as the aerosol-inducing procedures with the highest risk of infection transmission of SARS: tracheal intubation, tracheotomy care, airway care, and cardiac resuscitation, non-invasive ventilation and manual ventilation before intubation. Results were mixed as far as nebulizer treatments. With Ebola, the CDC recommended that pregnant workers not even care for those patients. We just don’t have enough data yet to make specific recommendations for pregnant workers and COVID.

Currently, hospitals are recommending immediate separation of newborns from COVID positive mothers postpartum. At our hospital currently, COVID positive mothers will remain in negative airborne isolation throughout their stay. Immediately after birth, the neonate is put into an isolette, separated from the mother and moved into the nursery under negative airborne isolation. Those mothers that choose to have their infants remain in the room for bonding must wear PPE( personal protective equipment) and the infant must stay in the mother’s room throughout the entire stay. Remember that so far, we have not seen vertical transmission (mother to fetus in the womb), but the neonate could still get infected after exposure to the mother after birth. Luckily, so far, it looks like children in general are mildly affected by COVID, but we really don’t know about neonates.

So, where does that leave breastfeeding? We have a very small amount of data that suggests that SARS is not transmitted through breastmilk, but we really don’t know about COVID. Even the SARS data is too limited to apply on a broad scale.

I get it. I just basically said that we really don’t know anything solid about COVID and pregnancy. The situation is just evolving too fast. We do have some possibly good news about the lack of vertical transmission but we need to keep watching. At this point, the best thing to do regarding pregnancy and COVID is to keep using the same methods that we already are to prevent the spread of other viruses like the flu. Tell patients to not go around known ill persons. Tell them to wash their hands frequently and not touch their face. Tell them to cover their coughs and sneezes and not just blast into the open air. Screen pregnant patients for upper respiratory symptoms, travel, cough and fever and triage accordingly. Separate ill patients from well patients. Limit visitors to labor and delivery and postpartum. Cancel mass gatherings and concerts. Maintain social distance. The reality is that pregnancy care does not truly lend itself to telehealth as a rule. These patients need regular visits. We need to take every universal precaution, like we should anyway. Give patients copies of their records frequently in case their care gets disrupted.

Basically, this situation is going to keep changing until it runs it’s course. This is the best info we have available right now. Until we have more data on more pregnant women, this is all I have to offer you right now. I think the key for now is to use common sense and universal precautions and to stay tuned for more updates as they arise. Hang in there and try to have a great day.

Dr. Katz