Oncologist and mum-to-be chronicles COVID-19 experiences

By Dr. Ananya Mandal, MDApr 26 2020

Writing in the latest issue of JAMA Oncology researcher Coral Olazagasti along with her Dr. Nagashree Seetharamu from Zucker School of Medicine at Hofstra, Northwell Health, Hempstead, New York, spoke about her experience being pregnant during the present COVID-19 pandemic. Olazagasti’s chronicle is titled “Facing a pandemic while pregnant.”

Facing a Pandemic While Pregnant. Doctor performing an ultrasound scan. Image Credit: Shutterstock

Beginning

Olazagasti was a second-year hematology-oncology fellow when on the 15^th of December 2019, she realized she was pregnant. There was no hint of what was to come in terms of the COVID-19 pandemic. She was bracing herself to face the challenges that a pregnancy, along with a fellowship entails. She was expecting an uphill task with her work and her pregnancy. What was unexpected in late December, were rumors about the spread of an unknown virus in China. The virus was identified to be associated with a seafood market at the end of December, and a cluster of patients was found to have developed pneumonia-like symptoms, which were unexplained.

Things start to come into focus

In time, the virus was identified as the novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes COVID-19 or coronavirus disease 2019. While initial cases were linked to the seafood market in Wuhan, soon there were reports of person-to-person transmission of the infection. By the end of January 2020, the virus had spread to at least 21 countries and numbers of cases were on the rise in these nations with a rapid spread from one individual to another.

The first physician dies of the infection

Olazagasti recalls that on the 7^th of February, the 33-year-old doctor who had first raised the alarm regarding this new virus and the unexplained respiratory distress it causes had died from the disease. He was persecuted initially for spreading false rumors when he had tried to bring the disease to the attention of the authorities.

The United States had its first confirmed case of the infection on the 20^th of January in a 35-year-old male who had returned from Wuhan, China – the epicenter of the infection. The patient was admitted to a care clinic in Washington State. He had a cough and fever on admission. The Centers for Disease Control and Prevention (CDC) obtained nasopharyngeal and oral swabs from the patient and tested it to be positive for the virus.

Information regarding the virus and its transmission disseminated

Olazagasti states that soon, the virus was all they could talk about and more and more information came into the forefront. The transmission of the virus was found to be aerosol borne, and it led to severe complications in some individuals. This included severe pneumonia, respiratory distress syndrome, and respiratory failure. People started dying.

Along with this information, starting the second week of February, Olazagasti began her three-month rotation duties of “inpatient consult rotations.” She was terrified that she would come in contact with a COVID-19 positive patient during her rotations. She reassured herself that since the disease seemed to be dangerous for the elderly and those with other serious ailments, she, a healthy 31-year-old was relatively safe. What was at the back of her mind at the time was the fact that because she was pregnant, she was in an immunosuppressed state. She wrote, “Despite not wanting to, I started fearing not just for myself, but also for my unborn, still-developing baby who I had already grown so attached to.”

New York records first case

On the 29^th of February, New York recorded its first case. Over the next few days, she wrote, the cases started multiplying and soon the numbers doubled. Olazagasti started feeling paranoid as 89 people were tested in quarantine in Nassau County. The hospital she worked with was located here.

Dilemma – doctor vs. mother

She faced a moral dilemma around this time. She wrote, “My thoughts kept fluctuating between a feeling of fear and my almost-reflexive sense of altruism, which is the very reason I chose this profession over others. I, like many others in my profession, have over the years developed a mindset that compels me to choose work over anything else.” She writes about how she had felt guilty earlier if she took sick days and worked through patient care despite minor ailments.

Thus she kept working “through overwhelming anxiety,” and the number of cases continued to rise. In her brain, her maternal instincts fought with her physician’s instincts she wrote, and this was happening daily as the situation remained grim and worsened every day. She almost wanted her one of her supportive colleagues and co-fellows to take over from her during this period, but one part of her told her that if she took necessary precautions, she would be safe.

Were necessary precautions enough?

She goes on to write that hospitals were running out of surgical masks and gowns and other protective equipment, and thus there was no hope that she would be able to take all the needed precautions not to catch the infection from a patient or a colleague who was COVID-19 positive. She remembers that the protective N95 masks were not easy to come by, and despite their disposable status, people were “writing their names on them and reusing several times over.”

Less number of tests

During this time, countries like South Korea were screening large populations for the infection, but the United States lagged in testing with a significant shortage of the testing kits, and the CDC had thus issued guidelines to test only a select few based on guidelines.

Institutions were testing for influenza and other diseases before they were allowed test for COVID-19, she wrote. But there were reports of patients being infected by both influenza and COVID-19. She spoke of a female patient reported by the Vienna International Centre, who had influenza in early March and later was positive for COVID-19.

Limited evidence of COVID-19 in pregnant patients

She wrote that since the virus and its effects were still being studied, there was little evidence of what it was causing to pregnant women and their unborn babies. An earlier study had shown that nine pregnant patients with COVID-19 did not develop severe symptoms and also “gave birth to healthy newborns.” More such, albeit small, studies were published.

Olazagasti wrote, “For a moment, I would like to believe that neither I nor my baby will get really sick from the virus based on these reports, but I cannot ignore the real chance that I or any of my colleagues working in health care might become a vector for the virus with minimal or no symptoms.”

Conclusions

She concluded that these were “uncharted territories” and some more than others, are at risk. She wrote, “Living and working in this era of horrific pandemic while pregnant is definitely not easy, but faith in God and support from my family, friends, cofellows, and institutional leadership has gotten me this far, and I hope it will continue as I tread along.” She went on to say that this would surely pass, and this journey “about how we learned, united, overcame, and grew together,” would be remembered later when it does.