Twenty-eight-year-old Priyanka Suresh was seven months pregnant when she was infected with COVID-19 in early May amid a raging second wave in the national capital. The mom-to-be had not left her home for over a month when she caught the virus.
Even as she awaited her RT-PCR results, Priyanka’s family doctor, in consultation with her gynaecologist, began treating her. But she showed no signs of improvement. On 5 May, her oxygen levels started plummeting.
“We ran from pillar to post to find a hospital bed. We took her in an ambulance – rushing from one hospital to another – before we found one. But, by then, I knew we had reached a place we could not get back from,” Suresh, her husband, broke down while speaking to The Quint.
Two days later, on 7 May, India registered almost 3,700 deaths on paper. Priyanka was one of the thousands of mothers-to-be who lost their lives between April and May this year.
And now, a latest study confirms that the second wave has been devastating for pregnant women as compared to the first.
What ICMR Study Reveals
According to a new study by the Indian Council of Medical Research (ICMR), the case fatality rate (CFR) in pregnant and postpartum women was 5.7 percent in the second wave as opposed to just 0.75 percent in the first wave.
CFR is crucial because it calculates the proportion of people who die of a disease – here, due to COVID-19 – among the total number of patients diagnosed with the disease. Data of nearly 4,000 COVID-positive pregnant women was analysed for the ICMR study that was released on 16 June and is due to be published in the Journal of Gynaecology and Obstetrics.
The number of symptomatic patients too, were far higher in the second wave. 28.7 percent of pregnant and postpartum mothers showed severe symptoms as against 14.2 percent who showed any COVID-19 symptoms during the first wave.
"“During the first wave of pandemic, hardly five of my patients were infected with COVID-19. Barely anyone had severe symptoms. But in this wave, if I had 100 patients at a point of time – at least 30 were infected. The severity was across trimesters. You could not say first trimester was less severe than third. It was a nightmare. As a doctor, you want the best for mother and baby.”" - Dr Manju Gupta, Senior Consultant Obstetrician & Gynaecologist, Motherhood Hospital, Noida, told The Quint
Echoing her, Dr Nupur Gupta, Director, Obstetrics and Gynaecology, Fortis Memorial Research Institute in Gurgaon, said that in the first wave, most pregnant women were asymptomatic and tested positive right before or after delivery.
“In the first wave, no specific treatment for COVID-19 was required for pregnant women. This time, it was the opposite – many of them had to make the difficult choice of premature delivery to save the baby or lost their baby – as they had to go in for Remdesivir or high dosage of steroids or were kept on oxygen support. It was heartbreaking to witness this – whether they are your own patients or not. We have never seen this kind of emergency before. If anything, it showed that overall we do not have the infrastructure to deal with this kind of emergency,” said Dr Nupur.
Of Difficult Choices & Lack of Access
Unlike the first wave, social media too, saw increased SOS calls for hospital beds for pregnant women across Indian cities – often delaying the medical treatment in most cases.
“We used to receive at least 25 SOS messages for pregnant women in late April and early May – across major cities. There were absolutely no beds. Hospitals would want to help but did not have a gynaecologist on call in case some major complications arose. While we tried our best to find beds for everyone, there were times we failed. The number was exponential,” said a volunteer who was running an SOS group on Telegram.
Some women like Bengaluru-based Aneesha Singh (name changed) were unware of their pregnancy until they were infected with COVID-19. After battling in the hospital for almost a month and being on oxygen support for over 20 days, Singh had to make a difficult choice.
"“I have irregular periods so when I missed my date for a couple of months, I barely paid attention to it. But when I started having symptoms, I was asked to take a bunch of blood tests – which revealed I was pregnant. My husband and I thought this was a silver lining amid chaos. Never thought my health would get worse and the baby’s growth would not be as it should be for the first trimester. Family and friends say it was early days. But I lost my child.”" - Aneesha Singh to The Quint
“Many women contracted the virus in their first three-four months and had to terminate their pregnancy on medical advice. Some fathers had to choose between saving their partners or their child. In some cases, doctors advised early delivery in just seven or eight months – but ended up saving neither the mother or the child,” Dr Nupur told The Quint, adding that the radiation from repeat CT scans in some cases proved harmful for the pregnancy.
The second wave also made it more difficult for pregnant women to get regular treatment – making them more susceptible to infections. Non-COVID-infected pregnant women too, were not able to get regular medical care – leading to further complications, stressed Dr Manju.
"“See, we can do online consultation and all that. But pregnant women need to be examined physically. Yes, if there were 10 visits required earlier, we have cut it down to five, as per WHO recommendation. But the fact remains that we cannot take them through pregnancy without physically examining them. There are complications due to hypertension or diabetes and many women have missed the level-2 ultrasound – which is key to look out for foetal abnormalities.”"Why Delay Their Vaccine?
The World Health Organization (WHO), in early June, said pregnant women may be vaccinated if they face high risk of exposure to COVID-19, and if they have co-morbid conditions. “The study underlines the importance of vaccination of pregnant and lactating women against COVID-19,” said ICMR in a brief statement.
But India is yet to start vaccinating pregnant women, due to lack of clinical trial data, even as experts maintain that protecting the mother and the baby is more important than ever.
“The odds of getting adverse effects from vaccinations are far lower than getting infected with COVID. In this situation, vaccination for pregnant women, who are at high risk of complications, should be prioritised,” said Yamini Sarwal, lead author of a yet-to-be published study on prioritising pregnant women for COVID vaccinations and the chief medical officer at the Vardhman Mahavir Medical College in Safdarjung Hospital, New Delhi told IndiaSpend.
“Initial days have been very dreary, have been very depressing, and every phone call used to scare me. I would think, please let this not be my patient who has had an emergency. We give three vaccines to an expecting mother – to that one more will be added. Isn’t it better than putting her completely at risk with evolving variants? We are not talking about one but two lives here,” says Dr Manju.
The WHO report has also backed this, saying vaccines protect both the mother and the foetus since the antibodies get transferred as part of the routine antenatal protocol, the report said.
The Federation of Obstetric and Gynaecological Societies of India had COVID-19 vaccine for pregnant and lactating women in April, amid the raging second wave, noting that the benefits of vaccines outweigh the risks.
On 13 May, the National Technical Advisory Group on Immunisation had advised vaccination for both pregnant and lactating women. But the Ministry of Health and Family Welfare allowed only lactating women to be vaccinated – leaving vaccination for pregnant women, one of the most vulnerable groups – on hold.
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