Covid-19: doctors in final trimester of pregnancy should avoid direct patient contactBMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1173 (Published 23 March 2020) Cite this as: BMJ 2020;368:m1173
All rapid responses
Abi Rimmer discussed updated guidance recommending that pregnant doctors in the final trimester should avoid direct patient contact for the duration of the Covid-19 pandemic. (1,2)
Stratification of healthcare worker risk-exposure is needed to minimise the use of ventilator resources in treating healthcare workers at peak and also to share the risk of fatality equitably amongst healthcare workers. This should be logical, evidence-based and not misinformed by differing experiences with other infectious diseases.
Data from Italy and China show no increase in mortality or morbidity among pregnant females arising from Covid-19 infection. By contrast, compared with Covid-19-infected females aged 30 to 39 years, fatality in males age 50 to 59 years is 37 times greater and, in females age 60 to 69 years, 28 times greater. (3,4)
Risk of fatality by sex and age:
relative to that of 30-39 year-old females
Age-group Female Male
20 to 29 0 0
30 to 39 1 3
40 to 49 3 9
50 to 59 10 37
60 to 69 28 123
The breadth and depth of raw data and analyses contained in the daily bulletins posted by the statistical service of the Italian Ministry of Health are exemplary; easily exceeding the quality of anything available in the English language. (4,5) Unfortunately, their scientific content appears to be under-utilised by those unable to read Italian. More condensed version are available in English,
As of 27 March, there were 79,968 recorded infections and 7,590 Covid-19-associated deaths in Italy. (4) The relative fatality rates, according to age, sex and number of co-morbidities are very clear, with male fatality over three-fold that of females by within each age band. Crucially, doctors under the age of 30 years appear to be almost entirely protected with regard to fatality.
Healthcare workers represent 9% of confirmed cases in Italy, the median age at confirmed cases and fatality being 49 and 63 years in healthcare workers. In the population overall median age of confirmed cases and fatality being 62 and 79 years, respectively. (5)
More than 50 Italian doctors and dentists infected with Covid-19 have died, and their obituaries were recently posted by the Milan newspaper Il Corriere della Sera. (6) For 25 of these, the obituary confirmed that they had been clinically active. These comprised one female (age 68 years) and twenty-four males (age range 49 to 74, mean 63 and median 67 years).
The 37-fold increased fatality for males over 50 years of age and 28-fold increased fatality for females over 60 years of age demonstrate the need for stratification of healthcare worker risk-exposure. This needs to be done rationally and not be based on historic sociological preconceptions of age and gender roles.
The policy of deploying healthcare workers at such a high relative risk of fatality from Covid-19 to patient contact requires immediate re-examination to minimise the use of ventilator resources at the peak in treating healthcare workers, and to share risk amongst healthcare workers more equitably.
Prof Graham Roberts
HRB-Clinical Research Facility, University College Cork, Cork, Ireland and Swansea University, Swansea, UK.
Dr Richard Quinton
Senior Lecturer, Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, UK.
Mrs Irene Stratton
Senior Medical Statistician
Gloucestershire Retinal Research Group, Cheltenham General Hospital, Cheltenham, UK
1. Rimmer A. Covid-19: doctors in final trimester of pregnancy should avoid direct patient contact. BMJ [Internet]. 2020 Mar 23 [cited 2020 Mar 28];368:m1173. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32205356
2. Information for healthcare professionals Coronavirus (COVID-19) Infection in Pregnancy.
3. Zhang L, Jiang Y, Wei M, Cheng BH, Zhou XC, Li J, et al. [Analysis of the pregnancy outcomes in pregnant women with COVID-19 in Hubei Province]. Zhonghua Fu Chan Ke Za Zhi [Internet]. 2020 Mar 7 [cited 2020 Mar 28];55(0):E009. Available from: http://www.ncbi.nlm.nih.gov/pubmed/32145714
4. (No Title) [Internet]. [cited 2020 Mar 28]. Available from: https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_26...
5. Caratteristiche dei pazienti deceduti positivi a COVID-19 in Italia [Internet]. [cited 2020 Mar 28]. Available from: https://www.epicentro.iss.it/coronavirus/sars-cov-2-decessi-italia
6. Coronavirus, i medici morti: le storie di chi si è sacrificato - Corriere.it [Internet]. [cited 2020 Mar 28]. Available from: https://www.corriere.it/cronache/cards/coronavirus-sacrificio-41-medici-...
Competing interests: No competing interests
I'm not clear how this can be evidence based when this virus has only been around 4 months. How can we know the impact on pregnancy outcomes or fetal abnormality rates with exposure in the 1st 2 trimesters?
Competing interests: No competing interests