As ICUs reach capacity, pregnant women must get vaccinated
As the chief medical officer for a large obstetrics (OB) medical network whose obstetrician/gynecologists are available in the hospital 24/7, I work with fellow OB/GYNs and labor and delivery rooms throughout the country.
In recent weeks, our network of 1,000+ OBs are witnessing a disturbing trend among pregnant women — between 200-250 distinct patients are showing up with COVID-19 each week at the hospitals in our network. This is the highest weekly number our network has seen since we began tracking this data back in 2020. What’s more, the majority of these recent encounters have taken place in the obstetrics emergency room, or OBED, representing 59 percent of the volume.
This uptick in cases is shocking and disturbing. Until August, hospitals were cautiously easing restrictions on labor and delivery rooms and relaxing visitation restrictions for visitors. All that has changed as hospitals across the country are reporting record numbers of COVID patients. Most of these cases are unvaccinated patients. The trajectory is likely to continue as the weather turns colder (bringing more people indoors), kids return to schools and a large number of holdouts continue to refuse vaccinations.
Much of the reluctance among pregnant populations initially came as a result of their exclusion from clinical trials for the Pfizer, Moderna and Johnson & Johnson vaccines. Flaming the resistance were false internet rumors that vaccinations could result in infertility. However, studies on pregnant women beginning last February show no increased risk of miscarriage from the shots and according to the Centers for Disease Control and Prevention, zero evidence that any vaccines, including COVID-19 vaccines, cause fertility problems in women or men.
What is documented is the danger pregnant women face if they contract COVID-19 and have not been vaccinated. Current research published in the American Medical Association’s JAMA Network Open shows that pregnant people who are infected by the virus are three times more likely than non-pregnant populations to end up in the ICU and up to three times more likely to need life support and have an increased risk of death. In addition to putting themselves in harm, by not getting vaccinated, pregnant women with COVID also face an increased risk of stillbirth and premature birth.
According to research published in the same journal, COVID infected pregnant patients were 40 percent more likely to deliver prematurely and were admitted into hospital ICUs at a rate six times higher than non-infected patients. For physicians, caring for pregnant patients in the ICU poses additional risks by straining already scarce resources meant to serve all patients needing emergency care, not just COVID patients. In a delivery setting, providers have to ensure the oxygen levels remain high to keep fetuses safe from the effects of a lack of oxygenation, and in some cases, performing risky emergency deliveries to avoid health complications for a compromised mother is the only choice.
The benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy — policymakers and health leaders must do better in ensuring that expecting mothers hear this message loud and clear. More is needed to help pregnant women understand the risks they face by choosing to forgo a preventative and potentially lifesaving vaccine.
Policymakers can take urgent actions to help correct misinformation by investing in outreach to help get the word out about vaccine safety to expecting mothers. This is particularly important among communities of color, who are being disproportionately impacted by both COVID-19 and maternal mortality. As one physician recently discussed in The Nation’s Health, helping communities to understand the risks of and helping them to identify trusted and accurate data can help with understanding the local impact of the virus.
Health systems must also deliver unvarnished evidence demonstrating the risk of serious complications and potential outcomes in a way that resonates with their patients. This conversation needs to include a reminder that the recent COVID-19 surge is affecting young and healthy pregnant people with no underlying illness or risk factors. By the time the patient presents in the labor and delivery unit or OBED with COVID, it could be too late.
And finally, the current situation underlines the critical need for resources to support physicians on staff in the ICU and emergency room setting. This means skilled specialists familiar with emergency procedures for pregnant patients, including OB hospitalists, nurse midwives, and others. Time-tested, professional medical staff are needed to support the existing workforce in keeping pregnant patients with COVID and their unborn babies healthy. Finding ways to reimagine the care team to ensure that hospitals are staffed with experienced physicians at all times is absolutely critical, particularly as more and more healthcare staff exit the workforce.
The situation is dire, but not without answers. By taking steps now to keep pregnant women informed of their risk, encouraging them to get vaccinated and preparing for those who end up in the ICU this fall, we can help ensure that the mortality rate of COVID-19 is much lower than current predictions are estimating and hopefully save many mothers and their babies.
Dr. Mark Simon is the chief medical officer of the Ob Hospitalist Group and a board certified OB/GYN based in Denver, CO. Twitter: @mnsmd
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