CHR’s COVID-19 Bulletin, 5/22/2020

[This article deals with an evolving situation with many unknowns. It was written by Norbert Gleicher, MD, on May 21, 2020 and published on May 22, 2020. For a list of all COVID-19 Bulletins, scroll to the bottom.] 

Though much still remains to be leared about COVID-19, clarity is starting to break through the clouds on a number of important issues. We here do not intend to repeat in detail what media are reporting on a daily basis but want to, with bullet points, simply summarize some of the conclusions that are becoming increasingly obvious but are not always reported by the media.

Mortality

  • The virus causing COVID-19 is highly infectious but has a much lower mortality than initially reported. It appears likey that the overall mortality is in the 0.25-0.85 range, if one considers all individuals infected. This is in the range of influenza virus infectivity.

Antibodies and Viral Mutation

  • It now also appears well established that, like other Corona viruses, COVID-19 infections produce traditional IgM and IgG antibodies; i.e., traditional humoral anti-viral immunity. What is not known yet is for how long this immunity lasts.
  • How quickly the virus mutates is also not known yet, but preliminary data suggest that the mutation rate in this virus is significantly lower than in influenza viruses. If confirmed, this would greatly enhance development of vaccines that do not, as influence vaccines do, have to be reinvented every year. 
CHR tries to combat misinformation about COVID-19 through these periodic COVID-19 Bulletins. Image by United Nations COVID-19 Response via Unsplash.

Risk Groups

  • It is incorrect to judge the clinical virulence of this virus based on its above-noted overall mortality rate because, probably, more than half of infected individuals either have no or only minimal clinical symptoms. These “low risk” patients, therefore, do not require protection from becoming infected.
  • To the contrary, society would benefit from these “low risk” individuals becoming infected as quickly as possible since, considering that this represents more than half the population, their immunity against the virus would quickly establish an adequate level of herd immunity in the community to protect more vulnerable populations from COVID-19 infections.
  • On the other hand, the mortality in “at risk” individuals is very significant. Though it is currently impossible to estimate an  individual’s risk of death if infected, in “high risk” patients, that risk can be substantial. Infection with COVID-19 in “high risk” patients, therefore, must be avoided at almost all cost, until either reliable immunization strategies are available or adequate herd immunity has evolved.

Mitigation Strategies

  • The virus is primarily transmitted through the air and not, as has been believed, from contact with surfaces. A large majority of transmissions occur in closed home environments (including nursing homes) and transmission is time-dependent: the longer the exposure, the greater the risk of infection. This is probably due to the fact that the risk of infection also relates to the size of the inoculum (i.e., how much viral DNA enters a person). The larger the inoculum, the more severe the disease and the higher the mortality.
  • Universally mandated home quarantines for the so-called non-essential workers, as currently still in place in New York, New Jersey and Connecticut (as well as in many other cities and states), epidemiologically and medically, make absolutely no sense. In retrospect, they likely never made sense!
  • A recent study by Morgan Stanley demonstrated no increase in adverse COVID-19 effects from reopening local economies in states that acted earlier than others. To the contrary, those states actually demonstrated fewer COVID-19 cases. These data may, however, be biased because less affected states, of course, can be expected to reopen earlier than more affected states, like New York and New Jersey.
  • In contrast to earlier recommendation by the CDC, face masks work in preventing virus spread if they are of good quality and if they properly cover the nose and mouth. Since even asymptomatic individuals can spread the virus, face masks should be required until herd immunity is established, either via vaccination or through natural evolution, whenever a second person is present, whether indoor or outdorrs. Concomitantly, social and sanitary habits of no handshaking, frequent hand-washing and avoidance of touching one’s face should be maintained.
  • Recently published data suggest that the number of deaths due to the deteriorating economic situation in the U.S. may have reached a point where it exceeds the death rate of the COVID-19 virus. In other words, the medicine causes more fatalities than the disease! 

Pregnancy and Reproduction

  • The COVID-19 virus does not appear to cross the placenta. A handful of cases reported in the literature where COVID-19 DNA and/or IgM antbodies to the virus were discovered in newborns (IgM antibodies are too large to cross the placenta), likely, represent artefacts since none of these newborns ever developed COVID-19 symptoms/disease. 
  • In contrast to the influenza virus, the COVID-19 virus does not appear to cause more severe disease in women who are pregnant. Available outcome data on COVID-19 infections for mothers and offspring are, however, still sparse.
  • COVID-19 viral DNA has in one study been reported in semen. However, like in newborns, detection of DNA does not mean infectious potential. That the COVID-19 virus can be sexually transmitted, as of this point, indeed, lacks all evidence.

In summary, the reopening of the U.S. economy appears overdue. This does not mean unrestricted reopening and abandonment of all quarantine measures but “guided” reopening, almost unrestricted for low-risk individuals and increasingly restricted with increasing risk status. Interested readers are also referred to CHR’s upcoming monthy newsletter for June, the CHR VOICE, where an article will address what it means “to follow science,” when combating the COVID-19 virus.

Other COVID-19 articles

  1. What we now know about COVID-19 and what it means for mitigation strategies (Published on May 22, 2020)
  2. COVID-19 response in retrospect, as well as going forward (Published on May 7, 2020)
  3. The essence of the COVID-19 pandemic (Published on May 7, 2020)
  4. Practical consequences of COVID-19 for CHR’s fertility patients (Published May 7, 2020)
  5. IVF after COVID-19: ASRM and SART release reopening guidelines for IVF centers (Published on 4/29/2020)
  6. One medical expert, missing from all COVID-19 task forces, who should be listened to (Published on 4/29/2020)
  7. Governments worldwide should have let herd immunity develop rather than cause one of the worst recessions on wild guesses of “experts” (Published 4/27/2020)
  8. Reciprocal collaboration among IVF centers for cycle monitoring may be on the wane (Published 4/22/2020)
  9. Is embryo freezing better than IVF during COVID-19 outbreak? (Published on 4/17/2020)
  10. When to restart fertility treatments after COVID-19 (Published on 4/17/2020)
  11. “Reopening” of fertility centers after COVID-19: How that may look like (Published on 4/17/2020)
  12. Some IVF centers may never reopen (Published on 4/17/2020)
  13. Skepticism warranted for “expert opinions” on COVID-19 (Published on 4/13/2020)
  14. Fertility Providers’ Alliance tries to reframe ASRM’s reaffirmation of COVID-19 guidelines as FPA victory (Published on 4/6/2020)
  15. States in the Northeast may see first signs of “flattening the curve” (Published on 4/6/2020)
  16. Reported death rate exaggerated by the media, shelter in place or herd immunity, first COVID-19 antibody test approved, and more (Published on 4/3/2020)
  17. What can I do to continue on my fertility journey? [VIDEO] (Filmed on 3/26/2020, published on 4/2/2020)
  18. “Controversy” over ASRM recommendation hints at investor interest’s power grab amid COVID-19 pandemic (Published on 4/2/2020)
  19. Pregnant women concerned over delivery and babies during COVID-19 pandemic (Published 4/1/2020)
  20. ASRM’s COVID-19 Task Force reaffirms previous recommendations (Published 4/1/2020)
  21. To stay open or not: IVF centers argue over ASRM guidelines on COVID-19 and fertility treatments (Published 3/27/2020)
  22. Concerning news on COVID-19’s effects on pregnancy and newborn (Published 3/27/2020)
  23. What’s urgent is urgent and what’s not urgent isn’t: Explaining ASRM recommendations on fertility treatments during COVID-19 pandemic (Published 3/26/2020)
  24. Patient autonomy and “do no harm” principles mean CHR continues to offer fertility diagnosis and treatments during COVID-19 crisis (Published 3/23/2020)
  25. ASRM and SART’s recommendations on fertility treatment during COVID-19 outbreak (Published 3/18/2020)
  26. CHR’s response to the COVID-19 outbreak: What we are doing to protect our patients, staff and community (Published 3/13/2020)
  27. Does COVID-19 have an effect on fertility? (Published 3/13/2020) 
  28. What happens if I get quarantined during an IVF cycle? (Published 3/13/2020)
  29. What happens if CHR is closed for quarantine during my IVF cycle? (Published 3/13/2020) 
  30. What should fertility patients do during the coronavirus outbreak? (Published 3/13/2020) 
  31. Should international patients of IVF do anything differently during the outbreak? (Published 3/13/2020) 
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.