--:-- Sean Ramos-Virm: Hey, I'm Sean Ramos-Virm and this is a Coronavirus Update from Today Explained for Monday, March 23rd, 2020.
--:-- Sean Ramos-Virm: It's been a hectic 24 hours for the Olympics. Yesterday, the head of the International Olympic Committee said that the IOC had ruled out canceling the Games but was open to postponing them. Shortly thereafter, Canada and Australia became the first two countries to say they would not send athletes to Tokyo if the games went ahead as scheduled. Then this afternoon, IOC veteran Dick Pound told USA Today that the games would be postponed until 2021, with the details to be figured out in the next month.
--:-- Canadian Prime Minister Justin Trudeau got mad today. He said in a press conference, we've all seen the pictures online of people who seem to think they're invincible. Well, you're not. Enough is enough. Go home and stay home. He threatened to use law enforcement to enforce the rules if necessary.
--:-- President Trump seemed mad today too. He all caps tweeted, this is why we need borders! The United States Senate failed to agree on what's now a $2 trillion stimulus package that would shore up the country during the coronavirus crisis. The crux of the disagreement appears to be a $425 billion fund the Treasury Secretary Steven Mnuchin could use to aid American companies. Mitch McConnell was all, are you kidding me, to Democrats and the Democrats were all oversight, please. And what about workers? Complicating matters further, McConnell needs more Democrats to vote for this thing than usual because several Republicans are now in quarantine after Senator Rand Paul tested positive for COVID-19 over the weekend. One of the now-quarantined senators is Mitt Romney of Utah. When President Trump was asked about GOP senators in quarantine yesterday, he said, Romney's in isolation? Gee, that's too bad. In case you were wondering if an adult was in charge, looks like maybe no.
--:-- If you have questions for the show, email us todayexplained at vox.com. You can tweet at us too, today underscore explained. I'm at Romis Vroom. Support for Today Explained comes from Adio. Adio is an AI-native customer relationship management platform that Adio says is built for the next era of companies. A powerful data structure adapts to your business model, sinks in all your contacts in minutes, and enriches your business with actionable data. Adio says it also allows you to create those email sequences, those real-time reports, those powerful automations, which they claim can help you build what matters most, your company. You can go to adio.com slash todayexplained to get 15% off your first year.
--:-- That's A-T-T-I-O dot com slash today explained. Let's not mince words here. Death is in the air. People are sick. People are dying. We get tallies every day from Italy, from the United States, from just New York City alone. We're worried about our loved ones. It's hard to not think about the end of life. But there's a lot of people in the world who are focusing on the other end of life, on creating it. I mean, think about how many people are at home right now with nothing to do with their significant other, right? I mean, in nine months, we're going to see a lot of babies, maybe named Corey or Rona or Fauci. But, you know, we'll get to that later.
--:-- What about people trying to give birth right now? A lot of people are thinking about that, including today's Explained MVP, Jillian Weinberger. Yes, I am, Sean. And I'm thinking about this because for many women, being pregnant and going through childbirth is the first major medical event they've ever gone through. There's all these doctor's appointments. There's the hospital stay. Some of them have to have surgery. And now they're having to do all of this in the middle of a pandemic with a lot of unknowns.
--:-- And we know one of these pregnant women going through all this right now. We do. Vox's Julia Baluz, our health care reporter. She has been reporting on coronavirus from her base in Vienna, Austria. And as of last Monday, she was nearly 40 weeks pregnant, about five days out from her due date. And this is when you called her up? Yeah, I gave her a call because I just wanted to see how she was doing. And she ended up taking me through what has to be one of the most dramatic days of her life.
--:-- I'm due on Friday and we had planned just to wait for that to have a childbirth that didn't have any extra medical interventions that weren't necessary. But over the last few days, the case toll in Austria has escalated quite dramatically. And because of what's happening across the border in Italy, the country has effectively gone the way of Italy and entirely shut down. Oh, wow. As I was talking to sources about what was happening in Italy last week, some of them knew I was pregnant. And they started to bring up this idea that I should consider an induction before the health care system was overwhelmed here like it is in Italy.
--:-- And when a couple of people first brought this up, I thought it sounded kind of crazy. And then things have escalated here so dramatically in the last couple of days that I started to talk to my doctor over the weekend about whether he thinks we should consider an induction and today went in for a checkup. We had an ultrasound and thankfully everything looked fine with the baby and then we started to ask about COVID-19 and how the hospital was preparing for that and just over the last few days they've started to screen people who are entering and only spouses of pregnant women can come into the hospital and and they also screened for their travel history and their temperature and and any symptoms that they may be having.
--:-- And he said as of today there are no cases in the hospital but things are changing by the half an hour here. So we came home from that appointment and kind of weighed the risks and benefits. And we think that the risks of having to have the baby in a much more precarious hospital and healthcare environment. We think that the risks of that outweigh the risks of doing this induction. How do you feel about it? I honestly, I can't even process any of this.
--:-- I absolutely didn't think we were going to consider an induction tonight, but viruses have ways of surprising people in societies, even viruses that we know about for a long, long time. Like, I've had a very hard time predicting where anything is going in this pandemic. And I think most people have. And I've tried to look for patterns and, you know, talk to some of the most knowledgeable people in the world over the last few months since I started covering this. It's very, very hard to discern where things are going.
--:-- I think when I started to report on what was happening in Italy and talk to people there, it became clear that Italy could be anywhere. What happened in northern Italy could be a town in the U.S. next week or could be Vienna this week. And I think just that uncertainty is what made us think hopefully we're making the best decision tonight. Do you think a lot of other pregnant women are making the same decision? Yeah, my doctor, so he's getting these requests from patients now about inductions.
--:-- So I hope researchers are starting to look at how among the tons of data that this pandemic is going to generate, how this will affect maternity care. Because, yeah, he said he's absolutely getting these requests. He just induced someone yesterday for the same reason. She was due in the next couple of days and wanted to avoid this potential chaos that we think is probably coming to the health system. But I definitely don't want to encourage a run on inductions or C-sections. Like, again, we're right across the border from Italy where they've had the biggest outbreak outside of China.
--:-- And the cases here are doubling every other day. So there is this potential for real mega healthcare disruption here on the scale that we've seen in Italy where doctors have had to turn to rationing care and routine care has completely ground to a halt. But we're really lucky to be in a place where there is a very strong health system and there is universal access to health care. And we didn't need to worry about the cost of being in an out of network hospital or all the added stresses that people in the US have right now and the stresses that people in health systems that aren't as prepared as Austria will face in this crisis.
--:-- So as crazy as all of this is, we're still privileged to be here and to have access to that. That was Julia on Monday afternoon last week. By Monday evening, she was on her way to the hospital to give birth. And she kept the updates coming. Here's the first from 8.30 p.m. Vienna a time. Julia was on her way to the hospital with her husband Axel. There's not a soul on the streets basically. We've just picked up a car share and this is one time where you don't think about the downsides of not owning a car in a pandemic. You don't really want to do a car share but we have no other choice.
--:-- Axel, how are you feeling? Absolutely ready and surreal doing this in a pandemic. What are you wearing on your hands? Gloves. We both have surgical gloves on. We haven't been really sporting them, but trying to minimize any risk. And right before we left for the hospital, we got a text message from our midwife telling us that once again, the protocols at the hospital had changed. And then once we enter for the induction, we basically can't leave again. So we can't go in and out of the hospital. So we had to quickly scramble and pack some extra underwear.
--:-- 20 minutes later, Julia arrived at the hospital. Fever, so fever, nine. No cough. No sore throat. Halt, sore throat. Nein. China, South Korea, Iran, Hong Kong, Italy, Germany, France, Spain, Austria, US. No. Dankeschön. So we just checked into the hospital, had our temperature checked, had to answer a questionnaire about our travel history and whether we had any symptoms of COVID-19. Thankfully, we could answer no way now and we're just going to go up to check in. And about an hour later...
--:-- We just heard from the midwife that in the hospital that's attached to this one, or right next to it, affiliated, that they have an anesthesiologist who tested positive without symptoms, and a bunch of people were exposed. It feels a little bit like a ticking time bomb, that they're going to have some problem here too. It's eerily calm, on the other hand, so it's a very... It was quiet. Yeah, very quiet. So it's a difficult thing to get your head around in terms of what's really going on. More from Julia and Jillian after the break on Today Explained.
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--:-- Read, watch, and listen to The Guardian for free at theguardian.com. All right, Jillian, so last we left off, Julia's at the hospital with her husband, Axel. They're about to get induced. They're about to do the baby birth thing. But they just found out that this neighbor anesthesiologist in the attached hospital has tested positive for COVID-19 and has been around a bunch of other people, not the best news to be getting as you're about to get induced. What happens next? So that was actually the last update I got from Julia for a while. What? That was the last thing you heard? I know. Yeah. Yeah. Yikes.
--:-- I don't want anyone to worry about Julia. Everything works out okay in the end, I promise. We'll get to that in a bit. But while I was waiting to hear how it all went, I ended up talking to an OBGYN about what pregnancy and childbirth looks like during a pandemic here in the U.S. My name is Tina Yarrington. I'm a maternal fetal medicine doctor at Boston Medical Center, and I'm also the director of labor and delivery there.
--:-- Dr. Yarrington told me that a pandemic can be especially scary for pregnant women because pregnancy changes a woman's immune system. In general, when you become pregnant, there's a little bit of a shift in the immune system that at its core keeps the woman's body from trying to attack the fetus, who would otherwise be seen as an outside organism or something. And that shift in the immune system affects the pathway that also protects her against many common viral infections.
--:-- So in principle, yeah, we do think that there's an immune change when you're pregnant that can make you more vulnerable. And at first pass, when coronavirus started to come to the fore, that was the assumption. and there's still very cautious language from the CDC, which I think is completely appropriate. However, at this point, I feel reassured and try to share this glimmer of positivity with my pregnant patients as well, that the early data about coronavirus infection in a pregnant woman suggests that it's, thank goodness, not any worse in the woman who is pregnant, that she gets sick.
--:-- There's a small risk of getting very sick. But for example, the 28-year-old otherwise healthy woman who is pregnant has basically the same course of coronavirus as a 28-year-old otherwise healthy woman who is not pregnant. And that's based on what we currently have and the landscape, to be fair, is always changing and evolving as we learn more. Who are the patients in the studies that have been done so far?
--:-- One of the limitations right now in understanding and interpreting how coronavirus may affect pregnant women, may affect anybody for that matter, is that the bulk of the data that we have specific to coronavirus is from a large cohort coming out of China. It's good data, it's well organized, it's pretty thorough and detailed. However, when I look at my patient population as a high-risk OB provider in an urban center, seeing mostly women of color, mostly women who are not native to the United States and of a wide variety of body shapes and sizes, I always have to pause and think about whether or not the study that I'm looking at really is generalizable to the mothers that I'm taking care of.
--:-- And with respect to that, like I said, while I take a note of positivity from the data from these large groups of Chinese people, I always have to wonder how a study that is based on women who look very different from my patients and have a very different range of other health conditions than my patients, how that study really translates to my patients. There is not yet a study out about how coronavirus plays out in the pregnant woman who has high blood pressure and diabetes and HIV.
--:-- We know that in the general adult population, those conditions in particular seem to confer a higher risk of the infection leading to more complicated disease, but we don't know how that plays out in pregnancy. And so I'm still waiting for optimal information for my sicker patients, that's for sure. And what about transmission between mom and baby? What do we know so far about that?
--:-- The question of transmission from mom and baby is such a critical one, and it's the one that's on the tip of the tongue of most of the patients that I saw this morning, and I'm sure most of the patients that I'll see this afternoon and tomorrow. The limited data that we have about that, fortunately, suggests that there is not transmission while the baby's in utero. And that is based on studies of the placenta to look and see if there's any virus in the placenta or the afterbirth from studies of amniotic fluid.
--:-- All of those point to a lack of transmission while the woman is pregnant. To be fair, the data is still evolving. And so I'm open to things changing. and I tell my patients always that this is the best information that I have right now, but everything seems to point against the possibility of infection while the baby's in utero. I feel like our responsibility now to our patients who have coronavirus infection, or who we aren't sure yet do not have coronavirus infection, but are symptomatic, is at the time of delivery, making sure that we are being really diligent of ensuring a safe environment for their newborn.
--:-- Because while there doesn't seem to be evidence of the infection transmitting through mom to baby while still inside once the baby comes out that baby is as vulnerable to infection as anybody else in that room who's wearing a mask And so the recommendation from the CDC what we're doing here as well, is if mom has known coronavirus infection at the time of delivery, or if she is symptomatic, high risk, and we don't know yet, if we're still waiting for the test result, then when that baby is born, the baby is separated from the mom until we had better information.
--:-- I can't even imagine what that's like. I have two kids myself, and I am a practitioner with a midwife heart who highly values the birth experience, but I also know all the work that goes into the nine months of growing that baby, and there's no question it's the right thing for the sake of the newborn. I know the reporter we talked to earlier, a friend of ours at the show, that was one of the things she was most concerned about was, you know, if she got infected, that having to be separated from the baby after the baby was born.
--:-- I can't even imagine what that would be like. What kinds of questions do your patients have about COVID-19? The first ones are the ones that you've already asked. If I get it, am I going to get critically ill? If I get it, do I have to live in the hospital? And I'll come back to why that's so relevant for my patients, I think in particular. And then if I get it, can I give it to my kids? Can I give it to my baby? Is my baby going to die? People really, they go down a scary pathway.
--:-- But I'll tell you this question of will I have to be in the hospital for a long time is a complex one in a safety net setting. Because for me to say to somebody, you have to be in the hospital might mean that there is no one to take care of the other kids at home, might mean that there's no one who can make any money for the household. It's a major disruption to their lives and not always possible. Yeah. Yeah, I'm sure.
--:-- How have you been communicating with your patients about this? What do you tell them? This week, the information has been coming in and evolving so quickly. Even the times that I'm in doing an ultrasound on somebody have been an opportunity to educate and quell fears. And so the ways we're trying to approach that is a thoughtful rescheduling of appointments so that you're only coming in as frequently as we really think is medically necessary. We'll reach out with more phone calls. You'll have probably more contact with us, which will give you a chance to share what you're feeling about the pregnancy, but also to ask new questions as they come up.
--:-- But the counterpoint to that is that I don't want you to be afraid of the hospital. We want to be really cautious with what we ask of you for routine care, assuming that all is well and you and the baby are perfect. But if at any point that changes, if there's a coronavirus fear, if you have cough and fever and new respiratory symptoms, or if you start to have cramping and bleeding or the baby's not moving, you need to know that the This hospital, this hospital, Boston Medical Center, just like every other hospital around New England and the country, are taking numerous steps to make sure that when you enter this space, that we are making it a safe space for you to engage in care.
--:-- We're doing everything in our power to reduce the chance that you would be exposed to something untoward with your necessary medical visits here so that you can walk in with confidence that your worry can be addressed, your baby can be evaluated, and you can continue to receive the best possible care for your pregnancy. All right, but Jillian, what about Belouz? What happens to Belouz? Yeah, so Julia Belouz, our Vox reporter in Austria, she was a little out of commission after giving birth for a while there. What do you mean?
--:-- She didn't send you a voice memo of getting induced? What's the deal, Belouz? What a slacker. No, we did not get a voice memo of her getting induced, but she did send one a little bit later in the week. Cuckoo. Cuckoo. Cuckoo. Cuckoo. Cuckoo. We just left the hospital and we're on our way home. It's Friday. So on Monday we made the decision to induce. And by Tuesday at 1pm we had a very special delivery. our first son. On the way home from the hospital, we went to bring the baby to meet his grandpa, who lives in Vienna. And we had to do it through grandpa standing at the window on the second floor of his old age home. And we had to stand outside and basically just wave.
--:-- So anyway, the very good news is that, you know, we were going to the hospital empty handed and we're bringing home a son. And we're just so, so happy to come home with this new life. We are happy for you, Beluz, and Axel, and your baby boy. Is his name Rona? Corey? Fauci? Let me know. You got my email?
