Our findings may shed light on the overall rate of infected people in New York City. Our screenings suggest more people are infected with the virus but are not becoming sick. We cannot say for sure how our findings apply to the general population because our group was made up of young, relatively healthy, pregnant women in an area of high virus prevalence. But this is one of the first opportunities to understand covid-19, the disease the virus causes, in a somewhat random sample of the U.S. population. Our findings have huge implications for everyday life on a labor and delivery unit, as well as potential broader implications.
For example, patients who test positive for the virus need to be managed with extra precautions to limit exposure and infection risk for other patients, support staff, their newborns and their health-care team members. Proper personal protective equipment must be worn, and patients must be isolated in private rooms, which require specialized cleaning. Pediatricians need to be informed of virus status so they can take proper precautions to limit the exposure of other babies.
While most of our patients may be less likely to suffer from the severe consequences of covid-19, many of our health-care personnel are not, and we need to keep them healthy. The labor and delivery unit is different from other units in many ways. We routinely have multiple groups of providers in one space: nurses, obstetricians, pediatricians and anesthesiologists. Exposure leading to infection could take providers out of work and away from other areas of the hospital that they routinely cover — and where they are very much needed.
Our patient population also is unique in that all will require admission to the hospital at some point in their pregnancy. During the pandemic, we are minimizing in-person contact using virtual visits, but some points of contact are unavoidable.
Patients need to see us for ultrasounds to check on the development of their babies’ organs and overall growth. Some patients will develop complications of pregnancy like preeclampsia, preterm labor or breaking their water early, and they’ll require admission to the hospital. Their babies will need to be examined and cared for by a pediatrician before they can be safely discharged from the hospital, and in most cases, they’ll visit a pediatrician again not long after they return home.
Understandably, patients are concerned. They worry about their own safety and that of their partners and newborns. Hearing that 1 out of 8 patients admitted to labor and delivery tested positive for the coronavirus and had no symptoms is jarring. We experienced the same emotions. It is why we have remained vigilant in our universal screening policy — so that not only are patients aware of their statuses, but we also can monitor them for symptoms.
Patients discharged from our service are followed with telehealth visits through the Mothers Center at NewYork-Presbyterian/Columbia University Irving Medical Center for 14 days after their positive test results. Luckily, so far, none of these patients has suffered serious medical problems.
This pandemic has created an ever-shifting landscape that has forced us to change multiple processes for patient, provider and public safety. With all the unknowns during this time, universal testing has taken at least one of them away. It has allowed us to protect our pregnant patients admitted to the hospital and know all precautions will be taken to minimize risk of exposure and infection. We will monitor them for any emerging symptoms. It also allows us to use personal protective equipment only when necessary.
To safeguard a woman’s pregnancy is to safeguard the future of our population. For our labor and delivery unit, universal testing is vital. At our hospital, we were fortunate to have executed a universal screening policy for our pregnant patients being admitted to labor and delivery quickly and efficiently, but we recognize the same may not be true across all centers and all patient populations. Broader testing will probably be key in controlling the spread of the coronavirus.