ODH urges vaccination for pregnant people against COVID

By CALLAN PUGH 

City editor 

Pregnant people are among those who are at risk for severe illness resulting from COVID-19 and are urged to choose to be vaccinated to protect themselves and their babies against the virus, Ohio Department of Health Director Bruce Vanderhoff said Monday in a press conference.

On Sept. 27, the Center for Disease Control sent out a health advisory urging pregnant people to opt to be vaccinated against COVID-19, Vanderhoff said, and since Sept. 27, there have been more than 125,000 laboratory confirmed COVID-19 cases among pregnant people with more than 22,000 hospitalizations and 161 deaths.

“The highest number of COVID-19 related deaths among pregnant patients in a single month in the pandemic was reported in August with 22 deaths across the country,” Vanderhoff said. “The [CDC] advisory also said that nationally, approximately 97% of pregnant patients hospitalized either for illness or with labor or delivery with a confirmed case of COVID-19 infection were in fact unvaccinated.”

Since mid-September, Vanderhoff said, the CDC indicated only 31% of those who were pregnant were fully vaccinated before or during their pregnancy and the majority of pregnant people remain unprotected against COVID-19 “putting them and their unborn babies at risk.”

COVID and pregnancy complications

Dr. Kamilah Dixon, assistant professor of obstetrics and gynecology at the Ohio State University Wexner Medical Center, said pregnant women who get COVID-19 have increased risk including pre-term delivery, which can result in increased NICU admissions and infant mortality.

“Additionally, when you get COVID-19 during your pregnancy, you’re at increased risk to severe disease,” Dixon said. “Increased risk to being hospitalized for treatment, a two-fold risk of being admitted to an intensive care unit. You have increased risk for need for ventilation or ECMO machines. … There is a 70% increased risk of death when you have COVID-19 and you’re pregnant.

“Generally, my patients are young and healthy. … But, just because of the physiology with pregnancy that puts you at an increased risk of severe disease with COVID-19. So, you are now in the high-risk category, whereas previously you may not have been. Additionally, if you have other health issues like obesity or asthma or diabetes, you’re at an [even further] increased risk for severe disease when you get COVID during your pregnancy.”

Dixon said as a mother herself she understands the concern pregnant women have about the things they put in their bodies affecting their babies. She also understands hesitancy because pregnant women weren’t included in the earliest trials with the vaccine.

“But the benefit is that we do have the V-safe program, which included about 161,000 pregnant people and information from that shows there were no adverse effects,” Dixon said. “We also have a separate registry that was developed by the CDC that had 5,100 pregnant people and in the New England Journal of Medicine study that came out in the spring they compared people and showed that people who got the vaccine and people who didn’t, and those pregnancy outcomes were the same. So, things like stillbirth, miscarriage, growth restriction, congenital anomalies — they were all the same. So, we have pretty good evidence now that we say this is a safe vaccine for you and your body.

Dixon said she also talks to her patients about getting the vaccine and producing antibodies that can be passed on to their babies to give babies protection before they’re born as well.

“People just need to get the vaccine,” Dixon said.

Safest bet for babies

President of the Ohio State Medical Association Dr. Lisa Egbert, who is an OBGYN in Dayton, said maternal instincts start before a woman even becomes pregnant and the “mama bear” instinct to protect their unborn child is something every mother has, which is why she understands the hesitancy, but is working hard to share all the facts with the pregnant people she sees.

“We know … that we have seen no increased risk of vaccines in pregnancy,” Egbert said. “And the CDC, the American College of OBGYN and the Society for Internal Fetal Medicine all recognize that that is true and have released statements to urgently increase vaccination rates for all pregnant women.”

Egbert spoke about the tough choice that partners and individuals have had to make when their loved one gets severely sick with COVID — having to risk delivering a pre-term baby and still facing the possibility of losing either the baby or the mother, or worse.

“I tell my patients all of these things to help them understand that the risk of vaccine, that we know is minimal in every study we’ve looked at, versus the risk of COVID in pregnancy is no comparison,” Egbert said. “And I ask them to please get vaccinated.”

Egbert said there’s been no increased risk seen from the vaccines to early pregnancies. Additionally, Egbert said women are encouraged to be vaccinated who are breastfeeding because antibodies are passed through the breast milk to the infant. All studies so far have shown no adverse effect on fertility, Egbert noted, and the infertility myths have been thoroughly debunked for both male and female fertility.

“If you’re thinking about being pregnant, the best thing you can do for your future baby is to be vaccinated prior to pregnancy, or if you haven’t been vaccinated yet and you are pregnant, during pregnancy, and if you haven’t been vaccinated during pregnancy, after pregnancy so you can transmit those antibodies to your baby through your breast milk,” Egbert said.

State of the state

While COVID-19 cases and hospitalizations across the state of Ohio are still high, with one in six hospitalized patients being hospitalized with COVID and one in four in the ICU battling COVID-19, Vanderhoff said the ODH is seeing early indicators that cases appear to be peaking and are beginning to point to a decline.

“I know it has been a very long journey,” Vanderhoff said. “We’re all tired of dealing with COVID-19, but I’d ask everyone to hang in there. Although our cases of COVID-19 remain extremely high, it is clear that our collective efforts really are paying off.

“We need to remain vigilant, and we need to protect ourselves from the spread of COVID-19 through vaccination and — especially in our schools where so many of our students either cannot or have not yet been vaccinated — wearing a mask. These are the keys to not only remaining healthy, but also to alleviating the currently intense pressure that is on our healt care systems and our children and adult hospitals really across the entire state.”

Reinfections

Vanderhoff also explained that the yearly review of case definitions has resulted in a change in how reinfections are counted for COVID patients. Anyone from Sept. 1 or on who is reinfected with COVID-19 90 days after their initial infection will be counted as a new case, Vanderhoff said, in alignment with the national guidance for how to properly count and classify these cases.

“Although the state and local health departments have been implementing proper public health action for reinfected individuals all along such as isolation of infected individuals and quarantine if they’re close contacts, these new infections haven’t been counted on the [state’s] dashboard, because they didn’t meet the case definition standard,” Vanderhoff said. “This updated definition provides better insight into the real spread of COVID-19 across our communities. The new definition does not apply retroactively to any individuals who might have been reinfected prior to Sept. 1.”

Vanderhoff said emerging information indicates that those who are not vaccinated against COVID-19 are more than twice as likely to be reinfected compared with those who are fully vaccinated.

Monoclonal antibodies distribution

Vanderhoff said monoclonal antibodies have become an important tool in the state for treating those who have had a positive COVID-19 test and who have been symptomatic for 10 days or less. The antibodies are utilized for people who present higher risk of COVID-19’s more serious symptoms.

Utilization of the antibodies has increased significantly in Ohio in recent months, according to Vanderhoff, with thousands of doses being administered at health care facilities.

Equitable allocations of the antibodies have now become the responsibility of the states rather than providers ordering directly from the wholesaler, Vanderhoff said, though the wholesaler still maintains the supply and distributes it.

Vanderhoff said the state is working to maintain equitable distribution with relation to location and time, so providers have a consistent and fairly distributed supply.