COVID-19 Care drills, Vitamin D, BCG vaccinations & laparoscopy

Fellow Colleagues,

As we approach the possible explosion of the Coronacrisis in our country, let us hope that we have some sort of advantage over the other countries affected that are not embracing the Equator.

There have been reports suggesting that BCG vaccination may reduce mortality from COVID-19. While mortality attributable to COVID-19 has devastated global health systems and economies, striking regional differences have been observed, with areas of routine BCG administration showing reduced infection rates. This has led to the start of an Australian study to see if the BCG vaccination helps healthcare workers. Notably, this piece of research has not yet undergone peer review, and these findings should be seen with a critical mind as many potential holes are already seen in the study with potentially ecological fallacies and not taking into mind the different strains of the Coronavirus (and their differing virulence). Let’s await more robust results prior to making conclusions. So nice to see the authors responsibly referring to the lack of peer review and therefore stating that these findings should not, at this time, change clinical practice.

Closer to home, the abundance of Vitamin D we can harvest means that we, ideally, should not be deficient in this important vitamin. A dissertation study for pregnant mothers living within the city of Nairobi showed that more than 3 out of 4 of the mothers were deficient (?mechanism – possibly reduced exposure to sunlight?) (Dodia 2013). Note that population-wide Vitamin D levels have not been researched, hence we are unsure if the ethnic African is actually deficient with the levels recorded in caucasian populations. It is a fact though, that the ethnic Africans require up to 10 times the Ultraviolet B exposure to synthesize the same amount of Vitamin D levels as Caucasians.

Why am I writing about Vitamin D? Aranow in 2011 wrote an easy-to-read paper on the immune-benefits of adequate Vitamin D levels and I quote ‘Vitamin D has important functions beyond those of calcium and bone homeostasis which include modulation of the innate and adaptive immune responses. Vitamin D deficiency is prevalent in autoimmune disease. Cells of the immune system are capable of synthesizing and responding to vitamin D.’ Highly recommended reading for both skimming as well as perusing (details on cellular responses to Vitamin D are also described). To wrap up this sunny paragraph – count your blessings and get out in the sun to help boost your immunity. Don’t forget to take your family out too. Remember this is not to go out and party with others!

Even closer to home, I am pleased to report that we had our mother-pushing-out-a-baby-while-having-COVID-features drill at the MPShah Hospital maternity. This happened in the wee hours on the 07th of April. It traced the journey of a mother in advanced labour who is driven into the hospital casualty, and her journey all the way into the labour ward and into the isolation room, care for her in case of requiring an emergency caesarean, and a drill for postpartum haemorrhage plus collapse in such a situation. Lots of lessons learned, and we have now sealed the gaps where potential patient care was compromised and where innocent bystanders could have been unnecessarily exposed. An excellent show of teamwork by our midwifery team – as expected.

Kudos to our hospital-wide COVID-19 medical team!

Invitation to take part in a survey on COVID-19 and maternity: The Institute of Tropical Medicine in Antwerp is conducting research into the provision of maternal/newborn care during the COVID-19 outbreak. The survey aims to collect responses and experiences specifically from health professionals working with women and newborns. This includes midwives, doctors, other clinical staff, and community health workers/breastfeeding counsellors. The intention is to repeat data collection regularly to capture changes across time and various contexts as this outbreak develops.

This survey aims to reach health professionals providing care to pregnant, labouring, and postnatal women and their babies. Take the online survey here (available in other languages)

Please share this survey with your colleagues and for questions please email Dr. Lenka Benova, lbenova@itg.be

The knee-jerk reaction to stopping laparoscopic surgery and choosing laparotomy due to potentially reduced viral exposure is now being slowly negated. The safety and overall advantages of laparoscopy seems to have stood the test of COVID-19, and I am pleased to say that further guidelines on gynae surgery continue to say that it is safe, as long as the necessary precautions are taken to prevent viral exposure and spread. https://www.cansage.org/message has an informative summary.

As our country takes a handle on reducing the community spread of the virus, let us do our part and ensure widespread use of masks (for what it is worth) as well as continuing social distancing.

Sunny wishes,

Raj

ps: it has come to my attention that Outlook and other inboxes may not display this newsletter properly. Please put the sender in the approved sender’s list, and ensure you click on ‘Always show images from this sender’ so as to spice up your reading.

References: A. Miller et al. Correlation between universal BCG vaccination policy and reduced morbidity and mortality for COVID-19: an epidemiological study. Medrxiv. 2020. doi: https://doi.org/10.1101/2020.03.24.20042937

Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59(6):881–886. doi:10.2310/JIM.0b013e31821b8755

Dodia, R. H. (2013). Vitamin D levels in the urban ethnic African pregnant woman (Unpublished doctoral dissertation or master’s thesis). Aga Khan University, Nairobi, Kenya