Prof. Oladapo Ashiru
We are living in unprecedented times, but coronavirus pandemic or not, the cycle of life continues. For many people, conception, pregnancy, labour and childbirth have neither paused nor stopped. What we do know is that there have to be modifications in how these come about.
In different parts of the world, lockdown measures are in effect to ensure that people stay at home and maintain physical distancing in order to stop the spread of the coronavirus pandemic. Nigeria is not an exception and indeed, many parts of the country have instituted various degrees of the lockdown. Anecdotal increase in sexual activity, which could potentially lead to conception, will, therefore, come as no surprise, especially in a country like ours where, according to the 2018 NDHS report, the total fertility rate is 5.3 children per woman and the contraceptive prevalence rate is 17 per cent.
With regard to patients undergoing fertility, relevant global associations have proposed that providers and clients should exercise caution. They should also explore individual exigent circumstances, such as urgent sperm or oocyte freezing for cancer patients, whose cancer treatment cannot be put on hold, and reach an informed agreement with affected clients.
Infertility is a serious disease that requires treatment promptly. Over time, an increasing number of patients whose care has been delayed are now in a situation that has become more urgent.
The majority of organisations, such as WHO, IFFS, ICMART, ASRM and the Nigerian AFRH recommend meticulous protocols for patients and staff of a fertility clinic necessary to commence and reactivate the treatment of infertility using Assisted Laboratory Technologies.
The primary recommendation by most of the organisations is that practices must ensure that they are adequately prepared to provide patient care in a manner that limits the risk to patients, staff, physicians and other health care providers. It includes substantial self-education and staying up to date, as new information emerges, on the risk of disease transmission by symptomatic and asymptomatic individuals.
In addition, practices must ensure that they are prepared to perform a formal risk assessment of practice activities and the physical plant by the practice leadership team using publicly available resources or with the assistance of experts. Practices should create or adapt existing written risk mitigation policies and procedures that include having an adequate supply of necessary resources and training for all staff.
In the light of ongoing pregnancies, guidelines from the SOGON, RCOG and ACOG state that although coronavirus is a novel disease, pregnant women are not at a higher risk of infection than the general public as long as they o the same rules of social distancing, regular hand washing and respiratory hygiene.
Concerning the conduct of antenatal check-up services, necessity, they say, is the mother of invention. Health care providers now offer telemedicine in a much more robust format than ever. It enables them to reduce the number of people in direct contact, while ensuring that pregnant women and their babies are not in jeopardy.
Labour and childbirth are being conducted with adherence to universal precautions, in addition to the use of personal protective equipment, more than ever. A few cases of newborns being positive for Covid-19 born to women who also had the disease were reported in the United Kingdom. All three babies survived and were discharged after testing negative. On a comforting note, also, the virus has not been found in the amniotic fluid of pregnant women nor the breast milk of lactating women as of today.
The search for a specific treatment or cure or vaccine is the hottest topic in the scientific community and not only as it affects conception and pregnancy.
So far, the options explored include:
Chloroquine/hydroxychloroquine phosphate, a drug famous for its treatment of malaria. According to a study in China by Gao, Tian, and Yang, the drug showed apparent efficacy and acceptable safety against Covid-19 associated pneumonia. An on-going case-control study conducted in Turkey, in which Hydroxychloroquine and Zinc are being given as a precaution to frontline workers and their close associates, may be able to provide us with further information into the role of hydroxychloroquine.
Experts from Germany, United Staes of Ameria, and South Korea are conducting clinical trials on Chloroquine. I am happy that Nigeria will attempt similar trials with Chloroquine. Hopefully, the trials will include Chloroquine and Zinc, a combination that is guaranteed to be successful in the treatment of COVID-19.
Remdesivir, a drug initially created to treat Ebola, is also being explored for its efficacy.
Yes, the vitamins and minerals are not left out- Zinc, Vitamin C, Vitamin D.
According to researchers at the Northwestern University, Vitamin D strengthens the person’s innate immunity (just like Zinc does) and prevents overactive response from the system that protects the body against infections.
Further yet-to-be-proven claims are the efficacy of Artemisinin (Wormwood), another anti-malarial drug, which is being used extensively in Madagascar. Some doctors in Ghana have also reported success with the use of the leaf of the Neem tree, also known locally as Dogo Yaro, for the treatment of COVID-19 cases.
A few Nigerians in London that tested positive for COVID-19 claimed they successfully treated the disease with garlic, ginger, lemon and tea made from the bark of the Enantia chlorantha plant (Awopa in Yoruba). A few others have added black seed (Nigella sativa).
We remain hopeful that in the not too distant future, we will have answers from these various studies to help us combat COVID-19. However, until a vaccine is available, and experts say it could be up to 18 months, the crisis of survival dictates prevention by staying at home, social distancing with face masks, building up immunity and using currently tested medication under a doctor’s supervision.