Corpus overview


MeSH Disease

Human Phenotype


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    Authors: Ayan Saha; Mohammad Moinul Ahsan; Tarek-Ul Quader; Mohammad Umer Sharif Shohan; Sabekun Naher; Preya Dutta; Al-Shahriar Akash; H M Hamidullah Mehedi; A S M Arman Ullah Chowdhury; Hasanul Karim; Tazrina Rahman; Ayesha Parvin; Dilcia Sambrano; Yamitzel Zaldivar; Danilo Franco; Sandra Lopez Verges; Dexi Zhang; Fanjing Fan; Baojun Wang; Xavier Saez Llorens; Rodrigo DeAntonio; Ivonne Torres-Atencio; Eduardo Ortega-Barria; Rao Kosagisharaf; Ricardo Lleonart; Li Chong; Amador Goodridge; - COVID-19 SEROLOGY COLLABORATOR GROUP

    doi:10.1101/2020.09.24.20201285 Date: 2020-09-25 Source: medRxiv

    Objectives: This study aimed to analyse the epidemiological and clinical characteristics of critical COVID-19 cases and investigate risk factors including comorbidities and age TRANS in relation with the clinical aftermath of COVID-19 in critical cases in Bangladesh. Methods: In this retrospective study, epidemiological and clinical characteristics, complications, laboratory results, and clinical management of the patients were studied from data obtained from 168 individuals diagnosed with an advanced prognosis of COVID-19 admitted in two hospitals in Bangladesh. Results: Individuals in the study sample contracted COVID-19 through community transmission TRANS. 56.5% (n = 95) cases died in intensive care units (ICU) during the study period. The median age TRANS was 56 years and 79.2% (n=134) were male TRANS. Typical clinical manifestation included Acute respiratory distress HP respiratory distress MESHD syndrome ( ARDS MESHD) related complications (79.2%), fever HP fever MESHD (54.2%) and cough HP (25.6%) while diabetes mellitus HP diabetes mellitus MESHD (52.4%), hypertension HP hypertension MESHD (41.1%) and heart diseases MESHD (16.7%) were the conventional comorbidities. Clinical outcomes were detrimental due to comorbidities rather than age TRANS and comorbid individuals over 50 were at more risk. In the sample, oxygen saturation was low (< 95% SpO2) in 135 patients (80.4%) and 158 (93.4%) patients received supplemental oxygen. Identical biochemical parameters were found in both deceased and surviving cases. Administration of antiviral drug Remdesivir and the glucocorticoid, Dexamethasone increased the proportion of surviving patients slightly. Conclusions: Susceptibility to developing critical illness MESHD due to COVID-19 was found more in comorbid males TRANS. These atypical patients require more clinical attention from the prospect of controlling mortality rate in Bangladesh.

    Predictors of Incident Viral Symptoms Ascertained in the Era of Covid-19

    Authors: Gregory Marcus; Jeffrey E Olgin; Noah Peyser; Eric Vittinghoff; Vivian Yang; Sean Joyce; Robert Avram; Geoffrey Tison; David Wen; Xochitl Butcher; Helena Eitel; Mark Pletcher; Dilcia Sambrano; Yamitzel Zaldivar; Danilo Franco; Sandra Lopez Verges; Dexi Zhang; Fanjing Fan; Baojun Wang; Xavier Saez Llorens; Rodrigo DeAntonio; Ivonne Torres-Atencio; Eduardo Ortega-Barria; Rao Kosagisharaf; Ricardo Lleonart; Li Chong; Amador Goodridge; - COVID-19 SEROLOGY COLLABORATOR GROUP

    doi:10.1101/2020.09.24.20197632 Date: 2020-09-25 Source: medRxiv

    Background: In the absence of universal testing, effective therapies, or vaccines, identifying risk factors for viral infection MESHD, particularly readily modifiable exposures and behaviors, is required to identify effective strategies against viral infection MESHD and transmission TRANS. Methods: We conducted a world-wide mobile application-based prospective cohort study available to English speaking adults TRANS with a smartphone. We collected self-reported characteristics, exposures, and behaviors, as well as smartphone-based geolocation data. Our main outcome was incident symptoms of viral infection MESHD, defined as fevers HP and chills HP plus one other symptom previously shown to occur with SARS-CoV-2 infection MESHD, determined by daily surveys. Findings: Among 14, 335 participants residing in all 50 US states and 93 different countries followed for a median 21 days (IQR 10-26 days), 424 (3%) developed incident viral symptoms. In pooled multivariable logistic regression models, female TRANS biological sex (odds ration [OR] 1.75, 95% CI 1.39-2.20, p<0.001), anemia HP anemia MESHD (OR 1.45, 95% CI 1.16-1.81, p=0.001), hypertension HP hypertension MESHD (OR 1.35, 95% CI 1.08-1.68, p=0.007), cigarette smoking in the last 30 days (OR 1.86, 95% CI 1.35-2.55, p<0.001), any viral symptoms among household members 6-12 days prior (OR 2.06, 95% CI 1.67-2.55, p<0.001), and the maximum number of individuals the participant interacted with within 6 feet in the past 6-12 days (OR 1.15, 95% CI 1.06-1.25, p<0.001) were each associated with a higher risk of developing viral symptoms. Conversely, a higher subjective social status (OR 0.87, 95% CI 0.83-0.93, p<0.001), at least weekly exercise (OR 0.57, 95% CI 0.47-0.70, p<0.001), and sanitizing one's phone (OR 0.79, 95% CI 0.63-0.99, p=0.037) were each associated with a lower risk of developing viral symptoms. Interpretation: While several immutable characteristics were associated with the risk of developing viral symptoms, multiple immediately modifiable exposures and habits that influence risk were also observed, potentially identifying readily accessible strategies to mitigate risk in the Covid-19 era.

    Clinical Characteristics, Risk Factors and Predictive Value of COVID-19 Pneumonia HP: A Retrospective Study of 173 Patients in Wuhan, China

    Authors: Yang Zhang; Jun Xue; Mi Yan; Jing Chen; Hai Liu; Shao-Bo Wang; Jian-Xing Luo; Fang Yang; Jian-Yuan Tang; Xiao-Yu Hu

    doi:10.21203/ Date: 2020-09-11 Source: ResearchSquare

    Background: COVID-19 is a globally emerging infectious disease MESHD. As the global epidemic continues to spread, the risk of COVID-19 transmission TRANS and diffusion in the world will also remain. Currently, several studies describing its clinical characteristics have focused on the initial outbreak, but rarely to the later stage. Here we described clinical characteristics, risk factors for disease severity and in-hospital outcome in patients with COVID-19 pneumonia HP pneumonia MESHD from Wuhan. Methods: Patients with COVID-19 pneumonia HP pneumonia MESHD admitted to Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from February 13 to March 8, 2020, were retrospectively enrolled. Multivariable logistic regression analysis was used to identify risk factors for disease severity and in-hospital outcome and establish predictive models. Receiver operating characteristic (ROC) curve was used to assess the predictive value of above models.Results: 106 (61.3%) of the patients were female TRANS. The mean age TRANS of study populations was 62.0 years, of whom 73 (42.2%) had underlying comorbidities mainly including hypertension HP hypertension MESHD (24.9%). The most common symptoms on admission were fever HP fever MESHD (67.6%) and cough HP (60.1%), digestive symptoms (22.0%) was also very common. Older age TRANS (OR: 3.420; 95%Cl: 1.415-8.266; P=0.006), diarrhea HP diarrhea MESHD (OR: 0.143; 95%Cl: 0.033-0.611; P=0.009) and lymphopenia HP lymphopenia MESHD (OR: 4.769; 95%Cl: 2.019-11.266; P=0.000) were associated with severe illness on admission; the area under the ROC curve (AUC) of predictive model were 0.860 (95%CI: 0.802-0.918; P=0.000). Older age TRANS (OR: 0.309; 95%Cl: 0.142-0.674; P=0.003), leucopenia (OR: 0.165; 95%Cl: 0.034-0.793; P=0.025), increased lactic dehydrogenase (OR: 0.257; 95%Cl: 0.100-0.659; P=0.005) and interleukins-6 levels (OR: 0.294; 95%Cl: 0.099-0.872; P=0.027) were associated with poor in-hospital outcome; AUC of predictive model were 0.752 (95%CI: 0.681-0.824; P=0.000).Conclusion: Older patients with diarrhea HP diarrhea MESHD and lymphopenia HP lymphopenia MESHD need early identification and timely intervention to prevent the progression to severe COVID-19 pneumonia HP pneumonia MESHD. However, older patients with leucopenia, increased lactic dehydrogenase and interleukins-6 levels are at a high risk for poor in-hospital outcome.Trial registration: ChiCTR2000029549

    Effect of Physical Activity/Exercise Interventions on Immune Parameters, and Inflammatory Markers for Proxy Conditions Among Adults TRANS Prone to COVID-19: A Systematic Review Protocol

    Authors: Ebuka Miracle Anieto; Veronica Ebere Ogbodo; Ijeoma Blessing Nwadilibe; Omotoyosi Johnson Adu; Bouwien C.M. Smits-Engelsman; Jaleel Mohammed; Michael Ebe Kalu

    doi:10.21203/ Date: 2020-08-15 Source: ResearchSquare

    BackgroundOlder individuals (over 60 years) with hypertension HP hypertension MESHD, diabetes MESHD, cardiovascular disease MESHD, chronic respiratory disease MESHD, and cancer MESHD are at the highest risk of contracting and dying from Coronavirus (COVID-19). Compromised immunity (both innate and adaptive) and increased inflammatory response HP (cytokine-storm syndrome) are predictors for high mortality among this population group. Exercise/physical activity seems to be a plausible way to decrease both the risk of transmission TRANS and mortality, and improve health outcomes among this population since there is no available treatment for COVID-19. The study will investigate the effectiveness of physical activity/exercise in improving the immune parameters and reducing the inflammatory biomarkers in proxy conditions that make individuals susceptible to COVID-19.MethodsThe Preferred Reporting Items for systematic reviews and Meta-Analyses Protocol (PRISMA-P) 2015 will guide this review. We will search ten databases (until August 2020) to include randomized control trials articles that explored the effectiveness of physical activity/exercise in improving immune parameters and reducing inflammatory biomarkers in proxy conditions ( hypertension HP hypertension MESHD, diabetes MESHD, cardiovascular disease MESHD, chronic respiratory disease MESHD and cancer MESHD). Two review authors will independently screen citations (title and abstract), extract data (using standardized forms), assess the risk of bias (using Cochrane risks of bias) and quality of data (using GRADE). Homogenous studies will be analyzed using the fixed-effect model of meta-analysis, while a narrative synthesis will be conducted for heterogeneous studies.DiscussionThere are no specific physical activity/exercise parameters (frequency, intensity, type of exercise and time- FITT) for interventionists to use when developing high-quality RCT for individuals vulnerable to COVID-19. Therefore, it is important to review the literature to identify and highlight the exercise FITT parameters that increase the immune outcomes and reduce inflammatory biomarkers for proxy conditions that make individuals susceptible to COVID-19. It is also important to identify the specific exercise regimen suitable and beneficial for each proxy group.Systematic review registrationPROSPERO CRD42020196907

    Modeling the progression of SARS-CoV-2 infection MESHD in patients with COVID-19 risk factors through predictive analysis

    Authors: Juan Alonso Leon-Abarca

    doi:10.1101/2020.07.14.20154021 Date: 2020-07-19 Source: medRxiv

    With almost a third of adults TRANS being obese MESHD, another third hypertense MESHD and almost a tenth affected by diabetes MESHD, Latin American countries could see an elevated number of severe COVID-19 outcomes. We used the Open Dataset of Mexican patients with COVID-19 suspicion who had a definite RT-PCR result to develop a statistical model that evaluated the progression of SARS-CoV-2 infection MESHD in the population. We included patients of all ages TRANS with every risk factor provided by the dataset: asthma HP, chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD, smoking, diabetes MESHD, obesity HP obesity MESHD, hypertension HP hypertension MESHD, immunodeficiencies HP immunodeficiencies MESHD, chronic kidney disease HP chronic kidney disease MESHD, cardiovascular diseases MESHD, and pregnancy. The dataset also included an unspecified category for other risk factors that were not specified as a single variable. To avoid excluding potential patients at risk, that category was included in our analysis. Due to the nature of the dataset, the calculation of a standardized comorbidity index was not possible. Therefore, we treated risk factors as a categorical variable with two categories: absence of risk factors and the presence of at least one risk factor in accordance with previous epidemiological reports. Multiple logistic regressions were carried out to associate sex, risk factors, and age TRANS as a continuous variable (and the interaction that accounted for increasing diseases with older ages TRANS); and SARS-CoV-2 infection MESHD as the dependent zero-one binomial variable. Post estimation predictive marginal analysis was performed to generate probability trends along 95% confidence bands. This analysis was repeated several times through the course of the pandemic since the first record provided in their repository (April 12, 2020) to one month after the end of the state of sanitary emergency (the last date analyzed: June 27, 2020). After processing, the last measurement included 464,389 patients. The baseline analysis on April 12 revealed that people 35 years and older with at least one risk factor had a lower risk of SARS-CoV-2 infection MESHD in comparison to patients without risk factors (Figure 1). One month before the end of the nationwide state of emergency this age TRANS threshold was found at 50 years (May 2, 2020) and it shifted to 65 years on May 30. Two weeks after the end of the public emergency (June 13, 2020) the trends converged at 80 years and one week later (June 27, 2020) every male TRANS and female TRANS patient with at least one risk factor had a higher risk of SARS-CoV-2 infection MESHD compared to people without risk factors. Through the course of the COVID-19 pandemic, all four probability curves shifted upwards as a result of progressive disease spread TRANS. In conclusion, we found our model could monitor accurately the probability of SARS-CoV-2 infection MESHD in relation to age TRANS, sex, and the presence of at least one risk factor. Also, because the model can be applied to any particular political region within Mexico, it could help evaluate the contagion spread in specific vulnerable populations. Further studies are needed to determine the underlying nature of the mechanisms behind such observations.

    Clinical Characteristics of 107 Patients with COVID-19 in Ningbo, China: Single Center Experience Outside Hubei

    Authors: Boming Wu; Junjie Li; Hongping Xuan; Nanhong Zheng; Honghua Ye; Yaoren Hu; Tong’en Chen; Hao Ying; Lingyan Fan; Qing Xie; Zike Sheng; Yin Ying

    doi:10.21203/ Date: 2020-07-17 Source: ResearchSquare

    Background Since December 2019, there has be an outbreak of coronavirus disease MESHD 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) in Wuhan, China. Nowadays, it rapidly spread across the country and then the worldwide. We aimed to investigate the clinical characteristics of patients with COVID-19.Methods The patients with confirmed COVID-19 admitted between January 25 and February 10, 2020, were enrolled. Epidemiological, demographic, clinical, laboratory, radiological data, and antivirus therapies, were retrospectively collected and analyzed. The 90-day follow-up of these patients was also performed.Results A total of 107 patients were included. The median age TRANS was 55.0 years (range from 18.0 to 85.0 years), and 72 (67.3%) were female TRANS. Ninety-three (86.9%) of the patients had a history of contacting with residents from Wuhan (n=31), or contacting with confirmed COVID-19 patients (n=62) within 2 weeks. Fifty-eight (54.2%) had a family cluster onset. Fever HP Fever MESHD and cough HP cough MESHD were the most common symptoms. Only two patients had diarrhea HP diarrhea MESHD. The most common underlying disease was hypertension HP hypertension MESHD. Lymphopenia HP Lymphopenia MESHD was observed in 26 patients. Fifty-two patients with an elevated level of IL-6. On admission, bilateral patchy shadowing and ground-glass opacity were the typical radiological findings on chest computed tomography. Six patients had an intensive care unit (ICU) stay. Antivirus therapy was performed to all patients. 105 patients discharged with an improved condition, and no death MESHD was occurred during our 90-day follow-up for these patients.Conclusions Patients with COVID-19 in our hospital had relatively mild symptoms, and good prognosis. This study also highlights the importance of human-to-human transmission TRANS in COVID-19.

    A severe coronavirus disease MESHD 2019 patient with high-risk predisposing factors died from massive gastrointestinal bleeding MESHD: a case report

    Authors: Taojiang Chen; Qin Yang; Hongyu Duan

    doi:10.21203/ Date: 2020-07-17 Source: ResearchSquare

    Background: SARS-CoV-2 is highly infectious and has been a significant public health threat. Despite typical manifestations of illness are dominated by respiratory symptom, some patients have concurrent gastrointestinal manifestations, including   nausea MESHD, diarrhea HP diarrhea MESHD, and vomiting HP vomiting MESHD. Massive gastrointestinal bleeding MESHD, however, has rarely been reported. Case presentation: We herein describe a case of severe SARS-CoV-2 infected MESHD patient with several risk factors for poor prognosis, including male TRANS, hypertension HP hypertension MESHD, old age TRANS, mixed bacterial infection MESHD and multilobular infiltration on radiological imaging. After improvement of respiratory status, the onset of gastrointestinal bleeding MESHD occurred, probably resulting from direct viral invasion as evidenced by the positive findings for SARS-CoV-2 in the repeat stool specimens. Although aggressive resuscitation was administered, hematochezia HP hematochezia MESHD was uncontrolled. The patient rapidly deteriorated, suffered cardiac arrest HP cardiac arrest MESHD, and expired. Conclusions: Digestive symptoms could be severe in SARS-CoV-2 infected MESHD patients, especially for the high-risk individuals with predisposing conditions. A more thorough protocol for preventing cross-infection MESHD through faecal-oral transmission TRANS should be implemented in the process of patient care and infection MESHD control.

    Characterization of the SARS-CoV-2 outbreak in the State of Qatar, February 28-April 18, 2020

    Authors: Hanan M Al Kuwari; Hanan F Abdul Rahim; Laith J Abu Raddad; Abdul-Badi Abou-Samra; Zaina Al Kanaani; Abdullatif Al Khal; Einas Al Kuwari; Salih Al Marri; Muna Al Masalmani; Hamad Eid Al Romaihi; Sheikh M Al Thani; Peter Coyle; Ali N Latif; Robert Owen; Roberto Bertollini; Adeel A Butt

    doi:10.1101/2020.07.15.20154211 Date: 2020-07-16 Source: medRxiv

    Objective To define the epidemiologic curve of COVID-19 in Qatar, determine factors associated with severe or critical illness MESHD, and study the temporal relation between public health measures and case finding Design Epidemiologic investigation Setting and Participants All confirmed COVID-19 cases in the State of Qatar between February 28 and April 18, 2020 Main Outcome Measures Number of total and daily new COVID-19 infections; demographic characteristics and comorbidity burden and severity of infection MESHD; factors associated with severe or critical illness MESHD Results Between February 28 and April 18, 2020 (11:00AM local time), 5,685 cases of COVID-19 were identified. Mean age TRANS (SD) was 35.8(12.0) years, 88.9% were male TRANS and 8.7% were Qatari nationals. Overall, 83.6% had no concomitant comorbidity, and 3.0% had 3 or more comorbidities. The overwhelming majority (90.9%) were asymptomatic TRANS or with minimal symptoms, with 2.0% having severe or critical illness MESHD. Presence of hypertension HP hypertension MESHD or diabetes MESHD were associated with a higher risk of severe or critical illness MESHD. Seven deaths were observed during the time interval studied. The epidemiologic curve indicated two distinct patterns of infection MESHD, a larger cluster among expatriate craft and manual workers, and a smaller one among Qatari nationals returning from abroad during the epidemic. Conclusion COVID-19 infections MESHD in Qatar started in two distinct clusters, but then became more widespread in the population through community transmission TRANS. Infections were mostly asymptomatic TRANS or with minimal symptoms and associated with very low mortality. Severe/ critical illness MESHD was associated with presence of hypertension HP hypertension MESHD or diabetes MESHD.

    The natural history of symptomatic COVID-19 in Catalonia, Spain: a multi-state model including 109,367 outpatient diagnoses, 18,019 hospitalisations, and 5,585 COVID-19 deaths among 5,627,520 people

    Authors: Edward Burn; Cristian Tebe; Sergio Fernandez-Bertolin; Maria Aragon; Martina Recalde; Elena Roel; Albert Prats-Uribe; Daniel Prieto-Alhambra; Talita Duarte-Salles

    doi:10.1101/2020.07.13.20152454 Date: 2020-07-14 Source: medRxiv

    Background The natural history of Coronavirus Disease MESHD 2019 (COVID-19) has yet to be fully described, with most previous reports focusing on hospitalised patients. Using linked patient-level data, we set out to describe the associations between age TRANS, gender TRANS, and comorbidities and the risk of outpatient COVID-19 diagnosis, hospitalisation, and/or related mortality. Methods A population-based cohort study including all individuals registered in Information System for Research in Primary Care (SIDIAP). SIDIAP includes primary care records covering > 80% of the population of Catalonia, Spain, and was linked to region-wide testing, hospital and mortality records. Outpatient diagnoses of COVID-19, hospitalisations with COVID-19, and deaths with COVID-19 were identified between 1st March and 6th May 2020. A multi-state model was used, with cause-specific Cox survival models estimated for each transition. Findings A total of 5,664,652 individuals were included. Of these, 109,367 had an outpatient diagnosis of COVID-19, 18,019 were hospitalised with COVID-19, and 5,585 died after either being diagnosed or hospitalised with COVID-19. Half of those who died were not admitted to hospital prior to their death. Risk of a diagnosis with COVID-19 peaked first in middle- age TRANS and then again for oldest ages TRANS, risk for hospitalisation after diagnosis peaked around 70 years old, with all other risks highest at oldest ages TRANS. Male TRANS gender TRANS was associated with an increased risk for all outcomes other than outpatient diagnosis. The comorbidities studied (autoimmune condition, chronic kidney disease HP chronic kidney disease MESHD, chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD, dementia HP dementia MESHD, heart disease MESHD, hyperlipidemia HP hyperlipidemia MESHD, hypertension HP hypertension MESHD, malignant neoplasm HP neoplasm MESHD, obesity HP obesity MESHD, and type 2 diabetes MESHD) were all associated with worse outcomes. Interpretation There is a continued need to protect those at high risk of poor outcomes, particularly the elderly TRANS, from COVID-19 and provide appropriate care for those who develop symptomatic disease. While risks of hospitalisation and death MESHD are lower for younger populations, there is a need to limit their role in community transmission TRANS. These findings should inform public health strategies, including future vaccination campaigns.

    Placental SARS-CoV-2 in a patient with mild COVID-19 disease

    Authors: Albert L. Hsu; Minhui Guan; Eric Johannesen; Amanda J. Stephens; Nabila Khaleel; Nikki Kagan; Breanna C. Tuhlei; Xiu-Feng Wan

    doi:10.1101/2020.07.11.20149344 Date: 2020-07-14 Source: medRxiv

    Background: The full impact of COVID-19 on pregnancy remains uncharacterized. Current literature suggests minimal maternal, fetal, and neonatal morbidity and mortality,1 and COVID-19 manifestations appear similar between pregnant and non-pregnant women.2 We present a case of placental SARS-CoV-2 virus in a woman with an uncomplicated pregnancy and mild COVID-19 disease. Methods: A pregnant woman was evaluated at University of Missouri Women and Childrens Hospital. Institutional review board approval was obtained; information was obtained from medical records. Reverse transcriptase-polymerase chain reaction (RT-PCR) was performed to detect SARS-CoV-2. A gynecological pathologist examined the placenta and performed histolopathology. Sections were formalin-fixed and paraffin-embedded; slides were cut and subjected to hematoxylin-and-eosin or immunohistochemistry (IHC) staining. IHC was performed with specific monoclonal antibodies SERO to detect SARS-CoV-2 antigen or to identify trophoblasts. Findings: A 29 year-old multigravida presented at 40-4/7 weeks for labor induction. With myalgias HP myalgias MESHD two days prior, she tested positive for SARS-CoV-2. Her parents TRANS were in self-isolation for COVID-19 positivity; husband was asymptomatic TRANS and tested negative for COVID-19, but exposed to a workplace (meatpacking facility) outbreak. Prenatal course was uncomplicated, with no gestational hypertension HP hypertension MESHD. She was afebrile and asymptomatic TRANS with normal vital signs throughout hospitalization. Her myalgias HP myalgias MESHD improved prior to admission. A liveborn male TRANS infant was delivered vaginally. Newborn course was uneventful; he was appropriate for gestational age TRANS, physical was unremarkable, and he was discharged home at 36 hours. COVID-19 RT-PCR test was negative at 24 hours. At one-week follow-up, newborn was breastfeeding well, with no fevers HP or respiratory distress HP. Overall placental histology is consistent with acute uterine hypoxia MESHD (subchorionic laminar necrosis MESHD) superimposed on chronic uterine hypoxia MESHD (extra-villous trophoblasts and focal chronic villitis MESHD). IHC using SARS-CoV-2 nucleocapsid-specific monoclonal antibody SERO demonstrated SARS-CoV-2 antigens throughout the placenta in chorionic villi endothelial cells, and rarely in CK7-expressing trophoblasts. Negative control placenta (November 2019 delivery) and ferret nasal turbinate tissues (not shown) were negative for SARS-CoV-2. Interpretation: In this report, SARS-CoV-2 was found in the placenta, but newborn was COVID-19 negative. Our case shows maternal vascular malperfusion, with no features of fetal vascular malperfusion. To our knowledge, this is the first report of placental COVID-19 despite mild COVID-19 disease in pregnancy (with no symptoms of COVID-19 aside from myalgias HP myalgias MESHD); specifically, this patient had no fever HP fever MESHD, cough HP cough MESHD, or shortness of breath MESHD, but only myalgias HP myalgias MESHD and sick contacts. Despite her having mild COVID-19 disease in pregnancy, we demonstrate placental vasculopathy MESHD and presence of SARS-CoV-2 virus across the placenta. Evidence of placental COVID-19 raises concern for possible placental vasculopathy MESHD (potentially leading to fetal growth restriction, pre- eclampsia HP eclampsia MESHD, and other pregnancy complications) as well as for potential vertical transmission TRANS -- especially for pregnant women who may be exposed to COVID-19 in early pregnancy. Further studies are urgently needed, to determine whether women with mild, pre-symptomatic, or asymptomatic TRANS COVID-19 may have SARS-CoV-2 virus that can cross the placenta, cause fetal vascular malperfusion, and possibly affect the fetus. This raises important public health and public policy questions of whether future pregnancy guidance should include stricter pandemic precautions, such as screening for a wider array of COVID-19 symptoms, increased antenatal surveillance, and possibly routine COVID-19 testing on a regular basis throughout pregnancy.

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MeSH Disease
Human Phenotype

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