Fortieth week

Next month, it will have been 9 months since the emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19), that is, the length of a full-term pregnancy. What can be expected? Perhaps favorable outcomes, such as the following:...

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Autor principal:	Sérgio Cavalheiro
Formato:	article
Lenguaje:	EN
Publicado:	Brazilian Society for Pediatric Neurosurgery 2020
Materias:	editorial covid-19 newborns pregnant Pediatrics RJ1-570 Surgery RD1-811
Acceso en línea:	https://doaj.org/article/bb31e17cd2df48e7b01a0f1190916ff5
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institution	DOAJ
collection	DOAJ
language	EN
topic	editorial covid-19 newborns pregnant Pediatrics RJ1-570 Surgery RD1-811
spellingShingle	editorial covid-19 newborns pregnant Pediatrics RJ1-570 Surgery RD1-811 Sérgio Cavalheiro Fortieth week
description	Next month, it will have been 9 months since the emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19), that is, the length of a full-term pregnancy. What can be expected? Perhaps favorable outcomes, such as the following: 1) there is a lack of viral transmission to the fetus; 2) there is a failure to produce malformations in the fetal central nervous system during the "fetal moment," that is, the period when the fetus or its parent becomes infected; 3) the fetus is immune to the virus; and 4) the fetus inherits acquired immunity from its mother during the infection period. These questions are pertinent, and the ability to address them is attributable to the speed at which our Chinese colleagues identified this new mutated virus. Their efforts in this regard are much appreciated. The same was not achieved when we encountered the Zika virus epidemic, during which it took us a considerable time to correlate microcephaly with congenital viral infection. To date, we have counted more than 18 million confirmed cases on the planet, including over 680,000 deaths. Will the fetuses of infected pregnant mothers be spared? On reviewing works published in English and Chinese languages, we managed to identify only four cases of probable mother-to-child vertical transmission, one of which was identified at 30 h of life. However, in most of these cases, maternal contamination occurred in the third trimester of pregnancy. What is the real damage to the fetus' central nervous system when contamination occurs during embryogenesis? Such questions will surely be addressed in the imminent months. This pandemic has also revealed to us the fragility of our health service, considering the relatively high mortality rates obtained in well-equipped intensive care units (ICUs) with well-trained medical staff, facilities which are scarce in many regions of our country. Two groups of patients have been of major concern to us: pregnant women and newborns. First, results have already revealed that pregnant Brazilian women who became infected with the new coronavirus had a mortality rate 3.4 times higher than that of uninfected pregnant women. Could genetic factors, immunological factors, or failure to follow up during the puerperal period have contributed to this outcome? However, newborns seem to be protected. Due to the vaccine load they receive, they can build immunity against coronavirus; even a small amount of angiotensin-converting enzyme 2 (ACE-2), which is a co-receptor for the entry of the virus into cells (located mainly in the lungs, intestine, and heart) may block the early stages of infection by binding to the spike protein, preventing it from entering the cells. Alternatively, even a repeated number of viral infections could cause natural immunity. Nonetheless, this protection has not manifested in indigenous children, who are often malnourished and extremely vulnerable to respiratory infections. The mortality rate in the indigenous child and adolescent population is 7.5 per 100,000 inhabitants, which is 10 times higher than that in the same age group for other Brazilians. Therefore, the decimation of our indigenous population can be anticipated. Inevitably, the Indian population appeals for help (figure 1). A new multisystem inflammatory syndrome has recently been identified as a long-term effect of COVID-19, where, due to an imbalance of the inflammatory response, several tissues are affected, such as those of the gastrointestinal system as well as cardiovascular, hematological, cutaneous, respiratory, and neurological tissues. Overall, 2% of affected children have died. Population growth, lack of basic sanitation, deforestation of our forest reserves, and the increase in global temperatures have contributed to the emergence of new infectious epidemics and pandemics. Yellow fever, Ebola, Dengue fever, Chikungunya, Zika, H1N1, H1N2, Middle East respiratory syndrome (MERS), and SARS are simply precursors of what lies ahead. This presents yet another great challenge for humanity, especially those who survive the next 4 million years on Earth.
format	article
author	Sérgio Cavalheiro
author_facet	Sérgio Cavalheiro
author_sort	Sérgio Cavalheiro
title	Fortieth week
title_short	Fortieth week
title_full	Fortieth week
title_fullStr	Fortieth week
title_full_unstemmed	Fortieth week
title_sort	fortieth week
publisher	Brazilian Society for Pediatric Neurosurgery
publishDate	2020
url	https://doaj.org/article/bb31e17cd2df48e7b01a0f1190916ff5
work_keys_str_mv	AT sergiocavalheiro fortiethweek
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spelling	oai:doaj.org-article:bb31e17cd2df48e7b01a0f1190916ff52021-11-23T21:46:36ZFortieth week2675-362610.46900/apn.v2i2(May-August).55https://doaj.org/article/bb31e17cd2df48e7b01a0f1190916ff52020-08-01T00:00:00Zhttps://www.archpedneurosurg.com.br/pkp/index.php/sbnped2019/article/view/55https://doaj.org/toc/2675-3626Next month, it will have been 9 months since the emergence of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19), that is, the length of a full-term pregnancy. What can be expected? Perhaps favorable outcomes, such as the following: 1) there is a lack of viral transmission to the fetus; 2) there is a failure to produce malformations in the fetal central nervous system during the "fetal moment," that is, the period when the fetus or its parent becomes infected; 3) the fetus is immune to the virus; and 4) the fetus inherits acquired immunity from its mother during the infection period. These questions are pertinent, and the ability to address them is attributable to the speed at which our Chinese colleagues identified this new mutated virus. Their efforts in this regard are much appreciated. The same was not achieved when we encountered the Zika virus epidemic, during which it took us a considerable time to correlate microcephaly with congenital viral infection. To date, we have counted more than 18 million confirmed cases on the planet, including over 680,000 deaths. Will the fetuses of infected pregnant mothers be spared? On reviewing works published in English and Chinese languages, we managed to identify only four cases of probable mother-to-child vertical transmission, one of which was identified at 30 h of life. However, in most of these cases, maternal contamination occurred in the third trimester of pregnancy. What is the real damage to the fetus' central nervous system when contamination occurs during embryogenesis? Such questions will surely be addressed in the imminent months. This pandemic has also revealed to us the fragility of our health service, considering the relatively high mortality rates obtained in well-equipped intensive care units (ICUs) with well-trained medical staff, facilities which are scarce in many regions of our country. Two groups of patients have been of major concern to us: pregnant women and newborns. First, results have already revealed that pregnant Brazilian women who became infected with the new coronavirus had a mortality rate 3.4 times higher than that of uninfected pregnant women. Could genetic factors, immunological factors, or failure to follow up during the puerperal period have contributed to this outcome? However, newborns seem to be protected. Due to the vaccine load they receive, they can build immunity against coronavirus; even a small amount of angiotensin-converting enzyme 2 (ACE-2), which is a co-receptor for the entry of the virus into cells (located mainly in the lungs, intestine, and heart) may block the early stages of infection by binding to the spike protein, preventing it from entering the cells. Alternatively, even a repeated number of viral infections could cause natural immunity. Nonetheless, this protection has not manifested in indigenous children, who are often malnourished and extremely vulnerable to respiratory infections. The mortality rate in the indigenous child and adolescent population is 7.5 per 100,000 inhabitants, which is 10 times higher than that in the same age group for other Brazilians. Therefore, the decimation of our indigenous population can be anticipated. Inevitably, the Indian population appeals for help (figure 1). A new multisystem inflammatory syndrome has recently been identified as a long-term effect of COVID-19, where, due to an imbalance of the inflammatory response, several tissues are affected, such as those of the gastrointestinal system as well as cardiovascular, hematological, cutaneous, respiratory, and neurological tissues. Overall, 2% of affected children have died. Population growth, lack of basic sanitation, deforestation of our forest reserves, and the increase in global temperatures have contributed to the emergence of new infectious epidemics and pandemics. Yellow fever, Ebola, Dengue fever, Chikungunya, Zika, H1N1, H1N2, Middle East respiratory syndrome (MERS), and SARS are simply precursors of what lies ahead. This presents yet another great challenge for humanity, especially those who survive the next 4 million years on Earth.Sérgio CavalheiroBrazilian Society for Pediatric Neurosurgeryarticleeditorialcovid-19newbornspregnantPediatricsRJ1-570SurgeryRD1-811ENArchives of Pediatric Neurosurgery, Vol 2, Iss 2(May-August), Pp e552020-e552020 (2020)

Fortieth week

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