Case 3
The third case describes a 26-year-old obese (BMI >
30kg/m2) African American female with no known chronic
medical conditions who was 18 weeks pregnant (G1P0) when she presented
in June 2020 complaining of a productive cough, chills, nausea, and
vomiting with a chest x-ray showed bibasilar air space opacities. Her
SARS-CoV-2 RT-PCR was positive (subsequently confirmed with qRT-PCR VL
1,518,000,000 copies/mL), and she was admitted to the hospital. She
improved after receiving supportive treatment for her symptoms and was
discharged 2 days later, remaining clinically well for almost 4 months.
She was exposed to a patient with COVID-19 at her place of work in
mid-October but tested negative by RT-PCR at that time. Three days
later, now 36 weeks pregnant, she developed congestion, cough, and
dyspnea and tested positive for SARS-CoV-2 by RT-PCR. She recovered at
home without treatment and had a spontaneous vaginal delivery of a
healthy baby in November. While no interim samples were available for
testing, prolonged viral shedding seems unlikely given the long period
(4 months) between the two episodes and the development of new typical
symptoms with her second event. Pregnant patients are known to be more
susceptible to respiratory viral infections in general, thought to be
due to a complex combination of hormonal and other immunomodulatory
changes in the presence of the fetus, as well as alterations in the
upper respiratory tract brought about by pregnancy [16]. However,
pregnant patients have not been shown to exhibit greater risk of
infection or mortality with SARS-CoV-2 [17] like that seen with the
H1N1 Influenza pandemic of 2009. Given the lack of reported cases of
reinfection during pregnancy to date, it does not seem to convey any
substantial increased risk for reinfection, although whether pregnancy
modulates humoral responses to SARS-CoV-2 infection or vaccination
remains unclear.