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.