Pregnancy
Currently, there is a paucity of knowledge and data related to the consequences of COVID-19 during pregnancy. However, pregnant women seem to have a high risk of developing severe infection and complications during the recent 2019-nCoV outbreak. This speculation was based on previous available scientific reports on coronaviruses during pregnancy (SARS-CoV and MERS-CoV) as well as the limited number of COVID-19 cases. Analyzing the clinical features and outcomes of 10 newborns (including two sets of twins) in China, whose mothers were confirmed cases of COVID-19, revealed that perinatal infection with 2019-nCoV may lead to adverse outcomes for the neonates, for example, premature labour, respiratory distress, thrombocytopenia with abnormal liver function and even death. It is still unclear whether or not the COVID-19 infection can be transmitted during pregnancy to the fetus through the trans placental route. A recent case series report, which assessed intrauterine vertical transmission of COVID-19 infection in the nine infants born to infected mothers, found that none of the infants tested positive of the virus. Likewise, there was no evidence of intrauterine infection caused by vertical transmission in the SARS and MERS epidemics.
The CDC asserts that infants born to mothers with confirmed COVID-19 are considered persons under investigation (PUI) and should be temporarily separated from the mother and isolated.
Breastfeeding and infant care
The data available to date is limited and cannot confirm whether or not COVID-19 can be transmitted through breast milk. Assessing the presence of COVID-19 in breast milk samples from six patients showed negative result. The CDC points out that in case of a confirmed or suspected COVID-19 infection, the decision of whether or how to start or continue breastfeeding should be made by the mother in collaboration with the family and healthcare practitioners. Careful precautions need to be taken by mother to prevent transmitting the disease to her infant through respiratory droplets during breastfeeding. This includes wearing a facemask and practicing hand hygiene before feeding the baby. In addition, it is advisable that breast pumps are cleaned properly after each use and, if possible, a healthy individual is available to feed the expressed breast milk to the infant.
Children and elderly population
On the basis of the available reports, COVID-19 among children accounted for 1-5% of the confirmed cases, and this population does not seem to be at higher risk for the disease than adults. There is no difference in the COVID-19 symptoms between adults and children. However, the available evidence indicated that children diagnosed with COVID-19 have milder symptoms than the adults, with a low mortality rate. On the contrary, older people who are above the age of 65 years are at higher risk for the severe course of disease. In the United States, approximately 31-59% of those with confirmed COVID-19 between the ages of 65 and 84 years old required hospitalization, 11-31% of them required admission to the intensive care unit, and 4-11% died.