Why South Africa’s first neonatal COVID-19 death is a big deal

Minister of Health Zweli Mkhize announced on 20 May 2020 that South Africa had recorded its first neonatal death where the child tested positive for COVID-19.

Much remains unknown about the baby’s birth and death, but Mkhize revealed that the child was born prematurely and died two days after. According to Mkhize, both the mother and baby tested positive for the coronavirus.

Mkhize did caution that “it is important to appreciate the complexities of the underlying condition of prematurity.”

In other words, we don’t yet know the full extent to which COVID-19 contributed to the baby’s death.

While the death of a baby is a devastating blow for parents, the details of this case may be scientifically significant.

By all accounts, COVID-19 and the coronavirus that causes it are going to be around for a while. At least another seven months, and perhaps eighteen months or more.

There are many things that we still do not understand about the virus, including what it means for pregnant women and their babies.

Coronavirus transmission from mother to baby

Can the baby get the virus or COVID-19 while in the womb, or are they protected? Are newborns more susceptible to catching the virus if delivered by Caesarean section?

Until recently, the few small studies that have been published involving women who get COVID-19 in late pregnancy have so far found no evidence of the virus being transmitted between mother and child before birth.

This was despite an early research letter by doctors from Wuhan and Chongqing which theorised that such transmission could be possible.

However, the many confounding factors in these studies meant it was difficult to rule out the possibility that babies were infected with the coronavirus after birth.

More recently, doctors in Toronto, Canada have reported a case which they describe as “probable case of congenital SARS-CoV-2 infection in a liveborn neonate”.

In other words, they have stronger evidence to suggest that transmission of the coronavirus may be possible between an infected mother and baby. The case study was peer-reviewed and published in the Canadian Medical Association Journal.

As these researchers noted: “Cases of suspected perinatal SARS-CoV-2 infection have been reported; however, in light of infrequent testing, the possibility of specimen contamination from infected maternal sites, the questionable validity of serologic testing, and a lack of standardized definitions for congenital, intrapartum and postpartum transmission, more evidence is needed to ascertain the route of transmission and to determine whether in utero transmission has in fact occurred.”

How threatening is COVID-19 to newborn babies?

Depending on how good the data is from the neonatal case in South Africa, it may add to the global scientific understanding about whether and how the virus may be transmitted between pregnant women and their babies.

Another major concern, though, is that a newborn’s death has been linked to COVID-19.

While there have now been a few cases reported of children under 9 years old dying of COVID-19 after being infected by the coronavirus, such fatalities remain low.

Reports of children who get COVID-19 are harrowing, but in one study, researchers said that they are somewhat encouraged by what they saw.

Researchers at Rutgers University in the United States said that the mortality rate for paediatric ICU patients was 4.2% compared to published mortality rates of as high as 62% among adults who are admitted to ICUs with COVID-19.

Children also had lower incidences of respiratory failure.

If the death of a newborn baby in South Africa can be conclusively linked to COVID-19, this may add to our understanding of the risks the coronavirus may pose to such children.

Awaiting a full report from Western Cape paediatricians

MyBroadband asked the Minister of Health for comment regarding this article. A spokesperson referred us to the Western Cape Government, stating that they are still awaiting a full report from the provincial government.

A spokesperson for the Western Cape Minister of Health referred our query to clinicians for comment.

When we followed up on the query, the spokesperson explained that the paediatrician’s report is still outstanding.

Now read: South Africa is entering the new phase of the COVID-19 pandemic – What you should do

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Why South Africa’s first neonatal COVID-19 death is a big deal