Dr. Meghana Rao is a physician at Mary’s Center in Washington DC, with a specialty in Obstetrics and Gynecology. One of her clinic sites is in Prince George’s County, the hardest-hit county in Maryland for COVID19 infections.  They had (and still have) some of the highest numbers of COVID+ pregnant women. She spoke to ICA about her patients, racial disparities, and vaccination.

Precautions as a caregiver

ICA: What precautions do you as a caregiver need to take during labor and delivery?

Dr. Rao: I get tested every week. Many of the protocols we use have had to be recreated from ground up because there has been no coordination at the national level. For example, how we test pregnant women, how we follow up in an outpatient setting, how often we have them come in, making sure they are comfortable getting care via telehealth. Clinics, states and cities have had to roll out protocols on our own. Our women’s health dept came up with their own guidelines. They were aggressive with testing, so they could find out how many were positive and might potentially infect staff and other patients. In DC, we tested all pregnant women when they came for labor and delivery. 

Everyone who needs testing goes to the respiratory clinic, which is separate.  ICA’s early support to Mary’s Center enabled us to expand care with COVID testing. It made it possible for the respiratory clinic to be outdoors, as we could get the supplies we needed.

ICA: Has there been a change in the number of patients you see?  Do you see fewer because of the pandemic?

Dr. Rao: Many clinics and hospitals are struggling to stay afloat. Dental services saw a decrease, as they were closed for months.  Ob/gyn is seeing a large volume, because of telehealth even though fewer patients are being seen in-person. While patients continue to be seen in-person for labor and delivery, other in-person visits such as for pap smears, routine physicals and childhood visits were postponed.

COVID-positivity in pregnancy

ICA: Do you see many pregnant women who are COVID-positive?

Dr. Rao: At the peak of the pandemic, Mary’s Center clinics, both in DC and in Maryland, had the highest number of COVID+ pregnant women. To understand why, we need to look at the general population. In Prince George’s County, the Hispanic community is mainly engaged in construction work. Undocumented people didn’t qualify for stimulus payments, and so had to go to work. With multiple family members living under the same roof, they showed the highest positivity rate. Pregnant women are part of the population, hence the high numbers of COVID+ pregnant women at our clinics.

ICA: What particular care do COVID+ expecting mothers need?  Are there complications during delivery?

Dr. Rao: In the beginning, little was known about COVID-19.  Since the initial manifestation was as a respiratory virus, we thought it would affect pregnant women more, as is the case for flu.  We were very cautious, and were checking in on COVID-+ pregnant women every 2-3 days during their 2-week quarantine period, helping them make appointments at the respiratory clinic.

During pregnancy, women don’t have as much room to breathe, so have more difficulty with breathing and oxygenation.  There is a higher chance of the baby being delivered pre-term to keep the mother healthy, to allow her to breathe easier. We now know there are a lot of GI issues, and we make sure the women aren’t dehydrated during pregnancy.

ICA: Can the virus be transmitted to the babies?

Dr. Rao: Newborns can get infected after delivery: it is not through the placenta, but through the air they breathe.

Racial disparities

ICA: Among the population served by Mary’s Center, what have you and your colleagues observed in terms of the racial disparities among those affected by COVID?

Dr. Rao: The African American population is disproportionately likely to get very sick. Among our patients, the percentage of those who got very sick is relatively low in Hispanic patients and higher in African Americans.

Vaccination

ICA: Have you received COVID-19 vaccination?  Have you received both doses? Any side effects?

Dr. Rao: Yes, I have been vaccinated.  The only side effect was a sore arm.

ICA: Should pregnant women be vaccinated?

Dr. Rao: The risks from getting COVID far, far outweigh the potential risks of getting a vaccine.  Pregnant women in the clinical trials got the vaccine. In fact, I am pregnant, and feel strongly that pregnant women should be vaccinated.

ICA: How do patients and staff at your clinic feel about getting vaccinated?

Dr. Rao: There is vaccine hesitancy among minority populations, among both patients and staff.  There is a history of ethical violations in minority populations that leads to this attitude. I operate at Howard University, and had 70% of staff express reservations.

Advice for us all

ICA: What advice do you have for all of us at this time?

Dr. Rao: The end is in sight, we have a vaccine!  Hang in there, keep wearing masks, keep washing your hands.