As COVID-19's omicron wave slowly declines nationwide, states like California have lifted their mandates requiring universal masking in public. Beyond California, Connecticut, Delaware, Maryland, and New York, have lifted mask mandates as well.
While the optics of the transition to a (hopefully) post-pandemic world appears to signal a moment of respite, many people who are considered to be at high risk for COVID-19 — particularly pregnant people — are rightfully wary of a return to a so-called normal. Indeed, because the squirrelly omicron variant can infect those are who are vaccinated (and boosted) against the virus — and because the risk of severe infection is higher for this demographic group — many of those who are pregnant are now left wondering how they are expected to navigate a less-cautious world, in which they remain more vulnerable.
Despite the omicron variant's ability to partially evade vaccines, ongoing evidence is clear that those that are pregnant should get vaccinated against COVID-19. Such vaccinations also protect the fetus, evidently: data from the Centers for Disease Control and Prevention released Tuesday showed that the chances of a baby 6 months old or younger being hospitalized due to COVID-19 are 61 percent lower if the mother received two shots of the Pfizer or Moderna vaccine while pregnant. Likewise, vaccinated pregnant women people are at a lower risk of getting infected with SARS-CoV-2 compared to unvaccinated pregnant people.
Yet research also continues to show that pregnant people are at a higher risk of experiencing severe illness from COVID-19 compared to those who aren't pregnant. Several studies have found that those who have COVID-19 during pregnancy are more likely to be at risk of preterm birth, stillbirth, preeclampsia, and other pregnancy complications.
While vaccinations reduce the risk of contracting COVID-19, vaccinated and boosted people — pregnant or not — can still get infected with the highly contagious omicron variant. Vaccination helps reduce the severity of the illness. This tricky balancing act highlights the disparities between who gets to enter this next stage of the pandemic worry-free and who does not.
Yet likely due to misinformation and fear, not enough pregnant people are vaccinated in the United States. According to the Centers for Disease Control and Prevention (CDC), there are 201,075 pregnant people who are vaccinated against COVID-19 as of February 14, 2022. Dr. Melissa Simon, an obstetrician gynecologist at Northwestern Medicine, tells Salon that is not enough — "period."
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It's a "cause for alarm," Simon continued. "Lifting mask mandates really harms vulnerable people, and that includes pregnant people [and] those under age five who can't get vaccinated." Simon said that a pre-pandemic normal would be "dangerous for people who are immunocompromised, and people who just can't get the vaccine because of certain reasons."
Simon also noted that just because governors are lifting mask mandates does not mean that theirs is a decision "rooted in science."
"It does not mean that it is the right thing to do, and that is really an important message that I don't hear anywhere," Simon said. "The governors that are lifting mask mandates are not scientists; they are politicians."
Dr. Stephanie Gaw, an assistant professor of maternal fetal medicine at the University of California, San Francisco, agrees.
"I think it's a little bit early for mask mandates to be lifted, to be honest, with the rates as high as they are," Gaw told Salon. "I would advise all my pregnant patients to continue masking in higher risk areas, indoors, with people you don't usually interact with, and maintain all the Covid precautions."
In a study published in the Journal of Infectious Diseases in January, researchers at Massachusetts General Hospital and Brigham and Women's Hospital reported that they detected the delta variant in the blood and placentas of women who had stillbirths and serious pregnancy complications, adding to a suspicion that the delta variant in particular was especially a danger to pregnant people. Notably, none of the women in the study had been vaccinated against COVID-19.
As science catches up with the omicron variant and how it might impact pregnancy, researchers are still investigating. Most recently, Oxford University scientists announced that they were going to study specific COVID-19 variants on pregnant people and newborns.
Simon tells Salon despite vaccination status, all pregnant people should still mask up.
"Regardless if you're vaccinated and boosted, if you're pregnant, when you're outside in a well ventilated area and you are alone, or you are with a group of people you normally associate with — like your family and friends who are also vaccinated and boosted, if you feel comfortable removing your mask, then fine," Simon said. But in more crowded and less ventilated areas, a mask is still a good idea. "The omicron variant is highly contagious, and therefore it's important to practice mitigation strategies," Simon added.
Simon urged anyone who is pregnant to avoid catching COVID-19 as best as they can.
"To this day, the data clearly shows that if you are pregnant and you get COVID-19, you have a higher chance of getting admitted to the hospital," regardless of which variant you contract, Simon said. "We know vaccination and boosting helps protect against severe cases of COVID and it helps protect against admission into the hospital and it helps protect against being transferred to the intensive care unit if you are pregnant," Simon continued.
But why are pregnant persons at higher risk if they contract COVID-19? Dr. Stephanie Gaw, an assistant professor of maternal fetal medicine at the University of California, San Francisco, told Salon there are two reasons that they face higher risk of hospitalization for severe disease with COVID-19. The first is that a pregnant person's immune system is a little weaker than usual, to maintain tolerance to the fetus while also protecting it.
"Pregnant women mount kind of a weaker immune response . . . they don't get sick with everything, all the time, but this is a little bit attenuated, a little bit weaker than when you're not pregnant," Gaw said.
Second, Gaw said, is the way that COVID-19 affects the respiratory system — and how that interacts with a pregnant person's body.
"The biggest danger with getting COVID or a respiratory disease during pregnancy is that when you're pregnant, your body changes and you need more oxygen — you have higher respiratory needs because as the baby's developing, and then you have lower oxygen reserves," Gaw added.
Gaw said this doesn't mean pregnant people shouldn't travel at all — or not do anything. Rather, everyone must make their own assessment.
"I don't think it's so dangerous that nobody should travel at all, but be thoughtful about where you're going and the COVID-19 rates where you're going," Gaw said. "The highest risk interactions are going to be in transit, like lining up in a queue, boarding the plane, et cetera — that's why mask mandates in higher risk areas like that are really important."
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