EFFECT OF HORMONAL CONTRACEPTION ON ILLNESS SEVERITY IN WOMEN WITH POSITIVE SARS-CoV2 TESTS

Abstract

19 symptoms or if they had been in contact with someone suspected or confirmed to be positive for the virus. Only patients determined to be at low risk for COVID-19 were allowed to enter the clinic for fertility treatment. Both patients and staff were required, upon arrival at the clinic, to wear a mask, complete a symptom-based questionnaire, record body temperature, and keep a safe social distance of more than 6 feet at all times. Any individual recording a fever over 100.4 O F and/or two or more symptoms was instructed to stay/return home for self-quarantine. Specimen collection for viral screening involved an anterior nare sampling method and storage in a FDA approved viral transport medium. Viral RNA was isolated using the MagMAXÔ Viral/Pathogen II (MVP II) Nucleic Acid Isolation Kit (Thermo Fisher Scientific). Molecular testing for active SARS-CoV-2 viral RNA infection was performed using the FDA emergency use authorized TaqPathÔ RT-PCR COVID-19 test (Thermo Fisher Scientific) for every patient within 3-5 days prior to oocyte retrieval or an attempt to achieve a pregnancy, and for all staff bi-weekly. Positive cases were reported to each respective local State Health Department.RESULTS: Of the 2,074 patients tested for COVID-19 between May and July 2020 across nine fertility clinics in the US, only 3 (0.15%) were found to be positive for SARS-CoV-2 viral RNA infection. In all cases the patients were asymptomatic and passed the triage protocol. PCR testing of staff bi-weekly identified 6 positive cases. All but one indicated having one or two mild symptoms. There were no recorded community transmissions among either patients to staff or between staff members.CONCLUSIONS: A comprehensive risk mitigation strategy that includes a combined triage protocol, safe social distancing and molecular testing for active SARS-CoV-2 viral RNA infection in both patients and staff enables early detection and isolation of infected asymptomatic or pre-symptomatic individuals, thereby creating a safe environment for patient care and staff welfare during the global COVID-19 pandemic.

Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception: a Cochrane systematic review

“…Three studies-Seeland et al, 20 Mujumdar et al, 21 and Costeira et al 22 -were comparative NRSIs with 314 704 participants in total (table 3). Seeland et al 20 and Costeira et al 22 stratified outcomes for premenopausal and postmenopausal patients, and we included only information from the premenopausal women.…”

“…Seeland et al 20 and Costeira et al 22 stratified outcomes for premenopausal and postmenopausal patients, and we included only information from the premenopausal women. Seeland et al 20 and Mujumdar et al 21 ascertained current use of contraceptives as well as COVID-19 positivity using diagnostic codes within medical records.…”

“…One study, Mujumdar et al, 21 included all users of any type of hormonal contraception as their exposure group while the others compared CHC users to people without any hormonal therapy. No comparative studies directly assessed venous or arterial thromboembolism as an outcome.…”

“…No comparative studies directly assessed venous or arterial thromboembolism as an outcome. Seeland et al 20 measured our secondary outcomes of mortality, while Mujumdar et al 21 and Costeira et al 22 measured hospitalisation rates and intubation. No studies reported data on our secondary outcome of ARDS.…”

“…We judged Seeland et al 20 to be at serious risk of bias from confounding as they did not identify which covariates were used for propensity score matching. Similarly, Mujumdar et al 21 did not report on variables used for confounding assessment. Costeira et al 22 did adjust for body mass index (BMI) and age, but did not include all prespecified confounders, and we judged there to be additional risk that variables were not validly measured as they were self-reported.…”