- 23-year-old female
- Admitted to the hospital during 35th week of gestation 
- Symptoms: fever (38.6°C), severe cough, and expectoration 
- RT-PCR detected both E and S genes of SARS-CoV-2 in blood and nasopharyngeal and vaginal swabs
- Normal pregnancy until diagnosis of COVID-19
- Hospital tests revealed the following: thrombocytopenia (54 × 109/L), lymphopenia (0.54 × 109/L), prolonged APTT (60 s), transaminitis (AST 81 IU/L; ALT 41 IU/L), elevated C-reactive protein (37 mg/L) and ferritin (431 μg/L)


Mother’s Diagnosis 

- Sedative and analgesic drugs were not administered
- Vital parameters were at normal levels
- Newborn was extubated after 6 hours
- Blood and nonbronchoscopic bronchoalveolar lavage fluid samples were collected before extubation and RT-PCR revealed the presence of both E and S genes of SARS-CoV-2 
- Nasopharyngeal and rectal swabs were collected at 1 hr of life, 3 days and 18 days; RT-PCR revealed the presence of both SARS-CoV-2 genes in each sample 
- Routine blood tests on the 2nd day revealed normal results
- Formula milk was used to feed the newborn

Newborn Care in the Neonatal Intensive Care Unit (NICU)

- On day 3, newborn experienced irritability, poor feeding, axial hypertonia and opisthotonos; however cerebrospinal fluid tested negative for SARS-CoV-2 
- Symptoms gradually improved over the course of 3 days, but mild hypotonia and feeding difficulty remained
- MRI on day 11 revealed bilateral gliosis of the deep white periventricular and subcortical matter, with slightly left predominance
- Newborn recovered slowly and was discharged after 18 days without antiviral treatments 
- A follow-up after 2 months revealed improved hypertonia, normal motricity, and MRI showed reduced white matter injury 


Manifestation of Health Complications in Newborn 

- Three days post admission, a category III-fetal heart rate was observed and thus a category II-Caesarean section was performed
- C-section was performed with intact amniotic membranes, in complete isolation and under anesthesia due to the mother’s respiratory issues
- During the C-section, clear amniotic fluid was collected before the membranes ruptured; the fluid tested positive for both the E and S genes of SARS-CoV-2 
- A 5 lbs, 9.6 oz (2540 g) male neonate was delivered 
- Newborn resuscitation was administered in accordance with current international guidelines
- Mother was discharged 6 days post delivery 


Newborn Delivery

In a comprehensive case study, Vivanti et al. report the first transplacental transmission of SARS-CoV-2 with clinical manifestation in the newborn, consistent with neurological signs and symptoms of the virus. 

Smith College

COVID-19 is spread through person-to-person transmission. The virus spreads mainly through close personal contact (such as when people are within 6 feet of one another) and through the respiratory droplets of someone infected with COVID-19.  Aerosol transmission is also likely, but the relative contribution of these smaller respiratory particles is not completely understood. While less common, spreading can also occur when people touch contaminated objects or surfaces and then their faces, eyes, or mouth. 

Transmission of COVID-19

Vivanti, A.J., Vauloup-Fellous, C., Prevot, S. et al. (2020). Transplacental transmission of SARS-CoV-2 infection. Nat Commun 11, 3572 

https://doi.org/10.1038/s41467-020-17436-6

https://www.nature.com/articles/s41467-020-17436-6

Transplacental transmission of SARS-CoV-2
infection

The reproductive/reproduction number of COVID-19 is estimated to be between 2 and 2.5 as of March 6, 2020. 

Reproductive Number of COVID-19

- American Association for the Advancement of Science

- American Veterinary Medical Association (AVMA)

- Asian Pacific Journal of Tropical Medicine (APJTM)

- BioMed Research International

- BioRxiv (Preprint)

- Emerging Infectious Diseases

- Environmental Research 

- Forensic Science International: Reports

- Infectious Disease Modeling 

- Infectious Diseases Society of America (Clinical Infectious Disease)

- Jama Network Open

- Journal of Travel Medicine

- Nature Communications

- Risk Analysis

- Science of the Total Environment

- Social Science Research Network (SSRN)

- The International Journal of Infectious Diseases  

- The Journal of the American Medical Association (JAMA)

- The Lancet

- The Lancet Infectious Diseases 

- The New England Journal of Medicine

- Travel Medicine and Infectious Diseases

- Veterinary Quarterly

- Virology Journal 

- World Journal of Clinical Cases




Transmission of COVID-19 References by journal

Cluster transmission has been noted in many COVID-19 studies
It is characterized by infections that are concentrated within a given area, often within families or social circles 

Cluster Transmission of COVID-19

- Asia
- Africa 
- North America
- South America
- Antarctica
- Europe
- Australia

Classification of studies on COVID-19 Transmission by Continents

Indirect Transmission of COVID-19

Previous reports indicate that asymptomatic transmission is possible, but since they’re hard to track, this poses a significant challenge to infection control practices.

Implications of Asymptomatic COVID-19 Transmission

- Super spreading events

- Climate

- Season

- Location

- UV & sunlight on the virus

- Virus concentrations in wastewater 

Factors that affect the transmission of COVID-19

Live animal food markets carry a great risk of transmitting zoonotic diseases compounded by the lack of safe and regulated hygienic practices. The Huanan South Seafood Market in Wuhan, China which sells wild exotic and domesticated live animals for consumption, was identified to be the epicenter of the COVID-19 pandemic. Bats are implicated to be the reservoir hosts of the virus, as SARS-CoV-2 is 96% genetically identical to bat coronavirus. Pangolins are also a possible host, as the RBD in the S protein show similarity to Pangolin-CoV. 

Any infections in animals with COVID-19 should be reported to the World Organization for Animal Health (OIE). The CDC reports that a number of pets worldwide are confirmed positive for COVID-19, though the risk of animal-human transmission in these cases are yet unclear.

Zoonotic Transmission of COVID-19

Transplacental Transmission of COVID-19

Determining this has critical implications: 

If primarily spread via droplets, then masks, distancing rule (6ft), etc. are effective in preventing transmission. Conversely, if primarily spread via aerosols, then preventative measures become less effective and thus need to be modified. 

Examining the source of transmission for both types of respiratory particles are crucial.



Aerosol versus Droplet Debate

Transmission of COVID-19 references by organization

Current data shows that infection rates of SARS-CoV-2 are low among children. It then can be said that they do not play a prominent role in the disease transmission of COVID-19 during the pandemic. Although the actual infection rate cannot be known due to under-reporting and a lack of available results from seroepidemiological studies, there are numerous findings against an increased risk of infection from children and findings that show a lower rate of infection and of contagion especially in children under the age of 10. It was also found that the transmission of SARS-CoV-2 is typically from an infected adult to a child and that a lack of evidence remains for the transmission of infection from an infected child to an adult. The cause of this lower virus transmission rate is still unknown, which calls for further investigations. 

Role of Children In Transmission

- Genomic Evidence of In-Flight Transmission of SARS-CoV-2 Despite Predeparture Testing
-  In-flight transmission of SARS-CoV-2: a review of the attack rates and available data on the efficacy of face masks

Air travel and COVID-19 transmission 

SARS-CoV-2 is a branch of the SARS-Cov family. It is spherical and enveloped with club-shaped spikes on the surface. Thus, it has the shape of a solar corona. Inside the nucleoplasm, the virus has single-strand RNA, which stores the genetic information of this virus. Due to the property of protein and RNA, the SARS-CoV-2 should be sensitive to temperature.

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