Background
The novel coronavirus disease 2019 (COVID-19) has been declared as a ‘pandemic outbreak’ and public health emergency of utmost international concern (1). Over 8.2 million confirmed cases and more than 446,392 deaths (as of 17/06/2020), the pandemic continues to harm significant number of people worldwide. Approximately, 5% of the infected cases are complicated by hypoxia and respiratory failure (2). The reported prevalence of severe pneumonia among Chinese patients was as high as 5% with an estimated mortality rate of 2.3 – 3.83% (3-5). Partial immune suppression, physiological and anatomical changes and multiple interaction with the healthcare system during pregnancy, presents an unprecedented challenge in managing this vulnerable population (2,6,7).
Previous infectious outbreaks such as, H1N1 influenza virus, Zika virus, severe acute respiratory syndrome corona virus (SARS-CoV) and Middle East respiratory syndrome corona virus (MERSCoV) have had significant adverse impact on maternal as well as perinatal outcomes (6,8). Data collated from these patients demonstrated higher rates of intensive care unit admission, intubation, and death compared with non-pregnant patients (7,9). Anecdotal evidence demonstrates 0.1–0.2% of all pregnancies are complicated by respiratory failure (10,11).
Till date, no pharmacological intervention has been proven effective to treat COVID-19. Despite promising outcomes, no high-quality evidence exists for the safety and efficacy of convalescent plasma in treating SARS-COV2 infection. Inconclusive, limited clinical experience has been reported supporting the use ECMO in the management of COVID-19 (12,13). In the absence of any definitive therapy, the cornerstone of COVID-19 treatment varies from symptomatic ambulatory care management to intensive care treatment (14).
Over the past decade, the healthcare system in Qatar has transformed to a world class public health system providing free or highly subsidized healthcare to all its citizens and residents (15-17). The tiny Arabian Peninsula is also reported to have one of the lowest COVID-19 fatality rates in the world estimating less than 0.07% (18).