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      The novel coronavirus (COVID-19) and unintended pregnancy during the quarantine period

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          Abstract

          To the editors of the Pan African Medical Journal The novel coronavirus (COVID-19) is highly similar to the Severe Acute Respiratory Syndrome (SARS) and is responsible for the 2019-2020 pandemic. The World Health Organization (WHO) has considered the vast prevalence of COVID-19 as a public health emergency [1]. Quarantine raises an important need for interventions to reduce unintended pregnancy. In the quarantine period, traffic restrictions imposed by governments result in reduces access to family planning equipment/contraceptives. With regard to reproductive health, the number of unintended pregnancies is expected to increase during the quarantine period resulting from the global encounter with COVID-19. Unintended pregnancy as a key challenge for the health sector imposes considerable socioeconomic costs on the society. In other words, from the socioeconomic perspective, unwanted pregnancy affects reproductive indices in the health system, thereby decreasing the quality of life and work force productivity [2]. In addition to unintended pregnancy, COVID-19 as a highly infectious disease can lead to high-risk pregnancies. Studies have indicated that suffering from SARS during pregnancy resulted in spontaneous miscarriage, preterm labor pain (PLP), Intrauterine Growth Restriction (IUGR), endotracheal intubation, admission to intensive care units, and Disseminated Intravascular Coagulopathy (DIC) [3]. COVID-19 also seems to have similar complications to those of other infectious diseases although no sufficient evidence is available in this regard. Chen et al. conducted a study on pregnant women with COVID-19 in Zhongnan Hospital, Wuhan, China from 20 to 31 January 2020 and reported none of the above mentioned complications. Therefore, there is no evidence regarding the impact of COVID-19 on pregnancy [4]. Nonetheless, such an impact may be possible since infections can lead to early uterine contractions and eventually preterm delivery [5]. Unintended pregnancies have an adverse effect on a child’s health. Various micro-level investigations have revealed the effect of children´s health on their ability to learn and acquire knowledge. In addition, adults´ health status could affect the labor force volume, absence from work, and workers´ efficiency. Moreover, macro-level studies have indicated that population´s health had a considerable impact on each country´s economic growth rate [6]. Unintended pregnancy may be accompanied with the probability of abortion. Considering the quarantine period, the number of unsafe abortions may increase particularly in developing countries. Unsafe abortions can lead to negative mental consequences, disability, and even maternal mortality. These can damage human work force quality and impose great expenditures on the health system that are not even recorded in the health sector´s balance sheets [7]. During the pandemic, most costs of the health sector taxpayers may also be allocated to unintended pregnancies and their reproductive outcomes. Conclusion Overall, unintended pregnancy and its undesirable maternal-infantile outcomes will increase the short- and long-term economic and psychosocial expenditures of this global crisis. As mentioned above, the COVID-19 pandemic may increase the probability of unintended pregnancy. Considering the limited access to contraceptives, particularly in poor and developing countries, during the quarantine period, they are recommended to be provided to families for free. In other words, contraceptives are suggested to be added to the families´ baskets of goods. Families and the youth are also recommended to be provided with online or offline educational applications on reproductive and sexual health for free. Prevention and control of unintendedpregnancy can, in turn, help save the government´s general budget and decline the healthcare cost inflation. Competing interests The author declares no competing interests.

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          Most cited references 7

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          Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding

          Summary Background In late December, 2019, patients presenting with viral pneumonia due to an unidentified microbial agent were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen, provisionally named 2019 novel coronavirus (2019-nCoV). As of Jan 26, 2020, more than 2000 cases of 2019-nCoV infection have been confirmed, most of which involved people living in or visiting Wuhan, and human-to-human transmission has been confirmed. Methods We did next-generation sequencing of samples from bronchoalveolar lavage fluid and cultured isolates from nine inpatients, eight of whom had visited the Huanan seafood market in Wuhan. Complete and partial 2019-nCoV genome sequences were obtained from these individuals. Viral contigs were connected using Sanger sequencing to obtain the full-length genomes, with the terminal regions determined by rapid amplification of cDNA ends. Phylogenetic analysis of these 2019-nCoV genomes and those of other coronaviruses was used to determine the evolutionary history of the virus and help infer its likely origin. Homology modelling was done to explore the likely receptor-binding properties of the virus. Findings The ten genome sequences of 2019-nCoV obtained from the nine patients were extremely similar, exhibiting more than 99·98% sequence identity. Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%). Phylogenetic analysis revealed that 2019-nCoV fell within the subgenus Sarbecovirus of the genus Betacoronavirus, with a relatively long branch length to its closest relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21, and was genetically distinct from SARS-CoV. Notably, homology modelling revealed that 2019-nCoV had a similar receptor-binding domain structure to that of SARS-CoV, despite amino acid variation at some key residues. Interpretation 2019-nCoV is sufficiently divergent from SARS-CoV to be considered a new human-infecting betacoronavirus. Although our phylogenetic analysis suggests that bats might be the original host of this virus, an animal sold at the seafood market in Wuhan might represent an intermediate host facilitating the emergence of the virus in humans. Importantly, structural analysis suggests that 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans. The future evolution, adaptation, and spread of this virus warrant urgent investigation. Funding National Key Research and Development Program of China, National Major Project for Control and Prevention of Infectious Disease in China, Chinese Academy of Sciences, Shandong First Medical University.
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            Virology, Epidemiology, Pathogenesis, and Control of COVID-19

            The outbreak of emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) in China has been brought to global attention and declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Scientific advancements since the pandemic of severe acute respiratory syndrome (SARS) in 2002~2003 and Middle East respiratory syndrome (MERS) in 2012 have accelerated our understanding of the epidemiology and pathogenesis of SARS-CoV-2 and the development of therapeutics to treat viral infection. As no specific therapeutics and vaccines are available for disease control, the epidemic of COVID-19 is posing a great threat for global public health. To provide a comprehensive summary to public health authorities and potential readers worldwide, we detail the present understanding of COVID-19 and introduce the current state of development of measures in this review.
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              Coronavirus Disease 2019 (COVID-19) and Pregnancy: What obstetricians need to know

              Coronavirus Disease 2019 (COVID-19) is an emerging disease with a rapid increase in cases and deaths since its first identification in Wuhan, China, in December 2019. Limited data are available about COVID-19 during pregnancy; however, information on illnesses associated with other highly pathogenic coronaviruses (i.e., severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS)) might provide insights into COVID-19’s effects during pregnancy.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                11 May 2020
                2020
                : 35
                : Suppl 2
                Affiliations
                [1 ]Social Determinants of Health Research Center, Department of Midwifery, school of medicine, Alborz University of Medical Sciences, Karaj, Iran
                Author notes
                [& ] Corresponding author: Mansoureh Yazdkhasti, Social Determinants of Health Research Center, Department of Midwifery, school of medicine, Alborz University of Medical Sciences, Karaj, Iran
                Article
                PAMJ-SUPP-35-2-29
                10.11604/pamj.supp.2020.35.2.23313
                7875721
                ©Mansoureh Yazdkhasti et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Letter to the Editors

                Medicine

                unwanted pregnancy, public health, covid-19

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