With the new surge in Covid-19 cases in Mauritius, I have been avidly following the latest unfortunate developments in my home country for a number of reasons but mainly because I am worried about my family who all live over there and, for more selfish reasons, I have been trying to plan a long overdue visit. The latter has been extremely tricky to organise given the various requirements for quarantine by the Mauritian and British governments and the fact that I cannot work remotely. I could go on and on about this as it has caused me a lot of grief, however, the purpose of this article is to provide evidence-based facts regarding pregnancy and Covid-19.

I was extremely surprised and worried regarding the response given by the Mauritian Health Minister Dr Jagutpal when asked if pregnant healthcare “frontliners” should continue to work, at the press conference on Thursday the 11th of March. His answer, I quote “…Partou kot ena Covid-19 dan lemond bann madam ki ansint, a okenn moman pann gagn okenn bann létid dir ki zot pli a risk ou bien zot rant dan bann leta pli sever kan zot kontrakte viris varyan...”. For those of you who do not understand creole, his answer was simply that there were no studies that showed that pregnant women are at higher risk of severe disease when they contract the virus (variant).

This statement is deeply troubling as it is factually incorrect. First of all, the use of the term “virus varyan” here is irrelevant as we have been repeatedly told during the daily press conferences that there is no confirmation that the virus circulating on the island is a variant. Secondly, and most importantly, studies carried out in the US, the UK and Mexico have all shown growing evidence that pregnant women are more vulnerable to severe illness from Covid-19 compared with non-pregnant women, particularly in the third trimester. I have gone through those papers, various reports published by different organisations as well as the recent guidelines published by the Royal College of Obstetricians and Gynaecologists (RCOG), which all support the fact that pregnant women contracting Covid-19 are at increased risk of more severe disease and poorer outcomes. I will go through some of these papers and numbers to explain why the statement made by the Health Minister is incorrect.

The US Centre for Disease Control and Prevention (CDC) published an updated study in November 2020. This large study, involving 23,434 pregnant women with symptomatic Covid-19, found that pregnant women were three times more likely be admitted to ICU and receive invasive ventilation and nearly twice as likely (1.7 times to be precise) to die. A paper (Allotey et al) published in the British Medical Journal (BMJ) in September 2020 showed similar results and the WHO has based its recommendations on this paper. Another large study from Mexico (Martinez-Portilla et al) compared 5,183 pregnant women with symptomatic Covid-19 with 5,183 matched non-pregnant controls. Again, this study showed that pregnant women had higher odds of death, pneumonia and ICU admission.

These studies all have their limitations but I think there is enough evidence out there to support the fact that a mandatory risk assessment of all pregnant healthcare “frontliners” should be carried out by their employers. In the UK, the guidance is clear, women who are less than 28 weeks pregnant should practice social distancing but can work in a patient-facing environment and women who are more than 28 weeks pregnant, or have underlying health conditions should avoid direct patient contact.

Hence I ask the question why this is not the case in Mauritius? The pregnant healthcare “frontliners” already have an increased risk with a majority being of Black, Asian and minority ethnic (BAME) background. I do hope that our Health Minister revisits this statement and puts a plan in place for this category of health workers.

Disclaimer: I am a final year Specialist Registrar in Rheumatology and General Internal Medicine in the UK and not an Obstetrician/Gynaecology trainee or specialist and this article provides clear evidence from peer-reviewed papers and guidance published by the RCOG. These are freely available online to the general public through a simple Google search.