A 39-year-old woman, Gravida 3, Para 2 at 29 weeks gestation presented to the emergency department with complaints of fever, chills and dry cough since 3 days. Her past medical history was significant for Rheumatoid arthritis treated with Methotrexate for 5 years, Non-Hodgkin’s lymphoma treated with chemotherapy 10 years ago and is in remission, Sjogren’s syndrome (diagnosed 1 year ago) and Rheumatoid arthritis (relapsed 2 years ago), currently on Hydroxychloroquine. On admission, she was febrile with a temperature of 102.2 degrees Fahrenheit, tachycardic at 126 beats per minute, tachypneic at 24 breaths per minute and mildly hypoxic at 94% on room air. She was mildly hypertensive with a blood pressure of 141/76. Her oxygen saturation improved to 100% after oxygen supplementation with 2 liters via nasal cannula.\nInitial labs were significant for a leukocytosis of 14.75 x 103/µl with neutrophilia, a normal lymphocyte count, elevated C-reactive protein (CRP), lactate dehydrogenase and D-dimer. Procalcitonin was normal. Blood cultures were collected. A nasopharyngeal swab sample was taken and tested positive for COVID-19 by polymerase chain reaction. CT angiogram of the chest revealed extensive severe bilateral focal ground-glass infiltrates () without evidence of pulmonary embolism. Given the patient’s history of autoimmune conditions, current pregnancy, severe imaging findings and overall septic picture, she was admitted to the Intermediate Care Unit for close monitoring despite minimal oxygen requirements. Since the patient meets the criteria for the severe disease defined as requiring supplemental oxygen, as per our institution's policy, Infectious disease (ID) consultation was requested to evaluate if the patient meets the criteria for the use of Remdesivir set forth by the Emergency use authorization (EUA) released by the FDA []. Patient met the criteria and ID physician suggested to initiate Remdesivir after discussing the risks and benefits and obtaining the patient's consent since the teratogenic side effects of Remdesivir are not known. Patient has been provided information regarding the possible side effects including unknown teratogenicity and provided the copy of the patient information released by the Gilead sciences. Patient consented for the use of the Remdesivir. After following the standard of work flow for the use of Remdesivir at our institute which includes approval by hospital pharmacy as per the EUA guidelines for the Remdesivir issued by the FDA, she received 200 mg of IV Remdesivir on Day 1 followed by 100 mg daily for the next 4 days. Since the patient is symptomatic for less than 7 days at the time of admission, she did not meet the criteria to receive the steroid therapy as per the RECOVERY trial.\nShe successfully completed the course of Remdesivir without any side effects and showed steady improvement throughout the hospital stay. Fetal activity was monitored every 8 hours using the external fetal monitor, with no abnormalities detected. As per the obstetrician’s recommendations, supplemental oxygen was provided to maintain saturations >95%. Oxygen saturations were around 98−100% while on 2 L via NC and weaned down to room air with saturations >95% by the time of discharge on day six.
Mrs. A, a 35-year-old at 27 weeks gestation, was referred to our institution with a fever (101.3 °F), flu-like syndrome, tachypnea (RR 28×/min; O2 saturation 94% room air), and anosmia. The patient had complained of symptoms for 4 days before admission. A chest X-ray was normal. A naso-oropharyngeal swab was positive for SARS-CoV-2 by real-time PCR (RdRP Cq 15.21; E Gene Cq 15.58) without abnormalities in a chest X-ray.\nThe patient was taken care of in an isolation ward for COVID-19 and given oxygen therapy 4 Lpm with a nasal cannula (saturation 96–97%). Remdesivir was given on HD 1 until HD 6. Daily fetal monitoring was performed using a fetal doppler and fetal kick count chart. During hospitalization, clinical symptoms improved. The patient was discharged after 7 days of hospitalization with a repeated naso-oropharyngeal swab for SARS-CoV-2 result which came back negative. The patient underwent vaginal delivery at 37 weeks gestation. A baby boy was born, 3100 g, 51 cm, A/S 8/9. Both mother and baby were in good condition after delivery.\nRemdesivir Protocol:\nDay 1: 200 mg IV single dose\nDay 2–5: 100 mg IV/daily