March 27, 2020

expert comment on Boris Johnson being tested positive for COVID-19

The UK Prime Minister, Boris Johnson, has announced that he has tested positive for COVID-19 and is self isolating at home. 

Prof Joy Lawn, Fellow of the Academy of Medical Sciences, and Director of the Centre for Maternal, Adolescent, Reproductive & Child Health at the London School of Hygiene & Tropical Medicine, said:

“Today, now that Boris Johnson is known to have tested positive, his partner joins a club of millions of worried pregnant women around the world.

“When a woman is pregnant her immune system is altered to enable her baby to grow and not be rejected as a ‘foreign body’. Women and babies can be vulnerable to infections during pregnancy have different effects depending on the infection and also on the stage of pregnancy.

“In early pregnancy (first 3 months) the effects can range from no effect, to fetal infection resulting in congenital syndromes (eg Zika or Congenital Rubella Syndrome) through to miscarriage. It is too early to know if Covid-19 has teratogenic effects like brain or heart structural changes since the first cases were only a few months ago. However other coronaviruses are not known to cause teratogenic effects. It will be important that we monitor carefully so we do not miss more subtle effects. For e.g. the Zika syndrome, was only detected due to many more severely affected babies and we now know Zika infection in pregnancy results in a wider spectrum of effects including more subtle developmental delay.

“In later pregnancy (Second and particularly later in the 3rd trimester (last 3 months)), if a woman is acutely unwell with a viral infection this may cause slower growth for the baby, or preterm birth, or in some cases stillbirth. For example, influenza in pregnancy is a very preventable cause of preterm birth and stillbirth each year in high income countries. At this later stage in pregnancy the baby’s organs are fully formed and there is not a risk of major teratogenic effects.

“Within a few days of giving birth if a woman has acute Covid-19 symptoms we expect more risk to the baby, as the woman may not yet have developed antibodies (especially IgG) to pass this protection to the baby. The baby may also be at risk of vertical transmission or infection in utero/during birth. So far we have very little data regarding vertical transmission for Covid-19. The UK one case may have been infected after birth. Several small Chinese studies do not conclusively prove if there is vertical transmission of the virus to the baby.

“The largest study to date was published on 26^th March and showed 3 of 33 neonates with or at risk of COVID-19 tested positive but the symptoms were mostly mild and they (and their mothers) all survived although were admitted in children’s hospitals in Wuhan and Shanghai. One who was more sick was also preterm and the respiratory problems may also have been from being preterm.

2 of 6 babies in a very small study had antibody response (IgM) to the virus but cannot prove that this was the baby’s IgM. The authors of the JAMA paper from Zhongnan Hospital note that it is possible the IgM was from the mother and crossed damaged placentas. Again all the babies survived.  

“If a baby is born to a Covid-19 affected mother, WHO has issued guidance¹ that where possible mothers and babies should stay together and breastfeeding should be supported.

“At present the biggest risk is for women all over the world who may not be infected but are now at definite risk of receiving sub-optimal care for them and their babies because of the pressure on the health system. Plus the change in experience for women in many settings where partners and families can no longer be with them. Meanwhile we urgently need to put in place case definitions and research protocols and so that these tiny studies coming from various places can be combined (including stillbirth outcomes) and make sense together to quickly get us the information we need to guide millions of anxious pregnant women and their families around the world.”

¹ https://www.who.int/news-room/q-a-detail/q-a-on-covid-19-pregnancy-childbirth-and-breastfeeding

Prof Ravi Gupta, Professor of Microbiology at the University of Cambridge, said:

“The diagnosis in the PM and Matt Hancock tell us that COVID-19 is indeed in general circulation. It highlights the critical need for testing to protect not only health care workers but also those in government leadership roles where difficult decisions may need to be taken in times of crisis. Of course testing for all is the ultimate aim, but for now there is a need to prioritise. With regard to pregnancy, data to date suggest no adverse outcomes where COVID-19 infection occurs in third trimester, as would be likely in the case of PMs partner. There have been occasional cases of babies being infected just after birth but it is unclear if the infection arose in utero or after birth.”

Dr Zania Stamataki, Senior Lecturer in Viral Immunology, University of Birmingham, said:

“The news that the prime minister has tested positive for COVID-19 comes just a day after the whole country demonstrated their support for the NHS with people clapping from their homes at eight o’clock, and some by fireworks. We have every confidence that the prime minister will receive the best clinical care, and wish everyone infected a speedy recovery.”

“The question remains if those that have recovered are protected against reinfection from the same virus, and if so, how long that protection would last. Very small studies have indicated encouraging results, but there is no conclusive evidence for protection at this time. This is because SARS-Cov-2 is a new virus for humanity, and there has not been enough time for us to determine if our immune system develops sufficient memory following infection to protect us from reinfection in the future. The coming months will be critical to study the evolution of the virus and our immune system to answer these questions.”

Professor Susan Michie FMedSci, Director of the UCL Centre for Behaviour Change, University College London, said:

“Whilst the PM was telling people to stay at home and keep at least 2 metres apart from each other, the House of Commons was open for business and face-to-face parliamentary activities were carrying on.  Given the transmission routes of touching contaminated surfaces and breathing in virus-laden droplets, it should not come as a surprise to hear that the PM and Health Secretary have tested positive for Coronavirus. 

“There are many reasons why those in leadership positions, including in Government, should practice what they preach.  The first is that such people are important role models, with the ability to enhance or undermine their verbal messages by their actions.  The second concerns trust.  If leaders do not adhere to their own recommendations, this undermines trust in them which in turn can undermine the population’s adherence to their advice.  The advice was to go to work only if essential or if you could not work from home and could guarantee your own and others’ safety by keeping at least 2 metres apart. 

“There are many sophisticated online platforms developed for international conferences and other large meetings that enable debates and voting: a puzzle why this was not set up in advance when the current pandemic situation was predicted.”

Prof Sally Bloomfield, Honorary Professor, London School of Hygiene and Tropical Medicine, said:

“Those of us who live in less crowded cities or rural settings should think ourselves very fortunate. Even if we are going to work, we have reasonable control on limiting the daily number of  people we are in ‘contact’  with – either because we have a fighting chance of maintaining the 2 metre rule, or maybe more importantly, because we have reasonable control when it comes to not touching surfaces that other people are frequently and recently touching.

“Boris et al do not have that luxury. Have you ever tried social distancing whilst standing on a moving commuter train?  You might just about be able to sustain the 2 metre rule, but you need to hang on to something, and that something will change from stop to stop, and the longer you stay on it, it will bring you into indirect contact with many more people than those you can actually see around you!  We need to always be aware of ‘the journey of the COVID-19 germ’.”

Dr Tom Wingfield, Senior Clinical Lecturer and Honorary Consultant Physician, Liverpool School of Tropical Medicine (LSTM), said:

“Like other human beings, our Prime Minister Boris Johnson and Health Minister Matt Hancock do not have immunity to the novel coronavirus, SARS-CoV-2, and can become infected. It is encouraging to see that, like the vast majority of people with Covid-19, their symptoms are mild. Just like all those affected by Covid-19 in the UK and beyond, I wish them a speedy recovery back to full health.”

Dr Michael Head, Senior Research Fellow in Global Health, University of Southampton, said:

“It is public knowledge that the Prime Minister’s partner is pregnant, and so a confirmed COVID-19 infection does give some concern around the health of mother and baby. It is reassuring that so far there have been few noted complications during pregnancy of infection with COVID-19. However, this is an emerging evidence base, so the health services will be cautious with the welfare of all expectant mothers and any associated risks.”

Prof Devi Sridhar, Professor of Global Public Health, University of Edinburgh, said:

“I fear the PM news today will swamp headlines & distract from core issues: We need governments to present clear strategy with deadlines attached for next few weeks. What is the concrete plan for testing? What is the plan for PPE for health workers? What is the status of ventilators? How is progress on antiviral and vaccine research going? What will the next 6 months look like and what is the medium-term planning taking place? These are the questions to keep asking.”

Prof Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:

“A virus does not respect authority or position. From lowly virologists to powerful prime ministers, all of us are susceptible to infection. This news highlights just how easy it is for this virus to pass under the radar and spread through our communities.

“Thankfully the prime minister is said to be suffering from mild symptoms, and it is exactly these mild symptoms that have enabled this virus to spread so widely. But of course, not everyone infected will be so lucky, we know that this is a virus that makes people seriously ill and even die. It is putting our hospitals under immense pressure and it is key for us to do what we can to slow it’s spread. Social distancing, good personal hygiene all can have an effect – let’s not lose sight of that.”

All our previous output on this subject can be seen at this weblink: www.sciencemediacentre.org/covid-19/

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