Nichole Kruk entered her second trimester of pregnancy just as the pandemic spread across the globe in 2020.

Unable to stay home, she worked a customer-facing job where for a while, the only personal protective gear on hand were cloth masks sewn by a colleague. She and another pregnant coworker swapped safety tips from their OB-GYNs and commiserated over all the unanswered questions: How would COVID-19 affect her baby? Would she be forced to deliver alone?

By the end of July, she’d managed to avoid getting sick and given birth to her first child, who “came out healthy and beautiful,” she said. She spent nine hours in labor, her mask on the whole time.

But just after the 2021 Christmas holidays, an unmasked coworker came to work sick. On Jan. 3, Kruk got the news: now five months into her second pregnancy and vaccinated, she’d come down with COVID-19.

With the omicron variant spurring a new rise in COVID-19 infections in El Paso, people who are pregnant face another wave of fear and uncertainty. They run not only an increased risk of severe illness and death from COVID-19 compared to the general population, but are also among the least vaccinated groups in the country, according to the Centers for Disease Control and Prevention, with nearly 60% still unvaccinated.

Kruk, 33, quickly quarantined at her mother’s house in Las Cruces, leaving her husband and young son in El Paso as many of the telltale symptoms wracked her body: a cough, sore throat, vomiting, congestion and a headache “like a baseball to the face,” she said.

Even worse was the isolation. Not being able to see her son “crushed my heart,” she said. “It was hard for him too. On FaceTime, I could see that he was mad and didn’t want to talk to me.”

She’d asked to talk to her OB-GYN about her infection, but he never called her back. “I feel like he’s not concerned about me as a patient or my child. It’s a little hurtful,” she said.

“I feel so misinformed,” she added. “I feel like I don’t know what’s going on.”

COVID-19 risks during pregnancy

Dr. Carla Ann Martinez, an OB-GYN with Texas Tech Physicians of El Paso and the maternal medical director for University Medical Center, frequently sees patients who share Kruk’s uncertainty and anxiety. Over the past two years, Martinez has entered into “so many discussions that you typically don’t have with young, healthy pregnant patients,” she said.

“Who do you want to make the decisions if you have to get intubated? Who do you want us to ask if we have to deliver you?” she said. “In general, we’re not usually faced with end-of-life decisions in a very young and typically healthy population.”

Speaking after a day at the clinic, Martinez ran through her notes. Of the 20 patients scheduled that day, three had called to cancel their appointments because they had COVID. Of the patients who’d entered the labor and delivery unit, about half had tested positive; all were asymptomatic.

“They’re all doing OK,” she said. But as cases mount in El Paso, Martinez, who has cared for just about every pregnant patient with COVID to come through UMC, is filled with dread.

There is evidence that the new omicron variant is more contagious but less severe than previous COVID-19 variants. But with more cases come more hospitalizations and more deaths, Martinez said.

The overall risk of severe illness or death from COVID-19 among pregnant patients is low, according to the CDC. Of the roughly 158,000 infections recorded among pregnant people in the last two years in the United States, 259 have died. At least one El Paso woman died of COVID-19 while pregnant.

But when comparing outcomes for people with symptomatic COVID-19 infections, studies have shown that symptomatic pregnant people are twice as likely to need to go to the intensive care unit or receive medical interventions such as invasive ventilation as compared to non-pregnant people. They also run a 70% higher risk of death, according to the CDC. Those risks continue until about six weeks after pregnancy.

That’s because the body’s immune system slightly lowers its guard during pregnancy so that it does not begin to attack the growing fetus. “In a sense, they’re immunocompromised,” Martinez said. They are at higher risk of other respiratory diseases like the flu, for which doctors also recommend that pregnant people get vaccinated.

Pregnant people with COVID also run an increased risk of preterm birth and more admissions to neonatal ICUs. And while it’s rare, about 1% to 4% transmit the disease to their newborns.

Deaths among pregnant people peaked in August and September 2021, during the delta wave of the virus. In late September, the CDC issued a health advisory urging pregnant people to get vaccinated, noting that approximately 97% of pregnant patients who were hospitalized with COVID-19 were unvaccinated. While omicron can cause breakthrough infections with vaccinations, vaccines still protect against severe illness.

Advice for pandemic pregnancy

Martinez recommends that pregnant patients go to a hospital for evaluation if they are having trouble keeping down fluids, experiencing fevers of 100.4 degrees or higher or their baby isn’t moving as much as usual.

She also recommends they go to the hospital if they feel short of breath. Physicians want to keep a higher oxygen saturation in the bloodstream for people who are pregnant. Anyone below 95% oxygenation who’s pregnant will be admitted to the hospital, she said. For non-pregnant people, that admission threshold is typically 92% or lower.

Above all, she recommends vaccination and booster shots. Studies have shown that COVID-19 vaccines are safe to take during pregnancy, including one recent evaluation of 40,000 pregnant people, Martinez said. Over the course of the pandemic, she has had one pregnant patient, who was unvaccinated, die of COVID-19. “Even one person dying is too many,” she said.

“At this point, it just really doesn’t need to happen anymore,” she said. “It really doesn’t.”

When Kruk’s isolation ended and she finally saw her son, the 1-year-old “gave me a couple of slaps,” she said. “(It was like he was asking) ‘where have you been, Mom?’ and then he just started to cry. It was really hard to see.”

Kruk is back at home, not fully recovered but feeling better. Through it, she’s been comforted by the movements of the child in her belly and the thought of the vaccine she’d received, protecting them both.

Cover photo: Nichole Kruk had to isolate herself from her 1-year-old son while COVID-19 positive during her current pregnancy. (Photo courtesy of Nichole Kruk)