Until very recently, the CDC was doing this, but specifically focused on the risk of COVID in babies, rather than obstetric outcomes. With their remit being curtailed, rather than extended, I don’t see us having answers to this anytime soon. 2/2

To my knowledge, no. One big challenge is that we no longer have the testing infrastructure to know who has or hasn’t had COVID and follow up outcomes. Another way to approach the question would be to look at outcomes in vaccinated vs unvaccinated pregnancies. 1/

But these stats on their own don’t convince me we’re seeing problems of repeat COVID infection in these services, and also don’t chime with what we’re seeing on the ground: business pretty much as usual, albeit that services are underfunded and understaffed (so… business as usual!) 12/12

Formal analyses of HES can be done, and this is one of the ways we found that COVID vaccination was safe in pregnancy, and put a numerical value on the harm of infection at the height of the pandemic. As I’ve said, I’d like to see an updated analysis. 11/11

So from all of this, I will say the same as I did when people were using HES to try and claim an increase in certain obs and gynae problems due to COVID vaccination.

So much goes into HES that you can’t use the raw figures to test these kinds of ideas. 10/

There’s also increased awareness about endometriosis, which is great! And longer waiting lists to see the gynae service - I am hearing years in some trusts - which is not. But both of these will cause an increase in HES. 9/

So these would not show up in the gynae HES. And many of those gynae conditions are ones that you live with for years before getting to hospital. For endometriosis, it’s 8 on average. People being seen in hospital now, on average, first visited their GP about it before the pandemic. 8/

Acute COVID outside of pregnancy can cause temporary changes to menstrual cycles, but these rapidly resolve. 7/

pubmed.ncbi.nlm.nih.gov/37562052/

Similarly, there have been a string of dreadful outcomes in labour recently and a number of maternity services are currently under investigation. My colleagues say that are practicing much more defensively in this climate, and this may well be playing into HES numbers. 6/

www.gov.uk/government/n...

The investigation into this came out in 2020. The guidance hadn’t yet been updated, but understandably people are being much more cautious about referring and admitting, which may well be causing that increase. 5/

www.hssib.org.uk/patient-safe...

Some important context here is that obstetrics and gynaecology in the NHS are in a bit of a state at the moment. In 2018 there was a high profile case in which someone attended for (what it turned out was) an ectopic pregnancy, was sent home and it ruptured… 4/

We just aren’t seeing COVID preterm births and stillbirths anymore. So the harm of infection in pregnancy now, if there is any, is subtle. Way more subtle than those increases in hospital attendance. 3/

But how bad is COVID in pregnancy now that people are no longer catching it for the first time? We don’t have formal studies on this (I wish we did! It would help us make decisions about whether it would be worth extending the vaccine offer) but, from the ground… 2/

First, it’s important to acknowledge that COVID can cause preterm birth and stillbirth when unvaccinated people catch it for the first time. This was a big problem in obstetrics during the pandemic, and the main reason we offered pregnant people vaccines. 1/

www.nature.com/articles/s41...

Jessie and I wrote at least a dozen times over the last few weeks, and she probably wrote just as much to @jsm2334.bsky.social, @doritreiss.bsky.social who I see are also quoted - as well as to ACIP members and Pfizer.

With thanks to @kevinault.bsky.social, who pinged me to say this was up.

Yes! This is super-interesting to me. In the UK, we make most of our fund/don't fund decisions in healthcare centrally, based on national statistics, modelling and all that jazz. I'm no fan of for-profit healthcare, but I do wonder if the profit motive is helpful when considering preventative care.

This also takes into account the financial cost of taking care of sick people, which is why some categories are marked as “cost saving”. At that price/dose in that group, it is cheaper to vaccinate than not. 2/2

Across the top is cost per dose of vaccine. The numbers underneath show how much it costs to save one year of someone’s life (adjusted for quality, so taking into account saving people from avoiding disability as well as death) at that cost per dose, in the age group. 1/