#17,748
With the opening caveat that association doesn't necessarily mean causation, late last week the NEJM published a correspondence from Chinese researchers who describe a 4-fold increase in the number of a rare congenital defect - situs inversus - diagnosed at two large obstetrical centers (Shanghai & Changsha) in the months following the end of China's Zero-COVID policy.
Normal anatomy is called situs solitus, while situs inversus describes the full (totalis) or partial reversal of thoracic and abdominal organs, which may include dextrocardia (heart on the right).
This condition is exceeding rare (roughly 1 in 10,000) - and while people with it can often lead normal lives - it can also present as part of an array of other birth defects (see Cleveland Clinic review on Situs Inversus) of varying severity.
This week's relatively brief NEJM correspondence describes a 7-month surge (January 2023 through July 2023) - peaking in April 2023 - of situs inversus at two large obstetrical centers in China. Follow the link below to read it in its entirety.Association of SARS-CoV-2 Infection during Early Weeks of Gestation with Situs Inversus
November 2, 2023
N Engl J Med 2023; 389:1722-1724
DOI: 10.1056/NEJMc2309215
Although the authors state that no conclusions can be drawn regarding causality, their observations suggest a possible relationship between SARS-CoV infection and the development of fetal situs inversus.
This (at its peak) 4-fold increase in situs inversus diagnoses began several months after China's abrupt end to their 3-year Zero-COVID policy, which resulted in hundreds of millions of COVID infections - and likely well over a million deaths - over a span of just a few months.
Last August, an investigative report published by JAMA Open estimated 1.87 million excess deaths in China in the two months following the collapse of Zero COVID. Another estimate from the EID Journal calculated 1.41 million deaths over 60 days.
Estimates aside, exactly what happened with COVID in China (both before and after Zero-COVID) remains a mystery. Despite persistent (albeit, unverifiable) reports of crematoriums running 24/7, hospitals overrun, and hundreds of millions of infections - officially - COVID was mild and deaths were relatively few.
The brief 4-fold increase in situs inversus diagnoses at these two facilities - when viewed against the backdrop of a massive wave of COVID infection - remained encouraging low.
But as with Long COVID, this reminds us there is still much about the impact of SARS-CoV-2 infection we don't fully understand.
