clearance of MERS-CoV (65). Given the lack of effectiveness and possible harm, routine corticosteroids should be avoided unless they are indicated for another reason. Other reasons may include exacerbation of asthma or COPD, septic shock, and risk/benefit analysis needs to be conducted for individual patients. Remark 2: A recent guideline issued by an international panel and based on the findings of two recent large RCTs makes a conditional recommendation for corticosteroids for all patients with sepsis (including septic shock) (66). Surviving Sepsis guidelines, written before these RCTs were reported, recommend corticosteroids only for patients in whom adequate fluids and vasopressor therapy do not restore hemodynamic stability (5). Clinicians considering corticosteroids for a patient with COVID19 and sepsis must balance the potential small reduction in mortality with the potential downside of prolonged shedding of coronavirus in the respiratory tract, as has been observed in patients with MERS (65). If corticosteroids are prescribed, monitor and treat hyperglycaemia, hypernatraemia, and hypokalaemia. Monitor for recurrence of inflammation and signs of adrenal insufficiency after stopping corticosteroids, which may have to be tapered. Because of the risk of strongyloides stercoralis hyper-infection with steroid therapy, diagnosis or empiric treatment should be considered in endemic areas if steroids are used (67). Remark 2 for pregnant women: WHO recommends antenatal corticosteroid therapy for women at risk of preterm birth from 24 to 34 weeks of gestation when there is no clinical evidence of maternal infection, and adequate childbirth and newborn care is available. However, in cases where the woman presents with mild COVID-19, the clinical benefits of aantenatal corticosteroid might outweigh the risks of potential harm to the mother. In this situation, the balance of benefits and harms for the woman and the preterm newborn should be discussed with the woman to ensure an informed decision, as this assessment may vary depending on the woman’s clinical condition, her Caring for pregnant women with COVID-19 11 Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: Interim guidance To date, there are limited data on clinical presentation and perinatal outcomes after COVID-19 during pregnancy or the puerperium. There is no evidence that pregnant women present with different signs or symptoms or are at higher risk of severe illness. So far, there is no evidence on mother-to-child transmission when infection manifests in the third trimester, based on negative samples from amniotic fluid, cord blood, vaginal discharge, neonatal throat swabs or breastmilk. Similarly, evidence of increased severe maternal or neonatal outcomes is uncertain, and limited to infection in the third trimester, with some cases of premature rupture of membranes, fetal distress, and preterm birth reported (68, 69). This section builds on existing recommendations from WHO on pregnancy and infectious diseases and provides additional remarks for the management of pregnant and recently pregnant women. Considering asymptomatic transmission of COVID-19 may be possible in pregnant or recently pregnant women, as with the general population, all women with epidemiologic history of contact should be carefully monitored. Pregnant women with suspected, probable, or confirmed COVID-19, including women who may need to spend time in isolation, should have access to woman-centred, respectful skilled care, including obstetric, fetal medicine and neonatal care, as well as mental health and psychosocial support, with readiness to care for maternal and neonatal complications. Remark 1: Appropriate IPC measures and prevention of complications as described above also apply to pregnant and recently pregnant women, including those with miscarriage, late pregnancy fetal loss, and postpartum/postabortion women. These IPC precautions should be applied for all interactions between an infected caregiver and a child. Remark 2: Mode of birth should be individualized based on obstetric indications and the woman’s preferences. WHO recommends that caesarean section should ideally be undertaken only when medically justified (https://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng.pdf?sequence=1). Emergency delivery and pregnancy termination decisions are challenging and based on many factors such as gestational age, severity of maternal condition, and fetal viability and well-being. Remark 3: Multidisciplinary consultations from obstetric, perinatal, neonatal and intensive care specialists are essential. All recently pregnant women with COVID-19 or who have recovered from COVID-19 should be provided with information and counselling on safe infant feeding and appropriate IPC measures to prevent COVID-19 virus transmission. At this point, there is no evidence that pregnant women present with increased risk of severe illness or fetal compromise. Pregnant and recently pregnant women who have recovered from COVID-19 should be enabled and encouraged to attend routine antenatal, postpartum, or postabortion care as appropriate. Additional care should be provided if there are any complications. Remark 1: All