Across the country, frontline medical workers are terrified about the potential of contracting the coronavirus because of a swarm of new cases, the lack of protective equipment and a dearth of nationwide standards.
For pregnant health-care workers, like Dr. Sonia Singh in Houston, circumstances are all the more frightening, given general uncertainty about whether they're at greater risk of getting sick from the virus.
Dr. Singh, an internist at Memorial Hermann Health System, is 33 weeks pregnant. Along with her fellow pregnant doctors and nurses across the country, Singh is working without clear guidelines on whether she should continue to see patients, although her hospital has encouraged her to switch to virtual consultations where possible.
Dr. Singh said she's avoiding in-person meetings with people experiencing respiratory issues and has been very concerned about bringing the virus home. She's even removed her wedding ring because it's one less that can be contaminated. About 80% to 90% of her visits now are virtual.
"I feel some guilt that I can't see my patients like I normally would," said Dr. Singh, who has a cleaning station in her home garage for when she or her husband, who's a critical care doctor and a pulmonologist, return for the day.
"We're constantly worried about giving it to each other," she said. The ritual involves washing their scrubs and wiping down their electronics.
Across the world, the official guidance from public health officials varies widely about whether pregnant health workers should be in the presence of patients as the COVID-19 pandemic spreads. In the U.K., experts are now advising women who are more than 28 weeks pregnant to stop seeing patients, and pregnant health workers in Singapore are being advised to discontinue frontline duty.
The American College of Obstetricians and Gynecologists says that "very little is known" about COVID-19 and its effect on pregnant women and infants, but that "facilities may want to consider limiting exposure of pregnant health-care personnel to patients with confirmed or suspected COVID-19 infection, especially during higher-risk procedures."
For now, it's largely up to individual hospitals to determine whether to provide additional protections for pregnant medical workers.
The decision is particularly tricky because researchers haven't been able to determine the degree of risk that pregnant women face. Medical societies refer to pregnant women as part of the at-risk group, because symptoms might be more severe for them. The Centers for Disease Control has not yet documented an increased risk for pregnant people or fetuses exposed to the virus, but some CDC experts have warned that contracting the coronavirus while pregnant could leave women vulnerable to severe respiratory problems such as pneumonia.
"In general, pregnant women are a vulnerable group to any infectious disease due to altered physiology and immunosuppression," said Dr. Ruth Ann Crystal, a Stanford-trained obstetrician based in the Bay Area.
In New York, the concern is even more acute because the state is home to about half of the 60,000 confirmed COVID-19 cases nationwide.
At one hospital in New York, a pregnant doctor and pregnant nurse told CNBC that they're in close proximity to patients or fellow staffers who have been diagnosed with the virus. Both requested anonymity so they could speak freely about the situation.
The nurse said she notified her superior more than a month ago and was told by senior staff to keep treating patients in the hospital while wearing a surgical mask, a directive that differs from the broader message to employees. An email the nurse forwarded to CNBC from the hospital requested that, to preserve supplies, medical personnel avoid using personal protective equipment unless they're in the vicinity of a patient suspected or confirmed to have COVID-19.
Rather than abide by these instructions, the nurse said she is no longer going into work, putting her job at risk. She said two of her colleagues were recently diagnosed with the virus.
The doctor, who works in the emergency room, said she notified her manager of her pregnancy far earlier than she otherwise would have because the hospital has no official policy around whether pregnant medical workers should continue to treat patients in person.
One of her superiors advised her to transition to telemedicine full time so that she could stay at home, while the other said she was needed due to the shortage of emergency medicine doctors.
The doctor said she felt guilty even bringing up the fact that she was pregnant, and is encouraging development of a systemwide policy across U.S. hospitals
Dr. Jane van Dis, an obstetrician who works for Maven Clinic, said that pregnant doctors and nurses should move to telehealth as much as possible. Because of the newness of the disease, there may be risks that aren't well understood even as it spreads, Dr. van Dis said, adding that doctors can still have an impact while treating patients by phone or video.
"In the same way, many health-care organizations are moving their older practitioners to telemedicine," she said.