New Mothers who are Positive for COVID-19: What are the Issues Surrounding Breastfeeding?

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When it comes to food and health issues, no word is abused more than the word natural. From a marketing standpoint, the word natural is a money-maker, but from a scientific standpoint the word natural is meaningless.  Thus, whether you are purchasing a box of cereal for your family’s breakfast or deciding how to deal with an illness, you must be careful, and the same goes for breastfeeding. Just as a molecule of table sugar, sucrose, has the exact same chemical structure whether it comes from a wild sugar beet or from a food lab, the fact that infant formula is the product of technology, whereas breastfeeding evolved in nature is not a reason in itself to choose breastfeeding. When it comes to the nutritional content itself, modern infant formulas are actually pretty good. Nevertheless –so far– there are some components of breast milk that infant formula technology has yet to reproduce, making breast milk the better option for mothers who don’t have a medical reason to avoid feeding their infants with breast milk. This leads to a dilemma when we consider a highly contagious disease like COVID-19, since the prospect of infecting the infant goes up against the main chemical component that makes breast milk superior to infant formula: antibodies. These are immune system proteins that we introduced in a recent post and they are present in various body fluids, including breast milk.

If you have COVID-19, or have had it and recovered, your immune system is making antibodies against the causative virus, SARS-CoV2. As for whether such anti-SARS-CoV2 antibodies are actually present in human milk, there are very few data available on that topic, so there have been calls for a concerted effort to study lactating COVID-19 mothers. In the meantime, researchers have looked at milk from mothers that have been infected with other human coronaviruses that have caused outbreaks of severe respiratory disease (SARS-CoV1 and MERS-CoV), but such studies also tell us nothing conclusive as to whether we should expect breast milk to contain either the virus, or antibodies against it. Given the lack of information about breast milk together with the understanding that COVID-19 spreads mostly through droplets in the air and on hands and surfaces, the recommendation from the World Health Organization (WHO) is that mothers with COVID-19 can breastfeed, if they have mild symptoms. The WHO breastfeeding guidelines are as follows:

Women with COVID-19 who wish to breastfeed should:

  • Practice respiratory hygiene. This means wearing a mask while nursing
  • Wash their hands before and after touching the infant
  • Clean and disinfect surfaces that they have touched

Similarly, the US Centers for Disease Control and Prevention (CDC) advises that mothers with COVID-19 can breastfeed, either directly, or through expression and pumping of their milk, taking the following precautions:

If you have tested positive for COVID-19 and choose to breastfeed directly:

  • Wear a facemask and wash your hands before each feeding.

If you have tested positive for COVID-19 and are expressing breast milk:

  • Use a breast pump that is designated for your milk (not shared with anyone).
  • Wash your hands before touching pumps or parts of bottles and before expressing the milk.
  • After each use of the breast pump, follow the following recommendations for proper pump cleaning.
  • If possible, recruit somebody who does not have COVID-19 or another infectious disease to feed the infant with your expressed breast milk from a bottle.

Since we have mentioned hand washing above several times, we should also note that you should practice hand washing the correct way. Follow CDC recommendations on how to wash your hands, making sure that you spend time soaping and scrubbing your fingers in particular.

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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