A quick update on COVID-19, breastfeeding, and schools
How could the COVID-19 virus (SARS-CoV-2) spread to a baby?
COVID-19 (SARS-CoV-2) spreads from person to person through droplets that an infected person sneezes or coughs out. These droplets enter through the mucous membranes (wet parts) of their face – their eyes, nose and mouth – which provide a direct pathway to their throat and lungs. Direct membrane-to-membrane contact--such as kissing--can also spread the virus. The virus can also be spread by sharing items that go in mouths, eyes or noses, like bottles, cups or toys. Droplets might also fall onto a surface where you (or baby) then put your hands. If you don’t wash your hands, you could move the virus into your eyes, nose or mouth.
For parents, cough etiquette, avoiding face-touching, hand washing and sanitizers, and keeping surfaces clean are the prime methods of protection. Breast-feeding is protective. Avoid all contact with anyone who has fever or respiratory symptoms, or who is in quarantine from previous exposure or travel—even if they are a family member. Limit contact with those outside your immediate family.
Why are schools and child-care facilities open? Are they safe?
There appears to be a lack of severe COVID-19 illness in children and this has not yet been satisfactorily explained. Any child who is unwell, who is in quarantine following travel or contact with a positive case, should not be at school or childcare.
The question of risk for schools is based on a complex balance of information—including health, economic, behavioural and educational information--and depends very much on context and the phase of the epidemic. The decision is always open to change. Although children can contact Covid-19, current epidemiological patterns suggest that transmission between their peers is not happening. Risk reduction strategies—handwashing, sanitizers, cough etiquette, distancing—are imperative, so work to facilitate these. At present, having children in a structured environment, continuing their learning, is a safer option in transmission models than the unpredictable social interactions that are likely if schools and child-care are closed.
How can I identify safe play spaces?
Current government restrictions on travel, social interactions, and non-essential businesses need to be observed. Current Australian guidelines suggest a maximum of 10 people are acceptable in the one area—but calculated on 4 square metres per person in any closed space. Weddings are allowed 5 attendees; funerals 10. There are vigorous calls for deeper social distancing measures in Australia, and many of us are already observing these.
One of the provisions for leaving home is exercise, and of course, this is important for children as well as adults. Walking with your baby in the outdoors is important, staying 2 metres away from others. Avoid shared playground equipment—these are points of risk.
The guidelines around contact with other friends and their children are the same as the broader guidelines for the public. Make sure you are aware if either you or your guests are at any specific risk—symptoms, travel, exposure—and err on the side of caution by avoiding seeing them if concerned. Physical distancing based on calculating 4 square metres per person in a closed room is a good guide, but this also needs respectful mechanisms around interactions—individual serves rather than shared plates for example, being careful to sit across from each other rather than next to each other, and of course forgoing that usual hug, kiss, or handshake.
Although many public pools have been closed, there is no evidence that COVID-19 can be spread to humans through the use of pools and hot tubs. Proper operation, maintenance, and disinfection (e.g., with chlorine and bromine) of pools and hot tubs should remove or inactivate the virus that causes COVID-19.
What if I was infected? Should I breast-feed?
The best evidence suggests breast-feeding is protective of the baby--even if the mother is infected. There is limited research on whether the virus is present in breastmilk, but research on similar viruses such as SARS has not shown coronavirus virus in breastmilk. Given low rates of transmission of respiratory viruses through breast milk, the World Health Organization states that mothers with COVID-19 can breastfeed. Based on similar situations to COVID-19, the Communicable Disease Control in the US recommends that a mother with flu continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant. Wear a mask if you are infected. If expressing, wash your hands thoroughly in soapy water first, and extend hygiene measures to pumps and bottles. Some infected mothers in this situation may consider having someone who is well care for and feed the expressed breast milk to the infant.
25 March 2020
Peter S Hill
Honorary Associate Professor
School of Public Health
The University of Queensland
Phone: +61 (0) 449 287 892
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