Dr. Angela Bowen Bond is a researcher affiliated with the Arizona State University in the Center of Evolution and Medicine who passionately focuses on human milk sharing, WHO code compliance, and reproductive justice. She has written several peer reviewed articles on peer to peer human milk sharing, appearing in publications such as The Journal of Human Lactation, Breastfeeding Medicine, and Nursing Outlook. Human milk sharing is an oft- contested issue within lactation-land and I’m so grateful to have Angie share her expertise in this area. As we say in the call- and- response tradition of Black American churches, “I don’t know what you come to do…”, but here at the Mama’s Dula we fully support responsible milk sharing in ALL forms, whether via non- profit milk banking (HMBANA), peer to peer (Eats on Feets, HM4HB, or personal connection), or approved direct nursing.
COVID-19 Associated Risks of Milk Sharing
Dr. Angela Bowen- Bond Ph.D, MS
The recent pandemic of 2019-Novel Coronavirus (SARS-CoV-2) and the clinical COVID-19 illness cause by the virus has generated a lot of understandable fear. Several groups in our communities are at high risk for serious complications and death including our elders, friends and family with immune systems weakened by illness or cancer, those we know and love with heart disease and breathing challenges. It has been a little relief seeing that children and babies, usually a very high risk group, are at a lower risk of becoming very sick.
Low risk is not no risk, and there are still a lot of things we don’t know about this virus. That’s not surprising, since the virus moved from a different species to making people sick only 6 months ago. In six months, there have been hundreds of scientific papers, government guidelines, World Health Organization updates and other sources of scientific information released. Out of those hundreds of resources, 9 have tried to answer questions about what kinds of risks come from breastfeeding or feeding babies human milk.
That sounds like a small number, and it is if we compare it to something like the use of respirators for serious COVID-19, but that small number is encouraging. For the other two Coronaviruses that have caused pandemics (SARS and MERS), there are no studies that tried to look at what might happen if the virus passed to a baby in milk. There are some problems with these studies, though, and it is important to look closely at them.
Scientists have been studying HIV and how it can pass into milk for more than 40 years. What we have learned from HIV is that a virus needs two things to get into milk in high numbers: for a sick person to have a lot of viruses in their blood while they are making milk, and for the cells that make milk to be far enough apart for the viruses to get into milk. The gap junctions are the spaces between the cells that make milk. In a healthy person gap junctions are only far apart for a couple of days after a baby is born. This allows all of the immune cells a baby needs at birth to get into colostrum, the first milk.
The studies that looked for viruses in human milk did a great job looking for them right after babies were born, so the gap junctions were far apart and it was possible for viruses to get into milk easily. But, most of the patients they were studying weren’t sick with COVID-19 anymore, so there were probably no viruses left to get in the milk. The scientists didn’t say how high the number of viruses were for the patients that were still sick. So, we only have one part of what we should have when we talk about whether the virus gets into milk. There are thousands of babies being breastfed or given milk from a parent with COVID-19 around the world, and there aren’t any cases of babies getting sick or doctors thinking they got sick from human milk so far! That helps support the studies that didn’t find viruses in the milk. It also helps that milk has immune cells and special properties that make it hard for viruses to stay alive in milk. Right now, the evidence and what we already know about human milk shows a very low risk of babies getting sick from COVID-19 virus in human milk.
Only one of these studies looked for antibodies, the sign of immunity to a virus, in the milk. There were no antibodies to COVID-19 virus in the milk. Scientists are working hard to find a better ways of testing for antibodies for COVID-19, because they are very hard to measure with the kinds of tests we have now. Once there are stronger tests and more milk samples have been tested, there might be antibodies after all. But right now, it’s not true to say antibodies in milk will protect babies because we don’t have enough evidence. That doesn’t mean human milk can’t be protective, don’t forget the properties and cells that kill viruses that are always in milk!
Now the question is, how can we help keep babies safe while sharing milk? Click here for a resource from Eats on Feets.
What you can do as a donor
If you are donating milk that you collected after COVID-19 reached your area, talk with the family getting your milk about any time since then where you were not feeling well. If you are collecting milk now, you can take your temperature every day and make a not to yourself on your phone or in a journal if you started to cough or have other symptoms. You might decide not to share milk from those days.
Always wash your hands before pumping and make sure you are pumping in a clean area. Wipe the outside of your pump or carry bag with a cleaning wipe, or a rag with hot soapy water on it at least once a day. When you are cleaning your pump parts, make sure to take everything apart right away and soak it in hot soapy water! COVID-19 viruses are easily killed by soap and washing.
When you put milk into storage bags, don’t touch the insides of the tabs! Here is a video of opening a bag without touching the inside. You can also wipe the outside of the bag with warm soapy rag before you put it in the freezer if you want to be extra careful.
If you drop off milk to recipient families, leave the milk in a cooler at their door so that you maintain social distancing. Avoid shipping milk right now, because there are unexpected and sometimes long delays!
What you can do as a recipient
Talk to each donor about the dates when they might have been sick after the COVID-19 virus got to your area. If they were sick when they pumped or hand expressed the milk, that doesn’t mean the milk can’t be used if you still want it or need it. Coronavirus is killed during heating, so you might use flash heating or pasteurization to kill the virus. Remember this might make bacteria spores in the milk activate if they are there, but that risk is also very low.
When you pour the milk from storage bags, you can use a pair of washed scissors to cut between the two “zippers” on the bag. This way, you are cutting off the parts that might have been touched when the milk was put in the bag. Here is a video of what that looks like.
If you pick up milk from your donor(s), ask them to have it read and to set it outside when you get there so that you keep social distancing. Avoid shipping milk because some shipping companies are experiencing unexpected and sometimes long delays!
What you can do as lactation support provider or care provider
Be familiar with current guidelines for human milk feeding and COVID-19. Respect the needs of families to feed their babies in the way that is best for them. Formula is hard to find in some areas, and milk banks cannot provide milk to every baby that needs it. If you are uncomfortable with milk sharing, consider that the WHO has not changed it’s stance on milk from a healthy donor being an acceptable choice for feeding babies. There potential risks of formula feeding compared to human milk feeding from a donor are still important to consider. Families need our compassion and objectivity right now!