The Rona Chronicles: COVID-19 and Milksharing Pt. 2 (the Research)

Dr. Angela Bowen Bond is a researcher affiliated with 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.

Current COVID-19 and Human Milk Research

Dr. Angela Bowen Bond

To date, there are 9 publications specifically regarding human milk and the potential for spreading SARS-CoV-2/COVID-19 via human milk from parent to infant. Lackey and colleagues reviewed these studies and the paper pre-print can be found here.

In addition to their findings, the Lackey team described the evolutionary history of Coronaviruses and humans. Humans have 7 strains of Coronaviruses that we experience as colds. Of those 7 strains, only was has possibly infected an infant. The infant was presumed to have gotten the virus from milk, since he was exclusively breastfed and the virus was found in his stool. There are three Coronaviruses that have become capable of infecting humans (zoonotic) in the last 20 years: SARS, MERS, and now SARS-COV-2/COVID-19. Each of these viruses moved from their usual species, to a new reservoir host species that humans interact with as domestic animals or food. Humans became infected from the reservoir animals and then were able to spread the virus amongst ourselves (Horizontal transmission).

Transfer of the virus vertically, during pregnancy, birth, or through milk, has not been confirmed and published for any of the three zoonotic Coronaviruses. Human milk has only been tested for antibodies or virus in the case of SARS-CoV-2. Across the 9 studies published so far, 16 women provided 23 milk samples for analysis. No milk samples were positive for SARS-CoV-2 OR antibodies to SARS-CoV-2. These results are complicated because many of the patients were no longer sick with COVID-19 when tested, so there was no viral load, and those who were sick do not have reported viral loads. Milk samples were collected shortly after birth, which is the most likely time for viral transmission in milk, but methods of collecting and processing the milk are missing. This makes it impossible to consider the possibility of false-negative results for both the presence of the virus, and the antibodies.

There are also current frustrations with the limited sensitivity of tests for both the virus and antibodies. It will be important to stay up-to-date as new test methods and more milk samples being tested may lead to rapid changes in our understanding of how the virus may enter or persist in human milk. MERS has been reported to transfer into animal milk, and the virus remained viable and infectious for up to 48 hours, with one documented case of Vertical transmission. MERS is also capable of infecting humans who consume raw camel milk.

While the data are limited, the absence of reported or suspected cases of infants contracting the virus through human milk support the findings so far. It is also widely known that there are innate properties of human milk and active immune cells that target and kill viruses in human milk itself and when combined with infant saliva. The data does not support interrupting direct feeding of the infant with human milk, donating human milk if the donor is otherwise healthy or discouraging the use of donated human milk. Families sharing milk should continue to follow guidelines for informed milk sharing such as the Four Pillars of Safe Milk Sharing.

Parents should be encouraged to use impeccable hand hygiene, sanitize all parts of their pumps regularly, handle bags without touching the insides of the tabs or storage compartment, avoid milk contact with the tabs when thawing and pouring if possible and wipe down the exterior of their pump and storage bags daily at least. These are long-standing best practices, and now is a great time to make these best practices a foundation of our conversations with families.

Now is the time to meet every family we have the privilege of interacting with compassion and a dedication to their autonomy and agency. We do that by being honest, being objective, respecting their decisions needs and clamping down on our own possible biases with an iron grip so that we do not project insecurity onto the families we server. Now is not the time to join the bandwagon of professions taking paternalistic and even abusive stances toward birth and infant feeding decisions in the time of COVID-19.

Thank you to Dr. Bond for her contribution to The Mama's Dula and for all her efforts in human milk feeding and the COVID-19 response.

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