COVID-19 Hot Topics: Breastfeeding, and Mask Mandates

For so many of us in infection prevention and control (IPC) these are the months we often see as a busy time of year – influenza and respiratory virus season is not a traditionally quiet one in healthcare. But this year promises to be different, because everything in 2020 has been different thanks to coronavirus disease 2019 (COVID-19). The coming weeks will surely see high case counts following considerable travel, gatherings, and indoor activities due to cold weather. With COVID-19 numbers surging, the fatigue is real and the hope is that the implantation measures being put into place will help ease the burden.

Saskia v. Popescu, PhD, MPH, MA, CIC

There are two reports this week that are particularly insightful and relevant for IPC efforts in the face of COVID-19. The first regards breastfeeding in the context of COVID-19 as outlined by the US Centers for Disease Control and Prevention (CDC). Maternal and child health is a vital part of the work we do, but in the era of a pandemic, it can become difficult to develop protocols and strategies to reduce the risk of transmission between the breastfeeding parent and newborn.

This focus was a result of noticing a nearly 18% drop in in-person lactation support and that nearly 73% of hospitals discharged mothers and their babies less than 48 hours after birth. The gaps in knowledge and experience carrying to neonates born to mothers with COVID-19 creates a complex situation during a novel pandemic. “Follow-up of mothers with COVID-19 delivering at three large New York birth hospitals found reduced breastfeeding rates both in the hospital and after returning home among mothers who had been separated from their newborns,” says the study in the CDC’s Morbidity and Mortality Weekly Report (MMWR). “After identification of this finding, and the observed stress among mothers and newborns as a result of separation, the hospital system revised its policy and began to allow asymptomatic mothers with laboratory-confirmed COVID-19 to room-in and breastfeed.” Ultimately, 1344 surveyed hospitals painted a clear picture of a change that was desperately needed—focused efforts to ensure breastfeeding and IPC were syncing during this time to ensure adequate care for the newborn and mother.

The second report, also in MMWR, focuses on areas where mask mandates were mandated via executive orders. This has been a particularly hot topic, but recent months have seen more publications on the impact that mask mandates have had on COVID-19 incidence in the community. In this case, the authors focused on the state of Kansas and the executive order that required masks in public spaces which went into effect on July 3, 2020. The authors noted that following this order, incidence across the 24 counties with mask mandates decreased by 6% (new cases per 100,000 people) but in those 81 counties without mask mandates, COVID-19 incidence continued to increase.

The authors noted that “after implementation of mask mandates in 24 Kansas counties, the increasing trend in COVID-19 incidence reversed. Although rates were considerably higher in mandated counties than in nonmandated counties by the executive order, rates in mandated counties declined markedly after July 3, compared with those in nonmandated counties. Kansas counties that had mask mandates in place appear to have mitigated the transmission of COVID-19, whereas counties that did not have mask mandates continued to experience increases in cases.” Ultimately, we can glean from this that if you’re in an area with a mask mandate, it will likely help reduce cases, so adding these pivotal community pieces into the IPC plans are highly suggested.