Key Messages:

Risk versus Benefit

The implications of transmission risk need to be framed in terms of

• COVID-19 prevalence in breastfeeding mothers and
• the scope and severity of COVID-19 infection in infants when transmission occurs

compared to

• the adverse consequences of using breastmilk substitutes and
• separation of newborns and young infants from mothers.

A. Transmission Risk

RT-PCR detects and amplifies viral genetic material in samples, such as breastmilk, but does not provide information on viability or infectivity of the virus. Detection of COVID-19 viral RNA in breastmilk is not the same as finding viable and infective virus. Transmission of COVID-19 would need replicative and infectious virus being able to reach target sites in the infant and also to overcome infant defense systems.

Documented presence of replicative COVID-19 virus in cell culture from breast milk and infectivity in animal models are needed to consider breast milk as potentially infectious.

B. Potential Benefits of Breastfeeding

Secretory Immunoglobulin A (sIgA) have been detected in breastmilk of mothers with previous COVID-19 infection. Although the strength and durability of sIgA reactive to COVID-19 have not yet been determined, multiple bioactive components, such as lactoferrin, have been identified in breastmilk that not only protect against infections but improve neurocognitive and immunologic development of the child.

Compared to exclusively breastfed infants, the risk of mortality is 14-fold higher in infants who are not breastfed. Over 820 000 children’s lives could be saved every year among children under 5 years, if all children 0-23 months were optimally breastfed. For mothers, breastfeeding protects against breast cancer and may protect against ovarian cancer and type 2 diabetes.