COVID 19 Interim Guidance

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Coronaviruses are a group of viruses belonging to the family of Coronaviridae, which infect both animals and humans. Human coronaviruses can cause mild disease similar to a common cold, while others cause more severe disease (such as MERS – Middle East Respiratory Syndrome and SARS – Severe Acute Respiratory Syndrome). A new coronavirus that previously has not been identified in humans emerged in Wuhan, China in December 2019.

Signs and symptoms include respiratory symptoms and include fever, cough and shortness of breath. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome and sometimes death. Standard recommendations to prevent the spread of COVID-19 include frequent cleaning of hands using alcohol-based hand rub or soap and water; covering the nose and mouth with a flexed elbow or disposable tissue when coughing and sneezing (use of mask is being widely recommended); and avoiding close contact with anyone that has a fever and cough.

There is a growing body of literature on aerosol transmission of COVID 19 virus. Some medical procedures can produce very small droplets (called aerosolized droplet nuclei or aerosols) that are able to stay suspended in the air for longer periods of time. When such medical procedures are conducted on people infected with COVID-19 in health facilities, these aerosols can contain the COVID-19 virus. These aerosols may potentially be inhaled by others if they are not wearing appropriate personal protective equipment.  Therefore, it is essential that all health workers performing these medical procedures take specific airborne protection measures, including using appropriate personal protective equipment. Visitors should not be permitted in areas where such medical procedures are being performed.

Current evidence indicates that COVID-19 does not appear to directly impact newborns. Few novel coronavirus infections have been reported in newborns, and these were almost uniformly asymptomatic. The few that had symptoms were reported to have mild illness. There is no evidence of vertical mother-to-newborn transmission during pregnancy or via breastfeeding. The pandemic response requires redoubled efforts by health providers and facilities to ensure hygiene practices such as handwashing with soap before and after handling the newborn; frequent, routine cleaning surfaces with disinfectant; and use of masks for mothers who either have tested positive for COVID-19 or who have fever and/or respiratory symptoms typical of COVID-19.

Whereas the direct effects of COVID-19 on pregnancy and newborns are minimal, indirect adverse effects are becoming increasingly apparent and important areas of concern. These include potential disruptions of routine maternal and newborn health (MNH) care that is essential for the health and survival of mothers and newborns. Countries’ responses to the pandemic – such as social distancing measures – can pose threats to continuing best practices by health care providers, as well as to home caregiver practices that are essential to newborn health and survival. Leading examples of these threats to best MNH practices include separation of mothers and newborns instead of promoting immediate skin-to-skin contact and rooming in in facilities, immediate and exclusive breastfeeding, and Kangaroo Mother Care (KMC) for preterm and small babies. Thus, pandemic mitigation by social distancing should not result in unintended harm to mothers and their newborns.

There is also a risk to mothers and babies that pandemic responses limit needed psychosocial support to mothers during pregnancy, delivery, and in the postpartum period. Additionally, the economic toll of the pandemic response poses serious risks to many families – especially mothers and newborns – living in poverty or near-poverty. Policies and programs must recognize and take steps to prevent or ameliorate these important risks which may otherwise be overlooked.

The World Health Organization (WHO) and partners continue to monitor the evidence and provide guidance accordingly.

Messaging

Current WHO guidelines for babies of mothers with COVID-19:

  • Infection prevention and control are the first line of defense against COVID-19.
  • Strict hand hygiene before and after contact with the infant and routinely cleaning and disinfecting surfaces are critical.
  • Mothers should breastfeed and not be separated from their infants unless the mother is too sick to hold her baby.
  • If the newborn is ill and requires specialized care, the mother should be allowed access to the specialized care unit with proper infection prevention and control measures.
  • Breastfeeding mothers should be helped to clean their chest with soap and water if they cough on it before breastfeeding.
  • Mothers do not need to wash their breasts prior to every breastfeed.
  • Mothers should wear a medical mask; if they do not have a medical mask, they should still continue breastfeeding.
  • When breastfeeding is not possible, mothers should be encouraged to express breastmilk with support from a well person.
Programmatic Toolkit
Interim Guidance
  • Breastfeeding and COVID-19 Scientific Brief — This scientific brief examines the evidence to date on the risks of transmission of COVID-19 from an infected mother to her baby through breastfeeding as well as evidence on the risks to child health from not breastfeeding.
  • WHO Academy COVID-19 Mobile Learning App — Available in six languages, the app delivers mobile access to a wealth of COVID-19 knowledge resources developed by WHO, including up-to-the-minute guidance, tools, training, and virtual workshops to support health workers in caring for patients infected by COVID-19 and protect themselves as they do their critical work.
  • Frequently Asked Questions: Breastfeeding and COVID-19 for Health Care Workers (28 April 2020) — This FAQ complements the WHO interim guidance: Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected (13 March 2020) and provides clarifications regarding those recommendations.
  • Q&A on COVID-19, pregnancy & childbirth and on COVID-19 & breastfeeding — These Q&A provides answers on pregnancy, childbirth and breastfeeding when COVID-19 infection is suspected or confirmed.
  • Coronavirus disease (COVID-19) advice for the public: Healthy Parenting — This document brings to attention key health and human rights considerations with regards to the COVID-19 pandemic. It highlights the importance of integrating a human rights based approach and global cooperation in response to COVID-19. It provides key considerations in relation to addressing stigma and discrimination, prevention of violence against women, support for vulnerable populations, quarantine and restrictive measures and shortages of supplies and equipment.
  • Operational considerations for case management of COVID-19 in health facility and community — This document is intended for health ministers, health system administrators, and other decision-makers. It is meant to guide the care of COVID-19 patients:
    • As the response capacity of health systems is challenged; and
    • To ensure that COVID-19 patients can access life-saving treatment, without compromising public health objectives and safety of health workers.
  • Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected – Interim Guidance — This resource is intended for clinicians involved in the care of adult, pregnant, and pediatric patients with or at risk of severe acute respiratory infection (SARI), when infection with the COVID-19 virus is suspected.
  • Guiding principles for immunization activities during the COVID-19 pandemic — This document provides guiding principles and considerations to support countries in their decision-making regarding provision of immunization services during the COVID-19 pandemic, which is endorsed by the WHO’s Strategic Advisory Group of Experts on Immunization.
  • Advice on the use of masks in the context of COVID-19 — This document provides advice on the use of masks in communities, during home-care, and in health care settings in areas that have reported cases of COVID-19. It is intended for individuals in the community, public health and infection prevention and control professionals, health care managers/ administrators, health care workers, and community health workers.
  • Advice for health workers — This document focuses on responsibilities of health workers during the COVID-19 pandemic. It outlines occupational and health guidelines, as well as symptom awareness and spread prevention.
  • Advice for a safer workplace — This document points out that WHO and public health authorities around the world are taking action to contain the COVID-19 outbreak. However, long term success cannot be taken for granted. All sections of our society – including businesses and employers – must play a role if we are to stop the spread of this disease.
  • Surveillance and case definition — This document summarizes WHO revised guidance for global surveillance of COVID-19 disease caused by infection with novel coronavirus (COVID-19). WHO will continue to update this guidance as new information about COVID-19 becomes available.
  • Laboratory guidance — The purpose of this document is to provide interim guidance to laboratories and stakeholders involved in laboratory testing of patients who meet the definition of suspected case of pneumonia associated with a novel coronavirus identified in Wuhan, China.
  • Patient management — This document is intended for clinicians taking care of hospitalized adult and pediatric patients with severe acute respiratory infection (SARI) when COVID-19 infection is suspected.
  • Home care of patients with suspected infection or mild infection — This document was adapted from the interim guidance that addressed Middle East respiratory syndrome coronavirus (MERS-CoV) infection that was published in June 2018, and is informed by evidence-based guidelines published by WHO, including Infection prevention and control of epidemic- and pandemic-prone acute respiratory diseases in health care, and based on current information regarding COVID-19 infection.
  • Additional resources are regularly updated on the WHO website.
  • Please also refer to the current advice for the public
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