Every day, new information is released about the COVID-19 virus. New statistics refute earlier assumptions, new data challenges current protocols, and just-released guidelines are revised and replaced.
As a professional helping lactating families, how do you wade through the flood of information? And how do you translate it to action steps for your practice?
In a recent webinar Cecília Tomori, PhD, MA, Director of Global Public Health and Community Health at Johns Hopkins University School of Nursing, offered guidance on understanding COVID-19 data. Tomori weaves together a thoughtful and fresh multi-disciplinary discussion of the basics of the virus, how to digest and evaluate information and guidelines, and how to translate it all into practical action.
Below is a summary of the key take-aways from Tomori’s webinar.
Keep following emerging evidence. As a lactation professional, make sure you are staying up to date—and also make sure the sources you use are credible. Tomori herself relies heavily on the World Health Organization for information. (She includes a list at the end of her webinar of other reliable sources.)
Think critically. Be prepared to analyze and question what you hear and read. “Whatever level it is—locally or nationally—we can’t just read information uncritically,” Tomori says. “In a time of uncertainty and limited evidence with these … kinds of complexities, we really need to think very carefully.” Thinking critically means staying aware of your own biases, according to Tomori. “These are going to be deeply embedded and related to the cultural context that [you] come from,” she notes. “So this is going to take some deconstructing.”
Understand the limitations. When evaluating today’s newest COVID-19 information, Tomori says it is important to remember that we are living in an environment of constant change, and that new information is simply the best current understanding, not a definitive answer. “None of us knows everything, and tomorrow, there may be evidence that may change our minds,” she says.
Examine the implications for equity. “Health and illness is always shaped by structural and social inequities,” Tomori notes. “Epidemics are not equalizers. Just because the virus is not aware of social divides, the way in which it moves directly builds upon inequities. [The effect of the virus is to] heighten and reveal profound inequities, and to do so both globally and locally.” When evaluating a piece of COVID-19 guidance or information, Tomori urges practitioners to train themselves to ask, “How will this affect different people differently?”
Remain an advocate. When you see new COVID-19 policies or guidance affecting birthing or lactating families, Tomori advises reading it through a lens of advocacy for families. “Look for opportunities to support parents’ and infants’ rights,” she says. While some settings may offer less option for shared decision making than others, Tomori urges practitioners to work within their own settings to maximize the ability of parents to engage in understanding risk-benefit analysis and making choices.
Evaluate guidance on separation. One of the key questions during COVID-19 relates to the separation of birthing parents and infants. Tomori urges practitioners to understand that guidance is frequently rooted in a deep cultural bias toward seeing separation as neutral or default. “The mother and neonate are [seen as] completely separate individuals,” she says. “ …. These kinds of assumptions have to do with the socio-historical changes we have seen in the past 200 years … [mother-baby togetherness] is not considered something that is the default, but rather as a potential threat—in this case, a vector of transmission.”
In fact, the harms related to separation are extensive. “It takes the infant out of its normal niche, prevents co-regulation, disrupts breastfeeding, and presents a significant stress for mother, infant, and family.” Breastfeeding is especially important in offering protection from infectious disease, both from other illnesses and potentially mitigating COVID-19.
Seeing separation as inherently protective can also be misleading. “[The assumption is that] separating an infant from a COVID-19 positive [birthing] parent will achieve a neutral environment without the virus,” Tomori says. “But it actually exposes the infant to new exposures. Each health care worker or care handling the infant is a [potential] new exposure … the result is that the infant has a high likelihood of exposure but fewer benefits from proximity and breastfeeding.”
Transmission and clinical course in infants. The risk and clinical course of COVID-19 in infants has been the subject of a lot of interest, but data is still limited or incomplete. Evidence suggests a milder clinical course for COVID-19 in children overall, but the possibility of severe disease in infants, due to immune system immaturity and other factors. With regard to vertical transmission/in utero transmission, Tomori points out that a new study suggests it is possible but this finding remains unconfirmed. She says, “[This] may change in the coming weeks, but as of today, we do not have evidence of it.” There is no evidence of virus in breastmilk at this time either. The risk of transmission after birth can be minimized with good respiratory hygiene (e.g. wearing a mask) and handwashing.
Look for opportunities to collaborate. When trying to understand and apply COVID-19 information and guidance, do not go it alone, Tomori advises. Instead, connect with colleagues, learn from their expertise, and share your own. “Reach out to experts and ask for information,” she says. “This is a great opportunity for collaboration. We all need to be looking for opportunities to work together so we can support families the very best we can.”
The challenge of figuring out how to interpret new data and guidance during COVID-19, and how to provide answers to the families who rely on you, can feel overwhelming. But there are ways to work with the overwhelm, according to Tomori.
“Whenever we feel like there is overwhelming despair, I think it’s best to move toward action,” she says. “Work together. Communicate to address concerns, to raise questions, to relay information to colleagues, and to provide leadership in the environments where we operate.
“We are in this for the long haul,” she continues. “So we really need to be thinking very carefully about how we support families, because while it’s an emergency and many of us are dealing with very acute circumstances, we’re going to be dealing with some of these issues for many months to come. So we’re going to need to figure out how to build the best possible support that we can for families around the world.”
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