Donor breast milk banks (hereinafter – BM) is a special service created to collect, check, process, store and distribute valuable donor breast milk among babies who need it for one reason or another. Such banks are one of the most important strategic elements of government policy in support of breastfeeding.
The COVID-19 pandemic has impacted the entire world, all medical activities, including PMD, their ability to provide enough pasteurized donor milk for newborns who need it.
On February 25, the European Milk Banks Association (EMBA) released an official statement reaffirming the importance of donated breast milk. At that time, it was not reliably known whether SARS-CoV-2 (the virus that causes COVID-19) could penetrate into breast milk, however, it was suggested that even if it was possible, the virus would most likely be destroyed by pasteurization, like others already well studied coronaviruses. The EMBA recommended adding specific questions related to the risk of COVID-19 infection to donor questionnaires. For instance:
– stay or crossing a risk zone within the previous 14 days;
– close contact with a person who is suspected or confirmed to have COVID-19;
– visiting or working in a medical facility in which a confirmed case of COVID-19 infection has been identified.
Questions like this can help identify potential COVID-19 exposure candidates and not accept donations from them for two weeks.
A donor who shows signs of possible COVID-19 infection (cough, fever, sore throat, etc.) should suspend the donation and pass a nasopharyngeal culture. If the test is negative, donation can be continued. If the test is positive, the donation must be aborted until a negative test is received.
In China, donor screening has become even more rigorous and rigorous, while standards for donor screening and milk storage have been quite stringent in the past.
In the past, donors could express milk at home and bring it to hospitals where milk cans are located. Sometimes milk was also taken by courier directly from the donor’s home. Both of these options have now been canceled. Now, in order to donate milk, a woman must personally come to the hospital, where her temperature will be measured and she will be allowed to fill out a questionnaire that includes, among others, questions about whether she was herself or whether she communicated with someone who was in the epidemic zone for last 14 days. If everything is in order, she will be given a sterile container into which she can express milk. Milk brought from home is not accepted. Of course, not every donor will want to go through a similar procedure.
People in general tend to go out less often, and even more so to visit hospitals. Even when someone is sick, they often tend to stay away from hospitals, because they believe that all medical facilities are full of COVID-19. Patients with other medical conditions are discharged as soon as possible. As a result, both supply and demand for donated milk decreased (Kathleen A. Marinelli, 2020).
As of March 2020, it was illegal to go out in Italy except to buy groceries in supermarkets. Breast milk donation dropped significantly during this period, as people simply could not leave their homes to bring milk to the bank.
In Italy, a service has been developed to collect milk from donor homes. Unfortunately, this activity has also been hit hard as hospitals are committed to caring for people infected with COVID-19. In particular, in Milan there is a special system for the collection of donated milk at home, which serves three paper machines in Milan and is called Human Milk Link. The essence of this system is that a nurse specializing in breastfeeding drives a car to donor homes, collects milk and gives advice on feeding. This service was stopped on March 9, 2020, after which the donation of breast milk in Milan was practically suspended (Kathleen A. Marinelli, 2020).
In the United States, banks of donor milk as of March-April 2020 were actively looking for new donors, urging them to donate more milk, and hospitals – to rationally distribute it (first of all, to babies born prematurely, as the ones in greatest need of breast milk). Donors began to be additionally checked for international travel, as well as recent medical history, both of the donor and his family members.
There were no implications for supply or demand during this time, but a decrease in donations was seen as a very feasible option, since donors do not want to go out again. And even if they do, many banks are located in hospitals, where visitors are simply not allowed. Some banks used dairy warehouses for this case, where donor mothers could bring their milk by choosing the warehouse closest to home (Kathleen A. Marinelli, 2020, Bryant Furlow, 2020).
In April 2018, an individual nutrition unit was created in the neonatology department of a hospital in Madrid (Spain). The purpose of this unit was to collect, store and distribute surplus breast milk from mothers whose newborns were admitted to the intensive care unit. Further, such milk was pasteurized and distributed among needy babies born prematurely, taking into account the most suitable gestation and lactation period, without mixing milk from different donors. This practice has led to many positive health consequences for babies.
Interestingly, during the COVID-19 pandemic and general isolation, the amount of donated milk flowing to this department increased rather than decreased. Thus, before the pandemic, an average of 63.5 L / month was received, and during isolation in March – 111.92 L, in April – 106.88 L and in May – 91.2 L (Manuel Sánchez Luna et al. ., 2020).
There are currently about 80 donor milk banks operating in India. Among them there are those that accept milk brought from home, but most of the supply is formed from mother’s milk, which exceeds the needs of their own babies in the intensive care unit.
The peculiarity of collecting such milk is that the mother mostly pumps by hand under the supervision of a breastfeeding consultant, who, among other things, checks compliance with hygiene rules before expressing and during the process. There are breast pumps, but they are not very common due to low financial possibilities.
During the PMD pandemic, India also added questions about the history of travel or living in a high-risk area, information about contact with a person infected with COVID-19, as well as the presence of flu-like symptoms.
A news article published by the Regional Center in Jaipur, India, between March 23 and June 8, 2020, reported a 75% decrease in donated milk donations. Informal conversations between employees of different centers throughout the country indicate approximately the same numbers. It is not yet clear what is causing this significant decline: nationwide isolation measures, stigma and uncertainty associated with COVID-19, or a decrease in the number of patients and their length of stay in hospital (Maheshwar Bhasin et al., 2020).
Thus, the COVID-19 pandemic has had a significant impact on the operation of PM in various countries such as China, Italy, India. This influence was mainly expressed in a decrease in the amount of donated milk, and in some countries also in demand. It is understood that such an impact on donor breast milk transactions could limit the ability of these milk banks to provide enough pasteurized donor milk for newborns who need it. For this reason, BMD actively encourages potential donors to donate milk, which is valuable now, and also tries to collect excess milk expressed by mothers whose babies are in the intensive care unit.