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Summary of AAP Guidance on newborns exposed to COVID-19

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Summary of AAP Guidance on newborns exposed to COVID-19

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What to expect when coming to the hospital

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What to expect when coming to the hospital

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Families should understand that the current hospital environment is very different due to the pandemic.  Everyone entering the hospital is screened for illness and visitors are restricted.  Strict measures are in place to protect patients, families and health care workers.

Additionally we are screening all laboring moms for COVID-19 if they have symptoms.  If mom is found to be COVID+, her care will look very different from what the family has likely planned for.  Babies are bathed right after delivery (no delayed bath), no skin to skin time, and likely separation from her baby.  All these measures are to protect the baby but likely will be very difficult for the family.

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Most hospitals are allowing only one support person for laboring moms.  No other visitors may visit during this time.

Families can refer to the hospital's website for current visitor information (Stanford and ECH links below)

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Making sure everyone is healthy is important for you and your child, and all of our patients. One way we are doing this is by limiting the number of people in the hospital. As a reminder, anyone with a cough, runny nose, fever, or sore throat should not come to the hospital.

Current visitor guidelines

A total of 1 person (caregivers) will be allowed to enter the hospital and be at the bedside.

One partner or birth support person will be allowed with each patient on the Labor and Delivery, Antepartum and Maternity Units. .

Any person visiting the hospital must be 18 years or older.

No entry allowed for common space use (cafeteria, gift shop, pass through to Stanford Hospital, etc.)

Ways for patients to stay in touch with friends and family:

1. Make a phone call or video chat the child/family

2. Text, send an e-mail or greeting card.

3. Send balloons (mylar type only) or other gifts by ordering from the gift shop (650) 497-8596 during shop hours

Visit our Gift Shop >

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Patients & Visitors - Stanford Children's Health

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Making sure everyone is healthy is important for you and your child, and all of our patients. One way we are doing this is by limiting the number of people in the hospital. As a reminder, anyone with a cough, runny nose, fever, or sore throat should not come to the hospital.

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Visitor Restrictions Updated As of March 27

El Camino Health has reevaluated its visitor policy to support our patients needs while minimizing the risk of potential communicable diseases throughout the hospital. These changes are based on the most recent recommendations from the Centers for Disease Control and local health authorities. As a result of more restrictive measures being taken throughout the Bay Area related to COVID-19, El Camino Health's hospitals are implementing a new temporary, no visitor policy effective Tuesday, March 17, 2020. One adult visitor per patient will be allowed in our Mother-Baby areas and with patients at the end of life. All people entering the hospital will be screened, including a health screening, upon entrance.

During flu season, all patients and visitors are required to wear a mask in our emergency rooms. This practice began on November 1, 2019 with the onset of the current flu season.

We maintain regular communication with Santa Clara County Public Health Department, California Public Health Department and are up to date with CDC guidance. We will continue to update measures as needed to ensure the safety of our patients, employees, and visitors. For more information, click here.

We understand that visits from friends and family are important to our patients - and these visits are an important part of the healing process. Our visiting policies reflect this understanding, but our guidelines put patients' safety and well-being above all else. That means that in particular departments or circumstances we may have different visiting guidelines in order to protect the health of our patients.

Visiting Hours. Our visiting hours and guidelines are designed to protect the health and well-being of our patients, and ensure they get the care and rest they need.

Visiting Rights. Patients have the right to receive visitors, including a spouse, a domestic partner, family member or a friend - patients also have the right to withdraw or deny this consent at any time.

Visitor Guidelines. For our patients' comfort, please follow these guidelines when you visit our hospitals.

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El Camino Health has reevaluated its visitor policy to support our patients needs while minimizing the risk of potential communicable diseases throughout the hospital. These changes are based on the most recent recommendations from the Centers for Disease Control and local health authorities.

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Screening for COVID-19 in our laboring moms

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Screening for COVID-19 in our laboring moms

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All pregnant women will be screened at the entrance of the hospital to determine if possible PUI (e.g fever, cough, resp symptoms).  If the mom is determined to be a PUI, the hospital’s L&D triage policy will be applied to manage mom and baby.  Testing for COVID-19 will be performed on the mother.  This could mean separation of mom and baby but not necessarily.   The support person will also have significant restrictions on their movement in the hospital.  Once she delivers, the infant will be treated as a PUI until mom is determined to be negative.

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Centers for Disease Control and Prevention

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Frequently Asked Questions and Answers

Updated March 16, 2020

Pregnant women

We do not have information from published scientific reports about susceptibility of pregnant women to COVID-19. Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19. Pregnant women also might be at risk for severe illness, morbidity, or mortality compared to the general population as observed in cases of other related coronavirus infections [including severe acute respiratory syndrome coronavirus (SARS-CoV)* and Middle East respiratory syndrome coronavirus (MERS-CoV)] and other viral respiratory infections, such as influenza, during pregnancy.

Pregnant women should engage in usual preventive actions to avoid infection like washing hands often and avoiding people who are sick.

We do not have information on adverse pregnancy outcomes in pregnant women with COVID-19. Pregnancy loss, including miscarriage and stillbirth, has been observed in cases of infection with other related coronaviruses [SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV)] during pregnancy. High fevers during the first trimester of pregnancy can increase the risk of certain birth defects.

Pregnant healthcare providers

Pregnant healthcare personnel (HCP) should follow risk assessment and infection control guidelines for HCP exposed to patients with suspected or confirmed COVID-19. Adherence to recommended infection prevention and control practices is an important part of protecting all HCP in healthcare settings. Information on COVID-19 in pregnancy is very limited; facilities may want to consider limiting exposure of pregnant HCP to patients with confirmed or suspected COVID-19, especially during higher risk procedures (e.g., aerosol-generating procedures) if feasible based on staffing availability.

Transmission during pregnancy or during delivery

Vertical transmission includes transmission of a pathogen from a mother to her fetus or newborn before, during, or immediately after delivery. Transplacental transmission occurs during pregnancy when maternal viremia leads to transmission across the placenta (e.g., Zika virus). Perinatal transmission at the time of delivery can occur when the newborn comes into exposure with maternal bodily fluids during delivery (e.g., as occurs with herpes simplex virus [HSV]), through transmission of infectious virus through the breastmilk (e.g., as occurs with HIV), or other bodily fluids (e.g., as occurs with group B Streptococcus and vaginal fluids, influenza viruses and respiratory droplets), and some pathogens are transmitted by multiple routes.

In limited recent case series of infants born to mothers with COVID-19 published in the peer-reviewed literature, none of the infants have tested positive for SARS-CoV-2.* Additionally, virus was not detected in samples of amniotic fluid.

Limited information is available about vertical transmission for other coronaviruses (MERS-CoV and SARS-CoV) but vertical transmission has not been reported for these infections.

Infants

Based on limited case reports, adverse infant outcomes (e.g., preterm birth) have been reported among infants born to mothers positive for COVID-19 during pregnancy. However, it is not clear that these outcomes were related to maternal infection, and at this time the risk of adverse infant outcomes is not known. Given the limited data available related to COVID-19 during pregnancy, knowledge of adverse outcomes from other respiratory viral infections may provide some information. For example, other respiratory viral infections during pregnancy, such as influenza, have been associated with adverse neonatal outcomes, including low birth weight and preterm birth. Additionally, having a cold or influenza with high fever early in pregnancy may increase the risk of certain birth defects. Infants born preterm and/or small for gestational age have been reported among infants born to mothers with other coronavirus infections, SARS-CoV and MERS-CoV, during pregnancy.

At this time, there is no information on long-term health effects on infants either with COVID-19, or those exposed to SARS-CoV-2 in utero. In general, prematurity and low birth weight are associated with adverse long-term health effects.

Transmission through breastmilk

Current knowledge suggests that human-to-human transmission occurs by close contact with a person with confirmed COVID-19 mainly via respiratory droplets produced when a person with infection coughs, sneezes, or talks. Recent studies indicate that people who are infected but do not have symptoms likely also play a role in the spread of COVID-19. In limited case series reported to date, no evidence of virus has been found in the breast milk of women with COVID-19. No information is available on the transmission of SARS-CoV-2* through breast milk (i.e., infectious virus in the breast milk).

In limited reports of lactating women infected with SARS-CoV,* virus has not been detected in breast milk; however, antibodies against SARS-CoV were detected in at least one sample.

* SARS-CoV caused an outbreak in 2002-2003. The virus causing the current outbreak called SARS-CoV-2. As the name indicates, the viruses are related, however they are not the same.

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pregnant women; pregnancy; vertical transmission; breast feeding

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Frequently Asked Questions and Answers Updated March 16, 2020 We do not have information from published scientific reports about susceptibility of pregnant women to COVID-19. Pregnant women experience immunologic and physiologic changes which might make them more susceptible to viral respiratory infections, including COVID-19.

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Centers for Disease Control and Prevention

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These infection prevention and control considerations are for healthcare facilities providing obstetric care for pregnant patients with confirmed coronavirus disease (COVID-19) or pregnant persons under investigation (PUI) in inpatient obstetric healthcare settings including obstetrical triage, labor and delivery, recovery and inpatient postpartum settings.

This information is intended to aid hospitals and clinicians in applying broader CDC interim guidance on infection control ( Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings).

Since maternity and newborn care units vary in physical configuration, each facility should consider their appropriate space and staffing needs to prevent transmission of the virus that causes COVID-19. These considerations include appropriate isolation of pregnant patients who have confirmed COVID-19 or are PUIs; basic and refresher training for all healthcare personnel on those units to include correct adherence to infection control practices and personal protective equipment (PPE) use and handling; sufficient and appropriate PPE supplies positioned at all points of care; and processes to protect newborns from risk of COVID-19.

These considerations are based upon the limited evidence available to date about transmission of the virus that causes COVID-19, and knowledge of other viruses that cause severe respiratory illness including influenza, severe acute respiratory syndrome coronavirus (SARS-CoV), and Middle East Respiratory Syndrome coronavirus (MERS-CoV). The approaches outlined below are intentionally cautious until additional data become available to refine recommendations for prevention of person-to-person transmission in inpatient obstetric care settings.

Prehospital Considerations

Pregnant patients who have confirmed COVID-19 or who are PUIs should notify the obstetric unit prior to arrival so the facility can make appropriate infection control preparations (e.g., identifying the most appropriate room for labor and delivery, ensuring infection prevention and control supplies and PPE are correctly positioned, informing all healthcare personnel who will be involved in the patient's care of infection control expectations) before the patient's arrival.

If a pregnant patient who has confirmed COVID-19 or is a PUI is arriving via transport by emergency medical services, the driver should contact the receiving emergency department or healthcare facility and follow previously agreed-upon local or regional transport protocols. For more information refer to the Interim Guidance for Emergency Medical Services (EMS) Systems and 911 Public Safety Answering Points (PSAPs) for COVID-19 in the United States.

Healthcare providers should promptly notify infection control personnel at their facility of the anticipated arrival of a pregnant patient who has confirmed COVID-19 or is a PUI.

During Hospitalization

All healthcare facilities that provide obstetric care must ensure that their personnel are correctly trained and capable of implementing recommended infection control interventions. Individual healthcare personnel should ensure they understand and can adhere to infection control requirements.

Healthcare facilities should follow the above infection control guidance on managing visitor access, including essential support persons for women in labor (e.g., spouse, partner).

Mother/Baby Contact

It is unknown whether newborns with COVID-19 are at increased risk for severe complications. Transmission after birth via contact with infectious respiratory secretions is a concern. To reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, facilities should consider temporarily separating (e.g., separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother's transmission-based precautions are discontinued, as described in the Interim Considerations for Disposition of Hospitalized Patients with COVID-19. See the considerations below for temporary separation:

The risks and benefits of temporary separation of the mother from her baby should be discussed with the mother by the healthcare team.

A separate isolation room should be available for the infant while they remain a PUI. Healthcare facilities should consider limiting visitors, with the exception of a healthy parent or caregiver. Visitors should be instructed to wear appropriate PPE, including gown, gloves, face mask, and eye protection. If another healthy family or staff member is present to provide care (e.g., diapering, bathing) and feeding for the newborn, they should use appropriate PPE. For healthy family members, appropriate PPE includes gown, gloves, face mask, and eye protection. For healthcare personnel, recommendations for appropriate PPE are outlined in the Infection Prevention and Control Recommendations.

The decision to discontinue temporary separation of the mother from her baby should be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health officials. The decision should take into account disease severity, illness signs and symptoms, and results of laboratory testing for the virus that causes COVID-19, SARS-CoV-2. Considerations to discontinue temporary separation are the same as those to discontinue transmission-based precautions for hospitalized patients with COVID-19. Please see Interim Considerations for Disposition of Hospitalized Patients with COVID-19.

If colocation (sometimes referred to as "rooming in") of the newborn with his/her ill mother in the same hospital room occurs in accordance with the mother's wishes or is unavoidable due to facility limitations, facilities should consider implementing measures to reduce exposure of the newborn to the virus that causes COVID-19.

Consider using engineering controls like physical barriers (e.g., a curtain between the mother and newborn) and keeping the newborn ≥6 feet away from the ill mother.

If no other healthy adult is present in the room to care for the newborn, a mother who has confirmed COVID-19 or is a PUI should put on a facemask and practice hand hygiene¹ before each feeding or other close contact with her newborn. The facemask should remain in place during contact with the newborn. These practices should continue while the mother is on transmission-based precautions in a healthcare facility.

Breastfeeding

During temporary separation, mothers who intend to breastfeed should be encouraged to express their breast milk to establish and maintain milk supply. If possible, a dedicated breast pump should be provided. Prior to expressing breast milk, mothers should practice hand hygiene. After each pumping session, all parts that come into contact with breast milk should be thoroughly washed and the entire pump should be appropriately disinfected per the manufacturer's instructions. This expressed breast milk should be fed to the newborn by a healthy caregiver.

If a mother and newborn do room-in and the mother wishes to feed at the breast, she should put on a facemask and practice hand hygiene before each feeding.

Hospital Discharge

Footnote:

¹ Hand hygiene includes use of alcohol-based hand sanitizer that contains 60% to 95% alcohol before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Hand hygiene can also be performed by washing with soap and water for at least 20 seconds. If hands are visibly soiled, use soap and water before returning to alcohol-based hand sanitizer.

Additional resources:

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These infection prevention and control considerations are for healthcare facilities providing obstetric care for pregnant patients with confirmed coronavirus disease (COVID-19) or pregnant persons under investigation (PUI) in inpatient obstetric healthcare settings including obstetrical triage, labor and delivery, recovery and inpatient postpartum settings.

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It is unclear if COVID-19 can be transmitted vertically to babies.  There are a few articles about this possibility but the numbers are small.  The AAP report published on 4/3/2020 reviews the most current evidence.  It does appear that the risk is low and infants generally do well.

CDC recommends separation of mother and infant right after delivery to decrease risk of transmission of COVID-19 to the baby.  However,  rooming-in is acceptable if the family declines separation or if the hospital does not have space to separate mom and baby.  If the baby remains in mom’s room, precautions should be in place to minimize the chance of transmission to the baby:

Baby at least 6 feet from mom in isolette

Barrier/curtain between mom and baby

Healthy support person provides care to baby in PPE

Feed expressed milk but if mother chooses to breastfeed, she must wear a mask and perform hand hygiene.

Bath after delivery (no delayed bath)

No skin to skin after delivery

Follow PPE guidelines when caring for the infant.

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Centers for Disease Control and Prevention

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Background

This interim guidance has been updated based on currently available information about COVID-19 and the current situation in the United States, which includes reports of cases of community transmission, infections identified in healthcare personnel (HCP), and shortages of facemasks, N95 filtering facepiece respirators (FFRs) (commonly known as N95 respirators), and gowns. Here is what is currently known:

Mode of transmission: Early reports suggest person-to-person transmission most commonly happens during close exposure to a person infected with COVID-19, primarily via respiratory droplets produced when the infected person coughs, sneezes, or talks. Droplets can land in the mouths, noses, or eyes of people who are nearby or possibly be inhaled into the lungs of those within close proximity. Recent studies indicate that people who are infected but do not have symptoms likely also play a role in the spread of COVID-19. The contribution of small respirable particles, sometimes called aerosols or droplet nuclei, to close proximity transmission is currently uncertain. However, airborne transmission from person-to-person over long distances is unlikely.

Shortage of personal protective equipment: Controlling exposures to occupational infections is a fundamental method of protecting HCP. Traditionally, a hierarchy of controls has been used as a means of determining how to implement feasible and effective control solutions. The hierarchy ranks controls according to their reliability and effectiveness and includes such controls as engineering controls, administrative controls, and ends with personal protective equipment (PPE). PPE is the least effective control because it involves a high level of worker involvement and is highly dependent on proper fit and correct, consistent use.

Major distributors in the United States have reported shortages of PPE, specifically N95 respirators, facemasks, and gowns. Healthcare facilities are responsible for protecting their HCP from exposure to pathogens, including by providing appropriate PPE.

In times of shortages, alternatives to N95s should be considered, including other classes of FFRs, elastomeric half-mask and full facepiece air purifying respirators, and powered air purifying respirators (PAPRs) where feasible. Special care should be taken to ensure that respirators are reserved for situations where respiratory protection is most important, such as performance of aerosol-generating procedures on suspected or confirmed COVID-19 patients or provision of care to patients with other infections for which respiratory protection is strongly indicated (e.g., tuberculosis, measles, varicella).

The anticipated timeline for return to routine levels of PPE is not yet known. Information about strategies to optimize the current supply of N95 respirators, including the use of devices that provide higher levels of respiratory protection (e.g., powered air purifying respirators [PAPRs]) when N95s are in limited supply and a companion checklist to help healthcare facilities prioritize the implementation of the strategies, is available.

Capacity across the healthcare continuum: Use of N95 or higher-level respirators are recommended for HCP who have been medically cleared, trained, and fit-tested, in the context of a facility's respiratory protection programexternal icon . The majority of nursing homes and outpatient clinics, including hemodialysis facilities, do not have respiratory protection programs nor have they fit-tested HCP, hampering implementation of recommendations in the previous version of this guidance. This can lead to unnecessary transfer of patients with known or suspected COVID-19 to another facility (e.g., acute care hospital) for evaluation and care. In areas with community transmission, acute care facilities will be quickly overwhelmed by transfers of patients who have only mild illness and do not require hospitalization.

Many of the recommendations described in this guidance (e.g., triage procedures, source control) should already be part of an infection control program designed to prevent transmission of seasonal respiratory infections. As it will be challenging to distinguish COVID-19 from other respiratory infections, interventions will need to be applied broadly and not limited to patients with confirmed COVID-19.

This guidance is applicable to all U.S. healthcare settings. This guidance is not intended for non-healthcare settings (e.g., schools) OR for persons outside of healthcare settings. For recommendations regarding clinical management, air or ground medical transport, or laboratory settings, refer to the main CDC COVID-19 website.

Definition of Healthcare Personnel (HCP) - For the purposes of this document, HCP refers to all paid and unpaid persons serving in healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including body substances; contaminated medical supplies, devices, and equipment; contaminated environmental surfaces; or contaminated air.

Recommendations

1. Minimize Chance for Exposures

Ensure facility policies and practices are in place to minimize exposures to respiratory pathogens including SARS-CoV-2, the virus that causes COVID-19. Measures should be implemented before patient arrival, upon arrival, throughout the duration of the patient's visit, and until the patient's room is cleaned and disinfected. It is particularly important to protect individuals at increased risk for adverse outcomes from COVID-19 (e.g. older individuals with comorbid conditions), including HCP who are in a recognized risk category.

Before Arrival

When scheduling appointments for routine medical care (e.g., annual physical, elective surgery), instruct patients to call ahead and discuss the need to reschedule their appointment if they develop symptoms of a respiratory infection (e.g., cough, sore throat, fever) on the day they are scheduled to be seen.

When scheduling appointments for patients requesting evaluation for a respiratory infection, use nurse-directed triage protocols to determine if an appointment is necessary or if the patient can be managed from home.
If the patient must come in for an appointment, instruct them to call beforehand to inform triage personnel that they have symptoms of a respiratory infection (e.g., cough, sore throat, fever) and to take appropriate preventive actions (e.g., follow triage procedures, wear a facemask upon entry and throughout their visit or, if a facemask cannot be tolerated, use a tissue to contain respiratory secretions).

If a patient is arriving via transport by emergency medical services (EMS), EMS personnel should contact the receiving emergency department (ED) or healthcare facility and follow previously agreed upon local or regional transport protocols. This will allow the healthcare facility to prepare for receipt of the patient.

Upon Arrival and During the Visit

Consider limiting points of entry to the facility.

Take steps to ensure all persons with symptoms of COVID-19 or other respiratory infection (e.g., fever, cough) adhere to respiratory hygiene and cough etiquette (see appendix), hand hygiene, and triage procedures throughout the duration of the visit.

Post visual alertspdf icon (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) to provide patients and HCP with instructions (in appropriate languages) about hand hygiene, respiratory hygiene, and cough etiquette. Instructions should include how to use tissues to cover nose and mouth when coughing or sneezing, to dispose of tissues and contaminated items in waste receptacles, and how and when to perform hand hygiene.

Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60-95% alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins.

Install physical barriers (e.g., glass or plastic windows) at reception areas to limit close contact between triage personnel and potentially infectious patients.

Consider establishing triage stations outside the facility to screen patients before they enter.

Ensure rapid safe triage and isolation of patients with symptoms of suspected COVID-19 or other respiratory infection (e.g., fever, cough).

Prioritize triage of patients with respiratory symptoms.

Triage personnel should have a supply of facemasks and tissues for patients with symptoms of respiratory infection. These should be provided to patients with symptoms of respiratory infection at check-in. Source control (putting a facemask over the mouth and nose of a symptomatic patient) can help to prevent transmission to others.

Ensure that, at the time of patient check-in, all patients are asked about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of COVID-19 or contact with possible COVID-19 patients.

Isolate the patient in an examination room with the door closed. If an examination room is not readily available ensure the patient is not allowed to wait among other patients seeking care.

Identify a separate, well-ventilated space that allows waiting patients to be separated by 6 or more feet, with easy access to respiratory hygiene supplies.

In some settings, patients might opt to wait in a personal vehicle or outside the healthcare facility where they can be contacted by mobile phone when it is their turn to be evaluated.

Incorporate questions about new onset of respiratory symptoms into daily assessments of all admitted patients. Monitor for and evaluate all new fevers and respiratory illnesses among patients. Place any patient with unexplained fever or respiratory symptoms on appropriate Transmission-Based Precautions and evaluate.

Additional considerations during periods of community transmission:

Explore alternatives to face-to-face triage and visits.

Learn more about how healthcare facilities can Prepare for Community Transmission

Designate an area at the facility (e.g., an ancillary building or temporary structure) or identify a location in the area to be a "respiratory virus evaluation center" where patients with fever or respiratory symptoms can seek evaluation and care.

Cancel group healthcare activities (e.g., group therapy, recreational activities).

Postpone elective procedures, surgeries, and non-urgent outpatient visits.

2. Adhere to Standard and Transmission-Based Precautions

Standard Precautions assume that every person is potentially infected or colonized with a pathogen that could be transmitted in the healthcare setting. Elements of Standard Precautions that apply to patients with respiratory infections, including COVID-19, are summarized below. Attention should be paid to training and proper donning (putting on), doffing (taking off), and disposal of any PPE. This document does not emphasize all aspects of Standard Precautions (e.g., injection safety) that are required for all patient care; the full description is provided in the Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.

HCP (see Section 5 for measures for non-HCP visitors) who enter the room of a patient with known or suspected COVID-19 should adhere to Standard Precautions and use a respirator or facemask, gown, gloves, and eye protection. When available, respirators (instead of facemasks) are preferred; they should be prioritized for situations where respiratory protection is most important and the care of patients with pathogens requiring Airborne Precautions (e.g., tuberculosis, measles, varicella). Information about the recommended duration of Transmission-Based Precautions is available in the Interim Guidance for Discontinuation of Transmission-Based Precautions and Disposition of Hospitalized Patients with COVID-19

Hand Hygiene

HCP should perform hand hygiene before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves. Hand hygiene after removing PPE is particularly important to remove any pathogens that might have been transferred to bare hands during the removal process.

HCP should perform hand hygiene by using ABHR with 60-95% alcohol or washing hands with soap and water for at least 20 seconds. If hands are visibly soiled, use soap and water before returning to ABHR.

Healthcare facilities should ensure that hand hygiene supplies are readily available to all personnel in every care location.

when to use PPE

what PPE is necessary

how to properly don, use, and doff PPE in a manner to prevent self-contamination

how to properly dispose of or disinfect and maintain PPE

the limitations of PPE.

Any reusable PPE must be properly cleaned, decontaminated, and maintained after and between uses. Facilities should have policies and procedures describing a recommended sequence for safely donning and doffing PPE. The PPE recommended when caring for a patient with known or suspected COVID-19 includes:

Respirator or Facemask

Put on a respirator or facemask (if a respirator is not available) before entry into the patient room or care area.

N95 respirators or respirators that offer a higher level of protection should be used instead of a facemask when performing or present for an aerosol-generating procedure (See Section 4). See appendix for respirator definition. Disposable respirators and facemasks should be removed and discarded after exiting the patient's room or care area and closing the door. Perform hand hygiene after discarding the respirator or facemask. For guidance on extended use of respirators, refer to Strategies to Optimize the Current Supply of N95 Respirators
If reusable respirators (e.g., powered air purifying respirators [PAPRs]) are used, they must be cleaned and disinfected according to manufacturer's reprocessing instructions prior to re-use.

When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19. Those that do not currently have a respiratory protection program, but care for patients with pathogens for which a respirator is recommended, should implement a respiratory protection program.

Eye Protection

Put on eye protection (i.e., goggles or a disposable face shield that covers the front and sides of the face) upon entry to the patient room or care area. Personal eyeglasses and contact lenses are NOT considered adequate eye protection.

Remove eye protection before leaving the patient room or care area.

Reusable eye protection (e.g., goggles) must be cleaned and disinfected according to manufacturer's reprocessing instructions prior to re-use. Disposable eye protection should be discarded after use.

Gloves

Put on clean, non-sterile gloves upon entry into the patient room or care area.
Change gloves if they become torn or heavily contaminated.

Remove and discard gloves when leaving the patient room or care area, and immediately perform hand hygiene.

Gowns

Put on a clean isolation gown upon entry into the patient room or area. Change the gown if it becomes soiled. Remove and discard the gown in a dedicated container for waste or linen before leaving the patient room or care area. Disposable gowns should be discarded after use. Cloth gowns should be laundered after each use.

If there are shortages of gowns, they should be prioritized for:

aerosol-generating procedures

care activities where splashes and sprays are anticipated

high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing of HCP. Examples include:

dressing

bathing/showering

transferring

providing hygiene

changing linens

changing briefs or assisting with toileting

device care or use

wound care

3. Patient Placement

For patients with COVID-19 or other respiratory infections, evaluate need for hospitalization. If hospitalization is not medically necessary, home care is preferable if the individual's situation allows.

If admitted, place a patient with known or suspected COVID-19 in a single-person room with the door closed. The patient should have a dedicated bathroom.
Airborne Infection Isolation Rooms (AIIRs) (See definition of AIIR in appendix) should be reserved for patients who will be undergoing aerosol-generating procedures (See Aerosol-Generating Procedures Section)

As a measure to limit HCP exposure and conserve PPE, facilities could consider designating entire units within the facility, with dedicated HCP, to care for known or suspected COVID-19 patients. Dedicated means that HCP are assigned to care only for these patients during their shift.

Determine how staffing needs will be met as the number of patients with known or suspected COVID-19 increases and HCP become ill and are excluded from work.

It might not be possible to distinguish patients who have COVID-19 from patients with other respiratory viruses. As such, patients with different respiratory pathogens will likely be housed on the same unit. However, only patients with the same respiratory pathogen may be housed in the same room. For example, a patient with COVID-19 should not be housed in the same room as a patient with an undiagnosed respiratory infection.

During times of limited access to respirators or facemasks, facilities could consider having HCP remove only gloves and gowns (if used) and perform hand hygiene between patients with the same diagnosis (e.g., confirmed COVID-19) while continuing to wear the same eye protection and respirator or facemask (i.e., extended use). Risk of transmission from eye protection and facemasks during extended use is expected to be very low.

HCP must take care not to touch their eye protection and respirator or facemask .

Eye protection and the respirator or facemask should be removed, and hand hygiene performed if they become damaged or soiled and when leaving the unit.

HCP should strictly follow basic infection control practices between patients (e.g., hand hygiene, cleaning and disinfecting shared equipment).

Limit transport and movement of the patient outside of the room to medically essential purposes.
Consider providing portable x-ray equipment in patient cohort areas to reduce the need for patient transport.

To the extent possible, patients with known or suspected COVID-19 should be housed in the same room for the duration of their stay in the facility (e.g., minimize room transfers).

Patients should wear a facemask to contain secretions during transport. If patients cannot tolerate a facemask or one is not available, they should use tissues to cover their mouth and nose.

Personnel entering the room should use PPE as described above.

Whenever possible, perform procedures/tests in the patient's room.

Once the patient has been discharged or transferred, HCP, including environmental services personnel, should refrain from entering the vacated room until sufficient time has elapsed for enough air changes to remove potentially infectious particles (more information on clearance rates under differing ventilation conditions is available). After this time has elapsed, the room should undergo appropriate cleaning and surface disinfection before it is returned to routine use (See Section 10).

4. Take Precautions When Performing Aerosol-Generating Procedures (AGPs)

Some procedures performed on patient with known or suspected COVID-19 could generate infectious aerosols. In particular, procedures that are likely to induce coughing (e.g., sputum induction, open suctioning of airways) should be performed cautiously and avoided if possible.

If performed, the following should occur:

HCP in the room should wear an N95 or higher-level respirator, eye protection, gloves, and a gown.

The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for the procedure.

AGPs should ideally take place in an AIIR.

Clean and disinfect procedure room surfaces promptly as described in the section on environmental infection control below.

5. Collection of Diagnostic Respiratory Specimens

When collecting diagnostic respiratory specimens (e.g., nasopharyngeal swab) from a possible COVID-19 patient, the following should occur:

HCP in the room should wear an N-95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and a gown.

The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for specimen collection.

Specimen collection should be performed in a normal examination room with the door closed.

Clean and disinfect procedure room surfaces promptly as described in the section on environmental infection control below.

6. Manage Visitor Access and Movement Within the Facility

Establish procedures for monitoring, managing and training all visitors, which should include:

All visitors should perform frequent hand hygiene and follow respiratory hygiene and cough etiquette precautions while in the facility, especially common areas.

Passively screen visitors for symptoms of acute respiratory illness before entering the healthcare facility
Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, cafeterias) advising visitors not to enter the facility when ill.

Informing visitors about appropriate PPE use according to current facility visitor policy

Visitors to the most vulnerable patients (e.g., oncology and transplant wards) should be limited; visitors should be screened for symptoms prior to entry to the unit.

Limit visitors to patients with known or suspected COVID-19. Encourage use of alternative mechanisms for patient and visitor interactions such as video-call applications on cell phones or tablets. If visitation must occur, visits should be scheduled and controlled to allow for the following:

Facilities should evaluate risk to the health of the visitor (e.g., visitor might have underlying illness putting them at higher risk for COVID-19) and ability to comply with precautions.

Facilities should provide instruction, before visitors enter patients' rooms, on hand hygiene, limiting surfaces touched, and use of PPE according to current facility policy while in the patient's room.

Visitors should not be present during AGPs or other specimen collection procedures.

Visitors should be instructed to only visit the patient room. They should not go to other locations in the facility.

Additional considerations during periods of community transmission:

All visitors should be actively assessed for fever and respiratory symptoms upon entry to the facility. If fever or respiratory symptoms are present, visitor should not be allowed entry into the facility.

Determine the threshold at which screening of persons entering the facility will be initiated and at what point screening will escalate from passive (e.g., signs at the entrance) to active (e.g., direct questioning) to restricting all visitors to the facility.

If restriction of all visitors is implemented, facilities can consider exceptions based on end-of-life situations or when a visitor is essential for the patient's emotional well-being and care.

Limit points of entry to the facility.

7. Implement Engineering Controls

Design and install engineering controls to reduce or eliminate exposures by shielding HCP and other patients from infected individuals. Examples of engineering controls include:

physical barriers or partitions to guide patients through triage areas

curtains between patients in shared areas

air-handling systems (with appropriate directionality, filtration, exchange rate, etc.) that are installed and properly maintained

8. Monitor and Manage Ill and Exposed Healthcare Personnel

9. Train and Educate Healthcare Personnel

Provide HCP with job- or task-specific education and training on preventing transmission of infectious agents, including refresher training.

Ensure that HCP are educated, trained, and have practiced the appropriate use of PPE prior to caring for a patient, including attention to correct use of PPE and prevention of contamination of clothing, skin, and environment during the process of removing such equipment. Print CDC's factsheet 8.5×11pdf icon and poster 11×17pdf icon for one PPE donning and doffing method.

10. Implement Environmental Infection Control

Dedicated medical equipment should be used when caring for patients with known or suspected COVID-19.
All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer's instructions and facility policies.

Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.

Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product's label) are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.
Refer to List Nexternal icon on the EPA website for EPA-registered disinfectants that have qualified under EPA's emerging viral pathogens program for use against SARS-CoV-2.

Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine procedures.

Additional information about recommended practices for terminal cleaning of rooms and PPE to be worn by environmental services personnel is available in the Healthcare Infection Prevention and Control FAQs for COVID-19

11. Establish Reporting within and between Healthcare Facilities and to Public Health Authorities

Implement mechanisms and policies that promote situational awareness for facility staff including infection control, healthcare epidemiology, facility leadership, occupational health, clinical laboratory, and frontline staff about known or suspected COVID-19 patients and facility plans for response.

Communicate and collaborate with public health authorities.
Facilities should designate specific persons within the healthcare facility who are responsible for communication with public health officials and dissemination of information to HCP.

Communicate information about known or suspected COVID-19 patients to appropriate personnel before transferring them to other departments in the facility (e.g., radiology) and to other healthcare facilities.

12. Appendix: Additional Information about Airborne Infection Isolation Rooms, Respirators and Facemasks

Information about Airborne Infection Isolation Rooms (AIIRs):

AIIRs are single-patient rooms at negative pressure relative to the surrounding areas, and with a minimum of 6 air changes per hour (12 air changes per hour are recommended for new construction or renovation).

Air from these rooms should be exhausted directly to the outside or be filtered through a high-efficiency particulate air (HEPA) filter directly before recirculation.

Room doors should be kept closed except when entering or leaving the room, and entry and exit should be minimized.

Facilities should monitor and document the proper negative-pressure function of these rooms.

Information about Respirators:

A respirator is a personal protective device that is worn on the face, covers at least the nose and mouth, and is used to reduce the wearer's risk of inhaling hazardous airborne particles (including dust particles and infectious agents), gases, or vapors. Respirators are certified by the CDC/NIOSH, including those intended for use in healthcare.

Respirator use must be in the context of a complete respiratory protection program in accordance with OSHA Respiratory Protection standard (29 CFR 1910.134external icon ). HCP should be medically cleared and fit-tested if using respirators with tight-fitting facepieces (e.g., a NIOSH-approved N95 respirator) and trained in the proper use of respirators, safe removal and disposal, and medical contraindications to respirator use.

NIOSH information about respirators

OSHA Respiratory Protection eTooexternal icon

Strategies for Optimizing the Supply of N-95 Respirators

Filtering Facepiece Respirators (FFR) including N95 Respirators

NIOSH-approved N95 respirators list.

PAPRs have a battery-powered blower that pulls air through attached filters, canisters, or cartridges. They provide protection against gases, vapors, or particles, when equipped with the appropriate cartridge, canister, or filter.

Loose-fitting PAPRs do not require fit testing and can be used with facial hair.

A list of NIOSH-approved PAPRs is located on the NIOSH Certified Equipment List.

Information about Facemasks:

If worn properly, a facemask helps block respiratory secretions produced by the wearer from contaminating other persons and surfaces (often called source control).

Facemasks are cleared by the U.S. Food and Drug Administration (FDA) for use as medical devices. Facemasks should be used once and then thrown away in the trash.

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cdc guidelines infection control ncov 2019

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infection control novel coronavirus china

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persons under investigation novel coronavirus

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This interim guidance has been updated based on currently available information about COVID-19 and the current situation in the United States, which includes reports of cases of community transmission, infections identified in healthcare personnel (HCP), and shortages of facemasks, N95 filtering facepiece respirators (FFRs) (commonly known as N95 respirators), and gowns.

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LPCH Management of Newborns Born to COVID+ moms

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LPCH Management of Newborns Born to COVID+ moms

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The family will be offered two options:

1) Separate the infant from the mom.

Feeding:  provide expressed milk, banked breast milk or formula.

NO contact with mother unless her COVID returns negative.

Support person can stay with baby or mom

Bathe baby soon after delivery

2) Baby stays in mom’s room.

Baby is kept 6 feet away from mom in an isolette.

Mom to wear mask and perform hand hygiene before feeding baby.

Support person must be healthy and wear full PPE to care for baby.

Bathe baby soon after delivery

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If mom is COVID-19+, throat/NP swab testing performed at 24 and 48 hours is recommended for the newborn.  If both swabs are negative and the baby is asymptomatic, isolation precautions can be discontinued on the baby.  However, risk of exposure exists if the baby is in contact with an infected mom.   Additionally, many babies will be discharged before a second swab can be performed.

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Currently AAP recommends performing  procedures (i.e. circumcisions and tongue tie releases) on all well newborns before leaving the hospital if clinically indicated.

At LPCH, PUI babies are not allowed in nursery therefore circumcision cannot be performed before discharge.

PAMF Urology is unable to perform outpatient circumcisions at this time.

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AAP Report on Management of Infants Born to Moms with COVID-19

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AAP Report on Management of Infants Born to Moms with COVID-19

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Transmission through breast milk has not been documented but the data is limited.  CDC recommends feeding the baby expressed milk rather than direct breastfeeding.  Precautions should be taken when pumping to ensure the pump parts are clean and good hand washing.

Hand hygiene before pumping

After each pumping session, all parts that come into contact with breast milk should be thoroughly washed and the entire pump should be appropriately disinfected per the manufacturer’s instructions.

This expressed breast milk should be fed to the newborn by a healthy caregiver.

If a mother and newborn do room-in and the mother wishes to feed at the breast, she should put on a facemask and practice hand hygiene before each feeding.

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Breastfeeding and Pregnancy FAQ’s from CDC

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Breastfeeding and Pregnancy FAQ’s from CDC

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Centers for Disease Control and Prevention

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COVID-19 and pregnancy

Based on what we know at this time, pregnant people are at an increased risk for severe illness from COVID-19 and death, compared to non-pregnant people. Additionally, pregnant people with COVID-19 might be at increased risk for other adverse outcomes, such as preterm birth (delivering the baby earlier than 37 weeks).

Reducing your risk of getting COVID-19
It is especially important for pregnant people, and those who live with them, to protect themselves from getting COVID-19.
There is no way to have zero risk of infection, so it is important to know how to be as safe as possible. In general, the more people you are around, the closer you interact with them, and the longer that interaction, the higher your risk of getting and spreading COVID-19. Consider the level of risk when deciding whether or not to go out or interact with people who do not live with you. If you do go out, ensure you and the people who live with you are taking steps to protect themselves.

The best way to protect yourself and to help reduce the spread of COVID-19 is to:

Limit interactions with people who might have been exposed to or who might be infected with COVID-19, including people within your household, as much as possible.

Take steps to prevent getting COVID-19 when you do interact with others.

Wear a mask, especially when you cannot keep distance from other people. Avoid others who are not wearing masks or ask others around you to wear a mask.

Stay at least 6 feet away from others outside your household.

Wash your hands with soap and water for at least 20 seconds. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.

Avoid activities where taking these steps might be difficult.

If you are sick or think you were exposed to COVID-19

If you have symptoms of COVID-19, get in touch with your healthcare provider within 24 hours, and follow steps for when you feel sick. You can use CDC's self-checker to help you make decisions.

If you or someone you know has COVID-19 emergency warning signs (for example, trouble breathing, persistent chest pain, new confusion, inability to wake or stay awake, or bluish lips or face), seek emergency care immediately. Call 911.

Staying healthy during your pregnancy

Keep all of your healthcare appointments during and after pregnancy. Visit your healthcare provider for all recommended appointments. If you're concerned about going to your appointments because of COVID-19, ask your healthcare provider what steps they are taking to separate healthy patients from those who might be sick. If you need help finding a healthcare provider, contact your nearest hospital clinic, community health centerexternal icon or health department.

Talk to your healthcare provider about how to stay healthy and take care of yourself and your baby.

Ask questions you have about the best place to deliver your baby. Delivering your baby is always safest under the care of trained healthcare professionals.

Get recommended vaccines. Getting the recommended vaccines during pregnancy can help protect you and your baby.

Get vaccinated against influenza (flu). Others living in your household should also get vaccinated to protect themselves and you.

Get the whooping cough (Tdap) vaccine during pregnancy to protect your baby against whooping cough, which can have similar symptoms to COVID-19.

Keep at least a 30-day supply of prescription and non-prescription medicines. Talk to a healthcare provider, insurer, or pharmacist about getting an extra supply (for example, more than 30 days) of prescription medicines, if possible, to reduce your trips to the pharmacy.

Call your healthcare provider if you have any concerns about your pregnancy or if you get sick and think that you may have COVID-19. Call if you think you are experiencing depression during or after pregnancy.

Do not delay getting emergency care because of COVID-19. Emergency departments have steps in place to protect you from getting COVID-19 if you need care. If you need emergency help, call 911 right away. Tell them that you are pregnant and are having an emergency. If someone else is driving, call while you are on the way. If you need to drive yourself to the emergency department, call before you start driving.​

Caring for newborns when the mother has COVID-19

While much is still unknown about the risks of COVID-19 to newborns born to mothers with COVID-19, we do know that:

COVID-19 is uncommon in newborns born to mothers who had COVID-19 during pregnancy.

Some newborns have tested positive for COVID-19 shortly after birth. It is unknown if these newborns got the virus before, during, or after birth.

Most newborns who tested positive for COVID-19 had mild or no symptoms and recovered. However, there are a few reports of newborns with severe COVID-19 illness.

Caring for your newborn in the hospital if you are diagnosed with or test positive for COVID-19.

Current evidence suggests that the risk of a newborn getting COVID-19 from their mother is low, especially when the mother takes steps (such as wearing a mask and her washing hands) to prevent spread before and during care of the newborn.

Decide if your newborn is rooming-in with you in the hospital.

Discuss with your healthcare provider the risks and benefits of having your newborn stay in the same room with you. Having your newborn stay in the room with you has the benefit of facilitating breastfeeding and mother-newborn bonding. Start this conversation before the baby is born if possible.

Take precautions if your newborn is rooming-in with you in the hospital.

If you are in isolation for COVID-19 and are sharing a room with your newborn, take the following steps to reduce the risk of spreading the virus to your newborn:

Wash your hands with soap and water for at least 20 seconds before holding or caring for your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.

Wear a mask when within 6 feet of your newborn.

Keep your newborn more than 6 feet away from you as much as possible.

Discuss with your healthcare provider ways to protect your newborn, such as using a physical barrier (for example, placing the newborn in an incubator) while in the hospital.

Once your isolation period has ended, you should still wash your hands before caring for your newborn, but you do not need to take the other precautions. You most likely will not pass the virus to your newborn or any other close contacts after your isolation period has ended.

If you had symptoms, your isolation period ends after:

10 days since symptoms first appeared, and

24 hours with no fever, without fever-reducing medications, and

Other symptoms of COVID-19 are improving.

If you never had symptoms, your isolation period ends after
10 days have passed since the date of your positive COVID-19 test.

Caring for your newborn at home if you are diagnosed with or test positive for COVID-19.

If you are in isolation for COVID-19, take the following precautions until your isolation period has ended:

Stay home to separate yourself from others outside your home.

Isolate (stay away) from other household members who are not infected, and wear a mask in shared spaces.

Have a healthy caregiver who is not at increased risk for severe illness provide care for your newborn.

Caregivers should wash their hands for at least 20 seconds before touching your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.

If the caregiver is living in the same home or has been in close contact with you, they might have been exposed. They should wear a mask when they are within 6 feet of your newborn for the entire time you are in isolation, and during their own quarantine after you complete your

If a healthy caregiver is not available, you can care for your newborn if you are well enough.

Wash your hands with soap and water for at least 20 seconds before touching for your newborn. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.

Wear a mask when within 6 feet of your newborn and other people during your entire isolation period. The mask helps prevent you from spreading the virus to others.

Others in your household, and caregivers who have COVID-19, should isolate and avoid caring for the newborn as much as possible. If they have to care for the newborn, they should follow hand washing and mask recommendations above.

Once your isolation period has ended, you should still wash your hands before caring for your newborn, but you don't need to take the other precautions. You most likely won't pass the virus to your newborn or any other close contacts after your isolation period has ended.

If you had symptoms, your isolation period ends after:

10 days since symptoms first appeared, and

24 hours with no fever without fever-reducing medications, and

Other symptoms of COVID-19 are improving

If you never had symptoms, your isolation period ends after
10 days have passed since the date of your positive COVID-19 test

Breastfeeding and COVID-19

Current evidence suggests that breast milk is not likely to spread the virus to babies.

You, along with your family and healthcare providers, should decide whether and how to start or continue breastfeeding. Breast milk provides protection against many illnesses and is the best source of nutrition for most babies.

Helpful tips for starting or restarting breastfeeding

You may find it harder to start or continue breastfeeding if you are not sharing a room with your newborn in the hospital. Here are some helpful tips:

Frequent hand expression or pumping will help you establish and build milk supply if you are separated from your newborn in the hospital.

Pump or feed every 2-3 hours (at least 8-10 times in 24 hours, including at night), especially in the first few days. This helps the breasts to produce milk and prevents blocked milk ducts and breast infections.

If you are unable to start producing milk in the hospital after birth, or if you have to temporarily stop breastfeeding during your COVID-19 illness because you do not feel well enough, get help from a lactation support provider. Learn more about restarting breastfeeding (also called relactation).

You should always wash your hands with soap and water for 20 seconds before breastfeeding or expressing breast milk, even if you don't have COVID-19. If soap and water are not available, use a hand sanitizer with at least 60% alcohol.

If you have COVID-19 and choose to breastfeed

Wash your hands before breastfeeding

Wear a mask while breastfeeding and whenever you are within 6 feet of your baby.

If you have COVID-19 and choose to express breast milk

Use your own breast pump (one not shared with anyone else), if possible.

Wear a mask during expression.

Wash your hands with soap and water for at least 20 seconds before touching any pump or bottle parts, and before expressing breast milk.

Follow recommendations for proper pump cleaning after each use. Clean all parts of the pump that come into contact with breast milk.

Consider having a healthy caregiver who does not have COVID-19, is not at increased risk for severe illness from COVID-19, and is living in the same home feed the expressed breast milk to the baby. If the caregiver is living in the same home or has been in close contact with you, they might have been exposed. Any caregiver feeding the baby should wear a mask when caring for the baby for the entire time you are in isolation and during their own quarantine period after you complete isolation.

Keeping your baby safe and healthy

Do not put a face shield or mask on your baby

A face shield could increase the risk of sudden infant death syndrome (SIDS) or accidental suffocation and strangulation. Babies move around, and their movement can cause the plastic face shield to block their nose and mouth, or cause the strap to strangle them.

CDC does not recommend use of face shields as a substitute for masks.

Limit visitors to see your new baby

The birth of a new baby is a significant life event that typically brings families together to celebrate and support the baby and new mother. However, before allowing or inviting visitors into your home or near your baby, consider the risk of COVID-19 to yourself, your baby, people who live with you, and visitors (e.g., grandparents or older adults and other people at increased risk of severe illness from COVID-19).

Bringing people who do not live with you into your home can increase the risk of spreading COVID-19.

Some people without symptoms can spread the virus.

Limit in-person gatherings and consider other options, like celebrating virtually, for people who want to see your new baby. If you do plan to have in-person visits, ask guests to stay home if they are sick and ask them to stay 6 feet away from you and your baby, wear a mask, and wash their hands when visiting your home. For more information, please see considerations for attending or hosting a small gathering.

Keep distance between your baby and people who do not live in your household or who are sick

Consider the risks of spreading COVID-19 to you and your baby before you decide whether to go out for activities other than healthcare visits or child care.

Keep 6 feet of distance between your baby and people who do not live in your household.

Ask your child care program about the plans they have in place to protect your baby, family, and their staff from COVID-19.

Know possible signs and symptoms of COVID-19 infection among babies

Most babies who test positive for COVID-19 have mild or no symptoms.

Severe illness in babies has been reported but appears to be rare. Babies with underlying medical conditions and babies born premature (earlier than 37 weeks) might be at higher risk of severe illness from COVID-19.

Reported signs among newborns with COVID-19 include fever, lethargy (being overly tired or inactive), runny nose, cough, vomiting, diarrhea, poor feeding and increased work of breathing or shallow breathing.

If your baby develops symptoms or you think your baby may have been exposed to COVID-19:

Get in touch with your baby's healthcare provider within 24 hours and follow steps for caring for children with COVID-19.

If your baby has COVID-19 emergency warning signs (such as trouble breathing), seek emergency care immediately. Call 911.

Bring your baby for newborn visits

Ideally, newborn visits are done in person so that your baby's healthcare provider can:

Check how you and your baby are doing overall.

Check your baby's growth and feeding.

Check your baby for jaundice (yellow color in the skin or eyes).

Make sure your baby's newborn screening tests were done (including a bloodspot, hearing test, and a test for critical congenital heart defects) and do any repeat or follow-up testing, if necessary.

Call and notify your baby's healthcare provider before visiting, if you or your baby have COVID-19.

Ensure safe sleep for your baby

During the COVID-19 pandemic, parents may be extra stressed and tired. Making sure parents and babies get enough quality sleep, is very important. Take steps to reduce the risk of sudden infant death syndrome (SIDS) and other sleep-related deaths, by doing the following:

Place your baby on his or her back for all sleep times - naps and at night.

Use a firm, flat sleep surface, such as a mattress in a crib covered by a fitted sheet.

Have the baby share your room but not your bed. Your baby shouldn't sleep on an adult bed, cot, air mattress, couch, or chair, whether he or she is sleeping alone, with you, or with anyone else.

Keep soft bedding, such as blankets, pillows, bumper pads, and soft toys, out of your baby's sleep area.

Do not cover your baby's head or allow your baby to get too hot. Signs your baby may be getting too hot include sweating or his or her chest feeling hot.

Do not smoke or allow anyone to smoke around your baby.

Ensure your own social, emotional, and mental health

Call your healthcare provider if you think you are experiencing depression after pregnancy.

Learn about ways to cope with stress and tips for caring for yourself during the COVID-19 pandemic.

For more information see

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Based on what we know at this time, pregnant people are at an increased risk for severe illness from COVID-19 and death , compared to non-pregnant people. Additionally, pregnant people with COVID-19 might be at increased risk for other adverse outcomes, such as preterm birth (delivering the baby earlier than 37 weeks).

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Many families ask how to keep their babies and families healthy during this pandemic.  It is important they understand all the steps that have been taken at PAMF to keep patients and staff healthy like separating sick patients into a completely different site, cancelling non-essential patient visits to decrease traffic in our clinics, screening everyone who enters the building for symptoms, and wearing masks during patient encounters.  Hopefully families understand we have taken these steps to protect both our patients and staff.

Advice for families for home:

Good handwashing for all family members

Shelter in Place - stay home except for essential errands like doctor's appointments or groceries.

No visitors including grandparents.  This is very important to prevent the spread of COVID-19 since people can shed virus before they realize they are sick.

Provide breast milk for the baby if possible.  It has antibodies which helps prevent infection in the newborn.

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The family should continue to follow practices to minimize risk of exposure for the baby:

Baby at least 6 feet away from mom except during breastfeeding

Mom wears a mask if breastfeeding and practices breast care/hand hygiene

Hand hygiene for all household members

Clean high contact surfaces in the home

Uninfected individuals >60 years of age and those with comorbid conditions should not provide care if possible

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Centers for Disease Control and Prevention

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If you are sick with COVID-19 or suspect you are infected with the virus that causes COVID-19, you should take steps to help prevent the disease from spreading to people in your home and community.

If you think you have been exposed to COVID-19 and develop a fever and symptoms, such as cough or difficulty breathing, call your healthcare provider for medical advice.

Page last reviewed:

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If you are sick with COVID-19 or suspect you are infected with the virus that causes COVID-19, you should take steps to help prevent the disease from spreading to people in your home and community. If you think you have been exposed to COVID-19 and develop a fever and symptoms, such as cough or difficulty breathing, call your healthcare provider for medical advice.

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Since these babies are considered PUI’s, scheduling the first newborn visits will require care to ensure staff and patients are not compromised.

For all PUI babies, notify the PCP and site clinic physician T1 when scheduling the baby.

Flag the face sheet when registering the baby so the clinic staff are aware special scheduling protocols are needed.

ALAMEDA REGION:
TBD

CAMINO REGION:

Schedule the babies in the MV Respiratory Clinic.

Notify PCP and site T1 physician lead

MILLS PENINSULA REGION
TBD

PALO ALTO REGION:

Palo Alto site:

Baby will be seen in the isolation room.

Notify the PCP and the Tier 1 (Harry Dennis) about the need for the appointment with as much advance warning as possible.

Do not book COVID+ families with Drs. Dennis, Heneghan or DeHovitz.

Los Altos site:

Do not have an isolation room.

Baby to be seen at PA site until cleared from isolation.  Follow PA process.

San Carlos site:

Follow the PA Process

SANTA CRUZ REGION:
TBD

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If mom is COVID-19, an asymptomatic baby is considered to be a PUI until the following criteria are met:

1. Test-based strategy.

Two negative test results from at least two consecutive nasopharyngeal swab specimens collected ≥24 hours apart

1. Non-test-based strategy.

14 days of quarantine at home

For Symptomatic or COVID+ Patients, the Non-test-based strategy:

At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,

At least 7 days have passed since symptoms first appeared

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Per CDC recommendations, all infants born to COVID+ mothers will have a throat/NP swab for COVID-19 performed at 24 and 48 hours of life.  If both are negative and the baby is asymptomatic, the baby is not considered to be infected.  However, many babies born by vaginal deliveries will be discharged prior to the second swab being performed.  Additionally, the infant is still potentially exposed if staying in the same household as the parents.  For outpatient care and infection control, we should consider these asymptomatic babies as PUI's until 14 days after birth.

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CDC Guidelines for Discontinuing Home Isolation

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CDC Guidelines for Discontinuing Home Isolation

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Centers for Disease Control and Prevention

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CDC guidance for COVID-19 may be adapted by state and local health departments to respond to rapidly changing local circumstances.

Who this is for: Healthcare personnel managing patients with coronavirus disease 2019 (COVID-19).

What this is for: To help prevent the spread of the virus that causes COVID-19 in healthcare facilities.

How to use: Reference to guide healthcare regarding discontinuing transmission-based precautions and discharging hospitalized patients with COVID-19.

Guidance as of March 23, 2020

Clarified that patients with COVID-19 can be discharged from a healthcare facility whenever clinically indicated. Meeting criteria for discontinuation of Transmission-Based Precautions is not a prerequisite for discharge.

Updated guidance for a test-based strategy: The recommendation to collect both NP and OP swabs at each sampling has been changed so that only one swab, preferably an NP, is necessary at each sampling.

Added guidance for:

Discontinuation of transmission-based precautions without testing.

Discontinuation of empiric transmission-based precautions for patients suspected of having COVID-19.

When using a testing-based strategy for discontinuation of transmission-based precautions is preferred.

This guidance is based on available information about COVID-19 and subject to change as additional information becomes available.

For discontinuation of home isolation for COVID-19, see ( Interim Guidance for Discontinuation of In-Home Isolation for Patients with COVID-19).

For return-to-work criteria for healthcare personnel with COVID-19, see ( Interim Guidance for Discontinuation of In-Home Isolation for Patients with COVID-19).

The decision to discontinue Transmission-Based Precautions should be made using a test-based strategy or a non-test-based strategy (i.e., time-since-illness-onset and time-since-recovery strategy). Meeting criteria for discontinuation of Transmission-Based Precautions is not a prerequisite for discharge.

1. Test-based strategy.

2. Non-test-based strategy.

At least 3 days (72 hours) have passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath); and,

At least 7 days have passed since symptoms first appeared

When a Testing-Based Strategy is Preferred
Hospitalized patients may have longer periods of SARS-CoV-2 RNA detection compared to patients with mild or moderate disease. Severely immunocompromised patients (e.g., medical treatment with immunosuppressive drugs, bone marrow or solid organ transplant recipients, inherited immunodeficiency, poorly controlled HIV) may also have longer periods of SARS-CoV-2 RNA detection and prolonged shedding of infectious recovery. These groups may be contagious for longer than others. In addition, placing a patient in a setting where they will have close contact with individuals at risk for severe disease warrants a conservative approach.

Hence, a test-based strategy is preferred for discontinuation of transmission-based precautions for patients who are

Hospitalized or

Severely immunocompromised or

Being transferred to a long-term care or assisted living facility

If testing is not readily available, facilities should use the non-test-based strategy for discontinuation of Transmission-Based Precautions or extend the period of isolation beyond the non-test-based-strategy duration, on a case by case basis in consultation with local and state public health authorities.

The decision to discontinue empiric Transmission-Based Precautions by excluding the diagnosis of COVID-19 for a suspected COVID-19 patient can be made based upon having negative results from at least one FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2.

If a higher level of clinical suspicion for COVID-19 exists, consider maintaining Transmission-Based Precautions and performing a second test for SARS-CoV-2.

If a patient suspected of having COVID-19 is never tested, the decision to discontinue Transmission-Based Precautions can be made based upon using the non-test-based strategy described above.

Ultimately, clinical judgement and suspicion of SARS-CoV-2 infection determines whether to continue or discontinue empiric Transmission-Based Precautions.

Patients can be discharged from the healthcare facility whenever clinically indicated.

If discharged to home:

If discharged to a long-term care or assisted living facility, AND

Transmission-Based Precautions are still required, they should go to a facility with an ability to adhere to infection prevention and control recommendations for the care of COVID-19 patients. Preferably, the patient would be placed in a location designated to care for COVID-19 residents.

Transmission-Based Precautions have been discontinued, but the patient has persistent symptoms from COVID-19 (e.g., persistent cough), they should be placed in a single room, be restricted to their room, and wear a facemask during care activities until all symptoms are completely resolved or until 14 days after illness onset, whichever is longer.

Transmission-Based Precautions have been discontinued and the patient's symptoms have resolved, they do not require further restrictions, based upon their history of COVID-19.

References

Al-Abdely HM, Midgley CM, Alkhamis AM, et al. Middle East respiratory syndrome coronavirus infection dynamics and antibody responses among clinically diverse patients, Saudi Arabia. Emerg Infect Dis. 2019 Apr;25(4):753-66.

Al-Abdely HM, Midgley CM, Alkhamis AM, et al. Infectious MERS-CoV isolated from a mildly ill patient, Saudi Arabia. Open Forum Infect Dis. 2018 May 15;5(6):ofy111.

Chan JF, Yuan S, Kok KH, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020 Jan 24; 395(10223);514-23. doi: 10.1016/S0140-6736(20)30154-9.

Chan KH, Poon LL, Cheng VC, et al. Detection of SARS coronavirus in patients with suspected SARS. Emerg Infect Dis. 2004 Feb;10(2):294-9.

Cheng PK, Wong DA, Tong LK, et al. Viral shedding patterns of coronavirus in patients with probable severe acute respiratory syndrome. Lancet. 2004 May 22;363(9422):1699-700.

Corman VM, Albarrak AM, Omrani AS, et al. Viral shedding and antibody response in 37 patients with Middle East respiratory syndrome coronavirus infection. Clin Infect Dis. 2016 Feb 15;62(4):477-83.

Holshue ML, DeBolt C, Lindquist S, et al. First case of 2019 novel coronavirus in the United States. N Engl J Med. 2020 Jan 31. doi: 10.1056/NEJMoa2001191. [Epub ahead of print]

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020 Jan 24;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5

Hung IF, Cheng VC, Wu AK, et al. Viral loads in clinical specimens and SARS manifestations. Emerg Infect Dis. 2004 Sep;10(9):1550-7.

Liu W, Tang F, Fontanet A, et al. Long-term SARS coronavirus excretion from patient cohort, China. Emerg Infect Dis. 2004 Oct;10(10):1841-3.

Memish ZA, Assiri AM, Al-Tawfiq JA. Middle East respiratory syndrome coronavirus (MERS-CoV) viral shedding in the respiratory tract: an observational analysis with infection control implications. Int J Infect Dis. 2014 Dec;29:307-8.

Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020 Jan 24. doi: 10.1056/NEJMoa2001017 [Epub ahead of print]

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CDC guidance for COVID-19 may be adapted by state and local health departments to respond to rapidly changing local circumstances. Who this is for: Healthcare personnel managing patients with coronavirus disease 2019 (COVID-19). What this is for: To help prevent the spread of the virus that causes COVID-19 in healthcare facilities.

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California Perinatal Quality Care Collaborative and California Maternal Quality Care Collaborative are quality improvement organizations comprising over 90% of California's maternity and neonatal intensive care units. The safety and well-being of the healthcare workers, patients, and communities of California hospitals is our top priority. We have aggregated the following resources about COVID-19 in maternal and infant health to help hospitals and healthcare workers respond to the situation as it unfolds.

As this is a rapidly evolving public health pandemic, we encourage you to take into consideration the most recently available local health department and CDC guidance when developing your internal protocols. We have dated all of the links and organized them with the latest news first to support your information gathering. We will be updating this webpage frequently as new information becomes available. All the information on this website is published in good faith and for general information purposes only. From our website, you can visit other websites by following hyperlinks to external sites. While we strive to provide only quality links to useful and ethical websites, we have no control over the content of these sites.

Last Updated: Apr 7, 2020 @ 9:28 pm PDT

CPQCC/ CMQCC Webinars

Due to the rapidly changing guidelines around COVID-19, webinar recordings will be taken down after two weeks.

REGISTER HERE: Preparing your Perinatal Units to Respond to COVID-19: Transitions of Care and Neonatal Nutrition. (UC Davis Medical Center, 4/10/20 at 12:00 PM PST)

Preparing your Perinatal Units to Respond to COVID-19: Practical Recommendations from a Frontline Hospital. (Lucile Packard Children's Hospital Stanford, 3/24/20) | Webinar recording | Slide Set

Sample Hospital Resources

Organizational Recommendations

Additional Resources

Patient Resources

Data Registries

For questions or comments about any of the resources shared on this page please email info@CAperinatalprograms.org.

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California Perinatal Quality Care Collaborative and California Maternal Quality Care Collaborative are quality improvement organizations comprising over 90% of California's maternity and neonatal intensive care units. The safety and well-being of the healthcare workers, patients, and communities of California hospitals is our top priority.

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Resource from Hospitalist Wellness Subcommittee

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Resource from Hospitalist Wellness Subcommittee

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Updated April 7, 2020

Like many of you, we are closely monitoring the outbreak of novel coronavirus (COVID-19). We understand that news of the virus's spread can be alarming, and we want to assure you that our top priority is the safety of our patients, our employees, and our community.

Stanford Medicine continues to follow all protocols recommended by the Centers for Disease Control and Prevention (CDC) to keep our community safe and reduce the risk of exposure to COVID-19. And we have access to the best available information to update our institutional guidelines and processes, as needed, to respond to this evolving situation.

Stanford Children's Health welcomes generous donations of unused and unopened supplies of Personal Protective Equipment (PPE). Our health care workers are on the front lines during the COVID-19 outbreak, and our number one priority is their safety and that of our patients.

How you can help >

Below is an FAQ to help keep you informed about COVID-19, developments at Stanford Medicine, and steps that you can take to protect yourself.

About COVID-19
Q: What is a novel coronavirus?
A: A novel coronavirus is a new coronavirus that has not been previously identified. The virus causing coronavirus disease 2019 (COVID-19), is not the same as the coronaviruses that commonly circulate among humans and cause mild illness, like the common cold.

A diagnosis with coronavirus 229E, NL63, OC43, or HKU1 is not the same as a COVID-19 diagnosis. Patients with COVID-19 will be evaluated and cared for differently than patients with common coronavirus diagnosis.

How it spreads
Q: How does the virus spread?
A: This virus was first detected in Wuhan City, Hubei Province, China. The first infections were linked to a live animal market, but the virus is now spreading from person-to-person. It's important to note that person-to-person spread can happen on a continuum. Some viruses are highly contagious (like measles), while other viruses are less so.

The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (" community spread ") in some affected geographic areas. Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.
Q: Can someone who has had COVID-19 spread the illness to others?
A: The virus that causes COVID-19 is spreading from person-to-person. Someone who is actively sick with COVID-19 can spread the illness to others. That is why CDC recommends that these patients be isolated either in the hospital or at home (depending on how sick they are) until they are better and no longer pose a risk of infecting others.

How long someone is actively sick can vary so the decision on when to release someone from isolation is made on a case-by-case basis in consultation with doctors, infection prevention and control experts, and public health officials and involves considering specifics of each situation including disease severity, illness signs and symptoms, and results of laboratory testing for that patient.

Current CDC guidance for when it is OK to release someone from isolation is made on a case-by-case basis and includes meeting all of the following requirements:

The patient is free from fever without the use of fever-reducing medications.

The patient is no longer showing symptoms, including cough.

The patient has tested negative on at least two consecutive respiratory specimens collected at least 24 hours apart.

Someone who has been released from isolation is not considered to pose a risk of infection to others.
Q: Can someone who has been quarantined for COVID-19 spread the illness to others?
A: Quarantine means separating a person or group of people who have been exposed to a contagious disease but have not developed illness (symptoms) from others who have not been exposed, in order to prevent the possible spread of that disease. Quarantine is usually established for the incubation period of the communicable disease, which is the span of time during which people have developed illness after exposure.

For COVID-19, the period of quarantine is 14 days from the last date of exposure, because 14 days is the longest incubation period seen for similar coronaviruses. Someone who has been released from COVID-19 quarantine is not considered a risk for spreading the virus to others because they have not developed illness during the incubation period.

How to protect yourself
Q: Am I at risk for COVID-19 in the United States?
A: This is a rapidly evolving situation and the risk assessment may change daily. The latest updates are available on CDC's Coronavirus Disease 2019 (COVID-19) website.
Q: How can I help protect myself?
A: Visit the COVID-19 Prevention and Treatment page to learn about how to protect yourself from respiratory illnesses, like COVID-19.

CDC always recommends everyday preventive actions to help prevent the spread of respiratory diseases, including:

Avoid close contact with people who are sick.

Stay home when you are sick.

Put distance between yourself and other people. Keep about 6 feet between yourself and others.

Remember that some people without symptoms may be able to spread virus.

Avoid touching your eyes, nose and mouth with unwashed hands.

Stay home when you are sick.

Cover your cough or sneeze with a tissue, then throw the tissue in the trash.

Clean and disinfect frequently touched objects and surfaces using a regular household cleaning spray or wipe.

CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies) especially in areas of significant community-based transmission.

Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.

The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.

For information about handwashing, see CDC's Handwashing website.

For information specific to health care, see CDC's Hand Hygiene in Health Care Settings.

These are everyday habits that can help prevent the spread of several viruses.
Q: What should I do if I had close contact with someone who has COVID-19?
A: There is information for people who have had close contact with a person confirmed to have, or being evaluated for, COVID-19 available online.

Symptoms and testing
Q: What are the symptoms and complications that COVID-19 can cause?
A: Current symptoms reported for patients with COVID-19 have included mild to severe respiratory illness with fever, cough, and difficulty breathing.
Q: Should I be tested for COVID-19?
A: If you develop symptoms such as fever, cough, and/or difficulty breathing, and have been in close contact with a person known to have COVID-19 or have recently traveled from an area with ongoing spread of COVID-19, stay home and call your healthcare provider.

Older patients and individuals who have severe underlying medical conditions or are immunocompromised should contact their healthcare provider early, even if their illness is mild.

If you have severe symptoms, such as persistent pain or pressure in the chest, new confusion or inability to arouse, or bluish lips of face, contact your healthcare provider or emergency room and seek care immediately. Your doctor will determine if you have signs and symptoms of COVID-19 and whether you should be tested.
Q: Can a person test negative and later test positive for COVID-19?
A: Using the CDC-developed diagnostic test, a negative result means that the virus that causes COVID-19 was not found in the person's sample. In the early stages of infection, it is possible the virus will not be detected.

For COVID-19, a negative test result for a sample collected while a person has symptoms likely means that the COVID-19 virus is not causing their current illness.

Expectant Mothers
Q: Are pregnant women more susceptible to infection, or at increased risk with COVID-19?
A: We do not currently know if pregnant women have a greater chance of getting sick from COVID-19 than the general public nor whether they are more likely to have serious illness as a result. Pregnant women experience changes in their bodies that may increase their risk of some infections. With viruses from the same family as COVID-19, and other viral respiratory infections, such as influenza, women have had a higher risk of developing severe illness. It is always important for pregnant women to protect themselves from illnesses.
Q: How can pregnant women protect themselves from getting COVID-19?
A: Pregnant women should do the same things as the general public to avoid infection. You can help stop the spread of COVID-19 by taking these actions:

Cover your cough (using your elbow is a good technique)

Avoid people who are sick

Clean your hands often using soap and water or alcohol-based hand sanitizer

Q: Can COVID-19 be passed from a pregnant woman to the fetus or newborn?
You can find additional information on preventing COVID-19 disease at CDC's ( Prevention for 2019 Novel Coronavirus).
Q: If a pregnant woman has COVID-19 during pregnancy, will it hurt the baby?
A: We still do not know if a pregnant woman with COVID-19 can pass the virus that causes COVID-19 to her fetus or baby during pregnancy or delivery. No infants born to mothers with COVID-19 have tested positive for the COVID-19 virus. In these cases, which are a small number, the virus was not found in samples of amniotic fluid or breastmilk.
Q: If a laboring mother has a suspected or confirmed case of COVID-19, how can she prevent from passing it to her newborn baby?
A: We do not know at this time what if any risk is posed to infants of a pregnant woman who has COVID-19. There have been a small number of reported problems with pregnancy or delivery (e.g. preterm birth) in babies born to mothers who tested positive for COVID-19 during their pregnancy. However, it is not clear that these outcomes were related to maternal infection.
Q: What are some guidelines on breastfeeding for mothers with confirmed COVID-19 or under investigation for COVID-19?
A: To reduce the risk of transmission of the virus that causes COVID-19 from the mother to the newborn, the CDC recommends temporarily separating (e.g., separate rooms) the mother who has confirmed COVID-19 or is a PUI from her baby until the mother's transmission-based precautions are discontinued, as described in the Interim Considerations for Disposition of Hospitalized Patients with COVID-19.

A: Breast milk is the best source of nutrition for most infants. However, much is unknown about COVID-19. Whether and how to start or continue breastfeeding should be determined by the mother in coordination with her family and healthcare providers.

A mother with confirmed COVID-19 or who is a symptomatic PUI should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast.
Q: Can the transmission of COVID-19 be spread through breast milk?
If expressing breast milk with a manual or electric breast pump, the mother should wash her hands before touching any pump or bottle parts and follow recommendations for proper pump cleaning after each use. If possible, consider having someone who is well feed the expressed breast milk to the infant.

A: Much is unknown about how COVID-19 is spread. Person-to-person spread is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza (flu) and other respiratory pathogens spread. In limited studies on women with COVID-19 and another coronavirus infection, Severe Acute Respiratory Syndrome (SARS-CoV), the virus has not been detected in breast milk; however we do not know whether mothers with COVID-19 can transmit the virus via breast milk.

An interim guidance on breastfeeding for a mother confirmed or under investigation for COVID- can be found on the CDC website.
Q: What is the risk of my child becoming sick with COVID-19? Q: What about children who have preexisting conditions and/or additional health risks?
COVID-19 and children

A: Based on available evidence, children do not appear to be at higher risk for COVID-19 than adults. While some children and infants have been sick with COVID-19, adults make up most of the known cases to date. You can learn more about who is most at risk for health problems if they have COVID-19 infection on CDC's current Risk Assessment page.

A: At this time, in children, we are not yet sure if specific underlying medical conditions are associated with worsened disease. In older adults, certain preexisting health problems are associated with more severe cases of COVID-19.
Q: How can I protect my child from COVID-19 infection?
At present, Stanford Children's Health care teams are advising pediatric patients with existing medical conditions to follow the same guidelines that are in place for all children, including social distancing and thorough handwashing.

Parents should contact their pediatrician if their child shows signs of COVID-19, and follow their doctor's directions on obtaining testing if appropriate. Parents of patients with subspecialty needs should call their subspecialty providers if their child is diagnosed with or being tested for COVID-19, so that their care team can advise them in real time.

A: You can encourage your child to help stop the spread of COVID-19 by teaching them to do the same things everyone should do to stay healthy.
Q: Are the symptoms of COVID-19 different in children than in adults? Q: Should children wear masks?

Clean hands often using soap and water or alcohol-based hand sanitizer

Avoid people who are sick (coughing and sneezing)

Clean and disinfect high-touch surfaces daily in household common areas (e.g. tables, hard-backed chairs, doorknobs, light switches, remotes, handles, desks, toilets, sinks)

Launder items including washable plush toys as appropriate in accordance with the manufacturer's instructions. If possible, launder items using the warmest appropriate water setting for the items and dry items completely. Dirty laundry from an ill person can be washed with other people's items.

You can find additional information on preventing COVID-19 at Prevention for 2019 Novel Coronavirus and at Preventing COVID-19 Spread in Communities. Additional information on how COVID-19 is spread is available at How COVID-19 Spreads.
Q: What is Stanford Children's Health doing about COVID-19?
A: No. The symptoms of COVID-19 are similar in children and adults. However, children with confirmed COVID-19 have generally presented with mild symptoms. Reported symptoms in children include cold-like symptoms, such as fever, runny nose, and cough. Vomiting and diarrhea have also been reported. It's not known yet whether some children may be at higher risk for severe illness, for example, children with underlying medical conditions and special health care needs. There is much more to be learned about how the disease impacts children.

A: The CDC recommends everyone to wear a cloth face covering in public settings. However, cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
Q: Is it safe to go to the hospital or doctor's office?
COVID-19 and Stanford

A: As soon as the CDC sent an alert about the outbreak, our Emerging Infectious Diseases subcommittee was activated. The subcommittee, along with the Infection Prevention & Control Department, relies on information from the CDC, World Health Organization, State and local County Public Health Departments to maintain the most current information and recommendations. They also provide guidelines for screening of patients and procedures for health care workers to follow should a patient require isolation, and to ensure patient and health care worker safety.

With standard protocols in place at all times and working closely with our local and national government health agencies to update protocols as necessary, Stanford Children's Health is well-prepared to care for patients with symptoms of the novel coronavirus (COVID-19).
Q: What is telehealth virtual visits?
A: Stanford Children's Health has well-established measures in place to prevent transmission of all communicable diseases, including flu and other respiratory illnesses. There are respiratory etiquette stations for persons visiting with cough, and hand sanitizer is available. Our staff is trained to screen patients for cough, fever, and recent travel when they arrive.

If you are ill, please call ahead to your health care provider's office prior to arriving.

Our hospitals and clinical locations have taken additional measures to ensure safety for all patients, visitors and staff during the COVID-19 outbreak. If you have specific questions or concerns, please do not hesitate to ask your health care provider prior to your visit.

A: Telehealth virtual visits allow patients and/or their guardians to interact and consult with their health care provider, who can review the patient's medical information for the purposes of diagnosis and treatment, go over test results, fulfill prescriptions, and provide patient education.
Q: Does Stanford Children's Health offer novel coronavirus (COVID-19) drive-thru testing and who is eligible?
Virtual visits are being used both for virtual COVID-19 evaluations and to support non-COVID-19-related health care remotely to minimize patient and family exposure and support social distancing.

To get started with telehealth, talk with your provider's office to see if you are a good candidate for virtual care.

To learn more about this service, read the latest story.

A: Drive-through novel coronavirus (COVID-19) testing is available by appointment at Stanford Health Care. Drive-through appointments for Stanford Medicine's COVID-19 test are available for patients who have been referred by their medical providers.

Drive-through COVID-19 testing service, offered from 9 a.m. to 6 p.m., 7 days a week, at Express Care's Hoover Pavilion location in Palo Alto is by appointment only.

To learn more about this service, read the latest story.

The CDC website has additional FAQs on the topics of Travel, Pregnant Women and COVID-19, and COVID-19 and animals.

This page was adapted from CDC.gov, last accessed April 7, 2020. https://www.cdc.gov/coronavirus/2019-ncov/about

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COVID-19 Novel Coronavirus - Stanford Children's Health

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Updated April 7, 2020 Like many of you, we are closely monitoring the outbreak of novel coronavirus (COVID-19). We understand that news of the virus's spread can be alarming, and we want to assure you that our top priority is the safety of our patients, our employees, and our community.