From Jack Newman, with permission.  First the CMO from Toronto, then an
earlier mail from Jack to the CMO.
Rachel Myr
Kristiansand, Norway

From: Sheela Basrur
Sent: Thursday, May 08, 2003 11:58 AM
Subject: Re: SARS and breastfeeding
Hello Dr. Newman,

I share your concerns.  Since the risk of transmission is likely highest
from respiratory secretions, breastfeeding would likely help protect the
infant from infection through that route.  Attack rates have been exceeding
low in infants & children overall, and transmission has not been known to
result from exposure to an asymptomatic person.

In my opinion, a breastfeeding woman who has "been exposed" to SARS (but may
well never get sick from it) should continue to breastfeed to protect &
promote her baby's health.  I've copied my staff for any further info (or
contrary views!) that they may have... .

All the best,
Sheela
Dr. Sheela Basrur
Medical Officer of Health
Toronto Public Health
Email:  [log in to unmask]

(From Jack Newman to Sheela Basrur and others)
Hello all,

A local Toronto hospital has put out a statement which I have not seen
personally, that women exposed to SARS should not breastfeed and should
express and throw away their milk for 14 days after exposure.  I have not
personally seen this statement, but parts of it have been read to me by at
least two people.

I cannot understand this sort of approach.  The statement mentions that
because the coronavirus has been found in bodily fluids (well, sure!), then
it might be found in breastmilk as well (even though this has not been
documented, apparently), and then goes on to say that to be on the safe
side, the above stratagem should be used (pump and dump for 14 days).
But breastmilk is not like other fluids.  It contains a wealth of
antiinfective and specifically also, anti viral factors, which will help the
baby fight off most viral infections, or diminish the severity of the
illness, if the baby does get sick.  And there is no reason to believe that
the virus of SARS is any different than 99.9% of other viruses (perhaps with
the exception of retroviruses), in that breastfeeding protects the nursling
from it.

A virus appears in the milk usually only when the mother has it in her
blood, usually only a very short period of time, and usually before she
knows she is sick.

In one situation were several people were exposed to SARS (at a funeral)
only one person got sick.  To deprive breastfeeding babies of breastfeeding
on the supposition that the virus may appear in the milk, and that this
somehow represents a danger for the breastfeeding baby seems to me an
absurdity.

If anyone has more definite information about transmission of coronaviruses
through breastmilk, I would certainly like to know.  The statement from the
hospital is too typical however.  Breastfeeding is guilty until proved
otherwise.

Jack Newman, MD, FRCPC

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