The College has collated the following advice and information for midwives about COVID-19 (novel coronavirus). The situation is continually evolving and we recommend that midwives continue to check the Ministry of Health’s website for updates: https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus
The Ministry of Health has updated its advice to health professionals in its document, Interim Advice for Health Professionals: COVID-19 – 3 March 2020. The information that is directly relevant to midwives in both community and hospital practice has been reproduced here.
Background
Coronaviruses are a large and diverse family of viruses which include some known to cause illness in animals and humans, including the common cold, severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS).
A novel coronavirus currently called SARS-CoV-2 caused a cluster of viral respiratory illness (COVID-19) in Wuhan that had not previously been detected in humans or animals.
The number of detected cases due to COVID-19 has rapidly increased in Wuhan, but elsewhere in China the increase has been slower. Individual cases have been detected in other countries, with a number of countries now reporting local transmission. A large outbreak also occurred on a cruise ship. The virus can be spread through person-to-person contact.
The clinical signs and symptoms of COVID-19 infection that have been reported range from non-specific respiratory symptoms such as fever and cough, to shortness of breath and symptoms of pneumonia and severe acute respiratory infection. Reports suggest that most cases have mild illness, with about 20 percent having more severe illness requiring hospitalisation (mainly due to pneumonia). The virus has an approximately two percent fatality rate with most of those who have died from the virus to date suffering from pre-existing health problems.
Spread of infection
The parameters below are provisional estimates based on currently available data.
Incubation period
Provisionally, the incubation period is considered to be from 1-14 days (commonly 3 to 7 days).
Mode of transmission
Transmission is considered to occur primarily through respiratory droplets and secretions. Transmission is likely to occur through virus contact with respiratory mucosa or conjunctivae, either by direct exposure or by transfer on hands from contaminated fomites. The current evidence does not support airborne transmission, except during aerosol-generating procedures which include intubation, suctioning, bronchoscopy, tracheostomy, cardiopulmonary resuscitation.
Period of communicability
Provisionally, the period of communicability is considered to commence 48 hours before onset of symptoms and continue until the case is symptom free for 48 hours
Minimum precautions to reduce the general risk of transmission of acute respiratory infections
- Avoid close contact with people suffering from any acute respiratory infection.
- Frequent hand-washing and drying (or hand sanitiser), especially after direct contact with ill people or their environment.
- Keep hands away from face (eyes, nose and mouth).
- Everyone should practice cough etiquette (maintain distance, cover coughs and sneezes with elbow, disposable tissues or clothing and wash and dry hands).
- People with acute respiratory symptoms should stay home if unwell.
- Adhere to standard infection prevention and control practices in primary health care. All patients with respiratory infection and recent overseas travel history should be provided with a surgical mask upon entry to the facility. For suspect cases of COVID-19 infection, include contact and droplet precautions, such as personal protective equipment (PPE).
- Aerosol-generating procedures[1] should be avoided in primary health care.
Infection prevention and control (IPC)
Basic hygiene measures (as outlined above) are the most important way to stop the spread of infections, including COVID-19.
In a health care setting, in addition to basic hygiene measures, standard precautions should apply for all patients.
As soon as a case of COVID-19 infection is suspected, additional precautions (droplet and contact) should be immediately implemented, with airborne precautions when aerosolized respiratory secretion are generated from procedures like intubation, suctioning, bronchoscopy, tracheostomy, cardiopulmonary resuscitation.
Special situations: Health care worker close contacts
Health care worker close contacts (ie, persons exposed while unprotected, as described in Contact tracing and management) should be advised not to undertake work in a health care setting for 14 days following last possible contact with the confirmed case. They should also be advised to remain in self-quarantine for 14 days following last contact with the case.
Exposed health care workers who are DHB employees should discuss with the DHB infection prevention and control and/or occupational health teams.
Self-quarantine of health care workers should be managed the same way as close contacts.
Management of travellers
All travellers arriving in New Zealand from Category 1 countries should be registered with Healthline, be advised of COVID-19 symptoms and self-isolate for 14 days following departure from the Category 1[2] country.
Guidance on self-isolation can be found at health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-novel-coronavirus-self-isolation
People who are close contacts of confirmed COVID-19 cases should be notified to the local public health unit, receive daily monitoring of symptoms, self-isolate for 14 days following last contact with a confirmed case and be provided with information on what they need to do if they develop symptoms.
Travellers arriving in New Zealand from Category 2[3] countries should be advised of COVID-19 symptoms and be provided with information on what they need to do if they develop symptoms.
People with respiratory illness coming from any countries or areas of concern (Category 1 and Category 2 countries) should be assessed using infection prevention and control precautions (standard, contact and droplet). If they meet the suspect case definition, they should be immediately notified to the local Medical Officer of Health. In a hospital setting, the local infectious disease physician should also be immediately contacted.
Other information for Midwives
The following information specifically relevant to midwives and pregnant and breastfeeding women has been collated from other sources.
COVID-19 in pregnant and breastfeeding women
Pregnant women experience some immunologic and physiologic changes which could make them more susceptible to viral respiratory infections, including COVID-19. It is unknown whether there are adverse pregnancy outcomes in pregnant women with COVID-19. The virus for Severe Acute Respiratory Syndrome (SARS-CoV) has not been detected in breast milk but it is unknown whether women with COVID-19 can transmit the virus via breast milk. At this stage it is recommended that women with suspected or confirmed COVID-19 infection continue to breastfeed their babies unless specifically advised against this by the treating health professional. Links for detailed information are included at the end of this document.
Information about the role of midwives in disaster or emergency situations
The International Confederation of Midwives has a statement about the role of the midwife in disaster preparedness https://www.internationalmidwives.org/assets/files/statement-files/2019/06/role-of-the-midwife-in-disaster-preparedness-eng-letterhead.pdf
The College also has a consensus statement about infant feeding in emergencies and disaster
Important information for community midwives
- The College and MMPO will support midwives to ensure quality midwifery care continues to be accessible to all women in Aotearoa.
- In emergency circumstances there will continue to be funding and support available through the existing rural and urban locum contracts. The College and MMPO will provide information about this if and when needed.
- The College is in direct contact with the Ministry of Health and will update midwives about any developments related to COVID-19 and also any allocation of emergency contingency funding to this situation should it be made available.
Useful links
Check the Ministry of Health website regularly for updates
Ministry of Health – https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus
Interim advice for health professionals https://www.health.govt.nz/system/files/documents/pages/ministry-of-health-covid-19-information-for-health-professionals-3march2020.pdf
UNICEF – Coronavirus disease (COVID-19): What parents should know: https://www.unicef.org/stories/novel-coronavirus-outbreak-what-parents-should-know
World Health Organisation – how to use face masks https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks
CDC – Pregnancy – https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-faq.html
CDC – Breastfeeding – https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/pregnancy-guidance-breastfeeding.html
La Leche League International https://www.llli.org/coronavirus/
For COVID-19 health advice and information contact the Healthline team (for free) on 0800 358 5453 or +64 9 358 5453 for international SIMS.
[1] Aerosol-generating procedures include nebulizing, intubation, suctioning, bronchoscopy, tracheostomy, cardiopulmonary resuscitation.
[2] Category 1 countries, as of 3 March: Mainland China, Iran, Northern Italy, Republic of Korea
[3] Category 2 countries, as of 3 March: Hong Kong, Italy (other than northern Italy), Japan, Singapore, Thailand