Even With No Respiratory Symptoms, Infants With COVID-19 Can Spread Virus

By Linda Carroll

April 06, 2020

(Reuters Health) - Describing the case of a SARS-CoV-2 positive 6-month-old infant who was admitted to a Singapore hospital and kept in isolation there, researchers found viral contamination of the child's local environment but no contamination on a health worker's personal protective equipment.

Despite the infant having no respiratory symptoms, the infant's bedding, cot rail, and a table 1 meter (39 inches) away were found to be positive for SARS-CoV-2, according to the brief report published in the Annals of Internal Medicine.

Because there was a downward trend in viral load on surfaces with increasing distance from the infant, but an unexpectedly high viral load on the table, the researchers believe the table was likely contaminated through direct contact via the caregiver, rather than droplets emanating from the infant.

"Infants with COVID-19, despite not having any respiratory symptoms can contaminate the environment around them, directly or indirectly via the hands of the carer," said the report's lead author, Dr. Yung Chee Fu, a consultant with the infectious disease service in the department of pediatrics at KK Women's and Children's Hospital.

"In hospital settings, staff must be wearing appropriate personal protective equipment when caring for infants with COVID-19 even though they may be clinically well," Yung said in an email. "In non-clinical settings, the findings emphasize the importance of hand hygiene - hand washing or sanitizing - as well as environmental cleaning in reducing the risk of COVID-19 transmission."

The 6-month old infant was admitted to Yung's hospital because both parents were in isolation units of other hospitals for confirmed COVID-19.

"Whenever possible, mother and baby should be cared for together," Yung said. "However, sometimes infants have to be separated or isolated for clinical and/or infection control purposes. In this case, since the mother was also a confirmed COVID-19 case, as soon as it was clinically safe to do so, we expedited urgent transfer so she could be with her baby. Both mother and baby have been discharged and are well."

The baby was asymptomatic when admitted to the hospital, but nasopharyngeal swabs confirmed a SARS-CoV-2 infection with a very high viral load (threshold (Ct) values for N gene and Orf1ab gene polymerase chain reaction (PCR) assay were 15.6 and 13.7, respectively). The researchers report that the baby was in generally good health while in the hospital with a single spike in temperature to 38.5 degrees Celsius (101.3 degrees Fahrenheit) on day 2 after admission.

On the second day, the team sampled the infant's isolation environment and the PPE of the health worker who was looking after the infant. While in the room with the infant, the healthcare worker had worn a face shield, an N95 mask and a waterproof gown. Samples from the PPE, taken after the worker carried and fed the infant, were found to be negative for SARS-CoV-2.

Since the infant had no respiratory symptoms, the researchers suspect the environmental contamination might have come from the baby crying or drooling. The contamination of the table could have come from the health worker touching it, and from items such as baby formula and baby wipes that the health worker also touched before placing them on the table.

The findings came as no surprise to Dr. John Williams, chief of the division of pediatric infectious diseases at the UPMC Children's Hospital of Pittsburgh. "Infected infants - and for that matter, all infected people - contaminate the immediate environment around them with germs," Williams said in an email.

Earlier research showed that caregivers who directly contacted babies infected with RSV got sick, but not people who were more remote to the room where the babies were kept.

The best procedure for caring for COVID-19 positive infants is to practice good hygiene, said Williams, who was not involved in the new report. "Careful handwashing and avoiding face-touching remains very important, because touching the environment around an infected patient can transfer germs to the caregiver," he added. "In a hospital, we would also use gown, glove and mask precautions to minimize transfer of germs from the environment to the caregiver."

So, what about an isolated baby's need for touch?

"That's a great question and one we work very hard on," Williams said. "It's important to remain human and to recognize the need babies have for human contact. If a baby is infected, it's quite likely that their parent or primary caregiver is also infected. In that case they can provide normal close care. If the primary caregiver is not infected but at high risk - an elderly grandparent, for example - it would be ideal to get someone younger who is lower risk to stay with the baby."

When that's not possible there are workarounds, Williams said. "In our children's hospital we often have staff or volunteers who will hold sick babies while wearing proper protective gear," he added.

SOURCE: https://bit.ly/2wYqooo Annals of Internal Medicine, online April 1, 2020. (Editing by Christine Soares)