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    March 12th, 2020 Coronavirus Q&A questions and responses:

    Wedgwood Elementary is a K-5 school in Seattle Public Schools.  The Wedgwood PTA coordinated this Q&A session with Dr. Chetan Seshadri.  Dr. Chetan Seshadri is a parent to three Wedgwood students, an Associate Professor of Infectious Disease at the University of Washington, and a physician at Harborview Medical Center in Seattle, WA.  The notes and a summary of his responses to the questions are listed below.

    Principal Steve Liu facilitated the Q&A and parents/guardians at Wedgwood Elementary were asked to submit questions in advance of the session.  Ann Grodnik, Wedgwood PTA President, was handling technical support and monitoring questions that were sent by those streaming on Facebook Live.

    1. Before we can track an improvement in the local situation, we need to understand how bad it is. I have a feeling we are far from understanding how widespread it is due to the delay in testing. Do you have any sense on when we will know how widespread it is?

      I want to answer these questions based on the facts and also provide my opinions.  We should assume that the virus is widespread today because of how things evolved in China.  It was 30 days from when the virus was first detected until it had spread to all provinces in China.  Within a week and a half when the first cluster of cases was detected in China and they were aggressively testing everywhere.  Italy, this past week, did more tests in a day than the US did in weeks.  When you think about the first case in the US being detected at the end of January, then we are about two months in and can assume that the virus has been spreading everywhere.  When the first case was detected in Evergreen Hospital, there were cases that were simultaneously detecting cases at Harborview and other hospitals in around the area.  The first patients to test positive for COVID-19 did not have contact with each other so It is safe to assume that the virus had been spreading in the community for weeks. 

    2. For 85% of the people the virus does not require hospitalization. What is the average duration of the virus and what does it typical look like?

      When you get the infection and you start to feel sick, you will feel like you have the flu (muscle aches, fever, cough).  You will feel crummy at the beginning of the virus and most people will get better after about a week.

      1. Will I be sick in bed for 5,7,10 days?

        Some individuals will have flu-like symptoms for a week and will get worse after a week.  If you continue to have a fever, develop a worse cough, and be more fatigued.

      2. I’ve heard there is a 3-4 day incubation period where a person will not feel sick but they can still infect others. If I self isolate for 4-5 days am I safe to assume I am not a carrier?

        Our best estimate for the time when you have the virus until the time you start showing symptoms is about 4-5 days.  The time that you start showing symptoms is the time when you are the most infectious to the people in your home around you.

      3. What does the test look like and how is it administered?

        The test is a nasal swab that is inserted into your nose and it fairly uncomfortable.  The material is collected from the swab and a genetic test is run to determine if someone has the virus.

      4. If you get the virus, can you be re-infected or do you build immunity after having it?

        This is a new virus to humanity so the first time that this goes through the world will be the worst, and then subsequent years could be more mild or the virus could burn out.  H1N1 was new to humanity and has become a part of the annual flu cycle. 

    3. What should younger adults who are on immunosuppressive drugs be doing to protect themselves? How serious is the risk to individuals with underlying medical conditions?

      The risk is serious to individuals with underlying medical conditions.  We are not that particularly worried about children and younger, healthy adults.  We should practice social distancing to protect elderly individuals and those with underlying medical conditions.     

    4. [Mr. Liu] In the event of a protracted school closure, are there specific ways that we or the PTA might be able to help people in the Wedgwood elementary community that are dependent on these services?

      Please check the communications from Mr. Liu to the Wedgwood community regarding this. 

    5. I am wondering how the school district is determining how widespread the virus is, if children aren't being tested?Both of my children have been home sick with fevers and bad coughs all week.I have been told by their doctor and WA state hotline to just self-quarantine and treat like you would any type of flu because they are not testing kids.Will they start testing kids?

      The testing concerns have exposed the weaknesses in our health care system.  We did not have enough tests and now testing is increasing but we may be running out of other equipment around tests (swabs, protective equipment for those administering the tests, what supply chain limitations are present).  So who really needs this test?  If we know that children either don’t get this infection or they get it and it’s mild, then we may not test children but that means that we are okay with not knowing where the virus is and how it is spreading.

    6. As the weather improves, will we see the virus spread slow down, as a typical flu season would be?

      We’d like that to be true but there is no evidence that the Coronavirus will act like the seasonal flu.

    7. How are you and your colleagues doing?How can we help?What are our hospitals capacity and are they reaching their limits?Do you and your colleagues have enough protective equipment?

      This is an all-hands on deck kind of experience.  We are all proud to be in Seattle and to be a part of our response to the coronavirus, and to be part of the Seattle Flu Study and UW laboratory testing.  We are worried about what’s to come in that we [health care professionals] are preparing but we still don’t know what’s to come. 

    8. Would you advise against having your healthy, 65 year old parents fly to Seattle to watch your kids during the school closure?Healthy grandparents helping with childcare?

      Yes, I would advise families having any older individual (60-65 years old or older) come into contact with others, especially children.  The statistics from China and Korea, for those over the age of 80, it is a 20% fatality rate so there’s a one in five chance in dying from this infection.  There’s also a risk of being on an airplane (closed environment around many people for an extended period of time).

    9. With (what would have been) spring break approaching, many people are re-evaluating travel plans. Do you have thoughts or recommendations, particularly in regard to air travel, for parents and their kids? And how about for otherwise-healthy older adults (age 65 and up)?

      UW faculty members are no longer allowed to travel for work.  Personal travel is at the individual’s discretion but Seattle may be the safest place to be because some states do not have the testing capabilities set up right now.

    10. There have been a few questions about social distancing and families planning playdates and childcare rotations with friends and neighbors in order to be able to continue working.What are your thoughts and recommendations on families avoiding playdates and informal childcare options?

      This is why the decision was made to close schools.  It wasn’t going to be an easy decision and we won’t know if it’s the right decision.  But that’s the cost of this and we need to try to keep ourselves and our children away from others.  With the seasonal flu, it is effective to stop the spread of the flu by closing schools.  School closures should help decrease the spread of the coronavirus and we know that families will plan playdates or gatherings with 5-10 children with other families to stay sane.   

    11. There were a few questions about the testing dilemmas and the CDC.What are your thoughts public trust and the CDC and local health officials?

      There was recently an article about the testing but we need to give everyone the benefit of the doubt.  We are all in this together and we, as a health care community, were all unprepared for this outbreak.  Let’s find ways to work together to move forward. 

    12. Any new information about the severity of the illness with younger people?

      At this time, no child under 10 years of age, has died from COVID-19 worldwide. 

    13. Should we still go out to restaurants?

      What about the people who work in the restaurants and what is the risk to them?  We will need to work through this as a community as people who work in restaurants and other establishments rely on these businesses staying open. 

    14. How is the virus transmitted?

      A study that was put out last week in China is that clusters of infections (in households) and infected people were mostly in contact with only their household members.  Only about 15% of those who came in contact with someone who was infected, also became infected.  This is about the same percentage with the seasonal flu.  We need to do the same things as we would with someone who has the flu.  We should keep physical distance from those who are infected (at least six feet), and practice handwashing after touching anything that an infected person has touched. 

    15. What about therapy visits or doctor’s appointments and the need to have tele-health appointments?

      That should be something that these health care practices are looking into.

    16. When should we expect a vaccine to be available to the public?

      Kaiser Permanente in Seattle is launching a study to test a vaccine and they are looking for healthy volunteers for the study.  It will be about a year or a year and a half before we can expect a vaccine to be commonly available.  Vaccines that are being tested now won’t be helpful at this time for the common public.

    17. What precautions should people take with packages and food deliveries?

    Anything that I touch is dirty and potentially infected so I should wash my hands after touching delivered items, especially before preparing food and doing other things that might spread the infection.  We need to stop touching our faces.

     

    Notes from Coronavirus Q&A session on Thursday, March 5, 2020 at Wedgwood Elementary

    Wedgwood Elementary is a K-5 school in Seattle Public Schools.  The Wedgwood PTA coordinated this Q&A session with Dr. Chetan Seshadri.  Dr. Chetan Seshadri is a parent to three Wedgwood students, an Associate Professor of Infectious Disease at the University of Washington, and a physician at Harborview Medical Center in Seattle, WA.  The notes and a summary of his responses to the questions are listed below.

    Principal Steve Liu facilitated the Q&A and parents/guardians at Wedgwood Elementary were asked to submit questions in advance of the session.

    Information that was shared at the start of the Twitter Live stream event.

    • Wedgwood Elementary was disinfected the evening of March 4th, 2020 by a team from the district due to concerns about the norovirus/stomach flu.
    • Seattle Public Schools has a response team that is meeting daily to receive recommendations from the Department of Public Health and to decide next steps for the district.
    • The District, when considering school closures, must take into account lots of factors such as families needing to find childcare, social and economic impacts, and taking health care professionals and emergency responders out of the workforce to stay home with their children.
    • Seattle Public Schools is taking the coronavirus outbreak very seriously and student safety is our top priority!

    What symptoms should parents watch out for and what symptoms are the most common at the onset of the coronavirus?

    The Coronaviruses are a class of viruses that affect humans and we have all been affected by them because they are involved in the common cold.  There are also animal coronaviruses and, at times, there are animal coronaviruses that spread to humans so this is a new virus to humanity.  SARS and MERS are examples of other animal coronaviruses that made the jump to humans.  This coronavirus (SARS-CoV-2) is different and much more serious.  The first report of this coronavirus came out on New Year’s Eve where a household of five became diagnosed with severe pneumonia.  Only one of the individuals in this house had been to the market where the coronavirus originated.

    The data from Chinese CDC is that within 30 days, the coronavirus was in every province in China.  45,000 people have been infected in China and the vast majority of the infected had mild symptoms such as upper respiratory cold symptoms and mucus production.  Some individuals (5-10%) have developed severe infections because the virus travels further down in the lungs and the Chinese reported that there was about a 2% fatality rate.  Out of the 45,000 people that were infected in China, less than 1% of those infected were under the age of 10.  So, children are often asymptomatic, or they do not get the virus at all.  The elderly and those with underlying health conditions are those most susceptible to the most severe cases of the coronavirus.

    Who should get tested?  What is the turnaround time for testing, and do you have enough test kits?

    Dr. Seshadri is extremely proud to be a resident of this community, this city, and this state and WA State was the first to discover coronavirus based on testing.  Initially, the people who got tested had to have their tests sent to the CDC in Atlanta, which was a longer turnaround time.  Testing was limited until about last week where better tests were sent to WA State labs.  This past Monday, testing became active at the University of Washington and so next week, we will hear about exponentially more cases of the coronavirus because we have much more testing capacity.  The increase of cases will look dramatic, but this is due to cases that were already exposed weeks ago.  Those who should get tested are currently individuals who are hospitalized with severe cases but that will expand further as testing capacity is expanded.

    The Public Health Department does not want individuals with mild to moderate symptoms to go to the emergency room because they may get others sick.  Testing is primarily done with individuals who were exposed from the confirmed cases.  New patients with compatible syndromes are also being tested.

    How long can children and other healthy adults be carriers of the coronavirus in thinking about how children may spread the virus to the elderly and other with pre-existing conditions? 

    Nobody knows for sure.  Dr. Seshadri finds it hard to believe that children do not get the infection but that children are the silent part of the transmission cycle.  He worries that children and sick children’s’ interactions with grandparents, parents with chronic medical conditions, and those with underlying health conditions.  We may not notice children transmitting it to other children.

    How long can the virus live on surfaces and how does that compare to other viruses?

    Influenza provides us better information about how viruses survive on surfaces.  Influenza can survive on surfaces for a few hours or a day, but influenza is generally transmitted to people by other people.  Health professional’s infection control practices are very careful not to touch any object in the room of a person who is infected with the coronavirus, and all the objects are thrown away.

    Does the virus live on fabrics and clothing and do gloves help protect individuals?

    In the health care setting, that is definitely the strategy but in the household, it is difficult to provide care for your child while also avoiding contact with the same child.  A more efficient way to protect oneself is to keep your physical distance from those who are at risk.

    Does bleach kill the coronavirus?

    Absolutely and that is a standard practice at Harborview and the disinfecting that was done at Wedgwood follows that practice.

    Do you recommend that large group gatherings be canceled such as the Wedgwood Spring Musical?

    The purpose of closing and canceling group gatherings needs to be considered so if children were experiencing serious effects from the virus and were transmitting the virus to each other, then closing schools and gatherings would make sense.  That is not the case with the coronavirus and there is not evidence that children are part of the transmission chain.  But if the schools close and children still gather at Dahl park and have a playdate then we haven’t solved anything.  School closings also have immense social and economic disruption and the loss of essential personnel (health care providers and emergency responders) to the community.  Social distancing is better done in a staged way and not all at once.

    Is it safe to travel by airline, domestically, if things stay the same or if things get worse?

    Dr. Seshadri recommends not traveling to other parts of the country but he wonders if other parts of the country have the coronavirus but they haven’t tested and so they are not aware of current cases. 

    Do you and your colleagues have enough protective equipment such as masks and shields, and how do medical professionals protect themselves?

    Thank you so much to the individual who wrote this question.  Health professionals do not have enough protective equipment.  Masks are a great example in that N95 masks are typically used in hospitals and clinics by health professionals to keep themselves protected and that doctors and nurses wear N95 masks to treat tuberculosis patients but if there aren’t enough N95 masks available, then health professionals will find it difficult to adequately treat patients with coronavirus and tuberculosis patients.  Surgical masks help protect others from an illness that you have and N95 masks are very uncomfortable and people tend to touch their faces a lot if they are wearing these masks.  Please keep a small supply at your home if you have them but please consider donating N95 masks to health care facilities in the area.

    What was the role in the Seattle Flu Study in catching the coronavirus?

    The first patient was diagnoses in Everett with samples sent to the CDC.  The people the first patient came into contact with were also tested and all of the tests came back negative.  The second person, a high school student in Snohomish County, was diagnosed through the Seattle Flu Study.

    What are the indications that the coronavirus is more dangerous than the seasonal flu?

    The flu has caused more than 18,000 deaths in the United States and over 30 million people have been infected.  In WA state alone, there have been 50 cases of outbreak of the flu in nursing home facilities.  We may have become complacent because we have a flu vaccine that is partially effective and because we have drugs that are reasonably effective.  The mortality rate of coronavirus is around 2-3% but the mortality rate of influenza is under 0.5% so the coronavirus is 50 times more lethal.

    What cautions should asthmatic students or those with asthma take?

    We need to take into account vulnerable children.  As a parent and a professional, I am going to watch my kid with asthma very closely.  I know what he is like when he gets an asthma flare and I know how to treat him and when he gets better.  If things look different, then I will say something.

    Is it possible for a person to carry the coronavirus, infect others, and not actually get sick?

    That is what we could be seeing in that children may be transmitting the virus but not be getting sick.

    Can you clarify who should be tested and where should they go?

    The Public Health Department has guidelines on who to test and where to send the test.  The priority is to test those who are hospitalized and then eventually test outpatients.  Eventually, anyone who wants to get tested will be able to get tested.  The Gates Foundation recently announced additional funding for the coronavirus response and some funds will be given to the Seattle Flu Study to fund expansion of their testing capacity in the community. 

    What is the turnaround time for testing and is there plans for other testing sites to come online?

    The turnaround time at Harborview is about a day.  The turnaround time for tests if you are in the community are longer but not exactly known.  The other sites coming online are talking with the state so testing will probably get quicker.

    If a child with asthma is going through a rough period, should they come to school or stay home?

    If a student is having a hard time with asthma, then they should probably stay home.  My sense from the reports coming out of China is that children are not really a high risk group but we don’t know much information about children with medical conditions.

    Can you develop immunities to the coronavirus?

    Probably.  H1N1 was a new influenza a few years ago and many people got sick but the second wave was not as serious because most people had been exposed to it and developed at least partial immunity to it.  The coronavirus could be like SARS and burn out or it could be like H1N1 and be a part of the regular flu cycle.

    With children with chronic medical conditions, how concerned should parents be about exposure at school with students who may be non-symptomatic?

    Parents won’t be able to tell the difference between a student with a runny nose and a student with the coronavirus.

    How worried I be about my 80-year-old parents and should I keep my children away from their grandparents?

    That is the first social distancing that we should do and we should keep our children away from our most vulnerable.  That is one of the most difficult lessons we are learning from the Life Care Nursing home cases.

    Should grandparents keep their distance from children when the grandparents are care providers when the parents need to work or need their help?

    Dr. Seshadri told his parents and parents-in-law to stay away at this time.

    Do you have an idea of when the peak of the epidemic will occur?

    We haven’t tested enough and so we don’t really know where we are in the phase of the epidemic.

    How accurate is the testing?

    You know a test is good if it picks up everyone with what you’re looking for and if it doesn’t pick up those who don’t have it.  The test works reasonably well but there have been false negatives.  It is the test we have right now though.

    Talk about Trevor Bedford at Fred Hutch and his work.

    Trevor Bedford sequenced the virus from the first few patients to determine how long the coronavirus may have been spreading in the area and he suspected that 500-1000 individuals may have been infected for weeks before the second case appeared.  Dr. Seshadri does not doubt the findings from Trevor Bedford.

    How do we avoid panic and over-reaction?

    This Q&A session is one of the ways to help ease panic.  Please feel free to share this information with others.  Know that scientists are working very hard in Seattle on this and the Seattle Flu Study is working to know what is happening very quickly, more quickly than if this outbreak happened in another part of the country.  A new drug is being tested and a vaccine is also being tested.  We have so many great resources in Seattle and we don’t seem to over-react in this community.  Let’s work together to make logical choices such as social distancing from elders, canceling gatherings, and other logical measures.

    How are we address the coronavirus with our students?

    Staff are spending time talking with students about preventative measures such as handwashing, coughing into your sleeve, and washing hands after using a tissue.  Kids are also showing us their resiliency and that they are still focused on learning, having fun, and being with their classmates and friends.

    Do we have a drug for coronavirus?

    We have a drug that we are testing in this area and will probably see continued testing in other areas of the country as the coronavirus spreads.

    Is fever a hallmark of the coronavirus?

    Having a fever, muscle aches, and body pains are hallmarks of the coronavirus and having the illness develop into pneumonia.  This is happening more frequently with coronavirus than with influenza.

    Is a dry cough more indicative of coronavirus that a gurgled cough?

    I’m not sure.

    End of Q&A session