Provider FAQs – COVID-19

Updated Jan. 20, 2021

Below you will find FAQs on the following:

 

Do not delay care: Please help us remind families that if their child needs emergency or urgent care, not to delay taking them to the ED or urgent care. Seattle Children’s ED and urgent care clinics are open and have capacity.

Information for families: We are committed to keeping our patients, families and workforce safe from exposure to COVID-19. Families can find information here about the robust safety measures we have in place.

Thank you for your partnership.

 

Information about COVID-19 Testing

Q: Who is being tested for COVID-19?

A: Seattle Children’s continues to update its COVID-19 testing guidelines as the situation changes.

Given ongoing local transmission in WA State and concerns around asymptomatic infection and risks to healthcare workers performing aerosol generating procedures, we recommend the following:

Test the following for COVID-19:

  • Any patient with signs or symptoms potentially consistent with COVID-19, including: fever, cough, shortness of breath, fatigue, headache, chills, muscle or body aches, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, or diarrhea.
    • These patients may be tested; use clinical judgment on whether to test if symptoms are explained by another source
    • Patients involved in an illness cluster in a care facility or institution (e.g., those who live in a nursing home or group home)
    • Known close exposure to a confirmed COVID-19 case
  • All patients at admission to the hospital
      • Outside validated PCR test results are accepted if the patient was tested within 72 hours, they have stable symptoms, and they are not considered to be at high risk for COVID-19.
  • All patients two days prior to a planned aerosol-generating procedure (AGP), unless they tested negative within the last two weeks and have been continuously hospitalized without new respiratory symptoms.  Outside validated PCR test results are accepted as above. If families are unable to test two days prior to the planned AGP, exceptions can be made to extend that window to testing within 72 hours of planned AGP.
  • All patients, regardless of symptoms, who report they are close contacts of a case. A close contact is defined as someone who was within 6 feet of an infected person for at least 15 minutes starting from 2 days before illness onset (or, for asymptomatic clients, 2 days prior to positive specimen collection) until the time the patient is isolated. Close contacts who test negative for COVID-19 still need to remain quarantined for 14 days after their last date of exposure.
  • Asymptomatic patients who are:
    • Individuals exposed to COVID-19 during an outbreak in a congregate setting (e.g., long term care facility, shelter, correctional setting, agricultural worker temporary housing, meat-packing plant, etc.).
    • Persons from racial and ethnic minority groups disproportionately affected by adverse COVID-19 outcomes; currently this includes Hispanics and Latinos, Native Hawaiian–Pacific Islanders, African Americans, American Indians and Alaska Natives, whose work, living circumstances or inequitable access to healthcare, and higher rates of comorbid conditions puts them at higher risk of severe disease
    • Persons who are pregnant and present in labor
    • Newborns born to parents with suspected or proven COVID-19.
  • Pre-BMT patients will be tested per SCCA protocol.
  • Hem-Onc patients:
    • General Strategy
      • Test all patients upon admission to inpatient unless tested within the last 2 weeks
      • If new symptoms since last test:  test on admission.
      • 72 hours Prior to scheduled admit for chemo if not tested in the prior 2 weeks
      • 72 hours prior to apheresis for cell collection
      • 72 hours prior to t-cell infusion
      • 72 hours prior to offsite procedures, including IR/OR/MAST
      • 72 hours prior to radiation and Q 2 weeks while on XRT if being sedated for radiation
      • 72 hours prior to their hem/onc clinic procedure room procedure unless they have been tested within the prior 2 weeks
      • When symptomatic regardless of when the last test was
      • Think any symptoms listed on the screening tool OR fever independently
    • Specific Clinical Situations:
      • If asymptomatic patient tested on admission and subsequently develops fever, should be tested again.
      • If straightforward F&N subsequently develops symptoms in addition to fever-should be tested.
      • If any clinical change with symptoms or fever consider retesting.

DO NOT test the following groups:

  • Asymptomatic outpatients not meeting above criteria.

 

Educate all patients you test

If COVID-19 is being considered, whether testing is performed or not, provide the following guidance documents to patients, and emphasize the need to isolate for ill persons and self-quarantine for exposed contacts. Healthcare providers play a critical role in slowing transmission by identifying COVID cases recommending early isolation.

 

Community COVID-19 testing: We recommend that providers follow the Seattle Children’s guidelines above when referring patients for SARS-CoV-2 COVID testing at our drive-through site at SPLC or our Urgent Care locations (testing is done on-site at urgent cares, not via drive-through). Read more information about community COVID-19 testing offered by Seattle Children’s.

 

Q: For pre-operative testing at Seattle Children’s, what happens when patients live far away or cannot get tested in time?

A: We are screening all pre-operative patients for COVID-19. This includes patients who will have a procedure in an operating room and those who need anesthesia in Radiology. Families who have a procedure or surgery scheduled will receive a call from our Pre-Anesthesia Testing Coordinator (PATC) to discuss the requirements for COVID-19 testing and help schedule their test at one of our four local sites (Seattle, Bellevue, Federal Way, Everett). These tests need to be collected within two days, or 72 hours at most, prior to surgery/procedure. Seattle Children’s orders test and communicates the result.

We have a system in place to prioritize testing for pre-procedure patients. Families experiencing financial hardship or other extreme circumstances will be connected with our guest services and social work teams.

Out-of-area Testing

Outside PCR (nucleic acid amplification) test results from nasopharyngeal/mid-turbinate samples are accepted if the patient was tested within 72 hours of the procedure, they have stable symptoms, and they are not considered to be at high risk for COVID-19.  The patient’s PCP should order the test or the family may self-schedule a test if that is a locally available option. Results should be sent to Seattle Children’s to be entered in the patient’s EMR by 5 p.m. the day before procedure (fax results to the Seattle Children’s Pre-Anesthesia COVID-19 testing line at 206-987-2060). See our FAQ for more information.

Parent testing

In order for a parent to stay with their child in the hospital overnight when their child qualifies for double-rooming, they will need to be tested via PCR test within 72 hours of the procedure. Our PATC will review this requirement with the family during the pre-procedure call.

When 24 Hour Tests are Necessary

Requests for testing within 24 hours may come up for cases that are added last minute. These families can come to Seattle to have their testing performed within the 24 hour period.

There will be patients who will be unable to undergo testing prior to surgery due to distance or urgency of procedure. If testing cannot be conducted, there will be a clinical escalation to decide if the procedure should:

  • Be postponed until testing can be completed
  • Proceed – with appropriate precautions in place to protect our workforce

Q: When should a second test be obtained for SARS-CoV2?

A: Rationale for obtaining a 2nd testing during a course of illness:

  • Well-designed PCR tests for SARS-CoV2 have high analytical sensitivity, but clinical sensitivity is unknown due to lack of clinical gold standard.
  • Clinical sensitivity is dependent on where the patient is in the course of their illness and the associated viral load (viral load decreases later in the course of illness).
  • SARS-CoV2 appears to have anatomical tropism. For instance, in general, shedding persists for longer in lower respiratory tract specimens and as a result, lower respiratory tract specimens have higher sensitivity than upper respiratory tract specimens.
  • Our testing strategy at Seattle Children’s calls for utilizing upper respiratory tract specimens as the primary specimen because it is not always possible and is often not easy to obtain a lower tract specimen from a pediatric patient.
  • However, when suspicion for SARS-CoV2 disease (COVID-19) is high, consideration should be given to obtaining a second test and preferably from the lower respiratory tract if possible.

Procedure:

Identify which patients have a higher pretest probability of COVID-19:

  • Rapid or severe respiratory decompensation without alternate explanation with or without chest CT findings consistent with COVID-19

OR

  • Lower respiratory tract disease (cough, increased RR, SOB, or 02 requirement) without another etiology

AND one of the following:

    • Close contact exposure to known COVID+

 OR

    • Patient lives in facility / group home

OR

    • Radiological evidence consistent with COVID-19 (CXR: bilateral infiltrates, not lobar consolidation; CT: ground glass opacities)

Preferred 2nd samples:

  • Productive cough: collect sputum if possible
  • No cough or non-productive cough:
    • Preferred specimens: induced sputum, deep suctioning through ETT, BAL
    • If above not possible or feasible: consider repeating middle turbinate (MT) swab or other upper respiratory tract sampling

Isolation Considerations based on 2nd SARS-CoV2 test results

  • Lower respiratory tract specimen
    • Positive: SIU
    • Negative: Can transition to viral respiratory precautions (due to pre-existing respiratory symptoms/signs)
  • Repeat MT swab or other upper respiratory tract sampling
    • Positive: SIU
    • Negative:
      • High index of suspicion of COVID-19: remain in SIU
      • Lower index of suspicion of COVID-19: discuss with ID to consider whether strict isolation or viral respiratory isolation outside SIU is appropriate.

Q: How many children have tested positive?

A: As of Dec. 1, 2020 Seattle Children’s had tested 18,901 pediatric patients with 383 testing positive, for a positivity rate of 2.0%. Approximately 1 in 4 individuals who tested positive were asymptomatic.

Q: How will I know if you are treating my patient for COVID-19?

A: If your patient is seen at Seattle Children’s for suspected COVID-19 (or any other condition), you will receive our standard fax communications regarding ER summary, admission, discharge etc.

Q: Does Seattle Children’s offer testing for staff with symptoms of COVID-19?

A: Seattle Children’s offers testing for workforce members who have symptoms of COVID-19. At this time testing is available to Seattle Children’s workforce who have a badge. This includes active community medical staff members with a Seattle Children’s badge.

Q: Is Seattle Children’s offering COVID-19 testing for the pediatric community?

A: Yes, since May we have offered drive-through SARS-CoV-2 COVID testing to the pediatric community at our Sand Point Way Learning Center and in-clinic testing at our four Urgent Care locations (Seattle, Bellevue, Everett and Federal Way). Community providers who wish to have their patients tested at Seattle Children’s should submit this requisition form to authorize the patient’s test. No walk-up testing is permitted; the requisition order is required and a testing appointment must be made. Read more information about our COVID-19 testing for the pediatric community.

Q: Where else can pediatric patients get tested?

A: Public Health – Seattle & King County has opened two new large-scale testing sites in Seattle for COVID-19; they are in SODO (3820 6th Ave. S.) and Bitterlake (12040 Aurora Ave. N.) and free to everyone regardless of insurance or immigration status.

Community Testing Sites

The Washington Department of Health has published a map of all Washington state COVID-19 testing sites.

Q: Will you notify PCPs of their patients’ coronavirus test results?

A: Results will be sent to the provider who ordered the test, regardless of whether it is positive or negative. If Seattle Children’s orders the test we will notify the patient’s PCP. You can expect to receive a copy of our standard lab report via fax. (Please note: inconclusive results are being treated as “positive” until confirmed by the State or CDC.)

When PCPs order the test, results will be sent only to the PCP and not the family.

  • Results from our regional urgent care clinics will be provided within 48 hours.
  • If you don’t receive your results within the time expected, please call our clinical lab at 206-987-2102 for assistance.

When Seattle Children’s orders the test (as opposed to a PCP ordering a test), we provide the test results to families within 48 hours and direct them to contact their child’s PCP if their child’s test is negative and they have follow-up questions.

For more details about testing methodology, interpretation and reliability, see FAQ: Clinical Laboratory Testing for COVID-19 at Seattle Children’s.

Q: Does Seattle Children’s offer antibody testing?

A: Yes, Seattle Children’s and UW Medicine labs are performing the Abbott SARS-CoV-2 IgG immunoassay on the ARCHITECT instrument. This is a chemiluminescent microparticle immunoassay (CMIA) used for the qualitative detection of IgG antibodies to SARS-CoV-2 nucleocapsid protein in human serum and plasma.

This test is not FDA-approved for diagnosis of infection due to SARS-CoV2; however, the data presented in the package insert demonstrate it is a sensitive test for detecting past SARS-CoV2 infection. It also appears to be specific; however, more testing in the setting of other human coronavirus infections is needed. Thus a positive test likely indicates past infection due to SARS-CoV2 while a negative test indicates that a person likely did NOT experience infection with SARS-CoV2. See the indications for testing and the FAQs below for more information.

Community providers can order the test the same way they currently order other lab tests at Seattle Children’s; no special requisition is needed. Test details are here.

Indications for serological testing for SARS-CoV-2 (COVID-19)

  • Patients who have had a prior illness consistent with COVID-19 more than 21 days ago and either tested negative or were not tested
  • Patients who had a known exposure to SARS-CoV-2 more than 21 days ago

CAUTION:

  • Serological testing is NOT indicated for diagnosis of acute infection and should not be ordered while a patient is being investigated for active SARS-CoV-2 infection
  • For patients with new or persistentCOVID-19 symptoms, or if there is concern for active infection, molecular testing (PCR) with a nasopharyngeal swab is recommended prior to considering serologic testing
  • It is unknown if a positive antibody test indicates any level of short or long term protection against SARS-CoV-2; antibody test results should not be used to guide return-to-work decisions
  • Immunocompromised patients who have COVID-19 may have a delayed antibody response and produce levels of antibody which may not be detected as positive by the assay

At this time, it is not known whether the presence of antibodies confers protection from reinfection with SARS-CoV-2, how long the antibody response lasts, or the association between antibody response and clinical outcomes of individuals with COVID-19.

Sensitivity: According to published series, at 2 weeks after onset of symptoms, sensitivity is over 50%. At approximately 25 days after symptomatic infection in hospitalized patients, the sensitivity approaches 100%. The Abbott product insert reports higher sensitivity, with 91% sensitivity by 14 days after symptom onset. The sensitivity of the test among subjects with asymptomatic infection is unclear, and the duration of positive results (seropositivity) is unknown.

 

 

Information about COVID-19 Treatment

Q: What are Seattle Children’s guidelines for treating COVID-19 and MIS-C?

A: A Clinical Standard Work pathway for COVID-19 was created by a multidisciplinary team based on the available literature and will be updated frequently. There are separate algorithms for acute COVID infection and Multisystem Inflammatory Syndrome in Children (MIS-C). The current versions can all be found here: COVID-19 Clinical Standard Work pathway (includes Acute COVID and MIS-C Care Treatment algorithms).

Q: What do we know about risk factors for the pediatric population?

A: According to the CDC, people of any age with the following conditions are at increased risk of severe illness from COVID-19: chronic kidney disease, chronic obstructive pulmonary disease, immunocompromised state (cancer, solid organ transplant, etc.), serious heart conditions (complex congenital heart disease, heart failure), obesity (BMI 30 or higher), sickle cell disease, and type 2 diabetes mellitus. Children who have medical complexity, who have neurologic, genetic, metabolic conditions, or who have congenital heart disease might be at increased risk for severe illness from COVID-19 compared to other children.

 

Information about COVID-19 Vaccines

Q: Is vaccination underway at Seattle Children’s?

A: Yes. We are pleased to say that Seattle Children’s began vaccinating its workforce for COVID-19 on Dec. 16, 2020.

Like other healthcare systems in Washington, Seattle Children’s has limited information at this time about the types and quantities of vaccines we will receive in the near future. As we learn more, we will share.

We are relying on information from the CDC’s Advisory Committee on Immunization Practices (ACIP) and state and local public health authorities to guide our decisions on safe and equitable distribution of our vaccine supply.

 

Q: Who is receiving vaccines at Seattle Children’s?

A: Due to limited availability, we are prioritizing timing of vaccination in accordance with recommendations from our multi-disciplinary Vaccine Task Force and federal and regional guidance.

Healthcare personnel at the highest risk of exposure are being offered the vaccine first in an effort to maintain medical surge response capacity.

We began with Phase 1A, the front line workforce members and community providers. They are divided into three groups. We are currently offering vaccines to those in Phase 1A – groups 1 and 2.

Phase 1A, Group 1 — Workforce members who have direct patient contact and the highest risk of exposure, including the following:

  • Work in COVID-19 acute care/PICU SIU
  • Work in ED (direct patient care and support services)
  • Work in urgent care centers
  • Work in SARS-CoV-2 testing sites/labs handling potentially COVID-19-positive samples
  • COVID-19 vaccination staff
  • COVID-19 screeners who swab workforce members and families for COVID-19, safety officers/security
  • Pediatric residents based at Seattle Children’s
  • Fellows working in the above high-risk areas
  • Other trainees working in the above high-risk areas
  • Team members who perform high risk AGPs in the airway (anesthesiologists, pulmonary and otolaryngology providers, dental, respiratory therapists)

Phase 1A, Groups 2 and 3

  • Group 2: Includes active community medical staff with privileges, other inpatient providers with privileges, our SCCN partners and clinicians working in juvenile rehabilitation centers.
  • Group 3: Includes active community medical staff without privileges who are not part of another health care system. We will contact this group directly via email once we have more information to share about timing and scheduling. We don’t expect to begin offering vaccines to this group until late winter but the timing could be sooner or later depending on our future vaccine allotments.

Community providers employed by other health systems should obtain their vaccination from their home institution.

Future vaccine phases in 2021 will include more of our Seattle Children’s workforce members, patients and community healthcare partners. We will rely on federal and regional guidelines to prioritize within these groups.

 

Q: Is Seattle Children’s requiring its workforce to be vaccinated?

A: No, but everyone is strongly encouraged to get the vaccine. Getting vaccinated will help maintain a safe work environment, allow our healthcare workers to continue to safely care for patients during this surge, and decrease their risk of getting COVID-19 or potentially exposing others to it, including family, friends and the community.

 

Q: Is there a cost for workforce members to get the vaccine?

A: No, vaccines are free to all Seattle Children’s workforce members.

 

Q: Who will be receiving the 20% of the vaccine Seattle Children’s received designated for “the community”?

A: Our active community medical staff will be offered the vaccine, as detailed above, as well as students and trainees who are at Seattle Children’s. We are also identifying community and vendor partners who may be able to receive their vaccines at our sites.

 

Q: Can my clinic staff receive the vaccine from Seattle Children’s? What about locums providers who work in community practices? 

A: Not at this time. We are following state and local public health guidelines to prioritize groups for vaccination. If vaccine becomes available for clinic staff and/or locum providers, we will announce it. Please be sure you are subscribed to Provider News to ensure you hear from us.

 

Q: If healthcare providers and their staff can’t get the vaccine at Seattle Children’s where else can they get it?

A: It’s not clear yet. You can ask your primary care provider if and when they will be offering a vaccine, and if you are employed by a health care organization, you can ask your employer when they will offer vaccines. However, it is likely they will not know yet. You can also check with local public health agencies and the Washington State Department of Health for information about when vaccines will be more widely available.

As Moderna and others ramp up production of their vaccines that don’t require extreme cold storage like Pfizer’s, vaccine availability should greatly improve.

Information for independent, non-hospital associated practices:

 

Q: How will I receive communication from Seattle Children’s about scheduling a vaccine?

A: If you are an active community medical staff member, with or without privileges at the hospital, you will receive direct communications from Seattle Children’s when the vaccine is available to you. If you are not a member of our active community medical staff, please subscribe to Provider News to receive future notification of vaccine availability.

Q: Do I have to come to Seattle Children’s to get vaccinated?

A: Yes. The hospital is currently the only location where we are offering the vaccine.

 

Q: Which vaccine will I receive? Can I choose?

A: The vaccine given on any particular date and time will depend on our supplies and logistics. A choice won’t be offered. We currently have only the Pfizer vaccine, which is given in two doses several weeks apart. Other vaccines that we may receive in the future may also be given in two doses. Second doses will be the same type as the first, which means if you get a Pfizer vaccine in the first dose, your second dose will be Pfizer also.

 

Q: Are there any precautions to receiving the vaccine for individuals on immunosuppressive therapies?

A: We recommend following the guidance of the CDC’s ACIP on this matter. According to ACIP’s website on Dec. 20, 2020: “Persons with HIV infection or other immunocompromising conditions, or who take immunosuppressive medications or therapies might be at increased risk for severe COVID-19. Data are not currently available to establish vaccine safety and efficacy in these groups. Persons with stable HIV infection were included in mRNA COVID-19 vaccine clinical trials, though data remain limited. Immunocompromised individuals may still receive COVID-19 vaccination if they have no contraindications to vaccination. However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, as well as the potential for reduced immune responses and the need to continue to follow all current guidance to protect themselves against COVID-19…” (ACIP website, in the section “Vaccination of persons with underlying medical conditions”).

 

Q: If I tested positive for COVID-19, do I still need to get the vaccine?

A: Yes, you should still get a vaccine; however, if you are eligible to receive your vaccine at Seattle Children’s and you have tested positive for COVID-19 in the past 90 days, we require that you defer your vaccine to allow vaccination of other healthcare workers who remain susceptible to infection, as current evidence suggests reinfection is uncommon during the 90 days after initial infection. Other institutions may have different policies.

 

Q: Can I get the vaccine if I have allergies?

A: Most people who have allergies can receive the vaccine. The one exception is those who have had a severe allergic reaction to the vaccine itself or any of its components; this group should not receive the vaccine. People who have had severe allergic reactions to other vaccines or injected medications can receive the vaccine, but they should be monitored for 30 minutes. Food, environmental, and animal allergies are not restricted from receiving the vaccine in any way. Our COVID-19 vaccination clinic is prepared in the event a vaccine recipient develops symptoms of severe allergy during the 15- to 30-minute monitoring period.

 

Q: Is it safe for pregnant and breastfeeding women to get the COVID-19 vaccine?

A: While pregnant and breastfeeding women can get the vaccine, we encourage them to contact their healthcare provider before getting the vaccine. None of the clinical trials for the COVID-19 vaccine included pregnant or breastfeeding women.

The Society for Maternal Fetal Medicine and the American College of Obstetrics and Gynecology recommend that pregnant and breastfeeding women who are high risk healthcare workers and first responders be offered and receive the COVID-19 vaccine. They also offer the following guidance and information, and recommend that you consult with your care provider if you have questions:

  • Vaccine safety and efficacy have not been tested in pregnancy.
  • The risk of maternal or fetal harm from an mRNA vaccine is unknown, but thought to be low.
  • COVID-19 disease carries increased risk in pregnancy, particularly for patients with obesity or other medical conditions.
  • Receipt of the vaccine is a personal choice.
  • Pregnant women who have a history of significant allergy to any of the COVID-19 vaccine components should not receive the COVID-19 vaccine until there is a better understanding of anaphylactic reactions to the vaccine.

The University of Washington has established a registry to follow pregnant and breastfeeding women who receive the COVID vaccine. Learn more and register. Questions can be directed to covidvaccpreg@uw.edu.

 

Q: What advice do you have for pediatric providers if they develop a reaction to the vaccine that mimics COVID-19 infection?

A: You should be tested for COVID-19 if you experience COVID-19 symptoms such as respiratory issues, sore throat or cough that aren’t compatible with an expected vaccine side effect (local site reaction, fever, fatigue, myalgia, headache). If you experience symptoms such as fever, fatigue, myalgia or headache that could be either related to the vaccine or COVID-19 or another viral infection, then it is fine to wait and quarantine at home. If you are having a vaccine reaction, it should resolve in 24 to 48 hours. If symptoms don’t resolve by the end of the third day — day 1 being the day of the vaccine — then test for COVID-19.

Providers should refer to the CDC’s guidance on return to work.

 

Q: Will a vaccine be tested in the pediatric population?  When? How?

A: Yes, pediatric testing of vaccines is already underway. Pfizer began testing in youth ages 12 to 17 in October. Moderna is slated to begin testing in the same age group shortly, and more vaccine makers are expected to begin pediatric trials once their drugs are approved for adult use. AstraZeneca is testing its vaccine in children, but so far only outside the United States. We don’t know when the pediatric data will be available or when a vaccine will be approved for youth.

COVID-19 vaccines, like other drugs, will be tested in progressively lower age groups, starting with teens and proceeding to the youngest children last. Even though babies have been affected by COVID-19 at a higher rate than children 12 months and up, testing will likely not skip past the other kids’ age groups.

Pediatric testing is necessary because drugs sometimes work differently in the pediatric population than adults, and children may have stronger reactions (more fever, joint or muscle ache or fatigue) because their immune systems are more active.

 

Q: Is there an opportunity for my patients to participate in COVID-19 vaccine trials?

A: Pfizer is recruiting individuals ages 12 to 15 for its COVID-19 vaccine study. Children may be eligible if they have not participated in a previous trial for COVID-19 and have no history of COVID-19 infection or a positive COVID-19 test. Learn more.

 

Q: When do you expect a vaccine for kids to be available?

A: We don’t know and would not want to speculate. It depends on when the vaccine studies can demonstrate the results needed. There is no word on whether we’ll have a vaccine for kids by next fall. It’s certainly a good goal, and we’d like to see it happen. Our state is not presently requiring children and teens to have a COVID-19 vaccine in order for them to return to school.

 

Q: What are the recommended pediatric priority groups to receive the vaccine?

A: It is undetermined at this moment. We need to wait to receive guidance from the CDC’s Advisory Committee on Immunization Practices (ACIP). Stay tuned.

 

Q: Are there any pediatric groups who should not receive the vaccine?

A: We don’t know yet. We are looking to ACIP to make that determination.

 

Q: What kind of side effects might we see in kids? Is it safe?

A: We don’t know for sure. We can expect to see some of the same side effects we’ve seen in adults: fever, fatigue and achy muscles and joints. There’s no reason to believe what we’ve seen in adults will be different in kids, but the studies will let us know. Typically, if a vaccine is safe for adults, it is safe in kids.

 

Q: Will the kids’ vaccine need to be repeated, like the adult one?   

A: Yes. The vaccines for kids from Pfizer and Moderna will likely be two-part vaccines like their adult counterparts. Johnson & Johnson is working on a vaccine that is one dose. We will not know the exact dose and frequency of a pediatric vaccine until the data comes out.

 

Q: Is Seattle Children’s participating in trials of the vaccine in kids?

A: Not currently. According to clinicaltrials.gov, the only Seattle-area institution currently participating in trials of a kids’ vaccine is the Benaroya Research Institute at Virginia Mason.

 

Q: Most pediatric community clinics will not have capability to store the Pfizer vaccine. How will this be addressed?

A: Pfizer’s vaccine requires unusually deep cold storage, which Seattle Children’s can provide but many clinics in the community cannot. As more vaccines become available that don’t require nonstandard, deep cold storage like Pfizer’s, we expect to see improved availability of vaccines to community clinics.

 

Q: Will Seattle Children’s vaccinate pediatric patients ages 16 to 18 since the vaccines are approved for that age group?

A: We are waiting for ACIP to provide guidance on offering vaccines to patients ages 16 to 18.

 

Q: Where can patients go to get vaccinated if their pediatric clinic isn’t offering it?

A: It’s too soon to say. It’s possible Seattle Children’s will offer COVID-19 vaccinations at our regional clinics when more vaccines are available, but nothing is planned yet. Our best guess is that we will rely on clinics to distribute the Moderna or any other vaccine that they are able to properly store in their own refrigerated facilities.

 

Q: Do you have suggestions on how to calm parent uneasiness about getting kids vaccinated?

A: The CDC provides talking points and materials for providers to discuss the COVID-19 vaccine with patients and families. See “Talking to Recipients about COVID-19 Vaccines” on the CDC website, which includes these documents:

 

More Resources

 

Information about Telehealth

Q: Are you offering provider ambulatory telemedicine and telephone visits?

A: Seattle Children’s has swiftly changed our care model to meet the clinical needs of patients during the COVID-19 outbreak. We now offer telehealth visits instead of in-person appointments when it is medically appropriate and possible. Nearly all Seattle Children’s specialties are conducting some visits via telehealth and have processes in place to accommodate patients when clinically appropriate. Learn more.

The Office of Civil Rights (OCR) issued a statement that allows enforcement discretion of normal HIPAA rules.

OCR will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. This means that non-public-facing applications are approved during this period of time. However, if these applications are linked to your personal device, patients will see your personal information (e.g., cell phone number).

 

 

Changes to Ambulatory Clinics, Services and Scheduling

Q: Are all Seattle Children’s clinic locations open and seeing patients?

A: All of our sites of care are open and seeing patients except our Outpatient Psychiatry and Behavioral Medicine Clinic at Overlake and South Sound Cardiology in Centralia, both of which remain closed for in-person visits.

Locations that were temporarily closed this spring due to COVID-19 are back open (Sleep at Overlake, Olympia Clinic, South Sound Cardiology clinics in Olympia and Tacoma).

Q: What changes have you made to ambulatory appointment scheduling?

A: The following triage guidelines are in place through at least June 30 to ensure a consistent approach to scheduling ambulatory patients across all specialties and locations during COVID-19, including EKG and EEG appointments. The guidelines are intended to continue to provide needed care to patients, preserve PPE, and promote social distancing for our staff, providers, and community. Adhering to the standards will avoid the need to reschedule patients, decrease growth of scheduling backlog and access constraints, and allow for appropriate prioritization once standard operations resume.

These standards apply to currently scheduled patients and new scheduling requests, for new and return appointments:

Tier 1:  Patients who need to be seen in person by the provider before July 1

  • Clinical situation that could be compromised by delay in care and requires physical examination to support clinical decision-making

Tier 2: Patients who can be seen with a telephone or telehealth visit — can be scheduled at any time.

  • Follow up care where the physical exam is not essential to decision making
  • Key physical exam or imaging findings may be obtained by other means (e.g., PACS, photos, etc.)
  • Referrals/consults that can be assessed with a telephone or telehealth visit 

Tier 3: Patients who can be rescheduled or placed in the queue for scheduling when we resume normal business operations — can be placed in a queue to schedule an in-person visit at a later date.

  • Patient condition does not suggest clinical urgency
  • Family prefers an in-person visit
  • Clinic does not have capacity or ability to provide a telehealth or telemedicine visit
  • Referral/consult cannot be assessed with a telephone or telehealth visit

Q: Any other changes in scheduling?

A: Seattle Children’s Contact Center has shortened its hours to close to inbound calls at 5 p.m. rather than 6 p.m. New inbound calling hours are 7 a.m. to 5 p.m. Outbound calls will still occur until 6 p.m.

Q: Are surgeries continuing?

A: Yes. Patients are required to take a COVID-19 test within 72 hours of their surgery.

Q: Are there any changes to Seattle Children’s outpatient radiology services?

A: Yes. Families who need diagnostic x-rays at Seattle Children’s are now required to schedule an appointment.  We are no longer accepting walk-in patients. Families should call 206-987-2089 from 7 a.m. to 6 p.m. Monday through Friday to schedule an appointment. We will evaluate urgency and consider less investigative studies when appropriate.

We continue to offer our full range of imaging services at the hospital and clinics in Bellevue, Federal Way, and Everett. We welcome your referrals.

X-rays can still be done as part of an urgent care visit.

Q: Are there any changes to Seattle Children’s laboratory services?

A: Labs continue to be open to walk-in visits, with COVID-19 screening in place at entrances. Laboratory hours at our South Clinic in Federal Way and North Clinic in Everett have been slightly reduced to 7:45 a.m. to 4 p.m. on Saturdays (closed for lunch from 11 to 11:30 a.m.). Monday through Friday hours at these two clinics remain 7:30 a.m. to 6 p.m., closed Sunday. View our Laboratory Medicine and Pathology website for a full listing of all our lab locations and hours.

Q: Can families still use the hospital pharmacy?

A: In response to COVID-19, the Outpatient Pharmacy at Seattle Children’s hospital campus in Seattle now offers curbside pickup and mail order prescription options (some restrictions apply). Families who need to fill their child’s prescription on-site or request a refill should inquire with pharmacy staff to discuss pick-up or mail order options.

On-site pick up is still available 24 hours a day, 7 days a week at the hospital campus in Seattle. Prescriptions must be written by a Seattle Children’s physician.

Q: What are your visitor/caregiver policies?

A: Due to the surge in COVID-19 cases in our region and nationally, Seattle Children’s is returning to stricter guidelines regarding visitors in both our inpatient and ambulatory settings in order to protect the health and safety of our patients, families and workforce.  Outpatients will only be allowed a single caregiver effective Monday, Nov. 30.  Siblings may not accompany the patient and caregiver inside the hospital.

 

Changes at our Hospital Campus

Q: Are you accepting older patients?

A: To support regional hospital capacity, Seattle Children’s is prepared to accept transfers from other hospitals of pediatric and young adult patients up to age 30.

Q: If one of my patients is an inpatient at Seattle Children’s, what can they expect?

A: The clinical staff and providers at Seattle Children’s are trained on the identification, isolation and treatment of COVID-19 and other infectious diseases. At this point in time:

  • If an inpatient does not have cold or flu-like symptoms, they will continue to receive care without change.
  • If the primary caregiver has symptoms of fever or cough, they should not visit.
  • To protect our patients, families and staff from a possible exposure to COVID-19, we currently allow only two primary caregivers to visit a patient.

The situation with COVID-19 is evolving and procedures for patient care will necessarily change to best protect patients, their families and staff.

Q: Has your visitor policy changed?

A: To maintain the social distancing guidelines that have been proven to help slow the spread of COVID-19, effective Nov. 30 patients in both our inpatient and ambulatory setting will only be allowed a single caregiver.

Inpatient care visitor policy update:

  • All families may identify two caregivers for their child’s inpatient stay.
  • Only one caregiver may be at the bedside at a time.
  • The two caregivers will remain the primary caregivers for the entirety of the hospitalization.
  • The following exceptions will continue to apply:
    • Caregivers of patients at the end of life may request an exception
    • Patients whose caregivers are receiving discharge teaching
    • Siblings who are younger than 12 months of age and who are breastfeeding may remain in a room with the breast-feeding parent if the patient is in standard precautions

We will continue evaluating and adjusting our practices to maintain the safety of our patients, families and workforce throughout this rapidly changing pandemic. The visitor policy is subject to change quickly if the pandemic continues to worsen and if statewide restrictions are enacted.

Q: Are you screening visitors?

A: All patients and visitors are being screened for COVID-19 at our facility entrances. As we learn more about the coronavirus and the symptoms it can cause, we’ll continue to assess our entrance screening process and make adjustments as necessary to help keep our workforce members and patients safe. Based on recent findings about the virus, we have added additional symptoms to our entrance screening process.

View our screening algorithms for:

Visitors to the Lab who screen positive will be escorted to a negative pressure room to have their labs drawn, rather than diverted to the ED.

Q: Is Palliative Care still available for consults?

A: Seattle Children’s Palliative Care program has temporarily scaled back its on-site availability at the hospital to minimize the risk of COVID-19 to staff, families and patients.

Below are guidelines for consulting Palliative Care plus information about their revised staffing model.

1)   For new consults, Palliative Care will accept consults with the following criteria:

  1. Patients who are nearing or who are at the end-of-life, including pain & symptom management
  2. Goals of care consults
  3. Complex medical decision making

2)   Except as noted above, in general Palliative Care will default to phone and virtual check-ins with patients and families but will provide in-person care if the family/team feels this is necessary and it is safe to do so.

3)    Monday through Friday, the team has decreased staffing on-site with others working remotely.

  1. On-site staffing includes two clinical staff on-site for new consults and to see patients/families
  2. There is no change to after-hours and weekend staffing (one medical provider available via on-call or through the paging operator)

4)    All outpatient consults will be via telehealth.

5)    If you are unsure if a consult is appropriate at this time, or have any questions or issues that the Palliative Care team can support, please do not hesitate to reach out to the team any time, 24/7 through the hospital operator. The team is happy to support providers and teams on primary palliative care skills.

6)    For communication with the Palliative Care team, for general questions, and patient updates/information, please use the Palliative Care Program distribution list at PediatricAdvancedCareTeam@seattlechildrens.org. For more acute issues, please page our on call attending or APP through the hospital operator.

The Palliative Care team looks forward to the time when they will be able to ramp their services back up and engage in the incredible collaborative service to patients and families with partners at Seattle Children’s and in the community.

 

 

Changes to ED or Urgent Care

Q: Should PCPs send patients to Seattle Children’s Emergency Department?

A: Yes. Please send your patients to Seattle Children’s Emergency Department if they need emergent treatment (see the criteria for being admitted). We are open and have precautions in place to keep patients, families and staff safe. Please call our ED Communications Center first at 206-987-8899.

Q: Are there any changes to Seattle Children’s Urgent Care?

A: Our Urgent Cares continue to have capacity. Only one caregiver is allowed to accompany a patient to their appointment (i.e. no siblings).

 

 

Changes to Classes and Courses

Q: Are classes and courses continuing at Seattle Children’s?

A: Due to COVID-19, Children’s had to pause or significantly modify many education and training programs earlier this spring. A multidisciplinary work group has developed a plan to resume some high-priority education and training. The following categories have resumed:

  • Required competency — Resume Basic Life Support (BLS); Neonatal Resuscitation Program (NRP); Pediatric Emergency Assessment, Recognition and Stabilization (PEARS); Cardiopulmonary Resuscitation (CPR); and Pediatric Advanced Life Support (PALS).
  • Academic partner education (students) — Resume with a limited number of students.
  • Competency simulations — Resume high-priority simulations such as central venous line placement, Code Blue, Code Purple, and new space.

CME courses are being offered virtually. Check our website for details.

Safety remains our top priority. All training and education activities will follow strict infection prevention protocols. We will provide additional information in the coming weeks. Dates are subject to change based on the rapidly changing nature of the pandemic.

 

Additional Resources

If your patient has questions or is concerned about COVID-19, please refer to these resources from Washington State Department of Health:

For the most up-to-date information about COVID-19, please visit:

For additional information to support families, see:

Seattle Children’s Panel Discussions on COVID-19

  • COVID-19: The Seattle Children’s Experience: Seattle Children’s infectious disease and emergency medicine experts shared their experiences from the front lines at the epicenter of the COVID-19 outbreak in the United States. This event includes a Q&A on how to prepare. Watch the video.
  • Confronting Tragic Choices in the Midst of a Pandemic: Our regional disaster healthcare network is one of the few in the country that has been focused on planning around a severe pandemic. Watch our panel discussion on how decisions are made when resources are scarce.

Information Line for Families

Community members may call our COVID-19 information center at 1-833-987-2100 to learn how Seattle Children’s is responding to this pandemic or to schedule a COVID-19 test once it has been ordered by their PCP. The line is open 8 a.m. to 5 p.m., Monday through Saturday.

This information line does not provide:

  • Medical advice or symptom triage related to COVID-19 or other medical conditions. Families should talk with their primary care provider about care recommendations.
  • Test results or other information about COVID-19 testing. Families who were tested at a Seattle Children’s location should wait to be called with results.
  • Scheduling or cancelling appointments. Over the coming days and weeks, our clinics will call families to either reschedule or convert appointments to telemedicine or telephone visits when possible. Families should call their clinic directly for questions about upcoming appointments.