Provider FAQs – COVID-19

Updated August 2022

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Information about COVID-19 Vaccines

Q: Is the COVID-19 vaccine available at Seattle Children’s?

A: Yes, we offer the Pfizer and Moderna vaccines. For details, visit our COVID-19 information page.

Q: Do you screen kids to see if they should have the vaccine?

A: We advise families to talk with their PCP about any questions or concerns related to the vaccine and their child’s medical needs. We will ask some screening questions at the appointment to confirm this is the right time for the child to receive the vaccine, but our vaccine clinic staff will not be able to advise families if any underlying health conditions could stop them from receiving the vaccine or should be considered before receiving it.

Q: When and where are appointments available?

A: WE offer the vaccines at our main hospital campus, Odessa Brown Children’s Clinic (OBCC), our South Clinic in Federal Way and through some school-based clinics. Appointments are required and must be made via our scheduling portal. We do not offer walk-in vaccinations.

Q: Are there any precautions to receiving the vaccine for individuals with underlying conditions?

A: We recommend following the guidance of the CDC’s ACIP on this matter.  See “Considerations for vaccination of people with certain underlying medical conditions” on the CDC website.

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

A: The CDC recommends the vaccines for everyone age 6 months and older unless they have had (a) a severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the COVID-19 vaccines or (b) immediate allergic reaction of any severity to a previous dose or known (diagnosed) allergy to a component of the vaccine.

Q: Does the vaccine have side effects on kids?

A: Like adults, children may have pain, redness or swelling in the arm where they got the shot. They also may experience tiredness, headache, muscle pain, chills, fever or nausea. Symptoms are usually mild and go away in a few days. Some people have no side effects.

Q: What is the risk to children of myocarditis or pericarditis from the vaccine?

A: CDC is monitoring rare reports of myocarditis and pericarditis following COVID-19 vaccination which mostly have occurred in male adolescents and young adults age 16 years or older. Symptoms were temporary (up to a few days) and included fatigue, chest pain, and disturbances in heart rhythm. There were no deaths. CDC continues to recommend COVID-19 vaccination for everyone 6 months of age and older, absent allergic reaction to a previous dose of the vaccine or a vaccine component.

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 COVID-19 Testing and Treatment

Q: Are you offering testing to the public?

A: Seattle Children’s offers COVID-19 testing for patients ages 20 and younger who have symptoms or have had close contact with someone who tested positive for COVID-19. A referral is required. For complete details, see COVID-19 Testing Information.

Q: What criteria should community providers use when referring a patient for COVID-19 testing?

See below and please follow the criteria Seattle Children’s uses for testing its own patients.

Q: Who is Seattle Children’s testing for COVID-19?

  1. Any patient with signs or symptoms potentially consistent with COVID-19 who is at high risk for progression to severe COVID disease (see list of risks on CHILD), 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.
  2. All Seattle Children’s patients two days prior to a planned aerosol-generating procedure (AGP), unless they tested negative within the last 7 days and have been continuously hospitalized without new respiratory symptoms.
    1. Outside PCR (nucleic acid amplification) test results from NP/middle turbinate swab samples are accepted if the patient was tested within 48 hours, they have stable symptoms, and they are not considered to be at high risk for COVID-19. Results should be visually confirmed and sent to HIM to be entered in the EHR. To summarize, what tests are “accepted” versus “not accepted”: Anterior nasal swab specimens are also acceptable when obtained from asymptomatic patients.
    2. Accepted vs. not accepted:
      • ACCEPTED: Molecular tests (NAAT, PCR) that are “rapid” (e.g., Cepheid, Biofire) or “regular” (e.g., ours, Hologic, Roche, Abbott Alinity, etc.) and performed in accredited laboratories.
      • NOT ACCEPTED: Any “Antibody” test. Any “antigen” test with a negative result. Some molecular tests (NAAT, PCR) with known poor performance (example: Abbott ID Now). Any test result that lacks details about the platform or test method.
    3. If you are presented with a test result from an accredited laboratory but you are uncertain about the acceptability of the test, please find the test on the FDA website (Diagnostics EUAs – Molecular Diagnostic Tests for SARS-CoV-2 | FDA) and then call the SCH Microbiology Laboratory with this information (test name and performing lab) and ask for ‘Director Review’ of a COVID-19 test platform. Drs. Murphy and Bell will review with SCH Microbiology Staff.
    4. 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.
    5. For patients who previously tested positive for SARS-CoV-2, please see COVID-19: Testing Previously Positive or Exposed Patients Prior to Procedures with AGPs, 12944.
    6. All patients with ongoing AGPs should be tested for COVID-19 every seven days.
  3. Asymptomatic patients who are:
    1. Hospitalized newborns born to parents with suspected or proven COVID-19
  4. All patients at admission to the hospital.
    1. Note: NICU infants for whom swabbing may be injurious, may have lower respiratory tract samples submitted if possible. If this is not possible, and the patient’s previous test is negative and they are asymptomatic, repeat testing may be performed at the discretion of the care team.
  5. Previously positive inpatients:
    1. Patients will be cleared from Airborne Strict Isolation by IP and placed in Strict Isolation for 30 days.
    2. No testing is required unless the patient develops symptoms consistent with COVID-19.
      • If a patient becomes symptomatic and tests positive, the recurrent infection must be considered
    3. Patients who are admitted during active COVID infection, who are cleared from both COVID isolation and 30 days of AGP isolation, should not be retested prior to AGPs for 90 days if they remain asymptomatic. (90 days starts from the start of COVID infection/isolation period.)
  6. Pre-BMT patients: will be tested per SCCA protocol.
  7. Heme-onc patients:view section at the end of this document for further information.
  8. We DO NOT test the following groups: asymptomatic patients not meeting the above criteria.
    1. Asymptomatic outpatients not being admitted
    2. Ambulatory symptomatic patients not being admitted and who are not at high risk of severe COVID disease
    3. Close contacts with exposure who do not meet one of the testing criteria above

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 the 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).

  • ACCEPTED: Molecular tests (NAAT, PCR) that are “rapid” (e.g., Cepheid, Biofire) or “regular” (e.g., ours, Hologic, Roche, Abbott Alinity, etc.) and performed in accredited laboratories.
  • NOT ACCEPTED: Any “Antibody” test. Any “antigen” test. Some molecular tests (NAAT, PCR) with known poor performance (example: Abbott ID Now). Any test result that lacks details about the platform or test method.

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 unless they have proof of full vaccination. 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:

  1. If suspicion for COVID-19 is high, a second test should be obtained, preferably from the lower respiratory tract if possible.
  2. Well-designed PCR tests for SARS-CoV2 have high analytical sensitivity, but clinical sensitivity is unknown due to lack of clinical gold standard.
  3. Clinical sensitivity is dependent on day of illness and the viral load (viral load is lower later in the illness).
  4. 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.
  5. 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 difficult) to obtain a lower tract specimen from a pediatric patient.

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 the above is not possible or feasible: consider repeating the middle turbinate (MT) swab or nasopharyngeal (NP) sample

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 NP swab
    • Positive: SIU
    • Negative:
      • A 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 will I know if you are treating my patient for COVID-19?

A: You will receive our standard fax communication regarding ER summary, admission, discharge etc. You can expect to receive a copy of our standard lab report via fax within 48 hours of the test. (Please note: inconclusive results are being treated as “positive” until confirmed by the State or CDC.) If you don’t receive your results within the time expected, please call our clinical lab at 206-987-2102 for assistance.

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

A: We send results to the provider who ordered the test. If we order the test, we notify the patient’s PCP as well as the family, and ask the family to direct any questions to their PCP if their test is negative

Q: Does Seattle Children’s offer antibody testing?

A: Yes, two types.

Seattle Children’s offers the Abbott SARS-CoV-2 IgG nucleocapsid and spike immunoassays on the ARCHITECT instrument. These are chemiluminescent microparticle immunoassay (CMIA) used for the qualitative detection of IgG antibodies to SARS-CoV-2 nucleocapsid or spike protein in human serum and plasma.

Antibodies to the spike protein should be detectable after natural infection or vaccination (antibodies to the nucleocapsid protein are only detectable after infection).  It is not yet known how long antibodies will be detectable in blood.

These tests are not FDA-approved for diagnosis of infection due to SARS-CoV2; however, the data presented in the package insert demonstrates they are 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.

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 persistent COVID-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

Ordering antibody testing

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.

Sensitivity: According to the published series, at 2 weeks after the 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.

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

A: According to the CDCadults 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), diabetes, obesity (BMI 30 or higher), pregnancy, smoking, substance use disorders, sickle cell disease, and trisomy 21. Children with underlying medical conditions are at increased risk for severe illness compared to children without underlying medical conditions. Current evidence on which underlying medical conditions in children are associated with increased risk is limited. Current evidence suggests that children with medical complexity, with genetic, neurologic, and metabolic conditions, or with congenital heart disease can be at increased risk for severe illness from COVID-19. Similar to adults, children with obesity, diabetes, asthma or chronic lung disease, sickle cell disease, or immunosuppression can also be at increased risk for severe illness from COVID-19.

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).

Information about Visiting the Hospital

Q: Are you screening visitors?

A: Yes. 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.

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.

See our Visitor Information and What to Expect

Q: Are lab and radiology still offering walk-ins?

A: Yes.

Q: Can families still use the hospital pharmacy?

A: Yes. On-site pick-up is 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.

Our pharmacy also offers curbside pickup at the hospital 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.

Changes to Inpatient Care

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.

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

Changes to ED or Urgent Care

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

A: Yes, patients who truly require emergency care should come to the ED.  Seattle Children’s is experiencing very high inpatient and ED volumes at this time. See our ED or Urgent Care Referral Guide if you are not sure whether to send them. If you are sending a patient, please call our ED Communications Center first at 206-987-8899 and let the family know the ED is at full capacity to set expectations.

We ask that providers continue to manage patients in outpatient settings whenever possible.  

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

A: Our Urgent Cares are open but have limited availability. We have some limited walk-in availability daily, but due to overwhelming demand, there have been days when we need to redirect urgent care patients elsewhere. Please encourage families to schedule online to ensure appointment availability. Appointment slots open at midnight for the upcoming day.

Additional Resources

If your patient has questions or is concerned about COVID-19, please refer to these resources from the 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.