When health officials learned a Seattle Children’s patient tested positive for the novel coronavirus 2019 (COVID-19) in late February, it sent a ripple through health and scientific communities nationwide. It was the first example of community transmission in the state of Washington, indicating the virus causing COVID-19 had likely been spreading in Seattle and the surrounding region undetected.

It was a moment Seattle Children’s had prepared to face since establishing an incident command center more than one month prior. From this command center, teams from across the organization met to support advance planning and coordinate actions for a potential COVID-19 surge in the region.

“Before there were any confirmed cases in the U.S., Seattle Children’s anticipated the potential for an outbreak in our region,” says CEO Dr. Jeff Sperring. “Over the past several weeks, we have provided specialized training for our team, established strict protocols for health and hygiene, and consolidated essential supplies so we would be ready to protect our patients.”

Now other cities are turning to Seattle for insight on what to expect as the growing pandemic reaches their communities. InHouse offers a behind-the-scenes look at how Seattle Children’s is responding to this quickly evolving global health issue.

“Seattle Children’s is committed to taking a national leadership role in the response and understanding of this emerging pandemic,” Sperring says. “We are collaborating with local and national public health agencies as this complex situation evolves. We are also joining forces with our children’s hospital colleagues in the U.S. and around the world to learn from others and share our experiences so that children in other communities can benefit.”

Previous Ebola, H1N1 outbreaks provided a head start on planning

The Emergency Department (ED) and the inpatient units opened in 2013 were designed to have the space and the flexibility to make configuration changes as needed. This design helps protect staff and faculty members, while also giving patients what they need, when and where they need it. It was one of the many reasons Seattle Children’s was designated as one of Seattle’s Ebola Centers.

Seattle Children’s Emergency Department has established a curbside initial assessment screening for patients with travel or COVID-19 exposure history.

“As the tertiary pediatric care center in Seattle, we have to be ready for whatever comes, whether it’s an infectious disease or an exposure or an earthquake or anything like that,” says Dr. Tony Woodward, medical director of Emergency Medicine.

In preparation for the anticipated influx of patients, Seattle Children’s built a tent outside the ED to increase capacity to see patients.

“We may use that as an auxiliary waiting room similar to what we did with H1N1. We may use it as an area to see patients who are less sick and don’t require all the resources in the ED, to allow them to come in and go out very quickly without having to set foot in the hospital,” Woodward says.

Woodward and his team also established a curbside initial assessment screening, which allows patients to drive up to the hospital in their car for initial “valet” questions. If the patient has travel or exposure history or respiratory or other symptoms potentially suggestive of COVID-19, a nurse conducts a second curbside screening. If the nurse deems the patient should be isolated for their care in the ED, the patient parks their car in the designated parking area (nearby parking, no valet or medical staff enters the vehicle) and is provided a mask prior to entering the hospital.

Diana Johnson recently brought her 15-month-old son, Arden, into the ED for a severe stomach bug and respiratory infection. She was impressed by all the precautions she noticed upon their arrival.

“It really makes me feel safe bringing my medically fragile baby here,” she said. “I see it as a positive thing, not a scary thing. It’s really encouraging [that Seattle] Children’s is taking the COVID-19 illness seriously and that they’re prepared.”

Recent innovations in care delivery are helping. Precautions to protect patients and healthcare workers.

Patients showing potential symptoms of COVID-19 and who need to be cared for at the hospital are admitted to Seattle Children’s Special Isolation Unit.

If a patient is showing potential symptoms of COVID-19 and needs to be cared for in the hospital, they are admitted to Seattle Children’s Special Isolation Unit (SIU). This is a unique area of the hospital designed for situations such as this. The SIU was first activated during an Ebola outbreak in 2014. Seattle Children’s activated the SIU for COVID-19 at the beginning of March. The SIU has the ability to care for approximately 20 patients, with the ability to expand if needed.

“Right now, anyone who is admitted to the hospital with a respiratory illness is tested for COVID-19 and we use the appropriate isolation procedures to protect our patients and staff members until we see a negative test result. We’re utilizing our SIU to care for kids who have the respiratory symptoms of COVID-19, but also those who have a history that suggests they may have been exposed to COVID-19,” says Therese Mirisola, director of Infection Prevention.

In addition, Seattle Children’s has increased the use of telemedicine to care for patients in the ED and the SIU. Virtual care technologies like telemedicine help the hospital address two mounting concerns.

“By limiting the number of times the care team and other staff members need to go into a patient’s room, we not only help prevent exposure to and the spread of COVID-19, but it also helps us conserve personal protection equipment (PPE),” Mirisola explains. “Right now, that’s a paradigm shift. I want to protect children from exposure to the disease while they are in the hospital, but I need to protect my workforce as well.”

Seattle Children’s is also offering testing for workforce members who have symptoms of COVID-19 as another way to monitor the health of its employees and limit spread of the illness. The testing site offers drive-through, walk-up or bike-through nasal swab testing with results available in 48 hours.

New research to understand SARS-CoV-2 (the virus that can cause COVID-19) in children and adults

At the Center for Global Infectious Disease Research at Seattle Children’s Research Institute, researchers have rapidly pivoted their efforts to begin research on SARS-CoV-2.

One such research study that’s awaiting approval to begin as soon as next week seeks to understand why children don’t seem to be getting as sick from this particular virus compared with adults, which could provide insights into treatment for individuals with serious COVID-19 disease. The center’s co-director, Dr. Lisa Frenkel and her colleague, Dr. Whitney Harrington, both pediatric infectious disease specialists, want to apply their past experience examining the differences in children and adults infected with HIV to the current pandemic.

If approved, their proposed study would track 500 Seattle Children’s employees and their immediate family members for one year.

According to Harrington, this will provide valuable epidemiological data from a community cohort on who’s becoming infected, when they’re becoming infected, and who’s getting sick from the infection. The researchers also hope to compare the immune responses of study participants who develop no or mild symptoms to those who develop COVID-19 using a systems biology approach.

“It’s unclear whether children are less susceptible to infection or whether they acquire infection at the same rate as adults,” she says. “That’s one of the key questions we want to understand in our study.”

On the frontlines of testing a coronavirus vaccine candidate in humans

Dr. Rhea Coler and her team at the Coler Lab are lending their expertise to support research on an experimental coronavirus vaccine.

The Coler Lab at the research institute is using their expertise to support the clinical trial of an experimental coronavirus vaccine funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the U.S. National Institutes of Health. The trial is being conducted at the Kaiser Permanente Washington Health Research Institute in Seattle, part of NIAID’s Infectious Diseases Clinical Research Consortium. It is the first trial in people of any vaccine for SARS-CoV-2.

In collaboration with Kaiser, Dr. Rhea Coler, senior investigator in the Center for Global Infectious Disease Research, is leading a team of Seattle Children’s researchers who will isolate cells and plasma from the blood samples of study participants receiving the experimental vaccine. Investigators at NIAID’s Vaccine Research Center, who worked collaboratively with ModernaTX, Inc. to develop the vaccine, will then conduct the initial analysis of the clinical samples. The information gained from the analysis of these clinical samples will be used to determine whether various doses of the vaccine induce the types of immune responses that may offer protection against SARS-CoV-2.

“Our collaborators at Kaiser immunized the first individual in this trial yesterday,” Coler says. “That’s just over 60 days of the virus being sequenced, which is amazing. It is a timeline that has never occurred for past vaccines, and it has only happened because everyone is coming together to work on this as efficiently and rapidly as we can.”

Western Washington-based consortium solving the structural secrets of the novel coronavirus to aid vaccine, drug development efforts

Another collaborative research effort led by Dr. Peter Myler, principal investigator, has already contributed findings about SARS-CoV-2 for vaccine development efforts, and new knowledge generated daily is expected to aid in drug development.

Dr. Peter Myler is lead investigator for a consortium working to solve the 3D structure of proteins from infectious disease organisms, information that can be used to develop vaccines, new drugs and diagnostics for clinical use.

Myler serves as lead investigator for the Seattle Structural Genomics Center for Infectious Disease (SSGCID), a consortium funded by NIAID. The consortium includes teams from the research institute, pharmaceutical company UCB, the University of Washington and Washington State University. The consortium works to solve the 3D structure of proteins from infectious disease organisms and give insights into their function. That information can then be used to develop vaccines, new drugs and even diagnostics for clinical use. To date, SSGCID has solved more than 1,250 protein structures, including 2 from SARS-CoV-2.

“Within two months of having the sequencing information, our cryoEM lab — headed by David Veesler at the University of Washington — solved the viral surface protein,” Myler says.

“One of the things that can be difficult to understand is why we do this type of basic research. I mean, who cares what a protein looks like? Well, one reason is so that we’re ready when a threat like COVID-19 emerges and we can move very quickly to get the answers needed to help make an impact against the disease,” he continues.

Though children appear less affected by the virus, it’s vital to ensure their social and mental wellness

Children and teens trying to make sense of what the COVID-19 pandemic means for their families and communities may feel more worry than usual. Any caregiver can take steps to help children and teens cope during this stressful time, which may include illness, disruption to normal routines and feelings of isolation resulting from measures to slow the spread of COVID-19 in the community.

Start by talking to your child about COVID-19 and address their concerns with facts. Caregivers can support children who are sick at home by choosing activities they can do with ease beyond TV, video games and the Internet. Fending off boredom and restlessness in healthy children at home due to school closures is another concern top of mind for parents and caregivers. Child development experts recommend keeping children of all ages stimulated throughout their day by introducing new types of play and learning activities.

For children receiving care in the hospital, child life specialists provide age-appropriate play that also adheres to any infection prevention precautions in place.

“Many children in the hospital are unable to visit with siblings, friends or extended family members due to visitor restrictions to limit the spread of COVID-19,” says Dr. Ruth McDonald, vice president and chief medical officer. “We know this can be stressful for both the caregiver and the child, so any outlet we can provide to our patients to help them play normally or connect with the outside world is especially important now.”