Managing your Health as our Communities Re-Open Virtual Town Hall

(gentle music) [HealthONE Managing Your HealthAs Our Communities Reopen] [Virtual Town HallDiscussion May 28, 4-4:45pm] – Dr.

Reginald Washingtonis a pediatric cardiologist [Maureen McDonaldAVP Community Engagement, HealthONE] who serves as the chief medical officer for Presbyterian/St.

Luke's and Rocky Mountain Hospital for Children.

Dr.

Washington is veryactive in the community, serving on several boards of nonprofit organizations.

I'm gonna start with you, Dr.

Washington, and invite you.

I've asked our speakersto share opening remarks addressing what we need to know about the spread of the virus, staying safe as our communities reopen and what is projected for the future as we work to control the spread.

After our— Thank you, Maureen.

– Yes, after our physician remarks, we will look forward to a dialogue.

And we'll welcome your questions and insights, members of the audience.

So those of you that are listening have been muted.

And the best way to ask a question is through the Q and A feature, which should be on theright side of your screen.

You can send in a question anytime, and some of you sent in questions in advance of this, andwe have them right here and I'll be posing them to our speakers.

We'll be looking at your questions and we'll ask them of our experts when the dialogue portion begins.

So I'll let you take itaway, Dr.

Washington.

Thank you so much.

– Thank you, Maureen, and thank you for all of you who have taken time out of your busy days to participate in this dialogue.

[Reginald Washington, MDChief Medical Officer] [Presbyterian/St.

Luke's Medical CenterAnd Rocky Mountain Hospital For Children] And we do encourageyour questions and input as we go through this afternoon.

We do realize that asthe community opens up, in Maureen's remarks, she mentioned that the governor has allowed various businesses to open, and we encourage that.

We also realize that people have a reluctance to go toa healthcare provider, including a hospital, because there's this widespread notion that hospitals are full of patients with COVID-19 and that they're very likely to get infected if they come to one of our facilities.

So one of our purposes of this afternoon is to assure you that we have taken extraordinary steps to assure you that we will protect you, as well as patients and families, so that that event will not occur.

Let me review quickly some of the things that we have done.

We have limited access points to enter our facilities.

Simply put, there's several doors that will not be available to people to enter the hospitalor the emergency room.

We do this in an effort to allow us to screen patients, families and visitors.

We ask questions about their symptoms, if they've been exposed to someone with the COVID virus.

We also take their temperature using a non-touch technique.

Once someone has passed that screening, we give them a mask and we request that they wear this mask whenever they're in our facilities.

This is not only for your protection, but to protect others as well.

We take this part of our mission very, very seriously.

We do not want anyone to feel like they're at risk if they come to one of our facilities.

In addition, we have a way to monitor how patients travel throughout our facility.

If you're coming, for example, for an elective procedure, be that a surgery or an imaging, an X-ray or something of that sort, we have a special entrance that we would like people to use.

Again, we do this to limit traffic and how one transversesthroughout the facility.

Rest assured that we do have patients with COVID within the facility, but they are isolated not only from other patients, but the staff that care for them are isolated, so there won't be anycross-caring involved.

We do this so that if youcome into our facility for a particular procedure or surgery, you will not come in contact with anybody who is suspected or has been diagnosed with the COVID virus.

We also limit visitors.

We do understand that when a patient is in the hospital, part of their healing involves care and family visits, but we do limit the number of visitors, again, to keep that social distancing possible.

Finally, we have taken and removed all vending machinesand self-service things within our hospital.

We do this, again, to protect people from being exposed.

So you can get good, nutritious foods and drinks within the hospital, just not in a self-service environment.

Again, let me emphasize we do all of these things to assure you, your family and all our visitors that they will be in the safest environment possible.

Maureen, I'll turn it back to you.

– Okay.

I will ask you some of the questions that have come across the transept already, Dr.

Washington.

One is we've been told by our doctor to quarantine for two weeks before our baby is born, as well as those who will have exposure to the baby will needto have self-quarantined for two weeks before they interact with our new baby.

Can we get clear guidelines on how quarantine is defined? For example, can we be outside with masks on and practicesocial distancing, and consider that being in quarantine? – First of all, I don't want to contradict any medical advice that anyone has received.

If you have questionsabout a particular piece of advice you receivedfrom a healthcare provider, you should go back and get clarification from that provider.

Having said that, we do think that everyone who is going to come to a hospital for anything should limit their contact with people for at least seven days or so prior to that visit, if possible.

Now, what does that mean? That means you should avoid (audio cuts out) know if people are doing exactly what they're supposed to be doing.

So for example, you don't wanna go to a mall or to a department store or to a grocery store where some people are wearing masks and others are not.

You shouldn't go to those environments unless it's absolutely necessary.

You shouldn't be exposed to people who may or may not have symptoms.

And the more people you're exposed to, the more possible that exposure might be, so we ask you to isolate yourself from that kind of environment.

We do ask you to dometiculous hand washing and, obviously, wear your mask and avoid contact with your face and with your maskwhile you're wearing it.

Make sure the mask covers your nose and your mouth, not just your mouth.

So those are the commonsense kinds of things.

Certainly, if you're coming in contact with somebody who you know is sick, please avoid that, evenif it's a family member.

So I think those are kinda general guidelines to observe.

– Thank you.

There's another question about children.

My daughter is 18 months old and has been home fromdaycare since March.

We've been able to work at home and maintain our employment, but we need to go back to work.

Is it safe for her to go back to the daycare center? And— Well, it's, yes.

– And if she goes, can she visit with her, my grandma, her grandmother? Her 65-year-old grandmother.

– [Reginald] Those aretwo separate questions.

The first is— Yes.

– Daycares have been provided some guidance on what to do to assure the safety oftheir young customers.

Certainly, we think thereshould be limited numbers of children in various rooms.

That number depends onhow big the area is, but certainly it should not be as crowded as it was before the pandemic started.

Also, it's strongly encouraged that once you're in a room, you stay with those kids in that same room.

In other words, you don't go from room to room, visit to visit.

Also, the same is true with teachers.

It's a good idea that the same teacher be with those childrenthroughout their stay in the daycare center.

It is important that parents, as well as teacher, wear masks.

They practice very good hand hygiene, wash their hands, et cetera.

And certainly, if anybody has any symptoms that suggest they might be coming down with any illness, COVID or anything else, they stay away from the daycare center.

It's also very importantthat the daycare center wipe down the surfaces very, very often and do it very thoroughly.

Now, with those precautions, we feel that daycare centers will probably be safe.

As far as visiting with somebody who might be at risk for having a bad outcome from COVID, I think you still need to practice that safe distancing.

And so I probably would be a good idea not to let that young infant visit, unfortunately, with a grandparent until we know more about how this daycare center issue is going to play out.

If it were me, I know it's difficult, particularly for the grandparents, not to see their grandchild, but I think I would be more cautious as soon as daycare centers open up to see how that's going to play out.

That's my personal advice.

– Thank you so much.

We will come back to many other questions that we have, but at this moment, I'd like to invite our other speaker, Dr.

John Hammer, to weigh in.

And we just saw him.

We are having some technicaldifficulties today, so we may have some issues there.

But I believe that Dr.

Hammer is on the line.

– [John] Yes.

– And may I introduce Dr.

Hammer as a specialist in infectious disease and the person who serves as the president of the Department of Medicineat Rose Medical Center.

So Dr.

Hammer, I will let you take it away in terms of what you were going to discuss related to the epidemiology of the virus, mentioning your thoughts about a potential vaccine and the spread of the virus here in Colorado.

– [John] Thank you, Maureen.

– Oh.

– Good afternoon.

– Can others hear Dr.

Hammer? No, we can't hear you.

(John speaks too low to hear) Let's see if we can give Dr.

Hammer a moment to try something different because we can't hear him.

– [John] Oh.

– [Maureen] Is that you, Dr.

Hammer? Can you? – Yes, can you hear me now? – [Maureen] Yes, yay! (claps) – [John] I'm not reallysure what happened.

(Maureen laughs)- Okay, wonderful.

Good to see you.

– Great, yeah, I justmissed a lotta things.

Okay, good.

So thanks for the opportunityto be here and discuss [John Hammer, MDInfectious Diseases, Rose Medical Center] kind of, what I'd like to do is start by discussing a brief timeline of the Colorado experience with COVID that we've experienced overthe course of the last, it's only been three months, but it feels like it's been about a year.

Our experience in Colorado, certainly we were looking at the epidemic, the pandemic as it spread around the world.

And you would see thispattern starting in China, where you would have scattered cases.

Actually, the firstcases were probably there in mid-November.

They gradually kind of trickled along until they accelerated in their number in late December, and the Chinese authorities identified and described the SARS-CoV-2 virus, which is the cause of COVID-19.

We saw similar things happen, really, around the world, starting in Southeast Asia, but then in Iran, Italy, Spain, France.

Again, now we have evidence that there was probably ongoing transmission for weeks before we saw this rapid escalation of cases that threatened to overwhelm the medical systems there.

So you see a pattern of introduction, followed by rapid acceleration, or slow acceleration, then rapid to the point of where you have a surge of cases that can overwhelm a healthcare system.

So in Colorado, I turn back to late February when the state health department received our first testing supplies from the CDC to test the PCR, the test looking for the RNA in the virus.

And it was only week later, on March 5th, that we identified our first case.

Actually, it was a traveler, someone who was visiting a ski resort.

I'll get to that (laughs) in a second.

But he had been, he was from California, but he'd actually been in Italy, where they had a largeoutbreak prior to that.

So within five days, Governor Polis declared a state of emergency, requesting funds fromthe federal government.

And at that time, there had only been 17 cases reported, but he was trying to get ahead of the curve 'cause I believe we all saw what was coming.

By March 26th, the Stay-at-Home Order was then declared.

At that time, we had500 hospitalized cases and about 60 deaths.

Well, over the course ofthe next three months, we had 24, 000 known cases.

There have been only 160, 000 tested, so the actual number of cases has certainly been muchgreater than 24, 000.

We've seen cases from 60 counties.

Certainly, some counties are better represented than others in terms of their numbers.

We've had 271 outbreaks in facilities, over 4, 000 patients hospitalized with over 1, 100 deaths due to COVID-19 to date.

Fortunately, with theStay-at-Home measures that were put in place, we finally, we started to see a peak of the numbers of positive cases, with the percentage of positive tests peaking the week of April 14th at around 25%, and decliningjust a couple days ago to less than 5%, whichis certainly welcome.

We've also seen the number of deaths, it peaked a little bit later, as we typically see, the week of April 19th.

And now we see a great, a really relief to our medical system as the number of deathsand cases fall off.

So on April 26th, we were able to switch, the governor switched to a Safer at Home status.

This basically allows local governments to relax their measures as they see fit.

Basically, comprised within that, there's been a slow rollout of activities that can be practiced around the state.

Spring skiing will be opened up, private campsites, in addition to the state-held parks.

In-person dining, as of yesterday, at 50% capacity is to be allowed as long as appropriate measures are put in place.

Children's summer daycamps are set to open on June 1st.

So what does Safer at Home mean to us, to the general population? It's still recommended that we stay home as much as possible.

It's still recommendedthat we wash our hands on a regular basis, especially when we're out in the community.

It's still recommended that we wear face coverings or maskswhen out of the home, especially when you'rein an indoor setting where you can't control your environment.

And it's recommended that we not travel between communities.

Staying within roughly10 miles of your home is generally recommended.

But the most important thing, in my mind, is that we continue to recommend for those that are at higher risk of severe disease, that they stay at home, they stay in place.

That we put a cocoonaround that population to protect them from potential infection that could be devastating.

So in addition to that, the state health department is planning on increasingtesting dramatically, hopefully.

And they're also planning on increasing contact tracing associatedwith that testing, where we try to find cases associated with positive tests.

So, again, the question's been raised, why does Colorado have more cases than our neighboring states? Certainly, Nebraska, probably related to the meatpacking facilities.

Arizona, they've had issues, not as great as ours, though.

And I believe that it's likely because of that first case that I mentioned as an example.

It was probably the ski industry that brought people into our state from around the countryand around the world to ski, as we saw our first outbreaks in our resort communities back in early March.

So at this point in time, we've contained the spread.

Our COVID cases are down.

The hospitals are opening up to more routine servicesthat we need to do because there are otherillnesses out there that need to be treated.

But what can we do to protect ourselves and our family? I think the first thing toconsider is this concept of asymptomatic andpre-symptomatic spread.

Those people that have the virus may not be experiencing symptoms at the time, so they may be out in the community, hopefully with a mask, but maybe not, going to the grocery store and potentially spreading the virus.

So again, we need to remember to wear the mask, wear face coverings in case we are one of those people.

Remember, the masks are designed, the face coverings are not designed to protect ourselves.

They're designed to protect other people from our secretions.

And it really is important that if we're going to be in a closed environment where we might have tobe closer to people, it is important to try to contain that spread of, potentialspread of infection.

Now, as the importanceof respiratory spread has increased, hand washing has kinda fallen off as a likely cause of infection or transmission, but it's still there and it is important to wash your hands after you contact surfaces in the community outside your home.

Again, face masks are great, facial coverings are great, but, again, maintaining that socialdistancing is important.

And it's also important to remember that exposure riskbasically is a composite of both distance, how close am I to another person who may be infected, and of time.

Has it been 30 seconds? Has it been 10 minutes or more? With more time being associated with more risk.

Now I'll turn a little bit to testing.

So what modalities do we have for testing today? Right now, in the hospital and at our testing centers, et cetera, we use the PCR, which is basically a tool that diagnoses or that finds the RNA of the virus itself.

And we use that fordiagnosis of infection.

It's usually present atthe time of infection and probably prior to infection.

That is the primary test that we use, and we're trying, people are looking at more rapid antibody tests, but unfortunately, the history of antibody tests for respiratory viruses has not been great.

With the influenza, sorry, I didn't mean antibody, I meant antigen test.

The history, the influenza antigen test is really not sensitive at all, but people are working on that for COVID-19 as well.

Now, there's been a lot of talk about antibody tests, and antibody tests are basically tests that measure our immune response to the virus.

Now, there's a lot of issues with that.

First of all, there have been a ton, over 60 to a hundred tests, released into our country, but there've only been a handful that have been FDA approved under the Emergency Use Act, and none of those havebeen fully FDA approved.

So we have some tests that have some good data, but they haven't been really fully vetted by the FDA, and that's one concern.

But there are a few tests that are probably reasonablethat are out there.

The other problem thatwe have with antibodies, number one, they're not good for testing an acute infection, and you usually don't become positive until the second week of infection.

Number two, we don't really know whether antibodies are protective.

We think that they probably are.

If we look at people that have had COVID-19, they're very unlikely.

There hasn't been a case described of somebody getting infected twice yet.

So antibodies are probably protective for some duration, but wedon't know the duration of that protection.

It could be months, itmight be a year or two.

With the original SARS virus in 2003, the duration was abouta year to two years, and it gradually faded over time.

Antibodies are really important, though, when we try to look at how many, if we go back and look at how many people were actually infected.

We can go back and dosurveys of populations, we can look and see how many people, asymptomatic or symptomatic, were actually infected over time.

And that'll be important going forward as we learn more abouthow this virus behaves in our community.

Now with respect to vaccines, I'll do this quickly.

The question is always asked, why the heck does it take so long? And it does take a long time.

Vaccines typically are developed over a period of years, sometimes even decades, so to say we're going to have a vaccine in 12 months, 18 months, I guess it is possible, but it's gonna take a lot of work to get there.

Now, in describing the landscape, there are over 102 vaccine candidates that are out there right now.

Nine of those have reached phase 1 and phase 2 trials, andI'll talk about that a second, in a second.

But there are multiple different types of technologies being used.

Some of those have not even been used in an FDA-approved vaccine to date.

But every vaccine has to undergo a series of testing.

Usually there's animal testing, primarily, to make sure that itinduces antibody and works.

Then it goes to phase 1 testing in humans, which determines primarily safety and antibody response.

That's usually a small number of people, maybe 10, 20 people.

Phase 2, you get maybe tens or a few hundred people in a study that, again, looks at safety and dose finding, which doseis appropriate of vaccine.

And phase 3 studies are huge studies, usually 10, 20, 30, 000 people.

And, again, you're looking at safety because you need large numbers to look for odd events, but you also look for efficacy in the real world.

If you produce an antibody, that's great, but does it really protectpeople from infection? And that's usually important.

So if you have a vaccinethat makes it through all those hurdles, lookslike it's going well in phase 3, then youmight start production.

Production takes time, and we're looking at producing not millions, but billions of vaccine 'cause this is a pandemic infecting the entire world.

So my prediction, maybe next spring.

If we reach phase 3studies in this winter, maybe we'll have, start to get production of a vaccine in the spring, but we'll see.

– Thank you so much, Dr.

Hammer.

I really appreciate that.

And I do have a couple of questions, one for each of you.

I'm gonna go back to Dr.

Washington for this question about.

Can you talk, Dr.

Washington, about the COVID-19-linked syndrome that is impacting children? – Yes, thank you for the question.

There have been a series of children, first overseas in Britain and in Italy, and then in New York City and now throughout the United States, it's called the multisysteminflammatory syndrome.

What that simply means, multisystem means it's more than one organ.

So these children have symptoms involving multiple organ systems, and I'll describe thosein detail in a minute.

And it's a syndrome.

What a syndrome means, it's a collection of symptoms that seem to travel together.

So there's no one testto see if these children have this new syndrome, so we have to rely on acollection of symptoms.

They can be a variety of things.

Almost all these children had GI symptoms, so they have diarrhea or stomach cramps.

They usually have a rash.

They have very red soles of their feet and palms of their hands.

They can have cracked lips.

They can have redness in their eyes.

They can be irritable and just not feel very well.

Now, there is a previous syndrome called Kawasaki's that had a very similar collection of symptoms.

Kawasaki's has been around for about 30 or so years.

No one quite knows exactlywhat agent causes Kawasaki's.

Through the years, there have been various agents who have been implicated, but there's not one that has really been incriminated without some question.

But we do know most patients who have Kawasaki's are usually under the age of five and they usually have had a virus of some type prior to their onset of symptoms.

The reason Kawasaki's is important, that over time we have learned that a percentage of children who get Kawasaki syndrome develop abnormalities of their coronary arteries, and these can become quite serious.

They're not very common, but they can become quite serious.

And for that reason, children who have Kawasaki syndrome need to be followed for a number of years bya pediatric cardiologist, looking for the possibility of developing these symptoms.

So when this new syndrome came about, there was an uptick of the symptoms I described, and most of those children had evidence that they had either been exposed to COVID-19 or actually had COVID-19 themselves.

So if you look for antibodies that Dr.

Hammer's described, the majority of kids who have this new syndrome havepositive antibodies, but most of them did not have the classic symptoms of COVID-19.

So that's what it amounts to.

We've had several cases in Denver.

We've had three or four cases at the Rocky MountainHospital for Children.

Children's Hospital of Colorado has also had several cases.

And now because of this smattering of cases throughout the world, the Centers for Disease Control, the World Health Organization, the American Academy of Pediatrics and others now request that any physician who sees a child with this syndrome report that so that we begin to track them and figure out what'sgoing to happen to them.

But we don't believeit's Kawasaki syndrome.

We believe this is separatefrom Kawasaki syndrome.

So the only other thing I would remind everybody who's on this call is that if you have a child who develops any of those symptoms, again, a fever, redness of their soles of their feet or the palms of their hands, a rash, irritability, some GI symptoms, sometimes a headache, take your child to thenearest healthcare provider do make sure they do not have this collection of symptoms that we call this syndrome.

It's important because some of these kids can become quite sick, some of them requireadmission to the hospital for observation, so donot take it lightly.

– Thank you, Doctor.

I heard you say earlier that we've seen some resistance or reluctance on the part of people to come and use the emergency room.

Certainly not just in our system, but nationwide we're seeing a drop in people coming to the emergency room for heart events and stroke events and things like that.

And it sounds like for, in the cases of these pediatric symptoms, we should be sure that people feel very comfortable goingto the emergency room or going to their healthcare provider.

– Two points you make, Maureen, in that comment.

First of all, if you feel like you need to see a healthcare provider, you're having symptoms of anything, you're absolutely correct.

There have been patients who have been documented to have a stroke who did not wanna seek medical attention because they did not wanna come to a hospital or an emergency room because they had fear of catching COVID-19 when, in fact, they were having a stroke.

There are patientswho've had heart attacks, documented heart attacks, who would not seek medical attention because of that fear.

And to tell ya how extreme it can be, there was a patient, not in Denver, but there was a patient who was scheduled for a liver transplant.

A donor was identified.

The patient was preparing to go to the hospital to receive his new liver, and then turned around and said, “I'm not gonna go because “I might get COVID-19.

” The point of all of that is if you need medical attention, by all means, seek medical attention.

Most all hospital facilities have mechanisms in place to really limit your exposure to COVID-19.

The other thing I would mention, if you're going to anyhealthcare provider, if you have symptoms that are similar to COVID-19, please notify the healthcare facility that you have these symptoms so they canisolate you immediately.

That is also true if you're calling the EMS service and you're having respiratory symptoms orbeen exposed to COVID-19.

It's a very good idea to alert that facility or the EMS that you have that so you can be isolated.

– So when you call 911, you should say that so that your ambulance driver would know.

– Absolutely true.

And in addition, all EMS now, because they can never be certain, are taking extraordinary precautions to protect themselves, and they also do an extraordinary job of cleaning all their instruments, their facility, theirambulance, their stretchers.

All of those things arevery meticulously cleaned in between transporting patients, so don't be fearful of that, either.

– Great, thank you.

Thank you, Dr.

Washington.

Dr.

Hammer, I have a question for you that came across the line.

Why are people with diabetes and other underlying conditions at higher risk? Why is that? – That's a great question.

You know, as Dr.

Washingtonwas talking about, this inflammatory syndrome in kids, it behaves like, it'swhat we call a vasculitis.

Basically, it affects orinflames blood vessels.

And we actually see this in our adults with severe disease as well.

We see increase incidence of both venous blood clots, clots going to the lung.

We see arterial issues as well.

There have been young people with large vessel strokes in New York, again, where you had a lot of infection, who were found to be positive for the COVID by PCR.

So I think that the common denominator amongst those with diabetes, heart disease, hypertension is that all those havevascular disease components.

And I think that whatwe're likely to find, and, again, there's a lotta research going into this right now, is that they're predisposed to having this endothelial, basically the infection of the lining of the blood vessel by virtue of the fact that they have underlying disease in the first place.

But it's a great question.

And, again, we get reams of information coming out on this onan almost daily basis, and it'll be a field of research for months and years to come.

– So we're coming fairly close to time.

I'd like for you both to comment in order, and I'll ask Dr.

Washington to go first, on this notion of sort of as we reopen our communities and as we are making decisions about the risks that we are deciding to take, whether it'sto see our grandchildren or to get together with another couple for dinner, social distancing and safe with two different tables and meals or whatever it is, we've heard you say keep that mask on.

We've heard you say limit the number of people you're with.

So I think about this insort of some quadrants, time and space.

How much time you're exposed.

What the space distance is for people to actually move about.

How many people you're seeing and where you are.

If you're outdoors, which sounds like it's a lot safer than indoors.

Is that correct? So if people are thinking through what risks am I, Maureen, willing to take as I begin to live my life more fully and go outside my house sometimes, as I'm weighing the difference between going to the grocery store or going for a bike ride by myself, I should be thinking with this lens on of time and space and people and place.

– [John] Undoubtedly.

– How else would you add to that or how else would you describe how you and your families are handling COVID? – Yeah, great question, Maureen.

I think that we're at a period now, we're kind of moving into what, for better or for worse, is a new normal.

And we're all going to have to make these choices over time.

And these choices, over a period of weeks and months, may change over time as the incidence of the disease kinda ebbs and flows.

And hopefully we see a continued decline in infection, but I thinkeverybody fully expects that it will be coming back, to some degree, hopefullyin a manageable degree.

So when I go outside, I think of just the thingsthat you think about.

Certainly when I'm out of doors, the risk of transmission is much less.

There's never reallybeen a described outbreak associated with an outdoor exposure.

There was one in China, but it was prolonged face-to-face exposure outdoors.

So I think, and mostscientists will agree, that you're looking at volume, the amount of virus that is taken in by a breath, and in the outdoor setting, you have dispersal of virus to the point where you're not going to see the amount that's required to actually get infected.

Likely, it is much less.

Again, if you're doing those other things, primarily practicing social distancing, if you stay six to 10 feet away, if you're wearing a mask if you have to be closer to people, all those things still come into play.

And at least for the foreseeable future, until something changes dramatically, hopefully for the better, I don't see that as changing too much.

Again, from the social standpoint, I think it's important, as well, that we gradually are going to need to expand our social circles.

We can't just live withour families forever.

I know that it's incredibly stressful in everybody's home I've spoken with.

And so our kids need to be able to interact with other kids.

It's what developmentally they have to do.

And so we have to figure out ways to make that safe.

I understand that the schools are coming up with methods to make school a safer experience.

But again, we need to start to slowly open the tap, do things on an incremental basis and monitor the disease as we do that so we don't get to a point where we have escalating, rapidlyescalating infection.

And again, all the while, we need to try to do all we can to protect those vulnerable populations, the elderly and those peoplewith multiple disease, or multiple underlying illnesses.

– That's very well said, and I won't repeat any of that.

What I will mention is that we have to pay particular attention to our children becausethis is all new to them, and children pick up on things that we're not always cognizant of.

For example, if a parent or a family is very anxious about COVID and it's all they speak about, and they either express concern, panic or what have you, children pick up on that.

So please be aware that you don't have to have the TV on all the time to the news that's talking about COVID because children may not really receive that aswell as some adults.

So be aware of that.

Also, set a good example.

And also structure.

I get questions from families about, well, my kids are driving me crazy.

What do I do? Well, you have to structure their day.

You have time for play, you have time for some typeof learning activities.

You have time for watching the media.

And pay attention towhat they're watching, regardless of their age.

These are some of the tips you can use to make it more tolerable for both you and your children.

But children are, sometimesthey're very anxious.

You pick up on that, talk about it, discuss it with them attheir appropriate age level.

But be aware, this is a stressful time not only for adults, but also for children.

And they have to understand, in terms they can understand, why they have to wear a mask, why they can't see their friends, why they have to social distance.

And I think if you arejust upfront with that, without being overbearing with it, you'll find that they tolerate it much, much better.

– Very excellent point.

And the whole behavioral health piece of this is enormous and perhaps a conversationfor another day.

But I'm so gratefulthat you brought that up because I know parents arevery concerned about it.

My very last and very quick question, and then we'll wrap up, very, very rapid roundhere with you, Dr.

Hammer.

Should people be wipingdown their groceries when they get them home before they put them in their cabinet? – Well, certainly, I wouldn't wipe down food directly, food products directly.

With respect to the packaging itself, what I do and what I've discussed with other infectiousdisease providers like me, I typically will unpack the groceries.

I will put things in the counter.

Then after everything is put up, I will wipe down the counter or the surface where the groceries were.

Then I would wash my hands.

Always remember, from the standpoint of fomites and things, it really is hands to face.

And so washing your hands frequently is recommended over tryingto disinfect a package.

And remember, again, though our early focus was on transmission by things, fomites, things that we touch and then touch our face, that still can happen.

It's much less likely than the respiratory droplet route of transmission.

– Great, thank you so much.

I'm gonna just wrap us up.

I wanna start by thinking both of our experts, Dr.

Reginald Washington, chief medical officer at Presbyterian/St.

Luke's and Rocky Mountain Hospital for Children, and Dr.

John Hammer, who is an infectious disease specialist who is the head of theDepartment of Medicine at Rose Medical Center.

We want to let those of you who are listening knowthat we'll be following up with an email that this video will be available next week as something that canbe shared with others.

And we really wanna thank each of you for listening in, for joining today, for offering your questions and insights, and for your interestin keeping yourselves, your family and our community safe.

Thank you so much for being with us today.

(gentle music) [HealthONE].

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