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Public Health Essentials

A place to highlight the work of the Snohomish Health District as well as share health-related information and tips. Have an idea or question? Drop us a line at SHDInfo@snohd.org.

Sep 14

Updates for parents and guardians: September 14, 2020

Posted on September 14, 2020 at 3:40 PM by Kari Bray

There’s a lot to keep track of during this pandemic, and it can feel overwhelming. We want to keep parents and guardians up-to-date during an unusual back-to-school season.

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Aug 12

COVID-19 Updates for Parents and Guardians: August 12, 2020

Posted on August 12, 2020 at 11:49 AM by Emily Oomen

As the start of the 2020-21 school year nears, parents and guardians of school-age children have been hit again with one of the ongoing, growing impacts of the coronavirus pandemic: remote learning is recommended to start the school year.


The challenges presented by COVID-19 also are being felt keenly by child care providers who must adapt to new health and safety measures, and by families who cannot keep children home from child care.


The Health District does recommend remote learning to start the coming school year, as well as continuing to keep children home from child care when it is possible to do so. These are important for fighting the COVID pandemic, but we also know that these recommendations create hardship.


The Governor, Superintendent of Public Instruction, and Department of Health also have released a framework for schools to use when making decisions about reopening. It is line with the local recommendation. Schools in areas with high transmission are encouraged to offer remote learning with potential for limited, small group in-person instruction for high-need students.


More than 75 cases per 100,000 population is considered high transmission under the statewide framework, and Snohomish County is at nearly 100 cases per 100,000. Getting case rates down to between 25 and 75 cases per 100,000 could allow for more flexibility, such as in-person instruction for younger age groups and remote or hybrid options for older students. Additional in-person learning options could be explored once case rates drop below 25 per 100,000.


“Returning to in-person learning together with the ancillary services, social supports and other enhancing activities that come along with in-person education is a goal that is shared by the Health District,” Health Officer Dr. Chris Spitters wrote in his recommendation to schools, sent July 29. “Yet, the reality of an attempt at in-person learning in the current situation would likely fall far short of that ideal and may come at an unacceptable cost in human health and further disruption of the learning environment.”


Many people have shared concerns and questions about schools and child care. We aim to address some of those in this blog. Please know that decisions around schools and child care are not made lightly, nor are they made without consulting others. The Health District continues to work with our public health partners throughout the state, the county’s Department of Emergency Management, and schools and child cares in Snohomish County.


Are schools prohibited from reopening?

The recommendation from the Health District and the statewide framework strongly support remote learning to start the school year, for both public and private schools. However, they are recommendations, not orders. Schools and school districts are making local decisions. Please monitor communications from your child’s school.


The Centers for Disease Control and Prevention (CDC) has released guidance for K-12 administrators to aid in preparing for the upcoming school year. Washington’s Office of Superintendent of Public Instruction (OSPI) also issued a district planning guide and FAQ for reopening schools. The Health District is not reviewing or approving plans for schools that choose to reopen, but will be involved if there is a case or outbreak at the school, or if there is an imminent disease control risk posed by the opening of the school that, in the judgment of the health officer, merits prohibiting that opening.


In the event of a case or outbreak of COVID-19 at a school, the school is required to cooperate with the public health investigation and to follow the directives of the local health officer, up to and including closure of classrooms or the entire facility (RCW 70.05.070; WAC 246-101-420; WAC 246-110-020).


Why recommend remote learning if child cares are open?

It’s true that child care providers face many of the same challenges as schools during this pandemic. However, child care is essential for children whose parents cannot keep them home at this time.


In a child care environment, which generally has a smaller total number of children than a school, the risk of amplifying community transmission is limited by that size. Generally, schools have many more students than the number of children present at any one child care. With increasing transmission rates in the community and hundreds of students sharing a school building, the probability of establishing sustained transmission in the school setting – and it leaking into the community – is greater.


It is important to reduce transmission in child care environments, as well, and the Health District continues to support child care providers in this effort. Guidance for child cares includes: excluding ill children and staff; wearing face covers; ensuring frequent hand hygiene; cleaning and sanitizing surfaces; avoiding or limiting activities that require close contact or shared objects and surfaces; keeping groups of children consistent; and limiting group size.


What about essential workers who can’t stay home with kids?

This is one reason child cares remain open with health measures in place. It is not realistic to expect that all parents or guardians can stay home or make other reliable arrangements for child care.


The state’s framework also allows for returning to in-person instruction for younger students sooner than for older students. Middle and high schoolers are more likely to be able to stay home and engage in remote learning without constant supervision.


Work to provide resources for health workers, first responders, and frontline workers who need child care for their families continues. We hope to have more to share soon.

Do I really have to keep my kid home from child care, school or other settings if they have the sniffles?

Short answer: yes. We recognize it can be inconvenient for parents to have sick kids stay home, and there are many possible non-COVID causes for a runny nose or mild sore throat. But we are experiencing a public health emergency, so the rules are stricter right now.


We need everyone’s help in preventing the spread of germs and illness. During this pandemic, children need to be kept home and out of child care with even mild cold-like symptoms such as a runny nose, cough, sneezing, sore throat, etc. Without testing, we can’t be sure whether the symptoms are those of a cold, the flu virus, or COVID-19. Even if the symptoms are for a cold or the flu, we don’t want that spreading, either.


If my child was identified as a close contact of a COVID case but tests negative, can they go back to child care?

Anyone who has had close contact with a COVID-19 case must quarantine for 14 days from the date of their last contact with that person, and they should get tested roughly 5-7 days after their last exposure. If test results come back negative, they still must complete the 14-day quarantine period. A test may be falsely negative or have been done too soon after exposure to detect the virus.


I’m not trained to be a teacher. Who is going to teach my kids while school is closed?

Remote learning doesn’t mean no school at all. Educators throughout Snohomish County are working hard to prepare for and provide lessons remotely. There is no doubt that distance learning requires new and different efforts on the part of parents or guardians, and it can be extremely challenging. But you are not in this alone. Please check with your child’s school on resources for those who need extra help, and remember that teachers are still there to teach their students, even if it all looks different than usual this fall.


What about kids who need extra support or have special learning needs?

The Health District will support exceptions in school plans to allow for in-person learning among small cohorts of high-need children with proper prevention measures in place. 


How long until schools reopen for in-person instruction for all students?

There’s no magic date or timeline. The recommendation for remote learning is for the start of the fall term, with hopes that in-person instruction may resume in some form later in the year. As with many aspects of this pandemic, it is crucial to continue monitoring the situation and adapt to the health and safety needs. The Health District is in regular communication with local schools and school districts.


Other countries/states/areas have opened schools.

They have, with mixed results on the outcome for COVID transmission.


We are still learning about this virus, and we cannot gamble the health and safety of our community on limited examples from other parts of the world.


Our focus is not on the rest of the world, or even the rest of the country. It is on Snohomish County, and the circumstances here. Health behaviors and other factors can vary from place to place, and we need to look at what is happening locally to help schools make decisions that are appropriate for this community.

But I heard that kids don’t spread COVID-19…

We’re not going to gamble on that, either. Generally, children are quite good at spreading respiratory illnesses. It’s no secret that kids share germs, as well as bring them home to friends and family.  Even if children are less efficient transmitters of COVID-19 than are adolescents and adults, the consequences to older and medically vulnerable adults of amplifying transmission can be severe or even fatal.


We aren’t certain to what degree children contribute to the spread of COVID, specifically. Existing evidence suggests children are infected less often than adults and may be less efficient transmitters, but the data is not conclusive. The cost could be lives if schools were to reopen under a misinformed assumption that kids are unlikely to spread COVID.


Children are not considered a high-risk group for severe illness from the infection, but we know they can become ill with COVID. The age range for confirmed cases in Snohomish County (people who have tested positive for COVID) starts at 0 – even infants can catch this illness. Two Snohomish County children have been hospitalized with serious post-infectious inflammatory complications of COVID-19 that can appear similar to Kawasaki syndrome (multi-system inflammatory syndrome in children [MIS-C]).


Also, there are staff, parents, volunteers, and other adults who interact with each other and with the children. Schools are an integral part of the community as a whole – transmission in the community affects schools, and transmission in schools affects the community.


There are negative consequences of having children stay home.

We agree.


How students respond to remote learning can vary widely. Some prefer it, while others have a difficult time with instructional, social and emotional changes from in-person to online. Many students have friends, activities and trusted adults at school, and schools can be a connection to food and other necessities for some. It will likely be a long time before we fully understand the impact this pandemic is having on young people.


We understand that the recommendation for remote learning extends hardship, uncertainty and equity gaps already occurring during this pandemic. A multi-agency workgroup of state and local education and public health staff, along with representation from education-oriented non-governmental organizations, is working to address learning needs, childcare, and other branching impacts of this difficult choice. 


Keep in mind that there would be a host of consequences and considerations should schools reopen in high-transmission areas, as well. Closing portions or all of campus as well as having exposed staff and students quarantine when there are cases could create a disjointed learning environment and schedule. If cases are identified in a school setting, it is likely to be scary and stressful for staff, students and families. And should a staff member, student, or student’s loved one be hospitalized or die from COVID-19, the impacts of that also would be felt throughout the school community.


We want children to get back to school, too. But we are in the middle of pandemic. Remote learning may not be ideal for education, but it is an important part of limiting the spread of COVID-19, avoiding a dangerous increase in hospitalizations, and preventing deaths.


We can all have a hand in reopening schools by taking steps to reduce the spread of illness.

  • Wear your face cover in shared spaces
  • Wash your hands often
  • Avoid get-togethers with more than five people from outside of your household
  • Keep your social group small and consistent
  • Stay home if you are ill and get tested if you have COVID symptoms
  • Clean and sanitize the surfaces you touch most at home or in your workspace


Now is also a good time to talk with your children about how they can help keep themselves and others healthy by following these same steps. Lead by example. Emphasize the importance of following the new health rules when schools do reopen.


Please be patient and kind with your school, teachers, other parents and guardians, and children or teens who are understandably frustrated and confused. Be patient and kind with yourself, too. You want the best for your kids, and we are doing our best to keep them – and you – healthy.


If your child/student is having difficulty adapting to the demands or stress of remote learning, discuss the situation with his/her teacher and health care provider. 


This pandemic has been challenging in so many ways. We are all learning right now.


Thank you for continuing to learn with us, too.


Additional Resources:

American Academy of Pediatrics

American Academy of Child & Adolescent Psychiatry 

Centers for Disease Control & Prevention



Aug 12

Dear Snohomish County, It’s Been Six Months: July 20, 2020

Posted on August 12, 2020 at 9:33 AM by Emily Oomen

To our friends and neighbors in Snohomish County:

It’s been six months since the first reported case of COVID-19 in the U.S. was identified here.

A lot has happened.

We are in challenging times, facing a pandemic that has created new problems while amplifying existing hardship for many.

When we had that first case in January, the novel coronavirus was cause for concern but it wasn't a pandemic. We didn’t have a coronavirus outbreak, just one known patient who took the right steps, sought care, and was isolated at the hospital. 

The Health District was already addressing a hepatitis A outbreak. The group at the table – literally at a table in a meeting room, before so many conversations were virtual – expanded to include more staff working to contain a novel virus that didn’t have a name yet. As the weeks went on, the conversation shifted from containment to mitigation, which boils down to this: no one could put a lid on this virus. The new disease was going to keep spreading.

As the emergency response for coronavirus ramped up, many partners stepped up to support Snohomish County and the Health District. There are too many partners to name, and we are thankful for all of the agencies, organizations, businesses, staff, and volunteers who have participated in the response. 

Things changed quickly as our community worked together to address the spread of this illness. "Wash your hands and stay home if you’re sick” turned into “wash your hands and stay home except for essential work or errands.” School campuses closed and lessons moved online. Activities were canceled. Businesses and organizations closed in-person operations. Roads and sidewalks were eerily empty.

The proverbial curve flattened. The rising local case count was controlled in time to spare our medical system, while elsewhere in the world and country we saw how devastating an overwhelmed system could be.

Then came the shift to questions about reopening businesses, activities and schools. Those conversations are ongoing, and probably will be for quite some time. Careful reopening efforts are underway. Snohomish County in June moved from Phase 1 to Phase 2 of the Governor’s Safe Start Plan. And now there’s a pause on moving further in the phases because case numbers are ticking up again and we are now well into a second wave of sustained transmission in the community.

Early blog posts on this platform explained why the risk to the general public in the U.S. was considered low at the time, and that this was a rapidly evolving situation. The rapidly evolving part still holds true. Pandemics don’t take perfect, linear, easy-to-follow paths. There will be ups and downs throughout this response, which makes it especially challenging. As we’re seeing now, we can make good progress only to find we need to hit pause again because the virus is circulating.

And as for that whole low-risk piece? That’s certainly not the case anymore. But such is the nature of viruses like this – they are very, very good at getting around.

We are closely monitoring the situation, including case rates, hospital capacity, testing, contact tracing, and risk to vulnerable populations. 

We’ve learned throughout this pandemic that we must be cautious, adaptable, as clear as possible about the steps we need to take, and – perhaps most importantly – kind to one another. 

A few other things we’ve learned in the last six months:

  • There are a number of possible COVID symptoms. It’s not just fever, sore throat, or cough to watch for anymore. Body aches, nausea, diarrhea, fatigue, even loss of taste or smell are all on the list now. This illness doesn’t look the same in everyone.
  • Some people don’t even have symptoms. Or they have really mild symptoms. But you can still spread the illness even if you are not symptomatic. Recently, about 85% of positive cases in Snohomish County have been symptomatic, while about 15% have not reported symptoms.
  • Cloth face coverings over the mouth and nose help. They trap respiratory droplets that could otherwise carry the virus from one person to another. They’re most useful to protect others around the wearers, not the wearers themselves. So everyone should be wearing one in public; that way, we all protect each other.
  • Social distancing, or physical distancing, is part of our vocabulary now. We’ve all probably memorized that six feet is the minimum distance to keep between ourselves and others. And we have a lot of creative ways of measuring that. It’s the wingspan of a bald eagle, or the average length of a llama (from rump to nose), or the full stretch of a personal jump rope.
  • Some people are at higher risk of severe illness than others – including people who are over 60 years old and those who have underlying medical conditions like heart, lung, or kidney disease. But anyone can become severely ill, and this illness can be dangerous for the young as well as the old.
There have been other pandemics, and other diseases with pandemic potential. They are part of what public health monitors, prepares for, and helps respond to when the need arises. But this pandemic has had a drastic impact, and there’s been much to learn about COVID-19. It flared into outbreaks, then a crisis that caught the U.S. and other countries in its grip and still refuses to let go.

There are moments that show the strongest parts of humanity. Healthcare workers, first responders, and frontline workers have risked their own safety to keep others safe and well. Emergency response workers, volunteers, donors and leaders have stepped up to make sure people have necessities in a time of economic strain. Educators and parents rallied to teach students through challenges none of them expected. People who missed in-person interactions connected with social groups through virtual means. Crafters made and donated cloth face covers, and businesses began selling a variety of styles – there are options to showcase your favorite fandom, or to have a window of clear plastic so people can see your smile or read your lips.

We’ve also seen dark moments. More than 180 people in Snohomish County have died of this disease. The initial wave of cases came close of overwhelming local hospitals and medical resources. There wasn’t enough personal protective equipment; everyone in the nation needed it at the same time. Many in our community have been out of work for weeks or even months. Small businesses have suffered and unemployment has spiked. We’ve missed out on celebrating important milestones that would usually be marked by gatherings because it isn’t safe to bring too many people together. 

People are anxious to get back to normal. Or something that looks closer to normal. 

We miss “normal,” too. 

We’ve seen and heard your questions, concerns, worries, frustration, anger, and emotional/mental fatigue. We don’t always have answers to the questions, but we’ll keep working on it. As for the concerns and emotions – we share many of them. We want you to be safe and healthy during this pandemic. We also want you to be able to work and learn and see the people you love. 

Thank you to all who have made sacrifices to help slow the spread of this virus, whether you are a healthcare worker on the front lines or a community member who decided to cancel a birthday party or stay home from a big Fourth of July barbecue. It takes all of us. We see you, and we are immensely grateful for all you are doing during this crazy time.

We are six months in, and we can’t offer an end date. We don’t want to sound like it’s all doom and gloom, because this county is a place where compassion and resilience are abundant. However, it’s not fair or helpful to sugarcoat it: This fall and winter have the potential to be particularly rough. At this very moment we appear to be in the early stages of a rising second wave that has zero chance of being reversed without changes to our collective behavior.

We can all take steps to keep ourselves and others healthy. 
  • Avoid gatherings, parties or other get-togethers of any sort. Stick with your household and a maximum of five non-household members as your small, consistent group of social contacts until further notice.  
  • Going where there will be people other than your household members? Wear a cloth face covering. It’s the kind thing to do. It’s also required by the Governor’s order. 
  • Not feeling well? Stay home. Seriously. Are you on the fence because your throat only hurts a little, or it’s just the sniffles? Better to be cautious. Stay home.
  • See those hands? Wash ‘em. Soap and water. Count to 20 while you scrub.
  • Check your purse/pocket/glovebox. Do you have a cloth face cover and hand sanitizer with you when you go out? You should.
  • Think about the surfaces you touch most in your home and workplace. Then clean and sanitize them.
  • Stay informed. Share reliable information. Don’t spread rumors or false claims. They can be just as contagious as a virus.
  • Be kind. Be patient. Be strong.
  • Remember that you are not alone. We are in this together.
Check out a timeline of the first six months at www.snohd.org/528/COVID-19-Six-month-timeline
Six Month Timeline Snapshot