Office of Congresswoman Jayapal 

Good evening, everyone and thank you for your patience. Welcome to tonight’s online briefing with Congresswoman Jayapl and Dr. Alex Greninger from the University of Washington. Before I turn it over to Congresswoman Jayapal, please note that you can submit questions on the Q&A if you are participating via Zoom online, and with that, I will turn it over to Congresswoman Jayapal.

Rep. Jayapal  (0:36) 

Good evening, and thank you so much. Thanks for joining me at this unprecedented and challenging time for the community.

I know there is a lot of heartache and anxiety out there, and the purpose of this briefing is to try and continue to share as much as we can about what’s going on what we’re doing, and to answer some of your questions that you’ve been sending in over Facebook and Twitter and online.

I want to thank Dr. Alex Greninger. We are just so incredibly fortunate to have Dr. Grenniger here at the University of Washington lab, doing the work that he is doing, and honestly lending expertise across the country on exactly how we’re tackling this here at the University of Washington, here in Seattle, and here in Washington State. So thank you, Dr. Greninger, for lending your time to us tonight.

Over the last few weeks, our region has been at the epicenter of the COVID-19 pandemic in the United States. When I hosted my last tele Town Hall, just eight days ago, we had 162 cases in Washington State and 423 nationally. There were over 4000 people on that call, and we were able to answer some of the 120 questions that we got. Sadly, we’ve seen the number of cases across the country rise rapidly, and we are now in the middle of a global pandemic and a state of the national emergency with more than 1100 confirmed cases and 67 deaths in Washington State and more than 7000 cases nationally, and 97 deaths nationally.

I know this crisis has caused great anxiety and uncertainty. I know many of you are home with your kids. I know many of you are looking after your elders and your parents that are in your family and you’re worried about how we’re going to get through. We will get through this and we’ll get through it together, and my role is to try to provide you with regular updates, to get as much information out to you as possible, and then tell you what I’m trying to do in Congress and update you on those actions that we’re taking in Congress to mitigate the harm of this virus to ensure public safety and to shore up our workers and our economy, and I also want to use these calls to just update you on the latest guidance from public health officials that will help keep us all healthy and safe.

Before I do that, though, I just want to express my condolences to the family and friends of those who have lost loved ones. My heart goes out to you, and I also want to express my appreciation to everyone that has been involved with the response the city, county and state and federal public health experts, the frontline health care workers and first responders who have been working overtime to respond to cases, care for the sick and protect our region, to the workers who continue to do the work, whether it’s our garbage collectors or grocery store workers, the people that are out there continuing to do work because we need those things to continue to happen. Each and every single one who has stepped in to help those who are hurting right now. Thank you so much. You are showing the world the sense of community that makes me so proud to be your representative in Congress.

As you know, our local, state, city and county leaders have taken swift measures to slow the spread of the virus, and because we’re first everybody’s been looking to us, all the schools in Washington are closed now through the end of April. And earlier this week, Governor Jay Inslee, who has just been a phenomenal leader for us in this time, and King County Executive Dow Constantine, restricted gatherings of more than 50 people until at least the end of March. Smaller gatherings are also prohibited unless the CDC or Washington State Department of Health, public health, and the social distancing guidance is followed. Bars, restaurants, clubs, gyms and other social gathering places are all shut down at least through the end of March, the ban does not apply to pharmacies or grocery stores at this time, and generally, I would just say gatherings of any size are highly discouraged. I’m sitting here in my home today and we are practicing what we preach. Both of our offices are teleworking and we are doing everything we can to continue to serve you, but also keep our staff safe. But also anybody else that is out there, that’s vulnerable.

I know these are very challenging restrictions, but they will save lives, and so I thank you for making these big changes to your daily lives for the greater public good. Governor Inslee has also issued multiple emergency proclamations today to help provide relief to workers and businesses as well as renters and residents who are negatively impacted. Today’s actions from the Governor include a statewide eviction moratorium for 30 days. In order to give the Washington State Department of Revenue the authority to waive interest fees, late payment penalties and due dates for a broad range of taxes, and that is retroactive to February 29, the date that the Governor declared a state of emergency here in Washington. It also included waiving the one-week application waiting period for unemployment insurance because we know how incredibly important that is to people, and then expanding eligibility for the family emergency assistance program, which is cash assistance to now include low-income families without children. So those are important steps that the governor has taken and also our city has taken some important steps that I’ll mention later.

We are very grateful to the Governor, to Dow Constantine, and to Mayor Durkan for all working together working with the congressional delegation to do all we can at every level, in terms of how we are responding in Congress. We passed a $8.3 billion relief package that was signed two weeks ago and was signed by the President, and it addressed the needs of particularly our public health departments that desperately needed assistance so they could continue to do what they were doing just after midnight on Saturday, and that bill was passed by both the House and the Senate and signed into law by the President.

Just after midnight on Saturday, the House passed the Families First Coronavirus Response Act, which was our second piece of emergency legislation to address the emerging needs of the coronavirus epidemic. We are still waiting to see what changes the Senate is making and what the President ultimately signed into law, but I will go through just a couple of the things that that piece of legislation included.

The bill did include free coronavirus testing for people, who are for a vast majority of people, who are including those who are uninsured or underinsured, I will tell you, I’m disappointed that it did not include testing for certain categories of immigrants, including undocumented immigrants, DACA recipients and legal permanent residents that have been here for less than five years. We are working to get that fixed right now because what we know is in a public health crisis, making sure that everybody who is sick and with this virus is able to come forward and be tested without the cost of that testing.

We also included in the bill another important priority that I championed alongside many of my colleagues on the House Education and Labor Committee, and that has increased funding more than a billion dollars for food assistance for several nutrition programs, including snap student meals, seniors neutral programs and food banks.

We also included paid emergency leave with 10 days of paid sick leave, and for certain categories of workers, up to three months of paid family and medical leave. I will tell you that this provision as written in the original House Bill was far stronger and it was unfortunately weakened by Republicans in the House, and potentially, we can do more in the Senate. So we are trying to shore up that paid leave for everybody, and we can give you more details on exactly who is covered and how much they’re covered until once we see the final bill.

We enhanced unemployment insurance in our bill that we passed, and we increased federal funding for Medicaid to support local, state, tribal and territorial governments.

So there is a lot of work to do even to fix some of the provisions in that bill that we hoped would be stronger, but we are already working on a third piece of legislation that we hope we will pass next week, that is really going to be an important stimulus for individuals and working families across the country, and so, some of those steps that we are pushing for as co-chair of the Congressional Progressive Caucus, but also as the senior whip of the Democratic Caucus, we are pushing to try to include direct cash support to the most vulnerable, including gig workers, independent contractors, and low wage workers.

We know that there are a lot of these folks that have not been covered by the bills we’ve passed. We are aware of that and we’re trying to get cash support directly out to people as quickly as possible.

We also are putting together a much more comprehensive package for small businesses. I had a call with many of our small businesses in the district yesterday. It was heartbreaking. These small businesses are the heart and soul of our communities and our economy, and many of them are trying to keep their employees whole and even as they deal with potentially shuttering down, and so we know that loans are not enough that there need to be direct grants, that expanding unemployment insurance is critical for many of these folks that may not be covered, and also expanding the amount of unemployment insurance, and we also know that we need to look at making sure that rent can cover utilities, some of those other expenses that don’t just go away for small businesses, and I would include nonprofits and arts organizations in that.

The third area we’re hoping to do some more work on here is protecting the most vulnerable within the prison system and the immigration detention centers. This is very, very important to me and to others in our caucus and we think we should be not only ensuring treatment and testing but also we should be actually getting folks out of immigration detention systems that don’t need to be they’re the most vulnerable populations and using alternatives to detention in both situations. We are working on issuing and clarifying specific provisions related to the treatment of immigrant communities.

We’re also looking to invest in child care during the school closures and other educational needs to ensure our kids get to stay on track and graduate, and finally, we are working on a number of higher education provisions that we hope will include some level of loan forgiveness during this crisis for many of our students who have student loans outstanding. So that’s just a short list.

I’m also calling for a federal moratorium on evictions and foreclosures and other housing assistance including infusion of resources into service providers and cities and towns that are assisting persons who are experiencing homelessness. These issues predate this pandemic, but in a lot of ways, they’ve been brought into focus in recent days. Tomorrow, I will introduce a comprehensive bill, The Housing is a Human Rights Act, aimed at supporting those experiencing homelessness. That bill would invest significant federal dollars in providing emergency services as well as an infrastructure to expand shelter and permanent housing – and it would push back against harmful narratives that treat people experiencing homelessness as less important or less deserving of help.

This week, I also joined a few of my colleagues to call on mortgage lenders to halt foreclosures, and so we’re hoping to include a number of pieces of that bill into any legislation that we move forward.

Here, in the city of Seattle, Mayor Durkan and the City Council have taken swift and bold action. They’ve put a moratorium on rent-related evictions, provided vouchers for families to buy food and household goods and opened up funds to support creative workers and arts organizations.

So we are pioneers on bold, progressive solutions for working people –and we are going to make sure that that tradition continues. In Congress, my colleagues in the Washington State delegation and I are continuing to push to make sure our state gets the resources that we need.

One of the critical areas has been our PPE needs – our personal protective equipment for our frontline workers and our healthcare workers, and so I led a letter along with Representative Jamie Herrera Beutler and a bipartisan group from our state delegation to the Department of Health and Human Services Secretary Alex Azar, and it was urging him to expedite the supply of that PPE.

Last night, I spoke to the Assistant Secretary of Health and Human Services and he has expedited, based on our call, the requests or requests for PPE, so we’re hoping we get that very, very soon.

Last week, I was also able to get a top-level DHS official to guarantee that the administration’s horrific public charge rule, which makes immigrants afraid to seek medical care would not apply to seeking care for COVID-19. It is now on the DHS website, and we know that this doesn’t take away all the fears but we hope that it helps a little bit. There is even more that we’re doing that I will touch on later.

But we are so fortunate to have with us a real expert and innovative innovator and pioneer with our own Dr. Alex Greninger from the University of Washington School of Medicine. Some of you may have seen a really terrific Times article from Monday. The title was How Intrepid Labs Lose and Seattle Ramped Up Tests as Coronavirus Closed in, and that article featured what Dr. Greninger and his colleagues have been doing. Thanks to them, the University of Washington has conducted more than 4000 tests, and I am just so grateful for their early leadership and that Dr. Greninger has generously offered some of his time this evening to take some time to speak to you and to take some questions. So with that, let me turn it over to you Dr. Greninger.

Dr. Greninger (16:36) 

Thanks, Representative Jayapal. My name is Alex Greninger. I’m an assistant professor here at the University of Washington Medical Center, and I’m a Laboratory Medicine Specialist. I specialize in laboratory testing, which has become very germane here for this coronavirus.

So here at the University of Washington Medical Center, we came online early with a test now more than two weeks ago, we’ve actually done more than 14,000 tests so far. We are at about 2000 a day right now. That’s our current capacity, though tonight, we should bring on an additional instrument, and over next week more additional instruments, and allow us to get up over 3000 tests per day. Unfortunately, we are detecting more than 120, sometimes 150 cases of COVID-19, every day here in our clinical lab.

Testing is very important for peace of mind for being able to allocate healthcare resources and isolate individuals who have COVID-19 and prevent onward transmission of the virus. It’s also important to protect our healthcare workers, our healthcare, labor supply, our first responders, and other vulnerable populations, especially those in nursing homes and assisted living and other institutionalized populations. Those populations actually have been reprioritized by the Washington State Department of Health and here at the University of Washington Medical Center as well. So we’re trying to expedite testing for inpatients people who need supportive care for getting test results faster so we can conserve that personal protective equipment that Congresswoman Jayapal mentioned earlier today.

With that, I’m happy to take any particular questions you have about coronavirus, clinical symptoms of coronavirus and testing of coronavirus specifically, especially here in the Seattle area. I think one of the most important public health measures, other than washing your hands and to try to avoid touching your face, is to basically in all the social distancing measures is be sure to call ahead if you develop the most sensitive symptom for this condition for COVID-19 is fever and then followed by cough.

These are nonspecific symptoms, and so if you develop a fever, to call your healthcare provider, your healthcare system, and you usually actually have special COVID-19 related phone trees or people waiting on to answer your questions to screen, and then to decide, whether there’s testing needed or what the best thing to do is. Don’t go straight into a clinic and present to the emergency room unless you absolutely absolutely need supportive medical care.

But I want to focus mostly on your questions tonight, and so I’m happy to take any questions you have. Thank you for having me.

Rep. Jayapal (19:33) 

Thank you so much, Dr. Greninger. So I want to start with just a couple of medical questions that have come in tonight and over the last few weeks, and you were just starting to get at a few of these things, around what to do. So here, I’ll give you four of them. “If I’ve been exposed to the coronavirus, is there an incubation period if you have had COVID-19 can you be reinfected? If someone has recovered from COVID-19? Are they still carriers of the disease? And can they still affect other people? Is there a level of immunity that you want to talk about? And then what do we know about the impact on older folks as well as younger, younger people?” And I can go through each of those one at a time if you need me to repeat this.

Dr. Greninger  (20:24) 

Thank you. I appreciate it. So, yes, coronaviruses, same as all viruses, have an incubation period after you’ve been exposed to the virus. I think one of the most difficult things about this particular coronavirus is it actually has a long incubation period. It’s been stated unhelpfully, that it’s one to 14 days. That’s a very broad range. It’s not really operationalizable, but 14 days is the maximum length that will follow you for specific symptoms after you’ve been exposed so after your 14 days, usually, you’re in the clear. The other stat that’s really important here is that, for people that become symptomatic with the virus, they develop that fever, they don’t usually develop shortness of breath or symptoms that caused them to present for medical care until maybe six or seven days after as well. And so what that means is that this whole time, many cases, when we detect a case, that usually is when someone’s presented for medical care, and so if you go back seven days from when the symptoms occurred, and you go back seven days from when the incubation period occurred, you’re starting to talk about detecting cases who’s transmissions happened 14 days ago — which is why it’s been so important to be very proactive with these social distancing measures, and that’s really what’s going to bend the curve here. It’s a very difficult virus to just do contact tracing and isolation to be able to follow that up, because the cases are so far from the past. There was also a question, if you’ve had COVID-19, on incubation periods. We don’t really know. Right now, I haven’t seen that in terms of from an incubation exposed well, we’ll swab you and we have people we’ve tested three or four or five times, if they’ve had specific symptoms. We try to go just with one specimen for each person. But right now, if you’ve been exposed, that’s a reason to potentially get tested, but we usually like you to have a symptom like a fever — and that is a good reason for a test. If you’ve just been exposed, we might swab. If you get a negative, we will still be having to swab you again later. So it’s better wait for at least a few days.

If you’ve had COVID-19 can you be reinfected? The answer to that seems to be no. People develop immunity against this virus, that’s how they recover. This virus is very young. It’s only been in humans for about four or five months now, the genomic diversity is actually quite limited overall for the one that’s spreading in humans, and so there’s not much diversity to allow it to become reinfected. It’s really not going to happen. I can create a situation where distantly it might, but it really is not a thing that happens. That immunity will cause you to not be reinfected. The one thing I will say is because the virus can be in different parts of your respiratory tract — it can both be any upper respiratory tract and the lower respiratory tract — you sometimes see stories of quote-unquote, “reinfection.” But really what it is, is that the person who was tested positive, then they later tested negative and then it tested positive. And really, it was the same virus; it just had that negative result in-between when they did and did not swab. I don’t think it’s reinfection.

If someone has recovered from COVID-19 they still carry the disease and can they affect other people? So, if you’ve recovered from COVID-19, it’s very unlikely that you will transmit. However, you still can shed virus at low levels. I think there was one paper that showed that you could have shedding up to 21 days, and this is known in other respiratory viruses as well, and that’s why I think the CDC released from isolation still wants negative swabs — though they might update that guidance. But basically, to be really sure. you’re still shedding virus at a low level. That said, it’s not really clear how much of it’s a major force and transmission. But certainly, we can still detect the virus even after people for maybe a week after they’ve gotten better, and that’s really that’s true with really any virus. Honestly, your immune system has worked its ways so you’ve protected yourself, but maybe there’s still some virus and some mucus or something like that, that can still be detected. And, as he said before on the reinfection, there’s definitely a level of immunity, and I think that’s going to be really important for us to have tests developed that we can test for immunity, as this virus right now in a pandemic will likely be with us for a while, and we’ll need to know who has been infected — especially if there are these asymptomatic cases that can happen. We need to know did you have a case, and that’ll be helpful for peace of mind, and to be able to follow others and protect other individuals. And then the most important thing about COVID-19 is really its disproportionate morbidity and mortality among the elderly. This virus really is not found in young people. You can look at the statistics. I mean, obviously, we don’t test as many young people for this particular virus as we do in the hospital — there’s a little bias in the data that we see from other places like the Washington Department of Health as well. But only 2% of the cases in Washington state have been found among people under the age of 20. Very, very few cases and children. The cases in the elderly, though, if you’re over 60, that’s a good reason to consider being tested. When you have these symptoms, you’ll have a higher priority for being tested. The morbidity and mortality, the hospitalization rates in some of these studies, especially when people over 60 is quite significant, and that is really the main issue is that the virus is able to transmit among younger, healthy people, they get ill, and some of them do present to the hospital, but it’s really among the older individuals. You saw that with the LifeCare episode in Kirkland, and a lot of fears in nursing homes and assisted living facilities and a lot of preventive measures being taken out which is appropriate to prevent that virus from introducing those communities where it can have very, very high morbidity mortality, we say really relative, to other respiratory viruses, that’s really what we’re comparing to, I think I will couch it in with Dr. Falci said that dirt is 10 times worse than the flu, maybe even more honestly.

Rep Jayapal (27:06) 

Well, let me just follow up on that. We have a question from Katie on Facebook, which says, “Are there positive cases without fever?” And I would just maybe expand that to something you and I were talking about before the call: Are people potentially transmitting without having symptoms? And then also, when you said the virus doesn’t exist,but you said something about how the virus isn’t there for younger people. Isn’t that partly because we’re not testing a wide enough population and that perhaps the negative effects that we’re seeing in vulnerable populations is certainly not there and younger people but part of that is because we’re but in terms of the presence of the virus it can be there in the full population. Is that accurate?

Dr. Breninger  28:00 

Even when we test in younger individuals, in kids, we don’t find it. We really have almost no cases from them. So yes, absolutely. From an absolute case number in Washington State, there’s probably disproportionate testing among older individuals, we’ve already said it’s a reason to get tested and are preferentially tested. So there’s more testing since we’ll find more cases. But even if you just look at the rates of positivity among different hospitals, that we see the pediatric is much lower. It’s actually really quite significant. It’s definitely some biology there that we just don’t completely understand, but need to figure out. I forget exactly what the first question though, was that you asked. I apologize.

Rep. Jayapal (28:49) 

Sorry, because I threw in a second one. Katie from Facebook asked, Are there positive cases without fever?

Dr. Breninger (28:56) 

Yes. So there are. Again, I just want to keep hitting them. high points though here, which is that fever is the most sensitive symptom. And some original reports out of China say 98%. I’ve heard different statistics for clinical and different populations between 80 and 98%. About two thirds to somewhere about 70 to 80% have a cough. So it’s really the fever. That’s the most sensitive symptom that you see in the screening of airports and other places around the world. They’re really looking at temperature first, rather than asking for lower respiratory tract issues. But it is true, there are those cases that don’t have a fever. But again, it’s relatively rare. You would need to you then you would need to have shortness of breath or some other reason to be tested.

Rep. Jayapal (29:51) 

Great. Here’s another question from Facebook. It’s from Jason. “I’ve read both that COVID-19 is spread only via droplets and that it can be airborne. Can you tell us which it is?”

Dr. Breninger  30:03 

Yeah, I think that there is some mixed data on this. We typically talk about droplets. We talk about almost all respiratory viruses, honestly. Droplets basically mean it’s gonna drop like it’s gonna fall — gravity has its effect on that particle. Airborne means that it is so small that it floats in the air, and it’s not just like it’s falling just because of gravity. So they’re able to stay buoyant in the air in a way. I did see something about more data on airborne on potentially longer-distance spread. I think this is one of those areas in transmission about viruses, especially respiratory viruses, it’s just not as well worked out as we’d like it to be. I mean we’re talking about staying six feet away from each other. I mean, six feet is good, eight feet is better than that. These things are going to actually scale, probably by a square or more of the radius of that how far away you are, and so from a precautionary principle, those distances are something you want to be aware of. But right now in the hospitals, we’re still focusing mostly on droplet spread that I’ve seen.

Rep Jayapal (31:23) 

Okay, great. We have a number of questions around testing. A number of our constituents have asked about how quickly we’ll have universal access for testing in clinics, hospitals, drive-throughs and ensure that testing and treatment are available to everyone even if they’re uninsured. Can you share anything with us about what you’ve learned through your work at UW? And then also, there was a question here about the sensitivity and specificity of your tests, and you might want to just Talk about that as well.

Dr. Greninger (32:10)

Okay, cool. So right now where we are in the King County Seattle area and right now we are one of the University Washington medical centers, one of the major test providers. As I said, we’re doing about 2000 tests a day right now. We’re hoping to get up to about somewhere around 3000 by the beginning of next week, that’s our goal. And then we’ll keep going by 1000 a week to every 10 days, adding more on that capacity. So that’s been real strain on just physically processing the specimens. We’ve got research volunteers from across the University coming in to help process specimens. We just bought another floor in this building where we’re at, so we can continue to process specimens and open a special lab. And we’re getting multiple high throughput analyzers that have recently been given emergency use authorizations by the FDA. For right now, we’ve been running what’s called a laboratory-developed test. It’s a little bit more manual and we do 2000 tests a day on — and it’s really hard to scale that process to get up to 5000 tests a day.

There are so many people. This has been such a great team effort, honestly, at the University of Washington and across all the hospitals here. So we’re actively sending samples out to help people validate these tests and these other platforms, and the FDA has allowed a lot more emergency use authorizations to come through in the last week. This week, we’ve seen other big reference labs that have some really big, big, big guns when it comes to being able to get instruments that are already in labs, and so it’s really then about shipping the kits, and so we’re actively trying to get those kits. We’re getting more, we got more today, we’ll get more tomorrow. Other hospitals will be able to have those instruments and be able to provide their own testing. So to answer your question, I’ll put my nickel down, I think from a unit, but I don’t want universal testing sounds like, but what I think will be a much better place in three to four weeks. There’s so much demand for testing that it’s hard to know exactly where the right population is still to test when that comes on. But I want our first job here to be to expand capacity, so then, we can take those limitations. Some of the limitations include that we’d like to be testing more outpatients right now, we really would, and so taking off those limitations is required. First, we have the supply. We know that there’s a lot of interest and need for testing. But as I said before, right now we’re prioritizing inpatients people who need supportive care, healthcare workers, first responders, and institutionalized populations and we’re also prioritizing this unit. But it’s really going to take the whole community of hospitals and clinical labs to bring on testing for this, and then they’re also I’d say also the big out the big referee national reference lab. So Quest and Labcorp, still are able to be offered to test. It’s tough, they’re a big national chain, so it’s hard for them to meet all the demands of the country at one time, as their turnaround times can be like three to four days. But those are also options for outpatient testing currently, here. They’re still accepting samples. We haven’t heard anything about them saying they’re not able to.

Rep. Jayapal (35:50)

So while we’re on testing, here’s a question from Instagram. “I’m concerned about access to testing because my doctor advised that even though I’m symptomatic, there isn’t access. So the only solution is complete isolation, which I’m adhering to. Do you have any?” You’ve addressed that this person would be able to, at some point be able to get tested. But anything else you want to add there?

Dr. Greninger (36:15) 

Yeah, I think they can get tested. So are we actually accept outpatient specimens I wouldn’t actually question the medical provider or whatnot on this. I think that it is helpful to get the message out to medical providers that there is access to testing, again, at Qwest lab, University of Washington Medical Center. The turnaround time may be 48 hours to 72 hours. This may not overnight — may not be that same day. But we do have access to that testing. This is true with many respiratory viruses where we don’t have a treatment, there’s still a logic right now, like “Oh, well, maybe I want some test,” but for this one, we are really actively testing. I want to go back you asked one of the questions that was in that previous question: What was the sensitivity and specificity of the test? So we talked about two types of sensitivity and specificity. We talked about analytical sensitivity and specificity, and then clinical sensitivity and specificity. So analytically what basically happens — you go to a healthcare provider, you have fever and cough, they put a swab into your nose that goes to the back of your throat called nasopharyngeal swab, and they put that swab in three mLs of liquid, and that swab is sent to the lab. And first, we basically make sure it’s exactly your specimen — so there’s no specimen swaps or any problems in the pre-analytical phase. We take that specimen, we log it in, we send it to our lab here, and we take some of that liquid from that to put it in a different tube. So it can be a nucleic acid that can be extracted from it, and then we run what’s called a reverse transcriptase RT PCR which allows us to sensitively detect the RNA from the virus, and almost most of the talus, all the tests out there are looking at two parts of the virus. So they’re actually quite sensitive and civic, the analytical sensitivity and specificity of our tests have been really excellent. We’re working actively with our state public health lab colleagues. They’re actually totally open for testing too, if you want to there’s a message there, their turnaround times are down to under a day, under a day and a half. So they’re doing quite well as well.

So there are opportunities for testing the state public health lab, and they’ve been really helpful to help us come online, and our tests, we actually run the same test, the CDC based assay, and it’s a good test. It’s a really good test, and has a high analytical sensitivity specificity in our testing has been entirely concord to date, which I think both are proud of so we don’t really we haven’t had any. We haven’t had any bona fide false negatives or false positives from an analytical sim for another question, and that was a clinical sensitivity specificity, which is how this test relate to coronavirus disease — and there one of the issues that can be as I think I said before the virus can be in different parts of your respiratory tract. So it starts in the upper respiratory tract, and then it can go into your lungs and from the lower respiratory tract infection, that’s really where a lot of the morbidity comes from. So most of the specimens that we get are from swabbing your nose into your throat, or through your throat oropharyngeal or nasopharyngeal swab. We can also test lower respiratory tract specimens to sputum, and then Bronchoalveolar lavage. The state will do Bronchoalveolar lavage, we can do sputum, but they will do any of these guys. And so I do think there’s an angle there and there have definitely been reports this is an active piece of debate. I think it’s been settled that the best sample to easily sample and process in the lab is nasopharyngeal swab. The best sample perhaps could be sputum because you cough it up from your lower respiratory tract and it comes out of your upper respiratory tract — so you do it yourself. So there’s no swab, but it samples both portions of your respiratory tract. The problem with sputum is that in viral pneumonia, you have a dry cough, it’s usually a non-productive cough. So it’s very hard to produce that, that specimen. And then they’re not the easiest specimens to process in the lab. So they’re kind of slow, and so we’ve been going with the nasopharyngeal swabs, and we talked to our clinical colleagues that if, if you get a negative in something doesn’t seem right, please re-swab, swab in different places in the respiratory tract, send a lower respiratory tract specimen, and that can be done as well. So, I think the clinical sensitivity has not completely been worked out as a subject of active investigation. But for the nasopharyngeal swab, it’s probably upwards of like 95% because it kind of defines the disease. So it depends on what clinical syndrome you’re describing for your testing. But that’s something that I think people should be aware of is that no test is perfect. I think our biggest issue right now is making sure we have the swab touching the right place of your respiratory tract for getting the best result. Sorry, that wasn’t real inside ball and lab medicine but, real talk

Rep. Jayapal  (41:13)

Totally fascinating, and I know that we’re gonna let you go in a minute, and then I’ll continue to take questions. But here’s one last question for you, this is from Cheryl from Zoom: Can you give some guidelines for those of us living in apartment complexes? I just found out that someone in the building has tested positive as and is in the hospital and I’m not sure what to do.

Dr. Breninger (41:38) 

Wow, I’m sorry to hear about that. The first thing I would say is to contact the Department of Health in King County, I would actually ask them because there could be changing guidelines, I can offer you a personal viewpoint on what you can do, but I think there are different guidelines and thought processes on that — and this question does come up. I think the first thing you can do to protect yourself is to worry about contact surfaces. So first not contacting surfaces not touching things that you don’t need to touch will help reduce transmission, alcohol-based wipes or alcohol-based disinfectants for your hands were quite well to PRL. That’s why there’s a pure oil shortage. But alcohol-based wipes, soap, and water worked great against enveloped viruses like coronaviruses, and then the bleach wipes as well worked very well against specific surfaces for areas that you might touch the apartment. But it is also a reason to be at home and try to self isolate to your own degree and to present those sorts of other transmissions that can occur via touching services and closer living situations.

Rep. Jayapal (42:52) 

Yeah, and actually, my team is contacting some distilleries in the district because there are some distilleries, one in Oregon, that was creating sanitizers distributing them for free, which was amazing, and so if we have some folks like that, that can do it in our district, that would be fantastic. Dr. Greninger, I’m gonna let you go. I’ll continue to take questions from folks. But I just want to say thank you so much for your work, and for just sparing a little bit of time. I know how busy you are. We really appreciate it, and we are grateful to you. Thank you very much. So we’re going to continue to take some questions that have come in from social media, and so the first one is a constituent call to ask: “How can we keep people in their homes without risk of eviction or foreclosure?” and this is, this is just incredibly important, and as I mentioned earlier, on the call, Governor Inslee ordered a 30-day statewide moratorium on business. The cities of Seattle and Burien have also ordered moratoriums on rent based residential evictions, and the King County Sheriff’s Office will not serve or enforce evictions on foreclosures for residential and commercial properties during this crisis, so we know that there’s more that is needed. And as I mentioned earlier, actually, I don’t think I mentioned this earlier, along with two other members of Congress, I sent a letter to the major mortgage companies today, demanding that they stop all foreclosures during the COVID crisis, and we’re working on additional relief bills that would provide some more relief to tenants, to people who are trying to pay their mortgages and people who are experiencing homelessness. And I just want to also remind everybody, I know we’re a compassionate community, but it is deeply important to treat people who are experiencing homelessness as valued members of our community and to give them safety and respect as we do so.

Okay, the next question I’m going to take came from Instagram. “I’m concerned about how this will affect workers who are losing pay, people held in detention centers and prisons and folks who live outside, and I’m also concerned about current ICE raids.” I am with you. This is a really important question and those of you who know me know my history on immigration, and you know that this has been one of the issues that I’ve continued to lead on in Congress. We know that ICE has a terrible track record for keeping people healthy and safe in detention centers. There are eight people who have already died in ICE custody just this fiscal year, and there have been numerous calls for ICE detention centers and prisons to reduce their populations in order to promote public health inside. I have also been calling for updated measures to keep people healthy on the inside — including just some really simple things like waiving commissary fees on soap and other hygiene products, and I’m working right now to call upon ICE to stop all arrests unless someone poses a really significant public safety risk, and to make sure that ICE does not do any arrests at hospitals, health providers, social service providers, sensitive locations, everyone deserves the opportunity to stay healthy during this crisis, regardless of their immigration status, or involvement in the criminal legal system, and then I mentioned earlier that one of the things we’re calling for is to actually release people out of the ICE detention centers, who are who don’t need to be there. There are a lot of people out of the 56,000 that are held in ICE incarceration centers every night. The vast majority have never committed a crime, much less been charged with a crime. They’re often awaiting asylum procedures, other things, and we think that this is a perfect time to use alternatives to detention. So they are not in those facilities and not able to practice any kind of physical distancing.

Next question, somebody tweeted, “I am your constituent, I have a small business, and the only way that I won’t fold is if I get some working capital infusion. This cannot be a tax credit for the next year alone that I need to take on. Business owners need three months of working capital grants.” Yes, we had a call yesterday with small business owners, and a big part of our priority package that we’re putting forward for this next package is actual immediate assistance. So ideally in the form of grants, forgivable loans or other means that don’t require a payment to come to do later on, and also that we want to address the issues of rent. In an ideal situation, we would be forgiving rent for small businesses, making sure that your utilities stay on. We could also do it by giving a landlord potentially some incentives to do that. We’re working on the details of that. But we hear the urgency of this, and it is going to be a big priority in this next piece of legislation that hopefully we pass next week.

Brian on Facebook asked, “Will there be changes coming from the IRS for payment of taxes, I suspect that many people won’t be able to pay by April 15.” So yes, that’s a great question. The IRS actually announced earlier this week that it has postponed the deadline for filing taxes by 90 days to July 15, for individuals who owe a million dollars or less, and corporations that owe $10 million or less, so there is a bit of relief there.

The question here is from Facebook, “We were already in a children’s behavioral health crisis, and programs supporting families are shutting down. Will you please consider proactive mental health support for all families during this time?” Yeah, this is really, really important. You know, I’ve been calling this physical distancing, instead of social distancing, because honestly, I think what we need to do is be connected. We need to really try to support each other as much as possible. I know in our office, we’re doing Zoom calls instead of just telephone calls, just some level of interaction with other folks, and we know that there are real mental health questions out there, and we want to try and make sure that we are addressing some of these behavioral health issues that are coming forward and being exacerbated by the crisis. So we are going to try to make sure that we get some mental health supports for all families in this next package, and you know, there are going to be a number of packages coming forward, and so we will continue to add to whatever we can get done as we go through.

So I think that it is six o’clock we started a little bit late, but I do want to make sure we stick mostly to the time that we have. So I know we didn’t get to a lot of questions. But that’s all the questions that we have time for tonight, and just as we did after our last tele Town Hall, my commitment to you is that my staff will go through all of these questions, and we will make sure that you get a response as long as we have your contact information — and we are going to continue to do as many of these as possible. This is the first Zoom call that we’ve done. So it looks like we had a really fantastic response both on Zoom and on Facebook Live. So we will continue to take this format in as well as making sure that we use all the other formats that are available to us. If anybody is not on our email list, we send a lot of updates out by email, please go to my house website, which I don’t have in front of me, but maybe Subhan can give it to you as we close up, and make sure that you sign up for those emails for that email list so that you get the most up to date emails from us. I am really committed to ensuring that you have the information you need during this crisis, and as always, my office is here to help, and I just want to thank my incredible staff, both in the district office and the DC office for just remarkable work to try to help constituents through everything that you’re going through –and also to help me push for the things we need in these legislative pieces. Let me end with this. Some of you have heard me from time to time paraphrase the lead vocalist of Alabama Shakes. Her name is Brittany Howard. When she was on NPR, she described the ruptures in our society that need healing at this moment in time, and this was before the coronavirus pandemic. It has become clear to me that the ruptures that were caused before we ever reached this pandemic are coming to light. In this pandemic, many of those underlying problems and inequalities that are our country has been facing for years. In fact, in some cases, decades of disinvestment by the federal government in basic infrastructure, including our public health system — so that we have a Medicare for all system, so that we have free tuition for higher education. Much of that disinvestment in that basic infrastructure is coming back to bite us now, and this crisis has revealed the problems with what I call me first instead of we first society, a society that fails to recognize how deeply interconnected we are, and that too often privileges the wealthy and the well connected over the common good. But this is also a moment when we the people get to reclaim the best of who we are as human beings and to radically rethink what our souls It should look like. So over the coming days and weeks, I hope that each of you will be safe and healthy, that you’ll stay home and that you’ll take every precaution you can take, and I urge you to please implement the public health best practices that we’ve all been encouraged to take. I also hope that you’ll find time to take care of yourself and others around you, especially elderly neighbors, especially pregnant people, new parents, people with disabilities who may need assistance with groceries or household tasks, and who happen to live on your street or in your neighborhood. I hope that you’ll share where you can since there’s probably always someone who has less than you do, and I just hope that you breathe in generosity and love and abundance and breathe out anxiety, fear, and scarcity. I hope that you tell the people that you love them and know that there’s no shame in asking for help if you need it, and thank the workers that are still doing the work that we need to be done. The many public health workers, the first responders, the garbage collectors, the grocery store workers, the food suppliers, the truck drivers, the government employees, the service providers, and so many more that are just keeping things going during this crisis. We are strong, we are incredibly resilient, and we will weather this together with open hearts and with all the sadness and the joy that those open hearts allow us to feel. So thank you so much for joining us. Stay in touch, and we will too. Thanks and have a great evening.

Office of Congresswoman Jayapal

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