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Lessons from coronavirus surveillance testing in Seattle-area homeless shelters

UW Medicine infectious disease research assistant Brigitte Neuville prepares SARS-CoV-2 testing equipment at a homeless shelter in King County, Wash. Her team’s work was part of a community-based surveillance study on detecting the pandemic coronavirus among homeless populations, and looking at factors that protect against or increase the spread of the virus at shelters. Credit: Taylor Johnson

A study of SARS-CoV-2 at 14 shelters in the Seattle metropolitan area underscores the importance of active, community-based pandemic surveillance for homeless populations. The results indicate a need to provide routine viral testing outside of clinical settings for this vulnerable, hard-to-reach group.

“Individuals who are homeless are hard-to-reach populations; they may be less likely to access the healthcare system when they are sick. This study demonstrates that a strategy to do broad testing of individuals in is an effective way to identify new cases and prevent further spread,” said senior author Dr. Helen Y. Chu, asssociate professor of medicine, Division of Infectious Diseases, University of Washington School of Medicine in Seattle.

The researchers looked at characteristics that may play a role in SARS-CoV-2 spread among their residents and staff.

“Crowded conditions, communal sleeping, and shared hygiene facilities could foster transmission,” said Julia H. Rogers, lead author of the study and a graduate student in epidemiology at the UW School of Public Health.

The risk that people with asymptomatic infections could pass along the virus also supports the idea of creating a regular test strategy for shelter residents and staff, even for those who don’t feel sick. Many of the infections detected in this study were asymptomatic.

The findings are reported Sept. 15 in the Annals of Internal Medicine.

Other studies of COVID-19 in homeless shelters have concentrated on specific outbreaks. This newly released research began as an offshoot of

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Creating a Toilet Training Plan

These are the tools you will need to create your own toilet-training plan and implement it at the best time for your child. But there are certain universal rules relating to toilet training—as well as to other aspects of parenting—that will enhance your family’s experience no matter what method you choose. These include:

  • Be positive. Children learn better when they are praised for their progress rather than punished for their mistakes. Do what you can to help your child succeed as often as possible—even if it means learning gradually, one tiny step at a time. When she progresses, give her a hug, some praise, and perhaps even a small tangible reward. When she fails, tell her you’re sure she’ll do better next time and ask her to help you clean up.

  • Be consistent. Create reasonable expectations according to your child’s abilities, express them clearly and frequently, and expect your child to at least try to follow them every time. Keep her bathroom routine as consistent as possible, with her potty in the same place every day and the sequence of actions—including wiping and hand washing—the same every time. While she is toilet-training, praise your child for each success, and provide predictable, nonpunitive consequences (such as helping to clean up) for each failure. Make sure that your approach to toilet training is consistent with those of your child’s other caregivers as well.

  • Stay involved and observe. Very young children’s needs, behaviors, and abilities change frequently and, to some extent, unpredictably. Toilet-training approaches that worked two weeks ago may not work today, and skills that your child mastered in the past may temporarily disappear in the face of new challenges. Continue to monitor your child’s bathroom behavior throughout toilet training and afterward so that you can quickly identify and resolve