Featured | Mount Sinai Today

The Selikoff Centers for Occupational Health at Mount Sinai Provide Undocumented Immigrant Workers With the Care They Need

Updated on Mar 14, 2023 | Community, Diversity and Inclusion, Featured

Many of the approximately eight million undocumented immigrants in the United States workforce hold critical and essential jobs. Some of these jobs are in construction, cleaning services, transportation—jobs that ensure we have everything from electric power to groceries to child care.

Undocumented workers are more likely to suffer work-related injury or illness than native-born workers, and more likely to experience dangerous working conditions than documented immigrants.

Yet undocumented immigrant workers are less likely to seek care and benefits for their work-related injury or illness.

There are many reasons for this: fear of employer retaliation, including wage theft, firing, and deportation; lack of awareness of rights and resources; intimidation by complex systems and processes; and mistrust in government and health care institutions. Anti-immigrant rhetoric in the United States intensifies many of these fears.

The Selikoff Centers for Occupational Health at Mount Sinai are dedicated to providing all workers, including undocumented immigrant workers, with the care they need.

Michael Crane, MD, MPH

“All workers have the right to health and safety on the job. It is essential that undocumented workers be made aware of and connected to the services they need and deserve,” says Michael Crane, MD, MPH, Medical Director of the Selikoff Centers. “We are dedicated to providing the highest quality care to all workers across our community, including those who are undocumented.”

Undocumented workers have rights and protections under health, safety, and anti-discrimination laws. The Selikoff Centers for Occupational Health at Mount Sinai, as part of its mission through the New York State Occupational Health Clinic Network, provides no-cost, confidential health care and other support services to all workers who have suffered a work-related injury or illness, regardless of documentation or insurance status. This includes evaluation, diagnosis, and treatment of work-related conditions. Services also include screenings for hazardous exposures (such as asbestos, lead, and other toxins), injury prevention, benefits counseling, and social work services.

“As members of the New York State Occupational Health Clinic Network, we provide health and safety-related services designed to reduce workplace injuries and illnesses,” says Dr. Crane, who is also a Professor of Environmental Medicine and Public Health at the Icahn School of Medicine at Mount Sinai. “We diagnose and treat ill and injured workers with the goal of safely returning them to work. Our doctors are experts in occupational medicine who understand work-related injury and help their patients obtain appropriate Workers’ Compensation benefits. Our patients may also avail themselves of the guidance and support of our experts in ergonomics, industrial hygiene, social work, and vocational counseling.”

Agata Bednarska

Undocumented workers are eligible for New York State Workers’ Compensation. This law provides benefits for lost wages and medical treatment when a worker becomes sick or injured because of their job. At the Selikoff Centers, Workers’ Compensation coordinators guide patients through the process, which can be overwhelming and confusing. This is especially important for those facing language barriers or who are mistrustful of government systems.

“Navigating the New York State Workers’ Compensation system can be challenging for many injured and sick workers” says Agata Bednarska, Outreach and Education Manager. “Our Workers’ Compensation coordinators are here to educate, support, and assist patients with filing for New York State Workers’ Compensation benefits. We place significant emphasis on educating our patients about their legal rights. Advocacy, education, and treatment by our specialists can reduce the very significant economic burden of injury or illness on the worker and their family.”

Meet Rachel Vreeman, MD, MS, Director of the Arnhold Institute for Global Health at Mount Sinai

Updated on Mar 21, 2023 | Adolescent Health, AIGH, Featured

“I never wanted to be in a lab or doing statistics, but I absolutely love asking questions about how to best provide care for kids.” – Rachel Vreeman, MD, MS, Director of the Arnhold Institute for Global Health.

Rachel Vreeman, MD, MS, is Chair of the Department of Global Health and Health System Design at the Icahn School of Medicine at Mount Sinai and the Director of the Arnhold Institute for Global Health. A pediatrician and researcher, she also continues her research work around HIV, with a focus on East Africa, as well as other global work related to children and adolescents living with HIV.

In addition, Dr. Vreeman chairs the Global Pediatric Working Group for the International Epidemiologic Databases Evaluating AIDS (IeDeA) consortium, a global consortium of HIV care programs funded by the National Institutes of Health that compiles data for more than two million people living with HIV.

Prior to joining Mount Sinai in 2019, she served as Director of Research for the Indiana University Center for Global Health and for the AMPATH Research Network, and was an Associate Professor of Pediatrics at the Indiana University School of Medicine and the Joe and Sarah Ellen Mamlin Scholar for Global Health Research. She received her bachelor’s degree from Cornell University where she majored in English literature. She has a master’s degree in clinical research from Indiana University School of Medicine and a medical degree from Michigan State University College of Human Medicine.

In this Q&A, Dr. Vreeman, who is also a best-selling author of books that debunk medical myths, discusses her vision for the Arnhold Institute for Global Health, how she has witnessed the transformation of care for children with HIV, and what it takes to be a good doctor and researcher.

Can you tell us a little bit about yourself and your background?

I am a pediatrician and researcher who specializes in trying to figure out how to improve care for children and adolescents growing up with HIV all around the world. I have worked for almost the last 20 years in a partnership in Kenya, growing a health care system for families with HIV and engaging with Kenyan partners around how we can best treat HIV in places like East Africa. I grew up in Michigan, then went to college at Cornell, medical school at Michigan State University, and trained in pediatrics at Indiana University. At Indiana University, I was introduced to global health through a long-standing partnership called the Academic Model Providing Access to Healthcare in Kenya, a 30-plus-year partnership between North American medical schools and a medical school and hospital system in western Kenya. I started spending about six months of the year living and working in Kenya, focused on the care of children with HIV.

One of the things that many people in global health don’t know about me is that I’ve co-authored three best-selling books that debunk medical myths people tend to hold about their bodies and health. This myth-busting has given me lots of interesting opportunities to talk about science and health; it has been featured in The New York Times, USA Today, The Los Angeles Times, Newsweek, and many other publications and on various television and radio shows such as Good Morning America and CNN.

A pediatrician and researcher, Rachel Vreeman, MD, MS, Director of the Arnhold Institute for Global Health, is also a best selling author. Here three books she co-authored:

Don’t Swallow Your Gum: Myths, Half-Truths, and Outright Lies about your Body and Health
Don’t Cross Your Eyes…They’ll Get Stuck Like That! And 75 Other Health Myths Debunked
Don’t Put THAT in THERE! And 69 Other Sex Myths Debunked

What is your vision for the Institute?

My vision for the Institute is that we would grow and deepen a small set of global health partnerships that radically improve the health systems in the places where we are partnering—and that these partnerships would model equity, sustainability, mutual trust, and mutual benefits. Through these kinds of partnerships, I believe the Arnhold Institute for Global Health will be able to move forward research, health care delivery, and educational opportunities that transform health care systems for vulnerable populations. Right now, we are growing these partnerships in Kenya, Nepal, Ghana, and New York City, and we are starting to see the first glimpses of how these partnerships can meet the health needs of populations such as adolescents living with HIV, neighborhoods with diverse populations struggling through COVID-19 spikes, pregnant people with unacceptably high rates of deaths and complications, and people seeking care for chronic diseases like hypertension in rural communities. I cannot wait to see our work like this continue to grow through the partnerships we have formed with academic medical centers, health systems, and government public health partners.

Nima Lama, left, Minister of Health for Bagmati Province in Nepal, presents Dr. Vreeman with a Nepali gift.

How did you get into the adolescent health field?

The most incredible privilege of my career has been the opportunity to become a pediatrician who can focus on supporting adolescents and young adults globally, including those who are living with HIV. In the early years that I worked in Kenya, our hospital wards and our clinics were full of young children who were dying from HIV. Two-year-olds, 3-year-olds, 4-year-olds. I did not take care of more than a handful of older kids. None of the kids born with HIV lived that long.

And now, our clinics in Kenya are such very different places. They are full of teenagers doing teenager things. Going to school, struggling through becoming adults, making friends and arguing with friends. All the good stuff and all the hard stuff. And HIV is now a chronic disease that they are living with. I love getting to watch youth transform not only their own stories, but also start to transform our world. It is the most inspiring, hope-bringing, sometime scary, but always precious thing.

Adolescence is this critical time for youth—the time that often decides whether a person stays in school, remains free of infections like HIV, whether they get pregnant young or not, what their use of drugs or alcohol might look like, and how their social circles develop. But most global health systems have very few services to support all aspects of adolescent health. There are often not places for adolescents to get vaccines or mental health support or family planning services—let alone basic check-ups. Now, I get to focus much of my own work on growing care programs to support adolescent health in places like Kenya.

What is the best part of your job?

I love new ideas. And I love tackling big problems. The very best part of my job is getting to support our multinational teams as everyone collaborates to dream up new ideas that provide better health care and better access to health care for people around the world.

What are you most excited about for the future of the Institute?

At the Institute, we now have the opportunity to change how health care is provided for big groups of people, often living in poor or remote places around the world. We even have the opportunity to work on national health systems and revamping how they provide care to populations like women and children. Being able to have this kind of impact, to be able to be part of scaling up better and more just systems—especially to serve children and women—is so exciting to me.

Do you have any advice for someone looking to go into your field?

I would not be afraid to bring all of yourself to the work that you want to do. For example, I thought that being a book-loving, former English major who loves stories was an interesting part of who I was, but I never thought that it would be part of what it looked like to be a good doctor. In fact, when I started medical school, I thought it might be a real liability that I did not have the kind of science background that many of my peers do. Instead, I learned over time that how we care for people as patients requires us to be very good listeners to their stories. Even more, it is critical to the work I do every single day that I can capture our ideas and their significance in writing.

And, it always helps to stay curious. Once I was in pediatrics, I did not really have any idea what kind of specialty area or focus I might want. I loved taking care of children and addressing the needs of their families, and I had never once thought about a research career. After seeking and questioning during my years of residency, it took a smart mentor to point out to me that I really love working to try to fix health care systems so that they provide better care for the most vulnerable children and their families—and that this was what health services researchers do. I begrudgingly agreed to try out a research elective and quickly discovered that my love of figuring out ideas for how to fix things was actually the perfect basis for growing research. I never wanted to be in a lab or doing statistics, but I absolutely love asking questions about how to best provide care for kids.

Mount Sinai Physicians Aid Colleagues in War-Torn Ukraine

Mar 9, 2023 | Community, Featured

In Ukraine, doctors are working to continue giving quality care to patients with inflammatory bowel disease. Mount Sinai has stepped in to help by offering courses over Zoom with more than 250 doctors.

Amid the ongoing war in Ukraine, doctors are desperate to continue giving quality care to patients with inflammatory bowel disease (IBD), a condition that causes chronic inflammation of the gastrointestinal tract. Determined to help, Jean-Frederic Colombel, MD, and his team created the “Mount Sinai IBD Course for Ukraine,” a series of remote courses that support IBD doctors in the country. “As soon as I was aware that there was a need, I immediately said ‘yes,’” says Dr. Colombel, Director of the Susan and Leonard Feinstein IBD Clinical Center and the Leona M. and Harry B. Helmsley Charitable Trust IBD Center at Mount Sinai, and Professor of Medicine (Gastroenterology). “Also, because I’m European, I’m very emotional about what’s going on in Ukraine, because I know several of these doctors.”

Jean-Frederic Colombel, MD

As an IBD specialist who practiced in his home country of France before joining Mount Sinai in 2013, and who served as President of the European Crohn´s and Colitis Organisation from 2008 to 2010, Dr. Colombel was in a unique position to help. Working closely with his network of colleagues both within and outside of Mount Sinai, Dr. Colombel and his team organized the series of courses over Zoom. In all, three courses have been held since August so far, with up to 250 Ukrainian doctors attending both live and recorded video sessions. Dr. Oleksandr (Alex) Shumeiko, a Ukrainian gastroenterologist currently undergoing training at the University of Cincinnati, worked closely with Dr. Colombel to organize the courses and helped spread awareness among colleagues in his home country.

Ukraine is a leader among Eastern European countries in the field of IBD. However, the war has forced many doctors there to rethink how they treat patients—using minimal resources, rather than the latest developments and innovations in their field. “Because of the war, it was back to some basics, and how to deal with that,” Dr. Colombel explains.

Since the war began a year ago last February, patients and doctors have faced multiple dilemmas— disruption of logistics, the closure of hospitals under constant shelling, damage to energy grids—all of which makes it almost impossible to provide quality diagnoses and treatments for patients. Many health care workers and patients have become refugees or were displaced, partially or completely unable to access IBD treatment. Before the war, Ukrainian centers were tightly involved in clinical trials for IBD, providing opportunities for advanced therapies and cutting-edge medical care. Now, those trials have closed and many hospitals have lost resources to provide adequate IBD care. As a result, most patients are relying on humanitarian efforts to receive treatment.

As the war continues to disrupt health care systems, Mount Sinai’s IBD Course for Ukraine is helping Ukrainian physicians support IBD patients with minimal resources. For example, one course trained doctors in the management of long-term use of steroids for patients with IBD. While not recommended under normal circumstances, Dr. Colombel says the treatment is necessary for patients in Ukraine. “Because the typical biologics prescribed to IBD patients are not available due to the war, Ukrainian doctors wanted to learn how to minimize the side effects of steroids, which was sometimes the only treatment option,” Dr. Colombel says.

In fact, a majority of the courses have focused on practical topics, such as managing stomas following surgery, optimizing nutrition, treating IBD during pregnancy, caring for children with IBD, surgical options for IBD patients, and more. When Dr. Colombel asked Mount Sinai colleagues with IBD expertise to participate, many were eager to help. “This was extra work for all of them, but everybody was very enthusiastic. And actually, we had almost too many people who wanted to participate.”

The courses “perfectly align” with Mount Sinai’s core values of creativity, empathy, and teamwork in times of crisis, he says, because they offer “the best education for doctors in the Ukraine to provide the best care for all their patients, rather than a select group of patients who are the most wealthy.”

While organizing the courses over Zoom was relatively simple, Dr. Colombel says it was “very emotional,” because some doctors attended a live course in Kharkiv while missiles struck the city. He imagined what it would be like to provide care to patients under similar circumstances. “This would be a heartbreaker,” he says. “Very often, we don’t think about the consequences for doctors and patients to be at war like that. It is not like Ukraine is a country that never had access to the best care—they had access to very good care before, and then, suddenly, boom—nothing. So this is a big deal.”

Aside from helping doctors in Ukraine access the knowledge they need to treat patients, Dr. Colombel says it was just as important for them to see that their colleagues outside Ukraine were willing to help.

“Any sign of solidarity that you can bring for them, psychologically, is very important,” he says.

A damaged operating room inside a Ukrainian IBD center.

Ukranian IBD doctors examine an image together

Ukranian doctors meet for training on how to use diesel generators

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FREEDOM Trial Finds That High-Dose Anticoagulation Can Improve Survival for Hospitalized COVID-19 Patients

Mar 7, 2023 | Cardiology, COVID-19, Featured, Research

The FREEDOM trial was initiated and led by Valentin Fuster, MD, PhD, President of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

An international trial led by Mount Sinai found that high-dose anticoagulation can reduce deaths by 30 percent and intubations by 25 percent in hospitalized COVID-19 patients who are not critically ill, when compared to the standard treatment, which is low-dose anticoagulation. The innovative FREEDOM trial was initiated and led by Valentin Fuster, MD, PhD, President of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.

The study results were announced Monday, March 6, in a late-breaking clinical trial presentation at the scientific sessions of the American College of Cardiology Together With World Congress of Cardiology (ACC.23/WCC) in New Orleans and simultaneously published in the Journal of the American College of Cardiology.

“What we learned from this trial is that many patients hospitalized with COVID-19 with pulmonary involvement, but not yet in the intensive care unit (ICU), will benefit from high-dose subcutaneous enoxaparin or oral apixaban to inhibit thrombosis and the progression of the disease,” Dr. Fuster says. “This is the first study to show that high-dose anticoagulation may improve survival in this patient population—a major finding since COVID-19 deaths are still prevalent.”

Clinical Insights, Early in the Pandemic

This work was prompted by the discovery early in the pandemic that many patients hospitalized with COVID-19 developed high levels of life-threatening blood clots. In March 2020, during the early days of the pandemic, Dr. Fuster observed patients with blood clots in their legs who had been admitted with COVID-19. After hearing from colleagues abroad of other cases of small, pervasive, and unusual clotting that had triggered myocardial infarctions, strokes, and pulmonary embolisms, he initiated decisive action.

“We became one of the first medical centers in the world to treat all COVID-19 patients with anticoagulant medications,” says Dr. Fuster, a pioneer in the study of atherothrombotic disease. “It was a decision that we believe saved many lives.”

This early protocol led to groundbreaking research and insights by Mount Sinai into the role of anticoagulation in the management of COVID-19-infected patients. Mount Sinai research showed that treatment with prophylactic (low-dose) anticoagulation was associated with improved outcomes both in and out of the intensive care unit among hospitalized COVID-19 patients. Researchers further observed that therapeutic (high-dose) anticoagulation might lead to better results. Then, they designed the FREEDOM COVID Anticoagulation Strategy Randomized Trial to look further into the most effective regimen and dosage for improving outcomes of hospitalized COVID-19 patients who are not critically ill.

Researchers enrolled 3,398 hospitalized adult patients with confirmed COVID-19 (median age 53) from 76 urban and rural hospitals across 10 countries—including hospitals within the Mount Sinai Health System—between August 26, 2020, and September 19, 2022. Patients were not in the ICU or intubated, and about half of them had signs of COVID-19 impacting their lungs with acute respiratory distress syndrome (ARDS). Patients were randomized to receive doses of three different types of anticoagulants within 24 to 48 hours of being admitted to the hospital and followed for 30 days. Equal numbers of patients were treated with one of three different drug regimens: low-dose injections of enoxaparin, high-dose injections of enoxaparin, and high-dose, oral doses of apixaban. They compared the combined therapeutic groups to the prophylactic group.

Informing Future Care

The primary endpoint was a combination of death, requirement for ICU care, systemic thromboembolism (blood clots traveling through the arteries), or ischemic stroke at 30 days. This endpoint was not significantly reduced among the groups. However, 30-day mortality was lower for those treated with high-dose anticoagulation compared with those on the low-dose regimen. Seven percent of patients treated with the low-dose anticoagulation died within 30 days, compared with 4.9 percent of patients treated with high-dose anticoagulation—an overall reduction of 30 percent. The need for intubations was also reduced in the high-dose group: 6.4 percent of patients on the high-dose regimen were intubated within 30 days compared with 8.4 percent in the low-dose group—a 25 percent reduction. The study showed high-dose anticoagulation to be especially beneficial for patients with ARDS, a condition where COVID-19 damages the lungs. Among patients with ARDS at the time of hospital admission, 12.3 percent in the low-dose anticoagulation group died within 30 days, compared with 7.9 in the high-dose group.

All groups had low bleeding rates, and there were no differences between the two therapeutic blood thinners for safety and efficacy.

“This is an important study for patients with COVID-19 who are sick enough to require hospitalization but not so ill as to require ICU management. In this group of patients with radiologic evidence of ARDS, therapeutic dose anticoagulation prevents disease progression, especially the need for intubation, and saves lives,” says co-Principal Investigator Gregg W. Stone, MD, Professor of Medicine (Cardiology), and Population Health Science and Policy, at the Icahn School of Medicine at Mount Sinai. “This is especially important as COVID-19 is not going away. Even in the United States, the current number of daily deaths, although much lower than at the peak of the pandemic, is twice that compared with just one year ago. And in other countries COVID-19 is raging”

The FREEDOM trial was coordinated by the Mount Sinai Heart Health System. Dr. Fuster raised all funding for the trial.

Mount Sinai Experts Discuss the Future of Cancer Care and Research

Updated on Mar 7, 2023 | Featured, Research

More than 50 years after the United States formally declared war on cancer, what is the prognosis for innovative cancer research and care?

Two Mount Sinai leaders in cancer care and research, Ramon Parsons, MD, PhD, Director of The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai, and Cardinale Smith, MD, PhD, Vice President, Cancer Clinical Services for the Mount Sinai Health System, offered their perspectives as part of a recent 92nd Street Y online event. You can watch the video here.

The two agreed on this overarching message: Tremendous progress has been made in unraveling the complex biology of cancer and targeting its many forms with advanced new medicines, particularly immunotherapies. But looming just as large are the challenges that remain in areas like overcoming resistance to these medicines, early detection of cancer through screening, and ensuring the equitable distribution of cancer care to diverse and disadvantaged populations.

Ramon Parsons, MD, PhD

“After 50 years we have a much more sophisticated understanding of how genes are altered in the cancer cell and how cancer cells reprogram the tumor microenvironment,” said Dr. Parsons, the Ward-Coleman Chair in Cancer Research. “And that has pushed the envelope in terms of our knowledge of the biology of cancer and, just as importantly, how we treat it. We’re seeing better outcomes for more and more of our patients and believe cancer rates will continue to come down because of treatments we didn’t have in the past, and more informed prevention.”

Dr. Smith, who is also Chief Medical Officer for the Tisch Cancer Hospital and a Professor of Medicine (Hematology and Medical Oncology), described the dramatic changes in cancer care and treatment, particularly in her specialized field of lung cancer.

“When I finished my fellowship training 12 years ago we had just two drugs for lung cancer, and now there are so many more,” she said. “Patients I treated as a fellow are still alive today thanks to clinical trials for new investigative drugs they were able to enroll in.”

Immunotherapies have carved out many of the greatest gains, while also raising some obstacles for the research community. Immunotherapy refers to treatments that use a person’s own immune system to fight cancer.

“The next frontier is determining which patients are going to have a long-term response to immunotherapy, and how do we overcome the resistance we so often see with these therapies,” said Dr. Parsons. “That’s the biology we still need to figure out, and to that end some of the research we’re most excited about is aimed at helping us better understand the switches in the immune system and how they can be regulated therapeutically.”

Two other areas of research where Dr. Parsons sees great promise are tumor suppressors, which are genes that regulate a cell during cell division, and liquid biopsies, which can detect through a simple blood test at the doctor’s office circulating tumor cells and tumor DNA.

With a strong background in tumor suppressors, he sees great advantage in being able to develop gene therapy or other innovative approaches to restore tumor suppressors, a natural part of the body’s defense mechanism that becomes altered or mutated in almost every type of cancer.

Liquid biopsies, still in early-stage development, could be another significant development. “This idea of being able to catch cancers before they are recognizable is going to ultimately move the needle in improving patient survival,” he said.

Cardinale Smith, MD, PhD

For Dr. Smith, early detection includes more aggressive screening by the health care providers.

“Uptake of lung cancer screening has been slow,” she said. “A lot of the work we’ve been doing at Mount Sinai is connecting with the community to understand what their needs are and how they prefer to partner with us. As a result, we’ve increased mammographies for women to detect breast cancer, and improved colorectal cancer screening for both men and women. Now we need to make the same kind of progress with lung cancer screening.”

She noted that as part of its outreach, Mount Sinai in April 2022 launched the Mount Sinai Robert F. Smith Mobile Prostate Cancer Screening Unit after noticing a high mortality rate for the disease in certain neighborhoods of New York City with a high Black male population. The purchase was funded by a $3.8 million donation from philanthropist Robert F. Smith. This successful effort between the Institute and the Department of Urology has been collecting blood samples to measure PSA levels and referring individuals for follow-up care when a problem is detected.

The nation’s war on cancer formally began with the National Cancer Act of 1971, which established the National Cancer Institute. As for the future of cancer care, Dr. Smith foresees patient care navigation and a palliative care workforce as movements with transformative potential.

Navigators with the ability to compassionately guide people through the often challenging cancer screening and treatment process would be an extremely beneficial allocation of resources, she maintains. So would development of specialized palliative care teams that could provide training and skills to oncologists and other clinicians, including nurses and advanced practice providers.

“We know that palliative care when combined with standard oncologic care can improve patients’ quality of life and mood by decreasing depression,” she said. “It also decreases unnecessary utilization of acute care, such as emergency room visits, hospitalizations, and readmission. Most importantly, it aligns cancer care with the goals and values of the patients, which all of us as clinicians need to hold as sacred in the years ahead.”

What Should I Do If My Child Has Norovirus?

Updated on Feb 24, 2023 | Adolescent Health, Featured, Pediatrics, Your Health

If your child has a stomach bug, it could be norovirus—a highly contagious stomach virus that causes diarrhea and vomiting. Cases of this virus are on the rise in New York City and much of the northeastern United States, according to the Centers for Disease Control and Prevention.

While typically mild in older children and adults, lasting usually only a few days, norovirus can cause severe dehydration in babies and kids with certain underlying conditions. Knowing how to care for them is crucial.

In this Q&A, Tessa Scripps, MD, a pediatrician at the Mount Sinai Kravis Children’s Hospital, and Assistant Professor of Pediatrics at the Icahn School of Medicine and Mount Sinai, answers your questions about the disease, including what to do if your child is sick.

What is norovirus, and what are norovirus symptoms?

Norovirus is a common contagious virus that inflames the intestines, causing nausea, diarrhea, and throwing up. Sometimes it can also cause fever. The disease is spread when particles from an infected person’s feces or vomit spreads to others, typically in bathrooms, but also by eating or drinking contaminated foods and beverages; using contaminated utensils; touching contaminated surfaces; or having any direct contact with someone who is infected. Norovirus is highly transmissible, and infected people can actually shed billions of norovirus particles at a time, but it can take fewer than 100 norovirus particles to make another person sick. People are most contagious when they actively have symptoms and in the few days after their symptoms have resolved.

Tessa Scripps, MD

How can I protect my child from catching norovirus?

The most common way norovirus is spread is through close contact with an infected person, so it’s a good idea to keep kids some distance from people who are sick, or who have recently recovered from being sick. Norovirus can infect an entire family at the same time, since even simple contact with others can lead to infection. So, the most important thing is for kids to wash hands frequently with soap and warm water, and for adults to do the same, especially if any of you have been in contact with a person who has symptoms. Alcohol-based sanitizers do not work as effectively against preventing transmission.

My child has norovirus. How does their age or health condition affect their risk for severe illness?

Newborn babies and children who have underlying chronic illnesses such as kidney disease and diabetes are at higher risk for becoming dehydrated and severely ill because excessive fluid losses can affect their kidney and their liver function. It’s important they get medical attention right away if symptoms last longer than three days or if they’re unable to keep hydrated.

What symptoms might indicate my child needs medical help?

Watch for symptoms of dehydration, such as decreased or less frequent urination and small volume- or very dark or strong-smelling urine. If it has been more than eight hours from when your child has had a wet diaper or used the toilet to pee, reach out to your doctor for advice. A rapid heart rate or a significant change in your child’s activity can also be a sign of dehydration. If you notice that your child seems very lethargic and listless, you should seek medical advice right away.

What can I do to help my child recover from norovirus?

Once the virus has passed and the vomiting and diarrhea have subsided, make sure they are well hydrated and rested. For newborns and infants, you can give them small amounts of breast milk or formula. Toddlers, older children, and adults should drink small volumes of fluids—about one to two ounces every one to two hours—to ensure fluids get absorbed and to prevent recurrent vomiting. Drinking water and electrolyte fluids like Pedialyte^®, Gatorade, or watered down apple juice can be very useful to maintain hydration, and can help prevent complications from norovirus. They can also have bland foods like rice, dry cereal, applesauce, bananas, and crackers.

Are there any medications I can give my child to ease their norovirus symptoms?

There are no over-the-counter anti-diarrheals or anti-nausea medicines that are recommended for children. In rare cases, pediatricians may prescribe Zofran, an anti-emetic, to help children stop vomiting so they can re-hydrate without the need for intravenous fluids.

How do I prevent norovirus from spreading to my other kids?

It is important that everyone in your house washes their hands regularly with warm water, and avoid sharing food and drinking cups with anyone who is sick. You should also wipe down any contaminated surfaces with a bleach-based disinfectant, especially toilets and sinks after an infected child has used them. And everyone should try to maintain some distance from infected household members while they’re actively sick.

Is there a test for norovirus I can give my child?

Testing is available. However, norovirus is similar to other types of stomach infections, such as rotavirus, and symptom management is the same, so testing isn’t useful. If there has been an outbreak at your child’s school and they are sick, there is a good chance they have norovirus.