More and more people in public spaces are no longer wearing masks to prevent the spread of COVID-19. In one of the biggest shifts, airlines have dropped requirements for wearing masks on flights, though mandates to wear masks remain for New York subways, buses, and commuter trains.
The changing rules can be confusing if you are trying to do all you can to reduce your risk of infection. In this Q&A, Bernard Camins, MD, Medical Director for Infection Prevention at the Mount Sinai Health System, who has been tracking COVID-19 since the first cases were identified in New York in March 2020, offers some basic guidance. As always, the best protection is to get your vaccination and booster shots as recommended by health authorities.
If you have to travel by plane, how can you do so safely?
Now that masking is no longer required on all airline flights, it is important to remember that masking does protect you. It also depends on what type of face mask you wear. For example, a well-fitting mask is better than a loosely fitting cloth mask. If you needed more protection—because you’re immunocompromised, which means you have a reduced ability to fight infections, or you have relatives or loved ones who may be at increased risk for complications from a COVID-19 infection—you may want to take additional steps to reduce the chance of getting infected. The best way to do this is by wearing a more protective mask. Double masking with a medical or surgical mask on your face and then wearing a cloth mask on top is an easy way to accomplish that. So the mask fits your face better. Other better protective masks are KN95s and N95s. They work better because they fit snugly against your face.
Anything else?
You could sit by the window, which keeps you away from everyone walking down the aisle. And it keeps you away from most interactions with other people, which reduces your risk for exposure. You can also board the plane as late as possible, and try to leave the plane as soon as possible.
Do the air filter systems in planes help?
Airplanes are equipped with very effective air filtering systems. While you’re up in the air, the air is filtered by HEPA filters, and they are very effective at eliminating droplets that can transmit the virus that causes COVID-19. (HEPA stands for high efficiency particulate air). But these filters are not functional while the plane is on the tarmac, during boarding, or takeoff. That’s why you may want to take extra precautions until you are in the air.
You are taking a trip yourself, what are you planning to do?
As a matter of fact, I am leaving on a trip to Europe. In order to prepare myself, and being over 50, I’ve taken a second booster shot of the COVID-19 vaccine because I did qualify for it. Just in case I need the extra protection in situations that I cannot control. We plan to dine outdoors as much as possible. If you are over 65, and certainly if you are immunocompromised, you should get the second booster once you’re eligible. That increases your chances of being able to avoid getting severe disease or being hospitalized from getting COVID-19 infection. I also plan on wearing more protective masks like an N95 and keeping it on even though they’re no longer mandatory while I’m on the plane.
If others around me are not wearing masks, does it still help if I wear a mask?
Yes. Wearing a mask, especially one that fits tightly on your face, can protect you if others are not wearing their mask. For example, health care workers rely on masks when they are taking care of patients. Most of the times, even COVID-19 patients are not wearing masks. Health care workers use N95 masks to protect themselves. So, if you are able to get an N95 or a KN95 masks that fits your face well, that will then be more protective for you. If you can’t get those masks, then studies have shown that putting on a medical or surgical mask, which are more loosely fitting, with a cloth mask on top is almost as good as wearing a tighter fitting mask.
When does it make sense to get a PCR test rather than a rapid test?
If you develop symptoms of COVID-19, you should get a PCR test if you have easy access to one. Antigen tests, more commonly referred to as rapid tests, are also helpful because they’re much more available to the public. But they are not as accurate. One of the ways you could use the antigen test is after your trip if you can’t easily access a PCR test. Test yourself two to four days after your trip, or sooner if you develop symptoms.
What about traveling by car or subway?
If you are taking a taxi or a ride sharing service like Uber, you can politely ask your driver to wear a mask if they are not doing so. And roll down your window for better ventilation. On a bus or subway, where it may be crowded, a well-fitting mask will provide additional protection.
Any final thoughts?
Keep in mind that you should evaluate your own risks when you travel. For example, eating outdoors may be safer than eating indoors, especially if you are immunocompromised. This includes those who have a weakened immune system, such as those receiving treatment for cancer, or if you’re at high risk for complications, such as those who are older than 65 years or those with chronic medical conditions. Parents of unvaccinated children may prefer to be more careful to avoid being infected. It’s also good for everybody to check themselves for symptoms of COVID-19 daily and get tested if you develop symptoms. That way, you can isolate appropriately if you test positive. Finally, you should be up to date on your vaccination. If you’re unvaccinated, please get vaccinated. If you are fully vaccinated you should get a booster shot when eligible. And if you are over 50 and potentially at risk for complications because of other illnesses, you should consider getting the second booster if you’re eligible.
Richard “Woody” Wood enjoys wakeboarding, traveling, and other activities.
Among the top myths about people with spinal cord injuries are that they are to be pitied, that they always need help, and that they can’t lead independent and fulfilling lives. All of these were gently dispelled in a virtual talk led by Angela Riccobono, PhD, Director of Rehabilitation Neuropsychology; Richard “Woody” Wood, Outreach Program Coordinator in the Mount Sinai Spinal Cord Injury Rehabilitation program; and Yesenia Torres, Accessibility Outreach Coordinator of the New York City Taxi and Limousine Commission.
The talk, hosted by the Office for Diversity and Inclusion (ODI) at Mount Sinai, was titled “Debunking Common Myths about Spinal Cord Injuries” and may be viewed here. It was part of the second annual Raising Disability Awareness Virtual Talk Series, launched by ODI for Disability Awareness Month to raise awareness and promote an inclusive and equitable workplace and health care environment for people with disabilities.
Yesenia Torres
Ms. Torres, who conducts training in disability awareness and etiquette, had two important tips: If you wonder if a person with disabilities needs help “Just ask first,” she said. “Do you need some help, and how can I help you? Those are the major questions.” And when referring to some with a disability, mention the person first, then the disability if it is relevant.
“We are us. We’re out there. We’re individuals. We do everything, maybe with a different form of doing it,” Ms. Torres said. “But our disability does not define us.”
Dr. Riccobono said while furthering diversity and inclusion, it was important to be both informed and socially aware of the issues that people with disabilities face. For example, those with spinal cord injuries often need more room to maneuver. With so many buildings having tiny bathrooms, narrow doorways, and stairs instead of elevators, life can be much more difficult for people with disabilities. In a health care facility, exam tables, mammogram machines, and even clothing racks may not be reachable for those with spinal cord injuries.
Ms. Torres and Mr. Wood recounted some of their own life experiences to dispel some common myths and point out the tremendous diversity within the community of people with disabilities.
Richard “Woody” Wood
One myth that people with spinal cord injuries face is that they are sad, depressed, or ill. “I’ve actually known someone who told me that they were sitting on the street and somebody just came and put money in their lap,” Dr. Riccobono said. Mr. Wood added that while he was waiting for a ride, a woman randomly gave him a dollar, even though he was talking on a brand new iPhone.
There is the mistaken belief that people who use wheelchairs cannot have fulfilling sex lives. “That’s the furthest from the truth,” Mr. Wood said. Ms. Torres added that her sex life is even better now. “Intimacy with your partner becomes very important and very powerful,” she said.
Angela Riccobono, PhD
The myth that people in wheelchairs can’t travel is also pervasive. “I travel a lot. And I’m actually organizing a trip to San Diego with my siblings, because I need a break. I’ve been doing too much,” Ms. Torres said, and described services that help with air travel. “Everything is out there for us. We go to the counter, and we say that we’re in a wheelchair. If we want, we can take our own wheelchair, or they could put us on a service wheelchair that’s very narrow and fits in the aisle of the plane. So, whoever wants to go out and travel, there are no ‘buts,’ because there’s help out there.”
Dr. Riccobono shared some recommendations, such as taking action by changing one’s beliefs and assumptions about people with spinal cord injuries, changing one’s behavior to include hiring people with disabilities to enhance inclusion in the workplace, and advocating for those who need it the most. “Listening to the needs of the community and working together to create positive change is an excellent way for experiences to get better,” she said.
At the beginning of 2022 when the Mount Sinai Health System was experiencing a surge in COVID-19 patients, which included many members of its own staff, 60 students at the Graduate School of Biomedical Sciences at the Icahn School of Medicine at Mount Sinai stepped up to lighten the load of non-medical staff as part of a Student WorkForce.
It was the fourth time since the outbreak of COVID-19 that the Student WorkForce at Icahn Mount Sinai sprang into action to help alleviate staffing shortages. In the latest effort, they were part of a team of more than 200 medical, master’s, and PhD students who took on vital roles while many employees were out sick—staffing the waiting rooms and employee call center, coordinating employee testing, and even delivering food to patients.
The Student WorkForce was created in March 2020 as New York City hospitals became the national epicenter of the newly declared pandemic. Since then, tasks have been reshaped to meet new needs, and unlike in previous waves, the students received an hourly wage for their work.
“I was grateful for the opportunity to help,” says Yesha Dave, a second-year graduate student doing research in neuroscience. “I could somewhat understand the burden on health care systems after seeing it through the experiences of my sister and parents, who are all physicians.”
Ms. Dave worked in the Employee Health Services office at The Mount Sinai Hospital instructing staff on how to collect saliva samples for their own PCR tests and registering them for tests. She worked one or two shifts per week from early January through the end of February, seeing as many as 100 individuals per week. During a previous effort for the Student WorkForce in 2021, she had assisted elderly New Yorkers get their COVID vaccines, helping them navigate the lines and fill out the requisite forms. “I understood their occasional frustration and tried to make the experience as easy as possible for them,” she says.
Ms. Dave says she was attracted to Mount Sinai’s rich research opportunities, especially those related to COVID-19 and neuroscience when she enrolled in the graduate program. She expects to receive a Master of Science in Biomedical Science in June before starting medical school in July. “It’s awesome to be part of the Health System at such a historic time,” she says.
Oluwafunmilayo (Funmi) Oguns is pursuing her Master of Public Health (MPH) in global health, with a concentration in epidemiology and biostatistics. After graduation, her plan is to attend law school to focus on public health policy as it relates to social determinants of health. “When I received the email sent to medical school and graduate students asking for help to relieve staffing shortages brought on by skyrocketing COVID-19 cases after the holidays, I just knew I had to help,” Ms. Oguns says.
She and an MPH classmate, Spundan Davé, set up shop at Jane B. Aron Residence Hall and helped test hundreds of students who were returning to school following their holiday break, observing them self-swab, and offering whatever assistance was necessary to complete their testing. They spent 16 hours on this task the first week, while also taking classes. When Ms. Oguns herself tested positive for COVID-19 during the Omicron wave, she continued to work shifts after leaving isolation. In addition to this special project and her classes, Ms. Oguns is the editor of The Scoop, a Graduate School student newspaper.
Ms. Oguns lived nearly seven years in Nigeria, where she saw first-hand how lack of medical care impacts people’s lives. “All my grandparents in Nigeria passed away before the age of 65 due to limited access to health care and education,” she says. “That’s what motivated me to pursue a career in public health.”
Pamela del Valle is a fourth-year PhD student in neuroscience, where she is studying the sympathetic nervous system to shed light on the comorbidity of Parkinson’s disease and melanoma. She has been involved in a wide range of diverse organizations, both on campus and off, including the Student Council, where she focused on mental health and wellness for students; Students for Civic Engagement; and the Scientific Workers Collective, an organization dedicated to politically engaging the scientific community. She is also looking for ways to integrate her study of the brain with her passion for the arts.
So when the call went out for students to help deliver food trays to hospital patients during the Omicron surge, she says the assignment appealed to her and she found the experience moving. “I think it’s important for students to be exposed to all facets of the hospital, and I got to see a side of the hospital I don’t normally see,” she says. “It was eye opening to experience the camaraderie and the energy of the kitchen staff, to hear their music, and to see how lively it was while everyone was trying to work together to get their jobs done.”
Brian Soong, an MD/PhD student studying cancer immunology, had a different kind of inspirational experience. He served as an Emergency Department technician, filling in for the professionals who were among the hardest hit during the pandemic. Mr. Soong helped to check in patients, took their vitals, shadowed nurses conducting triage, and did whatever he was called upon to do.
“This was a once-in-a-lifetime opportunity to help our nation in crisis,” he says. “It was remarkable to hear the stories told by staff and patients and to understand how things have changed in the hospital since the first COVID-19 wave. I love doing research, but the patient interaction was entirely new to me, especially since our clinical experiences have been limited due to COVID-19. It was really fulfilling.”
Dina Doustmohammadi is pursuing her Master of Health Administration remotely from her home in southern California, so while she was eager to join the WorkForce, she was limited in how she could help. After a short stint clearing recovered COVID staff to return to work, she settled in as part of a two-person team scheduling asymptomatic testing at all Mount Sinai hospitals.
Working with a senior operations manager, she also coordinated the schedules of Student WorkForce participants and employees ensuring there was sufficient coverage where needed. “I liked the dynamic, fast-paced work environment that was always changing as testing demand and positivity rates ebbed and flowed and coverage needs constantly shifted,” Ms. Doustmohammadi says. She was also involved in verifying vaccine status for employees, ensuring all were compliant. All told, she logged close to 200 hours over six weeks.
Ms. Doustmohammadi is in a two-year program but is being fast tracked to complete her studies in one year so she can begin medical school this summer.
“I feel lucky that I was able to help,” she says. “This experience has taught me that the administrative staff have been the unsung heroes of the pandemic. Just as importantly, I really appreciate how helpful the entire Student WorkForce was and how they managed the demands put on the system. Had it not been for the students, it’s hard to see how the system would have been able to absorb the losses created by the staffing shortage. It was very inspiring to see everyone working together toward a common goal.”
Just over two years ago, the World Health Organization declared COVID-19 to be a pandemic. New York City quickly became the epicenter, and the Mount Sinai community rose to the challenge.
Now, at this moment of cautious hope, a cross-section of the Mount Sinai community—front-line providers, researchers, and leadership—took a moment to consider two questions about the pandemic: What have we learned, and what lies ahead?
Here are thoughts from some of Mount Sinai’s leadership.
David Muller, MD
What have we learned? Never to take each other for granted; to say “thank you” and “I love you” as often as possible; not to underestimate our capacity for rising to a challenge; that those of us at the margins of society because of the color of our skin or our socioeconomic status always disproportionately bear the brunt of a crisis, and that this is a crime against humanity.
David Muller, MD, Dean for Medical Education and the Marietta and Charles C. Morchand Chair for Medical Education
An excerpt from Relentless: How a Leading New York City Health System Mobilized to Battle the Greatest Health Crisis of Our Era, by Deborah Schupack:
As it ripped through New York City and, soon enough, across the United States—which throughout 2020 suffered the most deaths in the world—COVID-19 laid bare the challenges, strengths, and weaknesses of the American health care system. From its vantage point in the center of the storm, and with a history of leading at medicine’s progressive edge, Mount Sinai experienced the challenges earlier than most and responded in full force, building on foundations of strength to both respond immediately and begin to shape post-pandemic health care.
Mount Sinai rapidly established several new programs to address needs that the pandemic had uncovered or, more often, elevated–needs that were known, were already being addressed to some degree. But the greatest exogenous shock in more than a century dramatically accelerated several trends already in motion.
“We acted very quickly to understand the disease better, to understand the consequences of the pandemic,” said Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System. “We put these findings into place almost immediately. We invested in understanding the effect of the disease on our front-line workers’ mental health, in understanding why people of color were having worse outcomes, in developing a data center to inform diagnosis and treatment, and in systematically monitoring and analyzing the long-term impact of COVID-19. This was not only the right thing to do, we had an obligation to act—not only for us, but for the nation and for the world. We were the epicenter of the epicenter.”
As it was caring for patients and conducting science, Mount Sinai was also aiming to shift the health care system, bending it toward racial equity and social justice, toward honoring health care workers as not just heroes but humans in need of help, and toward a true partnership with the patient, particularly in defining this novel disease, its symptoms and its acute and chronic impact. Mount Sinai was trying to ever shorten the bridge between medicine and science, leveraging big data and amplifying collaborations across all axes, including much valued public-private partnerships. And it was moving flexibly and nimbly at a pace never before traveled in health care, and urging a new focus on cultivating resilience—of systems, spaces, stuff, and staff—to sustain itself and the people it serves in a decidedly uncertain future.
Kelly Cassano, DO
For me, the pandemic has been about the people: the patients, staff, and our colleagues.
All of our relationships, individually and collectively, have been impacted in large and small ways. We have been humbled as individuals, as teams, and as an organization.
For what in moments of time seemed impossible, we endured and overcame many hurdles, together, to deliver the possible.
We are truly Better Together.
Kelly Cassano, DO, Chief Executive Officer Mount Sinai Doctors Faculty Practice Senior Vice President for Ambulatory Operations, Mount Sinai Health System Dean for Clinical Affairs, Icahn School of Medicine at Mount Sinai
Gary C. Butts, MD
These last two years have challenged us as a system, as a community, and as individuals in many ways, but in particular regarding equity as a core value. As spotlights have become more focused on the myriad racial injustices and inequities we face, locally and nationally, it has made us question our successes and the impact of our work on our broader Mount Sinai community and the many communities we serve.
It has become clearer that we must recommit and accelerate Diversity, Equity, and Inclusion (DEI) efforts—to establish a DEI learning community; to expand efforts for inclusive recruitment, mentoring, and development; and to enhance our capabilities to address care access and delivery and the disparities in health outcomes, among other important priorities.
We are reminded that racism is an important underpinning and contributor to these ills and that addressing these successfully requires deep, broad, and enduring solutions and authentic commitment and accountability from all of us. Finally we have learned and witnessed the value of family, friends, and community, and the importance of wellness and balance to support our professional work and to sustain ourselves, particularly during times that stretch our reserves.
Gary C. Butts, MD, Executive Vice President for Diversity, Equity, and Inclusion, Mount Sinai Health System Dean for Diversity Programs, Policy and Community Affairs, Icahn School of Medicine at Mount Sinai
David Reich, MD
What have we learned? We learned that the challenges we faced any particular week of the spring 2020 COVID-19 crisis were often completely different a few days later. Creating ICU and hospital capacity, building laboratory testing capability, developing new clinical protocols, including the world’s first anticoagulation dosing regimen, redeploying staff, and finding enough PPE were the overwhelming clinical and logistical needs at that time.
Perhaps more important, we learned that we could eliminate barriers and silos to leverage the collegial interactions of clinical physicians and nurses with virologists, data scientists, and the vast resources of the world-leading Icahn School of Medicine at Mount Sinai. We brought science into the real-time service of conquering a new disease and saving patient lives. This is the lesson that persists and has enriched our future.
What lies ahead? We see that change is a constant and that we must maintain and strengthen the linkages between our scientists and clinicians to succeed in rapidly changing circumstances. With the likelihood of new variants, vigilance and rapid adaptation by public health officials and health systems require seamless sharing of information.
Vigilance takes the form of closely monitoring laboratory COVID-19 testing, hospitalizations for severe illness, and the impact of less severe illness on maintaining workforces and vital services. Integrating artificial intelligence/machine learning and precision medicine are legacies that will improve our future.
David Reich, MD, President, The Mount Sinai Hospital and Mount Sinai Queens
Marta Filizola, PhD
“What have we learned?” Key elements that will help us better respond to future pandemics, specifically the need for: effective communication strategies, enhanced IT infrastructure/resources/expertise, workplace flexibility for all stakeholders at all career levels, and advocacy to facilitate the mobility of trainees.
Marta Filizola, PhD, Dean, Graduate School of Biomedical SciencesSharon and Frederick A. Klingenstein-Nathan G. Kase, MD Professor Pharmacological Sciences, Neuroscience, and Artificial Intelligence and Human Health
In Graduate Medical Education, we have learned much from the COVID-19 pandemic:
Residents and fellows, who are on the front lines of patient care, play a crucial role understanding and treating patients with this disease.
Physicians learned even more about using current data in strategies to protect themselves from infectious diseases (personal protective equipment, vaccination, strategic isolation, treatment).
We live in a world without borders. A disease that impacts a corner of the world will eventually affect all of us. We must provide resources to employ prevention and treatment strategies to all people, regardless of where they live and their ability to pay.
Public health is a precious right. Health care must be available to everyone and not based upon the ability to pay for it.
Michael Leitman, MD, FACS, Dean for Graduate Medical Education
Pam Abner, MPA, CPXP
We learned that we have to think differently and not rely on responses that are tailored for one group—treating people the same.
To be equitable and care for marginalized groups, we have to reach into our communities to include their input and perspectives in order to connect with them and consider their needs and concerns.
COVID-19 was eye-opening; it exposed how we truly needed to use new thinking and approaches to be equitable.
Pam Abner, MPA, CPXP, Vice President and Chief Diversity Operations Officer for Mount Sinai Hospital Groups
Jeremy Boal, MD
The COVID-19 pandemic has transformed our Health System in so many positive ways.
We are more resilient and more adaptable than at any time in our history. We are more trusting of each other.
We are much quicker to dive in and help each other. We are more willing to forgive each other’s mistakes and flaws. We have dropped so much of our baggage so that we can best serve those who need us most.
Jeremy Boal, MD, President, Mount Sinai Beth Israel Executive Vice President and Chief Clinical Officer, Mount Sinai Health System
The American College of Cardiology (ACC) has established a new award in honor of Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.
The first “Valentin Fuster Award for Innovation in Science” was announced at ACC’s 71st Annual Scientific Session in Washington on Monday, April 4. It was presented to Dr. Fuster to honor his significant contributions to cardiovascular medicine as a champion of scientific research and an innovator in the delivery of science through novel mechanisms, and his international voice on the importance of embracing scientific inquiry to improve the care of cardiovascular patients and promote life-long heart health.
The award will be given to a single physician annually for the next 15 years.
Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital, right, with Dipti Itchhaporia, MD, FACC, President of the American College of Cardiology.
“I am grateful to have this award established in my honor. I am proud to begin this legacy and hope this motivates others to have a significant impact in the field of cardiovascular medicine,” Dr. Fuster said. “I look forward to meeting future honorees and learning about their contributions to combating heart disease and promoting health.”
Dr. Fuster is currently the Editor in Chief of the Journal of the American College of Cardiology (JACC), which ranks among the top cardiovascular journals in the world for its scientific impact. He is a past president of both the American Heart Association and the World Heart Federation. He is a member of the National Academy of Medicine, where he served as chair of the Committee on Preventing the Global Epidemic of Cardiovascular Disease, and was a Council member of the National Heart, Lung and Blood Institute. Dr. Fuster was also President of the Training Program of the American College of Cardiology.
Dr. Fuster’s research is unparalleled in areas relating to the causes, prevention, and treatment of cardiovascular disease globally, and spans the full range from hardcore basic science and molecular biology through clinical studies and large-scale multinational trials to population health and global medicine. He has 35 worldwide honorary degrees and is the most highly cited Spanish research scientist of all time, according to Google Scholar.
In addition to Dr. Fuster, four other top cardiovascular physicians from Mount Sinai Heart received prestigious honors at the ACC Scientific Session.
George Dangas, MD, PhD, Professor of Medicine (Cardiology) and Director of Cardiovascular Innovation at the Zena and Michael A. Wiener Cardiovascular Institute at the Icahn School of Medicine at Mount Sinai, was awarded the 2022 Master of the ACC Award by the American College of Cardiology. This recognizes and honors his consistent contributions to the goals and programs of the ACC and his leadership in important College activities. Recipients of this award must be members of the College for at least 15 years and have served with distinction and provided leadership on various College programs and committees.
Robert Rosenson, MD, Professor of Medicine (Cardiology) and Director of Cardiometabolic Disorders at Icahn Mount Sinai, and Gilbert Tang, MD, MSc, MBA, Professor of Cardiovascular Surgery at Icahn Mount Sinai, received the 2022 Simon Dack Award for Outstanding Scholarship for their exceptional contributions to JACC for their peer reviews. Dr. Rosenson and Dr. Tang are among five physicians to earn this distinguished honor for 2022. Criteria include reviewing more than 11 papers a year and being on time with their reviews 100 percent of the time. This is the sixth time Dr. Rosenson will receive this award, and the second time for Dr. Tang.
William Whang, MD, Associate Professor of Medicine (Cardiology) at Icahn Mount Sinai, has been named an Elite Reviewer for the Simon Dack Award for Outstanding Scholarship for contributing high-quality critiques to the journal. Criteria include reviewing more than nine papers a year and reviewing on time 85 percent of the time. Dr. Whang is among 10 physicians to receive this honor for 2022. This will be Dr. Whang’s second time receiving the Elite Reviewer award. He is also a two-time past recipient of the Simon Dack award.
Aphasia is loss of the ability to understand or express spoken or written language. It commonly occurs after strokes or traumatic brain injuries. It can also occur in people with brain tumors or degenerative diseases that affect the language areas of the brain.
According to the National Aphasia Association, this disorder affects about two million people in the United States, and is more common than Parkinson’s disease, cerebral palsy, or muscular dystrophy, yet most people have never heard about it. That changed after the family of actor Bruce Willis announced he will step away from acting following a recent diagnosis of aphasia.
Laura Stein, MD, MPH
In this Q&A, Laura Stein, MD, MPH, Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai and attending physician at the Mount Sinai and Mount Sinai Queens Stroke Centers, discusses how aphasia is diagnosed, the potential burdens for families and caregivers, and some treatment options, notably treatments by speech-language pathologists.
What is aphasia?
Aphasia is a term doctors use to describe the loss of one’s ability to use their language function, or communicate with the world around them. It’s due to damage in the brain. It’s easy to lose sight of how all-encompassing language function is. It’s what we say with our words. It’s understanding others. It’s our ability to read, our ability to write, our ability to do everything in between. We have to remember that aphasia represents a symptom that patients experience or a sign doctors look for on their exams. It’s really just a term describing these problems with language and communication. It tells us nothing about why someone is having problems with their language and communication. I also want to acknowledge that aphasia can be profoundly difficult and frustrating for patients and their families. Our ability to communicate with the world around us is paramount to the human experience.
What are the signs and symptoms of aphasia?
The signs and symptoms of aphasia are actually quite varied, depending on the individual. Aphasia can be so mild that someone talking to an individual with an aphasia might not even know that they have it. In such a case, someone with a mild aphasia might have trouble coming up with words or the names of objects. At times, their speech may sound broken and fragmented, but they may still be able to communicate what they want to communicate and understand what people are saying, what they’re reading around them. Unfortunately, aphasia can be very debilitating at times, and some people have a difficult time making their needs known or understanding what’s going on around them. These can be very troubling and frustrating symptoms for patients and their families to live with.
How is aphasia diagnosed?
Aphasia is diagnosed with a detailed examination of one’s language function, and might be performed by a neurologist like myself, or a speech-language pathologist. It’s really important to assess every component of language function. We listen to what somebody says, whether spontaneously or with various prompts. We assess what they understand when they’re spoken to. We assess their ability to read, their ability to write, their ability to name everyday objects around them, their ability to repeat sentences that are spoken to them.
What causes aphasia?
The causes of aphasia can be quite varied. Anytime language function is abnormal, we worry about damage to specific locations of the brain where the language centers are located. In a majority of people, the language centers are on the left side of the brain, but in a small minority they may be on the right. Aphasia is more common in older individuals, and stroke is the most common cause because of how many people have strokes in our society at older ages. However, there are many causes, like a degenerative disease that might cause dementia, a tumor, infection, or head trauma. But it’s really all about figuring out what part of the brain is not working normally, and why
What are the types of aphasia, and how do they differ?
There are multiple types of aphasia. The networks that underlie language function are complicated and interconnected. We’ll break it down in broad senses: There are expressive and receptive aphasias. With expressive aphasia, an individual has difficulty expressing themselves—speaking in sentences, coming up with words, writing; their speech may sound broken and fragmented. With receptive aphasia, an individual has more trouble understanding language, what people are saying, what they are reading. Someone may have a mixed aphasia, with expressive and receptive components. The most profound aphasia is a global aphasia, where all aspects of language function are impaired, and it is incredibly difficult to communicate with the world around you.
How is aphasia treated?
First and foremost, we have to understand what the cause of the aphasia is. Once we identify a cause, such as a stroke, we can think about treatments and if we can prevent the aphasia from getting worse. Beyond that, we think about how can we help the individual rehabilitate. We have outstanding speech-language pathologists who are specially trained in optimizing one’s language function and their ability to communicate with the world around them, despite their aphasia.
