Bernard Camins, MD, Medical Director for Infection Prevention at the Mount Sinai Health System, discusses how to stay safe in your day-to-day routine and clarifies new guidelines from the Centers for Disease Control and Prevention (CDC).

How safe is public transportation? Are there any new measures New Yorkers should take?

As a New Yorker, I take public transportation all the time. I take both Metro North and the subway. I believe that it’s safe, otherwise I wouldn’t be taking them. I agree with the guidance that masking should be mandatory in every form of public transportation. Masking has made an impact in keeping us safe through the entire pandemic. So, if we all continue to wear face coverings while taking public transportation, we will continue to be safe.

How safe is it for parents to send their kids to school?

All schools in New York City, private or public, should be following the guidelines set forth by the New York City Department of Education and the recommendations of the New York City Department of Health and Mental Hygiene. If I had a child who was school age, I would feel safe sending them to school based on those guidelines. I would also follow all the recommendations for parents made by those organizations. The New York City Department of Education summarizes much of the guidance here.

Are there any additional measures parents can take to protect their children?

It’s important that if your child is eligible to be vaccinated, you should vaccinate your child as soon as possible against COVID-19. And now that certain age groups are eligible to get the booster, parents should take advantage of that as well.

Have the recommendations changed in terms of what type of mask people should wear?

Because Omicron is more infectious, there have been some reports in the media that cloth masks may no longer be appropriate or adequate insofar as protecting us from this particular variant of COVID-19.  But right now, we don’t have enough data to be sure. If people want to be better protected, they should first make sure their mask is well-fitted. You may want to consider double masking in which you would wear a medical or surgical mask underneath a cloth mask. This would simulate, or be equivalent to, a KN95 mask which is 95 percent effective in filtering respiratory droplets. But no matter what mask you wear, it will be ineffective if you don’t wear it properly—meaning that it should cover your nose and your mouth.

What should I do if I come into close contact with a person who is positive for COVID-19? What defines a close contact at this time?

If you haven’t received your booster shot, and you have a close contact with someone who has tested positive for COVID-19, you should quarantine for five days, according to new CDC recommendations. Afterwards, you should wear a mask in public for another five days. The CDC also recommends that you should get tested five days after the exposure. A high-risk contact or high-risk exposure is defined as being within six feet of someone who tested positive for COVID-19 for more than 15 minutes, and this could be cumulative over a 24-hour period. If you have received your booster shot, you do not need to quarantine following an exposure, but you should wear a mask for 10 days after the exposure and get tested at day 5 if you still do not have symptoms, according to the CDC. This is why it is important to get a booster shot as soon as you are eligible.

Is there anything else that has changed recently that people should know?

One thing that I want to highlight is the new CDC recommendation that if you were found to be infected with COVID-19, you only need to isolate for five days. To correctly count these five days, you should consider the date of symptom onset as Day Zero. If you are asymptomatic, Day Zero would be the date of your positive test. On the day after Day Five, you can leave isolation as long as you keep your mask on when you’re in public. And you should avoid places where you would have to take your mask off, such as restaurants.

With the rise of the highly contagious Omicron variant, more and more people are testing positive for COVID-19, even those who have diligently taken all precautions throughout the pandemic.

There’s not necessarily cause for alarm. The Omicron variant, though far more contagious than earlier strains, appears to produce less serious symptoms, especially if you have been vaccinated and received a booster.

If you have just tested positive and are wondering about next steps, here are answers to some of the questions that Mount Sinai experts are fielding right now.

How should I care for myself?

You should rest, stay hydrated, and treat your symptoms with medications for fevers, cough, and other cold symptoms. For more information about how you can take care of yourself at home, read this article from Abigail R. Chen, MD, Senior Medical Director at Mount Sinai Doctors Downtown.

What does it mean to self-isolate?

• Self-isolating requires staying away from other people. Stay home unless you need medical care.
• Do not go to work, school, or public areas. Do not use public transportation, ride sharing, or taxis.
• If possible, stay in one room, away from others in your home, and use a separate bathroom.
• Practice basic hand hygiene.
• Avoid sharing personal household items, such as dishes, towels, and bedding. Wash these items after using them.
• Clean “high touch” surfaces daily. These may include counters, doorknobs, bathroom items, and phones. Clean any surfaces that may have blood, stool, or other bodily fluids on them.

Be especially careful if there are older adults in your home, or anyone with serious medical issues. These people may become more seriously ill from this infection. Do not handle pets or other animals while sick.

What should I tell my close contacts?

Anyone who has had close contact with you should call their doctor if they develop symptoms that may be caused by COVID-19. Symptoms may include sort throat, runny nose/nasal congestion, headache, fever, cough, or shortness of breath.

When can I stop self-isolating?

You can stop self-isolating after these three things have happened:

1. You have not had a fever (your temperature has been less than 100.0° Fahrenheit or 38.0° Celsius) consistently for at least three days (72 hours) without taking fever reducing medications, such as aspirin or acetaminophen (Tylenol).
2. Your breathing is improving.
3. The recommended duration for isolation after testing positive for COVID-19 is constantly evolving. Staying at home for at least 10 days is the safest option for everyone. If you cannot stay home for 10 days, you may start going out on day 6 if you are fever-free for 24 hours, but you must wear a mask constantly when around other people until the 10 days are up. You should avoid travel and going to public places where you or others have to take off their masks, like restaurants, until the 10 days are up. If you are an essential worker, there are recommendations from the New York State Department of Health that will guide you on how to return to work safely in 5 days.

When should I call my doctor? 

Call your doctor if you start to feel worse, such as experiencing increased congestion, coughing, chest pain, or fever. For Mount Sinai doctors, most follow-up visits can be scheduled as a video visit or over the phone. For a video visit, you must have a MyChart account.

Seek emergency medical treatment if you have difficulty breathing; if possible, call ahead to let them know you may have COVID-19. If you call for emergency assistance to get you, put on a face mask before emergency medical services arrive.

With so much news about the Omicron variant, it can be hard to keep track of the latest developments. So here are eight key takeaways from the experts at Mount Sinai.

1. Booster Shots are Crucial Protect yourself and those around you with the vaccines. If you have already received the initial round of vaccine shots, get the booster shot as soon as you are eligible. You can make an appointment here.

• If you got the two-dose Pfizer-BioNTech vaccine, you can get the booster five months after your second shot. If you got the two-dose Moderna vaccine, you can get the booster five months after your second shot. You can get either the Pfizer or Moderna booster shot, whichever is available.

• If you received the Johnson & Johnson vaccine, you should get a booster shot two months after your shot. You can get any of the three vaccines for the booster; health authorities recommend getting the Pfizer or Moderna vaccine for your booster.

2. Severe Disease in Unvaccinated People  The available data continues to indicate the Omicron variant causes less severe symptoms than the Delta variant. Note that a lot of the data available on the Omicron variant causing less severe symptoms is in the setting where the majority of the people being exposed are fully vaccinated. The Omicron variant can still lead to severe disease in unvaccinated people. Many fully vaccinated people infected with the Omicron variant experience little or no symptoms, often similar to the common cold. That’s one reason why the Centers for Disease Control and Prevention recently eased the guidelines on self-quarantining. But those who are infected still pose a risk of spreading the infection to others who may be immunocompromised, such as older adults and those with some serious illnesses, who are at greater risk of serious illness from COVID-19.

3. Keep Up With Safety Steps  Getting vaccinated and a booster will keep you from getting a serious illness. But being vaccinated will not keep you from spreading the infection to others, especially if you have no symptoms while you are contagious. That is why we need to keep doing what we have been doing—wearing masks in indoor public settings, practicing social distancing, and avoiding large gatherings. And if you are experiencing any symptoms, please stay home.

4. Omicron Variant Spreading Rapidly Since it was first detected in the United States, the Omicron variant has spread rapidly in the New York metropolitan area and throughout the country, with COVID-19 cases surpassing the peak of daily reported cases of the earlier surge over the summer. The positivity rate in New York City (the percent of people tested who are positive, not including most home tests) is at record levels. Fortunately, thanks to the New York region’s high vaccination rates, almost all infections are mild to moderate in severity and do not require hospitalization.

5. Omicron Variant More Contagious The Omicron variant is more contagious than the Delta variant because of the many mutations that have occurred, which makes the virus harder for your previously formed antibodies to bind and neutralize it. As a result, the Omicron variant is surpassing the Delta variant as the dominant strain, much as the Delta variant surpassed the Gamma, Beta, and Alpha variants that came before it.

6. Antiviral Treatments  Promising, But Not Widely Available While doctors have learned much about COVID-19, there are no widely available, effective treatments for the infection that results from the Omicron variant. Most of the monoclonal antibodies, which had shown promise for earlier variants, are not considered effective for the Omicron variant. The U.S. Food and Drug Administration recently authorized the first pills for treatment of the virus, Pfizer’s Paxlovid and Merck’s molnupiravir. The pills are only authorized for treatment of those who are at high risk for progression to severe COVID-19, including hospitalization or death. These treatments are not yet widely available and will be reserved for a limited number of patients most at risk for developing serious disease.

7. More Children Are Getting COVID-19 Mount Sinai is seeing an increase in children with COVID-19 at Mount Sinai Kravis Children’s Hospital and in our Emergency Department. Many are either not vaccinated or not eligible for vaccination. Severe COVID-19 infections among children remain uncommon. Our pediatric vaccination pods are open and accepting patient appointments, and we highly encourage parents to have eligible children vaccinated. You can make an appointment for a first dose here and for a booster here.

8. Cause for Optimism  There remain many reasons for optimism. Our medical community has the resources and experience to care for those who are in need of treatment for COVID-19 or other medical conditions. Mount Sinai, for example, continues to follow strict protocols to maintain the safety of patients, employees, and the community, as it has throughout the pandemic. In South Africa, where the Omicron variant was first detected, there are reports that the number of cases has begun to fall off significantly.