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COVID-19 Survivors Only Need One Vaccine Dose, New Study Shows

Mar 11, 2021 | Featured

New research from the Icahn School of Medicine at Mount Sinai shows that COVID-19 survivors build strong immune responses after one vaccine dose. In fact, their immune response to the first vaccine dose is equal to—or in some cases even better than—the response to a second vaccine dose in someone who has not had COVID-19.

These significant new findings appear in a study led by Viviana Simon, MD, PhD, and Florian Krammer, PhD, which was published in a letter to the editor in the March 10, 2021, edition of The New England Journal of Medicine.

Viviana Simon, MD, PhD

“We believe that a single dose of the authorized mRNA vaccines (from Pfizer-BioNTech and Moderna) is sufficient for people who have already been infected by SARS-CoV-2,” the virus that causes COVID-19, says Dr. Simon, Professor of Microbiology, and Medicine (Infectious Diseases), at Icahn Mount Sinai. “Our study showed that the antibody response to the first vaccine dose in people with pre-existing immunity is equal to or even exceeds the response in uninfected people after the second dose.”

The study included 110 participants. After their first vaccine dose, COVID-19 survivors who were seropositive at the time of the dose generated antibody levels that were 10 to 45 times higher than their seronegative counterparts who had never been infected by SARS-CoV-2. Equally significant, antibody levels in seronegative individuals rose by a factor of three after their second vaccine dose, while seropositive individuals had no increase in their levels of antibodies after that dose.

Panel A shows the quantitative SARS-CoV-2 spike antibody titers or levels for 110 participants. (These were assessed by means of enzyme-linked immunosorbent assay and expressed as area under the curve [AUC].) Some participants with pre-existing immunity had antibody titers below detection (AUC of 1) at time point before vaccination. Panel B shows the relative frequency of vaccine-associated side effects after the first vaccine dose in 230 participants.

“Our findings suggest that a single dose of vaccine elicits a very rapid response in individuals who have previously tested positive for SARS-CoV-2,” says Dr. Krammer, Mount Sinai Professor in Vaccinology in the Department of Microbiology at Icahn Mount Sinai. “The first dose for these individuals resembles the second (booster) dose in people who have not been infected.”

There were no substantial differences between the Pfizer-BioNTech and Moderna vaccines in the antibody responses they elicited, according to the researchers.

Florian Krammer, PhD

Mount Sinai’s team also observed that in an overlapping group of 230 participants, seropositive individuals experienced more intense—but well tolerated—physical reactions than seronegative individuals following their first doses of the vaccine. Interestingly, the frequency with which they reported fatigue, headaches, fever, chills, and muscle and joint pain after their first dose was similar to the responses among seronegative individuals after their second vaccine dose. Researchers say this is to be expected after the body recognizes the virus—or vaccine—and responds vigorously.

Drs. Simon and Krammer say their findings will require further investigation to determine whether these early differences in immune responses are maintained over a prolonged period of time. If the results hold up, they could influence a change in public policy that would require COVID-19 survivors to have only one dose of the authorized mRNA vaccines. According to Dr. Krammer, several European countries have already updated their policies based on these findings.

“If that approach were to translate into public health policy (that is more widely adopted), it could not only expand limited vaccine supplies, but control the more frequent and pronounced reactions to those vaccines experienced by COVID-19 survivors,” says Dr. Simon.

One Year Later: Icahn School of Medicine at Mount Sinai Says ‘Thank You’ To Residents Who Joined Front-Line Workers During Pandemic Peak

Mar 3, 2021 | Community, Featured

Andres Arredondo, MD

There are many reasons why the Mount Sinai community should be thankful for the residents and fellows who help provide care every day. But their contributions during the height of the pandemic a year ago may be one of the most dramatic, and that was on the minds of many recently as they marked “Thank a Resident Day.”

“As New York City entered its darkest days during the peak of the pandemic, our residents and fellows wanted to jump right in and join their colleagues on the front lines in an act of great professionalism and compassion. They were the backbone that kept us all going during a very difficult time,” says I. Michael Leitman, MD, FACS, Dean for Graduate Medical Education at the Icahn School of Medicine at Mount Sinai. “It makes me proud and very, very happy to know them and work shoulder to shoulder with them,” says Dr. Leitman, a surgeon who specializes in minimally invasive surgical innovations to treat abdominal conditions.

Icahn Mount Sinai runs the nation’s largest and one of the oldest training programs for medical residents. Each year, these programs train approximately 2,500 residents and clinical fellows—doctors in training—in every specialty, including several specialty areas that are highly ranked by Doximity, which polls doctors on the best U.S. training programs. Specialties ranked in the top 20 include Dermatology (No. 4), Physical Medicine/Rehabilitation (No. 9), Nuclear Medicine (No. 12), Otolaryngology (No. 12), Psychiatry (No. 15), OB/GYN (No. 18), and Ophthalmology (No. 20).

Andres Arredondo, MD, is a resident in emergency medicine at The Mount Sinai Hospital who spent time at Elmhurst Hospital in Queens—considered an epicenter of the pandemic in New York City—when the pandemic struck last spring. Originally from Colombia, he was struck by the disproportionate effect of the pandemic on the Hispanic community.

Ciera Sears, MD

“The impact of the pandemic on the Hispanic community really highlighted the need for us to place an emphasis on addressing the social determinants of health, such as economic stability, crowded living conditions, quality education, and access to health care,” he says. “We worked long, hard hours but we banded together and supported each other. I was impressed by my fellow residents. Some voluntarily worked extra shifts, some started fundraisers for the Queen’s community, while others helped out in departments that were stretched. We all pushed ourselves to give as much as we could. I’m thankful for all of these things.”

Ciera Sears, MD, a fellow in Geriatrics and Palliative Medicine, was one of many fellows and residents called upon during the pandemic to embed in the hospital’s emergency department, where she would provide counsel to patients at risk of dying, all the while giving much appreciated support to her busy colleagues in the ED.

“We were seeing patients in the worst days, close to death, and alone. Because it was too risky to allow family to enter the hospital, their only support was their doctors and nurses,” says Dr. Sears. Dr. Sears was infected with COVID-19 during the first week New York State was in lockdown. She lost her sense of smell for six months but is now feeling well.

At the same time, the Black Lives Matter movement was gaining momentum, and Dr. Sears was on the front lines. “Here I was risking my life to fight this pandemic which disproportionately affects Blacks and Hispanics, and simultaneously engaging in protests,” she says.

Click here to watch a special video thanking Mount Sinai residents and fellows from Scott Gottlieb, MD, the FDA commissioner from 2017 to 2019, who graduated from Mount Sinai School of Medicine and was a resident in Mount Sinai’s Internal Medicine Residency Program. Dr. Gottlieb is a member of the Mount Sinai Board of Trustees.

Caitlyn Kuwata, MD

Caitlyn Kuwata, MD, also a fellow in Geriatrics and Palliative Medicine, was deployed to the ED where she used her training in palliative medicine to support patients and their families with difficult decisions and symptom management, sometimes with patients who had very little time left.

“Because the COVID numbers were so high, we did a lot of emergency consults on big issues like patient values and goals surrounding quality of life in the context of COVID. It was very eye opening and emotional. One of the hardest aspects of our work was assisting our patients in saying goodbye to family members who were not allowed to visit,” she says.

She became infected with COVID-19 in March. “The two week quarantine while sick was really hard. I wanted to work and I wanted to be useful,” she says.

“Like all of our wonderful staff, my fellows were rock stars during the pandemic and beyond,” says Helen Fernandez, MD, MPH, Professor and Program Director for Geriatrics and Palliative Care at Icahn Mount Sinai, the top rated Department of Geriatrics in the United States according to U.S. News & World Report. “They were true advocates for patients and caregivers, helping them navigate complex decision making. I consider myself extremely lucky to work with such gifted and talented staff. Our future is bright.”

Thank a Resident Day, created in 2018, was marked on February 26. It is one of a number of programs run by the Arnold P. Gold Foundation to champion humanism in health care. The foundation also established the White Coat Ceremony in 1993 as a way to welcome first year medical students.

Artificial Intelligence Tools May Detect Abnormalities that Could Otherwise Be Missed

Updated on Nov 19, 2025 | Artificial Intelligence, Featured, Research

Mount Sinai radiologists are comparing machine-read patient discharge summaries with original, human-read reports.

A patient’s electronic health record typically contains a trove of information that can be used to help predict and manage their future health needs. But much of that information is often composed of unstructured or fragmented data that first must be translated into language that physicians are able to understand.

A new partnership between the Mount Sinai Health System’s Department of Radiology and an Israel-based start-up, Maverick Medical AI, is exploring how to accomplish that task through the use of artificial intelligence. In a proof-of-concept study, Maverick’s deep learning and natural language processing (NLP) algorithms are being used to accurately identify co-morbidities in 1.5 million patient discharge summaries and radiology reports. If it is successful, Maverick’s program could open the door for its use in an array of medical, research, and business opportunities at Mount Sinai.

David Mendelson, MD

David Mendelson, MD, Vice Chair of Radiology Information Technology at the Icahn School of Medicine at Mount Sinai, is playing a key role in the research. He says one of Maverick’s strengths is its ability to report on secondary abnormalities in nearby organ systems that are sometimes only partially seen or could possibly be overlooked in radiological screenings.

“If someone is screened for lung cancer and the findings are negative, that’s great news for the patient,” says Dr. Mendelson. “But if natural language processing could identify secondary indications like coronary artery calcification or abnormal density of the liver, which might suggest non-alcoholic fatty liver disease, that information could prove very useful to physicians and patients. Physicians might be able to take preventive steps to improve outcomes for patients and ultimately lower health care costs downstream.”

Determining whether Maverick’s propriety algorithm can provide that important information is the responsibility of Pamela Argiriadi, MD, Assistant Professor of Diagnostic, Molecular and Interventional Radiology at Mount Sinai. Dr. Argiriadi and a team of residents are spot-checking secondary co-morbidities extracted by the algorithm from an ocean of radiology reports and discharge summaries to determine how they compare to the original, human-read reports.

“Radiology reports contain a wealth of information and we hope our study will shed light on how key-word phrases in those documents can be mined to provide input into the well-being of patients,” Dr. Argiriadi says. “A major goal of ours is to improve communication with primary care providers by reporting secondary findings to them, which can result in follow-up treatment and preventive medicine.” The software can recognize these findings within the report, extract them, and flag them for the provider.

Yossi Shahak, Co-founder and Chief Executive Officer of Maverick Medical AI, estimates that as much as 80 percent of a patient’s health information remains untapped due to its unstructured format. Translating that raw, fragmented data into medical coding language would provide physicians with actionable clinical insights.

“We are starting with radiology and hope to expand the vocabularies across many medical subspecialties, like cardiology and gastroenterology,” says Mr. Shahak. “That expansion of our data sets could provide Mount Sinai physicians with significant value when they mine it for often overlooked chronic conditions and risk factors. In addition, the conversion from unstructured data into medical coding will help Mount Sinai improve their financial capabilities.”

Should You Get the COVID-19 Vaccine If You Are Pregnant?

Updated on Jun 30, 2022 | BFWHRI, COVID-19, Featured, OB/GYN, Vaccines, Women's Health

If you’re pregnant, you likely have a lot of questions about whether it’s safe for you and your baby to receive a vaccine against COVID-19. In this Q&A, Jill Berkin, MD, Assistant Professor of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, draws on her vast experience as a high-risk obstetrician—as well as her own pregnancy—to offer her perspectives on side effects, vaccines and breastfeeding, and how to decide if vaccination feels right for you.

“Pregnant women should weigh their personal risks of coronavirus exposure against their tolerance of the unknown regarding vaccination,” says Dr. Berkin, who received two COVID-19 vaccine shots during her second trimester of pregnancy. “Right now our information is limited, but all the information we do have suggests that COVID-19 vaccines are safe in pregnancy.” She suggests those with specific questions about their own situation consult with their health care providers.

Why did you get the COVID-19 vaccine?

As a high-risk obstetrician I saw firsthand how pregnant women were affected by COVID-19. I also thought about my day-to-day exposure to the coronavirus through my work. I was more concerned about the known risks of infection than the unknown risks of vaccination, so my decision was easy.

Jill Berkin, MD

In general, do you think other pregnant women should get the vaccine and why?

It’s really important for pregnant women to realize that we don’t have data saying the vaccine is unsafe during pregnancy. Even though our data are limited, all of it points to the fact that vaccination is safe, and we don’t see any side effects specifically impacting the pregnancy itself. We haven’t seen any harm among women who were pregnant after receiving the vaccine in clinical trials.

In addition, each individual pregnant woman has to evaluate her own potential risk for exposure just like I did for myself. As a health care worker my exposures were great, so they outweighed any fears of the unknown with the vaccine. And of course, people who are pregnant may want to consult their own physicians for advice as well.

What are the risks and complications of COVID-19 and pregnancy?

Most pregnant women infected with the coronavirus will have symptoms similar to those who are not pregnant. The vast majority of pregnant women affected are asymptomatic. A large portion of the population has symptoms similar to a cold or flu, including muscle aches and fever. Then there’s a small portion of the population that has more severe disease that might require hospitalization. The data we have now comparing pregnant individuals to non-pregnant individuals shows that symptomatic pregnant women do have a slightly higher risk of a hospital admission, ICU admission, and even mechanical ventilation, but there’s no increased risk of mortality.

Would you say then that pregnant women are at higher risk of developing severe COVID-19?

While it’s hard to fully analyze, the data suggests that pregnant women are at increased risk for developing severe complications of COVID-19. But we have to remind ourselves that in general, pregnant women who become ill are more likely to present to their physicians than women of the same age who are not pregnant, and that’s because you see a doctor more often when you’re expecting. Doctors will also be biased towards admitting women who are pregnant and keeping a closer eye on them because there are two patients at stake.

For those getting the COVID-19 vaccine, what are some side effects to be expected?

The most common side effect that people report is soreness in the arm, similar to a lot of other vaccines. Afterwards some patients might experience mild cold- or flu-like symptoms for about 24 hours. This seems to happen more frequently with the second dose, which is three or four weeks after the first dose. Pregnant women, along with the rest of the population, can take pain relievers such as Tylenol after their vaccine shots to help alleviate some of those symptoms.

Do you think there’s an optimal time for receiving the vaccine during pregnancy?

We don’t have any research to suggest that there is an unsafe time to vaccinate during pregnancy. However, pregnant women might consider not receiving the vaccine during the first trimester. This is only because in general we avoid medical interventions in the first trimester, which is the period of “organogenesis” when the baby’s organs are forming. We don’t have data suggesting there are any negative effects of the vaccine on organ systems. But because we are dealing with a lack of information regarding COVID-19 vaccines and pregnancy—and out of an abundance of caution—perhaps delaying vaccination until the second or third trimester, if possible, could be beneficial.

What do you recommend about vaccination during breastfeeding?

The vaccine certainly has no risks, and only potential benefits. We know that one of the most wonderful things about breastfeeding is that women pass antibodies through their breast milk to their babies. We don’t have much information specifically about antibodies created from COVID-19 vaccination being passed through breast milk. But we do have encouraging data about women who were infected with coronavirus itself forming antibodies and passing those antibodies along through the placenta and through breast milk. So the benefit of being able to protect children against coronavirus when a vaccine is not currently available to children is a remarkable thing and a unique advantage of being a lactating mom.

Luciana Vieira, MD, who conducted the Q&A, is an assistant Clinical Prof of OB/Gyn and Reproductive Science at ISMMS and the Blavatnik Family Women’s Health Research Institute Scholar for 2020-2021. Dr. Vieira has been integral in creating a perinatal database to collect/analyze data on maternal + neonatal outcomes within Mount Sinai Health to improve care.

Vaccines, Variants, and Measured Expectations—A Question and Answer Session with Judith A. Aberg, MD, a Leader in Infectious Diseases at Mount Sinai

Updated on Jun 30, 2022 | COVID-19, Featured, Vaccines

Judith A. Aberg, MD

Several worrisome new variants of SARS-CoV-2, the virus that causes COVID-19, have been detected within the United States since the COVID-19 vaccine rollout began in December, raising concerns about the nation’s ability to return to normal in 2021. Chief among these concerns is whether the national effort to vaccinate as many Americans as possible—and as quickly as possible—will be able to offset the virus’s enhanced ability to spread. At the heart of that question lies another: Will the authorized vaccines from Moderna, Inc., Pfizer/BioNTech, and Johnson & Johnson offer adequate protection against these new variants?

To answer these questions and more, Mount Sinai Today recently turned to Judith A. Aberg, MD, Dean of System Operations for Clinical Sciences, and Chief of the Division of Infectious Diseases, at the Icahn School of Medicine at Mount Sinai. Dr. Aberg, the Dr. George Baehr Professor of Clinical Medicine, leads the Mount Sinai Health System’s COVID-19 treatment and vaccine clinical trial efforts.

“We have to be clear that we are in unknown territory,” she says. “Every day we are learning something new. Individuals must have a realistic view of the immediate future and continue doing what we know works best: get vaccinated, wear masks, and practice social distancing—even after they are fully vaccinated.”

Do the vaccines from Moderna and Pfizer/BioNTech protect us from the new variants?

Dr. Aberg: At this time no one has sufficient data to really provide us with a definitive answer. We have indications from both Moderna and Pfizer/BioNTech that their vaccines produce enough effective antibodies to overcome the variants, but people may still become mildly ill from the variants although not severely ill. Both companies have also mentioned they are looking into making modifications to their vaccines, so there is the likelihood we will see them introduce booster shots in the coming months that may be more effective against new variants.

How effective is the Johnson & Johnson (J&J) vaccine that was just authorized by the Food and Drug Administration?

Dr. Aberg: I am very encouraged about the J&J vaccine, which is a single dose. We ran clinical trials at two of our hospitals, Mount Sinai Queens and Mount Sinai Brooklyn. In the United States, J&J found the vaccine was 72 percent effective. When they tested it in Brazil and South Africa—where new variants are widely circulating—the company found there were no deaths and it prevented people from developing severe disease. J&J is also looking into creating a booster dose and I imagine it will be very beneficial.

Will these variants prevent us from beating this pandemic?

Dr. Aberg: I suspect there are going to be more variants and we’re going to have to deal with them. Viruses want to live and they keep reproducing and mutating—whether it’s the human immunodeficiency virus (HIV), which causes AIDS, or the influenza virus, which develops different strains. Each year when I get the flu vaccine I hope that I won’t get the flu. There is still a chance, but the flu vaccine probably prevents me from developing a severe case.

With SARS-CoV-2, which causes COVID-19, you have variants. And until we have more data on vaccine durability and efficacy against the variants we’re going to have to do what we’re doing now. Vaccinated individuals should still follow safe practices but can feel some reassurance. And for those who aren’t yet vaccinated, don’t delay in getting whichever vaccine becomes available to you.

Is it okay to mix vaccines for the first and second doses or take more than one vaccine?

Dr. Aberg: Do not mix vaccines. Finish two doses of the same vaccine or, for Johnson & Johnson, take only the single dose. We do not know if the antibody response you get to one vaccine will impair your immune response to the other vaccine. Each vaccine, even Moderna’s and Pfizer/BioNTech’s, which are based on the same mRNA technology, is different enough.

Should vaccinated individuals test their antibody levels to make sure they are protected?

Dr. Aberg: No, we do not advise this. It is not informative. First, the vast majority of commercial antibody tests do not measure the antibodies you get from vaccines—they measure the antibodies you get from having COVID-19. These commercial serology results are not designed to detect immune response to the vaccine. There are tests that look for antibodies against the N protein or nucleocapsid. This is not coded for by the vaccine and will only inform about prior infection—nothing about your response to the vaccine. Second, the vaccine manufacturers have not reported what the antibody levels should be if you were to get a test that detects the S protein or spike, which is what the vaccines make antibodies against. We only know that people who were vaccinated had tremendous efficacy against getting COVID-19, and it may be irrespective of what their antibody levels are. There is more to immunity than just antibody production.

Do you recommend COVID-19 vaccinations for individuals who are immune-compromised?

Dr. Aberg: We do not have enough data to tell patients with compromised immune systems or who are on chemotherapies whether or not the vaccines are going to be effective for them. We are not saying they shouldn’t get vaccinated, we just don’t have enough data to determine how much protection they would receive. At Mount Sinai, we are involved in clinical testing of a hyperimmune globulin therapy—a purified, highly concentrated product of antibodies derived from antibody-rich plasma of people who have been infected by COVID-19 and recovered—which may benefit this population whose immune systems are impaired and cannot produce antibodies.

What is your advice for individuals who have been fully vaccinated?

Dr. Aberg: These vaccines are a very important part of our prevention toolbox. We cannot rely on just one thing. We don’t want to set expectations that you’re not going to get COVID-19, but the vaccines decrease your chances of getting really sick or being hospitalized. So until the virus is under better control and we do not see such a high incidence anymore, we still need to be careful. Don’t engage in magical thinking. I hear people say, “Now that I’m vaccinated I can go and do this and that.” And I say, “No, not really.” Everything in moderation.

Mount Sinai Researchers Report Significant Secondhand Marijuana Smoke Exposure In New York City Apartments

Updated on Jun 30, 2022 | Featured, Your Health

Mount Sinai researchers have raised concerns about significant exposure to marijuana secondhand smoke in New York City apartments.

Data from a new study suggesting nearly one third of families smell marijuana smoke when their children are present raises concerns about the potential impact of legalized marijuana on vulnerable populations, particularly children, according to the researchers.

The researchers described their findings in a study published recently in Academic Pediatrics. The study looked at secondhand smoke and thirdhand smoke—the particles from secondhand smoke that settle on furniture, carpets, and clothing—in multi-unit households, typically apartment buildings.

The lead author of the study is Lodoe Sangmo, a fourth year medical student at the Icahn School of Medicine at Mount Sinai who will graduate in May with Distinction in Research. Karen Wilson, MD, MPH, the Debra and Leon Black Division Chief of General Pediatrics at Icahn Mount Sinai, is the senior author on the study and an international expert on secondhand and thirdhand smoke exposure—what researchers call “incursions.” Dr. Wilson led an investigation in 2018 that found high levels of marijuana metabolite tetrahydrocannabinol carboxylic acid in the urine of young children whose parents also smoked tobacco. That study was published in Pediatrics.

Karen Wilson, MD, MPH

Researchers say the new study of families living in multi-unit housing in New York City builds on these earlier findings, suggesting that regulators take a close look at the impact on children when considering marijuana legalization.

“As we move towards the legalization of recreational marijuana in New York State, this study serves as a warning that our most vulnerable patient populations who live in multi-use housing will likely experience much higher levels of smoke incursions unless we are intentional about regulating exposure, particularly among children,” says Dr. Wilson, who is also Vice Chair for Clinical and Translational Research for the Jack and Lucy Clark Department of Pediatrics at Icahn Mount Sinai. Dr. Wilson notes that while most states with legal marijuana use restrict its use in public indoor and outdoor spaces, they do not have any restrictions on combustible marijuana use in the presence of children.

For their study, the researchers surveyed parents at four pediatric practices in the Mount Sinai Health System, collecting a total of 382 surveys between September 2018 and December 2019.

Parents were asked, “Do you ever smell marijuana smoke in your room/apartment/ condominium coming from another apartment, when you are with your child?” and “Do you ever smell marijuana smoke in common areas such as the hallway or stairwell, when you are with your child?”

Almost one third (30.6 percent) of participants reported both secondhand and thirdhand smoke, while 47.9 percent had neither incursion, with the remaining 21 percent reporting one or the other incursion.

Participants who identified as non-Hispanic black or Hispanic were more likely to report smelling secondhand smoke than non-Hispanic white participants, a finding that is consistent with disparities in secondhand smoke exposure, caused in part by unequal access and enforcement of comprehensive smoke-free policies within multi-unit housing, according to the researchers.

“In light of these findings, we hope to see the expansion of current policies that solely restrict tobacco smoke to include restrictions on marijuana smoke in order to mitigate disparities and protect vulnerable populations exposed to dual smoke exposure,” says Dr. Wilson.

The study was funded by the Children’s Center Foundation Board of Directors of the Mount Sinai Kravis Children’s Hospital at Icahn Mount Sinai.

According to Dr. Wilson, who chairs the American Academy of Pediatrics Tobacco Consortium, while many states have moved ahead with legalization efforts, research on the effects of secondhand marijuana smoke is still in its infancy.

“We do know that prenatal exposure to marijuana smoke affects brain development and behavior but we don’t know about post-natal impacts, nor about the long-term health effects. We know much more about the detrimental effects of tobacco smoke on children’s health,” says Dr. Wilson. “Studies have linked even low levels of cotinine, a biological marker of secondhand tobacco smoke, with decreased scores on cognitive testing, and asthma. Theoretically, that could suggest that low levels of marijuana could potentially be damaging to the brains and lungs of children.”

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