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A Service and Moments of Silence Honor Mount Sinai Family Lost to COVID-19

Updated on Jun 30, 2022 | Community, Featured, MSBI

Nosa Choi, RN, left, and Elvira Parales-Jose, RN, observed a Moment of Silence in the Intensive Care Unit at Mount Sinai Queens.

In solitude and in groups, at computer terminals, at nurses’ stations, and in corridors, faculty, staff, and students recently joined events that honored and celebrated members of the Mount Sinai family lost to COVID-19. The events—a Virtual Memorial Service and a series of Moments of Silence—were part of the mandate of the COVID-19 Memorial Committee, chaired by Jonathan A. Ripp, MD, MPH, Senior Associate Dean for Well-Being and Resilience, Icahn School of Medicine at Mount Sinai. And more projects are to come.

“The people we lost to COVID-19 were our colleagues, our friends, and our work family,” Dr. Ripp says. “There is a deep commitment across the Health System to remember them, honor them, and pay tribute to them. I am privileged to be leading a group that is working to fulfill that commitment.”

The Virtual Memorial Service on Tuesday, July 28, was attended via Zoom by more than 1,500 people from across all eight Health System hospitals, the School, and outpatient facilities. The service featured heartfelt music provided by the Louis Armstrong Center for Music and Medicine, poetry, and messages of healing from Mount Sinai chaplains the Rev. Amy Strano, M.Div, BCC, and Rabbi Jo Hirschmann, BCC, both members of the Memorial Committee; and from Vicki LoPachin, MD, MBA, Chief Medical Officer and Senior Vice President of the Mount Sinai Health System.

The names of those lost to COVID-19 were read by Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System. “We will always remember them for their work, and the lives they lived,” Dr. Davis said. “And they will forever be a part of Mount Sinai. I also want to acknowledge the family members who supported their loved ones in their quest to make the world a better place, including their work families, who I know miss them every day.”

The Mount Sinai community was saluted for teamwork at every level by 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. “Our response to the pandemic now and in the future is a seminal event in the history of Mount Sinai,” Dr. Charney said. “We lost some brave men and women in the midst of defeating COVID-19. We dedicate ourselves to finishing the work that they themselves were dedicated to.”

A week after the Memorial Service came a series of solemn Moments of Silence at 10:30 am and 4:30 pm on Tuesday, August 4, and 12:30 am on Wednesday, August 5. “The Virtual Memorial Service was a large event with many participants,” says Nathan Goldstein, MD, Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, who co-chaired the Virtual Memorial Service subcommittee with Rabbi Hirschmann. “We wanted the Moments of Silence to be more intimate, a chance to grieve and heal in small groups. To do this, we held three Moments of Silence to ensure that staff working shifts round the clock had a chance to participate.”

The work of the Committee continues with projects including an online Wall of Remembrance and physical memorials at sites across the Health System. If you would like to share your ideas about these projects, please email COVID19Memorial@mountsinai.org.

These men and women were our colleagues, our friends, our mentors, recipients of high fives, and providers of supporting shoulders. They were an important part of our day–bringing joy, encouragement and love.

Vicki LoPachin, MD, MBA, Chief Medical Officer and Senior Vice President of the Mount Sinai Health System

They dedicated their lives to health care. Each and every one of them played a unique and important role in helping patients and families. And we will forever be grateful for them.

Nathan Goldstein, MD, Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai

We lost some brave men and women in the midst of defeating COVID-19. We dedicate ourselves to finishing the work that they themselves were dedicated to.

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 will always remember them for their work, and the lives they lived. And they will forever be a part of Mount Sinai.

Kenneth L. Davis, MD, President and Chief Executive Officer of the Mount Sinai Health System

We know the world is a better place because it included the members of the Mount Sinai family, whom we lost to COVID-19. They changed and shaped us. We remember them.

Rabbi Jo Hirschmann, BCC, Director of Spiritual Care, Mount Sinai Downtown

May this be a time when we can feel the magnitude of loss, while also holding in gratitude the blessings that these individuals brought to our lives.

The Rev. Amy Strano, M.Div., BCC, Director of Spiritual Care, The Mount Sinai Hospital

Sickle Cell Patients Advised to Seek Care in Time of COVID-19

Updated on Jun 30, 2022 | COVID-19, Featured, Sickle Cell Disease, Your Health

File photo: Jeffrey Glassberg, MD

At the start of the COVID-19 pandemic, physicians who specialize in sickle cell disease feared that their vulnerable patients would be especially hard hit. Indeed, COVID-19 is still a serious public health threat, but the experience of patients with sickle cell disease has been surprising in many ways, according to Jeffrey Glassberg, MD, Director of the Comprehensive Program for Sickle Cell Disease at the Icahn School of Medicine at Mount Sinai. Here is what Dr. Glassberg says people should know about COVID-19—and about advances in sickle cell treatment that have made this a time of “tremendous optimism.”

What have you learned about the COVID-19 risk for people with sickle cell disease?

When COVID-19 initially became a problem for us in North America, we were very worried. This is especially true because people with sickle cell disease get something called acute chest syndrome, which is a situation where the lungs fill up with fluid and it becomes harder to breathe. Since COVID-19 is a disease where you get basically a viral pneumonia, I was very scared about what was going to happen to all the people that I take care of.

As it turned out, it was not nearly as bad as I had feared. Our patients actually wound up doing quite well. One after another was treated for a day or so, and released. So we were very relieved. And we pooled our data with other centers and found that only sickle cell patients with other serious risk factors, like major heart disease or kidney failure, did poorly with COVID-19. As the Centers for Disease Control and Prevention points out, COVID-19 is a new disease, and there is still only limited data and information about its impact and risks. But here on the ground, in clinics, this is what we have seen in recent months.

Is there an explanation for these outcomes?

We aren’t sure yet. But one thing we know about COVID-19 is that the older you are, the worse it is. And in general, our patients tend to be a little bit younger, partially because, sadly, the average lifespan for someone with sickle cell disease is probably around 50 years old. So we have a lot of young patients.

What do you advise your sickle cell patients to do now?

COVID-19 is still an infection that you don’t want to get. However, if you have sickle cell disease, there are real dangers to not getting your medical care, and so you shouldn’t put a stop to all visits to the hospital.

People with sickle cell disease need a lot of medical care. They need to be watched closely; they need to have their labs checked very often, on very specialized medicines. If our patients with sickle cell disease are unfortunate enough to get coronavirus, it seems as if they don’t have any additional risk, or at least not much more risk than a normal young person experiences. But the risk of not getting your medicine or not getting your labs checked—that’s big. You could be on the wrong dose of medicine. So especially now that the pandemic is cooling off, and we have low rates of coronavirus in the New York region, this is a great time to come and get your medical care and catch up on things that didn’t get taken care of during the height of the pandemic.

How prevalent is sickle cell disease, and what does it do to the body?

Sickle cell disease occurs in about 100,000 Americans and about three million people worldwide. It affects people who are descended from areas of the world that have had malaria—so that can be Africa, South America, or the Middle East. It is a disorder of the blood caused by a genetic mutation. And it causes effects in every part of the body, because blood supplies every part of the body, but the most common manifestation that we see is pain. Patients will have episodes where suddenly they feel terrible pain. That is described as worse than delivering a baby, worse than having your bones broken, and you very often need to come to the hospital to be treated.

What are some of the recent big advances in sickle cell treatment?

Sickle cell disease today is in a place where we have tremendous optimism. I remember back in 2010—the 100th anniversary of the discovery of the gene that causes sickle cell—we were lamenting the fact that we had only one medicine to treat this disease, hydroxyurea. Fast forward 10 years, and we have 40 medicines that are in development, and four really good medicines that are FDA-approved. In addition to hydroxyurea, we now have L-glutamine oral powder and crizanlizumab, which reduce the number of painful crises, and voxelotor, which improves anemia in people with sickle cell disease. And then we have gene therapy, which cures sickle cell disease. Gene therapy at this point should not be the option for everybody because you do need to get chemotherapy to get gene therapy. But we are really at the cusp, I feel, of curing the disease.

And while we wait for this cure, we have new medicines that enable us to control the disease to a level we never have before. So this is an incredible time for the community of people with sickle cell disease. If you don’t already have a sickle cell specialist, come and see somebody who is really plugged into all of this to make sure that you are availing yourself of all these new therapies.

Any final advice for people with sickle cell during the pandemic?

Anybody can have a bad outcome with this COVID-19, even a perfectly healthy 25-year-old person. And you can spread this virus even if you feel well. So we should all be very cautious. We should continue to wear masks; we should continue to wash our hands; and we should avoid unnecessary travel and unnecessary trips to crowded places.

We have been fortunate enough through this pandemic to learn a lot about telemedicine. And so we have expanded those options, where you can see a sickle cell specialist through telemedicine wherever you are in the tristate area, and get many of your needs taken care of. When it gets to the point where you need treatment in person or lab tests, it now makes sense to come in, because hospitals have done an excellent job making it safe.

Mount Sinai Research Shows That Children Have Lower Risk of Catching COVID-19

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

Supinda Bunyavanich, MD, MPH, and post-doctoral fellow Scott Tyler, PhD. File photo.

On Saturday, March, 14, as the U.S. economy was beginning to shut down due to the COVID-19 pandemic, Supinda Bunyavanich, MD, MPH, a mother of two young children and a Professor of Genetics and Genomic Sciences, and Pediatrics, at the Icahn School of Medicine at Mount Sinai, had a “eureka” moment.

“I was at home thinking about the world and how New York City was being hit, and I realized so much is unknown about this virus,” Dr. Bunyavanich recalls. As a parent, Dr. Bunyavanich says she was relieved to read that children appeared to be less susceptible to catching COVID-19 than the rest of the population based on reports from China, although no one knew precisely why.

Dr. Bunyavanich was on the phone that day with Alfin Vicencio, MD, Chief of Pediatric Pulmonology at the Icahn School of Medicine at Mount Sinai. They discussed how the SARS-CoV-2 virus, which causes COVID-19, might enter the body through ACE2 receptors—proteins on the surface of many cells, including those found in the lining of the nose. At that moment, she realized she had important data that connected both lines of research.

“I thought, ‘wait a minute,’ ” Dr. Bunyavanich says. “COVID-19 is a respiratory condition. I have data on what’s happening in the noses of people of many ages from my studies of asthma. Could it be that kids have fewer access points for the virus to enter?’”

In May, JAMA published the novel findings from Dr. Bunyavanich’s data, which showed that lower ACE2 expression in children relative to adults may help explain why the disease is less prevalent in young children.

“The degree to which we express ACE2 may play into how susceptible we are to the SARS-CoV-2 virus,” Dr. Bunyavanich says. “Our finding that there are age-related differences in the level of ACE2 is consistent with epidemiologic data from around the world that children suffer less from COVID-19. Lower nasal expression of ACE2 in children is a concrete finding from our study that might explain why children are less affected by SARS-CoV-2.”

Interestingly, Dr. Bunyavanich’s data are from a Mount Sinai study she has been leading for a few years that looks for nasal biomarkers for asthma. The data, part of a study of 305 individuals between the ages of 4 and 60, includes “an atlas of genes that a person expresses in their nose,” she says. “The original project wasn’t targeted to ACE2, but we had this library of information on hand, so we homed in on ACE2 given its potential role in COVID-19.”

The researchers found that young children have the least expression of ACE2 in their nasal passages and that the quantity increases with age, so that children 10 to 17 years of age have more than younger children, but less than young adults age 18 to 24. The highest level was found in individuals 25 and older.

It is possible, she says, that young children have plenty of virus particles in their noses, but perhaps they are less likely to enter the body. “Think of ACE2 as a doorknob that SARS-CoV-2 uses to get in. There might be plenty of virus waiting to get through the door, but it has a harder time compared to adults,” she says. “The virus won’t cause illness if it can’t get in.”

According to Diana W. Bianchi, MD, Director of the National Institute of Child Health and Human Development, young children tend to be mildly affected by COVID-19, and relatively few end up in intensive care units. Their symptoms also present differently than those in adults, with diarrhea, abdominal pain, and other gastrointestinal problems.

Many questions surrounding children and COVID-19 continue to be the focus of widespread debate, particularly as communities consider whether to reopen schools in the fall.

“In-person learning versus virtual learning is such a complicated topic,” says Dr. Bunyavanich. “For every family it’s going to require a different set of considerations about risk versus benefits and what their preferences are. Even though children are less susceptible overall, susceptibility might vary between individual children, and it’s still possible for children to carry the virus. You have to think of the whole web of complex interactions children have. That’s what makes it so hard.”

How Researchers—Using Adhesive Skin Tape Strips—Found a Single Gene Biomarker to Distinguish Atopic Dermatitis From Psoriasis

Updated on Jun 30, 2022 | Featured, Research

Emma Guttman-Yassky, MD, PhD

An estimated 31 million adults, and between 10 and 20 percent of children in the United States, have atopic dermatitis (AD), a common skin disorder commonly known as eczema. Another 8 million U.S. adults have psoriasis. Both are chronic and complex inflammatory skin conditions that involve systemic inflammation, skin-barrier disruption, and genetic and environmental factors.

AD results in widespread rashes and patches of dry, itchy skin when an individual’s immune system goes into overdrive. It highly interferes with a patient’s everyday life, causing a terrible itch that often disrupts sleep and other daily activities. Psoriasis is a disorder that causes skin cells to multiply up to 10 times faster than normal, making the skin build up into bumpy red patches covered with silvery white scales. Over the years, researchers, including Emma Guttman-Yassky, MD, PhD, at the Icahn School of Medicine at Mount Sinai, have made vast advances in understanding and treating AD and psoriasis.

Most recently, Dr. Guttman-Yassky, working with researchers from Mount Sinai and collaborating institutions, revealed progress on another front—finding a gene biomarker that could accurately differentiate between AD and psoriasis using less-invasive adhesive skin tape strips and avoiding skin biopsy.

“In the past, skin tissue biopsies have always been considered the gold standard for distinguishing between inflammatory skin diseases, but they can cause pain, scarring, and increased risk of infection,” says Dr. Guttman-Yassky, an expert in the molecular and cellular pathomechanisms of inflammatory skin disease. Her past revolutionary research on AD promoted development of targeted therapeutics for it. “Using small adhesive tape strips may provide, for the first time, a minimally invasive alternative to skin biopsies for monitoring biomarkers of patients with these particular skin diseases and beyond.” The team’s findings were published online in The Journal of Allergy and Clinical Immunology on Tuesday, July 21.

While tape strips are currently being used to help define unique genes and pathways, what the researchers were lacking was a comprehensive tape-strip molecular profile that would accurately capture the global gene signatures of lesional and nonlesional skin in AD and psoriasis—and differentiate one from the other.

Adhesive tapes are able to characterize atopic dermatitis and psoriasis skin profiles and identify a single biomarker that is able to accurately discriminate between these conditions with 100 percent accuracy.

In the study, the researchers evaluated tape strips obtained from 20 adults with moderate to severe AD, 20 with moderate to severe psoriasis, and 20 healthy individuals. The tape strips were placed on the skin and pressure was applied with fingers for approximately five seconds to capture the stratum corneum—the outer layer of the skin—and the upper part of the granular layer, a thin layer of cells.

From each subject, 20 tape strips were collected, some from lesions and the rest from clinically unaffected skin. The skin cells collected from the tape strips were subjected to global molecular profiling for identification of disease-related biomarkers.

After analysis, the researchers identified a single gene biomarker, nitride oxide synthase 2 (NOS2) that—with 100 percent accuracy— was able to distinguish between AD and psoriasis.

The researchers also captured other genes related to immune and epidermal barrier function that were dysregulated in AD and/or psoriasis, and that also distinguished each disease from the other. For example, tape strips from AD patients strongly expressed cell markers related to T-helper 2 (Th2) immune response, which is characteristic of AD, while psoriasis patients displayed much higher levels of Th1 and Th17 cytokines, which are characteristic of psoriasis.

Dr. Guttman-Yassky is the Sol and Clara Kest Professor and Vice Chair of the Kimberly and Eric J. Waldman Department of Dermatology at the Icahn School of Medicine at Mount Sinai. In January 2021, she will become its Chair—the first woman to serve as Chair of a Department of Dermatology in New York State. She will succeed Mark Lebwohl, MD, a legendary physician who has served with distinction as Chair of the Department for 24 years. Dr. Lebwohl has been promoted to Dean for Clinical Therapeutics.

Earlier in July, Dr. Guttman-Yassky received a National Institutes of Health (NIH) / National Institute of Allergy and Infectious Disease (NIAID) grant to study immune responses of patients with inflammatory skin diseases in the setting of COVID-19 infection.

Specifically, she will investigate whether systemic medications and biologics, such as dupilumab—a monoclonal antibody that binds to an inflammatory molecule, IL-4 receptor alfa, and inhibits the inflammatory response that leads to rashes and itching from atopic dermatitis/eczema—may have a positive or negative impact on COVID-19 responses in patients who have the disease. This two-year award is an addition to a seven-year grant by the NIH/NIAID to study mechanisms leading to variations in atopic dermatitis phenotypes.

Preliminary anecdotal reporting has shown that patients who have moderate to severe atopic dermatitis who take a biologic treatment such as dupilumab seem to be protected from developing serious complications of COVID-19 and are also less likely to be hospitalized due to complications.

According to Dr. Guttman-Yassky, Mount Sinai’s dermatology practices have more than 1,200 moderate-to-severe atopic dermatitis patients who are taking dupilumab, and no patients in her practice, to her knowledge, have reported being hospitalized with COVID-19, although many, she says, have been exposed to the disease.

The ultimate goal of the study is to help determine whether systemic treatments, including specific monoclonal antibodies, impact responses to COVID-19 infection, and whether some of these treatments can protect from deleterious COVID-19 effects.

“Understanding these immune responses in the presence of patients with atopic dermatitis is extremely important, as it will help to guide how we treat patients with COVID-19 during this very critical period and help provide a possible new treatment directed towards this virus,” she says. “This research project has the potential to directly impact the medical care of tens of thousands of patients in the United States with atopic dermatitis on systemic medications in the setting of the COVID-19 pandemic, reducing morbidity and mortality, particularly in populations disproportionately affected, such as African Americans.”

Most People Mount a Strong Antibody Response to COVID-19

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

Daniel Stadlbauer, PhD, a postdoctoral fellow in Florian Krammer’s laboratory, adds a substrate to an ELISA plate that indicates whether antibodies binding to the spike protein of the SARS-CoV-2 virus are present in a human serum sample. The deep yellow color indicates antibodies are present. No color means that antibodies are not present.

The majority of individuals with COVID-19—including those with mild infections—mount a robust antibody response that is stable for at least three months, according to a new study by researchers at the Icahn School of Medicine at Mount Sinai. This antibody response correlates with the body’s ability to neutralize or actually kill the SARS-CoV-2 virus.

Mount Sinai’s findings concur with studies conducted by major academic institutions elsewhere. Scientists have now had more than three months to track the levels of antibodies produced by individuals since the SARS-Co-V2 virus began to infect populations around the world.

“There were messages about the antibodies going away quickly. That’s not the case,” says Florian Krammer, PhD, Professor of Microbiology, Icahn School of Medicine at Mount Sinai, a senior author on the recent preprint study. “The take-home message is that it looks like a pretty normal immune response.” Dr. Krammer developed one of the first effective SARS-CoV-2 antibody tests, which received emergency use authorization from the U.S. Food and Drug Administration at Mount Sinai’s clinical laboratory.

Additional time will be needed to determine how protective those antibodies are and how long-lived they are beyond three months. So far, Dr. Krammer says, animal models show that antibodies to COVID-19 behave like typical antibody responses to other diseases, meaning they protect from reinfection. The same scenario is likely for the vast majority of individuals, he says. If people become infected again their symptoms would likely be less severe.

“You need to follow people to see how long the antibodies are stable. These studies require time and there will be more data as researchers look at antibodies after 3 months, after 6 months and then again after a year,” Dr. Krammer says. He and his colleague, Viviana Simon, MD, PhD, Professor of Microbiology, and Medicine (Infectious Diseases), at the Icahn School of Medicine at Mount Sinai, are doing exactly that. In a study called Protection Associated with Rapid Immunity to SARS-CoV-2 (PARIS), they are tracking the antibody levels of, approximately, 140 individuals over 12 months. “We examine the participants every two weeks so we get a very granular look at how the antibodies are moving,” Dr. Krammer says.

Within the human body there are several levels of defense. In a typical response, acute plasmablast B cells are generated within days of an infection. These first responders serve as the infantry and coalesce to make an initial bolus of antibody, but their strength soon wanes. Then the body’s immune system kicks in with long-lived plasma B cells, which provide antibodies over a long period of time, and memory B cells, which can respond quickly if the virus attacks again. COVID-19’s relatively long incubation period of upwards of 7 days, likely gives the body ample time to create antibodies quickly if a reinfection would occur.

In addition to these B cell antibodies, the human body makes memory T cells, which appear to be helpful in fighting off the SARS-CoV-2 virus. In fact, blood samples taken from individuals who survived the first SARS virus in 2002-2003—a coronavirus cousin of SARS-CoV-2—showed they still had active memory T cells 17 years later, according to the National Institutes of Health (NIH). Interestingly, the NIH reported that these memory T cells now also recognized part of the SARS-CoV-2 virus.

“There’s a lot of evidence that we see a normal immune response,” Dr. Krammer says. “Now that doesn’t mean we will all be protected forever. And it doesn’t mean that it’s impossible to get re-infected, specifically if someone is immune suppressed. We just don’t have that data yet. We will generate that data as we move forward.”

Cancer Survivor, 86, Recovers from COVID-19 with Help from Mount Sinai’s Unique Hospitalization at Home Program

Updated on Jun 30, 2022 | Featured, Patient Stories

When Paul Levine, 86, began feeling sick, with chills, fever, and weakness, he feared his cancer might have returned, so he called his oncologist. After learning Mr. Levine had lost his sense of smell, a symptom of COVID-19, the doctor immediately sent him to the hospital, where he was diagnosed with the disease.

In the hospital, Mr. Levine felt miserable. He was put on oxygen and given infusions of fluids. He had trouble sleeping and didn’t feel like eating. He missed his wife, Sondra, who called several times a day, and he missed her cooking.

After about a week at Mount Sinai Beth Israel, he was able to return home to his East Village apartment to continue his recovery, thanks to a unique Mount Sinai program that offers hospital care in home settings.

Since 2014, Mount Sinai has offered some patients arriving at the hospital the option of getting the care they need at home under its Hospitalization at Home program. The program provides twice daily visits from nurses, a special digital tablet to communicate with the hospital, and the ability to receive all needed tests and exams, including IV infusions, ultrasounds, and supplemental oxygen.

Shortly after patients with COVID-19 began arriving at hospitals, Mount Sinai developed a new program, called Completing Hospitalization at Home, that allowed appropriate COVID-19 patients like Mr. Levine to be discharged to home to complete their recovery, while receiving all of the care they would normally receive in the hospital.

“I believe that the hospital at home program gave me the best of both worlds. I had hospital care with the home cooking that was most important in recovering the weight I had lost, along with my wife’s care and company,” says Mr. Levine, who lost about 18 pounds.

Almost three months after his initial diagnosis, Mr. Levine, a diabetic who recovered from treatment for a blood disorder called chronic lymphocytic leukemia (CLL) more than a decade ago, was doing much better. He still felt some shortness of breath, even with minimal exertion. But he’s thankful to be at home and to finally get his appetite back, especially for his wife’s homemade mushroom and barley soup.

Linda V. DeCherrie, MD, the program’s clinical director and a Professor in the Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, said the program helps patients recover because they are more comfortable and find it easier to gradually return to normal activities, such as walking around and getting a cup of coffee. Studies show these patients have better outcomes.

“You are in your own bed, eating your own food, and enjoying the company of your loved ones,” said Dr. DeCherrie. “Being at home can help your recovery in many ways.”

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