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On the Front Lines for Older Adults: Mount Sinai’s Brookdale Department of Geriatrics and Palliative Medicine

Updated on Jun 30, 2022 | Featured

Our society is facing one of the greatest health challenges—the growth of the population of older adults. In less than 10 years, the number of persons over the age of 65 in the United States will exceed the number of people under 21 for the first time in history.

The recognition of this profound change in our society led to the founding of Mount Sinai’s Brookdale Department of Geriatrics and Palliative Medicine 38 years ago, and the Department’s focus on clinical care, research, and education has guided its growth ever since.

The Department’s vision and a commitment to innovation meant it was uniquely positioned when the COVID-19 pandemic hit New York City early this spring. In this Q&A, R. Sean Morrison, MD, the Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, explains how the Department responded and how its efforts helped save lives in New York and around the country.

The Mount Sinai Hospital Ranked Among Top in the Nation by U.S. News & World Report; Brookdale Department of Geriatrics and Palliative Medicine Claims No. 1 Spot in Specialty Rankings

Read the News Release

But challenges remain. Dr. Morrison says older adults face unique concerns, as many must continue to live in isolation, while Mount Sinai and other health systems face concerns of their own, as health care workers continue to cope with the difficult demands of the pandemic.

R. Sean Morrison, MD

“Our Department is working very hard to identify ways to bring a social connection to our older adults who need to be physically distant. Their feelings of isolation are real, and those emotions are ones that we don’t yet have a good solution for,” says Dr. Morrison. “Also, as we emerge from the COVID-19 surge in New York City and, hopefully, avoid another surge in the fall, we need to think about the emotional health of our health care workers, because long after we have a vaccine for COVID-19, the after-effects of caring for people will be with us and with our health care workers.”

What is unique about the approach of your Department?

In 1982, the first Chair of this Department, Robert Butler, recognized that if health care in this country was going to match the needs of its citizens, the focus needed to be on developing leaders who could care for the special needs of older adults. This Department was founded on the principle that health care must meet the needs of the society, and it must adapt as the demographics of that society changed. Over the past 30 years, this Department has led innovations in health care for older adults, developing models to find age-friendly health care for people in hospitals and in ambulatory clinics, training the leaders who have gone out throughout the United States to establish divisions and departments focused on the needs of older adults. Our research has led to fundamental changes in how we think about care for our most vulnerable patient populations.

How did this track record help you respond to the COVID-19 pandemic in New York?

The work that this Department had done under the leadership of its founding chair Robert Butler, and my predecessor, Albert Siu, positioned us to respond to the needs of New York City in a way that I don’t think any other institution could. The data that we had from China, from Italy, and from other earlier hot spots made us realize that the population at highest risk for severe COVID, and indeed for mortality, was the group of people that we care for, those over the age of 65. From the time that first case was reported, we put together a plan to ensure that our population would be cared for, that they would be safe. And that we would have a plan in place to provide the medical care, the added layer of support to families, and the security that the New York City population needed as COVID ravaged through our city.

What specific steps did you take and how did that help?

First of all, we put in place a system to ensure that we touched every single patient in our ambulatory clinics, that we contacted every single patient to talk to them about their wishes for care, to talk to them about how to avoid COVID and how to stay safe, and what to do if they developed symptoms. We rapidly developed a system of telehealth so that we could care for our patients in their homes, without them having to leave that safety, and so that they didn’t have to have health care providers coming in to see them.

How did that work?

We provided telehealth through something as simple as a telephone call, through video conferencing, and over a number of different platforms. For those people who needed face-to-face, in-person care, we expanded our home-based medical care so that we could go to see them, and keep them safe, rather than have them come to the hospital.

What other steps did you take?

In our hospitals throughout the Health System, we embedded our clinicians into the teams that were responsible for caring for the incredible numbers of patients who were coming into the programs. We embedded our clinicians in the emergency departments. We embedded our clinicians in the intensive care units. We embedded our clinicians within hospital medicine. Wherever patients with COVID were treated within the Mount Sinai Health System, a member of our Department was there to ensure that their special needs were met. We developed some very new and innovative models of care delivery that we took from concept to innovation to scale in a matter of days, rather than a matter of months.

Can you give an example?

We created a 24-hour telephone hotline that allowed overextended and overwhelmed emergency physicians and intensive care unit physicians to refer patients to us, so we could discuss their goals of care with them. We could advise around symptom management, and we could provide support to their families who could not see them, because no visitors were allowed in any New York City hospital during this time.

How was the Department able to scale up so quickly?

I think it was really three key elements that this Department has been doing since its founding, namely our focus on clinical care, research, and education.

A key part of our mission is to create leaders, not just in the care of older adults, but leaders in health systems, leaders in hospitals, leaders in community centers. For example, the senior vice president of the Mount Sinai Health System, who was responsible for coordinating clinical care throughout the pandemic, was a graduate of our fellowship program. He knew the importance of high-quality care for older adults during this pandemic and made sure that the patients in the Health System received that care, and that our Department was on the front lines. It was leadership within the Department, graduates of our training program, who developed the innovations, who developed the care models, who understood the need, throughout the Health System, for high-quality care for older adults.

Our research has focused on how do you deliver high-quality care to people outside of the hospital, outside of doctor offices. That allowed us to create new models of care that met the needs of the population.

And it was our educational efforts. We knew how to train, very quickly, other clinicians who may not have had training in the appropriate care of older adults, or the special needs of older adults, and be able to put that on the ground, right away, when patients and families needed it most. This Department trains 1 in every 10 geriatricians in the United States. Our graduates are in hospitals and health systems throughout the country.

What was the result?

The models of care that we have developed at Mount Sinai have been implemented in hospitals and health systems throughout the country. The work of our educators, providing high-quality technical support for the care of older adults, have been disseminated throughout the country. As other parts of the country wrestle with the challenges of COVID and, unfortunately, as the number of cases rise in other cities, as our experience this spring is being repeated elsewhere, the work of this Department, I believe, will save many, many lives throughout the country because of what we did in New York City.

So what are you focused on now?

As New York City has emerged from the surge of COVID, I worry about a number of challenges that we are facing and will continue for us. These challenges affect our patients, and our health care workers.

For patients, there is a sense of isolation. In order for our patients to stay safe, they have had to remain in their homes, often alone or with very few visitors. There is a sense of loneliness, indeed, the sense of purpose may seem limited, given how much of their time is spent isolating at home. We must ensure that we recognize their mental health needs, identify when isolation and distress becomes major depression, and provide support that helps our patients through the next six to nine months before we have a vaccine.

And what about health care workers?

The second challenge that I think we all face is that of the emotional health of our health care workers. My faculty experienced and saw more death in three months then many clinicians will see in entire careers. They were often the person holding the iPad so that their patient could say goodbye to their families and loved ones, or could have a conversation, not knowing what was going to happen to them and not being allowed to have their family there. Our faculty, our clinicians, our staff became patients’ families. They did that every single day, hour after hour, minute after minute. And it takes its toll.

Read about a patient who recovered from COVID-19 with help from Mount Sinai’s unique Hospitalization at Home program

New Clinical Trial Will Test Whether Ketamine Can Be Used to Treat Children with Autism

Jul 27, 2020 | Featured, Research, Seaver Autism Center

Sandra Sermone and her son, Tony, who has ADNP syndrome. Mrs. Sermone founded the ADNP Kids Research Foundation, which is funding Mount Sinai’s phase 2 clinical trial into the safety and efficacy of ketamine as a potential treatment.

Ketamine, an anesthetic medication that has also been approved for use in severe depression, is now offering promise to children with a form of autism known as ADNP syndrome, or Helsmoortel-Van Der Aa syndrome. Ten children, ages 5 to 12, will soon take part in a clinical trial conducted by the Seaver Autism Center for Research and Treatment at Mount Sinai to determine whether ketamine is safe and well tolerated, and able to help compensate for the neuropsychiatric deficits that stem from missing a copy of the ADNP gene.

This will be the first clinical trial launched for ADNP syndrome, which was identified in 2015. It is a testament to the dedication of parents and physicians at the Seaver Autism Center, and the potential of artificial intelligence (AI) in helping advance treatment research in rare disorders.

Ketamine and several other existing drugs were identified by an AI tool, mediKanren. It was created at the University of Alabama by a colleague of Matthew C. Davis, MD, whose child has ADNP syndrome. Dr. Davis and another parent, Sandra Sermone, investigated ketamine in relation to ADNP within the existing scientific literature and found that it upregulated expression of the gene. With this and other relevant clinical data in hand, they filed for intellectual property protection. Then Mrs. Sermone brought the information to leaders of the Seaver Autism Center, who agreed that it was worth further investigation. Alexander Kolevzon, MD, Clinical Director of the Seaver Autism Center applied to the U.S. Food and Drug Administration for permission to proceed with a clinical trial and received approval.

“We think ketamine has potential and that it’s safe, so we’re very excited about it,” says Mrs. Sermone, who founded the ADNP Kids Research Foundation in 2016. The Foundation recently ran a “virtual” fundraising effort that raised more than $150,000 in six weeks that will be used to finance the entire phase 2 clinical trial and begin to lay the groundwork for a possible phase 3 study.

Approximately 275 children worldwide have been diagnosed with the syndrome, which often is accompanied by other complex health issues of the heart and brain. “I am so grateful for the team at Mount Sinai. I’ve never seen a group more dedicated to working with patient groups,” she adds. “Ketamine is a repurposed drug, so if it shows efficacy we can hopefully move quickly into a larger, phase 3 clinical.”

Ana Kostic, PhD, Director of Drug Discovery and Development at the Seaver Autism Center, says, “Ketamine has been used for many decades. We know a lot about the molecule and its safety profile, and now to find new uses for it through scientific discovery is amazing.”

Since ADNP is very important for the development and function of the central nervous system, the ability to restore its functionality would be extremely beneficial.

Dr. Kolevzon says each of the children enrolled in the clinical trial will receive a single infusion of ketamine over a period of 40 minutes and will be monitored over the course of four weeks to assess improvement. In addition to determining its safety and tolerability, he says, “we are also really interested in clinical improvement. Kids with ADNP have a lot of sensory sensitivities that we can measure with different tools, such as electrophysiology.” This would enable the researchers to “see whether there are changes in the electrical patterns in the brain in response to ketamine, and that might give us insight into potential biomarkers. These children have language problems, behavioral problems, and sleep problems. There are a lot of issues that go along with ADNP syndrome that we’re hoping to potentially address.”

The promise of ketamine may also extend to larger populations of individuals with autism who do not necessarily have ADNP syndrome, according to Dr. Kostic. “It could have beneficial effects in people who don’t have the same mutation but who have similar deficits.”

Access to high-quality genetic technology has become increasingly affordable over the past several years and has enabled more families to receive accurate and earlier diagnoses of many disorders, including autism. In most cases, the younger a child receives intervention, the better their chances of improvement. Earlier diagnoses, and a potential treatment such as ketamine, provide Mrs. Sermone and other committed parents with hope.

“It’s incredibly important because, currently, there isn’t one single treatment for our children with ADNP syndrome,” says Mrs. Sermone. “Our kids don’t produce enough of the ADNP protein. It’s like they’re running on half a tank of gas. To improve the quality of their lives—for us, that would be amazing.”

Mount Sinai’s Master’s Commencement—A Time for Reflection and Recognition

Updated on Jun 30, 2022 | Featured, School

The Graduate School of Biomedical Sciences at the Icahn School of Medicine at Mount Sinai conferred 201 master’s degrees during a ceremony that was held virtually on Friday, June 26, as New York City continued to observe masking and social distance protocols in the midst of the COVID-19 pandemic. The Graduate School now has eight master’s degree-granting programs, including its newest, Biomedical Data Science, which graduated its first student.

“Class of 2020, I applaud your passion, your dedication, and your commitment to hard work,” said Marta Filizola, PhD, in greeting the graduates. Dr. Filizola is Dean of the Graduate School of Biomedical Sciences and the Sharon & Frederick A. Klingenstein/Nathan G. Kase, MD Professor of Pharmacological Sciences, and Neuroscience.

Marta Filizola, PhD

“This has, of course, been an academic year with an unusual conclusion. But even in these times, there is much to be grateful for. In a year when the world is filled with uncertainty, I also feel hope because of all of you,” she continued. “You have seen your studies through, and now, when they are greatly needed, you will be applying your new skills in biomedical sciences, in data science and statistics, in genetic counseling and clinical research, in public health and health care leadership, to meet some of the greatest challenges these fields have ever faced. Whether you continue in academia; pursue careers in biotechnology, pharmaceuticals, or other industries; or even start your own companies and show the world what it has been missing, I hope you will do it with drive, with discipline, with integrity, and with empathy. The world can use your help.”

Presiding over the ceremony was Eric J. Nestler, MD, PhD, Director of The Friedman Brain Institute, Dean for Academic and Scientific Affairs, and Nash Family Professor of Neuroscience. In addressing the graduates, he said: “We were caught flat-footed by COVID-19 and should have responded much better early on, but public health and modern medicine have saved the lives of innumerable people—through medical support, antiviral agents, and mitigation efforts—who otherwise would have died. And how impressive and heartening it has been to see the leadership role played by Mount Sinai and our health care heroes on the front lines in these efforts.”

Eric J. Nestler, MD, PhD

Still, Dr. Nestler cautioned, “As we continue to focus on containment and treatment, we must also now heed warnings on the impact of contagion on our humanity. We have already seen a dramatic increase in depression, post-traumatic stress, suicide, and drug overdoses, and we all expect that this is the tip of the iceberg of people who are hurting emotionally from the stress and fear of themselves or loved ones getting sick, in addition to the toll of social isolation and severe unemployment. We should also keep the toll of COVID-19 in perspective. Before the pandemic, 70,000 Americans died each year of drug overdoses, and 50,000 from suicides; one might argue that addiction, depression, and suicide have been pandemics for years to which our society has not paid nearly enough attention.”

Dr. Nestler introduced Helena Hansen, MD, PhD, Associate Professor of Anthropology and Psychiatry at the Grossman School of Medicine at New York University, who gave the Commencement address. Dr. Hansen also was awarded an honorary Doctor of Science degree for dedicating her “wide-ranging career to studying the intersections of social forces and medicine, identifying opportunities for improving health, and greatly improving access to care for all.”

Helena Hansen, MD, PhD

Dr. Hansen, who began her training at the peak of AIDS activism, challenged the graduates to seek wisdom in new places. “Our turbulent times have placed health inequalities and climate as centerpieces of social justice, at the very center of our society’s future. You, as highly trained scholars and practitioners of public health, are in the eye of the storm,” she said, as she provided the graduates with three principles for positive action. “Look for expertise and leadership from ‘below.’ The power structure of our society will continually belittle the knowledge of those who never had access to college or graduate education. Your job is to go against the grain and redefine knowledge, expertise, and power.”

She continued: “Look up to larger systems for fundamental causes of syndemics and health inequalities—their roots are almost always in policies and institutions. The predictable patterns of overlapping epidemics signal that they are biosocial in nature, that they represent the biological end points of social environmental assaults. Your job will be to continually redefine health problems from problems of individual behaviors to problems of pathological systems. Build communities of practice wherever you go: you will need the affirmation and power of many like-minded people.” Dr. Hansen concluded, “I congratulate you on choosing the eye of the storm for your career, and I look forward to meeting you there.”

Charles Sanky, MPH

Charles Sanky, a dual MD/MPH degree candidate who received a Master of Public Health degree and intends to complete his MD degree in 2021, was the student speaker. “I’d like to talk about muting ourselves,” he began. “It’s something we tend to do out of courtesy on Zoom calls, but we do this in real life, too—stopping ourselves from speaking our truth, taking action, and sharing what we have to offer. Some of us have felt powerless and incapable of meaningfully effecting change without more education, more skills, more experience. ‘If only I get my master’s, then I’ll be able to tackle the big questions. Then, I’ll be able to contribute. Then, I will be heard.’ We muted ourselves instead of realizing that we had a powerful voice all along.”

Mr. Sanky urged the Class of 2020 to not be silent. “Our graduation, this moment, celebrates our ability to raise our voices, to continue in that fight for serving humanity through health care,” he said. “We have the privilege, ability, and the duty to do something more, to push boundaries to reimagine solutions. In this moment, let’s promise ourselves that we will speak up, take action, be creative, and think beyond the structures handed to us. Class of 2020, let’s live our lives off mute.”

Meet one graduate with a passion for community wellness

Why a Master’s Degree? New Graduates Share Their Perspective and Aspirations

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

“Mount Sinai has been the perfect academic community for me for the past two years, growing my love of research while at the same time challenging me and developing my skills. I’m excited to keep chasing my aspirations as I continue on to complete my PhD at Mount Sinai and further my research goals.” —Kimberly Okoli, MSCR

“I’m the first one in my family to attain my master’s; therefore, while this is an academic achievement, it also feels like a hugely personal one. In retrospect, Mount Sinai provided the perfect environment and opportunity for me to pursue my graduate education. The rigor and wisdom of the professors really helped spark the curiosity and interest to learn. And, while my last semester here wasn’t exactly as I envisioned (due to COVID-19), Mount Sinai adapted really well and still opened new doors for me and my future.” —Aaron Sunil, MSCR

“The Master of Science in Clinical Research Program at the Icahn School of Medicine at Mount Sinai has the most comprehensive curriculum and exceptional faculty from a diverse clinical background, which provided me with the perfect intellectual and social milieu to extend my research skills and actively participate in this field. The knowledge and the experience I gained here will help me to pursue a career as a clinical researcher in the field of neurology.” —Dhaivat Shah, MBBS, MSCR

“My time in the Master of Public Health program gave me the opportunity to discover passions for health disparities research, environmental health, and preventive medicine that I never knew existed. Before coming here, I didn’t know that being a physician and research scientist was possible to balance. Having physicians as professors, and forming bonds with these mentors and becoming a part of their research endeavors created a very unique experience that I’m truly thankful for.” —Acacia Smash, MPH

“Upon graduating the Health Care Delivery Leadership Master’s program, I find both the world and myself transformed. The knowledge and expertise that I gained from the program have been invaluable in successfully leading my clinic through the pandemic. Armed with a renewed sense of determination and skills, I’m taking this opportunity to expand into various areas by both building on the clinic redesign I have started and taking the Addiction Medicine boards this fall.” — Jameela Yusuff, MD, MPH, Medical Director and Associate Professor of Medicine (Infectious Diseases), STAR Program, SUNY Downstate Medical Center

Meet one graduate with a passion for community wellness

Mount Sinai to Create and Test New Hyperimmune Globulin Drug for COVID-19

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

The Mount Sinai Health System in July will begin collecting high levels of blood-based antibodies from people who have recovered from COVID-19 as part of a $34.6 million clinical trial to create and test a hyperimmune globulin drug that would be used to treat early COVID-19 disease and to prevent specific at-risk populations from developing the disease.

Hyperimmune globulin is derived from pooled blood-plasma donations from many people with high levels of antibodies to COVID-19, as opposed to convalescent plasma, which uses just one donor per recipient. The pooled plasma is then then purified into a product that can be used as a treatment or prophylactic drug administered by injection or intravenously, conferring temporary immunity to the disease from the antibodies. The same process is used to prevent people from developing diseases such as hepatitis B and rabies.

To conduct clinical research trials, one of which is funded by the U.S. Department of Defense, Mount Sinai will work with two companies, Emergent BioSolutions and ImmunoTek Bio Centers, to produce the drug. It is expected to be given to patients with early disease, to front-line medical workers, and to military personnel who are unable to avoid close contact while training and conducting missions.

Jeffrey Bander, MD, Medical Director of Network Development for the Mount Sinai Health System, is assisting in recruiting donors for the clinical trial. “We’re not helpless against COVID-19,” Dr. Bander says. “People can fight back by donating antibodies.” While experts are not certain how long antibodies last, Dr. Bander says, “we do know that people who had the strongest antibody response still seem to have it three months later.”

To create the drug, Mount Sinai will rely on blood-plasma donations from people who recovered from COVID-19 during the spring surge of cases in New York City. People may donate twice a week for multiple weeks. A new collection center that can process 12 donors at a time has been established on The Mount Sinai Hospital campus.

ImmunoTek Bio Centers is assisting Mount Sinai in the blood-plasma collection. The plasma will be frozen on site and then transported to Emergent BioSolutions to pool it and create the hyperimmune globulin. Then the product will be sent back to Mount Sinai and other sites to be used in clinical trials.

Plasma Collection Center Seeks Potential Donors

The Mount Sinai Health System, in collaboration with Emergent BioSolutions and ImmunoTek Bio Centers, has established a Plasma Collection Center at The Mount Sinai Hospital to advance the development of hyperimmune globulin, a potential therapeutic.

You may be a candidate to donate plasma for use in this drug if you are age 18 to 65 and meet criteria including these: you have tested positive for SARS-CoV-2, the virus that causes COVID-19; have fully recovered; and have a high concentration of antibodies. If you are interested in donating plasma, please complete the prescreening questionnaire.

If you meet the qualifications to donate, a member of the Mount Sinai team will contact you to schedule a donation appointment.

“It is imperative that we have more options to prevent this terrible disease in front-line workers and other high-risk populations and to potentially decrease the severity of illness in those infected,” says David L. Reich, MD, President of The Mount Sinai Hospital and Mount Sinai Queens.

Suzanne Arinsburg, DO, Associate Professor of Pathology, Molecular and Cell Based Medicine, who is overseeing Mount Sinai’s blood-banking and donation process, says that monthly administration of hyperimmune globulin may also serve as a prophylactic treatment for people who would not be medically eligible to receive a vaccine.

The regulations surrounding blood-plasma donations that are used for hyperimmune globulin are stricter than for convalescent plasma, according to Dr. Arinsburg. Donors are carefully screened and participate by appointment only.

With convalescent plasma, “every patient is getting plasma from a different donor and every donor has a different amount of antibody, and there are always differences between donors that we may not understand,” says Dr. Arinsburg. “With hyperimmune globulin, the plasma is pooled from many donors and fractionated to highly concentrate the antibodies so that every patient gets the same amount. That removes the issue of differences between donors.”

Learn more about the Plasma Collection Center at Mount Sinai

First-Time Mother Receives Life-Saving Aortic Surgery

Updated on Jun 30, 2022 | Cardiology, Featured, Patient Stories

From left, Ismail El-Hamamsy, MD, PhD, Yulia Nurikyan, and Percy Boateng, MD.

A first-time mother received life-saving heart surgery at The Mount Sinai Hospital, thanks to her quick response to her symptoms and knowledge of her family’s health history, says a leader of her surgical team, Ismail El-Hamamsy, MD, PhD, Director of Aortic Surgery, Mount Sinai Health System, and first author of a recent paper on aortic dissection repair during the COVID-19 pandemic.

The patient, Yulia Nurikyan, was 38 weeks pregnant and had not been feeling well, with a backache that she thought was caused by her late-stage pregnancy. In mid-May, in the heat of the COVID-19 pandemic, she woke up at 5 am with a heavy feeling in her throat. She got out of bed for a glass of water, then fainted. Her husband, Antoan, quickly called 911, and an ambulance rushed her to Elmhurst Hospital in Queens.

Ms. Nurikyan told the medical team at Elmhurst that her father had died of an aortic dissection in his 40s, so they ordered a CT scan and other diagnostic tests, which showed that she had a bicuspid aortic valve. This was crucial information. About half of patients with this heart defect develop an aortic aneurysm, an enlargement of the vessel that can lead to aortic dissection. This is a tear in the inner layer of the aorta, the main blood vessel that brings oxygenated blood to the rest of the body. Some people with an aortic dissection feel no pain, but common symptoms are severe sudden pain in the upper back or chest, shortness of breath, and dizziness or fainting.

Ms. Nurikyan underwent an emergency C-section, delivering a baby girl, Livia. She held her daughter for a few minutes, then she was rushed to The Mount Sinai Hospital for emergency heart surgery, since the imaging tests suggested that her aorta was about to rupture, which could have proved fatal.

Yulia and Antoan Nurikyan with baby Livia.

“In cardiac surgery, this situation is at the top of the list of emergencies,” says Dr. El-Hamamsy, who treated Ms. Nurikyan as soon as she arrived. Dr. El-Hamamsy, senior faculty in Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, is an expert in the repair of aortic dissection and recently published a study that found a significant decline in reported cases during the COVID-19 crisis.

In the study, published in May in the Journal of the American College of Cardiology, researchers compiled data on surgical repair of acute Type A aortic dissection in 11 New York City hospitals from January 1, 2018, to April 15, 2020, counting March 1, 2020, as the first day of the COVID-19 pandemic in the city. The study found that these surgical repairs fell 76 percent after the COVID-19 pandemic began—from 12.8 cases per month before the pandemic to 3 cases per month after the pandemic.

The investigators presented several potential reasons for the decline, suggesting, for example, that some aortic dissection patients did not call for help, fearing COVID-19 infection; or busy first responders were delayed in providing aid; or overburdened emergency departments may have missed or delayed diagnoses. The study said, “Although no causal relationship can be firmly established among the drop in type A aortic dissections, the COVID-19 outbreak in New York City, and the increase in at-home deaths since the last week of March 2020, this gives pause for thought.”

Ms. Nurikyan experienced a Type A aortic dissection. In a successful procedure, Dr. El Hamamsy repaired her bicuspid aortic valve, removing some of the injured blood vessel and replacing it with a synthetic graft, working with David H. Adams, MD, the Marie-Josée and Henry R. Kravis Professor and Chair of Cardiovascular Surgery at the Icahn School of Medicine at Mount Sinai, and the Cardiac Surgeon-in-Chief of the Mount Sinai Health System, and Percy Boateng, MD, Assistant Professor of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai.

Ms. Nurikyan’s baby, Livia, had remained at Elmhurst, placed in neonatal intensive care because of fluid in her lungs. Ms. Nurikyan and daughter spent a week at separate hospitals, and her husband could not visit either of them due to safety rules during the pandemic, though the hospitals kept them in touch through video calls. The family was happily reunited on May 23, when Ms. Nurikyan was picked up by her husband and they went together to get Livia. “My baby was the one who got me through it,” she said in an article on her care in the Daily News. She said she was grateful for her healthier heart and for the compassionate and expert care her new family received.

Ms. Nurikyan’s quick response to her symptoms was crucial, Dr. El-Hamamsy says, a point reinforced by the recent study. “It is critical, as we adjust to the pandemic, to balance the public health imperative of social distancing with the individual need to consult in the presence of sudden severe symptoms. Furthermore, additional resources, ranging from telemedicine to numbers of first responders, should be greatly increased,” the study concluded. “This serves as a word of caution for cities yet to experience a surge in COVID-19 cases, as well as for future similar events.”

Learn more about Mount Sinai Heart

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