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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.”

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

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