Public Health Students Continue Training during COVID-19 Pandemic

Throughout the COVID-19 pandemic, Master of Public Health (MPH) students from the Graduate School of Biomedical Sciences at the Icahn School of Medicine at Mount Sinai have stepped up to the challenge of balancing their training in public health, continuing their in-progress research and outreach work, and taking on new responsibilities in managing the spread of the virus. Students have been involved in COVID-19 clinical care, research and the development of therapies, as well as volunteer work. This includes placing update calls to patients’ families, directing calls to resource hotlines, and coordinating food drop-offs to New York City residents. Showing resilience in the face of an unprecedented situation, students continued to meet the milestones of their professional degree program, and in May, the students celebrated yet another major accomplishment—the presentation of their MPH Culminating Experience project at Public Health Research Day.

More than 50 MPH students presented their graduate-level research at the first-ever virtual meeting of Public Health Research Day on Thursday, May 28. To bring the Mount Sinai community together, the Graduate Program in Public Health kicked off this year’s event with a timely lecture by Jessica Metcalf, PhD, Assistant Professor of Ecology, Evolution and Public Affairs at Princeton University, on the use of serology in monitoring health during the pandemic. Afterward, four students were given the honor of presenting their research in long-form oral presentations to more than 100 attendees on Zoom.

Sofia Bengoa presented work on the East Harlem built environment and its effects on adolescent well-being. Charles Sanky described results of the social determinants of health and patients’ lifetime experiences of discrimination as surveyed within an emergency department. Rui Jiang shared work on leveraging hyperlocal epidemiology to capture missed breast cancer screening opportunities. The last honored speaker was Shivani Rathi, who discussed the effects of early childhood stress, adult resilience, and sexual orientation in Gujarat, India. The afternoon followed with each student’s virtual poster presentation in specialty areas like health care management, epidemiology, global health, health promotion, and other public health fields. The following MPH candidates were recognized for their outstanding poster presentations: Debjyoti Datta, Salvatore Crusco, Erona Ibroci, Kayla Jaeckel, Charles Sanky.

The Graduate Program in Public Health united the student community for a uniquely heartfelt virtual gathering in which three MPH alumni candidly shared their post-graduation experiences. Molly Libou, MPH, Research and Surveillance Manager in the Bureau of Alcohol and Drug Use Prevention, Care and Treatment, NYC Department of Health & Mental Hygiene, walked students through her job search strategies and encouraged students to jump at opportunities to learn and advance in the field. Michael Smith, MPH, HIV Consultant, United Nations World Food Programme, earnestly shared how grueling work projects, like writing and rewriting a master’s thesis, were learning experiences that better prepared him for more significant challenges in his career. Finally, Erica Palladino, MPH, Public Engagement and Strategic Communications Fellow in the Office of the Surgeon General, illustrated the importance of preparing for your future workplace, but also acknowledged that learning will happen on the job as well.

“These are historic times for Public Health,” said Nils Hennig, MD, PhD, MPH, Director of the Graduate Program in Public Health. “We are all reminded how important the role of public health education, practice, and leadership is during this time. I have never been more proud of our students, faculty, and staff than in their response to the COVID-19 pandemic. In our program, I see an unwavering dedication to the public’s health.”

Staying Safe During the COVID-19 Pandemic and Beyond: A Guide for IPV Survivor Well-Being

Isolation, uncertainty about tomorrow, and fear of consequences that are out of their control can be common experiences, especially for those in abusive relationships. According to Angela Fernandez, Assistant Director of the Sexual Assault and Violence Intervention (SAVI) Program at Mount Sinai, the voluntary seclusion that many have been practicing in order to prevent the spread of COVID-19 may be compounding these realities for survivors of intimate partner violence.

“Abusers will often isolate a survivor and disconnect them from their support network,” says Ms. Fernandez. “COVID-19 is just another factor that makes these challenges harder for a survivor.”

How can survivors remain safe and connected to support when physical distance is essential for safety? As we weather the current pandemic, Ms. Fernandez provides safety tips for survivors—and their loved ones—that are applicable now and as we enter a new normal due to COVID-19.

Identify a “go to” person or network of people in your physical or digital community.

As much as possible, create scheduled check-ins with your support network, and identify at least two people you can contact with an established code word or phrase that will let them know that you are in trouble. Using this word or phrase will indicate that you need an immediate help or intervention.

Discuss with your support network what “getting help” means to you.

“Getting help” is a catch-all phrase that could mean any number of things. Be sure to let your support network know what should happen immediately after you use a code word/phrase/sentence. Would you like someone to help de-escalate a situation, should someone call 911, or do you need to leave?

“Every survivor’s situation is unique and evolving,” says Ms. Fernandez. She notes that physical violence is often seen as the main threat to a survivor’s safety, despite the prevalence of psychological, emotional, and sexual abuse—which are often concurring and are equally damaging to their well-being. “Using a code word or phrase could very well indicate the immediate need for emotional first-aid as much as a physical intervention.”

Be prepared to leave if your situation escalates.

Think about the easiest and safest routes for you to get out of your home quickly, if necessary. Keep an emergency bag that you can quickly fill (or, pre-packed if safe to do so) with a portion of your medication, money, important documents, and food and that you can access on your own time. Keep your identification on you as much as possible.

Identify the “safest” spaces inside.

To protect yourself during times of escalation, think ahead about what spaces feel safest. This might mean a room where there are no weapons (i.e. avoiding the kitchen) and/or has easy access to a door or window to exit the house or apartment. Identifying the safest areas within the home can at least reduce the risk of harm.

If you are part of a survivor’s support network, remember that the person experiencing intimate partner violence knows their situation best.  

What you believe to be best may differ from the survivor’s lived experience. In fact, for a survivor, the risks of leaving can often outweigh the risks of staying—especially during a pandemic that has exacerbated economic instability.

Supporters should be careful not to take control away from survivors, which is what the abuser is doing on a daily basis.

“When we look at the power and control dynamics, just because you think you are taking action with good intentions, doesn’t make it any less disempowering for a survivor,” says Ms. Fernandez. “We should be helping to re-empower that person by making sure they have space to consider what is best for them.”

This is especially important now when there are fewer resources available due to the pandemic but holds true during “normal times,” Ms. Fernandez says. Seeking police intervention should be the exception and not the general practice for supporting survivors of intimate partner violence, she says, but this calculation changes if there is a threat of serious and imminent harm.

If you or a loved one needs advice, assistance, or support regarding sexual assault or intimate partner violence; the Sexual Assault and Violence Intervention (SAVI) Program at Mount Sinai is available to help. For more information, visit the SAVI website or call 212-423-2140. 

Additional resources include the National Domestic Violence Hotline and Safe Horizon, which provides social services for survivors throughout the five boroughs.

People With Down Syndrome May Experience Severe Forms of COVID-19

Individuals with Down syndrome, the nation’s most common genetic disorder, represent a small, vulnerable segment of the U.S. population whose comorbid conditions may make them particularly susceptible to severe forms of COVID-19.

In fact, people with Down syndrome who are over the age of 30 appear to be about nine times as likely as the general population to be hospitalized for COVID-19, and their hospital stays tend to be more than twice as long, with a median of 17 days, according to a recent study from the Icahn School of Medicine at Mount Sinai that was uploaded onto the pre-print server medRxiv. Approximately 250,000 people in the United States have Down syndrome.

“When you don’t have a critical mass of people who are able to advocate for themselves, which is the case with Down syndrome, then people start falling through the cracks,” says the study’s senior author, Dusan Bogunovic, PhD, Associate Professor of Microbiology, and Pediatrics, and Director of the Center for Inborn Errors of Immunity, which is part of the Mindich Child Health and Development Institute. “We did not want that to happen. We felt that particular attention should be paid to the prevention and treatment of COVID-19 in individuals with Down syndrome.”

From left: Dusan Bogunovic, PhD, and Louise Malle, MD/PhD candidate

Dr. Bogunovic and MD/PhD candidate Louise Malle led a research team that examined the electronic medical records of 4,615 patients with COVID-19 who were hospitalized within the Mount Sinai Health System. They expected to find one or perhaps even two patients with Down syndrome based on the syndrome’s low prevalence within the population. Instead, they identified six adults, all of whom were in their 50s except for one, who was in her 30s. Two of the six patients, both in their 50s, succumbed to the disease. By comparison, Dr. Bogunovic says, 2 out of 30 cases were fatal in an age, sex, and race-matched control group of people who did not have Down syndrome.

Four of the six Down syndrome patients with COVID-19 were also diagnosed with sepsis, which is a marker of extreme inflammation, according to Ms. Malle. The individuals with Down syndrome were more likely to be hospitalized in an intensive care unit and to have been placed on a ventilator. In addition, she says, a constellation of other health issues associated with Down syndrome, such as autoimmune disease, epilepsy, and dementia, may have played a role in the severity of COVID-19. Further studies will be needed to determine whether these patients were more likely to produce higher levels of inflammatory markers.

Over the past 20 years, improved health care for individuals with Down syndrome has led to increased longevity, with many now living into their early 60s. That however, is still roughly 20 years shorter than individuals without the disorder. The median age of the hospitalized patients with Down syndrome was 54, roughly 12 years younger than the rest of the population that was hospitalized as a result of the disease.

Dr. Bogunovic says one positive finding was that “none of the patients we looked at were pediatric patients, so it does follow the trend of the general population that the older you are the more likely you are to be hospitalized with COVID-19.” He adds that the current study points to the need for “additional research into the medical conditions of marginalized patients with rare genetic conditions,” particularly during a pandemic.

Broadway Performers Honor Mount Sinai Graduates during Virtual Commencement

Virtual pomp and circumstance prevailed on Thursday night in a graduation of 62 Mount Sinai residents, and while commencement exercises via Zoom have become the new normal, a special performance by celebrity performers added an element of surprise for the newly minted doctors: an original song written just for them. The ceremony was held by the Department of Medicine at The Mount Sinai Hospital, which is part of the Icahn School of Medicine at Mount Sinai.

An offering of The Clear Day Project, the song, “Keep Your Head Up Child,” was written by actor Joe Tippett and performed by him and his Grammy award-winning collaborator, Sara Bareilles. The song was dedicated to the graduates of the Icahn School of Medicine at Mount Sinai and their instructors who have worked tirelessly and selflessly throughout the pandemic.

“Our Internal Medicine residents were on the front lines of the fight against COVID-19. Their dedication, compassion, and commitment were extraordinary. So I wanted to do something special for these residents who gave so much of themselves during this pandemic. I am thrilled that Sara Bareilles and Joe Tippett wrote this song to honor them and their hard work. I am so very grateful to them for recognizing their sacrifice and for helping us celebrate this important milestone in their medical careers,” says Barbara Murphy, MD, the Murray M. Rosenberg Professor of Medicine, Chair of the Department of Medicine for the Mount Sinai Health System, and Dean for Clinical Integration and Population Health.

The Clear Day Project is a living theatre project co-founded by former Carnegie Mellon drama classmates Jordan Dean, Kersti Bryan, and Dan Amboyer. Mr. Dean had two surgeries, including a 13-hour open-heart surgery, at The Mount Sinai Hospital in 2019. Reacting to the gravity of the pandemic, Clear Day Project assembled an eclectic series of New York performers, including Oscar, Golden Globe, Emmy, Grammy and Tony Award winners, to create artistic messages of gratitude and solidarity for front-line workers at the Mount Sinai Health System titled, “Songs for Mount Sinai”.

“The Clear Day Project was started as a space for New York City artists to bolster those most affected by COVID-19: the front-line workers and their families. We are in awe of the incredible, life-saving work performed by those on the front lines in the Mount Sinai Health System. Their tireless devotion to the people of New York during this once-in-a-lifetime pandemic deserves the highest recognition. We hope the graduates, their families, and staff love Joe and Sara’s performance as much as we do,” says Mr. Dean.

Vigils for Justice, Equality, and Health Equity

Clinicians across New York City joined in a “White Coats for Black Lives” march on Saturday, June 6, from Central Park’s East Meadow down Fifth Avenue to Columbus Circle. Hundreds of health care workers and medical students—wearing the requisite face masks—were demonstrating to address a range of issues, including the murder of George Floyd in Minneapolis and structural racism that has contributed to disparities in health, both during the COVID-19 pandemic and long before.

The event was led by White Coats for Black Lives, a medical student-run organization that was born out of demonstrations in 2014 after Michael Brown in Ferguson, Missouri, and Eric Garner in Staten Island were killed by police. Since then, the group has formed chapters around the nation with this mission statement: Eliminating racism in the practice of medicine and recognizing racism as a threat to the health and well-being of people of color.

Sites across Mount Sinai have also held vigils—including powerful events on Tuesday, June 2—in which participants observe 8 minutes and 46 seconds of silence, the amount of time George Floyd was held under a police officer’s knee, suffocating to death. Demonstrations also focused on Breonna Taylor, an African-American emergency room technician who in March was killed by the police in her own home in Louisville, Kentucky.

At noon on Thursday, June 11, 1199-SEIU encouraged its members to take that pause to show solidarity for George Floyd and so many others who came before him. Many 1199 members gathered outside of Mount Sinai Beth Israel to participate. And at Mount Sinai West and Mount Sinai Morningside, vigils were led by unions including 1199 and the New York State Nurses Association. Members of hospital leadership at the sites joined in solidarity.

How a Small Force of Mount Sinai Nursing Students Played Key Support Roles at the Height of COVID-19

Nursing student volunteers, from left, Pearl Scalzo, Sylvie Jean Baptiste, and Jacky Lee stocked emergency trays for the Mount Sinai Beth Israel Pharmacy.

Twenty-two students at the Phillips School of Nursing at Mount Sinai Beth Israel have logged more than 1,000 volunteer hours since early April, taking on key support roles in pharmacy and research to help overburdened Mount Sinai Health System staff at the height of the COVID-19 pandemic. The effort was launched by two student leaders, Shayna LaSala, President of Student Government at the School of Nursing, and Frances “Frankie” Burney, chapter president of its National Student Nurse Association. They say they were inspired by the several hundred medical and graduate students and postdoctoral fellows from the Icahn School of Medicine at Mount Sinai who had been volunteering through the newly created Sinai Student Workforce.

With the help of Dean Todd F. Ambrosia, DNP, MSN, APRN, FNP-BC, FNAP, Ms. LaSala and Ms. Burney created the Nursing Student Workforce, giving nursing students the opportunity to volunteer in the pharmacy at Mount Sinai Beth Israel and at Mount Sinai Morningside, and to play vital roles in a significant COVID-19 research project at the Icahn School of Medicine.

As part of their efforts, the nursing students assembled crash carts and emergency kits, prepared medications, and performed whatever tasks were requested by pharmacy technicians. One student who was particularly skilled in phlebotomy trained registered nurses and personal care assistants on the latest venipuncture techniques. They also joined a cadre of staff and other volunteers on the Mount Sinai COVID-19 Tissue Collection Taskforce, where they helped to create a biobank of specimens from COVID-19 patients that later would be analyzed in research laboratories as part of a study by Mount Sinai scientists. The students were assigned to help assemble test tubes, deliver them to unit nurses, and then collect the full ones hours later, working in day or evening shifts.

Nursing student volunteers, from left, Dominique Falci, Rebecca Dornfeld, and Gurpawan “Gia” Kang helped to create a biobank of specimens from COVID-19 patients as part of a research study.

“Our nursing students were determined to help during this crisis,” says Dr. Ambrosia. “Their actions demonstrated that nursing truly is a calling—one that attracts those who strive to help humankind. I am extremely proud to stand with them and the nursing profession as we continue to care for our patients and one another.”

“It was inspiring to be part of a team where everyone—doctors, nurses, volunteers—came together to get through this,” says Dominique Falci, a nursing student who was involved in both research and pharmacy tasks. “There were so many extremely sick patients and so much bad news, but staff and volunteers were so warm and supportive of each other. It was very uplifting, especially as a student,” she says.

The students believe they got a unique perspective that will influence how they perceive hospital relationships. “Everyone brings a different skill set into a situation,” says Ms. Burney. “This experience has, for me, highlighted the special relationship between doctors and nurses and how much they can achieve by working together closely as a team across all disciplines.”

The students volunteered between semesters, launching the project in April after completing their final exams. However, now that classes have resumed, most are unable to continue volunteering, though Ms. Falci intends to make it part of her schedule. Fortunately, as new COVID-19 admissions have been declining, there is less need for volunteers. The student volunteers, who are in the Accelerated Bachelor of Science in Nursing Program, will graduate in August.

“It really has been a privilege to ease some of the burden on front-line workers,” says Ms. LaSala. “And, seeing our student body come together and work seamlessly as an interdisciplinary team with the medical students and Mount Sinai staff during such a stressful time is a learning experience we’ll never forget.”

Nursing student volunteer Gurpawan “Gia” Kang, left, helped Nicole Simons, MA, Team Leader of the COVID-19 biobank research study, collect biospecimens at an inpatient unit in Guggenheim Pavilion.