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

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.”

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

“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

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

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.”

First-Time Mother Receives Life-Saving Aortic Surgery

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.”

Mount Sinai Welcomes Action by United States to Rescind New Restrictions on Student Visas

Mount Sinai is pleased to report that the federal government has rescinded a policy that would have stripped international students of their U.S. visas if their coursework was entirely online.

The Immigration and Customs Enforcement (ICE) policy would have put international students at an unnecessary risk of COVID-19 and potentially displaced them if their home countries have closed their borders. The Icahn School of Medicine at Mount Sinai proudly joined educational institutions across the nation in opposing the policy as soon as it was announced on July 6.  And on Monday Mount Sinai joined in filing an amicus brief in support of a suit that was brought by Harvard University and the Massachusetts Institute of Technology in U.S. District Court for the District of Massachusetts—calling the policy “arbitrary and capricious.” Scores of universities also supported the suit, as well as organizations representing international students.

During a short hearing Tuesday in Boston, the district judge made the sudden and welcome announcement that the new guidelines had been rescinded by the government. This reinstates a policy implemented in March amid the COVID-19 pandemic that gave international students flexibility to take all their classes online and remain legally in the United States.

“The ability of international students to study and conduct research at Mount Sinai is of great importance to us, and their contribution to our community enriches us all. Today’s battle was won, but the struggle continues. Therefore, as always, we stand in steadfast support of the rights and well-being of international students,” Kenneth L. Davis, MD, President and Chief Executive Officer, Mount Sinai Health System, and 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, said in a statement.

Testing Early for Viral Load May Lead to Better Care for Patients with COVID-19

Carlos Cordon-Cardo, MD, PhD

The more SARS-CoV-2 virus, or viral load, individuals have in their bodies, the greater their chances of dying of COVID-19. This association was borne out in a new study at the Icahn School of Medicine at Mount Sinai that was led by Carlos Cordon-Cardo, MD, PhD, the Irene Heinz Given and John LaPorte Given Professor and Chair of the Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Molecular and Cell-Based Medicine.

Dr. Cordon-Cardo and his team measured the viral load of 1,145 patients with COVID-19 who were admitted to the Mount Sinai Health System between March 13 and May 5, during the height of the pandemic in New York. These patients had an overall mortality rate of 29.5 percent. When the researchers adjusted for age, sex, and race, and comorbidities such as asthma, heart disease, hypertension, and chronic obstructive pulmonary disease, they found that a higher viral load was still associated with a significantly higher mortality rate.

Based on such a strong correlation, Dr. Cordon-Cardo and his team would like to see quantitative reporting for viral load added to the polymerase chain reaction (PCR) tests that are used to determine if someone has COVID-19. Right now, PCR tests provide a yes or no answer: either someone has or doesn’t have COVID-19. Determining an individual’s viral load would add another layer of knowledge and could be easily implemented by most testing facilities. PCR tests differ from antibody tests that establish whether someone has recovered and may now have some level of immunity.

The chart demonstrates a significant mortality difference between hospitalized patients with high and low SARS-CoV-2 viral load.

“At the beginning of the disease this is the first test you’re going to get, and more viral presence means a more aggressive disease,” says Dr. Cordon-Cardo. “Chances are you are going to get a lot sicker. Taking Tylenol and staying home is probably not going to be enough to help you.” If doctors are aware of a patient’s viral load, they would be prepared to help the patient remotely or admit them to the hospital for observation and, perhaps, early antiviral treatment. Clinicians would have the opportunity to treat the disease at its earliest stage, the best opportunity to prevent it from becoming more destructive.

The amount of virus individuals have in their body could also determine how much they are able to spread the disease to others. Early quarantining of these “superspreaders” would help protect others. Quantitative testing for viral load is relatively quick and inexpensive, according to Dr. Cordon-Cardo. Results can be obtained in a few hours and easily added to current PCR tests.

Understanding this key differentiator in disease progression is the first step in applying personalized medicine to the standard of care for COVID-19. The study’s first author, Elisabet Pujadas, MD, PhD, a Mount Sinai pathology resident and postdoctoral fellow, says, “Obtaining quantitative results that help guide management for the individual patient is one of the bigger goals here. COVID-19 is unique in that the disease offers many new challenges. People get sick and deteriorate so quickly that it surprises clinicians who are treating them. So it’s hard to know up front who is going to do worse than others.”

Knowing which patient is likely to become sicker would also help hospitals better manage their resources, she says. “This illness is not the same for everyone, and this information has great implications for what the best treatment for each patient may be and how we manage limited resources when there is a big surge of people who need to be cared for.”

Elisabet Pujadas, MD,PhD

Mount Sinai’s Department of Pathology is working closely with the Mount Sinai COVID Informatics Center, which was created in the spring to analyze large amounts of health data among patients with the disease. Together, the groups are developing algorithms based on viral loads, comorbidities, and other clinical values that would help doctors evaluate patients based on individualized data.

“All of this up-front clinical information would help guide us in knowing how infected the patient is, how concerned we should be, and which therapies could help or not so we could do a better job of caring for each patient,” says Dr. Pujadas.

Stratifying patients with COVID-19 would follow the same paradigm of care that has already been established for patients with HIV or cancer who receive personalized medicine.

“The more virus you have, the more virus is going to travel in your blood vessels, like cancer cells. And it happens that certain vessels have receptors to the virus that are hospitable,” says Dr. Cordon-Cardo. “In individuals who already have vascular damage you are now adding another condition and the patient is at much higher risk of getting worse. COVID-19 is different diseases at different moments. We should be able to apply the right treatments and the right management for the patient with the knowledge we are obtaining.”