A Look Back at the Pandemic, and Views on the Future

Mar 6, 2025 | COVID-19 Reflections, Featured

In early 2020, Mount Sinai treated the first COVID-19 patient. Shortly after that, New York State declared a state of emergency, and COVID-19 cases started to rise. Mount Sinai staff are coming together to share their experiences of overcoming the pandemic in a look back video, “COVID-19 Five Years Later: Reflecting. Learning. Advancing.”

“We stood at the edge of the worst health care crisis in modern memory,” said David L. Reich, MD, President and Chief Operating Officer of The Mount Sinai Hospital, who narrates the video. “And no one knew. Over the next eight weeks, over 18,000 New Yorkers would die of COVID-19—one every five minutes, over 350 every day.”

A timeline takes us through those challenging times, featuring the resilience of front-line staff in the face of what seemed like a never-ending flow of patients, while ICU beds filled up. The video, too, takes us through how scientists and researchers were working nonstop to understand the virus, and coming up with various ways to treat and test for COVID-19.

Five years since the pandemic was officially declared, the Mount Sinai Health System is able to reflect on what it achieved and learned since.

Check out other stories on COVID-19 reflections and stories

Mount Sinai COVID-19 Innovations: Improving Care After the Pandemic

Updated on Mar 3, 2025 | COVID-19 Reflections, Featured

Before COVID-19 was even formally recognized as a pandemic, David L. Reich, MD, President of The Mount Sinai Hospital, was hearing from his anesthesiologist peers in Europe about a terribly problematic “respiratory disease” with a high mortality rate.

“This trusted source was telling me that people were getting very ill, and hospitals were becoming instantaneously overwhelmed with patients requiring intensive care,” said Dr. Reich, who is also Chief Clinical Officer of the Mount Sinai Health System.

“It got me thinking: if we fell into a crisis like that, do we have the structure to transform our hospital from the normal state where 15 to 20 percent of patients require ICU-level care, to one that is nearly 100 percent ICU and the next level down—intermediate care beds?” he said.

As Dr. Reich and Mount Sinai started to make contingency plans for the arrival of COVID-19 in New York City, he realized tackling a pandemic required creative and innovative solutions. Over the course of the COVID-19 pandemic—declared as such in 2020—Mount Sinai created various capabilities to tackle the crisis.

Dr. Reich discusses some of the things that were done at Mount Sinai to help provide relief to patients, the community, and the staff during the pandemic, and how those things have changed since.

David Reich, MD, President of The Mount Sinai Hospital

Clinical Command Center

Prior to the pandemic, a new Clinical Command Center was tasked with finding ways to streamline various operations across hospitals in the Mount Sinai Health System.

At the start of the pandemic—even before social distancing became common policy—various leaders from within the Health System were meeting regularly on how to empower the Clinical Command Center to address the mounting cases of COVID-19.
As New York City was overwhelmed by patients requiring hospital care during the first wave of COVID-19, the Clinical Command Center helped bring patients to unique and temporary care locations, said David L. Reich, MD (right), seen visiting the patient care tents set up in Central Park, hours prior to the arrival of the first patient.
Under the guidance of the Clinical Command Center, respiratory therapists supervised medical volunteers to deploy ventilators to sites and areas with the greatest need.
Centralizing patient admission and intake protocol within the Clinical Command Center enabled patients to be seamlessly moved from one hospital to another during the pandemic.

Mount Sinai built upon the spirit of collaboration developed during the pandemic to expand the Clinical Command Center, and it has since taken on additional responsibilities to improve care to the community, said Dr. Reich.

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During the pandemic, we needed to be able to move patients around seamlessly among hospitals, especially as one or more hospitals exceeded their capacity to provide care. Many things are involved in moving a patient from one hospital to another, and with hospitals traditionally managing their own admitting offices and with individual intake protocols, there were opportunities for miscommunication and inefficiency at a time when that would have cost lives.

We did away with the barriers and empowered our nascent Clinical Command Center to centralize admitting work and transfer protocols across all of our hospitals in the system. We needed a centralized view that looked at bed capacity and management, resource needs, and medical and protective supplies. The aim was to operationalize a group with a cohesive view of a health system, rather than silos, each thinking for themselves rather than optimizing for the benefit of all.

And because we tore down those barriers, we were able to see who needed help and to fill that gap in any way necessary. For example, when the leadership team of Mount Sinai Brooklyn simultaneously fell ill from COVID-19, we sent the Vice President of Perioperative Services from The Mount Sinai Hospital and a senior nursing leader to Brooklyn to be temporary leadership.

Today, the Clinical Command Center continues to add additional functions to support health system experts. We’ve learned that there are some hospital functions that are better suited to being centralized, not just for cost savings but also from an effectiveness standpoint. And there are some functions that are better suited to sit within each site.

Read more about the Clinical Command Center at Mount Sinai

Testing Labs

At the height of the pandemic, city and state testing resources for COVID-19 were overwhelmed by the sheer volume of testing requirements. There was a pressing need for Mount Sinai Health System to establish its own high-capacity testing platform.

Mount Sinai tapped many of its own experts to launch its COVID-19 testing capabilities. Alberto Paniz-Mondolfi, MD, PhD, Director of Molecular Biology, was one of the key figures in launching a community testing program.

With all hands on deck and specialized equipment, Mount Sinai was able to bring its testing turnaround time down to under 24 hours.

As a result of a partnership with the Pershing Square Foundation, Mount Sinai was able to bring its testing capabilities to help schoolchildren return to classrooms, and help employees return to the workplace.

That testing program involved a simple, noninvasive saliva test. At its height, the program was collecting samples from more than 700 sites a day.
With the height of the pandemic over, the testing equipment and facilities have been repurposed toward the Mount Sinai Million Health Discoveries Program, a large-scale genetics study.
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At the start of the pandemic, we needed to be able to do our own tests for COVID-19, rather than sending samples out to the city and state, because they had a six-day turnaround for results, which was impractical for the situation then.

Initially, we were using supplies from our basic science laboratories, but then Roche released a diagnostic platform that worked on one of our large-volume analyzers. Suddenly, we were able to achieve testing with a turnaround time under 24 hours that resulted in identifying which patients could be removed from isolation, saving precious personal protective equipment at a time of severe shortage.

And then, in December 2020, Bill Ackman, co-trustee of the Pershing Square Foundation, came to us and wanted to fund a project to bring kids back to schools. To do so, we needed a better testing mechanism. In partnership with Rockefeller University, we were able to implement a COVID-19 saliva testing program.

At the peak of the testing program, we were collecting from 700 sites a day, as far north as New Haven, Connecticut, and as far east as Montauk on Long Island to support employees of the Metropolitan Transportation Authority. We were also testing schoolchildren in Westchester County, NYC residents, multiple private businesses, and US Open tennis players and staff.

Now that the COVID-19 pandemic has receded, the equipment purchased using the Pershing Square Foundation grant is still being put to good use. Mount Sinai has a research study called the Mount Sinai Million Health Discoveries Program. When samples, such as blood, are collected from patients as part of their routine care, with their consent, researchers extract the DNA information as part of a genetic sequencing project. The massive database of genetic information will inform future diagnostic and therapeutic discoveries and help to design personalized treatment protocols.

Read more about the Mount Sinai Million Health Discoveries Program

Recharge Rooms

Being on the frontlines during the pandemic was hard. Members within the Mount Sinai Health System came up with the idea of creating a space for staff to take a break and unwind.

Various unused public and medical spaces were turned into “recharge rooms.” Even medical examination beds that were unused due to the pandemic could find new purpose to help staff relax.

The spaces were fitted with soft or dim lighting, calming colors, and even soothing sounds and scents to help staff take their minds off the stresses of the pandemic.

“It was important for our staff to be able to take a break from the crisis,” said David L. Reich, MD, President of The Mount Sinai Hospital.

Even for temporary structures and tents erected to handle the high volume of patients at the height of the pandemic, it was important to ensure front-line staff had a place to take breaks.

The outpouring of creativity during the pandemic was inspiring. “I hope we access that creativity again and again,” said Dr. Reich.
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During the pandemic, our staff were very challenged by the high rates of patient mortality. It was a hard time. It was important for our staff to be able to take a break from the crisis, and people came up with the concept of recharge, or respite, rooms.

As we had limited resources, there was an idea to turn unused public spaces, such as family rooms or certain physiotherapy rooms, into spaces where our staff could sit in a peaceful environment. Some of these rooms had music, lighting, and even scents designed to reduce stress. Others were places where individuals could enjoy some quiet contemplation.

Today, many of these rooms have gone back to their original use to support our patients and visitors. A time of great crisis can spark great creativity, and as we work to lower barriers among our hospitals, I hope we access that creativity again and again.

Five Years Post-Pandemic: Here’s What We’ve Learned About Long COVID

Updated on Feb 24, 2025 | COVID-19 Reflections, Featured, Your Health

The year 2025 marks five years since the COVID-19 pandemic went global. Among the many who contracted COVID-19 and recovered from the acute infection, some feel as though the disease has changed their day-to-day health for the worse. Many report a “brain fog” in which it has become harder for them to focus or think clearly, while others have various symptoms, including fatigue, pain, or even digestion issues.

This collection of symptoms has many names, but it became most commonly known as “long COVID.” When it was first observed a few years ago, physicians and researchers were divided on how to define, diagnose, or even treat it. Even less was known about why long COVID occurs and who is at risk of developing it.

Today, the medical and research communities have come a long way in understanding and tackling long COVID, says David Putrino, PhD, Director of Rehabilitation Innovation at the Mount Sinai Health System. There are, unfortunately, still misconceptions about long COVID among patients and even some health providers, and dispelling such myths is key to proper treatment, he adds.

In this Q&A, Dr. Putrino discusses to say what is known about long COVID today.

Is there a clear definition for long COVID today?

Physicians now have clear clinical guidelines and criteria for diagnosing long COVID. According to the National Academies of Science, Engineering, and Medicine, long COVID is an infection-associated chronic condition whereby somebody who has survived an acute infection with SARS-CoV-2—the virus that causes COVID-19—fails to return to their pre-infection health status within a period of three months.

Long COVID symptoms can present in different ways:

  • Continuous, where symptoms remain constant and do not go away
  • Progressive, where symptoms worsen over time
  • Relapsing and remitting, where a patient can feel good for a while, and then have a period of feeling very poorly, and back and forth

“We need to start thinking about long COVID in the same way that cancer researchers have been thinking about cancer for the past three or four decades.” —David Putrino, PhD, Director of Rehabilitation Innovation at the Mount Sinai Health System

 

What different kinds of long COVID symptoms can patients have?

Long COVID has been described as a highly diverse disease state, with studies collectively noting more than 200 symptoms.

The most commonly reported symptom, which affects more than 90 percent of patients, tends to be fatigue and a phenomenon known as post-exertional malaise. The latter is a distinct kind of energy limiting illness where if you ask someone to perform an action—such as walking on a treadmill or riding a bike—they are able to do so. But after they exert themselves, they experience a significant worsening of symptoms or a cluster of new symptoms that persist weeks to months afterwards.

Cognitive symptoms are also common, such as a worsened ability to make decisions, plan things in advance, or even regulate emotions. People speak of “brain fog,” which includes changes in attention and in short- and long-term memory, and it is evident that SARS-CoV-2 infection can significantly affect cognition. In fact, a study published in The New England Journal of Medicine in 2024 showed that any person who survives a COVID-19 infection experiences, on average, a loss of six IQ points. This is a sobering fact that makes a strong case for all healthy individuals to avoid SARS-CoV-2 infections by taking the appropriate precautions.

Some people also report gastrointestinal disturbances. These can be wide-ranging, including having diarrhea, having to go to the bathroom more than usual, increased difficulty in food moving through the body, and/or extreme constipation. In addition, some might gain new intolerances to certain kinds of food, have difficulty finishing a meal, or reduced appetite.

Recently, researchers are discovering that around 50 percent of long COVID patients might have new-onset pain. This is a disease state that really affects every organ system.

In 2024, about 17 million adults report having long COVID
For adults with long COVID, 79% say long COVID has limited their activities
Of those who said long COVID limited their activities, 25% say it has done so by a lot
The group most likely to experience long COVID is adults ages 35-49
Women are more likely to experience long COVID than men, with 8.5% of women reporting past long COVID, compared to 5.2% for men
Source: CDC

Do we know why long COVID happens?

We are starting to understand that in some cases, it could be just one path causing the symptom. In other cases, it could be a combination of pathologies. Here’s what we have found so far:

  • Viral persistence: Different studies have identified the presence of SARS-CoV-2 remaining in the bodies of patients with long COVID, even after the acute COVID-19 phase. There is evidence of circulating viral antigens, spike proteins in plasma, viral fragments in the gut, and so forth. We are seeing that the persistence is not latent and it’s not harmless for people with long COVID—it’s causing problems.
  • Latent pathogen reactivation: For some people, even if persistent SARS-CoV-2 does not cause any damage to organs, it could have caused immune dysregulation, leading to reactivation of other latent viruses. There are studies that have shown herpes virus reactivations, such as Epstein-Barr virus, in patients with long COVID, and others showing reactivation of Bartonella infection as well. It may be that the SARS-CoV-2 viral infection kicks up other pathogens that were smoldering below the surface, causing inflammation and other problems.
  • Autonomic nervous system dysfunction: This is the part of your nervous system that controls blood pressure, digestion, sweating, and temperature control. And we’re seeing that the virus can knock this system out of balance. When it is disrupted, people can experience something called postural orthostatic tachycardia syndrome: when they go from lying down flat to standing, they experience unpredictable blood pressure and heart rate changes that can lead them to feel as though they’re about to pass out. This is frequently misdiagnosed as anxiety or panic attacks.
  • Autoimmunity: Relating to immune dysregulation, we are starting to see evidence that for a subset of people with long COVID, they have functional autoantibodies circulating in their body that are designed to attack and cause damage to the body’s own tissues. We have animal studies where mice that were injected with IgG antibodies from patients with long COVID started to develop symptoms similar to that of the patient, especially in new-onset pain, whereas that phenomenon was not seen in mice receiving IgG from healthy controls.
  • Hormonal dysregulation: There are multiple papers on long COVID impacts on hormones like cortisol, which affect wakefulness and inflammation, as well as androgenic hormones, such as testosterone and estradiol. So women with long COVID are much more likely to have extremely low levels of testosterone, and men with long COVID might have low levels of estradiol. This may also explain why long COVID is more frequently diagnosed in women compared with men.

Are there any misconceptions about long COVID?

For the clinical community, we’ve been focusing on getting out a main message, which is that long COVID requires a precision response. If a physician is asking, “Is there a cure—singular—for long COVID,” that is the wrong question. The correct question should be, “What are the tests and techniques I should be using to identify the symptoms of the patient with long COVID in front of me, and how do I proceed from there?”

We need to start thinking about long COVID in the same way that cancer researchers have been thinking about cancer for the past three or four decades. We have seen attitudes about cancer change, starting in the ‘80s when patients were told they got cancer because they had a “Type A” personality, to one today where a patient gets individualized treatment based on age, sex, gene profile, and so much more.

That’s the sort of precision we need in long COVID. What is your medical history? Your immune history? Any genetic expression that might predispose you to chronic illnesses?

Long COVID is classified as an infection-associated chronic condition, which includes chronic Lyme disease and myalgic encephalomyelitis/chronic fatigue syndrome. Historically, these chronic conditions have been viewed as largely psychogenic, and people have been told they can be cured with cognitive behavioral therapy and exercise.

I cannot stress how damaging this is to patients, and perhaps in 30 years, we will be looking back at our approaches and be ashamed of how we were framing long COVID for patients.

Long COVID affects many people, and it disproportionately affects young people too. These are people who are in their active, prime years and we need to help them lead their best lives.

Want to make an appointment for long COVID treatment, or curious to learn more? Visit our Cohen Center for Recovery from Complex Chronic Illness

A Patient Story: Living With Long COVID

Updated on Feb 25, 2025 | COVID-19 Reflections

World-renowned cellist Joshua Roman blends performance and storytelling to share his experience with long COVID he emerged with a profound acceptance of who he is, and a deeper understanding of what it takes to deal with a mysterious medical challenge.

In a video recorded at the Aspen Ideas Festival in 2024, he shares the story of illness and renewal through his own musical compositions and those of others. He also talks with David Putrino, PhD, about what we know about long COVID.

“I’m very excited to see that (Mount Sinai) is using every tool at their disposal to help me feel the best that I can and be able to live the best life that I can with this condition,” he says.

Click here to watch the full presentation.

 

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