COVID-19 | Mount Sinai Today

Behind the Scenes With Judith Aberg, MD, a Leader in Mount Sinai’s COVID-19 Response

Nov 17, 2020 | COVID-19, Featured

Judith A. Aberg, MD, is the principal investigator of multiple COVID-19 prevention and treatment trials at the Mount Sinai Health System.

“I did not anticipate how difficult it was—both for me and for the people who were turning to me for answers—to hear myself saying, ‘I just don’t know’ as often as I did during the early days of the pandemic.” Insights like this, and a look at the progress of COVID-19 vaccines, are offered by Judith A. Aberg, MD, a central figure in the Mount Sinai Health System’s pandemic response. Dr. Aberg, the Dr. George Baehr Professor of Clinical Medicine at the Icahn School of Medicine at Mount Sinai, is principal investigator of multiple COVID-19 prevention and treatment trials.

What was your most challenging day during the pandemic?

During the peak of the pandemic, there were so many challenging days and sleepless nights that it is difficult to choose just one! There were challenges, but there were also so many times that I felt pride in my own Infectious Diseases (ID) and Infection Prevention faculty and also in all the amazing triumphs occurring throughout the Mount Sinai Health System. We had so little knowledge about this disease and so few therapies to offer patients, yet there was the expectation that ID would have the answers.

As Chief, I needed to gather and disseminate the best available evidence, whether from our own observations, from preprint research or press releases, or from discussions with colleagues across the globe, in order to maintain the ID Division’s optimism and confidence in our recommendations. I have always been comfortable acknowledging the limitations of my own knowledge, but I did not anticipate how difficult it was—both for me and for the people who were turning to me for answers—to hear myself saying, “I just don’t know” as often as I did during the early days of the pandemic.

Nevertheless, we proceeded with the development of system-wide treatment guidelines based on best available evidence at the time, which would be frequently revised as more data became available. I am also proud that, despite the considerable clinical burden that COVID-19 placed on ID, we immediately launched into clinical trials and emergency use of investigational therapeutics. I am an experienced clinical trialist, but many of my faculty and our trainees are not. We all had to learn how to consent patients or their family members remotely, which is unprecedented in my experience, but necessary because family were not allowed to visit in person, and often they themselves were in quarantine. It was heartbreaking, listening to their stories and knowing that I had no answers or even the words to alleviate their fear and sadness.

At times, tensions ran high; it seemed as though everyone wanted their loved one to get whatever latest therapy was in the news. I received frequent calls and e-mails from patients’ family and friends, all advocating for their loved one to receive a potential therapy, regardless of limited supplies or use restrictions. It was a fine line, having to remind desperate families that every sick person is somebody to someone, while still maintaining compassion for their specific, personal grief. There were many nights when I would come home past midnight and sit with my laptop and phone, answering requests for help with what I hoped was reassurance and support, despite having no proven therapies to offer. Each patient lost was a tragedy, but the seemingly constant despair, particularly of those whose loved ones were rapidly worsening toward needing mechanical ventilators, was cumulatively overwhelming.

We were all just learning this disease, and yet therapeutic decisions still had to be made—so that is what I did. We have learned so much more now, even that some of our choices were not helpful, if not outright wrong. But at the time, we could only do what we thought was best.

How did the COVID-19 response affect you personally?

Like many, I have lost all semblance of balance between my work and personal life. And like many, I have lost colleagues and friends to the wrath of COVID-19. My ID faculty and staff know me as a person who is always on top of everything and available for them, but I have had to learn to let go and to accept that I just cannot do everything that I would like to. Since February, COVID has consumed almost every waking moment. I have seen my family only a handful of times and missed a few once-in-your-lifetime events of my grandchildren, and I haven’t turned off my cell or taken a day without work emails. COVID-19 has disrupted my life in ways both big and small. Fortunately, my family understands my sense of obligation and is supportive of my personal mission to push forward studies of potentially life-saving therapeutic and preventive interventions via the COVID Clinical Trials Unit.

What are the biggest challenges ahead in the search for a COVID-19 vaccine?

The first challenge was deciding which of the many vaccine studies we would offer. In consultation with the basic scientists, I learned as much as possible about the various novel vaccine platforms being developed and then made an executive decision to offer the trials of three vaccines, in addition to any that may be developed at Mount Sinai. One of the three vaccine uses messenger RNA (mRNA) to carry genetic instructions that prompt human cells to produce antibodies to COVID-19; another uses DNA to carry this kind of instruction; and the third, more traditional, vaccine uses a common adenovirus as a vector, or delivery system. Then we had to decide which sponsors to contract with. We have completed enrollment of 280 diverse participants in the Pfizer mRNA vaccine trial, which is expected to be the first vaccine to get an emergency use authorization at the end of this year or early next year. And this week, we opened the Janssen/Johnson & Johnson adenovirus vector vaccine at Mount Sinai Brooklyn and Mount Sinai Queens.

The biggest challenge will be assuring that every vaccine given emergency use authorization (EUA) has adequate safety, tolerability, immunogenicity, and efficacy despite the record pace at which they are being developed and tested. An EUA designation means that the vaccine may be beneficial; it does not mean that it is beneficial, which is a subtle distinction for the general public. If a vaccine is rushed into EUA and is later found to be unsafe or ineffective, there could be grave consequences for future vaccine acceptance and public trust. Appropriate expectations for the vaccine also have to be clearly conveyed. It will likely not bring an immediate end to COVID-19 by itself, but rather will become one of many measures in the prevention toolbox. We still will need to wear masks, use hand hygiene, social distance, and stay home when sick.

The other major issue is how the vaccines will be distributed globally. Who receives the vaccine first? Who will distribute it, and how? Some of the vaccines currently in clinical trials require storage in a deep freeze and are only stable for a short time, but most pharmacies and doctors’ offices do not have ultralow freezers. Some vaccines require two doses, which doubles the effort required to deliver it. Even if an EUA is issued, vaccine trials will still need to continue, possibly for years, to determine which vaccine is the safest, most well tolerated, and most effective at preventing infection or disease. To do so, vaccine trial participants will need to be willing to continue in the trial, not knowing if they have received vaccine or placebo, even when they become eligible to receive vaccine through the EUA process. The trial sponsors will need to assure that those who received the placebo will eventually be offered an active vaccine when available.

There are many challenges, but there is also much optimism that globally we can end this pandemic together. Never before have we had so many tools and resources at hand to rapidly employ and implement yet still had so much uncertainty of what the future will bring.

Esteemed Vaccinologist Weighs in on New Vaccines and the ‘Beginning of the End of the Pandemic’

Nov 17, 2020 | COVID-19, Featured, Research, Vaccines

Florian Krammer, PhD, right, filled out the paperwork needed to participate in Pfizer’s COVID-19 clinical trial and discussed the trial with Judith A. Aberg, MD, left, the Dr. George Baehr Professor of Clinical Medicine, and Chief of the Division of Infectious Diseases for the Mount Sinai Health System.

“Dear world, we have a vaccine!”

Florian Krammer, PhD, Professor of Vaccinology at the Icahn School of Medicine at Mount Sinai recently tweeted this in response to news of the interim results to Pfizer Inc.’s COVID-19 vaccine clinical trial, which showed high efficacy in the final, phase 3 round of human testing. “This is the best news since January 10,” Dr. Krammer added. On that date, China released the genome of SARS-CoV-2, the virus that causes COVID-19. Dr. Krammer’s laboratory at Mount Sinai immediately moved from developing a universal flu vaccine to creating the first test to detect the presence of antibodies to SARS-CoV-2 and the first to measure the amount of antibodies.

By November 17, Pfizer had updated its phase 3 results to report that its vaccine was 95 percent effective against COVID-19, across age, gender, race, and ethnicity demographics. Only one day earlier, Moderna Inc. confirmed that its COVID-19 vaccine candidate had a very high efficacy rate in its first interim analysis of its phase 3 study, prompting Dr. Krammer to tweet, “Dear world, we have a second vaccine.”

Both the Pfizer and Moderna vaccines are based on new RNA technology. Rather than containing pieces of an actual virus, as traditional vaccines do, these vaccines contain molecular instructions in the form of messenger RNA (mRNA) that tell human cells to make the virus’s spike protein, the immune system’s key target for the virus. If all goes well, the patient’s immune system will react by making antibodies to the spike protein—and these antibodies will also latch on to the spike protein of the real virus and disable the virus.

“This is the beginning of the end of the pandemic,” says Dr. Krammer. But important questions concerning COVID-19 vaccines still remain. This fall, he volunteered to take part in the Pfizer COVID-19 vaccine clinical trial under way at Mount Sinai and other locations in the United States and abroad. Like the other 43,538 trial participants, Dr. Krammer does not know whether he received a placebo or the real vaccine, which is how the placebo-controlled, randomized, observer-blinded vaccine trial is designed.

Mount Sinai Today recently asked Dr. Krammer to explain Pfizer’s phase 3 vaccine results.

Why are you enthusiastic about the Pfizer vaccine?

The results from the phase 3 trial have to be seen in the context of preclinical data, phase 1 and phase 2 trials, where Pfizer showed the vaccine worked in nonhuman primates. Also, in early clinical trials the vaccine induced good neutralizing antibody responses. Now, in addition to that, we get efficacy results—reduction of the incidence of disease in the vaccinated group—that are in the 95 percent range. Ninety-five percent is pretty good. Even a vaccine that affords 50 percent protection against severe disease would be positive news.

What questions do you have concerning the Pfizer vaccine?

Right now, Pfizer is reporting that the vaccine has 95 percent efficacy against symptomatic disease. That will likely protect at-risk individuals from severe disease outcomes. But we still don’t know if the vaccine can protect from asymptomatic infection. If it doesn’t, would it stop vaccinated individuals from spreading the virus to others? It will be difficult to determine if the Pfizer vaccine can achieve this, because it would involve routinely testing trial participants for the presence of virus, and you can’t do that with almost 45,000 people. Also, how long-lasting will the protection be? In other words, will the vaccine’s efficacy decrease over time, requiring people to get revaccinated?

Do Pfizer’s interim results bode well for other COVID-19 vaccines in the pipeline?

This is looking good for many of the other vaccine candidates. The fact that Pfizer’s vaccine is based on inducing neutralizing antibodies that protect from symptomatic infection might mean that many other vaccines are likely to work as well. Moderna’s vaccine is almost identical in terms of the immune response. Others are similar too.

What are Pfizer’s next steps?

Now that Pfizer has filed an Emergency Use Authorization application with the U.S. Food and Drug Administration (FDA) and the FDA has authorized the emergency use of the vaccine, it is likely that the vaccine will only be available for high-risk groups and front-line workers at first. Over time more people will get vaccinated but this will take months. Now, while we wait for the vaccine, we must keep the virus circulation down. Mask up, physically distance, and stick to guidelines and regulations.

Do any of these concerns dampen your enthusiasm for the vaccine?

No. From my point of view there is a light at the end of the tunnel. Right now, we need a vaccine that works, even if it would only protect for a few months or doesn’t completely stop transmission. That’s what we need to get halfway back to normal. We’ve been in this for 10 months. We can do it for a few more. We have to be patient.

What You Need to Know About COVID-19 Vaccines

Nov 12, 2020 | COVID-19, Featured, Vaccines, Your Health

There are new headlines every day about the rapid development of vaccines to prevent COVID-19.In this Q&A, Gopi Patel, MD, Hospital Epidemiologist at The Mount Sinai Hospital, Medical Director for Antimicrobial Stewardship for the Mount Sinai Health System, and Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, addresses some of the most pressing COVID-19 vaccine questions.

New Guidance on COVID-19 Vaccines: In April 2023, the Food and Drug Administration and the Centers for Disease Control and Prevention announced some major changes for COVID-19 vaccines. Click here to read more about what you need to know.

In general, how do vaccines work?

Vaccines expose us to pieces of either a bacterium or a virus, and our body mounts an immune response by making antibodies against those pieces. Antibodies are proteins that fight germs like viruses and bacteria by latching onto and disabling them. The goal is that our body will then recognize those pieces and use the antibodies to fight off any future exposure to the real bacteria or virus.

Can a COVID-19 vaccine give me COVID-19?

No. None of the vaccines in advanced clinical trials can give you COVID-19.

Gopi Patel, MD

Should I get a COVID-19 vaccine if I already have antibodies?

We are learning a lot more about the human response to COVID-19. A lot of people who have had COVID-19 did mount an antibody response, but we don’t know yet how long that response might last. So right now, if you have a history of COVID-19 it is still worthwhile to get a COVID-19 vaccine when they become available.

How will we know if a COVID-19 vaccine is safe?

The Food and Drug Administration (FDA), pharmaceutical companies, and scientists who are involved in vaccine development are all very committed to developing a safe and effective vaccine. There is rigorous testing for all vaccines to ensure safety. During any vaccine clinical trial, side effects or adverse events—health problems that happen after the vaccine is given, which may or may not have been caused by the vaccine—are recorded and monitored by safety monitoring boards before the vaccine becomes publicly available through either an Emergency Use Authorization or through FDA approval. All that data is made available and will be quite transparent. The goal is a safe and effective COVID-19 vaccine.

What if many people do not get a COVID-19 vaccine?

It is hard to say. Currently, the recommendation from the FDA is that if a COVID-19 vaccine is made available, it has to be at least 50 percent effective. That means when you test the vaccine in clinical trials, the group of people who got the vaccine has at least 50 percent fewer cases of COVID-19 than the “placebo” group who didn’t get the vaccine. I think there are lots of questions about how many individuals need to be vaccinated to reach what we call herd immunity, where the rate of immunity throughout a community makes the spread of a particular disease between individuals less likely.

What is herd immunity?

Herd immunity is the idea that you can protect vulnerable people if most of the population gets vaccinated and develops an immune response. We talked about this with something that hit New York hard in 2019, which was the measles. In the case of measles, when most people are vaccinated, that protects those individuals who cannot get vaccinated—the very young or those who have immune systems that can’t respond to the vaccine. So that’s the idea of herd immunity. It is very unclear at this point what herd immunity means for COVID-19. It may be that a lot of people may make antibodies, but we also have to make sure people don’t transmit infection. So practices like wearing masks, washing hands, and watching your distance are still really important, even in the setting of a vaccine.

How is Mount Sinai involved in the testing of a COVID-19 vaccine?

We’re very lucky at the Mount Sinai Health System in that we are actually involved in trials of COVID-19 vaccines. We’ve been involved in the trial of the Pfizer vaccine, one of the candidates that is furthest along in the process, and we’re starting enrollment in other trials soon. So we are prepared in terms of looking at the safety and efficacy of the four vaccines that are most advanced in Phase 3 clinical trials.

How is Mount Sinai planning for administering a vaccine once it becomes available?

Mount Sinai is already looking at how we would distribute and allocate a vaccine. It is important to remember that this vaccine would be administered under an Emergency Use Authorization from the FDA. So what would that look like? Who would we offer vaccination to, and how would we monitor those individuals? How would we make sure that we offer the vaccine to those who are most vulnerable to COVID-19 infection, whether it be in the community or in the health care setting? We know our health care workers are at risk. But we also know there are essential workers outside of health care who may be at risk. We’re working with our public health authorities—including the New York State Department of Health and our New York City Department of Health and Mental Hygiene—and watching the safety and efficacy data closely. Members of our Icahn School of Medicine at Mount Sinai faculty are working with New York State on the safety, efficacy, and evaluation of any vaccine candidate that becomes available in the next few months.

Get more COVID-19 vaccination information from Mount Sinai

New England Journal of Medicine Study of Marine Recruits Provides Lessons in Controlling the Spread of COVID-19

Nov 12, 2020 | COVID-19, Featured, Research

To effectively control the spread of SARS-CoV-2, the virus that causes COVID-19, public health measures such as wearing face masks, social distancing, and handwashing must be combined with repeated and widespread testing. That is the conclusion of a new study in The New England Journal of Medicine by researchers from the Icahn School of Medicine at Mount Sinai and the Naval Medical Research Center, who looked at disease transmission among 1848 Marine recruits between May and July 2020.

The researchers studied the Marine recruits, the majority of whom were male and between the ages of 18 and 20, while they were in a two-week supervised quarantine. The study results, published on November 11, showed that few infected recruits had symptoms before diagnosis of SARS-CoV-2 infection, that transmission occurred despite implementing many best-practice public health measures, and that diagnoses were made only by scheduled tests, not by tests performed in response to the daily temperature checks and symptom screening of the recruits.

“If you rely only on testing you are going to miss cases and the virus will escape, and if you just use public health measures it’s not going to be sufficient,” says the study’s senior author, Stuart Sealfon, MD, the Sara B. and Seth M. Glickenhaus Professor of Neurology at the Icahn School of Medicine at Mount Sinai. “If you do both of them together you should be able to control this highly infectious virus. We hope this information helps in developing more effective measures to keep military installations and schools safe.”

The study data revealed asymptomatic spread of the virus even under strict military orders for quarantine and public health measures that most likely experienced better compliance than would be possible in other youth settings like college campuses. The researchers noted that the virus was largely transmitted within a given platoon group which trained and ate together while maintaining social distancing, handwashing, and other methods of infection control.

The study enrolled participants from nine different Marine recruit classes, each containing 350 to 450 recruits, between May 15 and the end of July. The participants were offered enrollment in a prospective, longitudinal study after self-quarantining at home for two weeks prior to arrival at basic training. Once they arrived, they were required to follow strict group quarantine measures with two-person rooms for two weeks—the duration of the study period—before the start of the actual training. The supervised group quarantine took place at a college used only for this purpose. Each recruit class was housed in different buildings and had different dining times and training schedules, so the classes did not interact.

Each weekly class was further divided into platoons of 50-60. During the study period, all recruits wore cloth masks, practiced social distancing of at least six feet, and regularly washed their hands. Most of their instruction, including exercising and learning military customs and traditions, was done outdoors. After each class finished quarantine, a deep cleaning, using bleach on surfaces, occurred in all rooms and common areas of the dormitories before the arrival of the next class.

To determine asymptomatic and symptomatic SARS-CoV-2 prevalence and transmission during supervised quarantine, participants were tested within 2 days of arrival, at 7 days, and at 14 days using a nasal swab (PCR) test authorized for emergency use by the U.S. Food and Drug Administration. Analysis of viral genomes from infected recruits identified multiple clusters that were temporally, spatially, and epidemiologically linked, revealing multiple local transmission events during quarantine.

“The identification of six independent transmission clusters defined by distinct mutations indicates that there were multiple independent SARS-CoV-2 introductions and outbreaks during the supervised quarantine,” says the study’s co-senior author, Harm van Bakel, PhD, Assistant Professor of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai. “The data from this large study indicates that in order to curtail coronavirus transmission in group settings and prevent spill-over to the wider community, we need to establish widespread initial and repeated surveillance testing of all individuals regardless of symptoms.”

Insight into COVID-19 characteristics and SARS-CoV-2 transmission in military personnel has relevance to developing safer approaches for related settings composed primarily of young adults such as schools, sports, and camps.

This work was supported by the Defense Health Agency through the Naval Medical Research Center and the Defense Advanced Research Projects Agency.

Overwhelming Majority of People Mount a Strong Immune Response to COVID-19: A Good Sign for Future Vaccines

Nov 11, 2020 | COVID-19, Featured, Research, Vaccines

Patient samples to be tested for SARS-CoV-2 antibodies. Credit: Centers for Disease Control and Prevention/James Gathany

More than 90 percent of people who recovered at home from mild and moderate cases of COVID-19 produced a robust and possibly protective level of antibodies that remained relatively stable for at least five months, according to a new study by researchers at the Icahn School of Medicine at Mount Sinai.

The study, published in the latest issue of Science, was one of the largest of its kind ever conducted. It included 30,082 individuals who were screened at the Mount Sinai Health System. The patients, of diverse ages and ethnic and socioeconomic backgrounds, presented with a range of symptoms—from those who had almost none to those who spent several weeks in bed.

The findings are important because they provide irrefutable evidence that the body, in most cases, responds to COVID-19 by producing neutralizing antibodies that characterize a protective immune response, which does not quickly fade. Also significant, the findings apply to the majority of people who actually get COVID-19—those with mild to moderate cases.

This latest data confirms the strength and reliability of Mount Sinai’s ELISA antibody test, which was the first to detect the presence of antibodies to SARS-CoV-2, the virus that causes COVID-19 and the first to measure the amount of antibodies present in the blood.

“We will continue to follow a subset of these individuals over time to see how long these antibodies last, but so far the data are encouraging in terms of possible protection and the potential of vaccines working,” says the study’s first author, Ania Wajnberg, MD, Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai. “You can see that at five months the antibodies declined slightly, which is expected in a virus like this. But they certainly did not rapidly decline to zero, as had been reported in some press articles. That is not what we’re finding.”

Dr. Wajnberg says Mount Sinai’s leading microbiologists are working toward a better understanding of the precise level of antibody titers that would actually prevent an individual from getting sick from COVID-19 again. “That is going to take time,” she says. “We don’t want people with antibodies to think they can ignore guidelines around social distancing, masks, etc. But this is encouraging data.” Dr. Wajnberg says the team did not delve into the reasons why a very small segment of the patients did not mount a robust immune response, though this is seen in different viruses and may be an area of future research.

The study authors wrote that “Although we cannot provide conclusive evidence that these antibody responses protect from reinfection, we believe it is very likely that they will decrease the odds of getting reinfected and may attenuate the disease in the case of a breakthrough infection.”

“Vaccines generally work by eliciting an antibody response, and ongoing vaccine trials may also contribute to our understanding about the protective effects and duration of SARS CoV 2 antibodies,” says the study’s corresponding author Carlos Cordon-Cardo, MD, PhD, the Irene Heinz Given and John LaPorte Given Professor and Chair in Pathology, at the Icahn School of Medicine at Mount Sinai.

How to Safely Celebrate With Family This Holiday Season

Nov 9, 2020 | COVID-19, Your Health

Cozy family gatherings are a staple of the winter holiday season. But this year, with COVID-19 continuing to circulate throughout the country, getting together with family will look decidedly different.

In this Q & A, Krystina Woods, MD, Hospital Epidemiologist and Medical Director of Infection Prevention at Mount Sinai West, answers questions about how families can celebrate the holiday season while preventing the spread of COVID-19.

Read the latest recommendations from the CDC urging Americans to stay home this holiday season

How can families in the tristate area safely celebrate together this holiday season?

This year, in particular, everyone is really looking forward to holiday festivities because this has been a year in which we have had to keep our distance from friends and family. However, like with the rest of the year, the safest thing to do this holiday season is to gather virtually. Throughout the COVID-19 pandemic, we have learned that gathering outdoors presents a lower transmission risk than gathering indoors. But in the northeast, most of the holidays that we look forward to are going to be in colder weather which makes meeting outdoors impossible or, at the very least, uncomfortable.

I know that there are many people who are not looking forward to celebrating virtually, but in terms of safety, the best thing to do is to not meet in person.

I am hosting a small holiday dinner. Are there health-related questions I should ask guests before arriving?

If you are going to take the risk of gathering indoors, the most important thing to do is to make sure that everyone in attendance is taking precautions outside of the gathering. If you—the host—are very careful about masking, washing your hands, limiting outside activities, and you are working from home, then your risk for contracting COVID-19 is going to be low. So, you want to think about the people coming into your home. They should have a similar risk profile to yours.

It defeats the purpose for you to be super careful, and then invite someone to your home who is taking risks, like going out to a lot of events or parties. So, it is a good idea to get a sense of a guest’s risk profile if you don’t already know.

In a blog post on how to safely date during a pandemic, Mount Sinai pulmonologist Lina Miyakawa, MD, advised asking potential partners the following risk profile questions. They provide a great start in assessing anyone who enters your home for a holiday get-together.

To assess your guest’s risk profile, you can ask them these questions:

How many contacts do you have on a daily basis?
Who do you live with?
Do you leave the house? If so, where do you go?
Do you follow the recommendations to mitigate the risk of exposure, like wearing a mask and practicing social distancing?
Do you work in situations with high exposure risk?

If families choose to gather, what precautions should they take to minimize the risk of spreading COVID-19?

Here are five suggestions:

Head outdoors. If families insist on meeting in person, the most important thing would be to try to gather outside. But again, with the weather being what it is in the tristate area for the winter holidays, that will be tough.

Keep it brief. Although it goes against what we all think about holiday celebrations and how to enjoy them, keep any gatherings relatively brief. The longer you are with a group of people, the more chance you have of possibly getting sick.

Keep the numbers small. This isn’t the time for large extended family gatherings. This is the time to think about keeping the group smaller.

Increase the air flow. If you have to be indoors, make sure that the space is well ventilated. While it is not environmentally friendly to have windows open while the heat is on, it is essential to have fresh air coming in.

Mask up and keep your distance. If you are going to gather indoors, wear face coverings for as much of the gathering as possible. That may feel strange since you are inviting a sister or a parent to your home, but given the pandemic, it would make an indoor gathering safer for everyone. It is also important to keep six feet of distance from others, even if you’re wearing masks inside, and especially when you’re eating.

Should changes be made in how food is served?

Buffet-style meals are not ideal because you don’t want a whole lot of people handling utensils.

There are two different ways to serve food in a safer way. The first is that everybody brings their own dish which, would not work for a holiday like Thanksgiving because you will have a ton of food leftover. The second is that you have one person serve everyone, preventing each family members from touching the tongs, the spoons, the forks, etc., when filling their plate. This person should be masked and should clean their hands before touching any dishes or utensils.

Also, when sitting to eat, you should try to distance people by six feet. More space is better, but those who live in and around the New York metropolitan area don’t always have the luxury of ample space. However, if you will be gathering, try spacing out with six feet being the minimum.

Is it safer to gather indoors if all family members get tested for COVID-19 prior to gathering?

There are a lot of questions about using testing as a sort of permission slip to meet up with others.

If you test before you have a get-together, it is helpful if someone comes back with a positive test result. At that point, you know for sure that this person should be excluded from the gathering. However, it is not so helpful when someone receives a negative test because it does not give you an idea of their potential to turn positive within the next day or the next few days.

For example, if I receive a negative test on Monday, this result does not tell me what my status will be on Tuesday or Wednesday. So, if I attend a family gathering on Wednesday and I start experiencing COVID-19 symptoms on Thursday, everyone who I met at that family gathering will have been exposed to the virus.

Unfortunately, I think testing is giving people a false sense of security. You should continue to take all precautionary steps, specifically if your test result is negative. And, if it is positive, you know that you should be isolating at home and taking care of yourself.

How can families maintain safety in the 14-day window following an indoor gathering?

After any gathering, especially one that is indoors, keep your distance from other people in the two weeks following. This limits the potential that you unwittingly expose anyone to COVID-19. Also, if you go to a party and two days afterward an attendee tests positive, you will have to quarantine. So, if you kept to yourself for those two days after the party, you will not need to worry that you exposed a friend, colleague, or loved one to the virus.

See this flyer for more tips from Mount Sinai for how to have a safe holiday season