Mount Sinai Physicians Create an Effective Road Map for Treating COVID-19

Nov 5, 2020 | COVID-19, Featured, Research

Carlos Cordon-Cardo, MD, PhD

Experts at the Mount Sinai Health System have created a road map for clinicians to follow when providing care to COVID-19 patients, which characterizes four distinct stages of the COVID-19 disease cycle and outlines specific testing and treatment protocols for them. The new approach—called staging—is featured in the latest issue of Cancer Cell and is modeled after the way in which cancer and other complex diseases, such as chronic renal disease, are managed.

“COVID-19 parallels other very difficult diseases in that it manifests specific clinical phases of progression,” 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. “In the absence of clear guidance we thought staging this disease could help physicians navigate better by linking the right tests to the most appropriate interventions. We want to give patients a better chance of being cured based on objective laboratory data and clinical information that is appropriate at different stages of the disease.”

The study lists stage 1 as viral entry; stage 2 as viral dissemination; stage 3 as multi-system inflammation (severe); and stage 4 as endothelial damage, thrombosis, and multi-organ dysfunction (critical), which affects a minority of patients. The study authors draw comparisons between the spread of the SARS-CoV2 virus, which causes COVID-19, within the body, and the spread of cancer, which metastasizes throughout the body—both resulting from disease-producing agents that create a cascade of dysfunction.

Staging requires knowing more about the patient than simply whether they tested positive or negative for COVID-19. Physicians, and the community at large, would benefit from tests that would also offer an indication of the level of viral particles affecting the patient, either high or low; since a patient with a high viral load and comorbidities such as advanced age, hypertension, diabetes, and coronary artery disease would be at higher risk for a poor prognosis.

Visual Summary of COVID-19 Stages

Since the beginning of the pandemic, physicians have learned important lessons about giving treatments early in the disease cycle, when they are most effective. One example is convalescent plasma therapy, which is best given before the patient develops their own antibodies to COVID-19.

“Analogous to the way we treat cancer, COVID-19 treatments have to be adapted to the evolution of the disease,” says study author, Luis Isola, MD, Professor of Medicine (Hematology and Medical Oncology), and Pediatrics, at the Icahn School of Medicine at Mount Sinai. “Treatments that may be effective early on no longer impact late disease. Conversely, treatments that help patients with advanced disease may not help or be justifiable when they present with it.”

The study’s authors say it is important to have a systematic approach to COVID-19 diagnostics and treatments that would keep the disease from progressing in those who might develop severe cases. “The idea is for us to provide guidelines for people to understand that this is not a simple disease, but one that is more complex,” says Dr. Cordon-Cardo.

In May, Mount Sinai released an autopsy study of 67 individuals with COVID-19 who had been admitted to one of the Health System’s eight hospitals from March 20 to April 29. The study showed the degree to which COVID-19 can lead to excessive blood clots and multi-organ failure.

David Reich, MD, President and Chief Operating Officer of The Mount Sinai Hospital, and one the study’s authors, says, “We learned a huge amount from the autopsy and innovative laboratory data collected from the very large number of COVID-19 patients cared for in the Mount Sinai Health System. Synthesizing all of these data led to this staging concept that has the potential to help clinicians worldwide in their understanding of the stages of this disease and in guiding the appropriate use of emerging therapies.”

Mount Sinai’s road map would also help COVID-19 patients understand the state of their own health during the disease cycle. Cancer patients at stage 2, for example, understand the course of their disease will be easier than it would be at stage 3 or 4, when they would require more aggressive treatments. The same holds true for COVID-19.

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Should I Wait to Have My Child’s Vision Checked?

Oct 26, 2020 | Children's Health, COVID-19, Ophthalmology, Your Health

This academic school year—in addition to the usual school supply lists and purchasing of new shoes—parents must think about COVID-19 positivity rates, appropriate face coverings, and reliable in-home internet access. Whether your child will be learning in the school room or remotely, their eye health is important and should not be overlooked. Douglas R. Fredrick, MD, Professor of Ophthalmology and Pediatrics at the Icahn School of Medicine at Mount Sinai, explains what parents need to know about their child’s vision.

Should I wait until after the COVID-19 pandemic to get my child’s vision checked?  

Please do not delay having your children examined. It is important to make sure their vision is sharp and their eyes are healthy. Most of our sensory connection to the world is through our eyes. Children who do not see properly can have difficulty developing academically and socially. If we catch and correct vision problems early, we can improve children’s day-to-day life and functioning in school. We can also detect eye conditions that could lead to further problems down the line.

While COVID-19 is still of great concern,  Mount Sinai Health System has gone to extraordinary lengths to make sure every patient receives the best possible care in a safe environment. We have developed stringent protocols to protect your family and our community. For instance, face coverings are mandatory and social distancing is enforced throughout the Health System. Additionally, we disinfect continually and regularly test our staff for COVID-19.

How often should I have my child’s eyes checked?

The American Academy of Ophthalmology and the American Academy of Pediatrics recommend that pediatricians and family practitioners examine the eyes and check vision in newborns, age two months, six months, one year, then annually until age six, then every other year until age 18. Most pediatricians check vision every year during their annual exam, and many school districts perform screening each year, beginning at age five or six.

What are the signs that my child has vision issues?

If you notice your child squinting or tilting their head to see objects that are far away, rubbing their eyes after reading, or if their eyes drift toward the nose or outward—as though they are trying to see their ears—you should schedule an appointment with your child’s pediatrician for a vision exam. The same is true if your child complains about fuzzy or foggy vision. I also recommend that parents check in with their child’s teacher as they may see vision impairment related behaviors in the classroom.

My child is struggling with vision issues. How can I help?

The first step is to see your child’s primary care provider who will check for any other health conditions that may be contributing to your child’s difficulties. If the pediatrician finds decreased vision on a screening exam or has any other concerns, they will refer you to a pediatric ophthalmologist. These ophthalmologists have additional training in caring for children and often have specialized equipment and child-friendly offices.

During the examination, the ophthalmologist will do a thorough exam of your child’s eye—probably using dilating eye drops. If the doctor finds that your child is nearsighted or has another vision issue, they may prescribe glasses. If the examination is completely normal but your child is still having a problem with reading or learning, your primary care provider may refer you to an educational specialist or school learning specialist to test for learning disorders and make recommendations.

My child will be learning remotely this school year and I am concerned about eye strain. I’ve heard that blue light glasses can help with this issue. Is this true?

Blue light glasses are special eyewear that block or filter the high-energy blue light coming from computer, tablet, and phone screens. It is not clear that they help with eye strain or eye disease. A recent study performed at the State University of New York School of Optometry found that these glasses did not decrease eye strain with “near work”—activities that require near vision such as reading, writing, and watching television.

While it won’t hurt to use these glasses, there are better ways to reduce eye strain. For instance, have your child hold their reading material, laptop, or tablet at the appropriate distance and make sure they have enough light to see—but not so much it causes glare on the screen. It can also help to have your child take breaks every 20 to 30 minutes when they are doing screen work. I recommend giving your child a task that gets them on their feet and their eyes off the screen, like feeding your pet or taking out the trash.

Should I limit how much time my children spend on screens?

All children will be spending more time with their eyes on the screen this year than in the past and that is going to make it hard to limit screen time to the typical recommendation of two hours a day. This year, instead of enforcing strict limits, try to keep track of what they’re doing with their screen time. Although most of their screen use should be educational, you’ll need to allow time for play—both to relax and to enable them to have social time with friends. Physical activity should also be a part of their daily routine. The key is finding a balance. For more on how—or whether—to limit your child’s screen time, read this blog post from Mount Sinai pediatrician Micah Resnick, MD.

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Is It Safe to Seek Screening and Treatment for Breast Cancer During the Pandemic?

Oct 19, 2020 | Breast Cancer, COVID-19, Your Health

Managing breast cancer screening and treatment can be worrisome in the best of times. During the COVID-19 pandemic, you may be even more uncertain. Elisa Port, MD, Director of the Dubin Breast Center of The Tisch Cancer Institute at Mount Sinai, answers some of your questions.

I’m due for my annual mammogram but I’m scared of getting COVID-19. Should I delay until there’s a vaccine?

At the height of the pandemic in New York City, we were not recommending women come in for screenings. We asked women seeking elective care and routine follow-up appointments to wait. But the number of cases in New York has dropped dramatically, and we have instituted stringent protocols making our hospitals and medical facilities extremely safe. We hope everyone will get back on track with routine screening tests, including mammograms.

I feel a lump in my breast. Should I get it checked out or wait and hope it goes away?

Any woman who thinks she might have a lump in her breast should get it checked out. While many lumps are benign, women of all ages and backgrounds can get breast cancer. It’s important not to dismiss your concern and assume a lump will go away. I recommend that you make an appointment with your primary care physician to receive a full evaluation. Your doctor might perform a physical exam and order imaging tests such as mammograms or ultrasounds or even a biopsy.     

I successfully completed my breast cancer treatment. Am I immunocompromised and at increased risk of developing COVID-19?  

A history of breast cancer does not increase your risk of contracting COVID-19 and neither does receiving cancer treatment—including hormonal therapies and other medications. However, women who are actively receiving chemotherapy and who are immunocompromised, may be at higher risk. The signs of COVID-19 are generally the same for breast cancer patient as they for anyone else. At Mount Sinai, we screen everyone coming into our facilities for issues such as fever, cough, and travel from an area with a high positivity rate (“red zone”).

I’m feeling stressed because of the pandemic. Do you have any suggestions on how to cope?

Stress management is very personal. Coping mechanisms, too, are very personal. The most important thing is to make sure that you don’t spiral into negative behaviors, such as overeating or drinking too much. Try to find healthy outlets for your stress. That can include physical activities like walking your dog or exercising; social activities such as spending time with friends and family; or doing things that bring you joy, like reading, listening to music, or playing a musical instrument. For more on how to cope during the COVID-19 pandemic, read this article on resiliency featuring Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai.

Do you have any other thoughts about breast health?

Remember that breast cancer is an extremely treatable and curable cancer—and early detection and diagnosis are key to successful treatment. The best way to find a cancer early is by getting regular screenings. Starting treatment when a cancer is in the early stages is most effective as it can also mean using less aggressive treatment.

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My Child May Have Trouble Hearing. Will Remote Learning Hurt Their Progress in School?

Oct 8, 2020 | Children's Health, COVID-19, Ear Nose Throat, Your Health

This academic year, many children have returned to school virtually. While remote education may be a safer option for some, it is not without its drawbacks—particularly for children who are hearing impaired.

Enrique R. Perez, MD, MBA, an expert in managing adult and child’s hearing disorders and Director of Otology at The Mount Sinai Hospital, provides advice for parents who are concerned about their child’s hearing when learning remotely.

What are the signs my child may have trouble hearing?

To figure out if your child has hearing issues, I recommend that parents or guardians ask themselves a series of questions:

  • Do you find yourself raising your voice or calling out your child’s name several times before they respond?
  • Is your child not startled by loud noises?
  • Do you notice that your child often turns their head or shifts their body position when listening to others or the TV?
  • Does your child raise the volume on the television, computer, or their phone to an uncomfortable level?
  • Is your child struggling with academic work?
  • Is your toddler not learning to speak at the expected rate?
  • Does your child have a history of recurring ear infections?

If the answer to any of these questions is yes, your child may be struggling to hear. Pediatricians often perform routine screening for hearing loss and they may be able to uncover even subtle degrees of hearing loss.

I am concerned about taking my child for a check-up during the COVID-19 pandemic. Can I delay their hearing exam?

Deciding whether to seek medical care during the pandemic can be difficult, but delaying care always comes with some risk. Delaying a hearing check-up is especially worrisome for children with significant hearing loss who are not being aided with a hearing aid or other hearing device. This is true for children of all ages. Young children, learning to speak may experience delays in achieving appropriate communication milestones, and those who are speaking well but cannot hear properly may fall behind in school. Studies have shown that these setbacks may be irreversible and may limit your child’s academic achievement.

However, I understand the concern, especially if your child has a condition that makes them more vulnerable to COVID-19. Fortunately, most healthcare facilities follow strict guidelines to screen for and minimize the risk of contracting the virus. If you are apprehensive, I suggest that you contact the facility and ask about their protocols.

How can I help my child who is struggling with hearing issues?

The first step in helping your child is to schedule a proper evaluation by a doctor. You might start with your child’s pediatrician, who can screen for hearing issues, and then, if appropriate, can refer you to a specialist for diagnosis and treatment.

Additional ways that you can help a child struggling with hearing issues include:

  • Minimizing background noise when you are speaking to your child.
  • When talking to your child, face them directly and speak slowly and clearly. Try not to shout as that can distort your speech and make your child feel uncomfortable.
  • Make sure your child’s teachers and school are aware of your child’s hearing issue so that they can help.
  • Address any insecurity your child may feel regarding their hearing issues as stigma could prevent them from using devices, such as hearing aids. You want to help your child to be comfortable and confident when used a hearing assistive device, especially during these formative years.

How should I set up my child’s space for remote learning?

Remote learning can create new challenges—and some opportunities—for educating children with difficulty hearing. With the proper set-up and equipment, remote learning may be easier than in-person schooling for a child with hearing difficulties.

The first step is to give your child a quiet area in the home for schooling. They will also need a computer with a reliable internet connection and the ability to adjust the volume.

A strong, stable connection enables your child to see the teacher clearly. Importantly, it allows them to see visual cues—such as facial expressions—which are important communication tools for everyone, especially those with hearing loss. And, being able to adjust the volume enables your child to mute other students, allowing them to focus on the teacher. Your child may also benefit from using headphones, including noise cancelling ones, which are normally not allowed in a classroom.

How else can I help my child with remote learning?

I encourage parents and guardians to build a relationship with their child’s teacher. Often, teachers are the first to notice that a child may be struggling to hear. But fostering a connection with your child’s teacher may be easier with in-person schooling than remote learning. Additionally, it helps to stay involved with your child’s education so that you don’t miss any of the early signs of hearing loss that could compromise their ability to learn.

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Mount Sinai Actively Recruits Volunteers From Hardest Hit Communities for COVID-19 Vaccine Trial

Oct 5, 2020 | COVID-19, Diversity and Inclusion, Featured, Research, Vaccines

WillieBenjamin Loadholt, right, undergoes a checkup from Kiwan Stewart, RN, at The Mount Sinai Hospital prior to receiving his second injection as a participant in the phase 3 clinical trial for Pfizer’s COVID-19 vaccine.

Participating in the Mount Sinai Health System’s clinical trial for the Pfizer COVID-19 vaccine has been deeply personal for New York City educator WillieBenjamin Loadholt. He says it has provided him with the opportunity to be proactive, to contribute to a potential solution that could put an end to the COVID-19 pandemic, which has been “devastating to the African American community.”

For months, Mr. Loadholt says, “Every time I would go on a friend’s Facebook page I would see, ‘We regret to announce the passing or the transition of this person or that person.’ A friend of mine owns a funeral home and they were doing so many funerals. This one’s mom passed away, or this one’s father or sister passed away. It was heartbreaking.”

So, in August, when a friend told him about the Pfizer COVID-19 vaccine trial at Mount Sinai, Mr. Loadholt was eager to sign up. “We want to know what’s going on,” he says. “People perish from a lack of knowledge. How can we avoid this? How can we get solutions for this?” Participating in the search for answers to the COVID-19 pandemic is “worthwhile because I am able to help myself as well as my community. We can’t get this if we don’t help each other.”

Mount Sinai is actively recruiting volunteer participants in communities of color. “We want to make sure the trial is representative of the people who were hardest hit by COVID-19,” says Debbie Lucy, Program Manager for the Mount Sinai Health System’s COVID Clinical Trials Unit. Based on a legacy of mistreatment and longstanding inequities in access to health care, Black Americans, in particular, are more hesitant than other groups to embrace the use of experimental vaccines and therapies.

Debbie Lucy

In August, Ms. Lucy and her team began handing out information about the vaccine in the communities around The Mount Sinai Hospital, between 96th and 105th Streets, east of Park Avenue. In fact, Mr. Loadholt found out about the clinical trial from a friend who lives in the area and received a knock on his door from Mount Sinai.

“We have teams of people who are out in different areas trying to educate people and get them involved. We are talking to people, handing out flyers, and making as many connections as we can,” says Ms. Lucy. “We’re going to different grocery stores, hair salons, nail salons, laundromats, restaurants—any place where we think people of color are either working or going to.”

When Ms. Lucy met a man who told her that his family did not have any masks, she says she called up a team member who immediately brought several masks to the corner of East 103rd Street where they were standing. “He was in awe that we went the extra mile to do that for him,” Ms. Lucy says. “For him it was more than the masks we gave him; it was the fact that we connected with him and met his need immediately. We stood out there and talked with him and gave him additional information about participating in the trial.”

Mount Sinai has also held community forums that educate people of color about the Pfizer vaccine trial. In September, Mr. Loadholt discussed his experience at one of these forums. Ms. Lucy says, “We believe it’s easier for people who look like you to talk with you about participating in a trial because we recognize that there’s a lot of mistrust around research among people of color. Our ultimate goal is to find a vaccine that’s going to help prevent COVID-19, but with any trial we also want to test for safety to make sure it’s not causing any negative side effects in people, and that it’s well tolerated.”

Of the more than 180 COVID-19 vaccines under development, Pfizer’s RNA vaccine is one of the furthest along in the phase 3 clinical trials taking place at Mount Sinai and other locations throughout the United States. The vaccine is based on new technology and can be produced completely in vitro, or in a laboratory.

“I am grateful to individuals like Mr. Loadholt who are participating in this vaccine study and helping us to inform others,” says Judith A. Aberg, MD, the Dr. George Baehr Professor of Clinical Medicine, and Chief of Infectious Diseases for the Mount Sinai Health System. “Involvement with communities should not be overlooked due to false assumptions that people of color are unwilling to enroll in clinical trials. Such false assumptions result in harmful health disparities. We must provide everyone with the opportunity to participate in clinical trials and receive linkage to care. Only through engagement and education can people protect themselves and their loved ones.”

After receiving his second of two injections in September, Mr. Loadholt says he feels fine. He does not know whether he received the real vaccine or a placebo, which is how the placebo-controlled, randomized, observer-blinded vaccine trial is designed. He will be able to find this out in two years. “If I did receive a placebo, at least I can help another person of color receive the real one,” he says.

Mount Sinai has provided Mr. Loadholt and other trial participants with either an iPhone app or their own separate device to communicate any symptoms. “The staff at Mount Sinai has been wonderful,” Mr. Loadholt adds. “I would like Mount Sinai to do what they’re doing and be a beacon in the community.”

To potential volunteers, he says, “Don’t be afraid. Try it.”

If you are interested in volunteering for a COVID-19 vaccine clinical trial, please call 212-824-7714 or email: COVIDTRIALSINFO@MOUNTSINAI.ORG. Mount Sinai offers $119 in compensation for all visits related to the clinical trial. Watch the following video to learn more

Watch a video to learn more about our clinical trial
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Mount Sinai Scientists Find Children with COVID-19-Related Illness Display a Unique Pattern of Immune Responses

Sep 28, 2020 | COVID-19, Featured, Research

In Mount Sinai’s study, the children were age 12 on average and otherwise healthy.

MIS-C is a rare, potentially life-threatening syndrome that occurs about five weeks after children have been infected by the SARS-CoV-2 virus, which causes COVID-19. Most of the children are actually asymptomatic for COVID-19, but when they develop MIS-C they are hospitalized with shock, excessive blood clotting, gastrointestinal symptoms, and heart dysfunction.

In a new development, researchers at the Icahn School of Medicine at Mount Sinai have identified a unique pattern of immune responses that characterize multisystem inflammatory syndrome in children (MIS-C) and could eventually serve as a biomarker, or reliable indicator that would help diagnose the disease.

The Mount Sinai scientists discovered this unique pattern of immune responses by using sophisticated single-cell technology to analyze the blood circulating through the bodies of nine MIS-C patients who were treated at Mount Sinai Kravis Children’s Hospital between late April and June 2020. The researchers found elevated levels of specific cytokines—molecules that regulate immunity and inflammation—and chemokines—signaling proteins—that distinguished the MIS-C patients. The children were age 12 on average, otherwise healthy, and almost equally divided between boys and girls.

“In order for us to really understand MIS-C, we had to describe the disease, and this is the first in-depth mapping of what the disease looks like,” says Dusan Bogunovic, PhD, Associate Professor of Microbiology, and Pediatrics, and Director of the Center for Inborn Errors of Immunity, part of The Mindich Child Health and Development Institute and Precision Immunology Institute. Dr. Bogunovic is the corresponding author of a Mount Sinai study that describes the findings in detail. The paper was posted to the pre-print server medRxiv.org last summer and is now published in Cell.

Dusan Bogunovic, PhD

Conor Gruber, an MD/PhD candidate at the Icahn School of Medicine, a member of the Bogunovic lab, and the paper’s first author, says, “We have mapped autoimmune parameters at an unprecedented level. Now we need to know if this autoimmune component causes the disease or is just a byproduct of MIS-C. We’re actively researching this.” Autoimmunity occurs when an individual’s antibodies mistakenly attack their body. Since the body’s adaptive immune response to disease usually forms after several weeks—the same amount of time it takes for children to develop MIS-C—the researchers believe this is likely where the problem lies within the immune system.

When the initial cases of MIS-C began surfacing in the spring, several weeks after the surge of adult COVID-19 cases in the New York metropolitan area, MIS-C was considered an atypical form of Kawasaki disease, an acute systemic inflammation of the blood vessels, mainly affecting very young children. Since then, the World Health Organization has classified MIS-C as a distinct syndrome. The Mount Sinai study found that “overlapping features are striking, suggesting that MIS-C may lie along a spectrum of Kawasaki disease-like pathology.”

Although further studies into the causes of MIS-C are needed, says Dr. Bogunovic, the good news is that widely accepted protocols are in place for the successful treatment of the disease. He is less certain, however, about whether a child’s predisposition to MIS-C portends a predisposition to different autoimmune disorders down the line or will interfere with the ability to successfully receive a COVID-19 vaccine.

“All of these postulates need careful, methodical, and well-controlled experimental dissection,” the study authors wrote. “Until then, MIS-C remains scientifically puzzling, but therapeutically manageable.”

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