COVID-19 | Mount Sinai Today

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

Updated on Jun 30, 2022 | COVID-19, Featured, Research

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.”

New Mount Sinai Doctors Among Those Making Valuable Contributions During the Pandemic

Updated on Jun 30, 2022 | COVID-19, Featured

Olamide Omidele, MD, left, a participant in the Mount Sinai Medical Corps, with Mount Sinai residents who mentored him, from left: Julia Blanter, MD; Genevieve Tuveson, MD; Wells Andres, MD; and Kate Kerpen, MD.

In mid-April, as New York’s COVID-19 toll was mounting and medical teams were overwhelmed with patients, 19 fourth-year medical students from Icahn School of Medicine at Mount Sinai heeded the call and volunteered to graduate a month early. Together with 10 other early graduates from Albert Einstein College of Medicine, Rutgers New Jersey Medical School, and Duke University School of Medicine, they joined the Mount Sinai Medical Corps, a newly created training program that would allow them to begin clinical work providing vitally needed support services to overburdened staff at Mount Sinai Health System hospitals. All had been matched to Mount Sinai or other program residencies that would not begin until July 1. Each had cited a resolute need to help during a health emergency.

Initially, most new doctors were deployed in the internal medicine service as part of COVID-19 medical teams. Although they were not directly treating patients or even permitted to enter their rooms, they played a crucial role supporting the medical teams by updating patient charts, putting in orders, requesting physician consults, writing prescriptions, updating patients’ families and, most rewarding of all, coordinating patient discharges. Taking on these responsibilities enabled residents and attending physicians to spend more of their time dealing directly with patients.

“They were ready to go from Day One,” says Daniel I. Steinberg, MD, Professor of Medicine (Hospital Medicine), and Medical Education, at the Icahn School of Medicine at Mount Sinai. “They needed some onboarding, but they had the knowledge and skills and they integrated seamlessly into the hospital. They made a significant contribution and increased our overall efficiency for treating patients.” Dr. Steinberg is also Associate Chair for Education and Residency Program Director for the Department of Medicine at Mount Sinai Beth Israel.

A team of Icahn School of Medicine at Mount Sinai faculty, including David C. Thomas, MD, left, and Salvatore Cilmi, MD, supervised the Mount Sinai Medical Corps participants.

According to David C. Thomas, MD, Professor of Medicine (General Internal Medicine), Medical Education, and Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, the situation was unlike anything that anyone had ever seen and left “even our most experienced doctors wide-eyed.” He says, “These extremely committed medical students chose to drop themselves in at the peak of a pandemic without really knowing what to expect. They had to learn how to work in a hospital and while adjusting to a constantly evolving situation going on around them. They made me proud every day.” Dr. Thomas is also Vice Chair for Education, Department of Medicine, Mount Sinai Health System.

The Medical Corps doctors soon realized that the intensity of the experience—of seeing so many patients suddenly decline or pass away every day, of not having face-to-face patient interaction and not being able to touch them or hold their hand, of watching helplessly as patients were unable to see their families due to visitor restrictions—was extremely stressful. Some wonder if this experience will have long-term effects for them personally. “Most of our classmates processed the situation similarly,” says Katleen Lozada, MD, a new doctor who began her Emergency Medicine residency at Mount Sinai on July 1. “We were lucky to have each other to lean on for support.”

Katleen Lozada, MD, says of the experience: “We were lucky to have each other to lean on for support.”

The new doctors acknowledged the spirit of teamwork that they experienced. “It’s been inspiring to see how everyone has pulled together as a team,” says Olamide Omidele, MD, a Nigeria native who is now a urology resident at Mount Sinai. “Doctors, nurses, people from all different specialties, from senior people to junior people were all coming together with a common purpose. It was an awesome experience to be a part of.”

As the number of COVID-19 cases declined, Medical Corps doctors were redeployed where they were needed most, including presurgical testing, telemedicine triage, and other areas in the inpatient medical service. These responsibilities enabled them, with supervision, to act more in the capacity of residents. They were allowed to enter the rooms of non-COVID-19 patients and do what they were trained to do—to treat patients. “I’m someone who enjoys talking to patients and getting to know them and hearing their stories, beyond just their medical history,” says Yara Sifri, MD, who matched to Mount Sinai’s obstetrics and gynecology residency program and who herself had contracted a mild case of COVID-19 prior to joining the Medical Corps. “That’s what I find the most rewarding about being a doctor.”

Yara Sifri, MD, says the most rewarding part of being a doctor is “talking to patients and getting to know them and hearing their stories, beyond just their medical history.”

Medical Corps members worked approximately 50 hours per week for as many as eight weeks at The Mount Sinai Hospital, Mount Sinai Beth Israel, Mount Sinai Morningside, and Mount Sinai West. They worked under the supervision of a team of Icahn School of Medicine faculty who also oversee residency programs. In addition to Dr. Steinberg, they included John A. Andrilli, MD, Associate Professor of Medicine, and Program Director for the Internal Medicine Residency Program, Mount Sinai West/Mount Sinai Morningside; Alfred P. Burger, MD, Associate Professor, Medicine (Hospital Medicine), and Medical Education, and Associate Residency Program Director, Mount Sinai Beth Israel; Salvatore Cilmi, MD, Associate Professor of Medicine, and Program Director, The Mount Sinai Hospital Residency Program; and Alejandro Prigollini, MD, Assistant Professor of Medicine (General Internal Medicine), and Associate Residency Program Director, Mount Sinai Beth Israel.

“The team of residents and attendings was absolutely instrumental to the success of the program,” says Adriana K. Malone, MD, Associate Professor of Medicine (Hematology and Medical Oncology), Senior Associate Dean for Graduate Medical Education, and Program Director for the Medical Corps program. “In reflecting on the Medical Corps participants, they have had a very positive experience in a novel program—they were able to assist teams in the care of COVID-19 patients at the peak of the pandemic as well as gain confidence in the transition from medical school to internship here.” Their experience was also enhanced with a weekly seminar on COVID-19 topics and weekly debrief sessions.

“We could not be more proud of these young doctors for the courage, devotion, and altruism they have demonstrated, and will continue to demonstrate, throughout their careers,” says David Muller, MD, Dean for Medical Education, and Professor and Marietta and Charles C. Morchand Chair in Medical Education at the Icahn School of Medicine at Mount Sinai. “They are entering clinical medicine at a moment in history that will be remembered for generations as one of the most challenging times our nation has ever faced.”

How Can Parents Safely Get Children Outdoors This Summer?

Updated on Jun 30, 2022 | Children's Health, COVID-19, Your Health

As the number of COVID-19 positive cases continue to decrease across New York State, many families are wondering how to resume activities in their children’s lives. We spoke with Catherine Spaulding, MD, a pediatrician at Mount Sinai Urgent Care, to get advice on how parents can safely host playdates, have children attend summer camp, and otherwise get their children outdoors.

Overnight camps have officially been cancelled in New York State for this summer. What precautions should parents take if they are sending children to a day camp?

The New York Health Department has laid out a number of measures for day camps and other child care facilities to follow to ensure children’s safety. These steps include but are not limited to social distancing practices—such as having fewer campers together at a time—staggering drop off and pick up times, limiting non-essential employees and visitors to the camp, and mandating that all employees and campers wear a face mask when they are less than six feet apart. Other mandatory practices include enhanced cleaning and hygiene practices, improved access to hand sanitizer throughout the camp, and encouragement of frequent hand washing during the day.

Camps are also required to screen all employees, vendors, visitors, and children for symptoms or known exposure to a person with confirmed COVID-19 within the past 14 days. However, you can also keep your children and others safe by watching for signs of illness in your child. If you think they are getting sick for any reason, keep them at home, inform the camp, and talk with your doctor about next steps.

For more information about day camps in New York, check out these guidelines from the New York State Office of Children and Family Services.

How can parents safely organize playdates and trips to the playground?

The Centers for Disease Control and Prevention still recommends against playdates with children from other homes. However, if you choose to host a playdate, it is best to keep the group of kids as small as possible. Encourage outdoor playtime and handwashing for at least 20 seconds with soap and water throughout the day, especially after being in a public setting such as a playground. If the playdate involves transportation, try to space the kids as far from one another as possible in the car and drive with the windows down. As in any public space, it is always recommended that any child above the age of two wears a face covering.

Now that larger gatherings are allowed, can children attend birthday parties, cookouts, or other get-togethers?

Large gatherings are safest if they can be held outdoors and if social distancing is respected. A face covering should be worn, and everyone should use hand sanitizer or wash hands frequently throughout the event. If your child has any signs of illness, such as a cough or fever, they should stay home and avoid contact with other children. If you are hosting an event, it may be helpful to talk with other parents beforehand and encourage them to keep their kids at home if they have any symptoms.

Also, it is important to keep in mind that different parts of New York are in different phases of reopening, which changes the number of people allowed at one time. For instance, Phase One allowed ten-person gatherings while in Phase Three allows up to 25 people to gather. Before organizing any event, find out what phase of reopening your region is currently in on the New York Forward site.

If parents are uncomfortable connecting with other families for playdates or get-togethers, what outdoor activities can parents arrange to keep their children active?

Keeping your kids active and promoting time outdoors is really important for their physical and mental health. Outdoor activities such as riding a bike, going for a walk or run, or taking a hike are great ways to keep your children healthy and safe while simultaneously encouraging physical activity. It is best to avoid group activities like basketball or football since these sports require close contact with other kids. However, kicking a soccer ball around is a great option for outdoor play—just remember to wipe the ball clean before and after use.

For more ideas about how to safely engage in outdoor activities, check out this piece from HealthyChildren.org, a website from the American Academy of Pediatricians.

How Mount Sinai is Keeping Patients Safe

Mount Sinai Queens Nurses Share Memories With COVID-19 Patients’ Survivors

Updated on Jun 30, 2022 | COVID-19, Featured, Patient Stories, Stories of Strength

From left: The Rev. Dr. Rachelle Zazzu, Chaplain; Melissa Farmer, RN; Stefanie Dimitriadis, RN; Amparo Sullivan, RN; Jonathan Nover, RN, MBA, Senior Director of Nursing for the Emergency Department; and Francelia Thomas, RN, Nurse Manager.

The nurses of Mount Sinai Queens are giving a precious gift to families of patients who succumbed to COVID-19 during the height of the pandemic—their memories of the patients’ last days.

In one letter, carefully hand-written on lined paper, Amparo Sullivan, RN, reached out to the family of a patient who had “a nice smile behind her oxygen mask” and had spent peaceful moments chatting and holding her hand. “This courageous woman wasn’t just thinking about herself but was deeply concerned about how the pandemic was affecting us,” Ms. Sullivan wrote. “Her bravery and thoughtfulness gave me inspiration.”

Since May, Mount Sinai Queens nurses have been writing such letters to family members, in a program that arose from their determination to console families and their own need to remember the patients they worked so hard to save. The hospital is now returning to normal operations. But in April and early May, Mount Sinai Queens was hard hit by the pandemic; visitors were not allowed at that time, out of an abundance of caution, to help protect patients and staff.

“Our nurses were caring for people as they died, and I was praying for people as they died, and no family was present. And it’s heartbreaking,” says the Rev. Dr. Rachelle Zazzu, MA, DDS, Staff Chaplain for Mount Sinai Queens. “So we have been writing letters to the families, fundamentally saying, ‘Your mother was not just patient No. 1234. We cared for her, and we saw beauty in her, and we want you to know that when she died, she was taken care of with a lot of care.’”

So far about a dozen letters have been written by nurses including Ms. Sullivan, Melissa Farmer, RN, Stefanie Dimitriadis, RN, and Tamara Boncic-Heins, RN. The program began with a suggestion from Ms. Sullivan, says Jonathan Nover, RN, MBA, Senior Director of Nursing for the Emergency Department (ED) at Mount Sinai Queens.

“It was a very emotional time for everyone in the ED. So what Ampy Sullivan envisioned was this: If you are with a patient who is at an end-of-life moment and there is something you would like to share later with the patient’s family, jot down a note with the details and drop it into our Daisy box,” Mr. Nover said, referring to an awards program at the hospital. “Then the goal would be, when things calm down a little bit, to create a procedure for getting those letters to the patients’ families.

From left: Amparo Sullivan RN, Melissa Farmer RN, and Stefanie Dimitriadis RN.

That is indeed what happened. In addition to compiling the notes, Dr. Zazzu and Mr. Nover reached out to nurses for more remembrances during the daily huddles of departments such as the ED and Preoperative, Postoperative, and Palliative Care. Even after many weeks, the nurses had “amazing, vivid memories,” Mr. Nover says.

The nurses were told, “We don’t want this to be a burden, because you have a lot to do,” Dr. Zazzu says. “We are just saying that if writing a letter can help relieve a burden for you, all you have to do is write it, and I will take care of the rest, make sure it gets to the family.”

After receiving the letters, family members have been writing back in profound gratitude. One family called the Mount Sinai Queens nurses “RN angels” and offered to pray for their safety as they cared for patients. The letter-writing program is now well-established at Mount Sinai Queens, Mr. Nover and Dr. Zazzu say. And they hope it can spread through the Health System and beyond, because even though the crisis has waned in New York City, patients can still die without family members, far from home.

“It’s nice that we can tell families about their loved ones, and their stay, and how it affected us,” Ms. Sullivan says. “We hope it will give them a little peace of mind, and it’s therapeutic for us to share these experiences.”

Here are some of the messages from nurses to families, from heart to heart.

“Your mother was in no distress when she passed peacefully. I spoke to her, and told her how much her family loves her.”

“Your father was so, so brave. I won’t forget him.”

“People show you who they are down to the core when they are in life-and-death situations. Your mother was so kind. I prayed for her on my lunch break.”

Mount Sinai Receives $6.3 Million Federal Grant to Find Drugs That Protect Against COVID-19

Updated on Jun 30, 2022 | COVID-19, Featured, Research

In this plaque assay, the cell culture has been stained purple so that the infectious SARS-CoV-2 particles, or virions, can be seen clearly. The circles represent single infectious virions that have poked holes in the cell culture.

The race to identify U.S. Food and Drug Administration (FDA)-approved drugs that can be repurposed to prevent or treat COVID-19 is advancing toward the finish line, under a $6.3 million federal grant that was recently awarded to Benjamin tenOever, PhD, Irene and Dr. Arthur M. Fishberg Professor of Medicine, Icahn Professor of Microbiology, and Director of the Virus Engineering Center for Therapeutics and Research (VECToR) at the Icahn School of Medicine at Mount Sinai.

Dr. tenOever’s lab is currently testing a group of 20 promising drugs that were narrowed down from thousands over the course of several months by teams led by Donald Ingber, MD, PhD, at the Wyss Institute for Biologically Inspired Engineering at Harvard University, and Matthew Frieman, PhD, at the University of Maryland School of Medicine. All three institutions are working together under a one-year $16 million umbrella grant from the U.S. Defense Advanced Research Projects Agency (DARPA).They have created a full drug-testing pipeline with the goal of finding effective treatments for COVID-19 or prophylactics that prevent the SARS-CoV-2 virus from entering human cells. None exist at this time.

The institutional collaboration loosely resembles a relay race, with a baton that has now been passed from Harvard and the University of Maryland to Dr. tenOever’s lab.

“Both groups have provided me with a small list of drugs from their respective screens, with quite a bit of overlap, and we will decide together and with DARPA to prioritize the ones that are the most promising,” says Dr. tenOever. “We are running the last set of tests here.” The drugs have all been FDA-approved for a range of different treatments.

Members of Benjamin tenOever’s lab, postdoctoral fellow Ben Nilsson-Payant, PhD, left, and PhD candidate Skyler Uhl, enter Mount Sinai’s Biosafety level 3 laboratory to begin testing the SARS-CoV-2 virus in a batch of drugs that may protect against viral replication.

Each participant in the DARPA grant has contributed to a specific leg of the drug-discovery process. The Wyss Institute provided the human organ chip technology. The University of Maryland provided high-throughput screening. And Mount Sinai is testing the drugs in animal models using the actual virus.

Currently, Dr. tenOever’s lab is testing the drugs in lung organoids—tiny replicas of the human lung that are composed of multiple cell types. In July, his lab will begin to test the drugs in a more sophisticated human organ chip technology, which was developed by a Wyss Institute spinoff, Emulate, Inc. After that, Dr. tenOever’s lab will test the finalists in animal models.

He says his timeline is flexible. Largely, it depends on how quickly his lab finds something that appears to be really promising. “If we find a drug that looks fantastic, then we will probably focus on that one and learn everything we can about it and start a human trial because it’s already FDA-approved. But if none of the first batch of drugs work, we move onto the next batch,” Dr. tenOever says. “In cell culture, some drugs look like miracles. But when you move them into more complex systems like human organ chips, things really fall apart. Just because a drug works in cells doesn’t mean it works in animals. That’s exactly the kind of situation we want to avoid and exactly what my lab is trying to parse out.”

The goal of the DARPA project is to find drugs that can be used in the very early stages of the disease cycle to either prevent the virus from entering cells or dismantle the virus before it has a chance to replicate in the lungs. The drugs being tested in Dr. tenOever’s lab would focus on the early aspects of the disease prior to the respiratory complications of COVID-19. Once that occurs the disease is more about inflammation than viral infection and, for that reason drugs such as dexamethasone would be used to diminish inflammation.

Public Health Students Continue Training during COVID-19 Pandemic

Updated on Jun 30, 2022 | COVID-19, Featured, Public Health

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

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

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

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

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

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