COVID-19 | Mount Sinai Today

I Have Asthma. How Might COVID-19 Affect Me?

May 21, 2020 | Asthma, COVID-19, Your Health

Asthma is a very common respiratory condition in New York City—as well as other urban metropolitan areas—and is present in about 8 to 10 percent of the U.S. population. Because COVID-19 spreads through the respiratory system and attacks the lungs, those with asthma may be particularly concerned about contracting the virus. Linda Rogers, MD, Clinical Director at the Mount Sinai-National Jewish Health Institute, discusses what you need to know about COVID-19 if you have asthma.

Will I be at greater risk if I have asthma and COVID-19?

All of us who take care of patients with asthma have been concerned that having asthma may increase the risk of coronavirus or increase the risk of having a poor outcome from infection with coronavirus. Even under normal circumstances, asthma causes irregularities in immune response that may increase susceptibility to viral infection that can cause asthma to flare. There is also a subset of patients with asthma prone to wheezing and asthma flares when they develop viral respiratory infections. The coronavirus that causes COVID-19 is actually a distant relative of viruses that cause the common cold. These versions of coronavirus are normally in the community causing upper respiratory infections but unlike other viruses, such as respiratory syncytial virus (RSV) and rhinovirus, coronaviruses that cause the common cold are not among the more common viruses know to cause worsening asthma .

Generally, we’re seeing that asthma and allergies aren’t being found commonly in patients who are hospitalized with COVID-19 and who have died due to the virus. China and Italy have found very low rates of asthma in patients with a severe case of the virus and here in New York—out of thousands of patients who have died of COVID-19—the most common chronic illnesses that we find in patients who die of COVID-19 include high blood pressure, high cholesterol, diabetes, and heart disease.

How do I tell the difference between my asthma and COVID-19 symptoms?

Many of the symptoms of COVID-19 and asthma can overlap. Patients with the virus can have a dry cough and may become very short of breath—symptoms experienced by those with asthma. However, patients with asthma often find it difficult to exhale as opposed to those with COVID-19 who report difficulty taking a deep breath. So, the quality of shortness of breath may be different.

Additionally, patients with COVID-19 and those who have asthma might experience chest tightness. For patients with asthma, chest tightness should respond to quick relief medicine such as albuterol, whereas it’s less likely that the symptoms of COVID-19 would improve with albuterol. Moreover, with the virus you’re likely to have other symptoms apart from a cough, chest tightness, or shortness of breath. Often times, patients with COVID-19 will also have a fever, chills, fatigue, muscle aches, gastrointestinal symptoms, and alterations to taste and smell. Therefore, if you were to contract the virus, you would likely have symptoms other than cough, chest tightness or shortness of breath that would point in the direction of COVID-19 as opposed to your asthma.

What precautions can I take? Should I take my inhaler more often during this time?

If you are supposed to be taking daily medicine to prevent and control asthma symptoms, and you’re less than 100 percent perfect about doing that, now is a really good time to keep your asthma under control by taking your medicine regularly. However, there’s not really any benefit to taking extra doses of your quick relief medicine unless you are having symptoms for which you need relief.

Could my medication be weakening my immune system and put me at greater risk of contracting COVID-19?

Many or most patients with persistent asthma take inhaled medications to control their asthma that include inhaled corticosteroids. There has been some concern that inhaled corticosteroids may reduce immunity, but early data actually suggests the opposite. Based on some experiments done in the laboratory, the use of inhaled steroids may actually lower the presence of the ACE2 receptor—a protein present on many cells that is used by the virus to enter into the lungs and cause infection. While that is very preliminary data, it would suggest that the medicines are not harmful and actually could be protective.

Can my fear and anxiety about COVID-19 make my asthma worse?

This is a time of anxiety for all of us. It is a time where things are stressful and there is a lot of change. Stress is a driver of asthma symptoms and so it is necessary to manage our stress levels by getting enough sleep, eating well, and making sure we’re taking our asthma medication. Do all the things that you normally do to maintain your asthma and be sure to monitor your symptoms through journaling or with devices like a peak flow meter, which measures air flow from your lungs.

Although we need to be socially distancing, trying to spend time—at least remotely—with our friends and family can help reduce our stress levels. And, stay in touch with your health care provider through telemedicine. Reach out if your asthma worsens or you have symptoms that might reflect infection with COVID-19.

How Mount Sinai is Keeping Patients Safe

A Stirring Musical Performance Lifts Spirits at The Mount Sinai Hospital

May 21, 2020 | Community, COVID-19, Featured

Actor, singer, and Broadway performer Ciarán Sheehan thanked health care workers at The Mount Sinai Hospital with a repertoire of emotional, uplifting Broadway tunes on Tuesday, May 19. Mr. Sheehan completed the stirring musical performance before dozens of socially distanced patients, staff, and onlookers in the Guggenheim Pavilion with the hopes that his voice would echo throughout the Hospital.

“Mount Sinai holds a special place in my heart because my first son was born here,” said Mr. Sheehan of his desire to perform at the Hospital. “I wanted to say thank you for all that they are doing. I hope they enjoy it.”

Mr. Sheehan, who starred in Les Miserables and Phantom of the Opera on Broadway, performed various theatre standards including “Bring Him Home” and “Music of the Night” from the respective productions. He also performed “You’ll Never Walk Alone” from Carousel—a musical drama about love and loss—which may resonate with the difficulty faced by both patients and health care workers, many of whom have been compelled to distance themselves from friends and family during the COVID-19 pandemic.

“It is my favorite Rogers and Hammerstein song about overcoming adversity in life and being guided and cared for by those who love you, whether you can see them or not.”

Watch a short clip of Mr. Sheehan's performance

From left: David L. Reich, MD, President, The Mount Sinai Hospital; Ciarán Sheehan; and Erica Rubinstein, LCSW, CPXP, Vice President, Patient Experience, Mount Sinai Health System, prior to the performance.

Staff look on as Mr. Sheehan performs.

COVID-19 and Cesarean Births

May 21, 2020 | COVID-19, OB/GYN, Your Health

Having a safe delivery is top of mind for all pregnant women and their partners. As hospitals and health care centers continue to address the COVID-19 pandemic, safety has become increasingly important, especially for those having a cesarean birth—a surgical delivery that generally requires a longer hospital stay than vaginal delivery. Angela Bianco, MD, Medical Director of Labor and Delivery for the Mount Sinai Health System, discusses the changes that have been implemented to ensure a safe delivery and post-operative recovery for cesarean birth patients and their newborns.

What extra precautions are taken to ensure patient safety during cesarean delivery and during their hospital stay?

Twenty four hours prior to scheduled deliveries, all women and their support persons are tested for COVID-19. Patients and visitors must wear a face covering while in the hospital. If needed, staff will provide a mask.

While all patients and staff are required to wear face coverings, knowledge of the patient’s COVID-19 status directs the use of appropriate protective equipment.

All health care workers have been trained in appropriate use of personal protective equipment to safeguard themselves and their patients. Additionally, we have separate teams that transport patients to and from the operating room if the patient is positive for COVID-19. Patients with the virus are placed on a separate floor rather than in our Post-operative Recovery Room. During the postpartum stay, they are assigned a single room to recover in to avoid spread.

All areas are continuously disinfected, including waiting rooms, patient rooms, and high-touch surfaces such as door knobs and kiosks. Patient rooms in particular receive a ceiling-to-floor cleaning between patients, which takes approximately two hours and includes several quality assurance checks.

Has the recovery stay been adjusted due to the virus?

Yes, we have recommended discharge on post-operative day two rather than post-operative day three. We made this recommendation to decrease the length of stay in order to reduce exposure to new mothers and their newborns in a hospital setting. If there is a need to be discharged later than post-operative day two, than the stay may be extended.

How are doctors keeping in touch with patients after discharge?

Post-discharge patients are called within the first week, typically three days following their release. Patients have a telehealth visit at two weeks, but this can also be an in- person appointment for those who require a site visit or who are unable to communicate with their physician via telehealth.

Since women are being discharged a day early, are there additional precautions that need to be taken once they go home?

Generally, no. When released, pregnant women and their partners are given the same discharge instructions for post-operative day two release as they would have been given for a day three release. Instructions include when to call for issues such as high blood pressure and headache or if patients have questions about wound care or breastfeeding.

How Mount Sinai is Keeping Patients Safe

How I Recovered From COVID-19 at Home With the Help of a New App: A Patient Story

May 19, 2020 | COVID-19, Patient Stories, Your Health

Roberto Rapalo, a patient at Mount Sinai, at home with his family

Should I go to the hospital or stay at home? This is one of the first questions that people who think they have COVID-19 wrestle with. Now, thanks to a remote monitoring platform from Mount Sinai Health System called Precision Recovery, patients can have their symptoms monitored by a provider daily, and know that their care will be escalated if necessary.

Once a patient signs up, a member of the Precision Recovery team at Mount Sinai contacts the person for an online video chat. The patient then downloads a daily symptom tracking app onto any smart device which monitors symptoms of the virus, such as body temperature, cough, breathing levels, and body aches. A provider checks in with the patient weekly through video chat. But if the symptoms get worse, the patient is contacted by a provider to discuss the new or worse symptoms and determine if increased monitoring or an emergency room visit is needed.

Read more about Precision Recovery

David F. Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System, and Christopher Kellner, MD, a cerebrovascular neurosurgeon with the Mount Sinai Health System, developed Precision Recovery, an innovative system to monitor patients with COVID-19 symptoms remotely so they can stay home and rapidly respond to their needs when necessary. Click here to read a Q&A, in which they describe how this novel platform can help patients and hospitals in New York and throughout the United States.

“Precision Recovery worked great for me. COVID-19 was a battle—I had it for 14 days and each day was like a new round in a boxing match. Between Day 7 and 12, I was so weak it was difficult to think properly,” says Roberto Rapalo, a patient at Mount Sinai who used the new system. “I was struggling with the decision of whether to go to the hospital or not. It was scary, but the fact that my data was being monitored every day gave me confidence. Dr. Kellner was watching my symptoms progress, and I trusted the advice he gave me. He helped me get through this. In my opinion, you can’t get through COVID-19 by yourself.”

Precision Recovery was developed by David F. Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System, and Christopher Kellner, MD, a cerebrovascular neurosurgeon with the Mount Sinai Health System.

Dr. Kellner said the system allows physicians to closely monitor patients, which is important because the disease can take a different course for every one of them.

“Sometimes people are doing pretty well for a week or ten days, and they may even to start to feel better. But then they start feeling much worse for a day or two after that. That was the case with Rob,” he says. “He began having a hard time breathing and had fever again. So we initiated a video chat with him, and I was able to assess his condition. I saw that he was short of breath, but we talked through the criteria for coming to the hospital. That gave him the confidence that even though he was feeling worse, he would be able to ride it out at home. After a day of bad symptoms, he started to feel better, and he never had to come into the hospital.”

Mr. Rapalo said the system helped him track his symptoms and develop trust in his doctors.

“Every day I input my blood pressure, my temperature, my heart rate, oxygen saturation, as well as whether I had shortness of breath, chest pains, or other symptoms. And that helped me trust that the doctor really did understand what I was going through,” he says. “In the end, I really needed that pep talk. With any other disease I’ve had, once you start to feel better, that’s it. But COVID-19 is longer than any other disease I’ve had. And when I got worse after starting to feel better, that surprised me. So my conversation with Dr. Kellner made me feel that he had my back and was supporting me.”

What he experienced is typical for many COVID-19 patients, according to Dr. Kellner.

“Rob is a perfect example of what most people are going through with this disease. It’s unpredictable how it will go for each individual person. We’re still trying to figure that out as a medical profession, and sometimes there’s mixed messages,” says Dr. Kellner. “Someone might go to an urgent care center and be sent home with the instructions, if your symptoms get worse, contact your provider or call 911. If patients have this roller-coaster ride of symptoms, they need repeat assessments, and that’s what Precision Recovery provides.”

The goal of the system is to keep people out of the hospital who don’t need to go, and give people at home the assurance that they are being monitored effectively. Another goal is to catch people at home whose symptoms worsen and require hospitalization.

“That has happened—we saw that they met the criteria for being hospitalized, so we called an ambulance and contacted the emergency room to let them know that a COVID-19 patient was coming in,” says Dr. Kellner.

It’s important to note that this is a daily data entry by the patient, so doctors can’t necessarily react to an emergency. Patients may still need to call 911 in an emergency. Or they may need an urgent care visit or a virtual visit like Mount Sinai NOW. Precision Recovery fills a role somewhere in between.

Mr. Rapalo said he began feeling better after about two weeks with the illness.

“I turned a corner around Day 13 and now I feel so much better. My cough has decreased and I’m improving every single day,” he says. “I’m still entering my data every day, so that if I do get worse, I’ve got a safety net. I have an appointment with the physical therapist of the Precision Recovery program, and I’m looking forward to getting tips on how to improve my breathing and the tightness in my chest.”

He added, “The main benefit of the Precision Recovery program is that you have people standing by your side, fighting with you. And that helps with your mental side of your recovery, and helps you make the right choices for your care. I am looking forward to being 100 percent, and I believe the program is getting me there.”

To enroll in Precision Recovery, text “Precision Recovery” to 332-213-9130.

Learn more about Precision Recovery

Get more answers to your questions about health from Mount Sinai

Precision Recovery: New App Helps Patients by Monitoring COVID-19 Symptoms Remotely So They Can Stay Home

May 19, 2020 | COVID-19, Your Health

With hospital systems responding to unprecedented demand, and people with possible COVID-19 symptoms often unsure of where to get care, two Mount Sinai physicians saw an opportunity for technology to come to the rescue.

David F. Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System, and Christopher Kellner, MD, a cerebrovascular neurosurgeon with the Mount Sinai Health System, developed Precision Recovery, an innovative system to monitor patients with COVID-19 symptoms remotely so they can stay home and rapidly respond to their needs when necessary. In this Q&A, they describe how this novel platform can help patients and hospitals in New York and throughout the United States.

What is Precision Recovery?

Precision Recovery is a digital platform that goes a step beyond the typical telehealth scenario because it monitors the patient’s symptoms daily, enables us to get patients the right care for their situation, and escalate it when appropriate. Anybody in the country can sign up, just by texting the words “Precision Recovery” to 332-213-9130. We onboard them with a video chat and then they download an app on any smart device so that we can monitor their symptoms every day. The platform tracks the patient’s symptoms—whether it be fever, headaches, or respiratory symptoms—and alerts us to contact the patient if their symptoms are worsening.

We initially developed Precision Recovery as a program to help individuals recovering from stroke who needed close daily monitoring. In the wake of the COVID-19 crisis, we quickly adapted the program to provide day-by-day monitoring of individuals who are showing signs of COVID-19 but were unsure whether they should go to the emergency room or just ride it out at home.

We saw that people would go to the emergency room and one of several things might happen: they may or may not be tested, or no testing might be available, and many times they would be told that they were not sick enough to be admitted. And that might be the end of their care. If they get sicker, they don’t know whether they should go back to the emergency room or call a doctor, or just stay home.

There’s a lot of fear and anxiety around COVID-19. How does Precision Recovery provide a sense of security?

We want people to think of us as a safety net. We’re here to answer any concerns people have about their symptoms. Once a patient signs up, a provider from the Precision Recovery team will contact the person for an online video chat. As part of the onboarding, the patient downloads a daily symptom tracking app, MyCap, and enters their symptoms and vital data. The team is then able to track symptoms of the virus, such as body temperature, cough, breathing levels, and body aches. There will be a weekly video chat to check in on the patient through Zoom, but if we see symptoms get worse, we will get in touch with the patient. If necessary, we can get them an ambulance and get them to the right hospital. And we can do that for anybody in the country.

Is this available to other health systems?

Currently, this is only implemented at Mount Sinai but there are a numerous health care systems with whom we are collaborating to roll this out shortly in their hospitals.

Read about a patient who used Precision Recovery

Learn more about Precision Recovery

Get more answers from Mount Sinai to your health questions

Saving Lives, One Mask at a Time

May 19, 2020 | COVID-19, Diversity and Inclusion, Featured, School

Icahn School of Medicine at Mount Sinai student Tyler McChane (MS3) delivered mask kits to the New York Common Pantry in East Harlem.

Aishwarya Raja, a rising fourth-year medical student at the Icahn School of Medicine at Mount Sinai, looked at the East Harlem community that surrounds Mount Sinai and knew she had to help her neighbors as the COVID-19 pandemic surged in New York City. She understood they often lacked the most basic health care necessities, and with a sizable number of them considered essential workers and unable to stay at home, she wanted them to remain safe. She was unsure they would even have access to one fundamental item needed to confront the SARS-CoV-2 virus that causes COVID-19—protective masks.

Then, she had an idea and founded Mask Transit, an initiative dedicated to delivering masks and educational materials to vulnerable neighbors, an effort to help slow the spread of COVID-19. She mobilized 50 medical students across 15 institutions in mid-April, and they began sourcing and delivering masks and creating educational materials.

The project was launched under the guidance of Yasmin S. Meah, MD, Associate Professor of Medicine, and Medical Education. Dr. Meah is the Program Director and Chief Medical Attending of the East Harlem Health Outreach Partnership (EHHOP), Mount Sinai’s student-run, physician-supervised clinic, which provides free primary, preventive, and mental health care to uninsured adults.

“These students have done an amazing job of serving the most vulnerable members in the community,” says Dr. Meah. “Many of them are essential workers, isolated from services, with low health literacy, so getting masks and information into their hands can be lifesaving.”

Icahn School of Medicine at Mount Sinai student Matthew Eveleth (SY) put together mask kits that were mailed and delivered to more than 250 EHHOP (East Harlem Health Outreach Partnership) households.

Reema Navalurkar (MS3), and Parth Trivedi (SY), education co-chairs, developed educational materials to explain why and how to wear a mask, and how to clean it, along with information about COVID-19. Materials are available in Spanish, French, Mandarin, and Arabic, in addition to English. Under the leadership of Tyler McChane (MS3), the team sourced face masks and fabric. They found local seamstresses willing to donate their time to sew masks, and they partnered with grass roots organizations to help distribute them. The team delivered mask kits, consisting of masks and information, to distribution points and to individuals. They created a website, raised funds for their initiative, and promoted the program throughout the community and through social media.

To date, Mask Transit has distributed more than 6,000 mask kits with a goal of distributing 100,000 by mid-June. In addition to partnering with EHHOP, they also work with New York Common Pantry and Little Sisters of the Assumption Family Health Services, an organization that helps families meet basic needs, and they recently broadened their reach to West Bronx. Mask Transit has also established branches in Boston, where they are partnering with Boston Healthcare for the Homeless Program, and in New Haven, where they are partnering with the HAVEN clinic, Yale School of Medicine’s student-run free clinic. Their new goal is to branch out to all five boroughs in New York City and to other cities across the United States.

Aishwarya Raja, a rising fourth-year medical student at the Icahn School of Medicine at Mount Sinai, oversees the Mask Transit initiative that she founded in April 2020.

“What has been most rewarding is that we have been able to harness the power of individuals to make a difference,” says Ms. Raja. “Everyone—students, businesses, seamstresses, and community organizations—has stepped up. They are great examples of how kind, generous, and resilient our community members can be in the city’s time of need.”

Anyone interested in donating masks or mask materials can click here. To find out more information about the organization, visit masktransit.org or contact them at contact@masktransit.org.

Learn more about Mask Transit

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