COVID-19 | Mount Sinai Today

Can I Take Vitamins and Supplements To Boost My Immune System?

May 5, 2020 | COVID-19, Diet and Nutrition, Health Hub, Your Health

The COVID-19 pandemic has caused healthy people to think about ways to stay as healthy as possible. There are many ideas about how to stay healthy including drinking more water, getting more sleep and exercise. One place people are turning to for help is through vitamins and supplements.

However, should everyone begin a vitamin regimen? And, where should we start with taking vitamins?

In this Q&A, Hannah Kittrell, MS, RD, CDN, Clinical Research Associate and Director of the Mount Sinai Physiolab, provides some advice on which vitamins people should begin taking and discusses if supplements can really boost your immune system.

We hear a lot about taking vitamins, herbs, elderberry syrup, and other supplements to boost your immune system during the pandemic. Is it possible to ‘boost’ your immune system?

It depends on how you define “boost”, but there are certain nutrients that are vital for optimizing immune function. The immune system is a complex, interconnected system that requires all of its parts to work in harmony to function at its best. It is easy to “boost” a single entity, but something as complex as the immune system, not so easy.

There are specific nutrients that contribute to a healthy immune system, such as zinc, selenium, iron, copper, folic acid, vitamins A, B6, B12, C, and E, and the essential fatty acid omega-6 (linoleic acid). Deficiencies of these micronutrients may impact the immune system in a negative way.

To note, adequate amounts of these micronutrients can be easily obtained through eating a well-balanced diet composed of whole foods, with lots of fresh fruits and vegetables. Supplementation may be indicated in the case of deficiency, but you should always check with your doctor or a clinical dietitian prior to starting a supplementation regimen.

Where should you start in your vitamin regimen? A multivitamin? Vitamin C?

A general multivitamin is fine to start, however, adequate amounts of vitamins and minerals can be obtained through eating a well-balance diet. However, people who are likely deficient may also warrant supplementation. We recommend taking a look at your last blood test, which would show any recent deficiencies. Additionally, a comprehensive dietary evaluation conducted by a dietitian would determine dietary habits that can be improved upon.

What vitamins and minerals should we be certain to take in adequate amounts?

It is difficult to generalize vitamin/mineral needs for a large group of people, as supplementation recommendations are based on deficiencies or likely deficiencies for reasons such as access to food, malabsorption, or medical conditions, and can vary greatly from one person to the next.

However, there are certain micronutrients that are of importance for certain groups:

Children—Iron, vitamin D, vitamin A, vitamin C, calcium

Women—Iodine, vitamin D, vitamin B12, calcium, iron, folate

Adults— Iron, iodine, vitamin B12/B6, vitamin D, vitamin C, calcium, vitamin A, magnesium

Seniors—Vitamin B12, calcium, vitamin D, iron

Based on a nutrition report from the Centers for Disease Control and Prevention, the top five most common nutrient deficiencies among people who live in the United States include vitamin B6, iron, vitamin D, vitamin C, and vitamin B12. These deficiencies are mainly due to poor nutrition. And, again, if you follow a healthy food plan and eat adequate amounts of fruits and vegetables, in a variety of colors, then you should not have to worry about any micronutrient deficiencies.

How can we best support our immune system during quarantine?

The best way to support your immune function is by living a healthy lifestyle.

Be sure to get enough sleep. That is seven hours for adults, nine hours for teenagers, and 10 hours for children 12 and under.

Drink plenty of water—two cups shortly after waking and six to eight more throughout day—and stay active.

Also, everyone should try to eat a well-balanced diet with lots of fresh fruits and vegetables, as well as high quality sources of protein and fat like nuts, seed, legumes and beans, eggs and fish.

I Have A Cavity. Is It Safe to See My Dentist?

May 4, 2020 | COVID-19, Dental and Oral Health, Health Hub, Your Health

Although many are under stay at home measures due to the novel coronavirus pandemic, there are still some everyday issues that cannot be avoided—like dental pain. But, can you see a dentist during this time? John L. Pfail, DDS, Chief of the Department of Dentistry at the Icahn School of Medicine at Mount Sinai, explains which procedures can be addressed and which will have to wait.

Are dental procedures still being done in the office?

Currently, the American Dental Association (ADA) and the New York State Dental Society will only allow emergency procedures. COVID-19 is spread through respiratory droplets from the nose and throat. Some dental procedures can create large amounts of these droplets in the air, for example through cleanings and fillings, which could spread the virus.

Out of an abundance of caution, elective surgery, routine restorations like fillings and all procedures involving the use of an ultrasonic scaler—which is used to clean teeth as well as remove stains and plaque—have been postponed. If patients are experiencing mild discomfort, they should contact their dentist who can evaluate and advise if they should wait until a possible reopening of offices in late May.

What types of procedures are considered an emergency?

Emergency procedures depend upon the level of pain or discomfort the patient is experiencing. However, these procedures would include the following:

Emergency treatment for pain and swelling

Depending on severity these would include medicated restorations—fillings, drainage of swellings and infections, as well as the removal of the inflamed nerve tissue of a tooth—pulpotomy

Extraction of severely mobile, fractured, or decayed teeth

Denture adjustments of sore spots

These spots should be attended to as they can lead to open wounds that may become further complicated, causing infection.

Refilling prescription medications

Please consult with your dentist. With the advent of telemedicine, you may not need to come in to the office to be seen.

I have an emergency dental procedure. Is the office safe?

Yes, it is very safe as dental offices follow strict protocols on infection control and asepsis–being free of any disease causing organisms, this includes viruses and bacteria.

Additionally, the ADA is currently completing new guidance for when dental offices reopen for all procedures. Social distancing will be maintained, patients will be screened with temperature checks, and visitors will be limited. These are just a few of the changes that will be noticed in the dental office.

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Did SARS-CoV-2 Emerge From Nature or a Lab?

May 1, 2020 | COVID-19, Featured, Research

Photo Courtesy: National Institute of Allergy and Infectious Diseases

Did the SARS-CoV-2 virus emerge in the human population spontaneously or was it engineered in a laboratory? Several months into this pandemic, there are still many more questions than answers about this stealthy new coronavirus that has commandeered the world stage. Its ability to enter a human population for the first time and spread quickly and with such unpredictable outcomes has led to many conflicting theories and suspicions about its origins.

“People are hungry for basic information to dispel the rumors that are out there,” says Benhur Lee, MD, Professor of Microbiology and Ward-Coleman Chair in Microbiology at the Icahn School of Medicine at Mount Sinai.

In March, Jillian Carmichael, PhD, a postdoctoral fellow in Dr. Lee’s lab, created a blog to address the misinformation and confusion about the COVID-19 disease caused by the virus that she was seeing on social media. In addition, “I was getting so many questions about SARS-CoV-2 from friends and family that I couldn’t answer them all. I decided to reach out to my virology colleagues for help.”

Together with Christian Stevens, an MD/PhD student in the Lee lab, Dr. Carmichael launched a science-communications blog. Since then, they have worked with a team of graduate students and postdoctoral fellows to parse through reams of studies to create an ongoing series of posts that educate the public about what is plausible and what is not based on their knowledge of science and virology, in particular. Their posts have received traffic from more than 100 countries.

One persistent rumor they sought to demystify for the public was whether SARS-CoV-2 could have been deliberately engineered.

“While nothing is impossible in science, there are some things we do know, and it is very unlikely that SARS-CoV-2 could have been designed in a lab,” says Mr. Stevens, who helps engineer viruses in Dr. Lee’s lab. “We have a natural hypothesis that fits all the evidence so far.”

There are two ways to engineer something in biology, Mr. Stevens says. You take what you know works and piece it together so that it works in a new way. Or, you simulate the way nature does it and tweak it in order to make improvements.

“When the exact parts of the SARS-CoV-2 virus are plugged into a computer model, they look like they’re going to perform really badly,” he says. “The computer would tell you this is a terrible idea, try something better. A human would have been unlikely to rationally design this.”

In January, when the Chinese government released the virus’ genome, which showed its similarity to a virus from a horseshoe bat, researchers gained a better understanding of its makeup. They found that no prior studies existed to explain the way in which this new virus worked, and two distinct features made the theory supporting its natural evolution more likely.

First, a piece of the virus’ spike protein—called the receptor-binding domain (RBD)—provides the virus with an exceptional ability to attach to the ACE2 protein located on the outer surface of cells in various organs. Second, the backbone of the virus—its overall molecular structure—differed substantially from other coronaviruses and mostly resembled related viruses found in bats. If SARS-CoV-2 had been deliberately engineered in a laboratory it would have been constructed from a virus that was known to cause disease, and these did not.

In addition, the SARS-CoV-2 virus has features that would make it difficult to engineer in a lab. The RBD on the spike protein closely resembles that found in a coronavirus in pangolins—an animal also called a “scaly anteater” that is one of the world’s most trafficked. The theory that a bat virus mixed with, potentially, a pangolin virus, mutated, and then jumped to humans continues to make the most sense.

Then, he says, there is the virus’ biological makeup. It has a polybasic cleavage site, which appears to give it the ability to connect to many different tissue types in the human body. While additional testing is needed, early indications are that SARS-CoV-2 does hit many areas of the body in addition to the lungs. By comparison, previous coronaviruses all had monobasic cleavage sites that connected to fewer tissue types. And last, but not least, the virus has O-linked glycans, which may function to shield the virus from the immune system. This means that in order to develop, the virus probably would have needed a human immune system, something unlikely to have been engineered in cell culture.

On the flip side, says Mr. Stevens, there is plenty of evidence to support the premise that the virus emerged naturally and jumped into humans either already possessing the tools it needed to mutate and begin infecting them quickly, or acquiring these tools soon after landing in the human population.

To learn more about SARS-CoV-2, please go to the Lee lab’s science blog and subscribe for updates.

Mount Sinai Pharmacy Department Pitches In by Making Its Own Hand Sanitizer

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

Making hand sanitizer, from left: Kyle Farina, PharmD, pharmacy resident; and Melissa Brega, PharmD, and Amber Ng, PharmD, both Assistant Directors of Pharmacy Operations.

As the COVID-19 crisis has worn on, many Mount Sinai teams have found ways to pitch in and make do. One of them is the Pharmacy Department, which recently gathered a small team to make hand sanitizer to be used in the Health System’s pharmacies.

“We are always looking for ways to work smarter, and to use our resources wisely,” says Susan Mashni, PharmD, Vice President and Chief Pharmacy Officer, Mount Sinai Health System. The project came about for several reasons. Most important, there is a nationwide shortage of hand sanitizer, which led the U.S. Food and Drug Administration to release a new protocol, allowing pharmacies to make sanitizer internally for their own use. Around the same time, an inventory of the chemical storage space at the Mount Sinai Hospital Pharmacy found multiple gallons of highly concentrated alcohol, the kind normally used in laboratories.

“We were actually looking for something else, and we found the alcohol,” says Gina Caliendo, PharmD, Senior Director of Pharmacy, The Mount Sinai Hospital. “It had been there for so long that we didn’t know who had originally purchased it.”

The alcohol was perfectly usable, she says, and with that in hand, the next task was finding the other ingredients—hydrogen peroxide, glycerin, and a denaturing agent, usually an oil, that renders the alcohol undrinkable.

“The problem is that all of the ingredients you need to make it were also in short supply,” Dr. Caliendo says. The Department sent out a call to Mount Sinai’s research laboratories, and “the lab people answered right away,” she says, but ultimately the team found suppliers who could provide bigger quantities.

For the scented oil, there were many potential choices—peppermint, anise, wintergreen, clove, or eucalyptus. Dr. Mashni informally polled other Mount Sinai leaders on the daily operations call, and the winner was lavender. “We were able to find lavender oil in the appropriate amount,” Dr. Caliendo says. “And it had the added aromatherapy aspect. Lavender can help calm people down a little bit.”

Making hand sanitizer was a first for everyone. So the team studied the instructions, and did some math to scale the portions down, and Dr. Caliendo practiced making it at home. Finally, a small team went into action at The Mount Sinai Hospital Pharmacy, strictly following the FDA guidance. “We mixed the sanitizer, packaged it, labeled it, then quarantined it for three days to kill any spores in the bottles.”

The eight-ounce bottles they produced have been dispersed to pharmacies, where staff members use them for routine hand hygiene and in tasks like handling and preparing sterile products. The project may have been small scale, especially compared with the pharmacy’s other tasks, such as supporting system-wide studies and guidelines for the COVID-19 crisis. But it was gratifying to the team.

“Making some of our own sanitizer meant just a few more bottles that could be used on patient units or more public locations like the cafeteria,” Dr. Mashni says “It was something we could work together on—a way we could help out.”

Mount Sinai Develops ‘Pseudo Virus’ to Assess the Effectiveness of Antibodies

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

Benhur Lee, MD, Professor of Microbiology and Ward-Coleman Chair in Microbiology

As governments make plans to reopen their economies and seek reliable ways to ensure their populations can get back to work safely, high-quality antibody testing has emerged as the only way to truly determine which individuals may be protected against the SARS-CoV-2 virus that causes COVID-19. Microbiologists at the Icahn School of Medicine at Mount Sinai have created tests that are answering that need.

A team of scientists led by Benhur Lee, MD, Professor of Microbiology and Ward-Coleman Chair in Microbiology, has developed an assay that tests the quality of an individual’s antibodies to see whether they strongly neutralize the SARS-CoV-2 virus.

Using technology that differs from the more commonly used ELISA method of testing for antibodies, Dr. Lee’s lab has built an identical replica of the outer portion of the SARS-CoV-2 virus, or a pseudo virus. This replica allows researchers to see how well the antibodies from recovered patients actually block SARS-CoV-2 from entering into cells and effectively stop the infection in its tracks. Such neutralizing action provides confirmation that an individual is protected against the virus.

Using the ELISA test and the pseudo virus test together shows how well antibodies that bind to the spike protein also correlate with virus neutralization, says Dr. Lee. The two-step process can provide governments and institutions with a critically important starting point in effectively determining which individuals have been exposed to the virus and carry neutralizing protection.

There are still many unknowns. While the scientific community at large agrees that immunity to the SARS-CoV-2 virus offers protection from re-infection, there is no firm understanding of how long that immunity will last. In addition, researchers do not know whether there is a threshold or level at which antibodies correlate with immunity.

“The gold standard in determining whether someone carries neutralizing antibodies is by using a live virus to test their serum after it has been drawn,” says Dr. Lee. “But this is not scalable for the hundreds of thousands of samples that will need to be tested. So what we developed is a safe surrogate that represents the real virus and can be automated with high-throughput testing in scientific facilities used by many governments and universities around the world.”

Dr. Lee says his pseudo virus assay is essentially a bridge between the binding capability of the ELISA test and the “gold standard” of live-virus neutralization, which requires laboratories to carry a higher, biosafety-level-3 (BSL 3) designation, allowing them to work with dangerous or potentially lethal agents. The pseudo virus can be handled in more commonplace biosafety-level-2 (BSL 2) laboratories that are designated for working with milder agents.

The new pseudo virus can serve as a platform for creating and optimizing potential vaccine designs, generating monoclonal antibodies, and screening anti-viral peptides—all of which would be used to treat or prevent COVID-19.

Government health agencies and universities in the United States and around the world have been sending formal requests to use Dr. Lee’s assay, and he says he will look to them for feedback on how well it is working. “We’re spending time investing in quality control,” he says. “It is important that when we send out this test it works the way we say it works.”

Will Using A Steroid-Based Nasal Spray Increase My COVID-19 Risk?

Updated on Jun 30, 2022 | Allergy, Cold and Flu, COVID-19, Ear Nose Throat, Health Hub, Your Health

The Centers for Disease Control and Prevention considers those who are actively being treated with high-dose corticosteroids to be immunocompromised. Most nasal sprays for allergies do not fall into this category. Consult your primary care physician regarding the specific medication you are taking.

Allergy sufferers are hyperaware of every cough, sneeze, and sniffle entering the height of this allergy season. Those with allergies are not only concerned with distinguishing their allergy symptoms from the novel coronavirus that causes COVID-19, but many are now worried that the medications they take to manage their symptoms might put them at increased risk.

Steroid-based nasal sprays have come under particular scrutiny because the active ingredient—corticosteroids—can reduce the strength of the body’s immune system, which is concerning during a pandemic. Fortunately, nasal spray users need not worry. Anthony Del Signore, MD, PharmD, Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square, explains why allergy sufferers should keep using their medications.

Should I stop using my steroid-based nasal spray?

If patients are getting the relief that they usually receive from taking these medications, I typically say to continue using them. Often, symptoms of nasal drainage, nasal obstruction, or sinus infections will increase if you come off of the medications.

It is also important to remember that with topical intranasal sprays, as well as topical nasal rinses with steroids in them, the absorption of the steroid is quite low. And, there is conflicting evidence as to whether or not steroids taken this way will actually cause any decreased defense against the virus.

A lot of the data and recommendations that we’re getting is for systemic steroids, which are steroids taken by mouth or administered intravenously. That’s where we are seeing the decrease in the immune system.

As a result, I am staying away from prescribing oral steroids for the time being. But topical nasal sprays, as well as topical rinses, I’m okay with.

I take an allergy pill. Are there steroids in my medication?

We do not typically give oral steroids to patients complaining about the typical symptoms of seasonal allergies. Instead, we recommend nasal rinses/netipot, oral antihistamines, and intranasal antihistamines as well as intranasal steroids, with pretty good effect and results.

Oral steroids are usually reserved for more serious conditions like asthma, lupus, or severe systemic allergic reactions. And, if you have a more serious condition that requires the use of these oral steroids, you have to weigh the risks and the benefits. I would counsel these patients to practice social distancing, good hygiene, and taking other precautions. These preventative measures can often tip the scale so that the benefits outweigh the risk of the steroids.

What should patients do if they are concerned that their medications will decrease their ability to fight off COVID-19?

There’s a lot of information out there, and patients may be having a tough time finding the right answers. If patients have any questions during these tumultuous times, they should consider setting up an in-person or telemedicine appointment to talk with their health care provider. After getting a global view of the patient and seeing what other risk factors they have, proper recommendations can be made that may at least help to put fears at ease at a time that’s very uncertain for many.