COVID-19 | Mount Sinai Today

Overwhelming Antibody Response to COVID-19 is an Encouraging Sign, Researchers Say

May 13, 2020 | COVID-19, Featured, Research

Ania Wajnberg, MD, left, with Nurse Manager, Patricia Lazio, RN.

More than 99 percent of individuals who fully recovered from COVID-19 and had mild to moderate symptoms that did not require hospitalization went on to develop antibodies, according to a new study by researchers at the Mount Sinai Health System. The team looked at 1,343 people who either had confirmed cases of the disease or were suspected to have the disease between March 26 and April 10, 2020.

The study also showed that these IgG antibodies, or Immunoglobulin G—which appear after an acute infection and have the potential to confer immunity and protection against reinfection—were optimal for use in testing three to four weeks after the onset of COVID-19 and two weeks after the disease resolved.

“While we don’t know for certain whether having antibodies confers immunity at this point, or how long immunity would last, we are very encouraged that even those people who had mild cases of the disease did produce antibodies,” says the study’s first author, Ania Wajnberg, MD, Associate Professor of Medicine (General Internal Medicine) at the Icahn School of Medicine at Mount Sinai.

The encouraging findings support the potential of antibody-based blood tests to help understand the spread of COVID-19, the disease produced by the SARS-CoV-2 virus. The testing would provide lawmakers with a better understanding of how many people may possibly be immune and might be able to safely return to work as economies begin to reopen. At this time, there remains limited data worldwide on the development of antibodies to SARS-CoV-2, particularly the formation of IgG.

Mount Sinai has tested more than 22,000 individuals for antibodies since late March, when it became one of the first institutions in the world to begin treating COVID-19 patients with antibody-rich plasma from individuals who recovered from the disease. Mount Sinai identified individuals who had high titers, a measure of the concentration of antibodies, and referred them to the New York Blood Center, where they donated their plasma. As of May 11, more than 350 patients had received this convalescent plasma therapy through Mount Sinai, which is currently compiling data on the program.

The study also found that 19 percent of those who had recovered from COVID-19 still had evidence of the virus after receiving a nasopharyngeal swab of the back of their nose and throat. This has raised some concerns among patients who thought they may have been reinfected.

“More evidence is showing that people probably don’t need to be stressed about these positive swabs,” says Dr. Wajnberg. “We don’t know for certain why almost 20 percent of people had evidence of the virus weeks out from their symptoms. It is possible there’s some shedding of the virus still going on, but it is also possible that the test is picking up dead viral fragments. The scientific community is looking into this because it has major implications as to whether you need a negative swab to be cleared from this disease, which more people are thinking you don’t.”

One of the study’s authors, Florian Krammer, PhD, Professor of Microbiology at the Icahn School of Medicine at Mount Sinai, developed the antibody test that Mount Sinai uses. He says, “If you have higher titers you start to see neutralization. I can’t tell you that having a certain level of titers is protective against the virus, but we know from the vast majority of viral infections that neutralizing antibodies do protect you from getting infected. There are four human coronaviruses that give you a common cold, and in studies of those you get antibodies for one to three years and are protected during that time. In some cases you’re protected from getting reinfected, in other cases you might get a little infected but not have symptoms, and in other cases you may have symptoms but they’re much milder.”

In related news, the Mount Sinai Health System and California-based Sorrento Therapeutics, Inc. recently agreed to jointly develop antibody products that would act as a “protective shield” against SARS-CoV-2 coronavirus infection, potentially blocking and neutralizing the activity of the virus in at-risk populations, as well as recently exposed individuals.

How a Mount Sinai Program Is Helping Survivors of Sexual Assault and Intimate Partner Violence

May 13, 2020 | COVID-19, Featured, Public Health

In the midst of the COVID-19 pandemic, a very different health crisis is continuing unabated—sexual assault and intimate partner violence (IPV). An experienced and compassionate team at Mount Sinai is there to help.

“It’s been a little bit challenging, but we do not want to let that stop us from providing very critical services,” says Angela Fernandez, Assistant Director at the Sexual Assault and Violence Intervention (SAVI) Program, a team that includes physicians, social workers, and advocates. “We’re still operational.”

Founded in 1984, SAVI has offered free services and support to survivors in New York City for more than thirty years. Its most visible program trains 100 people a year to provide emotional first aid and bedside advocacy to survivors in emergency rooms throughout Manhattan, Brooklyn, and Queens. Volunteers undergo a 40-hour New York State Department of Health training and—following medical, background, and health screenings—commit to bimonthly, six-hour shifts in which they are on-call to be deployed when a participating emergency department has identified an instance of sexual assault or intimate partner violence. The volunteers are equipped to facilitate communication with law enforcement, counsel survivors on their rights, and help them identify and acquire basic needs like shelter. Ms. Fernandez sees advocates as a temporary best friend who can help survivors to navigate any uncertainty faced while in the emergency room.

This intimate, peer-to-peer service has been complicated by COVID-19, since in an abundance of caution, emergency rooms are barring most visitors. Fortunately, the Department of Health has mandated that all survivors are entitled to an advocate. SAVI began offering phone advocacy in mid-March to continue to provide this essential service while adhering to safety measures. Through phone advocacy, survivors can speak with an advocate—via a hospital line or their own mobile phone—to receive support, advice, and assistance.

“Our volunteers are still there. We are still responding to the need, albeit from a distance,” says Ms. Fernandez.

Fewer Domestic Violence Calls, but Not Necessarily Fewer Assaults

In early April, weeks after the “New York State Pause” closed most businesses and imposed social distancing, the New York Police Department released statistics showing a downward trajectory in crimes. For the month of March, domestic violence calls were down 15.3 percent.

“Sexual violence and intimate-partner violence was already grossly under-reported,” says Ms. Fernandez, who cautions that this downward trend does not mean that fewer assaults are being committed. “The fact that we are not seeing as many people making a police report is not surprising, because it’s already something that not a lot of people do.”

Additionally, survivors are not immune to troubling news reports about the pandemic. For a survivor, fear of contracting the virus when going to an emergency room may outweigh the need to seek help. This is particularly relevant for IPV survivors who, Ms. Fernandez notes, often do not seek medical care for the abuse itself but from underlying health conditions associated with abuse and trauma.

“It is in the middle of treating someone for a chronic stomach issue, an asthma attack, or a headache that will not go away in which it is disclosed that abuse is happening at home,” she says. “If a survivor knows that these symptoms cannot possibly be the virus, they may think—my issue isn’t serious enough.”

In fact, abusers may use the stay-at-home order, as well as the economic crisis caused by COVID-19, to further isolate survivors, forcing them to determine whether their home life is more or less threatening than potential exposure to the virus.

“It’s coming down to basic needs for many survivors, and an abusive person can exploit the situation, especially if they have food, shelter, and are even willing to pay someone’s phone bill,” says Ms. Fernandez.

SAVI employs licensed clinical social workers and mental health counselors who provide confidential, trauma-informed therapy to survivors who have left abusive situations as well as those currently in abusive situations. This service has largely shifted to HIPAA compliant virtual sessions—completed via phone or videoconferencing—although in-person sessions are available for emergency, high-risk cases.

“For some, the discussion is not about the abuse, it’s about survival. So many people have had to return to abusive situations, because they didn’t have anywhere else to go. Survivors are having to make really, really hard choices.”

Programs like SAVI hope to make these choices less daunting. Through phone advocacy, virtual counseling sessions, and ad-hoc in-person meetings, survivors can receive advice, assistance, and support from an experienced team dedicated to their physical and emotional safety.

“Survivors are very resilient,” says Ms. Fernandez. “This might not be the best time to make big decisions—like leaving an abuser. We understand that survivors know their situation best, and we are there for them every step of the way.”

If you or a loved one needs advice, assistance, or support regarding sexual assault or intimate partner violence; the Sexual Assault and Violence Intervention (SAVI) Program at Mount Sinai is available to help. For more information, visit the SAVI website or call 212-423-2140.

Learn more about SAVI

COVID-19 and Pregnancy: Answers to Your Questions

May 12, 2020 | COVID-19, OB/GYN, Your Health

As the COVID-19 pandemic continues to impact all facets of life, many have raised questions about the virus’ effect on pregnancy and delivery. Brian Wagner, MD, Medical Director of Labor and Delivery at Mount Sinai West, gives advice to expectant parents and those trying to conceive, and explains how Mount Sinai is creating a safe birthing place for mother, baby, and the extended care team.

Is it safe to get pregnant during the COVID-19 pandemic?

It is unclear whether couples should delay attempts to get pregnant. If you become pregnant now and become sick with the coronavirus, infection would most likely happen during the early part of your pregnancy. Unfortunately, we have limited research on what this could mean, and important questions about an increase in miscarriages or birth defects remain unanswered. Current data suggests that pregnant women are not at any increased risk when compared to non-pregnant individuals. We would recommend you have a conversation with your OB/GYN about your personal medical and obstetric history to help decide if this is the best time to conceive.

How does having COVID-19 complicate pregnancy?

As this viral infection is new, data is limited and just emerging. However, the limited data that exists is reassuring as it indicates that there is no increase in miscarriage or birth defects. With severe disease, there appears to be an increased risk of preterm birth; however, many of these babies were delivered to improve maternal outcomes and were not the result of preterm labor. Additionally, there is no strong evidence that the virus can pass from mom to baby. More information on how COVID-19 may affect pregnancy will emerge as more women deliver.

Are COVID-19 symptoms more severe in pregnant women? Are the symptoms different? Are pregnant women more at risk of contracting COVID-19?

In general, respiratory infections, like the flu, have been thought to be more severe in pregnant women. However, current data suggests the symptoms of COVID-19 appear to be the same as in the non-pregnant population. Symptoms tend to appear between 2 to 14 days from exposure and the most common symptoms appear to be cough, shortness of breath, and fever. In addition, pregnant women also appear to have the same risk for disease severity as non-pregnant individuals. The majority of pregnant women have mild symptoms and recover completely.

Pregnancy itself does not seem to increase the risk of infection or severe reaction to the virus. Pregnant women who have conditions such as diabetes and hypertension may be at increased risk for severe illness, but at the same level as the general population with those conditions.

Are obstetrics appointments being spaced further apart and/or being done via telemedicine appointments?

COVID-19 has necessitated a number of changes in the practice of medicine, in obstetrics and prenatal care. This has included spacing out appointments and grouping components of prenatal care together, including vaccinations and diabetes screening, and utilizing telehealth. As a result, a number of visits are being performed through videoconferencing and telephone. Patients are being asked to self-monitor with blood pressure cuffs and fetal heart rate monitors. This ensures that prenatal care continues to offer all the benefits while reducing the risk of exposure that comes with being out in the community. Of course, some elements of care will continue to require a face-to-face visit, including ultrasound examinations of the fetus.

How do pregnant women stay healthy during this time?

It is recommended that pregnant women take the same precautions as the general public to reduce their risk of COVID-19 infection. We know that the virus spreads from person to person through a number of methods, including droplets created when someone sneezes or coughs, close personal contact, and touching one’s eyes, nose, or mouth before washing one’s hands.

Steps that can help reduce your risk of infection include:

Wash your hands with soap and water for at least 20 seconds or clean your hands with hand sanitizer that contains at least 60 percent alcohol
Avoid touching your face, eyes, nose, and mouth
Avoid people who are sick, and maintain a safe distance of six feet from other people
Wear a face cover when leaving your house or apartment

In addition, general tips to stay healthy in pregnancy include eating a healthy diet, and getting regular exercise and plenty of rest.

Is it safe to give birth in a hospital during the pandemic? What is Mount Sinai doing to keep it safe for women to give birth during this time?

A hospital or certified birth center is the safest place to have your baby. Even the most uncomplicated pregnancies can develop problems or complications with little warning during labor and delivery. Being in a hospital allows you and your baby to have access to all the necessary medical care if these problems arise.

Due to COVID-19, at Mount Sinai we are taking extra precautions to ensure that you, your newborn, and your care team are safe and well. This includes extra cleaning and disinfection protocols, and wearing masks at all times and personal protective equipment as necessary. To enhance safety, you and your support person will be required to wear personal protective equipment—including a mask, gloves, and gown. The Mount Sinai Health System is screening all pregnant patients and their support partners for fever and symptoms of COVID-19 prior to admission since we know some people can have the virus yet be asymptomatic. All admitted patients and their support partners also will be tested for COVID-19. This ensures all the correct protective measures can be in place as needed to protect yourself and your newborn.

How Mount Sinai is Keeping Patients Safe

Large-Vessel Stroke and COVID-19 in Young Patients: New Insights

May 11, 2020 | COVID-19, Featured, Patient Stories, Research

The Icahn School Medicine at Mount Sinai team studying the relationship between stroke and COVID-19 included, from left, Thomas J. Oxley, MD, PhD; Johanna T. Fifi, MD; and J Mocco, MD, MS.

Cerebrovascular stroke specialists at the Icahn School of Medicine at Mount Sinai have reported on five patients younger than 50 years of age who presented to the Mount Sinai Health System in New York City with large-vessel stroke and COVID-19, surprising observations that were documented in The New England Journal of Medicine (NEJM) on Tuesday, April 28, 2020. Significantly, they have also determined that stroke patients may be delaying emergency care because of fear of COVID-19.

Large-vessel stroke, the most devastating form of stroke, occurs when there is a large blood clot in a major artery of the brain. It may cause severe symptoms in the patient and, when not diagnosed or treated quickly, may result in death or major disabilities. This form of stroke is typically seen in patients older than age 50.

“As the pandemic surged, we noticed a lot of the patients coming in for stroke were very young, and some of them did not have any traditional risk factors for stroke—but they were testing positive for COVID-19,” says the study’s senior author, Johanna T. Fifi, MD, Associate Director of the Mount Sinai Cerebrovascular Center, Director of Endovascular Stroke, and Associate Professor of Neurosurgery, Neurology, and Radiology. “We realized we had seen five young people with large vessel stroke within two weeks, and that was not usual,” adds Dr. Fifi. “By comparison, every two weeks over the previous 12 months, our service had treated, on average, less than one [0.73] patient younger than 50 years of age with large-vessel stroke.”

The patients described in the report were 33, 37, 39, 44, and 49 years old who presented to Mount Sinai during a two-week period, from March 23 to April 7, 2020. First author Thomas J. Oxley, MD, PhD, Instructor in Neurosurgery, and a specialist in vascular neurosurgery, was in the process of removing a blood clot from one patient. He was threading a tiny device through the artery to retrieve the clot, using an imaging monitor to guide him, and then he saw, he says, “There were new clots forming around the existing clot, in real time.” This was a very unusual finding.

While such observations are limited, and did not receive full peer review, NEJM says that it is sharing case reports like these that offer important teaching points or novel findings to communicate information on the global clinical effort against COVID-19. J Mocco, MD, MS, Director of the Cerebrovascular Center for the Mount Sinai Health System, Vice Chair of Neurosurgery, and Professor of Neurosurgery, says these five cases served as “an alert” to his stroke peers. The discovery of clots forming in the small vessels of many organs—in the lungs, heart, liver, and kidney—had already been reported in COVID-19 patients by several physicians from around the world, including pulmonologists and cardiologists at Mount Sinai.

One case highlighted in the NEJM report was that of a 33-year-old patient—a female who was described as previously healthy, and not having any of the usual risk factors for stroke.

She had reported symptoms of cough, fever, and chills for one week—possible symptoms of COVID-19—which were followed by progressive slowing or slurring of speech, with both numbness and weakness in the left arm and left leg over a period of 28 hours—symptoms of stroke. When she presented to Mount Sinai Brooklyn, her score on the National Institutes of Health Stroke Scale (NIHSS) was 19 (scores range from 0 to 42, with higher numbers indicating greater stroke severity). Dr. Mocco described it as “profound” stroke—the type, he said, that has the potential to result in the most severe physical and cognitive deficiencies.

Adding to the medical challenge was this patient’s delay in seeking medical care. Large-vessel strokes are very treatable, says Dr. Oxley, especially when treated within 6 hours, and up to 24 hours of the onset of symptoms. This patient, however, took more than a day to seek medical care. “She delayed seeking emergency care because of fear of COVID-19,” the report says. “She told us that she lives with elderly relatives, and she was afraid of exposing her family by going to the hospital, so she stayed home,” says Dr. Fifi.

Computed tomography (CT) and CT angiography showed a partial infarction of the right middle cerebral artery with a partially occlusive thrombus (blood clot) in the right carotid artery in the neck. Significantly, patchy ground-glass opacities in the lungs—a finding characteristic of COVID-19—were also seen on CT angiography. Testing to detect SARS-CoV-2, the virus that causes COVID-19, was positive.

The patient received antiplatelet therapy, which was subsequently switched to anticoagulation therapy. After a repeat CT angiography on Day 10 showed a complete resolution of the blood clot, the patient was discharged to a rehabilitation facility.

Among the four other patients, one was discharged home, another to a rehabilitation facility, one to the Mount Sinai stroke unit, and the fourth succumbed to his illness.

Since submitting their NEJM report, Dr. Mocco and his team have begun to analyze every stroke case that occurred while Mount Sinai hospitals were treating COVID-19 patients. “We saw a doubling in the rate of severe strokes, and more than half of the patients were positive for COVID-19,” he says. “And, we saw that they looked very different from the normal stroke population—they looked younger, and they were more likely to be men. It appears—very strongly—that there is an association here between the virus and forming blood-clots.” All of this requires more rigorous research, and the Mount Sinai stroke team will continue to observe and to collaborate on new investigations to increase understanding of the stroke and COVID-19 relationship.

In the meantime, each of them urges any individual who has stroke symptoms to seek immediate help. “Social distancing, isolation, and reluctance to present to the hospital may contribute to poor outcomes,” they wrote in the NEJM report. “Two patients in our series delayed calling an ambulance because they were concerned about going to a hospital during the pandemic.” Adds Dr. Oxley: “You need to call the ambulance urgently if symptoms such as facial drooping, arm weakness, and speech difficulties appear.”

Some Severely Ill Children May Mount an Overly Aggressive Response to COVID-19

May 8, 2020 | COVID-19, Featured, Research

George Ofori-Amanfo, MD, Chief of the Division of Pediatric Critical Care at The Mount Sinai Hospital and Mount Sinai Kravis Children’s Hospital

Nine pediatric patients admitted to The Mount Sinai Hospital during the past two weeks, who either tested positive for COVID-19 or had antibodies, had severe abdominal pain and low blood pressure, which progressed to shock. Some of the patients also had clinical signs of myocarditis. This inflammation affects the heart muscle and the heart’s electrical system, reducing the heart’s ability to pump and causing abnormal rhythms, or arrhythmias. SARS-CoV-2, which causes COVID-19, is the first coronavirus associated with myocarditis.

Prior to their infections, the patients—six boys and three girls—did not have co-morbidities that would have put them at higher risk for disease, according to George Ofori-Amanfo, MD, Chief of the Division of Pediatric Critical Care at The Mount Sinai Hospital and Mount Sinai Kravis Children’s Hospital.

“These patients presented with very unusual symptoms,” says Dr. Ofori-Amanfo. “Until now, the pediatric patients who came to the Emergency Department with COVID-19 all had respiratory problems like the adults—dry coughs, difficulty breathing, and sometimes decreased oxygen saturation. In this recent series of patients, the children presented with abdominal pain, low-grade fever, vomiting, and in some cases diarrhea.” The pain was so severe that one child was sent to Mount Sinai to determine whether the problem was appendicitis, which was not the case. Another child was sent to the hospital for a CT scan to see whether the cause was inflamed abdominal lymph nodes. This was also ruled out upon closer examination.

Two of the nine pediatric patients also had a rash and conjunctivitis, which put their symptoms in a constellation of conditions that are similar to but not the same as Kawasaki disease, which causes blood vessels to become inflamed and also affects the heart. Both of these patients were among those with the least severe symptoms.

Dr. Ofori-Amanfo says that when the children and young adults progressed into a state of shock with low blood pressure, they did not respond to the traditional methods of resuscitation and large amounts of IV fluids, so the clinicians gave them high doses of blood pressure medication, which helped. Three of the patients required mechanical ventilation for shock and two of these patients also required mechanical cardiac support.

“This is a new phenomenon and it is rare. Perhaps these patients had mild symptoms of COVID-19 or were asymptomatic. We think what we’re seeing is a post-infectious process. It is an aggressive immune response to either the virus or some aspect of the viral infection that we don’t know yet. Because when you look at their lab profiles, the patients have very elevated inflammatory markers and this suggests an acute inflammatory response,” says Dr. Ofori-Amanfo. “The exaggerated immune response affects the heart function, which is mildly to moderately depressed, and their low blood pressure is a result of the hyper state of their immune system.”

At Mount Sinai, a team of specialists in areas that include pediatrics, immunology, hematology, infectious diseases, and basic science is treating this syndrome by targeting and modulating the overwhelming immune response and managing anticoagulation therapies for potential strokes. “This is a real entity, but it is rare, and we are hypervigilant and looking out for our patients,” says Dr. Ofori-Amanfo. “We think we have developed some therapies that are working. We have really smart, dedicated specialists working together. It is a great partnership.”

Other hospitals in the New York metropolitan region, around the country, and in Europe have reported smaller clusters of similar pediatric cases.

“We are studying the children to learn what predisposes them to developing this syndrome,” Dr. Ofori-Amanfo says. “These children had siblings. We don’t know why one child gets this but his brother or sister doesn’t.”

I Think I Have COVID-19. How Can I Take Care of Myself At Home?

May 8, 2020 | COVID-19, Your Health

Most people who have COVID-19 can recuperate at home, while remaining in contact with their doctor. Abigail R. Chen, MD, Senior Medical Director at Mount Sinai Doctors Downtown, tells you what you need to know to address COVID-19 symptoms at home.

Can I stay at home if I have COVID-19?

Generally, yes. Most people who test positive for COVID-19 will have mild symptoms–like a cough or sore throat. If you are experiencing mild symptoms, you can certainly recuperate at home by treating with over-the-counter medications. Below, I outline how to address the most common COVID-19 symptoms at home.

For information on protecting others in your home, read through the CDC guidelines.

How do I treat fever from COVID-19?

The best way to treat fever from COVID-19 is with acetaminophen—the active ingredient in Tylenol and other over-the-counter painkillers. Some early reports suggested that ibuprophen—the active ingredient in Motrin, Advil, and others—may make COVID-19 worse. However, the U.S. Food and Drug Administration has found no link between ibuprofen use and severe COVID-19. Remember to follow the dosage and timing directions on the package.

What should I take for a cough?

Most of the time, coughs that come with COVID-19 are dry and do not bring up phlegm. They can be severe and may even disrupt your sleep—but may still be able to be handled at home. The best approach to a cough can be a cough suppressant like dextromethorphan –the active ingredient in Robitussin, Nyquil, and other over-the-counter medications. If your cough is making it difficult to sleep, try a semi-reclining position (about a 45-degree angle). Since the cough associated with the virus is dry, you do not need an expectorant—such as guaifenesin—which helps to clear mucus from the airways. If your cough is really making you uncomfortable, talk with your doctor, who can give you a prescription-strength medication, or let you know if you need to go to the hospital.

What can I do about fatigue?

The key is to listen to your body. It is not uncommon to feel fatigued even days or weeks after many other symptoms have resolved. If your body is telling you to sleep more than usual, you should respect that and lay down rather than getting back on your computer. If you are having difficulty sleeping, try adjusting your position. Many people have some level of insomnia these days, due to the stress of the stay at home orders.

What if I lose my appetite?

Many people with COVID-19 find their appetite has disappeared. It is important to remain hydrated and take in some calories to give your body strength to fight the virus. Many people find that traditional soups—such as chicken soup or rice porridge (also called congee or jook)—can be helpful. These soups are bland, easy to digest, and offer some nutrition to help your body get energy. But soups do not provide all the hydration you need. You should make sure to drink as much water or other liquid as you can. Once you feel better, try to eat a little more to give your body strength to continue to heal.

What if I have a sore throat?

If you find your throat hurts from coughing, acetaminophen may be able to help. Many people find it also helps to drink something warm or very cold; pick what feels best on your throat.

How do I address shortness of breath?

This is the most dangerous of the COVID-19 symptoms. When you are taking care of COVID-19 at home, your doctor will pay careful attention to how you are breathing. Typically, every video appointment will begin and end with questions about shortness of breath. If you notice a change in your breathing—for instance, if you normally have no trouble with a flight of stairs and now find yourself huffing and puffing—it may be time to go to the hospital. Your doctor can advise you.

What if I lose my sense of taste and smell?

This is one of the more unusual symptoms of COVID-19. It can appear even with the mildest of cases. Make sure to tell your doctor if you have lost either your sense of smell or taste. While we cannot give you back your ability to savor chocolate or sniff flowers, these symptoms can help your doctor determine whether you have seasonal allergies or the COVID-19 virus. To learn more about this unusual symptom, read this post from Mount Sinai rhinologist Patrick Colley, MD.

How often should I check in with my doctor?

You should keep in touch with your doctor regularly. If your doctor does not recommend a follow-up appointment, you should feel comfortable asking for one. It is important to understand that recuperating from COVID-19 is not a linear trajectory. You may start to feel better and then, after a few days, feel worse again. It is important, though, to have a doctor monitor your symptoms; he or she can tell you if what you are experiencing is standard or concerning. These days, many doctors are available by email, as well as phone and video.

Are there certain people who should be extra vigilant?

The elderly and people who have hypertension, obesity, and diabetes should be especially careful about discussing any COVID-19 symptoms with their doctor. These conditions have been closely linked to relatively severe cases of the virus. If you have any of these conditions and are experiencing any symptoms that resemble COVID-19, please keep in contact with your doctor.

What if my doctor tells me to go to the hospital? Do I have to?

If your doctor does advise you to go to the hospital, please do so. These days, many people fear hospitals and doctors’ offices. But health care facilities are taking special care to protect you. If you need hospital-level care, it is important that you get it.