Should I Prepare a COVID-19 Emergency Care Kit?

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

Everyone is worrying about COVID-19. At home preparation is essential for social distancing and in the unfortunate event that yourself or a loved one becomes ill. Stocking up on the basics is a good approach. But, what do you need to have on hand? Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, shares what you should have in your COVID-19 Emergency Care Kit.

What types of things should I keep on hand?

In general, you want to have cleaning and hygiene products, a 30-day supply of any medications you may be taking as well as other health care items, and food.

Besides my prescription medication, are there other medicines or medical supplies that I should have on hand?

You might want to stock up on daily multivitamins, vitamin C tablets, and electrolyte replacement drinks, such as sports drinks. Over-the-counter medications are also helpful—including cough, cold, and diarrhea relievers as well as pain and fever relievers like acetaminophen or ibuprofen. If there is a child in the home, be sure to pick up  children’s versions.

If you have special medical supply needs, try to have at least 30 days of supplies such as oxygen supplies, catheters, syringes, as well as blood test monitors and strips. Ensure any medical equipment you use is in good repair. This includes oxygen equipment, nebulizers, CPAP machines, hearing aids, glasses, and assistive technologies.

Also, you might want to have a pulse oximeter—which measures both oxygen levels and heart rate—as well batteries to operate the device. And, if you use a cane, crutch, walker, or wheelchair; check to make sure it is in good shape.

Are there specific cleaning and hygiene products that I should use?

When it comes to basic sanitation and hygiene items, try to have bleach, soap, hand sanitizer, antibacterial wipes, face masks, laundry detergent, and garbage bags on hand. You’ll also want to have some basic first aid supplies at home, like an inexpensive digital thermometer, gloves, and bandages.

Be sure to think about the non-food items you regularly purchase at the pharmacy or grocery store and try to have at least two weeks’ worth on hand. This includes toilet paper, toothpaste, tissues, batteries for hearing aids, and contact lens solution.

What should I have in terms of food?

The best case is to have about 30 days’ worth of food on hand. You’ll want to have nonperishable or canned food in your cabinet or pantry. Basics like rice, beans, and peanut butter are inexpensive and keep well. You might also want to have chicken soup, fresh ginger, onions, lemons, and oregano as well as high-calorie nutrient-rich foods such as avocados, honey, and pectin-rich foods like bananas and apples. If there are people in your family who need special foods—such as infants or people with dietary restrictions—be prepared for their needs as well. For more on how to stock your pantry during COVID-19, read this advice from Mount Sinai nutritionists.

If you have a pet, don’t forget stocking up on food, kitty litter, and pet medications.

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How Older Adults Can Protect Themselves From COVID-19

Updated on Jun 30, 2022 | COVID-19, Geriatrics, Your Health

COVID-19 is a concern for everyone. But the elderly may be at increased risk of contracting this virus–or developing a bad case of it. Linda V. DeCherrie, MD, Professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, shares information that the elderly and their caregivers can use during the time of COVID-19.

How can the elderly protect themselves from COVID-19?

The best plan is to avoid contracting the virus. To protect yourself, follow the guidelines from the Centers for Disease Control and Prevention. That means stay home as much as you can. Wear masks and gloves if you must go out in public. Make sure home health aides and any family wash their hands when they come into your home. And, keep in close communication with your doctors and health care team so that you can notify them immediately of any new symptoms.

Should older adults make plans for what to do if they get sick?

It’s always good to think ahead if you can. Now is a good time to talk about the “what ifs” and begin your advance care planning, if you have not done so already. The social workers at your hospital can help. You should also tell your loved ones what your wishes are.  

How can I avoid social isolation and depression?

This is always a concern for people living alone—and even more so now with widespread directives to practice social distancing. Fortunately, we’re in much better shape to address this potential for loneliness now than we were even ten years ago. Use Skype, FaceTime, Zoom, or other video chatting technology as much as you can to connect with loved ones.

It also helps to keep as close to a normal routine as possible. Make your bed every morning and don’t let dirty dishes sit in the sink. Get some exercise, either in your home or by taking a walk, while maintaining social distance. This is also the time to try activities that you don’t usually do: paint a picture, play an old-fashioned board game, piece together a 1000-piece puzzle, read that novel that’s been sitting on the shelf. Equally important, try to limit how much time you spend reading or listening to the news.  

Additionally, you might want to get to know your neighbors and talk with them about emergency planning. If your neighborhood has a website or social media channel, think about joining it for access to people and resources nearby.

While it is true that the available data shows that older adults—and those with serious illnesses—are at somewhat greater risk for severe outcomes if they contract COVID-19; it is important to remember that many older adults will not get the virus. And, among those who do, most will survive. Remember, this will pass. We will get through this together.

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COVID-19: Managing Anxiety and Depression

Updated on Jun 30, 2022 | COVID-19, Mental Health, Psychiatry, Your Health

The outbreak of COVID-19 is challenging all of us to cope in new ways. For people with depression and anxiety, life can seem overwhelming in normal times. Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai describes ways to deal with the feelings of anxiety and depression during this crisis.

Stress levels are high for everybody these days. For people who are already dealing with anxiety and depression, what advice would you give?

Many mental health providers are seeing their patients through telehealth. Should you not be able get to an appointment in person, your provider will likely be available to talk to you by phone or by online chat services like Zoom or Skype. It’s very important that while we isolate ourselves physically, we don’t isolate ourselves from the world or from people. If you can’t talk to your provider, make sure you are talking regularly to somebody, whether it’s a family member or a friend.  I encourage people to talk by phone, video call, Skype—or to reach out through social media.

The more we’re in touch with the idea that we’re all in the same boat, the less anxious we may become. Many people with depression and anxiety feel that no one understands them, and this increases the isolation.  Right now, a lot more of us are feeling isolated, so we are experiencing feelings that some people struggle with all the time.

Anxiety and depression are heightened by the feeling that no one can understand. But right now, we’re all going through the same thing and this provides an opportunity to really connect with each other as we realize that we’re part of a greater culture and humanity. I see an opportunity for healing, because more people will be able to empathize. Staying connected on social media and seeing what everyone else is going through may help people not feel so isolated.

I imagine being on social media can be a double-edged sword. How do you gauge when you’re exposing yourself to too much social media?

You certainly have to strike a balance. But I think the problem isn’t so much too much social media, but negative social media. It’s a matter of choosing your friends wisely, and choosing what you engage in. Sometimes we engage with people who trigger us with their negativity or politics that we don’t agree with.

But if you have friends who are posting important news information, humorous things, or positive items, this can be a great way to stay connected. It’s a good distraction from all the uncertainty and can be a pleasant way to spend some time. The positives of social media should be used to their fullest. Some people are sharing life-affirming stories about how people are helping each other. My rabbi posted a short, 20-second prayer that you could recite while washing your hands, while being mindful that your actions are helping to protect other people.  It can be a time to be inspired and connected to all the positives of humanity when we pull together.

Of course if you have friends who are posting things that you find upsetting, blocking or unfriending those people may help you feel in control at a time when you are controlling much less than normal. And that can be healthy. We have the power to mute negative messages.

What warning signs should you look for regarding anxiety and depression?

If you’ve gone a while without bathing, if you’re not eating, or not caring about getting dressed in the morning, letting the house get messy and out of control, then you should be getting outside help or trying to talk to someone. If you have thoughts that keep coming into your head that you can’t get rid of about becoming infected, or feeling everything around you is unsafe, that is also a sign that you might be getting very anxious. Even though there is truth to the idea that things on the outside might not be currently safe, social isolation, self-quarantine, and taking precautions should make you feel in control. If you can’t feel in control or feel your actions aren’t effective in increasing your safety, that is a warning sign.

We are in a real emergency. So it’s appropriate to have rational plans about worst case scenarios. What will I do if I get a fever or a cough? Do I have enough cough syrup in the house? Do I have a thermometer? These are reasonable thoughts to have, and formulating a plan for those things should provide reassurance.  But if they do not, it’s time to reach out to someone.

Mental health is being conducted on hotlines and many medical institutions have been preparing to deliver care like this for quite a while now. This is the day we’ve been preparing for—where people in need can have a reassuring voice on the end of the line that can walk them through their fears and anxieties.

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Preliminary Case Series Leads to New Questions About the Disease Progression of COVID-19 in Patients with Blood Clots in the Lung

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

Hooman D. Poor, MD, Assistant Professor of Medicine (Pulmonology, Critical Care and Sleep Medicine, and Cardiology)

A small, preliminary case series led by physicians at the Icahn School of Medicine at Mount Sinai found that five severely ill patients with the SARS-CoV-2 virus responded to the blood-clot-busting drug tPA when it was introduced as a life-saving measure. This response, and the large number of critically ill COVID-19 patients who have blood clots in their lungs, have raised new questions concerning the course of the disease and may present new possibilities for treating it.

“This case series pushes us to consider avenues of clinical investigation that are different from what they are now,” says the paper’s first author, Hooman D. Poor, MD, Assistant Professor of Medicine (Pulmonology, Critical Care and Sleep Medicine, and Cardiology). “Perhaps we should be looking at the disease from the standpoint of clots that form in the blood vessels and travel to the lungs.”

Dr. Poor says that more testing will be needed to determine whether the clots are the “inciting events in a subset of patients,” and not a complication that develops after these patients develop acute respiratory distress syndrome (ARDS). “ARDS looks the same, but it’s not,” he says. It requires “dramatically different treatments.”

According to the paper, the critically ill COVID-19 patients had relatively well-preserved lung mechanics, and did not develop stiffness of the lungs, despite severe gas exchange abnormalities. This feature is more consistent with pulmonary vascular disease and not with classic ARDS. The COVID-19 patients also demonstrated markedly abnormal coagulation with elevated D-dimers—small protein fragments present in the blood after a blood clot—and higher rates of venous thromboembolism, a condition where blood clots that form in the deep veins of the legs or groin travel and become lodged in the lungs.

Click here to read the paper titled “COVID-19 Critical Illness Pathophysiology Driven by Diffuse Pulmonary Thrombi and Pulmonary Endothelial Dysfunction Responsive to Thrombolysis.”

Mount Sinai’s paper cited autopsy studies from the SARS outbreak in the early 2000s, which revealed that patients had “pulmonary thrombi, pulmonary infarcts, and microthrombi in other organs.” SARS-CoV-1, the virus that caused SARS, and SARS-CoV-2, which causes COVID-19, belong to the same family of coronaviruses.

With mounting evidence that a consistent pattern of COVID-19 patients are presenting with blood clots, front-line clinicians at the Mount Sinai Health System and throughout the United States are reassessing and modifying existing guidelines that incorporate anticoagulation therapies.

Mount Sinai has provided treatment guidelines for its eight hospitals that address the significant role microthrombi—tiny clots composed of platelets—may play in patients with severe cases of COVID-19. The new guidelines help to inform clinical decision-making on administering anti-coagulation therapy for critically ill patients throughout the Health System. They call for patients who require hospitalization to be assessed for blood clots in their lungs by measuring their oxygen levels, testing for markers of clotting in their blood, and assessing their difficulty breathing or shortness of breath. Patients in intensive care units may also be eligible for a clinical trial at Mount Sinai that will examine the use of thrombolysis in respiratory failure due to COVID-19.

The recommendation was made by a panel of expert clinicians within Mount Sinai, and was based on published and rapidly emerging data, international and local experience, and autopsy reports.

Recently, the International Society on Thrombosis and Haemostatis recommended that all hospitalized COVID-19 patients, even those not in intensive care units, should receive prophylactic-dose low molecular weight heparin—a blood thinner—unless they have contraindications, such as active bleeding.

“If patients with COVID-19 show a small problem with their lungs, perhaps we should start them on blood thinners to prevent the clots from reaching the point where we have to administer tPA,” says Dr. Poor. “However, this treatment paradigm with early anticoagulation will need to be evaluated with well-designed clinical trials.”

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A Snapshot of the Extraordinary Contributions of Mount Sinai Students in COVID-19 Efforts

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

From left: Shravani Pathak (MS3), Samuel Paci (MS3), and PhD candidates Mark Roberto and Sindhura Gopinath, members of the PPE Task Force, inventoried PPE stock, coordinated with different floors, and distributed PPE across Mount Sinai West based on need.

In an extraordinary effort across the Icahn School of Medicine at Mount Sinai and its Graduate School of Biomedical Sciences in New York City, 200 students and postdoctoral fellows have volunteered more than 6,100 hours during a three-week period and continue to assist the Mount Sinai Health System during the staggering challenges of the COVID-19 crisis. As members of the Sinai Student Workforce, they have made an impact in a wide range of areas, from sourcing, acquiring and assembling personal protective equipment (PPE), to supporting clinical trials. An additional 450 student volunteers have since joined the effort.

Students are organized into task force teams working in the following areas: PPE, pharmacy, telehealth, administrative, operations, labs, and morale. The six-member COVID-19 Student Volunteer Leadership Team—Alexandra Agathis (MS3), Ben Asriel (MS4), Rohini Bahethi (MS3), James Blum (Scholarly Year), Zina Huxley-Reicher (MS4), and Shravani Pathak (MS3)—meets regularly with administration leadership to receive, triage, and coordinate requests from throughout the Health System. “Our students have become an essential part of the support system Mount Sinai needs to save lives and care for the communities it serves,” says David Muller, MD, Dean for Medical Education, and Professor and Marietta and Charles C. Morchand Chair in Medical Education.

“We know we’re making a huge difference because we can see it.” — Christopher Park (MS3), Icahn School of Medicine at Mount Sinai

Following is a snapshot of what they have accomplished.

The PPE Task Force, led by Annie Arrighi-Allisan (MS3) and Stephen Russell (MS3), sourced and acquired nearly 3,000 N95 masks, nearly 9,000 surgical masks, and 400 gowns. They assembled more than 1,500 durable, reusable face shields from 3M and distributed them to front-line health care providers, fitted staff with protective masks, and played an instrumental role in the distribution of 750,000 single-use face shields. Students worked in around-the-clock shifts to assemble more than 200 PPE go-bags for residents working at Elmhurst Hospital—which is part of a New York City integrated system of health care facilities that has been particularly hard-hit with COVID-19 cases, and with which Mount Sinai has an affiliation. In addition, the group trained more than 50 students to help fit clinical staff with new models of N95 respirators.

The Operations Task Force, led by Alexandra Capellini (MS2) and Christopher Park (MS3), delivered vital equipment, a task that requires unloading deliveries and assembling IV poles. One team assisted in rapidly engineering a method to transform 200 ResMed VPAP ST machines as a donation from Elon Musk, Chief Executive Officer of Tesla, Inc., as patient ventilators. They additionally helped write the assembly guide and operation instructions and assemble hundreds of units. Other teams provided support on clinical trials and promoted blood donations among their eligible classmates and peers.

From left: Jeremy Nussbaum (MS3), Marc Casale (MS3), Meygan Lackey (MS4), and Rebecca Rinehart (MS3) took inventory of COVID-19 medications, alerted staff of shortages, and distributed critical medications to hospital floors at Mount Sinai Beth Israel.

“This has been an intense, eye-opening experience and, for the first time, I’ve felt I was doing my small part to help with the response to the pandemic,” says postdoctoral fellow Dan Filipescu, PhD. “Prior to this, I had no idea how the day-to-day operations of a clinical trial worked, or the amount of effort that goes into caring for COVID-19 patients.”

Approximately 300 student volunteers from the Telehealth Task Force provided and obtained patient information—calling them with test results, calling hospitalized COVID-19 patients to gather information regarding emergency contacts, and triaging the palliative care hotline. Students were trained to know when to answer questions and when to refer them to their superiors. Using an online chat platform, they triaged patients with potential COVID-19 symptoms—providing them with additional information about the virus and how to self-isolate, and arranging virtual appointments with physicians, or sending them to the emergency room if necessary. To date, students have had more than 2,320 triage chats and test result updates with patients. “As future physicians, we entered this profession in order to help people,” says Harinee Maiyuran (MS4) who, with Sidra Ibad (MS1) leads the Telehealth Task Force. “Though we are unable to engage in direct clinical care, coordinating Telehealth has allowed me to not only participate but feel useful in these weeks of uncertainty and fear, and it has allowed me to give back to the New York City community that has become my home.”

Pharmacy was the first task force to send volunteers throughout the Mount Sinai Health System. Led by Benjamin Liu (MS3), the team has been troubleshooting Pyxis loading to help resolve medication supply shortfalls. When students at Mount Sinai Beth Israel made pharmacy leadership aware of a dwindling supply of Azithromycin, pharmacists were able to recommend a different medication for some patients to conserve their supply. Volunteers in the leadership suite assisted the Health System pharmacy director in researching treatment guidelines and protocols, and in reviewing charts to understand the impacts of the COVID-19 protocols.

Members of the Administrative Task Force, led by Christopher Ferrer (MS3) and Phillip Groden (MS3), handled remote medical scribe work and assisted outpatient practices with transitioning patients to Telehealth appointments. Working with the Department of Clinical Innovation, they reprogrammed tablets in every room and unit to allow for teleconferencing between patients, families, and staff. They have also been fielding offers of vital supplies and PPE and acquiring them for the frontlines. A group of student volunteers working with Materials Management leadership developed a system of creating inventories of crucial PPE supplies, leading to improvements in efficiency.

More than 40 student volunteers on the Labs Task Force, led by Michael Fernando (PhD2) and Maddie O’Brien (PhD2), have triaged more than 500 incoming requests for serum antibody testing. Working with the departments of Microbiology and Pathology, they have contacted approximately 200 donors with their results, and scheduled approximately 300 new participants prioritized for potential plasma donation. Their most recent initiative has 50 volunteers screening COVID-19 patients to assist the Operations team to prioritize candidates for plasma treatment.

Melissa Hill (MS3), left, and Sarah MacLean (MS3), learned that “it is impossible to breathe when wearing N95s correctly—and staff have to do it all day long.” They were members of a team that brought N95s and other PPE to Mount Sinai West.

As staff and volunteers throughout the Mount Sinai Health System work long hours under increasingly stressful conditions, keeping up morale plays a key role in the fight against coronavirus. The Morale Task Force, led by Ms. Arrighi-Allisan, Ella Cohen (MS1), and Katie Donovan (MS3), is charged with boosting morale among student volunteers and the greater Mount Sinai community. They have coordinated meal deliveries three days a week to all students remaining in nearby apartments, with leftovers going to residents, nurses, and other staff at The Mount Sinai Hospital. They distributed health kits containing a thermometer, pulse oximeter, a mask, and acetaminophen to students who are ill. They also fostered a sense of community through social media and blogs that highlight the achievements of student volunteers and have created an initiative to write letters to residents of nursing homes and other skilled nursing facilities.

Collaboration among peers extends beyond the Mount Sinai community and includes medical students from around the country. Students from the University of California, San Francisco, tweeted a seven-minute video to health care workers in New York City, showing solidarity, thanking them for their heroic efforts, and offering words of encouragement. “I am in awe of the way everyone has come together to fight this pandemic and all the hard work my peers have put into volunteering,” says Ms. Pathak. “I love collaborating with students from other schools as they reach out to me about how they can develop structures like our workforce in preparation for when the pandemic affects their communities.”

Adds Mr. Park about his experience on the Operations Task Force, “I think a lot of us are learning about the real meaning of resilience and adaptability by living it. We know we’re making a huge difference because we can see it. I am both inspired but also unsurprised by the student response, because this is the standard I knew that our student body functioned at and would strive for.”

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Elmhurst Hospital During COVID-19, An Experience Like No Other

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

Suresh K. Pavuluri, MD, MPH

The weekend of Saturday, March 14, marked a turning point for Suresh K. Pavuluri, MD, MPH, a second-year resident in Emergency Medicine at the Mount Sinai Health System, who was working in the Coronary Care Unit (CCU) at Elmhurst Hospital, a Mount Sinai affiliate. It was when the national discussion about the rising number of patients with COVID-19 became a deeply personal experience for him, and “everything just shifted quite dramatically,” he says.

Early that weekend, Dr. Pavuluri noted a couple of patients with suspected COVID-19 were being treated in the hospital’s Emergency Room and Medical Intensive Care Unit (MICU). That was consistent with his experience a week earlier, during his rotation at The Mount Sinai Hospital, where that hospital’s first COVID-19 patient had been treated and released.

But the trickle of patients at Elmhurst Hospital quickly changed into something very different as more patients started arriving. “It seemed to come out of nowhere,” he says. “Suddenly, everyone had COVID. It was as if this huge avalanche hit us and we were trying to dig our way out of it, trying to cope with all these patients. Initially, all the people who were under investigation for COVID were sent to the MICU. And that quickly changed because we didn’t have enough beds. So, then some of the floors were converted to handling these patients and others who had difficulty breathing.” The sickest patients, who required intubation to assist them with breathing, were sent to the intensive care units and what had been the CCU, where Dr. Pavuluri was busy tending to them.

Within days, the policy changed to not allowing any visitors or family members into the units with the sickest patients. “It was a way for us to protect the public, but it was also a way for us to protect our patients,” he says.

“So, all of a sudden, I could no longer have face-to-face conversations with family members, and we had to have discussions over the phone. It was difficult for the patients to not have their family members there because in intensive care there are so many nurses and doctors coming in and out. The lack of personalization was one of the hardest things about this. You can’t really comfort someone through a phone. The other part was that we spent a lot of time on the phone. We were receiving multiple phone calls a day from different family members. Obtaining consent to treat intensive care-level patients meant we had to track down family members as quickly as possible. Sometimes critically ill patients require multiple procedures. The patients were already intubated by the time they came upstairs. Some of the coronavirus patients were going into renal failure and needed dialysis. That is typical in the intensive care unit, but we never see the sheer volume of it. We never expected so many patients to require all of these things or this much attention. These were people in their 30s, 40s, 50s. We saw people in their mid-thirties with no prior medical problems. When this pandemic began, we thought it was going to be mostly elderly patients affected by this. Then we realized it’s anyone and everyone.”

During that turning point of a weekend at Elmhurst Hospital, Dr. Pavuluri says he began to hear the code “Team 700 to B4” on the overhead paging system more times than he could keep track of. It meant that a patient’s heart had stopped. At that point, Team 700 would rush into his unit and perform their assigned duties, from administering chest compressions to providing the medications needed to rescue the patient’s heart. “Before coronavirus took over our hospital, I may have heard this code once or twice a week,” he says. “But it became all too familiar. Sometimes, after several minutes, just when we felt defeated, the patient’s heart would start beating again and we’d sigh with relief and look at each other, acknowledging that it was just a matter of time until our next code.”

As the volume of patients entering Elmhurst Hospital increased, Dr. Pavuluri’s work schedule changed to meet the demand, from working every four days to 12-hour shifts. “We simply had to be resilient,” he says. “We had to be flexible and adapt to best serve our patients.”

More than a week later, Dr. Pavuluri developed COVID-19 too, and went home to nurse his splitting headaches, low-grade fever, exhaustion, chills, muscle aches, nausea, chest heaviness, congestion, and shortness of breath. He began to recover after five days. Eleven of his colleagues at Elmhurst Hospital also tested positive. By early April, Dr. Pavuluri was back at work, splitting his time in the Emergency Departments at Elmhurst Hospital and The Mount Sinai Hospital.

While he was home recuperating from COVID-19, Dr. Pavuluri had time to reflect.

“I can definitely say the experience will leave an impression on me and my colleagues for as long as we practice medicine. We did not anticipate this, and we were not prepared for this. I am really close to my family and they have been a great sounding board. My colleagues at work have been my great resource because they understand, they’ve been there. To be among the young doctors coming in and fighting the good fight—it’s been really gratifying. I am so proud to be among the nurses and doctors who are risking their lives every day in this pandemic. But there will be scars. It has been an experience like no other.”

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