Years from now, when I’m long retired, the word “COVID” will evoke vivid and emotional memories.
Its occurrence disrupted our collective timeline, much as the assassination of President Kennedy did for a generation past. Yet COVID-19 wasn’t a moment frozen forever in time. It has lingered with us, unwanted and lethal, reminding us always of the fragility of life and that a return to our pre-COVID existence will never be fully possible.
Too much has happened. Too many people have died. Too many lives have been altered. Too much water has flowed under this terrible bridge.
I remember a lot. I recall the early days, when the hospital presidents would meet and review our grim statistics: how many patients died, how many were placed on ventilators, how full were our morgues. You sometimes forgot—or you had to forget—that there were people behind the numbers. I have flashbacks to the day we limited many of our inpatient units to serve only COVID-19 patients. We knew so little about the virus that seemed to be lurking everywhere.
We didn’t know its transmissibility or whether our intrepid front-line staff would succumb to its clutches. I participated in a huddle on one of our COVID-19 units, and I recall just how young the care teams were. “Is this what it feels like to send soldiers into battle,” I thought. I was scared for them, but so intensely proud at the same time. I had a job to do. It was important. Theirs was important and courageous.
COVID-19 has taught us that our existence is vulnerable and fleeting; that our daily routines are simple but they matter; that masks and social distancing, though essential for a long time, inhibited our longing for interconnectedness; and that those of us who worked on the front lines of care were ordinary people who met the moment with grace, purpose, and humanity.
What lies ahead? The rest of our lives—lives whose trajectories have been bent but not broken; lives that have been reshaped, repurposed, but not reduced by this disease; lives that, at long last, are moving away from grim statistics and daily uncertainty and pointing instead toward a future of hope and promise.”
Arthur A. Gianelli, Chief Transformation Officer, Mount Sinai Health System President, Mount Sinai Morningside
Headlines are appearing about a new version of the COVID-19 virus—a new type of the Omicron variant called a subvariant. The original Omicron variant is the one that that caused cases to spike in December and January. It’s too early to tell whether the new subvariant will produce another surge, but a Mount Sinai expert urges you to keep an eye on the situation and pay attention to public health advice.
Public health officials are closely monitoring this subvariant of the Omicron variant, which is called BA.2 and has been cited in reports of increasing infections in Europe. A subvariant means this virus has variations from the first Omicron variant that came through New York City, called BA.1.
“We can never really predict whether what’s happening in Europe will happen to us as well, so the best thing to do is to remain vigilant,” says Bernard Camins, MD, Medical Director for Infection Prevention at the Mount Sinai Health System, who has been tracking COVID-19 since the first cases were identified in New York in March 2020.
The new subvariant, BA.2, is more contagious than the other Omicron subvariant BA.1 and is replacing the latter among the region’s population, according to Dr. Camins. But what’s most important to know is that existing vaccines still work against this new subvariant of Omicron to limit serious illness and hospitalizations. Antiviral medications are also effective and are now widely available.
Dr. Camins says you should continue to look to public health authorities such as the Centers for Disease Control and Prevention (CDC) and local public health agencies for official guidance on the Omicron subvariant and keep following any existing safety precautions that may apply to you.
For example, while new COVID-19 cases in New York City are rising slightly, they are still at low levels, so the current CDC guidelines for the region have no recommendations for masking in public. Dr. Camins advises that you should be sure to get vaccinated and boosted, and be aware that some people with weakened immune systems are at increased risk of infection so they may feel safer if they prefer to keep wearing masks.
The BA.2 news has prompted some to wonder about getting a fourth dose of the vaccine. On March 29, the U.S. Food and Drug Administration (FDA) authorized a second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccines for older people and certain immunocompromised individuals. A vaccine has not been authorized for kids under five.
From left: Florian Krammer, PhD, Adolfo García-Sastre, PhD, and Peter Palese, PhD
Microbiologists at the Icahn School of Medicine at Mount Sinai, who created the first and most reliable test to determine whether an individual has antibodies to SARS-CoV-2, have been monitoring the virus since it began circulating in Wuhan, China, in late 2019.
Now, Peter Palese, PhD, Horace W. Goldsmith Professor and Chair of the Department of Microbiology, and Florian Krammer, PhD, Mount Sinai Professor in Vaccinology— weigh in on the future of SARS-CoV-2 and its place in our lives. They, and their colleague, Adolfo García-Sastre, PhD, the Irene and Dr. Arthur M. Professor of Medicine, recently created a low-cost COVID-19 vaccine that can be manufactured wherever influenza vaccines are made—particularly in low-and-middle-income countries. The scientists are also working on a universal flu vaccine, which would confer immunity without having to be administered annually.
As we move away from this pandemic will SARS-CoV-2 continue to play a large part in our lives?
Dr. Palese: Clearly the future is difficult to predict, but one likely scenario would be similar to the way we manage influenza viruses, which necessitates continuing vaccinations as we go into the future—perhaps once a year or once every two years. In this case, the virus continually changes but the effects can be ameliorated by vaccines, and those vaccines have to be changed. But they reduce fatality and hospitalization and the need for people to stay home.
Dr. Krammer: In this scenario the virus is not going to disappear. It’s just going to stick around and become the fifth coronavirus that circulates in humans. The other four coronaviruses make up about 30 percent of all common colds, and they’re seasonal; they come in the winter like influenza.
Dr. García-Sastre: Some of these common coronaviruses that cause the common cold have been with us for a long time and are very different from SARS-CoV-2. They are happily living with us, rarely cause any major disease, and do not cause a threat.
Dr. Krammer: Now, influenza typically causes more damage than these common coronaviruses which are typically causing mild infection, except in people who have problems with their immune system who are sometimes brought to the intensive care unit. I think SARS-CoV-2 will land somewhere between influenza and human coronaviruses—between those two extremes.
Is it possible that this virus will simply disappear?
Dr. Palese: You can never exclude the possibility that this virus will peter out the way the coronavirus (SARS-CoV-1) did twenty years ago, when it emerged to cause some really high fatalities but disappeared. On the one hand it was a nightmare, but then it was over.
Dr. Krammer: I don’t think the virus will just disappear, but it might. We didn’t think there would be so many variants this quickly, especially not something like Omicron, so there might be surprises. I hope for society’s sake that this fades into the background and we’re not afraid every fall that another wave is coming. The scenario I would like to see in six months is that Peter and I – as virologists – are concerned about it but that the problem is insignificant enough so that the public does not have to be. We’ll see if that happens.
How do we continue to ensure protection from COVID-19?
Dr. Krammer: We have to look at the baseline immunity that exists in the population. If a lot of people have immunity and there is less virus circulating chances are that you either don’t get infected or, if you get infected, your immunity will be protect you against severe outcomes. Then the disease and infections become less relevant. And that is what we hope for. Now, you can get there through vaccinations—that’s the painless way, or you can get there by having had the infections, and that’s the painful way. But both contribute to having higher baseline immunity in the population. Unfortunately, even in this scenario, immunocompromised patients are still at risk of severe outcomes although there risk of getting infected is lower.
Dr. García-Sastre: Vaccinations are still the solution to the problem. We should make sure that as many people as possible are vaccinated and boosted.
Dr. Krammer: I think we need to keep working on vaccines against SARS-CoV-2. Right now we have this situation where the vaccine protects very well against severe disease if you’re not immune compromised. But those vaccines are not protecting very well from infection anymore. They did against the original virus, but not with the variants. That’s why, for example, we need a variant-specific vaccine for Omicron. There are ways to make vaccines differently so you get more sterilizing immunity, which would suppress infections more, in general, and that would make the world safer for those who don’t mount good immune responses.
Dr. Palese: In creating our COVID-19 vaccine at Mount Sinai, we are using the Newcastle-disease virus in a vector-driven approach. If the FDA [U.S. Food and Drug Administration] is agreeable and allows the comprehensive use of genetically modified viruses, such as ours, then we can prevent the emergence of these new variants by vaccinating right away with the correct vaccine against the new variant, and we should be in good shape.
Do you think the public needs a fourth vaccine right now?
Dr. Krammer: For populations that don’t mount optimal responses or their responses disappear quickly, there might be an advantage in getting another dose. But for the general population, I don’t think this is useful right now. If there is a fourth dose, it should be variant-specific, an adapted vaccine that reflects what’s circulating right now.
For immunocompromised individuals, there are already a couple of important therapeutic treatments—including PAXLOVID from Pfizer Inc., operating under the FDA’s emergency use authorization—that can help them to greatly reduce their risk of a severe outcome.
Is it feasible to create a universal coronavirus vaccine—similar to the universal influenza vaccine you are developing?
Dr. Krammer: By universal you mean a variant-proof SARS-CoV-2 vaccine, I assume? One that would protect against all variants? We’ve made a lot of progress with the universal influenza vaccine in the last few years. But vaccine development has just started for coronaviruses and there are a lot of approaches out there. Coronaviruses are very diverse. A truly universal coronavirus vaccine would include protection against SARS-CoV-1 and other viruses in that subgenus and then you have a bigger genus of betacoronaviruses and, in addition, you have alpha-, delta-, and gammacoronaviruses (meant are the coronavirus genera, not the SARS-CoV-2 variants). So developing a universal coronavirus vaccine that would protect against all of them is a very big ask. It might be possible at some point, but it is small steps now and would take a lot of time. Of course, something that protects against variants that are around now or could be developed within the next five years, that’s actually possible.
The CDC has assigned a “community level” of COVID-19 risk for each county in the United States, based on factors like total COVID-19 cases and hospital admissions. Right now the level is “low” in most of the New York City area.
The number of COVID-19 cases in New York is returning to the levels before the Omicron surge that began in December, and the Centers for Disease Control and Prevention has announced new guidance on masking.
We are heading in the right direction, and “there is reason for guarded optimism,” says Bernard Camins, MD, Medical Director for Infection Prevention at the Mount Sinai Health System, who has been tracking COVID-19 since the first cases were identified in New York in March 2020.
As the pandemic in New York approaches the two-year mark, here are four things to keep in mind:
Masks are still requiredin hospitals and health care facilities and on public transportation. N95 and KN95-type masks give you the most protection, followed by surgical masks, with cloth masks offering the least. We recommend you wear the best type of mask you are comfortable wearing that covers your mouth and nose.
The CDC has now assigned a “community level” of COVID-19 risk for each county in the United States, based on factors like total COVID-19 cases and hospital admissions. Right now the level is “low” in most of the New York City area. That means masks are not required in most places, but you can choose to mask at any time. If you have symptoms and a positive test you should isolate and stay home for at least six days and wear a mask when around others until you have recovered. If you have been exposed to someone with COVID-19, you should wear a mask around others until you are certain you have not been infected. You can check your county’s “community level” on the CDC website.
Getting vaccinated and a booster shot is still recommended and is the best way to protect you and your family against the disease. Boosters are recommended even if you have already had COVID-19.
There are still many people who are at higher risk of infection: older adults, people with weakened immune systems (such as those who have been receiving active cancer treatment for tumors or cancers of the blood), and kids under five, as vaccines have not yet been authorized for young children.
One final note: Mount Sinai is committed to providing you with the COVID-19 information you need to keep yourself and your family safe and healthy. You can always find the latest updates from public health authorities and on our website.
Several days after Christmas, second-year medical student Arman Azad met with top administrators at the Icahn School of Medicine at Mount Sinai to plan how he and fellow students could help the Mount Sinai Health System handle the crush of COVID-19 patients falling sick from the Omicron variant.
As co-leader of the Student WorkForce at Icahn Mount Sinai, Mr. Azad says his job involved “helping the Health System deal with the most severe bottlenecks, as cases rose and staff were in isolation, and then organizing students to address those needs.” He and his co-leaders worked closely with their deans to mobilize students for appropriate roles, ensuring they had the training and protective equipment needed to stay safe.
During this latest COVID-19 surge, 198 medical, PhD, and master’s students at Icahn Mount Sinai have logged roughly 5,000 hours performing various tasks. They have worked in the Emergency Departments at six of the Health System’s eight hospitals and have also helped run asymptomatic testing programs for staff in those locations. Students have assisted in the pop-up testing sites in the student resident hall. And at The Mount Sinai Hospital, which shares a campus with the school, they have delivered meals to inpatients and assisted in the urgent care center.
Their efforts represent the fourth wave of student involvement since Mount Sinai’s Student WorkForce was created in March 2020, at the start of the pandemic. Since then, the WorkForce has ebbed and flowed to meet the needs of Mount Sinai’s hospitals. Unlike in earlier waves, the students recently received an hourly wage for their work. Along the way, they have also honed their WorkForce model, sharing it with other schools and health systems throughout the country. Students published a paper about their contributions in June 2021 in Academic Medicine.
In addition to assisting staff, WorkForce members say the most gratifying aspect of their jobs is helping the patients who need Mount Sinai most. Many of Mount Sinai’s hospitals serve communities in New York City that have been disproportionately affected by the pandemic.
On New Year’s Eve, Mr. Azad worked in The Mount Sinai Hospital’s Emergency Department into the early morning hours, taking patients’ blood pressure and other vitals.
Calista Dominy and Brett Weingart
“It was a busy night and an opportunity to learn from experienced providers and offer relief to staff where I could,” he says. “The pandemic has brought to light many of the inequities in medicine, and Omicron only amplified that. For people who can’t access consistent primary care, the emergency room serves a critical role, one that was threatened by staffing shortages as COVID cases surged. I’m proud of my fellow students who did their small part to ensure the Hospital could continue providing care to those who needed it most.”
Shortly after recovering from COVID-19 herself, Calista Dominy—also in her second year of medical school—assisted in The Mount Sinai Hospital’s Emergency Department on New Year’s Eve, as well. Ms. Dominy says one of the things she loves most about Icahn Mount Sinai is its strong commitment to social justice and student advocacy.
“Working New Year’s in the emergency room is an experience I will never forget,” she says. “The Omicron surge brought many more patients through the doors on a night that is typically notoriously busy.”
Workforce member Jesse F. Mangold, who is a dual MD-PhD student with a specialty in microbiology, chose to deliver meals to The Mount Sinai Hospital’s COVID-19-positive inpatients.
Jesse F. Mangold
“Meal delivery may not be the first role that comes to mind when you think of a first responder, but it means a lot to patients who have reduced contact and need nutrition for recovery,” Mr. Mangold says. “There was this tremendous bottleneck because you couldn’t just enter their rooms with a tray. All of the safety precautions needed to be implemented. My task served two needs—to feed our patients and relieve our already taxed nursing staff.” Before he was able to enter a patient’s room, Mr. Mangold had to properly don his personal protective equipment and then properly doff it immediately after leaving.
In the Hospital’s kitchen, located in the building’s basement and through a labyrinth of hallways, Mr. Mangold worked alongside a staff member who was seven months pregnant. “She was putting the Hospital and its patients first and taking personal risks to bring meals to patients,” he says. “Every team member is essential. She is a health care hero.”
Second-year medical student Claire Ufongene helped Mount Sinai conduct asymptomatic testing of employees. “The asymptomatic testing program allows employees to regularly monitor their health and return to the hospital safely,” she says. “It’s been wonderful to work with members of the Mount Sinai community, including students and employees. I’ve been happy to contribute in a small way to facilitate a testing process that’s easy and accessible.”
Claire Ufongene
Early last year, medical student Aliza Gross became involved in addressing vaccine hesitancy and helping patients obtain COVID-19 vaccine appointments through the internet and their Mount Sinai MyChart apps. At Mount Sinai Morningside, on the Upper West Side of Manhattan, she recently helped counsel patients entering the Emergency Department about the benefits of receiving a vaccine.
“It was very meaningful to have patient contact after spending so much of our medical school career remote,” she says. During the most recent spike, Ms. Gross took on the role of Student WorkForce co-leader and started taking shifts in the Mount Sinai Health System’s Express Care center—an urgent care facility—helping administer COVID-19 testing to sick patients. “It was gratifying to help our staff where they were experiencing the biggest backlogs,” she says.
Now that the worst of the Omicron wave seems to be receding, Mr. Azad says students remain ready to respond to future COVID-19 surges. “One lesson from the pandemic is that all of us, no matter our training or background, can in some way help protect our Health System and those we care for,” he says.
As the highly contagious Omicron variant continues to spread, more and more people are thinking about getting tested for COVID-19. You may be feeling under the weather, or you may have recently spent time with someone who has COVID-19. You may want to get tested before seeing family or friends, or attending a large indoor gathering.
With a number of different tests available, many people have questions about which test to take, when to take it, and what their results may mean. In this Q&A, Aaron E. Glatt, MD, MACP, FIDSA, FSHEA, Chair of the Department of Medicine and Chief of Infectious Diseases at Mount Sinai South Nassau, explains how you can decide which test may meet your needs.
What types of tests are available? What are the differences between them?
There are a number of different ways that we can diagnose a COVID-19 infection. None of them are perfect, and each has their benefits and disadvantages. Let’s break it into two groups of testing: We have antigen tests, and we have PCR tests. Each of them has a role, and each of them has a slightly different situation where they may be preferable.
So we start off with the antigen test. This is what most people use at home. These are the tests you can buy at your local pharmacy. They are often referred to as “rapid tests.” If an at-home test is positive, and you are symptomatic, it’s highly likely that you have a COVID-19 infection. If you are taking this test because you’ve been exposed to somebody with COVID-19, it is also likely that a positive test is reliable. On the other hand, when these tests are negative, they’re just not good enough to necessarily rule out that a person does not in fact have COVID.
The other type of test is a PCR test. There are many different types of PCR tests. Most PCR tests will take 24 to 48 hours to return your results. PCR tests are somewhat more sensitive than rapid antigen tests. If your PCR test result is positive, that will almost always represent a true positive, meaning it is accurate and you do have COVID-19 or that you had it in the recent past. The issue with these tests, however, is that they’re so specific. That means they can remain positive even when somebody is no longer contagious, and they no longer have COVID-19. But in general, the PCR tests are very good. They can tell you with a little bit more certainty that you did have an exposure to COVID-19.
How do I know which test I should take?
We usually recommend you talk to your health care provider if you’re concerned that you may have COVID-19. If you have symptoms or if you were exposed to COVID, then you may want to go get an at-home rapid test. If your rapid test is positive, you should talk to your doctor to decide what, if any, additional tests need to be done. If you have more serious symptoms, you should be evaluated by a doctor no matter what the antigen or PCR test shows.
When should I get tested?
If you have symptoms, you should get tested right away. If you’re being tested because of an exposure, we usually recommend waiting at least two days, or 48 hours, before testing. There are always exceptions to the rule. But that’s the general recommendation.
How reliable are at-home tests?
There are different at-home tests, and some of them are more reliable than others. If you have symptoms, or you think there’s a likelihood that you do in fact have COVID, then these tests can be very useful if they’re positive.
If my test result is positive, what should I do?
The first thing to do is contact your doctor. This could be a telehealth visit. We want you reaching out to your provider and getting expert medical advice from the person who knows you and your medical history. Not everyone has the same level of risk. It’s best to have a health care provider decide what evaluation needs to be done, and what potential treatments, additional testing, and ongoing monitoring you may need.
If my test result is positive, when should I retest?
There isn’t necessarily a reason to retest if you’re positive and your clinical care is being handled and you’re doing better. Typically, we wait a certain length of time to decide that a person is no longer contagious, and that they can stop isolating. That may be a five day period of time, assuming your symptoms are resolving and you have no fever. After that, we recommend that you be extremely careful in terms of distancing and wearing a mask whenever you’re going indoors among other people for at least an additional five days. For somebody who’s having a little bit more of a complicated clinical course—for example, they are having symptoms that aren’t resolving or they’re having persistent fevers—then you can’t assume that in five days, they’re no longer contagious. This should be something that your doctor helps you decide based upon your particular symptoms and medical history.
If my test result is negative, does that mean I’m good to go?
Anyone who has symptoms should not be going into public gatherings with other people. If they do have to go indoors, they should be wearing a mask and distancing as much as possible. A negative test doesn’t mean you don’t have COVID, and it doesn’t mean you can’t be contagious. Even if it’s not COVID, it might be the flu or some other virus that could be contagious to other people. As a result, you should really try and protect everybody from whatever illness you may have.
If I have symptoms, but my test was negative, what should I do?
In that situation, there are additional tests that you can take, such as testing for the flu or additional testing for COVID-19. You should talk to your doctor if you have ongoing symptoms and you have a negative COVID test. It can be a telehealth discussion. You should speak with your doctor, who knows you, and knows your background and your risk factors for serious illness.
Why are testing and vaccination still important?
It’s very important that patients realize that while the press reports that Omicron is a mild illness—you just get a little bit of flu-like symptoms, and you’re fine—that’s not really true for everybody. If you’re not vaccinated, Omicron can cause severe illness. Even in vaccinated people, if they’re not boosted, they are still more likely to get into trouble. So the best recommendation at this point is to get a booster dose of the vaccine if you’ve gotten vaccinated, and certainly, if you haven’t been vaccinated, this is still a great time to get vaccinated.
A misconception is that the vaccines don’t work because there are breakthrough infections. Nothing can be further from the truth. These vaccines are phenomenally successful in preventing death, in preventing serious illness, in preventing admissions to the hospital. Omicron, while “milder” than the Delta variant, can still cause all of these things for some people. It’s critically important for everyone to protect themselves, protect their loved ones, and protect their community by getting vaccinated.
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Headlines are appearing about a new version of the COVID-19 virus—a new type of the Omicron variant called a subvariant. The original Omicron variant is the one that that caused cases to spike in December and January. It’s too early to tell whether the new subvariant will produce another surge, but a Mount Sinai expert urges you to keep an eye on the situation and pay attention to public health advice.
