Infectious Diseases | Mount Sinai Today

How Do I Keep My Kids Safe When They Return to School In Person?

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

As the Delta variant surges, and the timeline for vaccinating children under 12 remains uncertain, concerned parents are wondering how to keep students safe. But there are smart strategies for school children of all ages that can help protect them in the classroom.

In this Q&A, Roberto Posada, MD, a pediatric infectious disease specialist in the Jack and Lucy Clark Department of Pediatrics at Mount Sinai Kravis Children’s Hospital and Professor of Infectious Diseases and Medical Education at the Icahn School of Medicine at Mount Sinai, shares the best ways to help keep kids safe from COVID-19.

Given the current concerns about COVID-19, should parents be worried about sending their kids back to school?

I think it’s important for kids to go back to school not only for their education, but also for socialization and healthy development. But it’s also important to take precautions to make sure they return to the classroom in a safe way. If in-person learning is done safely, the benefits will outweigh the risk. According to the Centers for Disease Control and Prevention, children have been less affected by COVID-19 compared with adults. But kids can develop serious illness, especially those with underlying medical conditions, such as obesity, diabetes, and asthma; those with certain genetic, neurologic, or metabolic conditions; or those with congenital heart disease. In general, the best way to protect children is to make sure adults in the household are vaccinated.

What advice can you give to worried parents about keeping their kids safe at school?

It’s important to continue the things we’ve been practicing for the last year and a half: The main thing is that children over the age of two should wear a mask when they go to school. Children should also be encouraged to wash their hands, either with soap and water or with alcohol-based sanitizer frequently. Children should be encouraged to practice respiratory etiquette, which means coughing or sneezing into their elbow and washing their hands after coughing or sneezing. And they should be taught to maintain a safe distance at all times.

In addition, parents shouldn’t send their kids to school if they have a fever, cough, abdominal pain, or any symptom whatsoever of an illness, including COVID-19.

How worried should people be right now about the increasing cases of COVID-19?

The number of COVID-19 cases has been going up for the last several weeks in the United States, mostly due to the Delta variant. Vaccination is very important. Every child aged 12 and older should be vaccinated. The vaccine is safe, and in some cases it fully protects against COVID-19; in some cases people who are vaccinated may still get COVID-19, but usually it’s a much milder disease.

Is there any guidance for older vaccinated kids that you would recommend to parents?

What I want to stress is that even people who are fully vaccinated should be wearing a mask whenever they’re inside, whether they’re in school, on public transportation, in a store, or anywhere indoors. That applies to adults, as well. The reason is that even people who are fully vaccinated may have breakthrough infections, and they can still pass on the infection to other people. So by wearing a mask—in addition to getting the vaccine—you’re helping decrease cases in your area, which is what we all want.

When do you think the vaccine will be available for children 11 and under?

The original timeline was for this to be available in the fall. So let’s hope that’s going to be the case.

Is there anything else people should know about keeping their kids safe from COVID-19?

Any parent who has a particular concern about their child due to a chronic medical condition medical condition should talk with their pediatrician to come up with an individualized plan.

My Child Is Anxious About Returning to School In Person. How Can I Help Them?

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

With the start of the new school year, many kids may be relieved to return to in-person learning. But others may feel more anxious.

In fact, experts at the Mount Sinai Adolescent Health Center anticipate that this transition may be especially challenging and anxiety-provoking.

Rachel Colon, LCSW, a social worker at the Center who treats young people ages 10-26, says that her case load has nearly doubled as adolescents seek help for anxiety and depression.

Rachel Colon, LCSW

“Young people are feeling a great deal of anxiety about returning to school,” she says. “They don’t know what they’re stepping into, who their friends are, and they’re nervous about the lack of predictability in an environment that has always been safe and provided routine.”

Ms. Colon offers some steps you can use to help your kids with the transition to in-person learning this school year:

Have lots of conversations with your kids; keep the lines of communication open.
Empathize with your children; let them know they are not alone if they feel anxious.
Reach out to your child’s school to ask what steps are being taken to familiarize students with their surroundings.
Look for signs of withdrawal, isolation, stomach aches, headaches, irritability. These can be signs of depression and/or anxiety.
If your child is headed to a new campus, or stepping up from middle school to high school, offer to take a walk to school before the first day of school.

Heading back to school can be stressful even in normal times. Over the years, the Mount Sinai Adolescent Heath Center has compiled a list of seven things for kids and adults to do to start the year off right. Click here to see them on the Center’s kid friendly blog.

One potential new issue this year is that kids may feel they have lost touch with their group of friends, or that they don’t belong, and masks, while a critical safety tool, may make things more difficult.

“Many kids are telling me they don’t have a friend group anymore. They don’t know how their classmates will look,” she says. “With the potential requirement of masks, this will likely compound social anxiety because it’s hard to read expressions when a person is masked. Are they happy or sad? Are they smiling at me? Though masks are a crucial safety tool right now, kids really need simple cues—like a broad smile—to maintain social relationships.”

The Mount Sinai Adolescent Health Center is a comprehensive, integrated health center that provides nonjudgmental and confidential care to young people ages 10-26 in New York City—all at no cost to patients, regardless of insurance or immigration status.

Learn more about the Mount Sinai Adolescent Health Center

Check out seven back-to-school tips from the Mount Sinai Adolescent Health Center

Vaccine Facts: No, the COVID-19 Vaccines Were Not Made Too Quickly

Aug 12, 2021 | COVID-19, Vaccines, Your Health

One of the many misconceptions that some have about the COVID-19 vaccines is that they were developed too quickly. In fact, all of the normal safety steps were followed in developing the vaccines, and they are helping to bring the pandemic to an end. In a roundtable talk, experts from Mount Sinai answer some frequently asked questions.

Did scientists and the government take short cuts and develop the vaccines too quickly?

Scientists followed all of the normal safety steps that are taken when we create new vaccines. No safety steps were skipped. The Pfizer-BioNTech and Moderna vaccines were made with technology that has been studied for many years, and the Johnson & Johnson vaccine was made using traditional methods.

So how did we produce and test these vaccines as quickly as we did?

COVID-19 vaccines became the priority for everyone. Researchers around the world dedicated themselves at the same time to finding solutions. We quickly understood how well the vaccines worked because COVID-19 spread so rapidly. It became clear that people who were vaccinated weren’t getting hospitalized, weren’t in ICUs, and weren’t dying of COVID-19.

New Guidance on COVID-19 Vaccines: In April 2023, the Food and Drug Administration and the Centers for Disease Control and Prevention announced some major changes for COVID-19 vaccines. Click here to read more about what you need to know.

How do we know the vaccines are safe?

In the United States alone, nearly 200 million people have safely received the COVID-19 vaccines—twice as many as the flu vaccine. If you haven’t yet, we encourage you to get vaccinated.

Get more information from Mount Sinai about COVID-19 vaccines

Making Sense of the Pandemic Now

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

If you are fully vaccinated, are you protected from COVID-19? Will we need booster shots? What is the best way to keep children safe as they return to school?

These and other pressing questions were discussed in an Aspen Ideas Festival virtual event, in which Kenneth Davis, MD, MD, President and Chief Executive Officer of the Mount Sinai Health System, interviewed Judith A. Aberg, Dean of System Operations for Clinical Sciences, and Chief of the Division of Infectious Diseases, and Harm van Bakel, PhD, Assistant Professor of Genetics and Genomic Sciences and a leader of Mount Sinai’s Pathogen Surveillance Program. The interview, which was released in July, can be viewed here.

Dr. Aberg, who leads Mount Sinai’s COVID-19 clinical trial efforts, shared a favorite analogy about the vaccines’ effectiveness: “An umbrella will keep you dry for the most part, but you can still get wet in a bad storm,” she said. In the same fashion, “the current vaccines are highly effective even for the circulating variants, but we do expect there will be breakthrough infections in some individuals. So I encourage everyone to get vaccinated.”

Get more COVID-19 information from Mount Sinai

What You Need to Know About Heart Inflammation and the COVID-19 Vaccines

Updated on Jun 30, 2022 | Children's Health, COVID-19, Vaccines, Your Health

A woman talking to her young male patient in medical office

Researchers at the U.S. Centers for Disease Control and Prevention (CDC) are investigating a link between COVID-19 vaccines from Pfizer-BioNTech and Moderna and heart inflammation in young men and boys.

Kristin Oliver, MD, MHS, a pediatrician and preventive medicine physician at the Mount Sinai Health System and an Assistant Professor of Pediatrics, and Environmental Medicine and Public Health, at the Icahn School of Medicine at Mount Sinai, explains what parents, guardians, and young adults need to know about this rare side effect.

What is the situation as you see it?

The COVID-19 mRNA vaccines from Pfizer-BioNTech and Moderna have been linked to cases of myocarditis, which is an inflammation of the heart, and pericarditis, which is inflammation of the sac-like covering around the heart. Myocarditis and pericarditis can happen after an infection from different viruses, including SARS-CoV-2—the virus that causes COVID-19. They are more commonly seen in males.

How common is this side effect?

Myocarditis and pericarditis can be serious but, fortunately, these side effects to vaccination are very rare. While we don’t know the precise rate of these side effects in relation to COVID-19 vaccines, we do know that it is more commonly seen in men and boys and after the second dose of the vaccine. Signs of myocarditis and pericarditis tend to become visible within four days of the vaccine dose.

Keep in mind that as of July 2021, more than 52 million doses of the COVID-19 vaccines have been administered in the United States to people ages 30 or younger, and the CDC has only confirmed about 600 reports of myocarditis or pericarditis in connection with vaccination in this age group. The cases connected to receiving the COVID-19 vaccine have also been mild. So, the benefits of COVID-19 vaccination in this group still outweigh the risks of getting myocarditis from the vaccine.

What are the signs of myocarditis/pericarditis?

People with heart inflammation experience chest pains, difficulty breathing, heart palpitations, and excessive sweating. These symptoms may also be accompanied by stomach pain, dizziness, coughing, unexplained swelling, and even fainting. If a recently vaccinated person shows symptoms of myocarditis or pericarditis, they should seek medical attention.

The most common side effects from COVID-19 vaccination are pain at the injection site, fatigue, headache, fever, chills, muscle pain, or joint pain. These vaccination side effects can be managed with over-the-counter medication and rest.

What do you say to families who are concerned about this serious, but rare, side effect?

I’m honest with families when I talk about it, and I understand that it’s disappointing to learn about this connection. But because it happens so rarely and because COVID-19 infection can have serious consequences in adolescents and young adults, the benefits of vaccination still outweigh the risks.

In making any medical decision we are weighing the potential risks and benefits. Remember, the risks of COVID-19 infection in this age group are real and so are benefits of COVID-19 vaccination. Data from the CDC estimate that if we vaccinate one million males between the ages of 12 and 17, we will prevent: 5,700 cases of COVID-19, 215 hospitalizations, 71 ICU stays, and 2 deaths in this group.

But I always recommend that parents talk with their pediatrician about any concerns. Pediatricians know what’s important to you and your family and have lots of experience giving vaccines and answering these questions.

Get more COVID-19 vaccine information from Mount Sinai

Pandemic’s Toll on Mount Sinai Front-Line Staff Is Surveyed, and Addressed

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

Recharge rooms were created across the Health System in one of many initiatives informed by surveys of front-line staff.

Front-line staff who were already feeling burnout showed the most signs of mental distress during the height of the COVID-19 pandemic, while those who fared best had an active social network and felt supported by their supervisors. These were among the many lessons learned by a team of Mount Sinai researchers based on two surveys of front-line Mount Sinai staff in 2020.

“The main takeaway is what most people would expect—that if you’re involved in health care during a pandemic, it’s going to take its toll,” says Jonathan Ripp, MD, MPH, Dean for Well-Being and Resilience and Chief Wellness Officer at the Icahn School of Medicine at Mount Sinai. “But beyond that, we were able to identify what types of things may put you at greater or lesser risk of these mental health outcomes, and inform how we can try to mitigate them.”

The results were used in real time to develop programs to help Mount Sinai staff handle the pressures of the pandemic, Dr. Ripp says, and they are being shared with other institutions through journal publications and a Well-Being Toolkit developed by the Office of Well-Being and Resilience.

The three mental health outcomes studied were depression, anxiety, and post-traumatic stress disorder related to the COVID-19 pandemic. Among the more than 3,000 front-line staff members who responded to an initial survey in April and May 2020, 39 percent screened positive for at least one of these outcomes. The most significant factor predicting mental health symptoms was the presence of pre-pandemic burnout, according to studies published by the Mount Sinai team in The Journal of Clinical Psychiatry and Chronic Stress.

At the start of the pandemic, Mount Sinai focused on meeting the basic needs of front-line staff, such as providing free or subsidized food onsite.

“This means that if you already felt exhausted, fatigued, and detached from your work, you were more likely to develop these mental health symptoms during the pandemic,” says investigator Lauren Peccoralo, MD, MPH, Senior Associate Dean for Faculty Well-Being and Development, and Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai. The research team emphasized that burnout is distinct from other mental health issues in that it is more a function of the work environment, and can be remedied by strategies that support workers.

In the earliest days of the COVID-19 pandemic, the Office of Well-Being and Resilience assembled a group of researchers with backgrounds in psychology, psychiatry, survey design, and statistical analysis to examine its mental health consequences on the workforce, in an effort initiated by Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System.

The group sent surveys to more than 6,000 physicians, nurses, social workers, chaplains, and other front-line staff at The Mount Sinai Hospital during the height of the pandemic’s first wave in April and May 2020 and again seven months later. In the first survey, more than 3,000 respondents answered questions from three diagnostic series: the General Anxiety Disorder 7, the Personal Health Questionnaire 8, and the Post Traumatic Stress Disorder checklist. In the self-screening for depression, for example, about 26 percent of respondents reported that on more than half the days of the week, they felt such symptoms as taking little interest or pleasure in doing things, feeling hopeless, losing their appetite, having trouble staying or falling asleep, or difficulty concentrating.

The survey also asked open-ended questions about the respondents’ concerns. “There were a lot of infection-related worries. People were worried about PPE, about infecting colleagues or bringing COVID-19 home to their family members,” says Jordyn Feingold, MD, an investigator in the study, who graduated from Icahn Mount Sinai in May 2020 and is now a psychiatry resident. “There were worries about basic needs like getting food at work, and existential worries like ‘When is this going to end?’ and ‘When is life going to return back to normal?’”

The aid facilitated by the research team fell into three categories: providing basic needs like food and the proper personal protective equipment (PPE) and other materials; providing up-to-date information through channels including web sites and system-wide email broadcasts; and creating well-being spaces and onsite mental health and peer support to reduce the stress experienced by health care workers.

A Second Survey Finds an Increase in Burnout

The surveys also asked questions related to resilience, Dr. Ripp says. Specific factors that were found to be protective against mental health symptoms included getting enough sleep and exercise, having social emotional support, not using substances to cope, having sufficient PPE, and feeling supported by hospital leadership and valued by supervisors.

Simply feeling heard was also important, Dr. Feingold says. “Whether or not we have it in our control to fix all of these things right away,” she says, “just validating the concerns and letting people know that they’re not experiencing this in isolation, I think was really powerful.”

In the second survey, conducted from November 2020 to January 2021, more than 1,600 responded and of those, 786 staff provided follow-up responses on their mental health and well-being. The results indicate that mental health symptoms have declined, but the prevalence of burnout has increased, Dr. Peccoralo says. “We are still analyzing the data, but one thought is that the traumatic situation has largely gone away, but the work hasn’t. We’re all still working really hard, maybe even harder than we have ever worked before,” she says. “So we have to think about how we can tell if we are pushing people too much, and what we can do about it.”

The surveys have served an important role in helping Mount Sinai take care of its own, and in advancing knowledge of the mental health consequences of responding to a pandemic, Dr. Ripp says.

The needs identified in the surveys have informed the development of new initiatives, including the launch of the Center for Stress, Resilience, and Personal Growth, says its Clinical and Research Director, Jonathan DePierro, PhD, Assistant Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai. The Center is an innovative service supporting the resilience and psychological health of all Mount Sinai faculty, staff, and trainees through a series of evidence-based resilience workshops, a resilience-promoting app available for download on Sinai Central, ongoing outreach efforts, and up to 14 treatment sessions in its confidential faculty practice.

“Let’s hope that it’s a very long time before something like this pandemic happens again, but should it happen, I think the lessons that we’ve learned can apply,” Dr. Ripp says. “And then of course we can share those lessons, so that other institutions that haven’t had the opportunity to study this trajectory can learn from our experience.”