How Can I Tell the Difference Between Seasonal Allergies and COVID-19?

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

Today, every sniffle, every cough, and every sneeze are a cause for concern. “Do I have COVID-19?” races through our minds. Madeleine R. Schaberg, MD, Director of Rhinology and Endoscopic Surgery, Mount Sinai Downtown, helps you tell the difference between allergies and COVID-19.

How do the symptoms of seasonal allergies differ from COVID-19?

The main symptoms of allergic rhinitis or seasonal allergies are itchy, watery eyes, runny nose, nasal congestion, and sneezing, while the symptoms of COVID-19 are fever, cough, body aches, sore throat, and shortness of breath. Many symptomatic patients with COVID-19 will have a fever which, in an adult, is a temperature above 99°F.

Other symptoms of seasonal allergies include post-nasal drip, facial pressure and sinus headaches, and mild fatigue. We generally do not see a significant amount of coughing with seasonal allergies, except in patients with significant post-nasal drip or allergy associated asthma. Sneezing is generally a prominent feature of seasonal allergies, but it has not been reported with COVID-19, although it may happen occasionally.

In general, the key differentiating factors between COVID-19 and allergies are fever and body aches (malaise). Typically, you do not see either symptom in allergy sufferers. While you may see some mild fatigue with allergies, the fatigue we are seeing with COVID-19 is more extreme.

Are there other symptoms that may indicate COVID-19?

Yes, in addition to cough and fever, many patients will experience a loss of smell (anosmia). We don’t typically see a loss of smell with seasonal allergies, unless patients have significant congestion of the nasal passages or have polyps blocking their nasal passages. The loss of smell that is associated with COVID-19 is thought to be due to direct damage to the olfactory nerve and specialized olfactory neuroepithelium.

It’s also worth noting that, for most people, COVID-19 is an acute illness. Patients will develop symptoms between 2 to 14 days after being exposed to the virus. Those symptoms will then last 10 to 14 days. Although symptoms may differ from person to person, they will appear in most people within the 14-day exposure window. This is true whether you have a moderate case or a severe case.

Allergies are more of a chronic issue. They will generally manifest as mild symptoms and last for the allergy season, which is typically from April to mid-June.  Compared to COVID-19, seasonal allergies, as well as allergies that occur perennially, have a much longer time course. In addition, patients will often be familiar with their typical seasonal allergy symptoms, as they often will be similar each spring.

What is the treatment for allergies?

For allergies, the first line of treatment is over-the-counter antihistamines. The main inflammatory mediator of seasonal allergies is histamine. This would include such medications as, cetirizine, loratadine, fexofenadine, and levocetirizine. There are also many over-the-counter steroid nasal sprays, which are extremely effective for allergy relief, such as budesonide, fluticasone, and triamcinolone.

If patients don’t get relief with over-the-counter medication, then an appointment with a rhinologist would be appropriate to explore possible prescription medication.

There are many prescription medications that can be extremely helpful.

I’m unsure if I am suffering from allergies or COVID-19. What should I do?

If you are experiencing mild symptoms that you are concerned may be COVID-19, there are a number of testing options available.

In-person testing is available at all Mount Sinai Urgent Care locations for walk-in or scheduled appointment.

You can also have your symptoms assessed virtually throughout Mount Sinai Urgent Care. Physicians are available for online consultations, video calls, and via text from your mobile device. Additionally, you can contact your Mount Sinai primary care physician or use Mount Sinai’s Express Online Consult Click4Care to receive virtual assessment of your symptoms.

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I’m Young and Healthy. Why Should I Get the COVID-19 Vaccine?

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

States are moving quickly to enable more people to be eligible for the COVID-19 vaccines. In New York, for example, those 16 and older are now eligible. But many young adults may believe they do not need to get vaccinated.

In this Q&A, Michelle Cespedes, MD, MS, an infectious disease specialist at Mount Sinai who has treated many patients with COVID-19, explains that young people should get the vaccine to limit the spread of the disease, especially new variants; to avoid potential long-term complications for themselves; and to protect others, especially older family members, relatives, and friends. Dr. Cespedes is also an Associate Professor of Medicine at the Icahn School of Medicine at Mount Sinai.

Should young people worry about becoming infected with COVID-19?

This is a question I hear often these days. A lot of people think that because they’re young, they probably won’t get COVID-19. And even if they do, the reasoning goes, they won’t get a bad case. There are data that suggest younger people might not get as sick with the coronavirus as older people. They might be less likely to need hospitalization. But that doesn’t mean young people can’t get COVID-19 and potentially spread it on to other family members. This is especially important to remember when you think about visiting family members around the holidays. We saw that huge spike in cases last year right after Thanksgiving and Christmas. We’d like to avoid a repeat of that.

Is it true that if I get a mild case of COVID-19, it’s nothing to be concerned about?

It is true that young people might not get as sick as the elderly. But that doesn’t mean COVID-19 has no effect on you. Even people who had a mild case may experience long-term effects. Evidence suggests that COVID-19, like any other virus that causes inflammation, can affect the lungs, the nerves to the brain, and even the brain itself. For instance, the loss of taste or smell suggests inflammation in the nerves that control the ability to taste or smell.

Another common side effect is what we call brain fog, which is not a distinct medical or scientific term used regularly by medical professionals. Brain fog describes a collection of symptoms related to changes in thinking and memory. Patients who have had COVID-19 sometimes report that their thinking is sluggish or not sharp, often with poor memory, recall, or attention span. It can be best described as the sense that “I came into this room for something, but I can’t remember what.” While brain fog won’t land you in the hospital, it can last for many months.

Additionally, according to a study conducted by researchers at the Icahn School of Medicine at Mount Sinai and the Naval Medical Research Center, past COVID-19 infection does not fully protect young people against reinfection. The study found that reinfection was quite common amount young healthy adults, making it even more important for them to get vaccinated in order to prevent reinfection, boost their immune responses, and reduce transmission.

How does my getting the vaccine help other people?

When you get vaccinated, it means you likely cannot get the virus, which means it won’t make you sick—and you won’t pass it onto anyone else. In addition to protecting yourself, the vaccine also helps the larger community. If there are fewer targets for the virus to jump to, fewer people will get sick. And that means there will be less chance for more virulent variants to develop. Getting the vaccine is an act of love for your friends and family and the larger community.

 

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Mount Sinai Employees Reflect as a Community One Year into the Pandemic

Mar 16, 2021 | Community, COVID-19, Featured

On Thursday, March 11, 2021, Mount Sinai Health System employees marked one year since the World Health Organization declared COVID-19 a pandemic with a day of reflection.

Across Mount Sinai, at 10:30 am, 4:30 pm, and 11:30 pm, employees paused to reflect on everything they have experienced this last year—the loss of loved ones and cherished colleagues, the struggles that have helped them grow, the ways our world has changed, the means by which they find resilience, and the moments and people for whom they are grateful. Sharing this moment together allowed members of the Mount Sinai community to acknowledge where they have been, how they feel today, and how they will move forward together.

Employees at Mount Sinai Queens gathered outside to share the moment together while the Rev. Rachelle Zazzu, DDS, read a blessing and eloquently stated, “One year ago, COVID-19 changed the world. We could suddenly see the top of the tallest mountains, but not our friends and our family. And it changed us forever.”

At Mount Sinai Beth Israel, New York Eye and Ear Infirmary of Mount Sinai, and many of the surrounding ambulatory sites, leaders, chaplains, and wellness committee members rounded on all three shifts over a 24-hour period. They brought LED tea lights and sticky notes to work areas and invited staff to remember and reflect. Many expressed appreciation for the opportunity to participate. Recurrent themes included sadness about loved ones lost to COVID-19, hope about the approaching end of the pandemic, and pride in their “work families.”

The Mount Sinai Hospital, Mount Sinai-Union Square, and other ambulatory locations collected notes of resilience and loss in a central location with tea lights for the community to view and experience collectively. Many sites also shared information on Mount Sinai’s employee wellness resources.

“We had quite a bit of patient participation and a lot of valuable conversations about what people have endured in the past year, whom they have lost, and what they are grateful for,” said Lititia Satpathy, Project Manager, who organized the event at Mount Sinai-Union Square. “Hosting the event in the atrium attracted a lot of attention toward the table, and even if people did not choose to write a note or light a candle, almost everyone acknowledged the meaning behind this important day.”

Like the rest of the world, the Mount Sinai community has experienced immeasurable loss and sacrifice on an individual and community level. And yet, through groundbreaking innovation, an unwavering commitment to our patients, and exceptional agility and teamwork, Mount Sinai employees have saved thousands of lives and have vaccinated tens of thousands of people, bringing us closer as a community and closer to the end of this pandemic.

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Should You Get the COVID-19 Vaccine If You Are Pregnant?

Updated on Jun 30, 2022 | BFWHRI, COVID-19, Featured, OB/GYN, Vaccines, Women's Health

If you’re pregnant, you likely have a lot of questions about whether it’s safe for you and your baby to receive a vaccine against COVID-19. In this Q&A, Jill Berkin, MD, Assistant Professor of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, draws on her vast experience as a high-risk obstetrician—as well as her own pregnancy—to offer her perspectives on side effects, vaccines and breastfeeding, and how to decide if vaccination feels right for you.

“Pregnant women should weigh their personal risks of coronavirus exposure against their tolerance of the unknown regarding vaccination,” says Dr. Berkin, who received two COVID-19 vaccine shots during her second trimester of pregnancy. “Right now our information is limited, but all the information we do have suggests that COVID-19 vaccines are safe in pregnancy.” She suggests those with specific questions about their own situation consult with their health care providers.

Why did you get the COVID-19 vaccine?

 As a high-risk obstetrician I saw firsthand how pregnant women were affected by COVID-19. I also thought about my day-to-day exposure to the coronavirus through my work. I was more concerned about the known risks of infection than the unknown risks of vaccination, so my decision was easy.

Jill Berkin, MD

In general, do you think other pregnant women should get the vaccine and why?

It’s really important for pregnant women to realize that we don’t have data saying the vaccine is unsafe during pregnancy. Even though our data are limited, all of it points to the fact that vaccination is safe, and we don’t see any side effects specifically impacting the pregnancy itself. We haven’t seen any harm among women who were pregnant after receiving the vaccine in clinical trials.

In addition, each individual pregnant woman has to evaluate her own potential risk for exposure just like I did for myself. As a health care worker my exposures were great, so they outweighed any fears of the unknown with the vaccine. And of course, people who are pregnant may want to consult their own physicians for advice as well.

What are the risks and complications of COVID-19 and pregnancy?

Most pregnant women infected with the coronavirus will have symptoms similar to those who are not pregnant. The vast majority of pregnant women affected are asymptomatic. A large portion of the population has symptoms similar to a cold or flu, including muscle aches and fever. Then there’s a small portion of the population that has more severe disease that might require hospitalization. The data we have now comparing pregnant individuals to non-pregnant individuals shows that symptomatic pregnant women do have a slightly higher risk of a hospital admission, ICU admission, and even mechanical ventilation, but there’s no increased risk of mortality.

Would you say then that pregnant women are at higher risk of developing severe COVID-19?

While it’s hard to fully analyze, the data suggests that pregnant women are at increased risk for developing severe complications of COVID-19. But we have to remind ourselves that in general, pregnant women who become ill are more likely to present to their physicians than women of the same age who are not pregnant, and that’s because you see a doctor more often when you’re expecting. Doctors will also be biased towards admitting women who are pregnant and keeping a closer eye on them because there are two patients at stake.

For those getting the COVID-19 vaccine, what are some side effects to be expected?

The most common side effect that people report is soreness in the arm, similar to a lot of other vaccines. Afterwards some patients might experience mild cold- or flu-like symptoms for about 24 hours. This seems to happen more frequently with the second dose, which is three or four weeks after the first dose. Pregnant women, along with the rest of the population, can take pain relievers such as Tylenol after their vaccine shots to help alleviate some of those symptoms.

Do you think there’s an optimal time for receiving the vaccine during pregnancy?

We don’t have any research to suggest that there is an unsafe time to vaccinate during pregnancy. However, pregnant women might consider not receiving the vaccine during the first trimester. This is only because in general we avoid medical interventions in the first trimester, which is the period of “organogenesis” when the baby’s organs are forming. We don’t have data suggesting there are any negative effects of the vaccine on organ systems. But because we are dealing with a lack of information regarding COVID-19 vaccines and pregnancy—and out of an abundance of caution—perhaps delaying vaccination until the second or third trimester, if possible, could be beneficial.

What do you recommend about vaccination during breastfeeding?              

The vaccine certainly has no risks, and only potential benefits. We know that one of the most wonderful things about breastfeeding is that women pass antibodies through their breast milk to their babies. We don’t have much information specifically about antibodies created from COVID-19 vaccination being passed through breast milk. But we do have encouraging data about women who were infected with coronavirus itself forming antibodies and passing those antibodies along through the placenta and through breast milk. So the benefit of being able to protect children against coronavirus when a vaccine is not currently available to children is a remarkable thing and a unique advantage of being a lactating mom.

Luciana Vieira, MD, who conducted the Q&A, is an assistant Clinical Prof of OB/Gyn and Reproductive Science at ISMMS and the Blavatnik Family Women’s Health Research Institute Scholar for 2020-2021. Dr. Vieira has been integral in creating a perinatal database to collect/analyze data on maternal + neonatal outcomes within Mount Sinai Health to improve care.

 

 

 

 

 

 

Read more about what Mount Sinai experts say about vaccines

Vaccines, Variants, and Measured Expectations—A Question and Answer Session with Judith A. Aberg, MD, a Leader in Infectious Diseases at Mount Sinai

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

Judith A. Aberg, MD

Several worrisome new variants of SARS-CoV-2, the virus that causes COVID-19, have been detected within the United States since the COVID-19 vaccine rollout began in December, raising concerns about the nation’s ability to return to normal in 2021. Chief among these concerns is whether the national effort to vaccinate as many Americans as possible—and as quickly as possible—will be able to offset the virus’s enhanced ability to spread. At the heart of that question lies another: Will the authorized vaccines from Moderna, Inc., Pfizer/BioNTech, and Johnson & Johnson offer adequate protection against these new variants?

To answer these questions and more, Mount Sinai Today recently turned to Judith A. Aberg, MD, Dean of System Operations for Clinical Sciences, and Chief of the Division of Infectious Diseases, at the Icahn School of Medicine at Mount Sinai. Dr. Aberg, the Dr. George Baehr Professor of Clinical Medicine, leads the Mount Sinai Health System’s COVID-19 treatment and vaccine clinical trial efforts.

“We have to be clear that we are in unknown territory,” she says. “Every day we are learning something new. Individuals must have a realistic view of the immediate future and continue doing what we know works best: get vaccinated, wear masks, and practice social distancing—even after they are fully vaccinated.”

Do the vaccines from Moderna and Pfizer/BioNTech protect us from the new variants?

Dr. Aberg: At this time no one has sufficient data to really provide us with a definitive answer. We have indications from both Moderna and Pfizer/BioNTech that their vaccines produce enough effective antibodies to overcome the variants, but people may still become mildly ill from the variants although not severely ill. Both companies have also mentioned they are looking into making modifications to their vaccines, so there is the likelihood we will see them introduce booster shots in the coming months that may be more effective against new variants.

How effective is the Johnson & Johnson (J&J) vaccine that was just authorized by the Food and Drug Administration?

Dr. Aberg: I am very encouraged about the J&J vaccine, which is a single dose. We ran clinical trials at two of our hospitals, Mount Sinai Queens and Mount Sinai Brooklyn. In the United States, J&J found the vaccine was 72 percent effective. When they tested it in Brazil and South Africa—where new variants are widely circulating—the  company found there were no deaths and it prevented people from developing severe disease. J&J is also looking into creating a booster dose and I imagine it will be very beneficial.

Will these variants prevent us from beating this pandemic?

Dr. Aberg: I suspect there are going to be more variants and we’re going to have to deal with them. Viruses want to live and they keep reproducing and mutating—whether it’s the human immunodeficiency virus (HIV), which causes AIDS, or the influenza virus, which develops different strains. Each year when I get the flu vaccine I hope that I won’t get the flu. There is still a chance, but the flu vaccine probably prevents me from developing a severe case.

With SARS-CoV-2, which causes COVID-19, you have variants. And until we have more data on vaccine durability and efficacy against the variants we’re going to have to do what we’re doing now. Vaccinated individuals should still follow safe practices but can feel some reassurance. And for those who aren’t yet vaccinated, don’t delay in getting whichever vaccine becomes available to you.

Is it okay to mix vaccines for the first and second doses or take more than one vaccine?

Dr. Aberg: Do not mix vaccines. Finish two doses of the same vaccine or, for Johnson & Johnson, take only the single dose. We do not know if the antibody response you get to one vaccine will impair your immune response to the other vaccine. Each vaccine, even Moderna’s and Pfizer/BioNTech’s, which are based on the same mRNA technology, is different enough.

Should vaccinated individuals test their antibody levels to make sure they are protected?

Dr. Aberg: No, we do not advise this. It is not informative. First, the vast majority of commercial antibody tests do not measure the antibodies you get from vaccines—they measure the antibodies you get from having COVID-19. These commercial serology results are not designed to detect immune response to the vaccine. There are tests that look for antibodies against the N protein or nucleocapsid. This is not coded for by the vaccine and will only inform about prior infection—nothing about your response to the vaccine. Second, the vaccine manufacturers have not reported what the antibody levels should be if you were to get a test that detects the S protein or spike, which is what the vaccines make antibodies against. We only know that people who were vaccinated had tremendous efficacy against getting COVID-19, and it may be irrespective of what their antibody levels are. There is more to immunity than just antibody production.

Do you recommend COVID-19 vaccinations for individuals who are immune-compromised?

Dr. Aberg: We do not have enough data to tell patients with compromised immune systems or who are on chemotherapies whether or not the vaccines are going to be effective for them. We are not saying they shouldn’t get vaccinated, we just don’t have enough data to determine how much protection they would receive. At Mount Sinai, we are involved in clinical testing of a hyperimmune globulin therapy—a purified, highly concentrated product of antibodies derived from antibody-rich plasma of people who have been infected by COVID-19 and recovered—which may benefit this population whose immune systems are impaired and cannot produce antibodies.

What is your advice for individuals who have been fully vaccinated?

Dr. Aberg: These vaccines are a very important part of our prevention toolbox. We cannot rely on just one thing. We don’t want to set expectations that you’re not going to get COVID-19, but the vaccines decrease your chances of getting really sick or being hospitalized. So until the virus is under better control and we do not see such a high incidence anymore, we still need to be careful. Don’t engage in magical thinking. I hear people say, “Now that I’m vaccinated I can go and do this and that.” And I say, “No, not really.” Everything in moderation.

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Young, Asymptomatic People Can Get Reinfected With COVID-19 and Spread it More Than Once, Study Shows

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

A prospective study of 3,249 Marine recruits—who were mostly male and between the ages of 18 and 20—shows a significant risk of reinfection among those who have antibodies to SARS-CoV-2, the virus that leads to COVID-19.

The study, posted on MedRxiv, was led by researchers at the Icahn School of Medicine at Mount Sinai working with the Naval Medical Research Center. It found that the risk of reinfection in those with antibodies was 18 percent of the risk of infection in those without antibodies. Most of the reinfected Marines were asymptomatic, and none required hospitalization. The infections were detected by PCR tests.

The findings support the importance of vaccinating all segments of the population, including individuals who have SARS-CoV-2 antibodies but were never actually diagnosed with COVID-19, and those who were diagnosed, recovered, and think they are now safe from another infection. The study also points to the fact that young people, who are typically asymptomatic, may unknowingly spread the disease to others more than once.

“It is important that we don’t neglect this college-age group of the population,” says the study’s lead author, Stuart Sealfon, MD, the Sara B. and Seth M. Glickenhaus Professor of Neurology, Neuroscience, and Pharmacology and Systems Therapeutics at Icahn Mount Sinai. “They are such an important group in spreading the disease. Many young people have this ‘get it and get over it mentality’ and unfortunately they still have a surprisingly high risk of recontracting it and possibly spreading the virus to others.”

The six-week study was highly controlled. It involved two separate periods of quarantine and multiple tests for COVID-19 before the recruits entered basic training at Marine Corps Recruit Depot, Parris Island, in South Carolina. The study found that among those with antibodies, the reinfected individuals had lower antibody levels and more often lacked detectable levels of the virus-neutralizing antibody activity that blocks infection.

According to Dr. Sealfon, the findings should help resolve any concerns over whether people who have already had COVID-19 should receive the vaccine, particularly in light of current vaccine shortages.

Stuart Sealfon, MD,

“That’s an important take-home message,” says Dr. Sealfon. “Certainly we can show from this study that there’s a fairly high risk of reinfection and not everybody who has had infection will generate effective immunity. So you really want to vaccinate everyone and not worry if they’ve had it or not.”

Why some people fail to generate persistent immunity against reinfection from COVID-19 remains unknown. But highly variable responses to any disease are actually beneficial for evolution.

“When a new disease shows up, individual immune responses are variable to ensure survival at a population level,” says Dr. Sealfon. “People have different genetics that make up their immune systems. They have different previous exposure histories that train the immune system in how to respond to new infections. Immunity uses combinatorial systems to hedge its bets to try and generate the best response it can within an individual and to vary what’s happening across individuals. As a result of individual differences, some people generate more effective long-term immune responses than others.”

In the November 11, 2020, issue of The New England Journal of Medicine, Dr. Sealfon published an earlier study of these marine recruits during their initial supervised quarantine period. He showed that strict public health measures including wearing face masks, social distancing, hand washing, and widespread testing did not completely suppress transmission of SARS-CoV-2.

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