It has been three years since COVID-19 was declared a pandemic on March 11, 2020, by the World Health Organization. With New York City as an early epicenter, residents were hit hard. But from that experience, health care providers and researchers across the city found the opportunity to learn more about the virus and how to prepare for future pandemics.
Today, the city’s level of community transmission of COVID-19 is considered low, and the percentage of people who have completed their primary series of COVID-19 vaccinations is relatively high, according to the Centers for Disease Control and Prevention (CDC). Similarly, hospitalization and mortality rates from COVID-19 remained low in recent months, compared to the period between 2020 and 2022.
Bernard Camins, MD
These factors mean that New Yorkers can probably afford to relax their vigilance compared to previous years, notes Bernard Camins, MD, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and Medical Director for Infection Prevention at the Mount Sinai Health System.
“We have come a long way. However, we still need to monitor how COVID-19 is affecting those who are at high risk of complications.”
Bernard Camins, MD
Who should remain vigilant?
Vulnerable groups include those who are immunocompromised, and those aged 50 and older, even if they’ve been vaccinated for COVID-19. People with certain underlying medical conditions, such as cancer; chronic kidney, lung, or liver disease; dementia; diabetes; heart conditions, or obesity are also considered at heightened risk.
For younger or healthy individuals, having COVID-19 these days might involve cold-like or mild symptoms, says Judith Aberg, MD, Chief of Infectious Diseases for the Mount Sinai Health System and Dr. George Baehr Professor of Clinical Medicine at the Icahn Mount Sinai. But vulnerable populations are at risk for developing severe disease, she adds. This includes hospitalization, needing intensive care, requiring a ventilator to breathe, or even death.
For at-risk groups, masking is recommended, as is avoiding large indoor gatherings. People planning to be organ donors should also remain vigilant for signs and symptoms of COVID-19, as an active infection could complicate one’s ability to donate, Dr. Aberg says.
“Also, people seem to have forgotten about hand hygiene; that is still important,” she notes.
What protection measures are available today?
With the federal Test to Treat initiative in place nationwide since 2022, symptomatic individuals who test positive for COVID-19 at testing sites can receive antiviral treatment, such as Paxlovid, on the spot.
“Taking Paxlovid provides that extra protection from developing complications, and the sooner it is taken, the better,” says Dr. Camins. Patients are recommended to receive antiviral treatment within five days of developing symptoms.
“One mistake people make with antivirals is that they wait to see if they feel better or worse before seeking treatment.”
Judith Aberg, MD
“If you’re a senior citizen, or have any of the underlying health conditions, when you test positive and have any symptoms, go seek treatment immediately. Do not wait,” says Dr. Aberg.
All individuals, and especially vulnerable populations, should stay up to date with COVID-19 vaccines, including the bivalent boosters, which are authorized for those ages 5 and older. “However, among people who were recommended to receive the bivalent booster, very few of them did,” Dr. Camins points out. “It seems many people have moved on regarding the pandemic before we really should.”
Judith Aberg, MD
According to the CDC, 17 percent of the U.S. population ages 5 and up have received the updated booster. In New York, that number is 18 percent.
Data have shown that the updated boosters either prevented infection or reduced the possibility of developing severe disease in people who received them. Another possible benefit of keeping up to date with vaccination is that it might prevent new variants from being as deadly as previous strains, Dr. Aberg says.
Will we need annual boosters?
Just as the bivalent boosters were updated to protect against current circulating variants and strains of SARS-CoV-2, the virus that causes COVID-19, researchers and officials are monitoring how the pathogen continues to evolve. Most of the scientific and medical community believe that the virus is headed in the direction of becoming endemic, or regularly occurring, Dr. Aberg says. “However, the jury is still out on whether annual updated boosters will be necessary,” she adds.
Neither the Food and Drug Administration nor the CDC has made any determinations on recommending annual COVID-19 shots, unlike what they have done with the flu. The data on COVID-19 collected over the recent winter could provide clarity on whether another shot might be needed this fall, says Dr. Aberg.
There are other seasonal coronaviruses and rhinoviruses that cause respiratory infections that do not require annual boosters. “It’s hard to predict whether the virus will take another turn to cause more morbidity or mortality. We’ll have to wait to see what the data shows us,” Dr. Aberg says.
What other things about COVID-19 should we be aware of?
The public health emergency declaration, which has been in place since 2020, will come to an end on Thursday, May 11, 2023. This might have implications regarding cost sharing or coverage regarding various COVID-19-related services, such as testing, treatment, or vaccinations. This might mean some services will no longer be free or will start requiring copays, depending on the insurance.
While the New York State Department of Health has not released any guidance on cost impacts, providers need to inform their patients and communities to follow up with their insurance companies and be aware of possible coverage changes, Dr. Aberg says.
“People need to be informed about potential costs before seeking COVID-19 care,” Dr. Aberg notes. “But on the other hand, we don’t want people to avoid seeking help because of cost.” If a patient experiences troubling symptoms, such as shortness of breath or fever, they should see a primary care doctor or go to the emergency room, she adds.
The medical and science community is also closer to understanding post-acute sequelae of COVID-19, or the condition colloquially known as “long COVID.”
Anyone who is infected with COVID-19 has a risk of going on to develop long COVID, in which individuals experience symptoms that persist beyond three months after the acute phase. An estimated 1 in 13 adults in the United States have long COVID, according to the CDC.
“We’re starting to zero in on specific biomarkers for people with long COVID,” says David Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System. These include platelet hyperactivation, microclots, immune dysfunction, and microbiome dysfunction.
“We are getting the science to a place where we may finally be able to identify this condition objectively.”
David Putrino, PhD
David Putrino, PhD
This has allowed providers to be better educated about the sorts of things that could cause long COVID symptoms to flare up, Dr. Putrino says. The availability of objective biomarkers also means the ability to start testing therapeutics to treat long COVID.
“A year ago, I would have thrown my hands in the air and said there were no good drug trials for long COVID,” Dr. Putrino says. “Now, I feel a little confident that we can start promising patients that these trials are on the horizon.”
“We’re getting close to getting therapeutics to prescribe. I’m hoping that will be a reality over the next two years or so,” Dr. Putrino says.
While COVID-19 community transmission, mortality, and hospitalization rates have come down across the country in recent months, the efforts to understand more about SARS-CoV-2, the virus responsible for COVID-19, continue at full speed. “The energy is still robust,” says Judith Aberg, MD, Chief of Infectious Diseases for the Mount Sinai Health System and Dr. George Baehr Professor of Clinical Medicine at the Icahn School of Medicine at Mount Sinai.
Judith Aberg, MD
Much research progress has been made since COVID-19 was declared a pandemic by the World Health Organization on March 11, 2020, but more work remains to be done.
“At all levels, from academic institutions to federal agencies, resources are still being poured into studying COVID-19 and this level of dedication is unlikely to go away anytime soon.”
Judith Aberg, MD
“It is precisely because, as a community, we have put so much effort into studying COVID-19 that we were able to learn so much about the virus and come up with vaccines and therapeutics at an unprecedented pace,” says Miriam Merad, MD, PhD, Director of the Marc and Jennifer Lipschultz Precision Immunology Institute, and Mount Sinai Professor in Cancer Immunology.
How has COVID-19 knowledge grown over the years?
A recent breakthrough was learning why COVID-19 affects older people more severely than children, says Dr. Merad. In many other respiratory diseases, such as influenza, typically both very young and very old people are most susceptible to complications.
“One of the biggest factors we’ve discovered is that age affects innate immune response,” she says. Older individuals are more likely to have a defective response in which their type I interferon activity is less likely to mount an antiviral or anti-inflammatory response, she adds.
Understanding the links of age to inflammatory response had also been a big piece in solving the COVID-19 puzzle, Dr. Merad says.
“It appears that SARS-CoV-2 might not be directly destroying organs. Rather, pathogenic-led inflammation might be doing so instead.”
Miriam Merad, MD, PhD
While SARS-CoV-2 is in the class of coronaviruses, very little was known about its specific pathophysiology, how it infects cells and induces injury, and how the host can control the virus. The scientific community has made inroads into these fields over the past year, especially in recent months, Dr. Merad notes.
Miriam Merad, MD, PhD
At the start of the pandemic, there were also no objective biomarkers to characterize the disease. Today, researchers have identified various measures, including platelet hyperactivations, microclots, and immune and microbiome dysfunction, as ways to analyze the impacts of COVID-19 on the body, especially for post-acute sequelae of COVID-19, the condition colloquially known “long COVID.”
“It’s really bleeding-edge,” says David Putrino, PhD, Director of Rehabilitation Innovation at the Mount Sinai Health System. “It has really coalesced over time, and has taken two years before impressive articles were coming out about meaningful biomarkers.”
How had COVID-19 research been challenging?
“It is really difficult to do research in the middle of a pandemic,” recalls Dr. Merad. With measures in place to keep staff safe from infection, as well as prevent lab leaks, it became challenging to develop animal models. Additionally, given that COVID-19 was a new disease, there were few good models to start with, she adds.
Barriers to knowledge, tools, or resources also made studying COVID-19 an uphill task. As the disease has symptoms that span multiple specialties, including neurology, immunology, pulmonology, cardiology, and more, an effective effort into studying the pathogen required broad capabilities.
David Putrino, PhD
“I’m a neuroscientist, focusing on electrophysiology of the brain, and had a set of tools I was comfortable using,” says Dr. Putrino. “But along came COVID-19 and suddenly I had to become an expert on immune physiology, on drawing blood, and running a wet lab.”
“Collaboration became necessary, especially with people outside our usual fields.”
David Putrino, PhD
“While I feel fortunate that I’m in a position from a funding and career standpoint that can support my needs for long COVID research, many others aren’t as fortunate to develop those skill sets,” Dr. Putrino says. The reality of many scientists needing to keep their labs running and applying for grants could mean it was easier to relegate COVID-19 research to someone else, he adds.
The nascent field of COVID-19 research, especially for long COVID, means the scientific community is still divided on various definitions. But with the pandemic dying down, researchers are able to communicate and collaborate more effectively across the country on standards and definitions when it comes to conducting research or collecting data, especially as scientific conferences return in full force, Dr. Merad says.
What are some things we still don’t know about COVID-19?
On the clinical side, it is not clear for hospitalized patients what are the best immune modulating therapies or strategies. “When should we start combination immune modulating therapies? Are antivirals effective in patients on high flow oxygen if they still are shedding virus?” says Dr. Aberg. “We are still trying to optimize modalities.”
New treatments for COVID-19, including antiviral drugs such as Paxlovid, are now available to help reduce the likeliness of developing severe disease. But some shortfalls remain.
“For example, Paxlovid has significant drug-to-drug interactions and not everyone can take that,” notes Dr. Aberg. “We’re still learning how to be able to manage those who are immunocompromised and are experiencing persistent viral shedding.”
Some of the monoclonal antibody treatments that had been developed for COVID-19 and had shown efficacy earlier in the pandemic have since become less effective against current circulating variants. “We need to develop tools for rapid sequencing of virus to detect which variant is causing disease while simultaneously having available active antibody therapies. We hope that future anti-SARS-CoV-2 monoclonal antibodies will be effective to treat and prevent COVID-19, especially for those who are immunocompromised,” Dr. Aberg says.
In basic science, many questions about viral pathophysiology remain unanswered, especially with regards to how it affects coagulation, thrombosis, and inflammation, says Dr. Merad. Even with the success of COVID-19 vaccines at reducing infection incidence and severity, people still can still be infected, and it is not clear why that is so, she adds.
What is the current state of COVID-19 research and where is it headed?
Clinicians are looking at whether they can combine different treatment modalities, especially for immunocompromised patients, says Dr. Aberg.
The National Institutes of Health is still conducting its efforts through the networks the agency has formed during the pandemic, and is conducting multicenter clinical trials, Dr. Aberg points out. It has preserved its expedited pipeline for testing novel therapeutics, including the use of “adaptive platform studies,” where new investigative agents could use an adapted template without the need for developing a new protocol from scratch.
Long COVID clinical trials are coming down the pipeline, says Dr. Putrino. A trial to test the use of Paxlovid for treating long COVID has received an Institutional Review Board approval from the Food and Drug Administration, making it one of the first of its kind for a targeted treatment of the condition, he notes.
The discovery of objective biomarkers will also pave the way for new drugs to be developed for long COVID, or for existing treatments to be explored, says Dr. Putrino.
These biomarkers could also be leveraged for uses beyond COVID-19. “The pandemic made us realize how we have few assays to measure our immune fitness to tell us whether someone can be susceptible to disease,” says Dr. Merad. Immune biomarkers could be used to develop assays to measure whether an individual could mount a good immune response, perhaps to vaccination, or just in general. “Can we build novel tools to measure our immune fitness, in the same way we can measure our blood sugar?” she questions.
It is undeniable that clinicians and researchers are committed to COVID-19 research, says Dr. Merad. “That’s what we’re fighting for,” she says. “We’re talking to everyone—industry partners, government entities—on the need for continued effort, and everyone is on board.”
Here are Some COVID-19 Research Milestones at Mount Sinai
2022
Dec 8: Mount Sinai researchers published one of the first studies about changes in blood gene expression during COVID-19 being linked to long COVID
Aug 9: Mount Sinai launched CastleVax, a clinical-stage vaccine research and development company, whose capabilities can be leveraged to tackle SARS-CoV-2
June 28: Mount Sinai-led team showed immune particles derived from the blood of a llama could provide strong protection against every COVID-19 variant
June 14: Mount Sinai researchers have developed a rapid blood assay that measures the magnitude and duration of someone’s immunity to SARS-CoV-2
Mar 31: Faculty from the Icahn School of Medicine at Mount Sinai play key roles in the SAVE program, established by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health (NIH)
Mar 21: Clinical investigators at the Icahn Mount Sinai launched a Phase 1, open-label, placebo-controlled study to evaluate the safety and immunogenicity of an egg-based COVID-19 vaccine in healthy, vaccinated adults who have never been infected with COVID-19
2021
Nov 29: Icahn Mount Sinai served as a hub site for two cohort studies as part of nationwide health consortium study by NIH on the long-term effects of SARS-CoV-2
May 25: Mount Sinai and the Pershing Square Foundation expanded a saliva-based COVID-19 testing program
April 5: Mount Sinai launched the Mount Sinai COVID-19 PCR Saliva Testing program for businesses and leisure activities in New York
Jan 27: Mount Sinai researchers demonstrated using a machine learning technique called “federated learning” to examine electronic health records to better predict how COVID-19 patients will progress
Jan 27: Scientists at University of California, San Francisco, and the Department of Microbiology at Icahn Mount Sinai reported data showing the promise and potential of Aplidin® (plitidepsin), a drug approved by the Australian Regulatory Agency for the treatment of multiple myeloma, against SARS-CoV-2
2020
Dec 29: Emergent BioSolutions and Mount Sinai initiated a clinical program to evaluate COVID-19 Human Hyperimmune Globulin product candidate in the first of two Phase 1 studies for potential post-exposure prophylaxis in individuals at high risk of exposure to SARS-CoV-2
Sept 17: The Clinical Laboratories of The Mount Sinai Hospital has received emergency use authorization from the New York State Department of Health for quantitative use of Mount Sinai’s COVID-19 antibody test
June 17: Mount Sinai submitted a request to the U.S. Food and Drug Administration (FDA) for issuance of an emergency use authorization for quantitative use of its serologic test
May 14: Mount Sinai established the Institute for Health Equity Research to understand the effects of health issues including COVID-19
April 15: Mount Sinai Laboratory, Center for Clinical Laboratories received emergency use authorization from the UFDA for an antibody test
April 3: Mount Sinai developed a new remote monitoring platform to help health care providers care for COVID-19 patients who are recovering at home
April 1: Scientists, physicians, and engineers at Mount Sinai launched STOP COVID NYC, a web-based app to capture the symptoms and spread of COVID-19 in New York City
The FREEDOM trial was initiated and led by Valentin Fuster, MD, PhD, President of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.
An international trial led by Mount Sinai found that high-dose anticoagulation can reduce deaths by 30 percent and intubations by 25 percent in hospitalized COVID-19 patients who are not critically ill, when compared to the standard treatment, which is low-dose anticoagulation. The innovative FREEDOM trial was initiated and led by Valentin Fuster, MD, PhD, President of Mount Sinai Heart and Physician-in-Chief of The Mount Sinai Hospital.
The study results were announced Monday, March 6, in a late-breaking clinical trial presentation at the scientific sessions of the American College of Cardiology Together With World Congress of Cardiology (ACC.23/WCC) in New Orleans and simultaneously published in the Journal of the American College of Cardiology.
“What we learned from this trial is that many patients hospitalized with COVID-19 with pulmonary involvement, but not yet in the intensive care unit (ICU), will benefit from high-dose subcutaneous enoxaparin or oral apixaban to inhibit thrombosis and the progression of the disease,” Dr. Fuster says. “This is the first study to show that high-dose anticoagulation may improve survival in this patient population—a major finding since COVID-19 deaths are still prevalent.”
Clinical Insights, Early in the Pandemic
This work was prompted by the discovery early in the pandemic that many patients hospitalized with COVID-19 developed high levels of life-threatening blood clots. In March 2020, during the early days of the pandemic, Dr. Fuster observed patients with blood clots in their legs who had been admitted with COVID-19. After hearing from colleagues abroad of other cases of small, pervasive, and unusual clotting that had triggered myocardial infarctions, strokes, and pulmonary embolisms, he initiated decisive action.
“We became one of the first medical centers in the world to treat all COVID-19 patients with anticoagulant medications,” says Dr. Fuster, a pioneer in the study of atherothrombotic disease. “It was a decision that we believe saved many lives.”
This early protocol led to groundbreaking research and insights by Mount Sinai into the role of anticoagulation in the management of COVID-19-infected patients. Mount Sinai research showed that treatment with prophylactic (low-dose) anticoagulation was associated with improved outcomes both in and out of the intensive care unit among hospitalized COVID-19 patients. Researchers further observed that therapeutic (high-dose) anticoagulation might lead to better results. Then, they designed the FREEDOM COVID Anticoagulation Strategy Randomized Trial to look further into the most effective regimen and dosage for improving outcomes of hospitalized COVID-19 patients who are not critically ill.
Researchers enrolled 3,398 hospitalized adult patients with confirmed COVID-19 (median age 53) from 76 urban and rural hospitals across 10 countries—including hospitals within the Mount Sinai Health System—between August 26, 2020, and September 19, 2022. Patients were not in the ICU or intubated, and about half of them had signs of COVID-19 impacting their lungs with acute respiratory distress syndrome (ARDS). Patients were randomized to receive doses of three different types of anticoagulants within 24 to 48 hours of being admitted to the hospital and followed for 30 days. Equal numbers of patients were treated with one of three different drug regimens: low-dose injections of enoxaparin, high-dose injections of enoxaparin, and high-dose, oral doses of apixaban. They compared the combined therapeutic groups to the prophylactic group.
Informing Future Care
The primary endpoint was a combination of death, requirement for ICU care, systemic thromboembolism (blood clots traveling through the arteries), or ischemic stroke at 30 days. This endpoint was not significantly reduced among the groups. However, 30-day mortality was lower for those treated with high-dose anticoagulation compared with those on the low-dose regimen. Seven percent of patients treated with the low-dose anticoagulation died within 30 days, compared with 4.9 percent of patients treated with high-dose anticoagulation—an overall reduction of 30 percent. The need for intubations was also reduced in the high-dose group: 6.4 percent of patients on the high-dose regimen were intubated within 30 days compared with 8.4 percent in the low-dose group—a 25 percent reduction. The study showed high-dose anticoagulation to be especially beneficial for patients with ARDS, a condition where COVID-19 damages the lungs. Among patients with ARDS at the time of hospital admission, 12.3 percent in the low-dose anticoagulation group died within 30 days, compared with 7.9 in the high-dose group.
All groups had low bleeding rates, and there were no differences between the two therapeutic blood thinners for safety and efficacy.
“This is an important study for patients with COVID-19 who are sick enough to require hospitalization but not so ill as to require ICU management. In this group of patients with radiologic evidence of ARDS, therapeutic dose anticoagulation prevents disease progression, especially the need for intubation, and saves lives,” says co-Principal Investigator Gregg W. Stone, MD, Professor of Medicine (Cardiology), and Population Health Science and Policy, at the Icahn School of Medicine at Mount Sinai. “This is especially important as COVID-19 is not going away. Even in the United States, the current number of daily deaths, although much lower than at the peak of the pandemic, is twice that compared with just one year ago. And in other countries COVID-19 is raging”
The FREEDOM trial was coordinated by the Mount Sinai Heart Health System. Dr. Fuster raised all funding for the trial.
You may have noticed that more people you know have gotten COVID-19 recently. One reason is the virus that causes COVID-19 continues to evolve into variants that are more contagious.
The latest one is known as XBB.1.5, and since early December it has become the predominant variant in the New York metropolitan area, according to the Centers for Disease Control and Prevention (CDC).
This variant is thought to be highly transmissible due to its ability to partially evade antibodies produced through vaccines or past infections. However, the vaccines still offer excellent protection against severe illness and death.
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.
In this Q&A, Bernard Camins, MD, MSc, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System, explains more about the new variant and how to protect yourself.
No matter the variant, it is important to remember that COVID-19 is not going away. The key is to reduce transmission to those who are at risk of getting seriously ill:
If you feel sick, stay at home.
If you want to be more vigilant, wear a high-quality mask, avoid being unmasked at large indoor gatherings (such as eating at restaurants), especially when infection rates in your area are very high.
If you are at high-risk for a serious infection, talk with your medical provider so you are prepared should you get infected.
Don’t forget to get your flu shot; you can get that at the same time you get your COVID-19 booster shot.
How does this new variant differ from the earlier variants?
The nature of COVID-19 is that the new variants are likely going to be more contagious than the older ones. There is currently no evidence that this latest variant is more dangerous. The symptoms do not appear different.
Does the newest, updated booster shot help protect me from this new variant?
According to the CDC, being up to date with the bivalent booster that became available in September 2022 offers the best protection against COVID-19. (It is the only booster now available.) The updated bivalent booster specifically targets both the BA.5 sub variant of Omicron, of which XBB.1.5 is a descendent, and the original SARS-CoV-2 virus. The original COVID-19 monovalent vaccines, and the monovalent booster that became available in the fall of 2021, only target the original virus, and therefore potentially offer less protection against the Omicron subvariants.
I was recently infected with COVID-19. How long should I wait to get the latest bivalent booster?
You may consider waiting up to 90 days from your last infection before getting the bivalent booster. Reinfection is less likely in the weeks and months after infection. But you may want to talk with your provider if you are at increased risk of severe disease.
I never got any vaccines. Can I skip the first and second monovalent vaccines and just get the bivalent booster?
No. Before you can get the bivalent booster, you still need to get two doses of the monovalent vaccine.
I received my bivalent booster more than two months ago. Has my immunity started to wane?
Your immunity does begin to wane after three to four months, probably more so if you’re older, such as older than 50.
Can I get another dose to bolster my immunity?
No. Currently, there are no more recommended doses after you have already gotten the bivalent booster, regardless of how long it has been.
Will the bivalent booster and antiviral medications prevent me from developing long COVID?
We do not have definitive data yet to know how much protection the bivalent booster and antiviral medications such as Paxlovid™ offer against the development of long COVID. But we do know that being vaccinated certainly reduces your risk of developing it.
I am at high risk for complications from COVID-19. What should I do to protect myself from the latest subvariant?
Because COVID-19 is so widespread now, it’s hard to avoid getting infected or exposed. While it is reasonable to take precautions to avoid a COVID-19 infection, the goal should be to reduce the severity or prevent complications when you do get COVID-19. High-risk individuals should have a plan for how to get antiviral medications, which can prevent severe illness or death. For this to work, you must take the medications within the first five days of symptom onset. If you have not done so already, you should talk with your doctor or your care provider to create a plan for what antivirals you would need and how to get them. Having a plan is also important because you may be on medications that interact with certain antivirals, and you may need to stop taking those medications temporarily to prevent drug interactions. Those at high risk include older adults, those with chronic medical conditions, such as diabetes, and those with reduced ability to fight infections, such as those being treated for some cancers.
We are approaching the third holiday season during the COVID-19 pandemic, but this one is different from the others: Masking requirements and other social distancing guidelines are largely gone.
So what should you do if you are concerned about COVID-19 possibly interfering with your holiday plans? Just take some common-sense precautions, experts say. Here are some suggestions from Bernard Camins, MD, MSc, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System.
Pay attention to all your vaccinations. Continue to stay up to date with your COVID-19 vaccinations. On September 1, the Centers for Disease Control and Prevention (CDC) recommended that those over age 12 get the newest COVID-19 boosters that also target the Omicron variant, and on October 12, the CDC extended that recommendation to those ages 5-11. You should get this vaccine if it has been at least two months since your last COVID-19 vaccine dose. Also, don’t forget your flu shot, as this season is expected to be worse than normal. And remember these shots may take up to two weeks for full protection to kick in.
It’s just as important to stay up to date even if you had COVID-19. The newest vaccine provides added protection, according to the CDC. If you recently had COVID-19, you may delay the next vaccine dose for three months from the onset of symptoms or from your first positive test.
When traveling, consider wearing a high-quality mask in crowded public areas. A surgical mask, which is more comfortable than a snug-fitting KN95 mask, provides some protection against viral infections. That might be prudent for a long plane ride. But to ensure better protection, wearing a clean cloth mask on top of the surgical mask, or wearing a KN95 mask or N95 mask is recommended. Also, onboard the plane, the most important time to consider wearing a mask is while the plane is still on the ground; once airborne, the plane’s sophisticated air filtration systems come on. (Two important footnotes on masks: Masking is still required in health care facilities in New York State, and health care facilities in areas where there is high COVID-19 transmission may require them. You are supposed to wear a mask in public if you are just getting over COVID-19.)
Be especially careful at gatherings and celebrations. If you have been dining at restaurants indoors or attending gatherings indoors without a mask on, then you have been exposed to respiratory viruses already. This holiday season, you are probably more likely to get infected during the many hours you are with friends and family around the dinner table or celebrating inside. That’s what happened a year ago when social distancing guidelines were relaxed. So general guidance on gatherings remains: Remember that some people may be more at risk, such as such as older adults, those with chronic medical conditions, such as diabetes, and those with reduced ability to fight infections, such as those being treated for some cancers. More fresh air is better. You may want to ask those gathering to consider taking an at-home test in advance. Keep in mind these tests are not always sensitive enough to detect the onset of COVID-19 (home antigen tests should be performed at least three times, 48 hours apart after a high-risk exposure), and you could be infected and spreading the virus without showing any symptoms.
Have a plan. Talk with your primary care provider in advance about what you should do if you are at risk for severe complications from COVID-19 and think you have been exposed or start to show symptoms of COVID-19. For example, some clinicians may prefer you get a more sophisticated PCR test, rather than the simple at-home antigen tests. Some people with COVID-19, notably those over 65 or with other health conditions, might benefit from the antiviral therapy Paxlovid—though this must be taken within five days after symptoms start. Talking to your provider in advance can help you know precisely what to do, such as getting a prescription for Paxlovid, especially if you must take action over the weekend.
Recognize we are all learning to live with COVID-19. This viral disease, much like the flu or the common cold, is not going away. But with some basic precautions, it should not stand in the way of spending time with friends and family.
Over the years of the COVID-19 pandemic, SARS-CoV-2, the virus that causes the disease, has mutated many times. Each new version of the virus is called a variant or subvariant. The same COVID-19 vaccines that were made available since December 2020 have done a remarkable job in preventing severe disease and death but have become less effective at preventing infections because of the mutations.
That is, until the late summer of 2022, when the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) green-lighted “bivalent” formulations—an updated version of the vaccines—to be used against the newer variants of SARS-CoV-2.
Bernard Camins, MD, MSc, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System, explains what the bivalent vaccines do and the latest guidance on who should receive them and when.
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.
What does it mean that the vaccines are bivalent?
COVID-19 vaccines with bivalent formulations target the BA.5 subvariant of Omicron—one of the predominant circulating variants—as well as the original SARS-CoV-2 virus, says Dr. Camins. These include the vaccines from Pfizer-BioNTech and Moderna.
An updated vaccine is needed because the virus has mutated several times and is so different from the original strain that the previous monovalent version of the vaccine —targeting only one variant—might not provide adequate protection from infection, he says.
With bivalent vaccines now authorized for use, the monovalent versions of the COVID-19 boosters are no longer authorized. The primary series are still recommended before the bivalent booster can be administered.
How effective and safe is the updated vaccine compared to previous ones?
“It’s pretty much the same as the old vaccine,” Dr. Camins says. The difference is that the genetic makeup of the updated vaccines has an addition to account for the spike protein of BA.5.
The updated vaccines’ side effects are similar to previous versions. The most commonly reported side effects of the bivalent vaccines include pain, redness, and swelling at the injection site, fatigue, headache, muscle pain, joint pain, chills, swelling of the lymph nodes in the same arm of the injection, nausea/vomiting, and fever, according to the FDA.
“You probably would not notice it being different from any of the previous vaccine doses or boosters you’ve received,” Dr. Camins says.
The updated Moderna and Pfizer-BioNTech vaccines have both been studied for effectiveness and safety. Although the studies examined a bivalent formulation involving the original strain and Omicron BA.1, the FDA granted the vaccines authorization based on the totality of evidence, which included clinical and nonclinical data that demonstrated commonalities between BA.1 and BA.4/BA.5.
This method of studying and approving updated COVID-19 vaccines is similar to how new flu vaccines based on circulating strains are handled, he adds: “It is very analogous to what we do with the flu vaccine.”
Who is eligible for the updated vaccine and who should get it?
The Moderna updated booster is authorized for individuals ages 6 and older, while the Pfizer-BioNTech updated booster is authorized for those who are 5 and older.
Where can I get the updated vaccine?
If you live in the New York metropolitan region, you can check the New York State, New York City, New Jersey, or Connecticut websites for locations that offer appointments or walk-in vaccination. Major pharmacy chains are another place to try. If you live elsewhere, Dr. Camins recommends using vaccines.gov or reaching out to local health care providers and pharmacies.
When should I get the updated booster?
The updated vaccine is recommended to individuals two months after completing a primary series or a previous booster.
I got COVID-19 recently. Do I still need the updated booster?
“The updated booster is recommended even for those who have been infected with a previous variant or subvariant of SARS-CoV-2,” says Dr. Camins.
If you have been recently infected, it is reasonable to wait 90 days after symptom onset before receiving an updated booster, he says. However, the CDC has indicated it is also safe to seek an updated booster as soon as you are no longer contagious from a current infection.
Why do I need a booster when people still seem to get COVID-19 despite being vaccinated?
The updated vaccine booster was created to match the current circulating BA.5 subvariant better so it should protect patients from infection better than the previous version, although it’s not a 100 percent guarantee, Dr. Camins says. Receiving the booster could also lessen the chances of developing severe disease especially for patients who are at high risk for complications from COVID-19.
Will I need to keep taking updated boosters if there are new variants?
“We don’t know if future updated boosters are required,” Dr. Camins says. That determination could be based on the current circulating sub-variant, as well as the data from people who have received the updated booster for Omicron BA.5, he adds.
However, Dr. Camins notes that the White House’s COVID-19 Response Team is thinking of moving in the direction of rolling out annual, updated COVID-19 shots matched to current circulating strands. A single annual shot should provide a high degree of protection against serious illness all year, and could prevent thousands of deaths and hospitalizations annually, according to White House officials.
You may have noticed that more people you know have gotten COVID-19 recently. One reason is the virus that causes COVID-19 continues to evolve into variants that are more contagious.