Infectious Diseases | Mount Sinai Today

Most People Mount a Strong Antibody Response to COVID-19

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

Daniel Stadlbauer, PhD, a postdoctoral fellow in Florian Krammer’s laboratory, adds a substrate to an ELISA plate that indicates whether antibodies binding to the spike protein of the SARS-CoV-2 virus are present in a human serum sample. The deep yellow color indicates antibodies are present. No color means that antibodies are not present.

The majority of individuals with COVID-19—including those with mild infections—mount a robust antibody response that is stable for at least three months, according to a new study by researchers at the Icahn School of Medicine at Mount Sinai. This antibody response correlates with the body’s ability to neutralize or actually kill the SARS-CoV-2 virus.

Mount Sinai’s findings concur with studies conducted by major academic institutions elsewhere. Scientists have now had more than three months to track the levels of antibodies produced by individuals since the SARS-Co-V2 virus began to infect populations around the world.

“There were messages about the antibodies going away quickly. That’s not the case,” says Florian Krammer, PhD, Professor of Microbiology, Icahn School of Medicine at Mount Sinai, a senior author on the recent preprint study. “The take-home message is that it looks like a pretty normal immune response.” Dr. Krammer developed one of the first effective SARS-CoV-2 antibody tests, which received emergency use authorization from the U.S. Food and Drug Administration at Mount Sinai’s clinical laboratory.

Additional time will be needed to determine how protective those antibodies are and how long-lived they are beyond three months. So far, Dr. Krammer says, animal models show that antibodies to COVID-19 behave like typical antibody responses to other diseases, meaning they protect from reinfection. The same scenario is likely for the vast majority of individuals, he says. If people become infected again their symptoms would likely be less severe.

“You need to follow people to see how long the antibodies are stable. These studies require time and there will be more data as researchers look at antibodies after 3 months, after 6 months and then again after a year,” Dr. Krammer says. He and his colleague, Viviana Simon, MD, PhD, Professor of Microbiology, and Medicine (Infectious Diseases), at the Icahn School of Medicine at Mount Sinai, are doing exactly that. In a study called Protection Associated with Rapid Immunity to SARS-CoV-2 (PARIS), they are tracking the antibody levels of, approximately, 140 individuals over 12 months. “We examine the participants every two weeks so we get a very granular look at how the antibodies are moving,” Dr. Krammer says.

Within the human body there are several levels of defense. In a typical response, acute plasmablast B cells are generated within days of an infection. These first responders serve as the infantry and coalesce to make an initial bolus of antibody, but their strength soon wanes. Then the body’s immune system kicks in with long-lived plasma B cells, which provide antibodies over a long period of time, and memory B cells, which can respond quickly if the virus attacks again. COVID-19’s relatively long incubation period of upwards of 7 days, likely gives the body ample time to create antibodies quickly if a reinfection would occur.

In addition to these B cell antibodies, the human body makes memory T cells, which appear to be helpful in fighting off the SARS-CoV-2 virus. In fact, blood samples taken from individuals who survived the first SARS virus in 2002-2003—a coronavirus cousin of SARS-CoV-2—showed they still had active memory T cells 17 years later, according to the National Institutes of Health (NIH). Interestingly, the NIH reported that these memory T cells now also recognized part of the SARS-CoV-2 virus.

“There’s a lot of evidence that we see a normal immune response,” Dr. Krammer says. “Now that doesn’t mean we will all be protected forever. And it doesn’t mean that it’s impossible to get re-infected, specifically if someone is immune suppressed. We just don’t have that data yet. We will generate that data as we move forward.”

What You Need To Know About Taking A Vacation this Summer

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

After months of staying close to home and maintaining social distance, many in the New York metropolitan area are ready for a change of scenery. However, with COVID-19 still prevalent throughout the United States and border restrictions limiting international travel, is leisure travel safe?

Daniel Caplivski, MD, Director of the Travel Medicine Program at Mount Sinai, and Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, explains what you need to know about getting out of town as the nation continues to battle COVID-19.

Would you recommend leisure travel this summer?

I do think it’s possible to safely travel within the United States, but there are caveats.

It is important to assess the risk of COVID-19 for each traveler. The CDC has a nice set of recommendations to help you figure out who is the highest risk for having a very severe reaction to COVID-19. This list includes those who are diabetic or obese and older people—particularly those above age 60 or 70.

That is the first thing a traveler should consider—what is my risk of a severe outcome. Younger people can get very sick from COVID-19, obviously, but it’s a different set of considerations for older people and those with underlying medical conditions.

And then, what is the risk of acquiring the virus when visiting a particular area? The CDC also has outlines to help people think through this process. In the early spring, New York City had the most cases and the highest level of transmission. But now, the focus of the epidemic has shifted towards the south with states like Texas and Florida reporting a high number of cases.

So, those considering vacations this summer should look at the guidelines from the CDC to assess their risk and the risk of transmission within their destination.

If you will be travelling, what is the safest mode of transportation?

The CDC does a nice job of assessing each one of those modes of travel for risk and there’s some commonalities to all of them—any scenario where you are going to be in close contact with a lot of other people will increase your risk of contracting COVID-19. Whether in an airport or a train station, if you are in a location where it’s hard to socially distance, you will increase your risk.

In terms of mitigating that risk, wear a face covering throughout your trip—as appropriate—and have hand sanitizer with you at all times. Airlines are now allowing, travelers to carry larger bottles of hand sanitizer in their carry-on, which is helpful.

How high is the risk of contracting the virus from other passengers?

The risk from fellow passengers is probably highest from those who are within about two feet—so, within one row in either direction. That’s fairly small in terms of the overall number of people on the plane. Also, the air in planes is constantly being circulated with the outside air and filtered using high efficiency particulate air (HEPA) filters. That adds to some risk reduction. But you should still wear face coverings and use hand sanitizers, especially after engaging with high-touch surfaces like restroom handles.

If you are travelling by train, you can be a lot more spaced out. So, if you can find a seat that’s more distant from other people, that would mitigate your risk, along with wearing a face covering and using hand sanitizer. It’s also worth noting that Amtrak trains have an air filtration system as well.

Given that air and train travel—even when using proper precautions—involves encountering unknown people who may have the virus, is travelling via car or RV with family or friends the safest?

Since you are traveling with people that you know, that’s generally a safer scenario. But, usually you have to stop for gas, snacks, or even the restroom. So, hand hygiene remains important especially after using public facilities.

Once you reach your destination, are there activities that you should avoid?

Travelers should apply the same principle when traveling as they do in the New York metropolitan area. People have gotten used to the concept of wearing some sort of face covering, practicing social distancing, and avoiding scenarios where it’s very difficult or impossible to socially distance, especially when indoors. We know that the transmission of the virus in indoor facilities is much more efficient than in outdoor scenarios. So, whenever possible, try to look for outdoor activities as opposed to indoor ones.

Beaches are an example where, generally, it is possible to socially distance from people and reduce your risk of contracting the virus. Swimming pools can also be a safe place to go if you’re able to maintain social distancing as the chlorine in the water is considered to inactivate the virus. With these locations, travelers should be hyper vigilant in bathrooms, locker rooms, and changing areas where it may be more crowded and there are more high-touch surfaces.

Should you self-isolate after your vacation?

This depends on where you’re coming back from right. New York State has some guidelines for travelers returning from states where there’s a lot more COVID-19 cases.

There are going to be recommendations at the state level for self-isolation or self-quarantine for asymptomatic returning travelers. Travelers should keep an eye on state recommendations as well as the CDC map of where there are high levels of COVID-19 activity.

If you are going someplace that doesn’t have a high level of COVID-19 cases but you have contact with someone who is at high risk of a severe case of the virus, should you take extra precautions on your return?

The Mount Sinai Health System has some guidelines for our health care workers because we come in contact with people who are immunosuppressed and have a high risk for severe COVID-19. The common sense approach for travelers is what a lot of health care facilities like Mount Sinai are doing, which is requiring that people conduct a self-symptom check.

If you are returning from a relatively low risk area, do a self-assessment. You can return to being in contact with older loved ones, as long as you do not have a high fever, a cough, shortness of breath, loss of smell, or any of the typical symptoms for COVID-19.

Are there any additional behaviors that the public should be aware of when traveling during this time?

Lodging is a big consideration. My Mount Sinai colleague, Mirna Mohanraj, MD, addresses the safety considerations travelers should make when visiting a hotel or vacation rental in this blog.

Additionally, the CDC recommends bringing sanitizing wipes when you travel for high touch surfaces, like doorknobs and bathroom fixtures. The CDC also recommend basic things that have become second nature to many within the New York metropolitan area like no contact service and avoiding buffets, group gatherings, and gymnasiums.

How to Safely Visit the Pool and Spa This Summer

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

As the New York metropolitan area continues to keep the COVID-19 curve flat, more establishments have opened. But, before hitting the pool or booking an appointment at the day spa, be aware that the risk of contracting the virus has not dissipated.

“Any place where we have public interaction beyond our immediate family or immediate contacts, we are exposing ourselves to the virus,” says Waleed Javaid, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai. “The more people we meet, the more interactions we have, the expansion of our social circle; this increases our risk.”

Dr. Javaid explains what questions you should ask before visiting your local pool or spa to ensure the safest possible visit.

What precautions should you take before heading to the pool?

I think it will be important to make sure that the pool or hot tub that you are entering is following up on disinfection protocols. The cleaners and disinfectants used in and around the area should be registered by the US Environmental Protection Agency to kill the virus.

Do saunas and steam rooms pose a risk of spreading COVID-19?

If you’re not following social distancing guidelines, there is a risk. But it really depends on the size of the facility and how they may be modifying their business practices due to the virus.

Masking is not going to be effective in a sauna or steam room because—besides being incredibly uncomfortable—the moisture will likely reduce the efficacy of a face covering. So perhaps it is best to do individual saunas.

Not every place is going to do the same thing, so people should be proactive in asking about what kind of protections are in place for safety before entering an establishment.

Since there is no standard protocol for these establishments, what should people ask before visiting?

Before visiting a pool or spa, people should ask two questions: What is the facility doing to prevent the spread of COVID-19 and what is the process they are using to ensure the virus does not spread throughout their establishment.

From there, you can go into some specifics.

What disinfectant is in use?
What is the social distancing process and how is it being reinforced?
How many people are allowed in the facility at any given time?
How often are shared spaces being disinfected?
Is shared equipment being cleaned between each customer?

Additionally, I would recommend that people review guidance from the Centers of Disease Control and Prevention on public pools, hot tubs, and water playgrounds.

Despite spas being allowed to open, at this time gyms throughout the New York metropolitan area remain closed. Why are gyms particularly risky? Is the virus spread through sweat?

At this time, we do not believe that the virus is spread through sweat. However, the risk with gyms is related to the amount of people in an enclosed area. I continue to recommend that everyone stay safe by keeping their distance. So, individualized outdoor exercise like walking, jogging, running, or even outdoor yoga is better than exercising indoors.

Gyms have many people exercising indoors—whether on machines or in fitness classes—and sharing equipment. Contrast that with a spa where the activity—like a facial or a massage—though indoors, is individualized. So spas—where the interaction is often between one or two individuals—present a more controlled environment.

At least, that is how I think this decision is being evaluated.

Do you have any other advice about how to stay safe as we continue this reopening effort and begin to expand our social circles?

Everybody needs to take charge to protect their health and the health of those around them. If, for example, you feel unsafe in a grocery store because there’s too many people, don’t be afraid to remove yourself from that situation.

Also, just because more places are open doesn’t mean that you have to enter them, especially if strict social distancing is not being practiced.

Mount Sinai to Create and Test New Hyperimmune Globulin Drug for COVID-19

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

The Mount Sinai Health System in July will begin collecting high levels of blood-based antibodies from people who have recovered from COVID-19 as part of a $34.6 million clinical trial to create and test a hyperimmune globulin drug that would be used to treat early COVID-19 disease and to prevent specific at-risk populations from developing the disease.

Hyperimmune globulin is derived from pooled blood-plasma donations from many people with high levels of antibodies to COVID-19, as opposed to convalescent plasma, which uses just one donor per recipient. The pooled plasma is then then purified into a product that can be used as a treatment or prophylactic drug administered by injection or intravenously, conferring temporary immunity to the disease from the antibodies. The same process is used to prevent people from developing diseases such as hepatitis B and rabies.

To conduct clinical research trials, one of which is funded by the U.S. Department of Defense, Mount Sinai will work with two companies, Emergent BioSolutions and ImmunoTek Bio Centers, to produce the drug. It is expected to be given to patients with early disease, to front-line medical workers, and to military personnel who are unable to avoid close contact while training and conducting missions.

Jeffrey Bander, MD, Medical Director of Network Development for the Mount Sinai Health System, is assisting in recruiting donors for the clinical trial. “We’re not helpless against COVID-19,” Dr. Bander says. “People can fight back by donating antibodies.” While experts are not certain how long antibodies last, Dr. Bander says, “we do know that people who had the strongest antibody response still seem to have it three months later.”

To create the drug, Mount Sinai will rely on blood-plasma donations from people who recovered from COVID-19 during the spring surge of cases in New York City. People may donate twice a week for multiple weeks. A new collection center that can process 12 donors at a time has been established on The Mount Sinai Hospital campus.

ImmunoTek Bio Centers is assisting Mount Sinai in the blood-plasma collection. The plasma will be frozen on site and then transported to Emergent BioSolutions to pool it and create the hyperimmune globulin. Then the product will be sent back to Mount Sinai and other sites to be used in clinical trials.

Plasma Collection Center Seeks Potential Donors

The Mount Sinai Health System, in collaboration with Emergent BioSolutions and ImmunoTek Bio Centers, has established a Plasma Collection Center at The Mount Sinai Hospital to advance the development of hyperimmune globulin, a potential therapeutic.

You may be a candidate to donate plasma for use in this drug if you are age 18 to 65 and meet criteria including these: you have tested positive for SARS-CoV-2, the virus that causes COVID-19; have fully recovered; and have a high concentration of antibodies. If you are interested in donating plasma, please complete the prescreening questionnaire.

If you meet the qualifications to donate, a member of the Mount Sinai team will contact you to schedule a donation appointment.

“It is imperative that we have more options to prevent this terrible disease in front-line workers and other high-risk populations and to potentially decrease the severity of illness in those infected,” says David L. Reich, MD, President of The Mount Sinai Hospital and Mount Sinai Queens.

Suzanne Arinsburg, DO, Associate Professor of Pathology, Molecular and Cell Based Medicine, who is overseeing Mount Sinai’s blood-banking and donation process, says that monthly administration of hyperimmune globulin may also serve as a prophylactic treatment for people who would not be medically eligible to receive a vaccine.

The regulations surrounding blood-plasma donations that are used for hyperimmune globulin are stricter than for convalescent plasma, according to Dr. Arinsburg. Donors are carefully screened and participate by appointment only.

With convalescent plasma, “every patient is getting plasma from a different donor and every donor has a different amount of antibody, and there are always differences between donors that we may not understand,” says Dr. Arinsburg. “With hyperimmune globulin, the plasma is pooled from many donors and fractionated to highly concentrate the antibodies so that every patient gets the same amount. That removes the issue of differences between donors.”

Learn more about the Plasma Collection Center at Mount Sinai

Can I Delay Getting My Child Immunized Until After the COVID-19 Pandemic?

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

Starting at birth, children routinely receive immunizations against a variety of dangerous diseases. But due to the COVID-19 pandemic, parents may be waiting to begin—or resume—immunizations. Amy DeMattia, MD, MPH, Clinical Professor in Pediatrics at the Icahn School of Medicine at Mount Sinai, explains why it is important not to delay most immunizations and answers questions about the safety of the doctor’s office.

My child is very healthy. Why do they need to be immunized?

Immunizations are safe, very effective, and a routine part of pediatric health care. There are a number of important reasons to get your child immunized. First—and arguably most important—it can save your child’s life. We immunize children against 14serious diseases, including whooping cough, diphtheria, tetanus, mumps, measles,rubella, rotavirus, polio, chickenpox, hepatitis B, and meningitis.

Some of the conditions we immunize against can cause serious illness, complications such as loss of hearing or brain damage, or even death. The danger is not just in the developing world. In the United States, measles, mumps, and whooping cough infect and cause severe illness in children each year.

In addition, immunizations enable us to help protect each other. Some children cannot be safely immunized, including those who are too young, are immunocompromised, or are taking certain medications. If enough people are immunized against a disease, it means there is significantly less chance anyone will become infected. This is called “herd immunity.” The number of people who must be immunized depends on how contagious that condition is.

How do immunizations work?

Vaccines work by teaching the human body to recognize and fight off potentially harmful diseases. We give (either by mouth or through injection) a small amount of a weakened or dead virus or bacteria (called a pathogen) into the body. The body recognizes these pathogens as “foreign invaders” and responds by creating antibodies. Because the pathogens in the vaccine are already weakened or dead, they can’t hurt you. But the antibodies your body has developed can fight the infection—and “remember” the pathogen. Then, if the pathogen enters the body again, the antibody is already there, ready and able to fight it off. Some vaccines require more than one full dose to “teach” your child’s body to recognize and defend against the disease.

Can I delay getting my child immunized until after the pandemic?

The U.S. Centers for Disease Control and Prevention (CDC) developed the current immunization schedule based on how children’s immune systems respond to vaccines at various ages and how likely your child is to be exposed to a particular disease. It is important to follow the schedule so that your child is fully protected before possible exposure. Infants, like older people and those who are immunocompromised, are considered especially vulnerable. We want to get them the protection they need when they need it.

Is there any flexibility on delaying or spacing out vaccinations?

If you have any questions about vaccination scheduling, talk to your pediatrician first. Your doctor will know if there are any conditions that could affect your ability to delay an immunization.

In general, children under the age of two years require timely vaccination without any significant delay. There is more flexibility for children over age two, but this depends on the specific vaccination—not all can be delayed—and your family’s individual situation. For instance, in most cases you can take your child in for their second MMR vaccine anytime after four weeks from their first dose, though most children receive this vaccine between the ages of four and six years. Of note, however, many schools in New York State require two doses of the vaccine in order to attend. After one dose of the MMR vaccine, about 93 percent of people are immune to measles; the second dose raises that to 97 percent. While this might not seem like a big difference, it is significant in the world of immunology.

Is it safe to take my child to a doctor’s office?

We are fully committed to the safety of our patients and staff. While we understand that you may feel nervous, please know that we have put stringent protocols in place to protect every person, regardless of age.

How Mount Sinai is Keeping Patients Safe

New York City Is Reopening. Is it Safe to Date Again?

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

For much of spring, New York City bars, restaurants, and other public gathering spots remained empty of patrons as New Yorkers adhered to the strict social distancing mandate that helped flatten the curve of COVID-19. But, as the city moves through its phased reopening and people expand their social circle, is it safe to have in-person dates again?

Lina Miyakawa, MD, Assistant Professor, Medicine (Pulmonary, Critical Care, and Sleep Medicine) at the Icahn School of Medicine at Mount Sinai, explains how to seek intimacy while protecting yourself and any partners from COVID-19.

New York City is slowly reopening. As we enter a “new normal” with COVID-19 as a persistent threat, is it safe to re-enter the dating world?

I strongly agree with the recommendations from the U.S. Centers of Disease Control and Prevention (CDC) the World Health Organization to wear masks, socially distance, and practice hand hygiene. While I remain optimistic that our world will thrive again, this pandemic is far from over and another surge is a very real possibility.

If you are thinking about dating, you should consider the risks of any interaction and weigh the risk of possibly infecting yourself or a loved one. These are not easy decisions to make. But we can use this time for self-development as well as to build new skills of communication and intimacy.

Also, it is important to remember that COVID-19 recommendations continue to be updated as we learn more about the disease. Everyone should stay up to date with safety recommendations issued by their state and locality.

If you have decided to have in-person dates, when is it appropriate to have non-masked interactions?

There are currently no guidelines to inform us on how to transition from masked to non-masked interactions. However, it is important to note that mask wearing is based on a risk profile—low, medium, and high. For example, low risk would be walking alone through a secluded section of Prospect Park; medium risk would be strolling along Orchard Beach with a friend; and high risk would be boarding a crowded 7 train. The transition from masked to non-masked interactions should also be based on a risk profile.

To assess your partner’s risk profile, you can ask them these questions:

How many contacts do you have on a daily basis?
Who do you live with?
Do you leave the house? If so, where do you go?
Do you follow the recommendations to mitigate the risk of exposure, like wearing a mask and practicing social distancing?
Do you work in situations with high exposure risk?

Also, don’t forget considering your own risk profile. Do you have an at-risk contact (such as a grandparent or a friend with chronic medical problems) who you see regularly?

Is the virus spread through sex?

Although COVID-19 has been detected in semen and feces, currently we do not think that the virus is spread through the sexual act. But, given that the virus is spread through respiratory droplets—which are much more likely to be shared when in close contact with another person—many sexual acts will be considered high risk. So, as the New York City Department of Health details in its safer sex and COVID-19 fact sheet, minimizing risks by exploring other avenues of meaningful interaction is suggested and recommended.

What should you look for after being intimate with someone new?

After a close, high-risk encounter like sex, you should be mindful of your personal risk of contracting and falling ill to COVID-19 as well as the risk you may pose to those in your own circle. I recommend monitoring yourself closely for any symptoms of COVID-19 (fever, shortness of breath, cough, fatigue, the loss of taste and smell). Also, consider getting a COVID-19 test five to seven days after the interaction. I would also refrain from interacting with any at-risk persons within a 14 day period after the encounter. If you cannot avoid contact with a high-risk individual, take precautions to lower your risk profile by social distancing, choosing to interact with the individual in outdoor spaces as opposed to indoor spaces, and wearing a mask.

What do you tell patients who are frustrated with quarantine and eager to expand their social circle again?

I recognize that it’s not easy to practice social distancing and I acknowledge that human connection and touch is important.

However, just as it is common courtesy to step aside to create space for someone to walk by, you should wear a mask to protect others—as you may be an asymptomatic carrier. And, prior to opening up your circle, you should carefully consider your risk profile and that of your potential partner.

We are all linked in this global fight against COVID-19 and we have to look out for each other to stay safe. The most dangerous illusion you can have during a pandemic is that it’s only happening to other people, someplace else.

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