COVID-19 and Cesarean Births

May 21, 2020 | COVID-19, OB/GYN, Your Health

Having a safe delivery is top of mind for all pregnant women and their partners. As hospitals and health care centers continue to address the COVID-19 pandemic, safety has become increasingly important, especially for those having a cesarean birth—a surgical delivery that generally requires a longer hospital stay than vaginal delivery.  Angela Bianco, MD, Medical Director of Labor and Delivery for the Mount Sinai Health System, discusses the changes that have been implemented to ensure a safe delivery and post-operative recovery for cesarean birth patients and their newborns. 

What extra precautions are taken to ensure patient safety during cesarean delivery and during their hospital stay?

Twenty four hours prior to scheduled deliveries, all women and their support persons are tested for COVID-19. Patients and visitors must wear a face covering while in the hospital. If needed, staff will provide a mask.

While all patients and staff are required to wear face coverings, knowledge of the patient’s COVID-19 status directs the use of appropriate protective equipment.

All health care workers have been trained in appropriate use of personal protective equipment to safeguard themselves and their patients. Additionally, we have separate teams that transport patients to and from the operating room if the patient is positive for COVID-19. Patients with the virus are placed on a separate floor rather than in our Post-operative Recovery Room. During the postpartum stay, they are assigned a single room to recover in to avoid spread.  

All areas are continuously disinfected, including waiting rooms, patient rooms, and high-touch surfaces such as door knobs and kiosks. Patient rooms in particular receive a ceiling-to-floor cleaning between patients, which takes approximately two hours and includes several quality assurance checks.

Has the recovery stay been adjusted due to the virus?

Yes, we have recommended discharge on post-operative day two rather than post-operative day three. We made this recommendation to decrease the length of stay in order to reduce exposure to new mothers and their newborns in a hospital setting. If there is a need to be discharged later than post-operative day two, than the stay may be extended.

How are doctors keeping in touch with patients after discharge?

Post-discharge patients are called within the first week, typically three days following their release. Patients have a telehealth visit at two weeks, but this can also be an in- person appointment for those who require a site visit or who are unable to communicate with their physician via telehealth.

Since women are being discharged a day early, are there additional precautions that need to be taken once they go home?

Generally, no. When released, pregnant women and their partners are given the same discharge instructions for post-operative day two release as they would have been given for a day three release. Instructions include when to call for issues such as high blood pressure and headache or if patients have questions about wound care or breastfeeding.

How Mount Sinai is Keeping Patients Safe
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How I Recovered From COVID-19 at Home With the Help of a New App: A Patient Story

May 19, 2020 | COVID-19, Patient Stories, Your Health

Roberto Rapalo, a patient at Mount Sinai, at home with his family

Should I go to the hospital or stay at home? This is one of the first questions that people who think they have COVID-19 wrestle with. Now, thanks to a remote monitoring platform from Mount Sinai Health System called Precision Recovery, patients can have their symptoms monitored by a provider daily, and know that their care will be escalated if necessary.

Once a patient signs up, a member of the Precision Recovery team at Mount Sinai contacts the person for an online video chat. The patient then downloads a daily symptom tracking app onto any smart device which monitors symptoms of the virus, such as body temperature, cough, breathing levels, and body aches. A provider checks in with the patient weekly through video chat. But if the symptoms get worse, the patient is contacted by a provider to discuss the new or worse symptoms and determine if increased monitoring or an emergency room visit is needed.

Read more about Precision Recovery

David F. Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System, and Christopher Kellner, MD, a cerebrovascular neurosurgeon with the Mount Sinai Health System, developed Precision Recovery, an innovative system to monitor patients with COVID-19 symptoms remotely so they can stay home and rapidly respond to their needs when necessary. Click here to read a Q&A, in which they describe how this novel platform can help patients and hospitals in New York and throughout the United States.

“Precision Recovery worked great for me. COVID-19 was a battle—I had it for 14 days and each day was like a new round in a boxing match. Between Day 7 and 12, I was so weak it was difficult to think properly,” says Roberto Rapalo, a patient at Mount Sinai who used the new system. “I was struggling with the decision of whether to go to the hospital or not. It was scary, but the fact that my data was being monitored every day gave me confidence. Dr. Kellner was watching my symptoms progress, and I trusted the advice he gave me. He helped me get through this. In my opinion, you can’t get through COVID-19 by yourself.”

Precision Recovery was developed by David F. Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System, and Christopher Kellner, MD, a cerebrovascular neurosurgeon with the Mount Sinai Health System.

Dr. Kellner said the system allows physicians to closely monitor patients, which is important because the disease can take a different course for every one of them.

“Sometimes people are doing pretty well for a week or ten days, and they may even to start to feel better. But then they start feeling much worse for a day or two after that. That was the case with Rob,” he says. “He began having a hard time breathing and had fever again. So we initiated a video chat with him, and I was able to assess his condition. I saw that he was short of breath, but we talked through the criteria for coming to the hospital. That gave him the confidence that even though he was feeling worse, he would be able to ride it out at home. After a day of bad symptoms, he started to feel better, and he never had to come into the hospital.”

Mr. Rapalo said the system helped him track his symptoms and develop trust in his doctors.

“Every day I input my blood pressure, my temperature, my heart rate, oxygen saturation, as well as whether I had shortness of breath, chest pains, or other symptoms. And that helped me trust that the doctor really did understand what I was going through,” he says. “In the end, I really needed that pep talk. With any other disease I’ve had, once you start to feel better, that’s it. But COVID-19 is longer than any other disease I’ve had. And when I got worse after starting to feel better, that surprised me. So my conversation with Dr. Kellner made me feel that he had my back and was supporting me.”

What he experienced is typical for many COVID-19 patients, according to Dr. Kellner.

“Rob is a perfect example of what most people are going through with this disease. It’s unpredictable how it will go for each individual person. We’re still trying to figure that out as a medical profession, and sometimes there’s mixed messages,” says Dr. Kellner. “Someone might go to an urgent care center and be sent home with the instructions, if your symptoms get worse, contact your provider or call 911. If patients have this roller-coaster ride of symptoms, they need repeat assessments, and that’s what Precision Recovery provides.”

The goal of the system is to keep people out of the hospital who don’t need to go, and give people at home the assurance that they are being monitored effectively. Another goal is to catch people at home whose symptoms worsen and require hospitalization.

“That has happened—we saw that they met the criteria for being hospitalized, so we called an ambulance and contacted the emergency room to let them know that a COVID-19 patient was coming in,” says Dr. Kellner.

It’s important to note that this is a daily data entry by the patient, so doctors can’t necessarily react to an emergency. Patients may still need to call 911 in an emergency. Or they may need an urgent care visit or a virtual visit like Mount Sinai NOW.  Precision Recovery fills a role somewhere in between.

Mr. Rapalo said he began feeling better after about two weeks with the illness.

“I turned a corner around Day 13 and now I feel so much better. My cough has decreased and I’m improving every single day,” he says. “I’m still entering my data every day, so that if I do get worse, I’ve got a safety net. I have an appointment with the physical therapist of the Precision Recovery program, and I’m looking forward to getting tips on how to improve my breathing and the tightness in my chest.”

He added, “The main benefit of the Precision Recovery program is that you have people standing by your side, fighting with you. And that helps with your mental side of your recovery, and helps you make the right choices for your care. I am looking forward to being 100 percent, and I believe the program is getting me there.”

To enroll in Precision Recovery, text “Precision Recovery” to 332-213-9130.

Learn more about Precision Recovery
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Precision Recovery: New App Helps Patients by Monitoring COVID-19 Symptoms Remotely So They Can Stay Home

May 19, 2020 | COVID-19, Your Health

With hospital systems responding to unprecedented demand, and people with possible COVID-19 symptoms often unsure of where to get care, two Mount Sinai physicians saw an opportunity for technology to come to the rescue.

David F. Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System, and Christopher Kellner, MD, a cerebrovascular neurosurgeon with the Mount Sinai Health System, developed Precision Recovery, an innovative system to monitor patients with COVID-19 symptoms remotely so they can stay home and rapidly respond to their needs when necessary. In this Q&A, they describe how this novel platform can help patients and hospitals in New York and throughout the United States.

What is Precision Recovery?

Precision Recovery is a digital platform that goes a step beyond the typical telehealth scenario because it monitors the patient’s symptoms daily, enables us to get patients the right care for their situation, and escalate it when appropriate. Anybody in the country can sign up, just by texting the words “Precision Recovery” to 332-213-9130. We onboard them with a video chat and then they download an app on any smart device so that we can monitor their symptoms every day. The platform tracks the patient’s symptoms—whether it be fever, headaches, or respiratory symptoms—and alerts us to contact the patient if their symptoms are worsening.

We initially developed Precision Recovery as a program to help individuals recovering from stroke who needed close daily monitoring. In the wake of the COVID-19 crisis, we quickly adapted the program to provide day-by-day monitoring of individuals who are showing signs of COVID-19 but were unsure whether they should go to the emergency room or just ride it out at home.

We saw that people would go to the emergency room and one of several things might happen: they may or may not be tested, or no testing might be available, and many times they would be told that they were not sick enough to be admitted. And that might be the end of their care. If they get sicker, they don’t know whether they should go back to the emergency room or call a doctor, or just stay home.

There’s a lot of fear and anxiety around COVID-19. How does Precision Recovery provide a sense of security?

We want people to think of us as a safety net. We’re here to answer any concerns people have about their symptoms. Once a patient signs up, a provider from the Precision Recovery team will contact the person for an online video chat. As part of the onboarding, the patient downloads a daily symptom tracking app, MyCap, and enters their symptoms and vital data. The team is then able to track symptoms of the virus, such as body temperature, cough, breathing levels, and body aches. There will be a weekly video chat to check in on the patient through Zoom, but if we see symptoms get worse, we will get in touch with the patient. If necessary, we can get them an ambulance and get them to the right hospital. And we can do that for anybody in the country.

Is this available to other health systems?

Currently, this is only implemented at Mount Sinai but there are a numerous health care systems with whom we are collaborating to roll this out shortly in their hospitals.

Read about a patient who used Precision Recovery
Learn more about Precision Recovery
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Saving Lives, One Mask at a Time

May 19, 2020 | COVID-19, Diversity and Inclusion, Featured, School

Icahn School of Medicine at Mount Sinai student Tyler McChane (MS3) delivered mask kits to the New York Common Pantry in East Harlem.

Aishwarya Raja, a rising fourth-year medical student at the Icahn School of Medicine at Mount Sinai, looked at the East Harlem community that surrounds Mount Sinai and knew she had to help her neighbors as the COVID-19 pandemic surged in New York City. She understood they often lacked the most basic health care necessities, and with a sizable number of them considered essential workers and unable to stay at home, she wanted them to remain safe. She was unsure they would even have access to one fundamental item needed to confront the SARS-CoV-2 virus that causes COVID-19—protective masks.

Then, she had an idea and founded Mask Transit, an initiative dedicated to delivering masks and educational materials to vulnerable neighbors, an effort to help slow the spread of COVID-19. She mobilized 50 medical students across 15 institutions in mid-April, and they began sourcing and delivering masks and creating educational materials.

The project was launched under the guidance of Yasmin S. Meah, MD, Associate Professor of Medicine, and Medical Education. Dr. Meah is the Program Director and Chief Medical Attending of the East Harlem Health Outreach Partnership (EHHOP), Mount Sinai’s student-run, physician-supervised clinic, which provides free primary, preventive, and mental health care to uninsured adults.

“These students have done an amazing job of serving the most vulnerable members in the community,” says Dr. Meah. “Many of them are essential workers, isolated from services, with low health literacy, so getting masks and information into their hands can be lifesaving.”

Icahn School of Medicine at Mount Sinai student Matthew Eveleth (SY) put together mask kits that were mailed and delivered to more than 250 EHHOP (East Harlem Health Outreach Partnership) households.

Reema Navalurkar (MS3), and Parth Trivedi (SY), education co-chairs, developed educational materials to explain why and how to wear a mask, and how to clean it, along with information about COVID-19. Materials are available in Spanish, French, Mandarin, and Arabic, in addition to English. Under the leadership of Tyler McChane (MS3), the team sourced face masks and fabric. They found local seamstresses willing to donate their time to sew masks, and they partnered with grass roots organizations to help distribute them. The team delivered mask kits, consisting of masks and information, to distribution points and to individuals. They created a website, raised funds for their initiative, and promoted the program throughout the community and through social media.

To date, Mask Transit has distributed more than 6,000 mask kits with a goal of distributing 100,000 by mid-June. In addition to partnering with EHHOP, they also work with New York Common Pantry and Little Sisters of the Assumption Family Health Services, an organization that helps families meet basic needs, and they recently broadened their reach to West Bronx. Mask Transit has also established branches in Boston, where they are partnering with Boston Healthcare for the Homeless Program, and in New Haven, where they are partnering with the HAVEN clinic, Yale School of Medicine’s student-run free clinic. Their new goal is to branch out to all five boroughs in New York City and to other cities across the United States.

Aishwarya Raja, a rising fourth-year medical student at the Icahn School of Medicine at Mount Sinai, oversees the Mask Transit initiative that she founded in April 2020.

“What has been most rewarding is that we have been able to harness the power of individuals to make a difference,” says Ms. Raja. “Everyone—students, businesses, seamstresses, and community organizations—has stepped up. They are great examples of how kind, generous, and resilient our community members can be in the city’s time of need.”

Anyone interested in donating masks or mask materials can click here. To find out more information about the organization, visit masktransit.org or contact them at contact@masktransit.org.

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What to Expect at Your Child’s Telemedicine Well Visit

May 19, 2020 | COVID-19, Your Health

Telemedicine appointments with a pediatrician are one option available to parents who do not want to delay seeking care from their doctor. Carolina Pombar, MD, a pediatrician the Mount Sinai Doctors Faculty Practice and an Assistant Professor at the Icahn School of Medicine at Mount Sinai, explains what to expect from a telemedicine appointment and some of the benefits.

How is a telemedicine well visit similar to an in-office well visit?
Similar to an in-office visit, during the telemedicine visit, which consists of a face-to-face video conference with your child’s pediatrician, you will have the opportunity to discuss nutrition, development, sleep, parenting, updates on any chronic conditions, and any concerns you have.

How does a telemedicine well visit differ from an in-office visit?
Your child’s pediatrician will not be able to perform a complete exam, however there are many parts of the exam which can be observed on the video conference such as examining your child’s skin or looking for any signs your child may have difficulty breathing. Some of the screening exams which are performed in the office, such as hearing, vision, and blood pressure screens, cannot be done, however your child’s pediatrician will discuss with you the best time to have these checked. If your child is due for immunizations and/or lab work, the doctor will discuss with you the best time to bring your child in for these.

What are some benefits of telemedicine well visits?
During a time that you may not be able to bring your child to the office, telemedicine well visits give you the opportunity to connect with your child’s pediatrician, ask questions, and address concerns you may have. The doctor has the unique opportunity to observe the child in their natural environment, whether it be their permanent or temporary home. Children are often more comfortable in these familiar places and therefore are more playful and vocal. Your pediatrician will be able to do a developmental assessment based on these observations and can guide you about future milestones to look out for. Telemedicine visits let you and your child’s doctor stay up to date with your child’s medical care and allow your family to remain safe at home.

Carolina Pombar, MD

How can you and your child prepare for telemedicine well visits?
Prior to the visit, if you have a scale, you can try to measure your child’s weight without clothes and a diaper on. If you have a measuring tape, you can attempt to measure your child’s height by having them lie down, make a mark or place an object at the top of their head and bottom of their feet and measure the distance in between. Let your child’s doctor know about these measurements during the visit. They will be able to plot them, and you can review your child’s growth curve together.

During the visit, you should have your child available. It is okay if they crawl or walk off to play. Your child’s doctor is happy to observe them play as part of the visit. If possible, have your child wear clothes that can be easily raised up or pulled down in case there is anything you would like the doctor to examine as part of the telemedicine visit.

In which cases may your child’s pediatrician consider treating your child with antibiotics?
Antibiotics are medications which treat bacterial infections. Common bacterial infections that often require antibiotic treatment in children include ear infections, sore throat caused by streptococcal bacteria, certain skin infections, pneumonias, and urinary tract infections.

Why are doctors careful about prescribing antibiotics?
If antibiotics are overused, bacteria can become resistant to them and the medication loses its effectiveness in treating the bacteria. In addition, like all medications, antibiotics can be associated with side effects. Pediatricians have to carefully consider these variables when making the best decision for treatment for your child.

Is an in-office exam necessary to get a prescription for the antibiotics?
Pediatricians use the physical exam as an important diagnostic tool to make decisions about whether or not antibiotics are needed. Some parts of the exam/visit cannot be performed virtually. These include an internal ear exam, listening to the lungs, and swabbing the throat to test for infection. There are some parts of the exam that can be observed virtually including the skin exam and signs of difficulty breathing. If it is not possible for your child to come into the office, your pediatrician may recommend a telemedicine visit so they can observe your child. Based on the history and this observed exam, your child’s pediatrician may determine that a bacterial infection is likely and may consider prescribing antibiotics without seeing the child in the office.

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Overwhelming Antibody Response to COVID-19 is an Encouraging Sign, Researchers Say

May 13, 2020 | COVID-19, Featured, Research

Ania Wajnberg, MD, left, with Nurse Manager, Patricia Lazio, RN.

More than 99 percent of individuals who fully recovered from COVID-19 and had mild to moderate symptoms that did not require hospitalization went on to develop antibodies, according to a new study by researchers at the Mount Sinai Health System. The team looked at 1,343 people who either had confirmed cases of the disease or were suspected to have the disease between March 26 and April 10, 2020.

The study also showed that these IgG antibodies, or Immunoglobulin G—which appear after an acute infection and have the potential to confer immunity and protection against reinfection—were optimal for use in testing three to four weeks after the onset of COVID-19 and two weeks after the disease resolved.

“While we don’t know for certain whether having antibodies confers immunity at this point, or how long immunity would last, we are very encouraged that even those people who had mild cases of the disease did produce antibodies,” says the study’s first author, Ania Wajnberg, MD, Associate Professor of Medicine (General Internal Medicine) at the Icahn School of Medicine at Mount Sinai.

The encouraging findings support the potential of antibody-based blood tests to help understand the spread of COVID-19, the disease produced by the SARS-CoV-2 virus. The testing would provide lawmakers with a better understanding of how many people may possibly be immune and might be able to safely return to work as economies begin to reopen. At this time, there remains limited data worldwide on the development of antibodies to SARS-CoV-2, particularly the formation of IgG.

Mount Sinai has tested more than 22,000 individuals for antibodies since late March, when it became one of the first institutions in the world to begin treating COVID-19 patients with antibody-rich plasma from individuals who recovered from the disease. Mount Sinai identified individuals who had high titers, a measure of the concentration of antibodies, and referred them to the New York Blood Center, where they donated their plasma. As of May 11, more than 350 patients had received this convalescent plasma therapy through Mount Sinai, which is currently compiling data on the program.

The study also found that 19 percent of those who had recovered from COVID-19 still had evidence of the virus after receiving a nasopharyngeal swab of the back of their nose and throat. This has raised some concerns among patients who thought they may have been reinfected.

“More evidence is showing that people probably don’t need to be stressed about these positive swabs,” says Dr. Wajnberg. “We don’t know for certain why almost 20 percent of people had evidence of the virus weeks out from their symptoms. It is possible there’s some shedding of the virus still going on, but it is also possible that the test is picking up dead viral fragments. The scientific community is looking into this because it has major implications as to whether you need a negative swab to be cleared from this disease, which more people are thinking you don’t.”

One of the study’s authors, Florian Krammer, PhD, Professor of Microbiology at the Icahn School of Medicine at Mount Sinai, developed the antibody test that Mount Sinai uses. He says, “If you have higher titers you start to see neutralization. I can’t tell you that having a certain level of titers is protective against the virus, but we know from the vast majority of viral infections that neutralizing antibodies do protect you from getting infected. There are four human coronaviruses that give you a common cold, and in studies of those you get antibodies for one to three years and are protected during that time. In some cases you’re protected from getting reinfected, in other cases you might get a little infected but not have symptoms, and in other cases you may have symptoms but they’re much milder.”

In related news, the Mount Sinai Health System and California-based Sorrento Therapeutics, Inc. recently agreed to jointly develop antibody products that would act as a “protective shield” against SARS-CoV-2 coronavirus infection, potentially blocking and neutralizing the activity of the virus in at-risk populations, as well as recently exposed individuals.

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