Infectious Diseases | Mount Sinai Today

A Snapshot of the Extraordinary Contributions of Mount Sinai Students in COVID-19 Efforts

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

From left: Shravani Pathak (MS3), Samuel Paci (MS3), and PhD candidates Mark Roberto and Sindhura Gopinath, members of the PPE Task Force, inventoried PPE stock, coordinated with different floors, and distributed PPE across Mount Sinai West based on need.

In an extraordinary effort across the Icahn School of Medicine at Mount Sinai and its Graduate School of Biomedical Sciences in New York City, 200 students and postdoctoral fellows have volunteered more than 6,100 hours during a three-week period and continue to assist the Mount Sinai Health System during the staggering challenges of the COVID-19 crisis. As members of the Sinai Student Workforce, they have made an impact in a wide range of areas, from sourcing, acquiring and assembling personal protective equipment (PPE), to supporting clinical trials. An additional 450 student volunteers have since joined the effort.

Students are organized into task force teams working in the following areas: PPE, pharmacy, telehealth, administrative, operations, labs, and morale. The six-member COVID-19 Student Volunteer Leadership Team—Alexandra Agathis (MS3), Ben Asriel (MS4), Rohini Bahethi (MS3), James Blum (Scholarly Year), Zina Huxley-Reicher (MS4), and Shravani Pathak (MS3)—meets regularly with administration leadership to receive, triage, and coordinate requests from throughout the Health System. “Our students have become an essential part of the support system Mount Sinai needs to save lives and care for the communities it serves,” says David Muller, MD, Dean for Medical Education, and Professor and Marietta and Charles C. Morchand Chair in Medical Education.

“We know we’re making a huge difference because we can see it.” — Christopher Park (MS3), Icahn School of Medicine at Mount Sinai

Following is a snapshot of what they have accomplished.

The PPE Task Force, led by Annie Arrighi-Allisan (MS3) and Stephen Russell (MS3), sourced and acquired nearly 3,000 N95 masks, nearly 9,000 surgical masks, and 400 gowns. They assembled more than 1,500 durable, reusable face shields from 3M and distributed them to front-line health care providers, fitted staff with protective masks, and played an instrumental role in the distribution of 750,000 single-use face shields. Students worked in around-the-clock shifts to assemble more than 200 PPE go-bags for residents working at Elmhurst Hospital—which is part of a New York City integrated system of health care facilities that has been particularly hard-hit with COVID-19 cases, and with which Mount Sinai has an affiliation. In addition, the group trained more than 50 students to help fit clinical staff with new models of N95 respirators.

The Operations Task Force, led by Alexandra Capellini (MS2) and Christopher Park (MS3), delivered vital equipment, a task that requires unloading deliveries and assembling IV poles. One team assisted in rapidly engineering a method to transform 200 ResMed VPAP ST machines as a donation from Elon Musk, Chief Executive Officer of Tesla, Inc., as patient ventilators. They additionally helped write the assembly guide and operation instructions and assemble hundreds of units. Other teams provided support on clinical trials and promoted blood donations among their eligible classmates and peers.

From left: Jeremy Nussbaum (MS3), Marc Casale (MS3), Meygan Lackey (MS4), and Rebecca Rinehart (MS3) took inventory of COVID-19 medications, alerted staff of shortages, and distributed critical medications to hospital floors at Mount Sinai Beth Israel.

“This has been an intense, eye-opening experience and, for the first time, I’ve felt I was doing my small part to help with the response to the pandemic,” says postdoctoral fellow Dan Filipescu, PhD. “Prior to this, I had no idea how the day-to-day operations of a clinical trial worked, or the amount of effort that goes into caring for COVID-19 patients.”

Approximately 300 student volunteers from the Telehealth Task Force provided and obtained patient information—calling them with test results, calling hospitalized COVID-19 patients to gather information regarding emergency contacts, and triaging the palliative care hotline. Students were trained to know when to answer questions and when to refer them to their superiors. Using an online chat platform, they triaged patients with potential COVID-19 symptoms—providing them with additional information about the virus and how to self-isolate, and arranging virtual appointments with physicians, or sending them to the emergency room if necessary. To date, students have had more than 2,320 triage chats and test result updates with patients. “As future physicians, we entered this profession in order to help people,” says Harinee Maiyuran (MS4) who, with Sidra Ibad (MS1) leads the Telehealth Task Force. “Though we are unable to engage in direct clinical care, coordinating Telehealth has allowed me to not only participate but feel useful in these weeks of uncertainty and fear, and it has allowed me to give back to the New York City community that has become my home.”

Pharmacy was the first task force to send volunteers throughout the Mount Sinai Health System. Led by Benjamin Liu (MS3), the team has been troubleshooting Pyxis loading to help resolve medication supply shortfalls. When students at Mount Sinai Beth Israel made pharmacy leadership aware of a dwindling supply of Azithromycin, pharmacists were able to recommend a different medication for some patients to conserve their supply. Volunteers in the leadership suite assisted the Health System pharmacy director in researching treatment guidelines and protocols, and in reviewing charts to understand the impacts of the COVID-19 protocols.

Members of the Administrative Task Force, led by Christopher Ferrer (MS3) and Phillip Groden (MS3), handled remote medical scribe work and assisted outpatient practices with transitioning patients to Telehealth appointments. Working with the Department of Clinical Innovation, they reprogrammed tablets in every room and unit to allow for teleconferencing between patients, families, and staff. They have also been fielding offers of vital supplies and PPE and acquiring them for the frontlines. A group of student volunteers working with Materials Management leadership developed a system of creating inventories of crucial PPE supplies, leading to improvements in efficiency.

More than 40 student volunteers on the Labs Task Force, led by Michael Fernando (PhD2) and Maddie O’Brien (PhD2), have triaged more than 500 incoming requests for serum antibody testing. Working with the departments of Microbiology and Pathology, they have contacted approximately 200 donors with their results, and scheduled approximately 300 new participants prioritized for potential plasma donation. Their most recent initiative has 50 volunteers screening COVID-19 patients to assist the Operations team to prioritize candidates for plasma treatment.

Melissa Hill (MS3), left, and Sarah MacLean (MS3), learned that “it is impossible to breathe when wearing N95s correctly—and staff have to do it all day long.” They were members of a team that brought N95s and other PPE to Mount Sinai West.

As staff and volunteers throughout the Mount Sinai Health System work long hours under increasingly stressful conditions, keeping up morale plays a key role in the fight against coronavirus. The Morale Task Force, led by Ms. Arrighi-Allisan, Ella Cohen (MS1), and Katie Donovan (MS3), is charged with boosting morale among student volunteers and the greater Mount Sinai community. They have coordinated meal deliveries three days a week to all students remaining in nearby apartments, with leftovers going to residents, nurses, and other staff at The Mount Sinai Hospital. They distributed health kits containing a thermometer, pulse oximeter, a mask, and acetaminophen to students who are ill. They also fostered a sense of community through social media and blogs that highlight the achievements of student volunteers and have created an initiative to write letters to residents of nursing homes and other skilled nursing facilities.

Collaboration among peers extends beyond the Mount Sinai community and includes medical students from around the country. Students from the University of California, San Francisco, tweeted a seven-minute video to health care workers in New York City, showing solidarity, thanking them for their heroic efforts, and offering words of encouragement. “I am in awe of the way everyone has come together to fight this pandemic and all the hard work my peers have put into volunteering,” says Ms. Pathak. “I love collaborating with students from other schools as they reach out to me about how they can develop structures like our workforce in preparation for when the pandemic affects their communities.”

Adds Mr. Park about his experience on the Operations Task Force, “I think a lot of us are learning about the real meaning of resilience and adaptability by living it. We know we’re making a huge difference because we can see it. I am both inspired but also unsurprised by the student response, because this is the standard I knew that our student body functioned at and would strive for.”

Elmhurst Hospital During COVID-19, An Experience Like No Other

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

Suresh K. Pavuluri, MD, MPH

The weekend of Saturday, March 14, marked a turning point for Suresh K. Pavuluri, MD, MPH, a second-year resident in Emergency Medicine at the Mount Sinai Health System, who was working in the Coronary Care Unit (CCU) at Elmhurst Hospital, a Mount Sinai affiliate. It was when the national discussion about the rising number of patients with COVID-19 became a deeply personal experience for him, and “everything just shifted quite dramatically,” he says.

Early that weekend, Dr. Pavuluri noted a couple of patients with suspected COVID-19 were being treated in the hospital’s Emergency Room and Medical Intensive Care Unit (MICU). That was consistent with his experience a week earlier, during his rotation at The Mount Sinai Hospital, where that hospital’s first COVID-19 patient had been treated and released.

But the trickle of patients at Elmhurst Hospital quickly changed into something very different as more patients started arriving. “It seemed to come out of nowhere,” he says. “Suddenly, everyone had COVID. It was as if this huge avalanche hit us and we were trying to dig our way out of it, trying to cope with all these patients. Initially, all the people who were under investigation for COVID were sent to the MICU. And that quickly changed because we didn’t have enough beds. So, then some of the floors were converted to handling these patients and others who had difficulty breathing.” The sickest patients, who required intubation to assist them with breathing, were sent to the intensive care units and what had been the CCU, where Dr. Pavuluri was busy tending to them.

Within days, the policy changed to not allowing any visitors or family members into the units with the sickest patients. “It was a way for us to protect the public, but it was also a way for us to protect our patients,” he says.

“So, all of a sudden, I could no longer have face-to-face conversations with family members, and we had to have discussions over the phone. It was difficult for the patients to not have their family members there because in intensive care there are so many nurses and doctors coming in and out. The lack of personalization was one of the hardest things about this. You can’t really comfort someone through a phone. The other part was that we spent a lot of time on the phone. We were receiving multiple phone calls a day from different family members. Obtaining consent to treat intensive care-level patients meant we had to track down family members as quickly as possible. Sometimes critically ill patients require multiple procedures. The patients were already intubated by the time they came upstairs. Some of the coronavirus patients were going into renal failure and needed dialysis. That is typical in the intensive care unit, but we never see the sheer volume of it. We never expected so many patients to require all of these things or this much attention. These were people in their 30s, 40s, 50s. We saw people in their mid-thirties with no prior medical problems. When this pandemic began, we thought it was going to be mostly elderly patients affected by this. Then we realized it’s anyone and everyone.”

During that turning point of a weekend at Elmhurst Hospital, Dr. Pavuluri says he began to hear the code “Team 700 to B4” on the overhead paging system more times than he could keep track of. It meant that a patient’s heart had stopped. At that point, Team 700 would rush into his unit and perform their assigned duties, from administering chest compressions to providing the medications needed to rescue the patient’s heart. “Before coronavirus took over our hospital, I may have heard this code once or twice a week,” he says. “But it became all too familiar. Sometimes, after several minutes, just when we felt defeated, the patient’s heart would start beating again and we’d sigh with relief and look at each other, acknowledging that it was just a matter of time until our next code.”

As the volume of patients entering Elmhurst Hospital increased, Dr. Pavuluri’s work schedule changed to meet the demand, from working every four days to 12-hour shifts. “We simply had to be resilient,” he says. “We had to be flexible and adapt to best serve our patients.”

More than a week later, Dr. Pavuluri developed COVID-19 too, and went home to nurse his splitting headaches, low-grade fever, exhaustion, chills, muscle aches, nausea, chest heaviness, congestion, and shortness of breath. He began to recover after five days. Eleven of his colleagues at Elmhurst Hospital also tested positive. By early April, Dr. Pavuluri was back at work, splitting his time in the Emergency Departments at Elmhurst Hospital and The Mount Sinai Hospital.

While he was home recuperating from COVID-19, Dr. Pavuluri had time to reflect.

“I can definitely say the experience will leave an impression on me and my colleagues for as long as we practice medicine. We did not anticipate this, and we were not prepared for this. I am really close to my family and they have been a great sounding board. My colleagues at work have been my great resource because they understand, they’ve been there. To be among the young doctors coming in and fighting the good fight—it’s been really gratifying. I am so proud to be among the nurses and doctors who are risking their lives every day in this pandemic. But there will be scars. It has been an experience like no other.”

How to Talk to Your Child About COVID-19

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

Discussing difficult topics with children can be uncomfortable and this pandemic is no exception. Aliza Pressman, PhD, co-Founding Director and Director of Clinical Programming for the Mount Sinai Parenting Center, shares information parents and guardians can use as they care for children during the time of COVID-19.

Should I let my children watch the news?

If you want to give age-appropriate information to your kids, I recommend reading articles from reputable sources—either to them or with them—and then talking about the information. You may want to stick with resources that do not show images as it can be hard for children—and adults—to get images out of their minds.

We don’t want our children to see difficult images that we cannot control. For that reason, I would recommend turning off the news completely in front of younger children. In fact, older children and teenagers don’t really need those images either. Ideally, you should set aside time to watch the news to when you are alone or with other adults. This will also help manage your own stress because you will be limiting the amount of time you spend taking in this information.

I would discourage people of all ages from watching the news too much. Having the news on 24/7 heightens stress in the household and sends the message that you’re scared to turn the news off because you’re afraid you’ll miss something.

How do I help my child understand why they cannot see their friends and loved ones?

It can be hard for children to be unable to visit friends and loved ones, like grandparents, who they might be accustomed to seeing regularly. Try to empathize with your child and help them come up with proactive ways to connect with grandparents or other loved ones whom they cannot see.

This is the time to take advantage of social media and digital devices to empower your child to forge a connection with someone when they are not in the same room. Help turn sadness into productive action by encouraging your child to write letters, send notes, call, and video chat. These are beautiful ways to connect and show children that there is something they can do to help a person they love feel better.

If your child doesn’t have someone to connect with, there are organizations that can help you reach out, write letters, and draw pictures for elderly and vulnerable people who are currently isolated.

Should I tell my child if a loved one is seriously ill?

No matter how old your child is, it’s important to be honest and give your child the information needed. How you explain the situation depends on the child’s age.

For younger children, if a close family member is ill and you know how that illness is progressing, you can tell your child that the person tested positive for COVID-19. Explain the care that person is receiving and that you need to support them from afar.

If the person is very ill and you do not know what the outcome will be, it’s okay to express that to your child. Explain that the person is receiving great care and that you will keep in touch to see how things are going. You do not want to tell your child that everything is fine and then, all of a sudden, the person’s condition deteriorates.

On the other hand, if the person is asymptomatic and has tested positive, you don’t necessarily need to tell your children.

What if I or my partner becomes ill?

If you or your partner are sick, you need to tell your child what is going on. Explain that COVID-19 is very contagious. Explain that, in order to keep their body healthy and their parent’s body healthy, you will need to be separated for 14 days. You can make a calendar as a visual reminder of how long you will be apart. This can work well for the whole family as even adults can benefit from being able to check off each day of quarantine as it passes.

When you explain anything to children, be sure to check in first. See what they know already and then you can see where to begin with the explanation.

Dr. Pressman is the host of parenting podcast Raising Good Humans. Recently, she and Mariel Benjamin, LCSW, from The Mount Sinai Parenting Center, answered questions from health care providers and staff on the front lines to help support their parenting curing COVID-19. Additionally, The Mount Sinai Parenting Center maintains a COVID-19 resources page for parents, caregivers, and health care workers.

Managing Your Child’s Anxiety Caused By COVID-19

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

The COVID-19 pandemic is incredibly stressful for adults and can be puzzling and frightening for children. Aliza Pressman, PhD, co-Founding Director and Director of Clinical Programming for the Mount Sinai Parenting Center, shares advice for parents and guardians on how to manage your child’s anxiety as we navigate the uncertain times of COVID-19.

Are there steps I should take to help my child’s mental health?

This is a very confusing time for adults and kids. Typically, when kids are going through a new experience it is one that we, the adults, have been through. We’ve worked through it, we’ve grown up, and we’ve come out the other side. In this case, none of us have ever been through this and so our kids can’t look to us for that safe secure feeling. We don’t have a road map.

Be honest with your kids. Tell them that you know this is a new experience for all of us. Tell them that you understand if it feels scary or if they are worried. Remind them that you are right there with them.

How should I respond to my child’s anxiety?

Give your child permission to talk about what they are feeling and worrying about. Acknowledge their anxiety even if it has nothing to do with COVID-19 or is only slightly related to the pandemic. For instance, children may feel stress because they miss their friends or aren’t allowed to celebrate an event like a graduation or birthday. Try not to diminish their feelings or say ‘we have bigger things to worry about than your birthday party.’ Instead, tell them that you know it’s really hard. Let them know that you are aware that this is a big change. Assure them that you can figure out how to have celebratory experiences, even if they are not quite how you originally planned them.

This is a very challenging time for everyone. You can explain to children that they are being asked to be health superheroes. Through the practice of social distancing and by washing their hands thoroughly, they are keeping themselves safe and helping to protect others who are more vulnerable. This is a wonderful, empowering message that does not scare children.

Is it important that I keep my child’s routines going?

Although it can be hard to keep routines going during a time that has very few routines, kids and adults thrive on knowing what to expect each day. So, try to set up a flexible routine for the coming weeks or months.

I encourage writing out a plan for your children. If they are younger, you can draw a picture of the routine of the day or use photos from magazines to help them understand what to expect. Ask older children to come up with what they think is a good daytime routine. You want to make sure they are comfortable with the schedule, but you also want to get certain boxes checked about what needs to happen each day. Make sure that it includes something healthy for their bodies, something healthy for their brain, something healthy for their relationships, and so forth.

It’s also important to let children have some enjoyment. Allow them to be happy about getting out of some obligations they had prior to practicing social distancing. Your kids might be a little bit happy about spending more time at home with their parents. Let them know that it’s okay to have mixed feelings.

Also, allow yourself to embrace the new normal and accept that there may not be a completely perfect routine and predictable day-to-day experience. Children need to know what to expect, but they’re also very flexible if you explain clearly that there may come a time when the unexpected will arise. Children can take in new information and, if you are consistent, they will understand that you are there for them. Finally, if you are having any concerns about you or your child’s health and wellbeing, be sure to reach out to your health care provider for guidance and support.

Parenting During COVID-19

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

Trying to be the best parent possible is a challenge even in the best of times. It is even more complex during this pandemic. Aliza Pressman, PhD, co-Founding Director and Director of Clinical Programming for the Mount Sinai Parenting Center, shares information parents and guardians can use as they care for their children during the time of COVID-19.

How can I be a good parent at this time?

If you are worried you aren’t being the best parent possible, you should know that this is not the time to focus on trying to be the perfect parent. In fact, there’s never a right time because it simply isn’t possible. Besides, it’s important for kids to see that human beings are not perfect. That gives them permission to be imperfect too.

In addition, if you’re stressed and not taking care of yourself, that’s not good for anyone. As they say, you need to put your oxygen mask on first so you can take care of your little ones. In other words, it is important to alleviate some of your anxiety so that you can take the best possible care of your kids.

The news has me feeling tremendously anxious. How can I manage this?

We are in an unprecedented time. Feeling out of control or uncertain can lead to anxiety. Everyone is feeling this way now; you are not imaging your lack of control. It is important to realize that there is no way to get this 100 percent right. No matter how much time you spend reading articles and watching the news to try to make sense of what is going on, you won’t be able to.

The best thing you can do for yourself—and for your children—is to accept this and learn to tolerate the feeling of uncertainty. Focus on the things you can control, the problems you can solve. For instance, you can control washing your hands and teaching your children to wash their hands. You can control staying inside your home and maintaining social distance when you’re outside the home.

Do you have any tips to help me stop feeling so worried?

It is perfectly normal to worry right now. This pandemic is making all of us feel threatened. But remember, worrying about things you cannot do anything about will keep you from being able to take care of your family.

Try to find ways to release the underlying emotions, through activities such as meditation or gratitude practices. These approaches will get your nervous system into a state that allows you to alleviate some anxiety and think clearly. `Additionally, it can help to make anxiety a bit of a friend. Welcome that friend, and acknowledge that this is somebody who you’re going to be hanging out with for a while and you might as well get to know each other a little bit. Sometimes you are going to want your anxiety around, and other times you’re going to say you’d like to be left alone. One way to express this anxiety is by assigning different levels of stress a particular color, or a number from one to ten. This gives you a tangible way to acknowledge your anxiety level.

My child had a tantrum and I overreacted. How can I make things right?

Show some compassion for yourself. Forgive the hard moments where you overreact with your kids, have an outburst, or breakdown. And forgive your kids if they have an outburst or a breakdown. I’m not suggesting you do away with your boundaries or expectations for yourself or your children. But labeling those emotions, showing empathy and compassion, and then moving on is going to be a lot more helpful than expecting everything to go right all the time. This is a different kind of crisis. It’s going to be a marathon not a sprint. You need to brace yourself for a long haul.

This is a challenging time for all of us and there are certainly going to be parts of it that are unimaginably difficult. But when we have moments that are painful, we grow emotionally. And we come out the other side better able to adapt to difficult situations. Think of this challenge as an opportunity for you and your family to grow and adapt. Have the compassion to remember that this may not feel like a positive challenge, but it is necessary for growth.

How to Stock Up and Eat Well While Social Distancing

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

As multiple states issue shelter in place and stay at home orders to combat COVID-19, people across America are required to stock up on food for extended periods of time. Families want to remain food secure while making sure their kids eat nutritious meals.

Clinical Nutrition and Wellness Manager Kelly Hogan, MS, RD, CDN, and Clinical Nutrition Coordinator Rebecca Fernandez, MA, RD, LD, CDN, CDE, provide advice on stocking up and eating well as we do our best to stay home to ‘flatten the curve.’

What should people focus on when food shopping?

Rebecca Fernandez: Try to get things you can use long term like staples for the pantry. These are items that will not be expiring quickly like grains and oats which you can buy in large amounts. Also, consider getting shelf stable milk—which does not require refrigeration—and, unopened, is good for up to six months. Take advantage of the frozen goods like frozen vegetables and fruits that you can stick in the freezer.

Kelly Hogan: Going in the store with a list is important. You don’t want to forget anything and have to make extra trips. Having some go-to recipes that you can batch cook to have leftovers is helpful.

What should people avoid when shopping?

Ms. Hogan: Try not to feel like you have to buy a crazy amount of things at once. The grocery stores are not closing. They’re well stocked and will continue to receive shipments of food. Do try to limit your exposure to health advice online or through social media, as it often comes from those who are not health or medical professionals. For example, advice telling you to avoid or eat certain foods because they may impact immunity has been largely inaccurate and misleading. Focus on shopping for a variety of foods you know you enjoy and will use, including fruits, vegetables, whole grains, legumes, lean proteins and a few of your favorite treats.

What are some healthy snacks for kids?

Ms. Fernandez: There are gummy fruit snacks that are made with less sugar, less preservatives, and are flavored with real fruit juice. I encourage getting kids involved in making snacks whether it’s popping popcorn and adding toppings, such as a dash of maple syrup or Parmesan cheese, or making trail mix using nuts, pretzels, mini M&Ms, and chocolate chips.With these snacks, they’re getting the flavors they love (sweet and/or salty) but in a healthier more nutritious way.

Should we add any new vitamins to our diets during this time?

Ms. Hogan: Most healthy people do not need to take extra vitamin supplements, but this should always be discussed with their dietitian or doctor. I am always wary of herbal supplements, however, especially ones that claim to benefit immune health. These are not regulated by the U.S. Food and Drug Administration and may have adverse effects and/or interact with medications. Instead, focus on other things that can help with immunity such as eating healthy food, getting adequate sleep, and managing stress.

Sample Shopping List

Pantry foods

Pastas
Rice
Oats
Dry cereals (low sugar)
Unsalted/low salt crackers
Unsalted nuts
Beans/lentils
Tomato sauce
Granola bars
Dried fruits (apples, raisins, cranberries, mango, apricots)
Cooking oils

Foods that can be frozen

Meats (chicken, turkey, fish)
Vegetables (broccoli, green beans, peppers)
Fruits

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