Infectious Diseases | Mount Sinai Today

What do Cancer Patients Need to Know about COVID-19?

Mar 17, 2020 | Cancer, COVID-19, Your Health

COVID-19 is a concern for everyone. But cancer patients are among those at highest risk of contracting this virus–or developing a bad case of it. This is because most cancer patients have immune systems that have been weakened by cancer and its treatments. Cardinale B. Smith, MD, PhD, Chief Quality Officer for Cancer, shares information cancer patients need to know about COVID-19.

How can patients and caregivers protect themselves from COVID-19?

The most important thing that patients and caregivers can do is practice really great hand hygiene. Make sure to wash your hands for at least 20 seconds. You’ve probably heard about singing the Happy Birthday song twice; that is usually the right amount of time to soap and rinse your hands. If you are using hand sanitizer, make sure to pick one that is more than 60 percent alcohol.

Someone with cancer should limit contact with anyone who might be sick. Avoid large crowds and practice social distancing. The Centers for Disease Control and Prevention defines social distancing, in terms of COVID-19, as keeping six feet away from others. That means avoiding subways, buses, and other mass transit, and staying at home as much as possible. You can turn events that often involve large groups into virtual activities. Instead of going to the gym, for instance, you could watch a YouTube video and exercise along with it.

Which cancer patients are at greatest risk?

All cancer patients are at increased risk but patients at greatest risk are those who have recently had a bone marrow transplant or have blood cancers such as leukemia, lymphoma, and myeloma. Patients with these conditions tend to receive medications with a high concentration of immunosuppressants. If you finished treatment a while ago, you are probably not at increased risk.

What should I do if I have symptoms of COVID-19?

Cancer patients with symptoms that suggest COVID-19, such as coughing and high fever, should call their oncology team for expert guidance. Your oncologist is most likely to know if your symptoms suggest COVID-19 or if they are likely to be the flu, another respiratory infection, or if the symptoms are in line with your cancer diagnosis. Your cancer team can tell you if you need to come into the office to be checked.

What if I am feeling anxious?

Anxiety around COVID-19 is really high. Remember that for the vast majority of people who contract COVID-19, the virus is not fatal. Try not to let your fears get the best of you. Keep calm and practice the basic tips we talked about. That is your best bet, in terms of prevention.

Patients With COVID-19 Have Distinct Markings in Their Lungs, New Study Finds

Mar 10, 2020 | COVID-19, Featured, Research

Patients in China with COVID-19 showed distinct patterns in their lungs that became more defined within a few of days of disease onset, according to two cardiothoracic radiologists at the Mount Sinai Health System, who were the first in the nation to examine the CT scans of Chinese patients with the coronavirus.

The radiologists, Michael S. Chung, MD, and Adam Bernheim, MD, from the Icahn School of Medicine at Mount Sinai, say the distinct markings of these 121 patients offer objective evidence that could help doctors diagnose COVID-19 within minutes. The CT scans would support the health care community’s work in determining who has the disease and its ability to quickly isolate and treat patients. The test swabs being used to confirm the disease in patients can take up to 12 hours to process.

In a study that appeared in the February issue of Radiology, Drs. Chung and Bernheim described the disease characteristics of patients at four hospitals located in four different provinces in China. The patients were between the ages of 18 and 80, and their cases ranged from mild to severe. Of the patients who were scanned within two days after reporting symptoms, more than half showed no evidence of lung disease. Patients who were scanned three to five days after reporting symptoms showed distinctive patterns in their lungs.

A 65 year-old male with history of travel to Wuhan, presenting with fever and cough. CT obtained 11 days from onset of symptoms shows moderate lung disease with peripheral ground-glass opacities in both lungs (arrows).

A 51 year-old male with history of travel to Wuhan, presenting with fever and cough. CT obtained 3 days after onset of symptoms shows mild lung disease with peripheral ground-glass opacities in both lungs (arrows).

A 19 year-old male with history of travel to Wuhan, presenting with fever. CT obtained just 1 day after the onset of symptoms shows minimal lung disease, with very small amounts of ground-glass in the right lung (arrows).

A 29-year old male with unknown exposure history, presenting with fever and cough and requiring admission to the intensive care unit. The CT image shows diffuse bilateral confluent and patchy ground-glass and consolidative pulmonary opacities, with a striking peripheral distribution in the right lower lobe.

Dr. Chung, the study’s senior author, is an Assistant Professor of Diagnostic, Molecular and Interventional Radiology, and Medicine (Cardiology). Dr. Bernheim, the first author, is an Assistant Professor of Diagnostic, Molecular and Interventional Radiology. According to the authors, “Prompt recognition of the disease is invaluable to ensure timely treatment, and from a public health perspective, rapid patient isolation is crucial to containment of this communicable disease.”

The doctors say CT imaging is an efficient tool that is generally available throughout the world, even in places with more limited resources. The established imaging patterns of COVID-19 will provide doctors with the evidence they need to look for when making a diagnosis.

Early in the disease phase, the radiologists described a look of “ground-glass abnormality,” in the lungs. As the disease progressed, it was followed by what they called a look of “crazy paving,” which was followed by “increasing consolidation.” This imaging road map, they say, will help physicians predict disease progression and the development of complications.

For physicians, the most critical element in the severity of COVID-19 is the degree to which the lungs fill with fluid, with the worst outcome being the patient succumbing to pneumonia.

“The normal lung is black because it’s composed of air,” says Dr. Chung. “But in a patient with COVID-19 or another severe pneumonia, those areas become filled with cells, debris, pus, and fluid, and become white. That is a diseased lung that is not aerating, not exchanging oxygen and carbon dioxide. If it’s extensive enough and severe enough, and the body’s inflammatory response and immune system’s response can also cause downstream complications at the cellular level, that would make it difficult to oxygenate and could become fatal.”

Why some patients have more severe cases of the disease than others is still unknown, says Dr. Bernheim. He says that even though COVID-19 is in the same viral family as the SARS and MERS coronaviruses and “probably affects the lungs the same way, we are treating this as a new entity. We will have to see how it changes, progresses, and resolves, and treat it as a new area of research as opposed to just comparing it to SARS and MERS.”

Drs. Chung and Bernheim worked with Zahi Fayad, PhD, and his team at the Icahn School of Medicine at Mount Sinai’s newly renamed BioMedical Imaging and Engineering Institute, which creates novel imaging programs and medical technology. Dr. Fayad is the Institute’s Director.

How to Self-Quarantine Due to Coronavirus

Mar 4, 2020 | COVID-19, Your Health

As the novel coronavirus known as COVID-19 spreads around the United States, guidance for prevention and containment are being issued by the Centers for Disease Control and Prevention (CDC). People who have fever or respiratory symptoms, such as coughing and difficulty breathing, are being advised to stay at home except to get medical care. Krystina Woods, MD, Hospital Epidemiologist and Medical Director of Infection Prevention at Mount Sinai West, helps us understand the “dos and don’ts” of self-quarantining, and what that may mean for New Yorkers.

The CDC recommends staying home except to get medical care. How and why is this different from other respiratory diseases?

Many of the CDC guidelines for quarantine might be used by someone who has a severe case of the flu. But because we are just starting to understand how COVID-19 is being spread, and how long the incubation period is, the guidelines are going to be necessarily conservative.

The CDC recommends that the patient stay in a separate bedroom. And if possible, use a separate bathroom.

Yes, and that might pose a challenge to New Yorkers. Certainly, if there’s a separate bedroom and bathroom for the patient that would be best. Another strategy for roommates and spouses to consider: Is there a friend or family member the roommates or spouse can stay with? But even in small apartments, there are things you can do to protect each other. In studio apartments, separating the beds as much as possible is advisable. And because of the close proximity, the patient, roommates, and others in the household should wear masks.

If you share a bathroom, make sure you don’t share towels. The patient might bring their towel back to their own room if they have a separate bedroom. Always wipe down surfaces such as the sink, toilet handle, light switches, and door knobs with a household cleaner with disinfectant. Don’t share personal items such as toothbrushes or drinking glasses.

If the patient has their own room, they should wear a mask when they come out. And even though it’s winter, cracking a window for some ventilation is a good idea.

What precautions should people take concerning meals?

If the spouse or roommate can prepare meals for the patient, that would be best. Meals can be left outside the patient’s door, so the patient doesn’t need the kitchen. You can even text when the meal is on the way, or to communicate back and forth. Disposable plates and utensils might be an option, but not totally necessary. Washing the patient’s dishes immediately after use, and then washing your hands, should be enough.

What additional precautions should family, spouses, or roommates take?

Others in the household should wash their hands as much as possible. We touch so many things that could be contaminated without thinking: phones, microwaves, remote controls. Wash your hands before you leave home and when you get home. Wash them after touching anything the patient could have touched or used: bedding, dishes, the bathroom doorknob. Try not to touch your face, especially your eyes, nose and mouth.

If the patient has a medical appointment, it’s hard to get there without public transportation. What advice would you give?

People should avoid using subways, buses, taxis, or ride-sharing services if they’re sick. You should only go to medical appointments that are absolutely necessary, not routine appointments. Maybe a friend can give you a ride for appointments that are essential. If so, you might want to sit in the back seat instead of the passenger seat, and open the window.

How long will the self-quarantine last?

It’s hard to provide a time frame for any self-quarantine because it depends on the severity of the disease. Some people may have a very mild case, and some may have severe symptoms. The duration of symptoms varies from person to person. But certainly, a person should be quarantined while they have a fever or respiratory symptoms such as coughing or difficulty breathing. The New York Department of Health will be monitoring each case of COVID-19 very carefully, and they will provide guidance.

What Parents Should Know About the Novel Coronavirus and the Flu

Mar 4, 2020 | Cold and Flu, COVID-19, Your Health

The outbreak of a viral infection known as COVID-19, caused by a newly discovered coronavirus, is dominating the news, and governments, public health experts, and doctors are preparing for a growing number of cases around the world and in the United States.

The possibility of a coronavirus outbreak in the New York region, as well as the seasonal outbreak of the flu, pose special concerns for children. “There is a lot of anxiety out there and a lot we don’t know,” says Roberto Posada, MD, a pediatric infectious disease specialist in the Jack and Lucy Clark Department of Pediatrics at Mount Sinai Kravis Children’s Hospital and an Associate Professor of Infectious Diseases, and Medical Education, at the Icahn School of Medicine at Mount Sinai. “Fortunately we are learning from cases in China that most children don’t seem to get very sick from the coronavirus. But we also know that youngsters are one of the ways that viruses travel from one household to another.”

In this Q&A, Dr. Posada offers some basic advice for parents in the New York area.

What general advice do you have for parents who may be worried about their children?

The most important prevention strategy is to get your flu vaccinations. It’s not too late, and every child should be vaccinated every year. We are still seeing a lot of cases of the flu in the community, and some of these children need to be hospitalized. With all viruses in general and with respiratory-borne illnesses, everyone should wash hands frequently, with soap and water or with an alcohol-based sanitizer—especially before eating, after blowing your nose, and after entering your home from the outside. There is no difference between soap and water and a hand sanitizer when it comes to most viruses. Soap and water is preferable for eliminating gastrointestinal pathogens—infectious agents like viruses and bacteria that cause disease in your digestive tract—so that’s best after using the bathroom.

Also, teach children the proper etiquette for coughing or sneezing. They should use the inside of their elbow or blow into a tissue, and then wash their hands.

Are kids more at risk from viral outbreaks generally?

Kids tend to get more viral infections than adults, partly because their immune systems are not fully developed. How sick they can get depends on their age. Kids less than two years old are at higher risk for many infections like the flu.

How much of a risk does the coronavirus present for children?

We know from the data so far that the coronavirus seems to result in a very mild infection for children. Most of the patients that have been hospitalized or have died are older adults. Also, it is important to note that about 80 percent of people who have gotten the coronavirus experienced a very mild illness and did not need to be hospitalized. Unfortunately, about 20 percent of infected people develop more significant disease, and about 1 to 2 percent of all of those infected have died, again most of them older adults.

Should parents keep children out of public spaces, maybe off the subway?

At this time, I would suggest people in the United States go about life as normal, so long as they are washing their hands frequently. For example, if you take the subway or public transportation, or if you have been around people who are coughing or sneezing, it’s a good idea to wash your hands. Avoid as much as practical being in close proximity to people who are sick. You should also follow the news, as the recommendations from public health officials may change rapidly depending upon the cases we see. As always, the Centers for Disease Control and Prevention (CDC) and your local health department are the best sources of information.

The CDC recently said that if a widespread outbreak occurred in the United States, schools could be closed. Why is that an effective step?

If public health officials see the virus is spreading fast, and believe schools may be playing a role in facilitating the spread of the illness from household to household, closing of schools may be warranted.

How do children help transmit viral infections?

What happens with the flu or any virus is that young children pass them to their classmates. Young people are in such close contact with each other, especially if they are at day care, and it’s not uncommon for their saliva or mucus to mingle. They share toys, maybe even eating utensils. When kids get sick with an infection, they can pass the causative virus or bacteria along to other kids, and those kids then can bring it to their parents. That is how an illness crosses from one household to another and contributes to the spread of the viral infection.

Should we wear face masks?

At this point we are not recommending you or your children wear face masks to avoid getting sick. Face masks are mostly for health care workers who are in close proximity with people who are sick. And it can be helpful if someone who is already sick wears a face mask when in public spaces to prevent infecting others.

When should parents call the pediatrician if their child is sick?

My recommendations for the flu and other viral infections is the same as for illnesses in general. If your child’s symptoms are mild and in the respiratory tract, like a runny nose and sneezing, and if they are continuing with their other normal activities and these symptoms have lasted less than 24 hours, I would not worry or call. But if symptoms last more than 24 hours, if children also have a cough and fever, if they are not eating or drinking enough, and if they are disinterested in normal activities and look tired or sleepy, I would call your pediatrician. And let your pediatrician know if there is any history of travel or interactions with people who have been sick.

What You Need to Know About the Recent Novel Coronavirus Outbreak

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

A newly identified coronavirus now known as COVID-19 was first recognized in Wuhan, China, in early December 2019 and is rapidly spreading throughout the world.

Bernard Camins, MD, MSc, Medical Director for Infection Prevention for the Mount Sinai Health System, offers some basic guidelines for understanding this latest health concern. You can also get up-to-date information from the Centers for Disease Control and Prevention (CDC).

Who is most at risk?

According to the CDC, those at the most risk include: people in places where ongoing community spread has been reported and people who have had close contact with those who have COVID-19. In addition, people who recently traveled to an area where cases of COVID-19 are occurring are most at risk, and they should consult their doctor or the CDC for the latest information. The CDC maintains a list of countries with significant COVID-19 cases.

What are the symptoms?

Symptoms have included mild to severe respiratory illness with fever, cough, and difficulty breathing. The symptoms usually begin within two to three days of exposure but could take as long as 14 days to develop. These symptoms are also typical of the flu and other seasonal viral illnesses, and if you have symptoms like these and you have not traveled to an area with COVID-19 cases or been in close contact with someone who has, you probably have a seasonal illness and not the novel coronavirus.

What if I recently traveled to an area with COVID-19 cases and now have symptoms of a respiratory illness and/or fever?

If you feel sick with fever, cough, or difficulty breathing within 14 days after you return to the United States, you should seek urgent medical care. However, before going to your doctor’s office, an urgent care center, or an emergency room, call ahead and alert the staff about your recent travel and symptoms.

Avoid contact with others. Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing. Frequently wash your hands with soap and water for at least 20 seconds to avoid spreading the virus to others. Use an alcohol-based hand sanitizer if soap and water are not available. As soon as you arrive at the medical facility, let a staff member know about your symptoms and travel history. You should be provided with a mask and moved to an area away from other patients.

How is coronavirus spread?

There are many types of human coronaviruses, including those that cause the common cold. They typically spread from an infected person through the air in tiny droplets produced when coughing or sneezing. These droplets, when they come into contact with another person’s mucous membranes (e.g., mouth, nose, or eyes), can lead to infection. The virus can also be transmitted if you touch a person, an object, or a surface on which the virus has settled and then touch your mouth, nose, or eyes before washing your hands.

How can I protect myself?

As with other respiratory viruses, you can protect yourself from infection through frequent, proper hand hygiene, either with an alcohol-based hand sanitizer or with soap and water. Also, practice proper respiratory hygiene by covering your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

How is Mount Sinai prepared to treat infectious diseases?

For a long time, Mount Sinai has been developing procedures to make sure that people arriving for care at our facilities are quickly screened for infectious diseases. This includes questioning people about whether they have traveled abroad in the last three weeks or come into contact with people who are traveling abroad. Our procedures enable us to quickly isolate any possible cases of infectious disease.

Bernard Camins, MD, MSc, is Medical Director for Infection Prevention for the Mount Sinai Health System.

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How Important Is Getting the Flu Shot?

Updated on Jun 30, 2022 | Cold and Flu, Infectious Diseases, Your Health

Despite all the media attention about the novel coronavirus, now known as COVID-19, influenza is currently a much bigger risk for most people in the United States. Yet many people do not plan to get a flu shot this year. You may be busy, or perhaps you think you might get sick from the shot, or that it’s not necessary. Matthew Weissman, MD, MBA, a primary care doctor with the Mount Sinai Health System, explains why you shouldn’t put it off.

Why should I get the flu shot?

The flu shot is extremely important. It not only prevents you from getting sick from flu, but it can lessen the severity of flu even if it’s not a perfect match for the type that is going around. For instance, my own daughter got the B strain of the flu. Luckily, she had a much milder case of it because she got the shot.

People forget that the flu is a deadly disease. Each season, tens of thousands of people die from the flu, and hundreds of thousands are hospitalized, according to the Centers for Disease Control and Prevention (CDC). Most of the people who died were not vaccinated. If you’re overweight, pregnant, elderly, or a child, or you have other diseases, you’re in a high-risk category. When you add all those up, you’re talking about a wide swath of New Yorkers.

Keep in mind that the flu shot doesn’t just protect you; it protects your co-workers, your classmates, your parents, and your grandparents—including people whose immune systems may not be good enough to build up their own defenses. It’s like a ripple effect, or herd immunity. It would be a great idea to have a workplace event for people to get vaccinated. It’s a smart idea for businesses to help cut down absenteeism this way.

Some people don’t get the shot because they think they’re going to feel sick for a couple days. Is that true or a myth?

People’s responses vary. Some people do feel a little feverish, get a sniffle, or have a sore arm for a bit. That’s actually a good sign, because it means their immune system is revving up to combat the flu. I think that’s a fair price to pay for not being incapacitated for over a week or being at risk of death from a vaccine-preventable illness. And these side effects don’t happen to everybody, and it doesn’t happen every time.

People have all kinds of excuses why they can’t get the flu shot. People are sometimes worried that the shot may cause a bad reaction because they have an egg allergy. But there are lots of ways to deal with that, including some vaccines that were not created using eggs. People should ask their doctor to find out what’s right for them.

Bottom line, the benefit of the flu vaccine outweighs the risk for most people, by far.

Is it too late to get a flu shot this season?

Definitely not. Flu season doesn’t appear to have peaked yet. The flu season is generally during fall and winter. The CDC recommends that everyone six months or older get the flu shot. You can get it any time up until spring, so don’t wait.

Matthew A. Weissman, MD, MBA, is Chair of Medicine at Mount Sinai Downtown and Associate Professor of Medicine (General Internal Medicine), and Pediatrics, at Icahn School of Medicine at Mount Sinai