How Front-Line Health Care Providers Can Keep Their Families Safe

As COVID-19 continues to have a dramatic impact around the globe, and front-line doctors, nurses, and health care staff are managing a growing number of cases, there is understandable anxiety.

Waleed Javaid, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, and Director of Infection Prevention and Control at Mount Sinai Downtown, offers a perspective on how health care providers can help keep their families safe.

“Health care workers, like everyone in the community, should remember hand hygiene, be mindful of social distancing on the home front by avoiding large family gatherings, and in times of a pandemic, they need to have a plan for their families,” Dr. Javaid says.

In this Q&A, he provides additional advice to reassure health care providers how they can help keep their families safe.

What kind of issues do I need to discuss with my family?

Health care workers, like everyone in the community, should discuss all aspects of the pandemic with their families. Everyone should have a plan in place for their home should anyone in the family get ill—and most importantly, planning does not mean panic. It’s a simple thing: should somebody become ill, have you identified a place in the home, an extra bedroom, or separated area, for example, where they can remain separated? The vast majority of people who become ill can get better on their own, and with proper social distancing and precautions, family members can remain protected.

What kind of precautions do I need to take as I leave my shift?

Outside of the hospital environment—where you do not have protective equipment—it is important to reinforce that you should use the same precautions as everyone else: hand hygiene and maintain social distancing.,

First, wash your hands before you leave. Then, take a moment to gather your thoughts. Make sure that if you had any exposure, or any concerns of exposure, that you address it with your supervisor so the issue can be followed up immediately. Check your symptoms—How are you feeling? Also, take an additional moment—because in this crisis you have played a very important role. Wipe your work surface with hospital wipe, and remember to clean the surfaces again when you return.

Should I remove my work clothes before I walk into my house?

Before the COVID-19 pandemic, there was the general recommendation from infection prevention that health care workers in procedural areas like the operating room should change into street clothes before leaving the hospital. The recommendation is still true today. Health care workers who are involved in procedures that may lead to contamination of their scrubs with blood and body fluids should change into street clothes before leaving the hospital. For everyone else who does not work in procedural areas, donning and doffing PPE throughout the day may cause you to sweat more. Respiratory viruses, including coronaviruses, are not transmitted through articles of clothing. But it is not unreasonable to change when you get home if that would make you more comfortable.

Should I avoid my family members when I am at home?

If you are feeling well, there is no reason to avoid your family members. Frequent hand hygiene with soap and water or alcohol-based hand sanitizer is recommended. Everyone should make sure that they cover their nose and mouth when they cough or sneeze, but otherwise you may act normally with your family members.

Should I avoid interacting with my pets?

If you are feeling well, there is no reason to avoid your pets. Similar to contact with humans, you need to make sure that you cover your nose and mouth when you cough or sneeze.

Are there any additional precautions I can take at home—for example, wash my clothes separately?

There is no recommendation about separate clothing screening. But, washed clothes should be dried in a dryer because that helps reduce any contamination on the clothing. You should think about wiping the phone and other products with a compatible cleaner, preferably one that has antimicrobial rating. Wash your hands afterwards, and you should be good.

COVID-19: What Transplant Patients Need to Know

As the outbreak of COVID-19 widens, transplant patients have some special concerns. Meenakshi M. Rana, MD, the Director of Transplant Infectious Disease, Mount Sinai Health System, shares her perspectives on what transplant patients need to know about the virus.

Should transplant patients be concerned about COVID-19?

We’re just learning how this virus could potentially affect transplant patients. We do know that this virus is similar to other common respiratory viruses, and that the symptoms have a lot in common with the flu. Many of the patients affected by COVID-19 have mild symptoms, typically fever and cough. Many of them are fine at home, though some patients may have more severe complications such as pneumonia and may require hospitalization.

What is the special concern for these patients?

We are very concerned about our transplant patients because they have compromised immune systems, and they’re more at risk of having severe complications. It’s really important that our transplant patients take precautionary measures such as hand hygiene. We know the virus is spread by direct contact. However, it is easily killed simply by washing your hands with soap and water for 20 seconds, or using an alcohol-based hand sanitizer. So washing your hands is the most effective thing you can do to prevent transmission of this virus.

What other precautions should transplant patients take?

First of all, if you’re sick, please stay home. If you need to cough, don’t cough into your hands, cough into your elbow. Throughout your home, use a disinfectant to wipe off surfaces that are commonly used such as door handles, bathroom fixtures, and countertops.

As a practical precaution, make sure that you have an adequate supply of your medications at home. Call your physician and ask for a three-month supply of your transplant medications so you don’t run out.

And if you do go out, be very conscientious about hand hygiene and disinfecting surface like your phone. If you know someone is sick, this is not the time to visit with them. And in general, avoid large crowds.

What about masks?

We have been getting a lot of questions about whether protective masks are effective. We don’t think wearing a mask in public is an effective way of protecting yourself. Washing your hands and disinfecting surfaces is a much better way to prevent transmission of this virus.

What should transplant patients do if they have symptoms of COVID-19?

If you have symptoms such as fever, coughing, or shortness of breath, call your transplant provider. We want to know if our patients aren’t feeling well. We will ask about your symptoms. If you’re having mild symptoms, such as a cough, sore throat, or runny nose, we may advise you just to stay at home. We’ll follow up in a day or so to see how you’re doing. If your condition has worsened, and you have a high fever and shortness of breath, we may bring you into the hospital and evaluate you further. If you do decide to come in, we ask that you call ahead so that we know how to triage you, and so that we can determine the best location to receive you.

Meenakshi M. Rana, MD, is the Director of Transplant Infectious Disease for the Mount Sinai Health System. She is also Associate Professor of Medicine of Infectious Diseases at the Icahn School of Medicine at Mount Sinai.

I Am Diabetic. Am I At Increased Risk for COVID-19?

The novel coronavirus known as COVID-19 has upended the world. The entire country of Italy is on lockdown and Americans are being asked to stay indoors as much as possible, only venturing out for essential supplies like food and medicine.

People with compromised immune systems, like older adults and those with chronic medical conditions like diabetes, are particularly vulnerable to COVID-19. While safety precautions are the same as the flu, this virus is a much more serious illness. For people with diabetes, this means taking particular precautions to avoid the virus.

In this Q&A, Maria E. Peña, MD, Director of the Diabetes Alliance at The Mount Sinai Hospital, provides advice for people living with diabetes on how to navigate the world during the COVID-19 pandemic.

Why are people with diabetes more vulnerable to infections and complications of infections?

Diabetics have a compromised immune system which means that fighting viral infections takes longer and is more taxing on the body. Additionally, a report from the International Diabetes Federation found that viral infections cause fluctuations in blood glucose, making diabetes harder to control. And, viruses may thrive in environments of elevated blood glucose.

However, it is important to remember that although diabetics are more likely to experience complications when infected, it is unclear if diabetics are at a greater risk of contracting the virus.

What should people with diabetes do to prepare?

Patients should be sure to have all of their medications refilled as soon as possible, this also includes testing supplies for blood glucose self-monitoring. Additionally, if you are one of the many diabetes patients who has high blood pressure, be sure to have an at home blood pressure monitor.

As more potential cases arise, health care providers will be focused on caring for the sickest patients and office staffing may decrease. Therefore, there may be delays in refills. To avoid this, request that your pharmacy give you a 90-day supply of all medications. Additionally, be sure to have your doctor’s office contact information in case you have questions about your medication, blood sugar, or you are not feeling well.

Apart from making sure medications and medical supplies are on hand, what other precautions should diabetics take?

I recommend that diabetics create an emergency contact list of family members, neighbors, and/or friends who are aware of their medical history and medication list and can drive them to a hospital if necessary.

Additionally, avoid large public gatherings and designate someone to do your essential food shopping. Plan to have enough food and water in case you need to quarantine for several weeks. Hydration is particularly necessary when glucose levels are elevated.

Also, be sure to have soda, juice, and candy available in case your glucose levels drop rapidly. Patients with type 1 diabetes should ensure that they have glucagon kits that are not expired.

COVID-19 is a serious viral infection that appears to be more infectious than the flu and has no vaccine or antiviral to shorten its duration. Diabetics, and other immunocompromised people, should take detailed appropriate precautions to avoid possible infection.

Telehealth Aids in Fighting the COVID-19 Pandemic

Online doctor consultation using Click-4-CareAs the COVID-19 spreads throughout the New York area, the Mount Sinai Health System is making it easier—and safer—to get care.

Mount Sinai Now telehealth services offer several ways to get care remotely. You don’t have to worry about crowded public transit or waiting rooms. Using your phone, tablet, or computer, you can connect with a Mount Sinai expert to get your symptoms check, have a medical consult, and get the care you need, including a prescription if appropriate.

Each of these options costs $25 per consultation, not including any rates based on your phone or internet.

Mount Sinai’s three telehealth services are:

  • Video Urgent Care: Have a live online chat with an urgent care doctor in real-time. You’ll be connected within minutes with a physician who can provide an accurate diagnosis, provide next steps, and prescribe medication, if needed. This is not appropriate for emergency concerns. To get started, request a virtual doctor visit or download the free Mount Sinai NOW App in the Google Play store or iTunes. Video urgent care works with any Android or iOS phone or tablet released in the last few years, or any Mac or PC with a webcam and modern browser (Chrome, Safari, or IE 10+).
  • Click4Care: Available 24/7, this service lets you complete an online health interview at your convenience. You answer a series of questions about your symptoms. We may also need a photo of any area of concerns, such as a wound. Then a Mount Sinai Health System expert will review your information and craft a treatment plan, which may include a prescription if necessary. The expert will let you know when the results are ready—usually in an hour during office hours or first thing the next morning if you fill out the form after hours. If you need a prescription, Mount Sinai staff will send it to the pharmacy of your choice.
  • Text-to-Chat: This secure mobile web application allows you to talk with Mount Sinai on any mobile device. Just text 4-SINAI(474624) and our staff can arrange a virtual video visit or in-office appointment with a doctor. Within a few seconds, our staff will ask a few questions to find the best provider for you. Then you can continue your conversation in the same message window.

Mount Sinai has long been at the forefront of seamlessly integrating technology with patient care and is committed to providing high-quality care to you and your family. And Mount Sinai Now telehealth services makes it even more convenient.

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

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

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.