Headlines are appearing about a new version of the COVID-19 virus—a new type of the Omicron variant called a subvariant. The original Omicron variant is the one that that caused cases to spike in December and January. It’s too early to tell whether the new subvariant will produce another surge, but a Mount Sinai expert urges you to keep an eye on the situation and pay attention to public health advice.
Public health officials are closely monitoring this subvariant of the Omicron variant, which is called BA.2 and has been cited in reports of increasing infections in Europe. A subvariant means this virus has variations from the first Omicron variant that came through New York City, called BA.1.
“We can never really predict whether what’s happening in Europe will happen to us as well, so the best thing to do is to remain vigilant,” says Bernard Camins, MD, Medical Director for Infection Prevention at the Mount Sinai Health System, who has been tracking COVID-19 since the first cases were identified in New York in March 2020.
The new subvariant, BA.2, is more contagious than the other Omicron subvariant BA.1 and is replacing the latter among the region’s population, according to Dr. Camins. But what’s most important to know is that existing vaccines still work against this new subvariant of Omicron to limit serious illness and hospitalizations. Antiviral medications are also effective and are now widely available.
Dr. Camins says you should continue to look to public health authorities such as the Centers for Disease Control and Prevention (CDC) and local public health agencies for official guidance on the Omicron subvariant and keep following any existing safety precautions that may apply to you.
For example, while new COVID-19 cases in New York City are rising slightly, they are still at low levels, so the current CDC guidelines for the region have no recommendations for masking in public. Dr. Camins advises that you should be sure to get vaccinated and boosted, and be aware that some people with weakened immune systems are at increased risk of infection so they may feel safer if they prefer to keep wearing masks.
The BA.2 news has prompted some to wonder about getting a fourth dose of the vaccine. On March 29, the U.S. Food and Drug Administration (FDA) authorized a second booster dose of either the Pfizer-BioNTech or the Moderna COVID-19 vaccines for older people and certain immunocompromised individuals. A vaccine has not been authorized for kids under five.
Does your bed partner complain that you snore loudly or gasp for air in the middle of the night? Have you been nudged awake or kicked to the couch because your loved one can’t sleep? These are telltale symptoms of obstructive sleep apnea, and if you suspect you may have the condition, the person lying beside you may be your best ally.
Courtney Chou, MD, a sleep surgeon and an Assistant Professor of Otolaryngology at the Icahn School of Medicine at Mount Sinai, urges people to take this feedback seriously.
“Bed partners are an important referral source,” says Dr. Chou. “People with sleep apnea are often unaware of nighttime symptoms like snoring or interruptions in their breathing. And many either do not experience daytime symptoms, like drowsiness and difficulty concentrating, or think something else is to blame.”
What is obstructive sleep apnea?
Affecting as many as 22 million people in the United States, obstructive sleep apnea (OSA) is a serious sleep disorder that causes your breathing to repeatedly start and stop throughout the night. The condition occurs when the muscles of the upper airway relax and block the flow of air, which prevents your body from getting the oxygen it needs and causes you to wake up repeatedly during the night.
These nighttime disruptions can negatively affect the sleep of the OSA sufferer and can put a significant strain on relationships. In fact, frustrated companions are often the reason patients eventually visit a doctor.
“Bed partners end up suffering tremendously,” she adds. “They may struggle to fall asleep or stay asleep. Some couples end up sleeping in separate rooms.”
How do I know if my snoring is obstructive sleep apnea?
Consistent snoring, pauses in breathing, or gasping for air in the middle of the night are common symptoms of the condition and should be evaluated by a physician. If left untreated, sleep apnea can lead to serious complications. For instance, individuals with OSA are more likely to have high blood pressure, stroke, heart disease, and diabetes.
That being said, it is hard to make a diagnosis from symptoms alone. To know for sure, Dr. Chou explains, you need a sleep study. In the past, patients had to stay overnight at a sleep center for testing. But today, for most patients, a sleep study is performed at home using minimally invasive equipment, sometimes requiring only a special finger and wristband gadget that is connected to a smartphone. Home sleep tests record the number of times your breathing is interrupted throughout the night, revealing if you have OSA and, if so, how severe it is.
“I believe a lot of my patients would have come in sooner if they knew about home sleep studies,” explains Dr. Chou. “I have done it myself, and it was easy and comfortable. I don’t think anyone should be nervous about having a sleep study.”
How is obstructive sleep apnea treated?
If you are diagnosed with sleep apnea, there are three types of treatments that can help. Dr. Chou likes to start with the least invasive treatment.
CPAP (continuous positive airway pressure) therapy has long been the gold standard treatment for OSA. This is a machine that uses air pressure to keep the airway open throughout the night. Patients wear a mask while sleeping—placed over the nose or both the nose and mouth—that connects to this device. Although several options and models are available, research shows that only half of patients can tolerate sleeping with the mask.
Oral appliances are an alternative to CPAP machines or are sometimes used in conjunction with a CPAP device. Oral appliances are worn in the mouth to reposition your lower jaw while you sleep. These appliances are made by a dentist and molded specifically to fit your teeth.
Surgery is recommended when noninvasive therapies fail to provide relief or patients struggle to successfully use CPAP, oral appliances, or both. There are numerous options that open, reshape, enhance, or stimulate the upper airway and eliminate symptoms like snoring and breathing interruptions.
What are the surgical options to treat sleep apnea?
The type of surgery required depends on the severity of your symptoms, the severity of the condition, and your unique anatomy. Dr. Chou works closely with patients to decide what procedure is right for them.
Soft tissue procedures—Dr. Chou likes to compare the upper airway to a house. With soft tissue surgeries, the goal is to make more room by throwing out furniture or making it smaller. This may involve nasal, palate, or tonsil surgery, which creates more room in the passageways for air to flow.
Skeletal surgeries—With skeletal surgeries, the goal is to make the house bigger by building it out as you would by adding a new room. These more extensive operations include widening or forward movement of the jaws and chin advancement. The goal of these surgeries is to improve the position, balance, and movement of the upper airway.
Neurostimulation/Hypoglossal Nerve Stimulator—Inspire ™ therapy is a newer therapy that has been approved by the United States Food and Drug Administration. It stimulates the base of the tongue to expand the airway. Like a pacemaker, the device is surgically implanted into your chest and connected by a wire to the upper airway. You can control the device using a remote device. Mount Sinai’s Division of Sleep Surgery was one of the early adopters of Inspire therapy.
The CDC has assigned a “community level” of COVID-19 risk for each county in the United States, based on factors like total COVID-19 cases and hospital admissions. Right now the level is “low” in most of the New York City area.
The number of COVID-19 cases in New York is returning to the levels before the Omicron surge that began in December, and the Centers for Disease Control and Prevention has announced new guidance on masking.
We are heading in the right direction, and “there is reason for guarded optimism,” says Bernard Camins, MD, Medical Director for Infection Prevention at the Mount Sinai Health System, who has been tracking COVID-19 since the first cases were identified in New York in March 2020.
As the pandemic in New York approaches the two-year mark, here are four things to keep in mind:
Masks are still requiredin hospitals and health care facilities and on public transportation. N95 and KN95-type masks give you the most protection, followed by surgical masks, with cloth masks offering the least. We recommend you wear the best type of mask you are comfortable wearing that covers your mouth and nose.
The CDC has now assigned a “community level” of COVID-19 risk for each county in the United States, based on factors like total COVID-19 cases and hospital admissions. Right now the level is “low” in most of the New York City area. That means masks are not required in most places, but you can choose to mask at any time. If you have symptoms and a positive test you should isolate and stay home for at least six days and wear a mask when around others until you have recovered. If you have been exposed to someone with COVID-19, you should wear a mask around others until you are certain you have not been infected. You can check your county’s “community level” on the CDC website.
Getting vaccinated and a booster shot is still recommended and is the best way to protect you and your family against the disease. Boosters are recommended even if you have already had COVID-19.
There are still many people who are at higher risk of infection: older adults, people with weakened immune systems (such as those who have been receiving active cancer treatment for tumors or cancers of the blood), and kids under five, as vaccines have not yet been authorized for young children.
One final note: Mount Sinai is committed to providing you with the COVID-19 information you need to keep yourself and your family safe and healthy. You can always find the latest updates from public health authorities and on our website.
Heart disease is the leading cause of death in the United States. Some risk factors are unavoidable, but there are some simple things you can do to lower your chances of developing this condition by improving your overall health.
In fact, many patients are focused on losing weight but do not ask about how they can lead a healthier lifestyle to prevent illness, says Jeffrey I. Mechanick, MD, Professor of Medicine and Medical Director of the Marie-Josee and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart
“It’s interesting to think about what patients don’t ask,” he says. “They don’t say: How can I be healthier? How can I prevent chronic disease? How can I prevent heart disease? Weight loss is important, but the more significant issue is boosting your overall health.”
In this Q&A, Dr. Mechanick explains how you can start.
What are the major risk factors for heart disease?
Several types of causes, or drivers, can lead to heart disease. Primary drivers are genetics, environment, and behavior. Genetics and some environmental factors are things you cannot change—they are not modifiable. These include family medical history, gender, and heart defects you are born with (called congenital defects). Some primary drivers have to do with the environment you live in, such as exposure to solvents, pesticides, or other pollutants.
Other primary drivers can be changed or are modifiable. These include behaviors, such as tobacco use, being physically inactive, and consuming fatty/sugary foods, and the “built” (or human-made) environment, such as elevators, super-sized portions, and unsafe living conditions, which together fashion someone’s personal lifestyle. Secondary drivers are metabolic in nature and depend on primary drivers, create a risk level for heart disease, and are also modifiable. In other words, smoking; alcohol and drug abuse; not getting regular exercise; eating too much saturated fat, transfat, and cholesterol; being overweight or obese; stress; and irregular sleep patterns can all increase your chances of developing heart disease. Lifestyle issues can lead to metabolic problems, such as developing too much sugar in your blood (abnormal glycemia), prediabetes and type 2 diabetes, high blood pressure (hypertension) and high cholesterol. These metabolic issues increase your chance of developing heart disease.
How can I lower my risk of heart disease?
There are two ways to look at dealing with heart disease. One way is to wait until you have a problem, and then go see a doctor. The doctor will perform blood and urine tests and prescribe medication. Then the doctor will monitor your cholesterol, blood sugar level, blood pressure, and other factors.
The other approach is to prevent heart disease from developing in the first place. For years, doctors have focused on addressing issues such as blood pressure and cholesterol. We didn’t have a mindset for prevention. But now we know there are certain lifestyle choices you can make that can keep you from having to deal with heart disease.
This new mindset involves exercising every day, having healthy eating patterns (including plenty of fruits and vegetables and beans, and avoiding sweets), limiting alcohol consumption, reducing stress, and not smoking. Probably the most important message is not to wait until you have a heart problem, but to think about prevention. You can talk to your doctor about how to make these lifestyle changes. They will make sure you are healthier and have a longer, higher quality life ahead of you
What if I’m at risk of developing heart disease?
You need to take inventory of your risk factors. If there’s a family history, or if you smoke or are overweight or have been in the past, you may want to think about adopting a healthier lifestyle. The challenge with prevention is it takes place over a long period of time. So its value becomes diluted when you think about all the other more pressing issues of life. Because heart disease seems so remote—it’s usually not going to happen tomorrow or next week—people think they can deal with it later. But it’s important to take stock of your lifestyle and focus on prevention. You will reap the rewards.
How do you find a good heart doctor who focuses on preventative health?
I would encourage patients to speak to friends and family. Of course, if you have a doctor to speak to, they may have suggestions. Do a little research and look for strong health programs near where you live. Major medical centers often have programs that specialize in preventive health. You’re going to have to put a little elbow grease into this to locate doctors who are trained in traditional medicine and have expertise in preventive health and preventive cardiology.
How do I talk with the doctor?
First, meet with the doctor for a consultation. It’s important to be prepared. Write down the issues that you think are important, any areas that are of value for you, and any risk factors you may have. Also, write what you want in life so you can have a high-level discussion about what health is. In this way, you will establish a very fruitful, rewarding encounter with your physician that will become a good working relationship.
Becoming a parent is exciting, sometimes nerve-wracking, and comes with a heap of responsibility for the health and well-being of your child. And if your child has been diagnosed with a heart condition, anxiety can ratchet up due to the uncertainty of what the condition may mean for their future.
Robert H. Pass, MD, Chief of the Division of Pediatric Cardiology at the Icahn School of Medicine at Mount Sinai and co-Director of the Mount Sinai Kravis Children’s Heart Center, answers common questions that parents may have about diagnosing a pediatric heart condition and explains the safe, minimally invasive treatments that are now available.
How do I know if my child has a heart condition?
Many heart problems in children are obvious nearly from the moment of birth. In fact, the most common types of heart disease in children are congenital heart diseases, which are birth defects that affect how the structure of the heart as well as how the heart functions. Congenital heart disease is the most common birth defect, affecting a little less than one percent of the population.
One of the most common signs of heart disease among newborns is cyanosis, which is when a child has a low oxygen level, which lends a bluish tint to the skin and mucous membranes. Additionally, some newborns have symptoms such as poor feeding or sweating as they feed. Heart problems can also cause poor growth.
Still other concerns—like heart murmurs—are identified only through a physical examination or sonogram. Heart murmurs can be signs of a problem, or they can be what we call “innocent,” which means there’s actually nothing wrong. Some studies suggest that if a doctor listens closely enough, nearly half of all kids have murmurs. Fortunately, though, only a very tiny fraction of this group actually has a heart problem.
How are congenital heart diseases diagnosed and treated?
Most congenital heart conditions are diagnosed either on physical examination or ultrasound and increasingly can be diagnosed prenatally on ultrasound.
Depending on the diagnosis, there are a variety of surgical and non-surgical treatments for congenital heart disease. Non-surgical treatment or the “wait and see approach,” may be the best option for problems such as small holes in the heart and some forms of abnormal heart rhythm which can resolve spontaneously. If your child has a condition that needs surgical intervention, options range from open heart surgery to the use of catheter-based therapies.
What are catheter-based therapies?
Catheter-based treatment is a minimally invasive alternative to traditional open heart surgery in which small tubes are inserted into the blood vessels and allow for diagnosis and treatment of many heart problems. Among many conditions that can be addressed in this way, we use these procedures to close holes between the upper two heart chambers—called atrial septal defects. In the past, we routinely treated this condition with surgery. Now we manage about 75 percent using catheter-based treatments.
During a catheter-based procedure the thin, flexible catheter is inserted through the child’s groin into a blood vessel and up to the heart. A device is then introduced through the catheter to seal the hole. With open heart surgery, the child would spend two to four days in the hospital and another six weeks recuperating at home. Using this minimally invasive approach, most patients are in the hospital only one evening and then back in school within three or four days.
What makes the Mount Sinai Children’s Heart Center special?
Our Children’s Heart Center stands apart due to the integration among our services throughout the expanded Mount Sinai Health System. Our cardiology team works closely with our surgical team, and we seamlessly transition our pediatric patients into our very large and always growing adult congenital heart program headed by Ali N. Zaidi, MD, Associate Professor of Medicine (Cardiology), and Pediatrics; Director of the Adult Congenital Heart Disease Center; and Director of Pediatrics to Adult Transition of Care Program, at Icahn Mount Sinai. We view our work as a team sport, with many players working together to achieve the best possible outcome.
We develop individualized treatment plans for children with a wide range of heart problems, always taking into account the needs of our patients and their families. While there are outstanding cardiologists in many of the major centers in New York City, I have never worked with a group where every single physician is outstanding. It is inspiring for me and keeps me on my toes. Our patients inspire us every day.
Get more exercise and focus on healthy eating. That’s the message cardiologists from Mount Sinai Heart are promoting to lower the risk of heart attack and stroke during American Heart Month. This is especially important among high-risk groups.
Doctors continue to see increased sedentary behavior, unhealthy eating habits, and weight gain among patients—putting them at higher risk for heart conditions, including some that are potentially serious.
“It is so important for all, but especially the high-risk groups, to watch their diet and exercise more for heart disease prevention,” says Icilma Fergus, MD, Director of Cardiovascular Disparities for The Mount Sinai Hospital. “There are simple ways to get moving, not just going to the gym, but simply walking or doing housework to avoid being sedentary.”
Nearly half of adults in the United States—more than 121 million people—have some type of cardiovascular disease. The Centers for Disease Control and Prevention says it is the leading cause of death among men and women in the United States; nearly 650,000 die from it every year and, heart disease is preventable 80 percent of the time.
Certain minority groups, including Blacks and Latinos/Latinas, are also at higher risk due to genetic predisposition, diet, lifestyle factors, and socioeconomic factors. However, illness in any population can be prevented by taking simple steps towards a healthier lifestyle.
Tips for Lowering Your Risk of Heart Disease
Know your family history
Manage your blood pressure
Control your cholesterol
Maintain a healthy diet, eating nutrient-rich food and eliminating sweets
Limit alcohol consumption to no more than one drink per day for women and two drinks per day for men
Quit using tobacco or other inhaled substances, including both smoking and electronic cigarettes or vapes
Watch your weight and exercise regularly
Learn the warning signs of heart attack and stroke, including chest discomfort; shortness of breath; pain in your arms, back, neck, or jaw; breaking out in a cold sweat; and lightheadedness
COVID-19, Heart Disease, and Vaccinations
Adults with heart disease are also at increased risk of severe illness from COVID-19. According to the American Heart Association, COVID-19 patients with underlying conditions including cardiovascular disease are six times more likely to be hospitalized and 12 times more likely to die than patients without any chronic health problems. About one in three people with COVID-19 has cardiovascular disease, making it the most common underlying health condition.
Mount Sinai cardiologists encourage people in these high-risk groups to get their full dose of the COVID-19 vaccine, including the booster.
“People with heart disease and with risk factors including diabetes, hypercholesterolemia, and obesity are at higher risk of contracting a severe COVID-19 infection and having complications due to COVID-19 infection. Thus, we strongly recommend these patients get vaccinated. I know some patients have been reluctant; however, vaccines have been proven to be safe and to prevent severe infections and for the most part, are well tolerated,” says Johanna Contreras, MD, Director of the Ambulatory Heart Failure Network for the Mount Sinai Health System.
It is also important that you not put off getting regular medical care.
“It’s critical for patients to check in with their doctors and continue to schedule and keep their doctor appointments, along with following up on medications and taking them as prescribed,” says Dr. Contreras. “If you have any issues do not be afraid to call your doctor. It is important to see medical attention.”
Headlines are appearing about a new version of the COVID-19 virus—a new type of the Omicron variant called a subvariant. The original Omicron variant is the one that that caused cases to spike in December and January. It’s too early to tell whether the new subvariant will produce another surge, but a Mount Sinai expert urges you to keep an eye on the situation and pay attention to public health advice.
