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How the News About the New York Yankees and COVID-19 Shows Vaccines Are Working

Jun 8, 2021 | Featured, Vaccines, Your Health

Vaccination rates across the country are continuing to rise, with nearly 300 million doses given so far. Many sports teams set thresholds to encourage player and staff vaccination as vaccine eligibility criteria expanded in order to get back to in-person games, tournaments, and celebrations.

So the news that nine members of the New York Yankees tested positive for COVID-19 raised some concerns and generated some headlines.

But experts say there is little reason for concern. In fact, this situation shows the vaccines are working as expected, as Brian Cashman, general manager of the Yankees, was quick to note on the Yankees official Twitter account.

In this Q&A, Gopi Patel, MD, Hospital Epidemiologist at The Mount Sinai Hospital, Medical Director for Antimicrobial Stewardship for the Mount Sinai Health System, and Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, explains why the news about the Yankees provides more evidence that the COVID-19 vaccines are helping to end the pandemic by reducing the number of people who get very sick from the infection.

Many people may have been surprised or concerned when they heard that in one week, nine cases of COVID-19 were found in fully vaccinated members of the New York Yankees organization. Is that a concern to you?

It was a concern in the way it was first presented, which was that even though vaccinated, nine individuals contracted COVID-19. What really should have been emphasized is this: among those nine individuals, one had very mild disease, and the other eight were completely asymptomatic, meaning they did not show any symptoms of infection.

We have to remember that the practices of professional sports teams and the entertainment industry are very different from what we do in day-to-day life. They are tested frequently, in some cases daily, and these cases may not have detected if they didn’t have those protocols in place. What is especially important is, if we go back months ago, these individuals with COVID-19 may not have been asymptomatic. They may have been sick or even hospitalized with severe disease, and maybe in some settings they may have passed away.

Gopi Patel, MD

Although it’s not great for anybody to have COVID-19, what is very encouraging is that this situation with the Yankees shows that these vaccines work. They all received the Johnson and Johnson vaccine. We know vaccines prevent severe disease, hospitalizations, and people passing away from COVID-19. However, no vaccine is 100 percent, so it does mean that we need to emphasize the other things that we recommend: Wear masks and practice social distancing as appropriate. Make sure everybody around you is vaccinated, and practice behaviors that we’ve been asking people to practice if you don’t know the vaccination status of your colleagues or the individuals in your surroundings.

What are asymptomatic infections?

An asymptomatic infection is one where you don’t have symptoms that have been associated with COVID-19. You don’t have fever, you don’t have runny nose, and you don’t have a cough. You don’t feel what we call flu-like. You don’t have aches or pains; you haven’t lost your sense of smell. You don’t really feel sick.

What are breakthrough infections?

Breakthrough infections are infections that have been diagnosed in individuals who are two weeks or more out from their last dose of a COVID-19 vaccine. That’s 14 days or more out from one dose of the Johnson and Johnson vaccine, and that’s 14 days out from the second dose of either the Moderna or the Pfizer vaccines.

Since there is a possibility, albeit small, of a so-called breakthrough infection, should I continue masking and social distancing even though I am fully vaccinated?

It depends on who you’re around. You should feel confident that everyone is “safe” if you’re around a lot of people in your herd or your bubble who are fully vaccinated; if your whole family is vaccinated, and you’re aware of what kind of things they do, your risk of being infected if vaccinated is low. However, people could be immunocompromised, and vaccines are not 100 percent. Those are the patients we worry about with vaccines, because we don’t know how well vaccines will work in that population, although we are learning more, and we still encourage them to get vaccinated after speaking to their providers. If you have someone you’re visiting and they are vaccinated but they have some underlying immunocompromising condition, it’s probably best for you to mask and for them to mask too. If you’re at the grocery store or on public transportation, I would still recommend masking, because you don’t know what’s going on around you, and you don’t really know right now who’s vaccinated and who’s not.

If I am fully vaccinated, should I worry that I could pass the infection along to others?

We still are exploring and learning more about how this infection is transmitted among vaccinated individuals, so in the case of the Yankees, we don’t know how that happened. They did get the Johnson and Johnson vaccine, which is not as highly effective as the Pfizer or Moderna vaccine in preventing symptomatic infections but still very effective at preventing serious infections, hospitalizations, and death. We need to know in the case of the Yankees, was this a specific variant of concern? Was there a “super-spreader event” like an indoor gathering or an outing? We hope to learn more. I’m sure this is being investigated fully. I can’t really tell you if you personally should be worried about a breakthrough infection, but I do think you are less likely to have a severe infection if you are fully vaccinated.

What about spreading the infection to my unvaccinated children?

We always need to be concerned about our kids, depending on how old they are. If they’re less than 12, they may not be eligible to be vaccinated for a little bit longer, so we need to make sure we keep them safe. Those who are vaccinated may still be coming home to someone who is not vaccinated or interacting with someone who can’t be vaccinated at this time, such as those who may be immunocompromised or have other medical problems. It’s best to model the behavior you want kids to model. I’m the parent of a seven year old, so when she is wearing her mask, I’m wearing mine.

Should I be concerned about other people not getting vaccinated?

This is a global pandemic, and we all need to do our part. It’s important that if you have a vaccine story, if there’s a reason that you elected to get vaccinated, you share that story with others. We need to help people get to the place where they’re ready to be vaccinated. Some people have personal concerns about their medical condition; we ask that they speak to their health care provider.

I usually ask people if they can have conversations with at least two other people who are skeptical about vaccines or have concerns about vaccines, in a nonjudgmental way, and try to figure out what their concerns are. At least turn them to the right information, whether it be our website or the Centers for Disease Control or the New York City Department of Health and Mental Hygiene or the New York State Department of Health. I think it’s helpful to get people the information that they need to make the decision that’s best for them. It is one of the things that’s going to help this world get back to normal.

Get information from Mount Sinai about COVID-19 vaccinations and appointments

What Can I Do About My Menopause Symptoms?

May 26, 2021 | OB/GYN, Women's Health, Your Health

Menopause, also called the “change of life,” can be difficult to navigate. Fortunately, doctors can help. For answers to some commonly asked questions, we spoke with Elissa M. Gretz –Friedman, MD, Director of the Menopause Center at Mount Sinai and an Assistant Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai.

Can my doctor help with my hot flashes?

If you are having hot flashes which are disruptive to your life, talk to your doctor about your concerns as they can offer a number of options that may provide relief. Typically, your physician will start with the least invasive approach, which is often a discussion of lifestyle changes that may help, such as dressing in layers, keeping your home on the cooler side, and drinking ice water. Also, hot flashes are more common in women who are clinically obese, so your physician might recommend weight loss.

Some hot flashes are triggered. While it varies from woman to woman, these triggers can include alcohol, hot or spicy drinks, or even stress. Keep an eye on when your hot flashes occur and, if you find that an action or beverage sets them off, do your best to avoid it.

If lifestyle changes don’t help, doctors may suggest certain over-the-counter therapies including black cohosh and S-equol, which contain plant-based compounds that mimic estrogen, or Relizen®.

My menopausal symptoms are severe. Should I consider hormone therapy?

Menopause hormone therapy (MHT) involves taking medication that contains estrogen, the female hormone your body stops producing during menopause. It is the most effective treatment for hot flashes, vaginal discomfort, and other menopausal symptoms, and is typically prescribed to women who have severe symptoms. If you have not had a hysterectomy, it will be recommended that you take a combination of estrogen and progesterone. The progesterone is necessary to prevent developing cancer of the uterus.

Women who are less than 60 years old and less than 10 years from their final menstrual period are good candidates for hormone therapy. Before prescribing this therapy, a physician will take your medical and family history and perform a physical exam. You will also need an up to date mammogram. It isn’t safe to take MHT if you’ve had hormone-related cancers such as breast or endometrial cancer or have a history of undiagnosed bleeding or blood clots in the legs or lungs, coronary artery disease or stroke, or liver disease. Certain women that are very high risk for breast cancer are also not good candidates for estrogen and progesterone.

In addition to helping with menopausal symptoms, hormone replacement can decrease your risk of colon cancer or type 2 diabetes. And, it increases your overall life expectancy.

Are there options besides hormone therapy for my severe symptoms?

If you are not a good candidate for hormone therapy, there are alternative medications that we use for treatment of bothersome hot flashes and other severe symptoms of menopause. These are selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs). While these medications are typically used to treat depression and anxiety, they have also been shown in lower doses to help reduce hot flashes. The most common SSRIs used to help with menopausal symptoms is paroxetine, which is approved by the U.S. Food and Drug Administration for this indication. Citalopram and escitalopram have also been prescribed for this use. Helpful SSNIs include venlafaxine and desvenlafaxine. Gabapentin–a medication primarily used for nerve pain in those with shingles and seizures–has also been used for hot flashes, especially those that occur primarily at night, since it may make you tired.

What is a menopause specialist? Do I need to see one?

Menopause specialists are physicians with special training to address the issues of women in midlife. They are certified through examination by the North American Menopause Society and stay up to date on the newest research about midlife women’s health.

You do not necessarily need to see a certified menopause specialist as a matter of routine. But, if you are not getting the help you need to treat your symptoms, a specialist may be able to provide additional advice. We have a number of menopause specialists at Mount Sinai listed on our website and you can find a list of specialists throughout the country on the North American Menopause Society website.

Learn more about Menopause Care at Mount Sinai

What You Need to Know About Menopause

May 24, 2021 | OB/GYN, Women's Health, Your Health

Puberty isn’t the only hormonal change that your body will undertake. If you are a woman between mid-40s and mid-50s, menopause—also known as the ‘change of life’—is a significant, and natural, part of aging. While you are only ‘officially’ menopausal when you haven’t had a period in 12 months, menopause itself is a process that takes years and can affect your body in a variety of ways.

In this Q &A, Elissa M. Gretz-Friedman, MD, Director of the Menopause Center at Mount Sinai and an Assistant Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, explains the basics of menopause and its symptoms.

What exactly happens during menopause?

Basically, your ovaries exhaust their supply of eggs. Women are born with all the eggs they will have for their lifetime. When this happens the ovaries will stop producing estrogen and progesterone. Estrogen affects almost every system in the body so this is a big change. While most women experience menopause as part of healthy aging, some women may reach it early due to chemotherapy or if their ovaries are surgically removed for various reasons. Some younger women who go into early menopause due to chemotherapy may regain their menses after treatment ends.

It’s important to remember that, generally, menopause is a process, not an “on-off” switch. Before you reach menopause, you’ve probably been in what we call the menopause transition, or perimenopause, for five to ten years.

What should I expect in the years leading up to menopause?

Every woman experiences perimenopause differently. Most go through two phases. In early perimenopause, the level of estrogen in your body may rise and fall unevenly, which could cause a variety of symptoms, the most common being irregular periods. Women may find that the length of time between periods varies from one month to the next. For instance, you could have a 21-day cycle followed by a 35-day cycle. When your estrogen level is higher, you may experience increased bleeding or breast tenderness.

During the last one to three years of this process, called late perimenopause, your period might become lighter. You might have spotting between periods and the time from one period to the next may grow longer. They will be 60 days or even six or nine months apart. Any one of these menses could be the last. You are post menopausal when you have not had a period for one year.

How will my body react to menopause?

Hot flashes are the best known and most common symptom of menopause with about three-quarters of menopausal women experiencing the symptom. These uncomfortable feelings of warmth can last for two to four minutes and are often followed by sweating. Hot flashes can happen at any time during the day or night, and you may have several or many during a 24-hour period. Nighttime hot flashes might awaken you from sleep.

Other possible symptoms include anxiety, heart palpitations, or vaginal dryness, which can cause pain during sexual intercourse. Some women experience cognitive changes, such as difficulty learning new tasks, forgetfulness, and brain fog. You may also find it difficult to sleep.

The cognitive issues usually resolve after menopause. The vaginal symptoms will continue to worsen the longer you get from your last menstrual period.

Once you reach menopause, your doctor will begin to monitor you for osteoporosis, a disease that can leave your bones more brittle and fragile, making them more likely to break from a fall. Menopause is a risk factor for osteoporosis as lowered sex hormones—like estrogen—affect the bone remodeling process. Menopause related-bone loss will accelerate significantly in the two years just before and the two years after your final menstrual period. Bone loss will continue even after that point, but your bone density will not change as quickly.

Will menopause affect my libido? And, can I stop using birth control once I am menopausal?

Many factors can affect your libido, including stress level, sleep, partner issues—and menopause. The vaginal dryness that some women experience due to menopause can lead to painful intercourse which, in turn, can affect your libido. Fortunately, lubricants, vaginal moisturizers, and vaginal estrogen—which is safe to use in most women and can help restore the vaginal tissues—are helpful. Lubricants and vaginal moisturizers are available over the counter, but you will need to talk to your primary care physician or gynecologist for a vaginal estrogen prescription.

Also, while it is rare to become pregnant in your late 40s, it is not unheard of. It is recommended that women continue to use birth control until officially menopausal.

Learn more about Menopause Care at Mount Sinai

I Have Long COVID. How Do I Get Back to Physical Activity?

May 19, 2021 | COVID-19, Rehab Medicine, Your Health

Older woman on work out bench lifting free weights

Millions of people across the United States have contracted and overcome a COVID-19 diagnosis. However, for some, the road to recovery has been difficult. Known as ‘long COVID,’ some patients continue to experience symptoms of COVID-19 weeks to months after their initial diagnosis.

While experts are unsure of its prevalence, the number of people with long COVID is significant and has prompted the creation of programs like the Mount Sinai Center for Post-COVID Care where patients are treated and researchers investigate the condition. Joseph Herrera, DO, Chair of Rehabilitation and Human Performance for the Mount Sinai Health System, and cardiology fellow Saman Setareh-Shenas, MD, explain what it means to be a COVID-19 long hauler and how the Mount Sinai Health System is working to get these patients back to physical activity.

What is long COVID patient?

Saman Setareh-Shenas, MD: This is a patient with Post-COVID Syndrome, which is a series of symptoms ranging from shortness of breath, chest pain, heart palpitations, heart racing, the inability to return to pre-COVID level of physical activity, and brain fog. These symptoms are present for weeks after their initial COVID-19 symptoms have resolved. We have seen patients experiencing these symptoms for six months, or even longer.

Joseph Herrera, DO: We are seeing some patients that have not even been hospitalized with COVID-19 who are having difficulty progressing their activity to pre-COVID-19 infection levels. They will have good days and bad days, and will try to push themselves physically. But, instead of taking two steps forward, they take 10 steps back. That is a common theme with our long haulers.

How do you guide a patient back to physical activity?

Dr. Herrera: Important for a patient’s physical and cognitive activity is understanding their submaximal exercise limits. This is a measure of a patient’s aerobic fitness and maximum oxygen uptake while doing rigorous—but not overly strenuous—activity like jogging on a treadmill or using an exercise bike. Some patients who have difficulty with physical exertion may also benefit from a formal breath work program that helps patients understand breathing techniques. At Mount Sinai, we progress patients using the rule of tens. This means that every 10 days we increase the intensity duration of the exercise by 10 percent. So, it does take some time to get ‘back to normal.’ But we advise our patients that their body needs that time to heal and rest. The symptoms resolve, but it does take a prolonged period for those symptoms to get better.

What advice do you have for long haulers who are trying to get back into exercise?

Dr. Herrera: If you have long COVID, you have to respect the symptoms you are experiencing and understand that your body is in the process of healing. I advise patients to create a diary of what they are experiencing and work with a physical therapist to address their concerns. Slowly working toward a gradual return to activity is the goal. You can’t rush this. Anytime our patients try to rush the process, they end up taking 10 steps back instead of three steps forward.

Dr. Setareh-Shenas: COVID-19 comes with a lot of inflammation and the body needs time to heal. Give yourself that time; go slowly, and gradually you can get back to your baseline. Normal household stuff is important, like walking and grocery shopping. Then, once you are comfortable, move on to exercising and boosting your exercise capacity.

Dr. Herrera: I think the most important message is, if you’re experiencing any symptoms of long COVID, don’t push yourself too hard but do see a specialist. Get evaluated to see if you qualify for any of the programs that we offer at Mount Sinai.

Get more COVID-19 information from Mount Sinai

I Recovered From COVID-19. How Do I Get Back In Shape?

May 17, 2021 | COVID-19, Rehab Medicine, Your Health

If you are one of the millions who contracted COVID-19 in the past year, you may still be in the process of regaining the physical fitness lost from when the virus forced you to slow down and heal.

Joseph Herrera, DO, Chair of Rehabilitation and Human Performance for the Mount Sinai Health System, and cardiology fellow Saman Setareh-Shenas, MD, explain how those who have recovered from COVID-19 can get back into their pre-illness shape and how the Mount Sinai Post-COVID Care Center can assist them on their road to recovery. Two key takeaways: Take it slow and consider seeing a specialist if you encounter any hurdles along the way.

How does the effect of COVID-19 on the body influence my recovery?

Joseph Herrera, DO: We are seeing a range of symptoms, from mild to severe, in patients after being infected with COVID-19. The virus affects them both physically and cognitively, everything from increased fatigue, shortness of breath, and tachycardia, a medical term of a rapid heartbeat, and difficulty concentrating, also known as brain fog. Because of this, some patients find it difficult to get back to their pre-COVID level of physical activity.

What about athletes? Does COVID-19 affect them differently?

Dr. Herrera: We’ve seen a range of people who have been impacted by COVID-19, from recreational athletes to marathon runners and professional athletes. I would say that they, similar to the general population, have a range of symptoms, some very mild all the way to severe. Overall, I don’t think your pre-infection conditioning really prevents anything.

Saman Setareh-Shenas, MD: COVID-19 doesn’t discriminate between athletes and non-athletes. We have seen major effects from the virus as well as post-COVID syndrome in very healthy athletes.

When is it safe to resume physical activity after recovering from COVID-19?

Dr. Herrera: We’ve been advising symptom-free patients to resume activity as tolerated. If they’ve been hospitalized due to COVID-19 or have spent a prolonged time in bed while recovering, whether in an intensive care unit bed or in their home, we want to make sure that they can return to normal activity before progressing to exercise.

Dr. Setareh-Shenas: Early on in the pandemic as the initial wave of patients were recovering, we started noticing a lot of our patients were not immediately able to go back to their baseline exercise level.

At the Mount Sinai Post-COVID Care Center, we help patients regain their pre-COVID strength and conditioning by using recommendations based on guidelines by the Leadership Council of the Sports and Exercise Cardiology Section of the American College of Cardiology and findings by British researchers. These guidelines advise those in recovery to return to exercise very gradually. Don’t go back to where your baseline was. Wait at least seven to 10 days, and then take it slowly from there.

Dr. Herrera: We guide patients using the ‘rule of tens.’ For example, if a patient were lifting a hundred pounds prior to getting infected with COVID-19, we have them cut everything in half—or even a quarter—of the weight they previously lifted. Then we apply the ‘rule of tens,’ by increasing either the intensity or the duration of exercise by 10 percent every 10 days. This way, they have a gradual increase in activity.

What precautions should post-COVID patients take when getting back to physical activity?

Dr. Setareh-Shenas: In the past year, we have seen a number of patients in our post-COVID population who are experiencing heart racing, palpitations, or a new arrhythmia. So, as a precaution, I would say that patients recovering from COVID-19 who have chest pains or shortness of breath, should be evaluated by their physician or by an expert cardiologist at a Post-COVID Center.

For example, in our Cardiology Clinic within the Post-COVID Care Center at Mount Sinai, we evaluate patients who have complaints of chest pain or shortness of breath and conduct exercise testing to see their maximal exercise capacity and evaluate for any arrythmia during exercise. We want to know: Do they have any symptoms when exercising on the treadmill? Does their heart go under strain that’s not equivalent for their age group and their risk factors? So, patients should be mindful of this, especially if they have a history of cardiac issues.

Dr. Herrera: Most importantly, don’t push yourself too hard but do see a specialist. Get evaluated to see if you qualify for any of the programs that we offer at Mount Sinai.

Get more COVID-19 information from Mount Sinai

What You Need to Know About COVID-19 Vaccination in 12- to 15-Year-Olds

May 13, 2021 | Children's Health, COVID-19, Featured, Vaccines, Your Health

Schools, playgrounds, and, most of all, our children will soon be better protected against COVID-19, thanks to the latest news from the U.S. Food and Drug Administration (FDA). The agency has announced that the Pfizer-BioNTech COVID-19 vaccine is safe and effective for children between the ages of 12 to 15 and authorized emergency use of the vaccine; the CDC also recommends the vaccine in this age group. You may have questions about this new development. Kristin Oliver, MD, MHS, Assistant Professor of Pediatrics, and Environmental Medicine and Public Health, at the Icahn School of Medicine at Mount Sinai, has answers.

How effective is the Pfizer-BioNTech COVID-19 vaccine in children aged 12 to 15?

All indications are that COVID-19 vaccination is highly effective in children ages 12 to 15. In the trial, the vaccine prevented 100 percent of COVID-19 cases among participants who got the vaccine. It’s important to remember that the results we see in clinical trials—called efficacy—may be slightly better than what we see when the vaccine is out in the world—effectiveness. People in the clinical trials always get the vaccine exactly as indicated, but this isn’t always the case in the real world. Once we start immunizing more and more people over time, we’ll have a better sense of the vaccine’s effectiveness for ages 12 to 15, but I expect this will also be really high.

Is it safe?

The COVID-19 vaccine is safe for children ages 12 to 15, just as it is for people 16 and older. In addition, the FDA will continue to monitor safety for another two years.

Researchers at the CDC are investigating a link between COVID-19 vaccines from Pfizer-BioNTech and Moderna and heart inflammation in young men and boys. Myocarditis and pericarditis can be serious but, fortunately, these side effects to vaccination are very rare and the cases connected to receiving the COVID-19 vaccine have been mild. So, the benefits of COVID-19 vaccination in this group still outweigh the risks of getting myocarditis from the vaccine.

Will our children experience any side effects from the vaccine?

We can expect children to have side effects similar to what we’ve seen in adults. The most common are pain and swelling at the injection site, tiredness, and headaches. In the study fewer than one in five 12- 15 year olds who get the shot, had a fever. The good news is that these side effects usually only last for a couple of days and can be treated with over-the-counter medication.

Remember: these types of side effects are a sign that the body’s immune system is responding to the vaccine, which is a good thing. We have seen more of these side effects to the COVID-19 vaccination than, say, the tetanus booster or HPV vaccine. For that reason, you might want to have your child take the vaccine on day when you know they can take is easy the next couple days.

Are there some 12- to 15-year-olds who should not take the vaccine?

Anyone who has had an allergic reaction to any component of the vaccine, or who had an allergic reaction to the first dose of the vaccine, shouldn’t take it.

But peanut, egg, and other food allergies are not a contraindication. If your child has any of these allergies, they can take the vaccine. If you have any questions about your child’s allergies and COVID-19 vaccine, check with your pediatrician.

If my child had COVID-19, do they still need to get a vaccine?

The U.S. Centers for Disease Control and Prevention has said that everyone who can get a COVID-19 vaccine should do so, even if they’ve already had COVID-19. In general, we don’t know how long protection against the virus lasts after an infection, or how well previous infection prevents infection with some of the new variants. In our efforts to keep everyone healthy, the recommendation is to get vaccinated.

What are the benefits of vaccinating children ages 12 to 15 against COVID-19?

Vaccines are an important tool in protecting us from developing COVID-19. It is exciting that children ages 12 to 15 can now get vaccinated—and it is important that they do so. While it is true that younger people are less likely than their elders to get seriously ill and die from COVID-19, they are not immune to the virus. Children can, and have, contracted the virus, gotten seriously ill, and even died. So the first benefit of vaccination is to protect them from the virus and its complications. Additionally, we know that children can transmit the virus to others who are more at risk for serious complications. By vaccinating young teens, we can help prevent that transmission as well as protect grandparents, babysitters, and other more vulnerable people who are in their orbit.

Get more COVID-19 vaccine information from Mount Sinai

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