Face Coverings: What You Need to Know

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

Just about everything in our lives has changed due to the COVID-19 pandemic, especially in crowded metropolitan areas like New York. One of the more visible changes is that face coverings have become a part of everyday life. Bernard Camins, MD, MSc, Medical Director for Infection Prevention for the Mount Sinai Health System, offers some basic guidelines on face coverings.

Why should I wear a face covering?
Since early April, the U.S. Centers for Disease Control and Prevention has recommended that people wear cloth face coverings in public settings where other social distancing measure are difficult to maintain, such as when grocery shopping. Shortly afterwards, the governors New York, New Jersey, and Connecticut ordered people to follow the CDC recommendations.

Do I need to use a face mask like the ones I see doctors and nurses wearing?

No. In order to preserve supplies of face masks certified for use by health care workers, the directives require only that you cover your face.

What is the best face covering for me?

Anything that covers your nose and mouth while you are in public is what is recommended in order to prevent the spread of the infection. It can be a handkerchief or a scarf or a bandana. You can make something out of cloth. The CDC has provided plenty of helpful tips. You do not want something that can make you short of breath. There can be shortages of masks for some hospitals and health care institutions, which is why it’s best if you use something other than a medical grade face mask.

What do I need if I am going to Mount Sinai for care?

All staff at Mount Sinai will be wearing medical face masks. If you arrive with a face covering that is not a medical face mask, we will provide you with a medical face mask. If you brought your own medical face mask, you may keep that on during your visit.

Can I reuse my cloth facial covering?

Yes. But you should be aware that the CDC suggests cloth face coverings be washed daily. If you are reusing a facial covering, rather than throwing it away, you should be careful when you take it off, as it may have become contaminated, and you should wash your hands afterwards. Having more than one cloth face covering is recommended.

I have heard a lot about N95 respirators. Do I need one of those?

No. Those masks are specifically designed for health care workers. They must be properly fitted for health care workers in order to guard against breathing in the tiny virus particles that cause the COVID-19 infection while caring for patients who are infected.

Why do I need a face covering?

Wearing a face covering is mostly to prevent you from infecting others by preventing the spread of respiratory droplets that carry the virus when you cough or sneeze. This is important because you may be infected but not know because you do not show any symptoms. Wearing a covering on your face can also provide some protection to you against being infected by others. The COVID-19 disease is transmitted by tiny virus particles in the droplets that come from our mouth or nose when we cough or sneeze. A secondary and less common method of transmission is when these particles land on surfaces people touch, like a checkout counter at the store or a cell phone, and then touch their eyes, nose, or mouth, allowing the virus to spread. We maintain social distance so that if someone should cough or sneeze, these virus particles will fall towards the ground and not come close enough to allow us to breathe them in or to land on our clothing.

Should everyone wear a face covering?
Yes, except for children under the age of 2 or elderly people or others who may have trouble breathing.

I saw face masks advertised online. Is it okay to buy them?

You may be able to buy masks at the store or online. But you should be aware that there are some counterfeit masks on the market.

My glasses are fogging up when I wear a face covering. Any suggestions?  

This has been an issue for some people. Some research recommends cleaning your glasses carefully with soapy water and making sure they are dry before putting them on. Fogging can happen as you breathe out and the air goes upward towards your glasses, so you could also try ensuring the covering is tighter above your nose.

Seeing people in the community wearing face coverings makes me uncomfortable. What can I do?

People must change their thinking, their mindset about face coverings and realize that this is just a new part of our lives. It is something we need to become comfortable with in order to prevent the disease from spreading.

Read more about Mount Sinai and the novel coronavirus

Can I Receive Mental Health Care While Social Distancing?

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

Living through the COVID-19 pandemic can cause stress, anxiety, and depression, not to mention feelings of loneliness and isolation. But when we are under orders to stay at home, it is hard to get help for these issues. Fortunately, telepsychiatry—psychiatry appointments held by phone or  video session—are becoming more and more common and enable you to speak with a psychiatrist while maintaining social distancing. Claire Jackson-Rabinowitz, DO, Clinical Professor in Adult Psychiatry at Mount Sinai Beth Israel, shares some information you need to know about telepsychiatry.

What is a telepsych appointment?

Telepsychiatry is when we provide mental health care via phone or video sessions. Originating in the 1950’s, it has recently become more common as mental health care providers continue to provide care while maintaining social distancing.

We can perform most of  the mental health services we usually provide—aside from administering injectable medications—through virtual appointments. This includes initial consultations, one-on-one therapy, cognitive behavioral therapy, group treatment, family therapy, and medication management.

How does it work?

There are two types of telepsychiatry appointments: phone and video sessions. Most providers prefer video sessions because it gives us visual cues as well as verbal ones. However, if we do not have visual cues, we rely on other indicators such as tone of voice.

Before you log into a session, we recommend you find a quiet, private place to talk. If you are conducting your session over the phone, you will dial the number provided by your clinician or wait for a call. If you are participating in a video session, you dial into the telepsychiatry number and log into the video session on your phone, tablet, or computer. If your provider is still finishing up with another patient, he or she may guide you into a virtual waiting room. Otherwise, the provider will immediately invite you into the virtual session. These appointments generally last between 20 and 60 minutes. These days, with the added stress of the COVID-19 pandemic, mental health providers may also provide quick check-in calls for patients when needed.

In addition to one-on-one therapy, providers have found increased interest in group therapy such as mindfulness, which teaches anxiety-reducing techniques that include breathing and mediation. These skills are especially helpful during times of high stress.

Does telepsychiatry work for everyone?

Telepsychiatry works well for many people; some even prefer virtual visits over in-person appointments. Teenagers, for instance, are often excited to meet virtually. When we suggested this approach to our adolescent patients, they immediately downloaded the app and were ready to go. If you have a busy schedule, you may find it easier to squeeze in an appointment when you do not have to worry about travel time to and from appointments. And, in these days of limited childcare, at-home therapy may be easier for parents of young children.

I am reluctant to try virtual sessions. Are in-person appointments still available?

Yes.

We are open, and in-person appointments are available if you would prefer to see your therapist  face-to-face. However, to adhere to social distancing guidelines and keep all our patients safe, we would like to administer telepsych whenever appropriate and possible.

Also, please  keep in mind that in-person appointments during the COVID-19 crisis can be a bit disconcerting  as clinicians will  wear masks throughout the session.

How secure are these sessions? Will my privacy be protected?

We work hard to maintain your privacy and follow all HIPAA guidelines. We use a state-of-the-art security and encryption program for all sessions and we do not record calls nor is anyone in our office when we are speaking with a patient. For all appointments—intake and follow up— we check to make sure you are okay with working virtually. If you are not comfortable or able to complete a session via phone of video, we will work to schedule an in-person appointment.

Telepsychiatry has been very helpful during the COVID-19 pandemic. Many people may feel more stress, anxiety, and depression during these uncertain times. We are happy that we have been able to provide treatment throughout the crisis, and we look forward to continuing to do whatever we can to safely and responsibly provide care for those in need.

How can I make an appointment?

Please call us at the numbers listed below.

Mount Sinai Beth Israel:
212-420-2400 (All Patients)

The Mount Sinai Hospital:
212-241-5947 (Adults)
212-241-7175 (Children and Adolescents)

Mount Sinai Morningside and Mount Sinai West:
212-523-8080 (Adults)
212-523-3082 (Children and Adolescents)
212-523-3083 (CARES, a combined education and behavioral health program for teens)

Psychiatry Faculty Practice Associates:
To schedule an appointment with one of the physicians at The Mount Sinai Hospital’s Faculty Practice Associates (FPA), please call 212-659-8752 or email psychiatryfpa@mssm.edu.

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I Have Asthma. How Might COVID-19 Affect Me?

May 21, 2020 | Asthma, COVID-19, Your Health

Asthma is a very common respiratory condition in New York City—as well as other urban metropolitan areas—and is present in about 8 to 10 percent of the U.S. population. Because COVID-19 spreads through the respiratory system and attacks the lungs, those with asthma may be particularly concerned about contracting the virus. Linda Rogers, MD, Clinical Director at the Mount Sinai-National Jewish Health Institute, discusses what you need to know about COVID-19 if you have asthma.

Will I be at greater risk if I have asthma and COVID-19?

All of us who take care of patients with asthma have been concerned that having asthma may increase the risk of coronavirus or increase the risk of having a poor outcome from infection with coronavirus. Even under normal circumstances, asthma causes irregularities in immune response that may increase susceptibility to viral infection that can cause asthma to flare. There is also a subset of patients with asthma prone to wheezing and asthma flares when they develop viral respiratory infections. The coronavirus that causes COVID-19 is actually a distant relative of viruses that cause the common cold. These versions of coronavirus are normally in the community causing upper respiratory infections but unlike other viruses, such as respiratory syncytial virus (RSV) and rhinovirus, coronaviruses that cause the common cold are not among the more common viruses know to cause worsening asthma .

Generally, we’re seeing that asthma and allergies aren’t being found commonly in patients who are hospitalized with COVID-19 and who have died due to the virus. China and Italy have found very low rates of asthma in patients with a severe case of the virus and here in New York—out of thousands of patients who have died of COVID-19—the most common chronic illnesses that we find in patients who die of COVID-19 include high blood pressure, high cholesterol, diabetes, and heart disease.

How do I tell the difference between my asthma and COVID-19 symptoms?

Many of the symptoms of COVID-19 and asthma can overlap. Patients with the virus can have a dry cough and may become very short of breath—symptoms experienced by those with asthma. However, patients with asthma often find it difficult to exhale as opposed to those with COVID-19 who report difficulty taking a deep breath. So, the quality of shortness of breath may be different.

Additionally, patients with COVID-19 and those who have asthma might experience chest tightness. For patients with asthma, chest tightness should respond to quick relief medicine such as albuterol, whereas it’s less likely that the symptoms of COVID-19 would improve with albuterol. Moreover, with the virus you’re likely to have other symptoms apart from a cough, chest tightness, or shortness of breath. Often times, patients with COVID-19 will also have a fever, chills, fatigue, muscle aches, gastrointestinal symptoms, and alterations to taste and smell. Therefore, if you were to contract the virus, you would likely have symptoms other than cough, chest tightness or shortness of breath that would point in the direction of COVID-19 as opposed to your asthma.

What precautions can I take? Should I take my inhaler more often during this time?

If you are supposed to be taking daily medicine to prevent and control asthma symptoms, and you’re less than 100 percent perfect about doing that, now is a really good time to keep your asthma under control by taking your medicine regularly. However, there’s not really any benefit to taking extra doses of your quick relief medicine unless you are having symptoms for which you need relief.

Could my medication be weakening my immune system and put me at greater risk of contracting COVID-19?

Many or most patients with persistent asthma take inhaled medications to control their asthma that include inhaled corticosteroids. There has been some concern that inhaled corticosteroids may reduce immunity, but early data actually suggests the opposite. Based on some experiments done in the laboratory, the use of inhaled steroids may actually lower the presence of the ACE2 receptor—a protein present on many cells that is used by the virus to enter into the lungs and cause infection. While that is very preliminary data, it would suggest that the medicines are not harmful and actually could be protective.

Can my fear and anxiety about COVID-19 make my asthma worse?

This is a time of anxiety for all of us. It is a time where things are stressful and there is a lot of change. Stress is a driver of asthma symptoms and so it is necessary to manage our stress levels by getting enough sleep, eating well, and making sure we’re taking our asthma medication. Do all the things that you normally do to maintain your asthma and be sure to monitor your symptoms through journaling or with devices like a peak flow meter, which measures air flow from your lungs.

Although we need to be socially distancing, trying to spend time—at least remotely—with our friends and family can help reduce our stress levels. And, stay in touch with your health care provider through telemedicine. Reach out if your asthma worsens or you have symptoms that might reflect infection with COVID-19.

How Mount Sinai is Keeping Patients Safe
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COVID-19 and Cesarean Births

May 21, 2020 | COVID-19, OB/GYN, Your Health

Having a safe delivery is top of mind for all pregnant women and their partners. As hospitals and health care centers continue to address the COVID-19 pandemic, safety has become increasingly important, especially for those having a cesarean birth—a surgical delivery that generally requires a longer hospital stay than vaginal delivery.  Angela Bianco, MD, Medical Director of Labor and Delivery for the Mount Sinai Health System, discusses the changes that have been implemented to ensure a safe delivery and post-operative recovery for cesarean birth patients and their newborns. 

What extra precautions are taken to ensure patient safety during cesarean delivery and during their hospital stay?

Twenty four hours prior to scheduled deliveries, all women and their support persons are tested for COVID-19. Patients and visitors must wear a face covering while in the hospital. If needed, staff will provide a mask.

While all patients and staff are required to wear face coverings, knowledge of the patient’s COVID-19 status directs the use of appropriate protective equipment.

All health care workers have been trained in appropriate use of personal protective equipment to safeguard themselves and their patients. Additionally, we have separate teams that transport patients to and from the operating room if the patient is positive for COVID-19. Patients with the virus are placed on a separate floor rather than in our Post-operative Recovery Room. During the postpartum stay, they are assigned a single room to recover in to avoid spread.  

All areas are continuously disinfected, including waiting rooms, patient rooms, and high-touch surfaces such as door knobs and kiosks. Patient rooms in particular receive a ceiling-to-floor cleaning between patients, which takes approximately two hours and includes several quality assurance checks.

Has the recovery stay been adjusted due to the virus?

Yes, we have recommended discharge on post-operative day two rather than post-operative day three. We made this recommendation to decrease the length of stay in order to reduce exposure to new mothers and their newborns in a hospital setting. If there is a need to be discharged later than post-operative day two, than the stay may be extended.

How are doctors keeping in touch with patients after discharge?

Post-discharge patients are called within the first week, typically three days following their release. Patients have a telehealth visit at two weeks, but this can also be an in- person appointment for those who require a site visit or who are unable to communicate with their physician via telehealth.

Since women are being discharged a day early, are there additional precautions that need to be taken once they go home?

Generally, no. When released, pregnant women and their partners are given the same discharge instructions for post-operative day two release as they would have been given for a day three release. Instructions include when to call for issues such as high blood pressure and headache or if patients have questions about wound care or breastfeeding.

How Mount Sinai is Keeping Patients Safe
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How I Recovered From COVID-19 at Home With the Help of a New App: A Patient Story

May 19, 2020 | COVID-19, Patient Stories, Your Health

Roberto Rapalo, a patient at Mount Sinai, at home with his family

Should I go to the hospital or stay at home? This is one of the first questions that people who think they have COVID-19 wrestle with. Now, thanks to a remote monitoring platform from Mount Sinai Health System called Precision Recovery, patients can have their symptoms monitored by a provider daily, and know that their care will be escalated if necessary.

Once a patient signs up, a member of the Precision Recovery team at Mount Sinai contacts the person for an online video chat. The patient then downloads a daily symptom tracking app onto any smart device which monitors symptoms of the virus, such as body temperature, cough, breathing levels, and body aches. A provider checks in with the patient weekly through video chat. But if the symptoms get worse, the patient is contacted by a provider to discuss the new or worse symptoms and determine if increased monitoring or an emergency room visit is needed.

Read more about Precision Recovery

David F. Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System, and Christopher Kellner, MD, a cerebrovascular neurosurgeon with the Mount Sinai Health System, developed Precision Recovery, an innovative system to monitor patients with COVID-19 symptoms remotely so they can stay home and rapidly respond to their needs when necessary. Click here to read a Q&A, in which they describe how this novel platform can help patients and hospitals in New York and throughout the United States.

“Precision Recovery worked great for me. COVID-19 was a battle—I had it for 14 days and each day was like a new round in a boxing match. Between Day 7 and 12, I was so weak it was difficult to think properly,” says Roberto Rapalo, a patient at Mount Sinai who used the new system. “I was struggling with the decision of whether to go to the hospital or not. It was scary, but the fact that my data was being monitored every day gave me confidence. Dr. Kellner was watching my symptoms progress, and I trusted the advice he gave me. He helped me get through this. In my opinion, you can’t get through COVID-19 by yourself.”

Precision Recovery was developed by David F. Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System, and Christopher Kellner, MD, a cerebrovascular neurosurgeon with the Mount Sinai Health System.

Dr. Kellner said the system allows physicians to closely monitor patients, which is important because the disease can take a different course for every one of them.

“Sometimes people are doing pretty well for a week or ten days, and they may even to start to feel better. But then they start feeling much worse for a day or two after that. That was the case with Rob,” he says. “He began having a hard time breathing and had fever again. So we initiated a video chat with him, and I was able to assess his condition. I saw that he was short of breath, but we talked through the criteria for coming to the hospital. That gave him the confidence that even though he was feeling worse, he would be able to ride it out at home. After a day of bad symptoms, he started to feel better, and he never had to come into the hospital.”

Mr. Rapalo said the system helped him track his symptoms and develop trust in his doctors.

“Every day I input my blood pressure, my temperature, my heart rate, oxygen saturation, as well as whether I had shortness of breath, chest pains, or other symptoms. And that helped me trust that the doctor really did understand what I was going through,” he says. “In the end, I really needed that pep talk. With any other disease I’ve had, once you start to feel better, that’s it. But COVID-19 is longer than any other disease I’ve had. And when I got worse after starting to feel better, that surprised me. So my conversation with Dr. Kellner made me feel that he had my back and was supporting me.”

What he experienced is typical for many COVID-19 patients, according to Dr. Kellner.

“Rob is a perfect example of what most people are going through with this disease. It’s unpredictable how it will go for each individual person. We’re still trying to figure that out as a medical profession, and sometimes there’s mixed messages,” says Dr. Kellner. “Someone might go to an urgent care center and be sent home with the instructions, if your symptoms get worse, contact your provider or call 911. If patients have this roller-coaster ride of symptoms, they need repeat assessments, and that’s what Precision Recovery provides.”

The goal of the system is to keep people out of the hospital who don’t need to go, and give people at home the assurance that they are being monitored effectively. Another goal is to catch people at home whose symptoms worsen and require hospitalization.

“That has happened—we saw that they met the criteria for being hospitalized, so we called an ambulance and contacted the emergency room to let them know that a COVID-19 patient was coming in,” says Dr. Kellner.

It’s important to note that this is a daily data entry by the patient, so doctors can’t necessarily react to an emergency. Patients may still need to call 911 in an emergency. Or they may need an urgent care visit or a virtual visit like Mount Sinai NOW.  Precision Recovery fills a role somewhere in between.

Mr. Rapalo said he began feeling better after about two weeks with the illness.

“I turned a corner around Day 13 and now I feel so much better. My cough has decreased and I’m improving every single day,” he says. “I’m still entering my data every day, so that if I do get worse, I’ve got a safety net. I have an appointment with the physical therapist of the Precision Recovery program, and I’m looking forward to getting tips on how to improve my breathing and the tightness in my chest.”

He added, “The main benefit of the Precision Recovery program is that you have people standing by your side, fighting with you. And that helps with your mental side of your recovery, and helps you make the right choices for your care. I am looking forward to being 100 percent, and I believe the program is getting me there.”

To enroll in Precision Recovery, text “Precision Recovery” to 332-213-9130.

Learn more about Precision Recovery
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Precision Recovery: New App Helps Patients by Monitoring COVID-19 Symptoms Remotely So They Can Stay Home

May 19, 2020 | COVID-19, Your Health

With hospital systems responding to unprecedented demand, and people with possible COVID-19 symptoms often unsure of where to get care, two Mount Sinai physicians saw an opportunity for technology to come to the rescue.

David F. Putrino, PhD, Director of Rehabilitation Innovation for the Mount Sinai Health System, and Christopher Kellner, MD, a cerebrovascular neurosurgeon with the Mount Sinai Health System, developed Precision Recovery, an innovative system to monitor patients with COVID-19 symptoms remotely so they can stay home and rapidly respond to their needs when necessary. In this Q&A, they describe how this novel platform can help patients and hospitals in New York and throughout the United States.

What is Precision Recovery?

Precision Recovery is a digital platform that goes a step beyond the typical telehealth scenario because it monitors the patient’s symptoms daily, enables us to get patients the right care for their situation, and escalate it when appropriate. Anybody in the country can sign up, just by texting the words “Precision Recovery” to 332-213-9130. We onboard them with a video chat and then they download an app on any smart device so that we can monitor their symptoms every day. The platform tracks the patient’s symptoms—whether it be fever, headaches, or respiratory symptoms—and alerts us to contact the patient if their symptoms are worsening.

We initially developed Precision Recovery as a program to help individuals recovering from stroke who needed close daily monitoring. In the wake of the COVID-19 crisis, we quickly adapted the program to provide day-by-day monitoring of individuals who are showing signs of COVID-19 but were unsure whether they should go to the emergency room or just ride it out at home.

We saw that people would go to the emergency room and one of several things might happen: they may or may not be tested, or no testing might be available, and many times they would be told that they were not sick enough to be admitted. And that might be the end of their care. If they get sicker, they don’t know whether they should go back to the emergency room or call a doctor, or just stay home.

There’s a lot of fear and anxiety around COVID-19. How does Precision Recovery provide a sense of security?

We want people to think of us as a safety net. We’re here to answer any concerns people have about their symptoms. Once a patient signs up, a provider from the Precision Recovery team will contact the person for an online video chat. As part of the onboarding, the patient downloads a daily symptom tracking app, MyCap, and enters their symptoms and vital data. The team is then able to track symptoms of the virus, such as body temperature, cough, breathing levels, and body aches. There will be a weekly video chat to check in on the patient through Zoom, but if we see symptoms get worse, we will get in touch with the patient. If necessary, we can get them an ambulance and get them to the right hospital. And we can do that for anybody in the country.

Is this available to other health systems?

Currently, this is only implemented at Mount Sinai but there are a numerous health care systems with whom we are collaborating to roll this out shortly in their hospitals.

Read about a patient who used Precision Recovery
Learn more about Precision Recovery
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