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Vaccine Facts: COVID-19 Vaccines Are Safe—and Essential—for Pregnant Women

Sep 23, 2021 | COVID-19, Featured, OB/GYN, Vaccines, Women's Health, Your Health

For those who are pregnant or considering getting pregnant, there are so many health questions, from “Is caffeine okay?” to “Can I still exercise?” But during the COVID-19 pandemic, some are also wondering if the COVID-19 vaccines are safe to take.

In this Q&A, Joanne Stone, MD, MS, Director of Maternal Fetal Medicine at the Mount Sinai Health System, explains the dangerous risks of COVID-19 during pregnancy, shares the facts on why you should get the vaccine, and offers reassurance for those who may be worried.

New Guidance on COVID-19 Vaccines: In April 2023, the Food and Drug Administration and the Centers for Disease Control and Prevention announced some major changes for COVID-19 vaccines. Click here to read more about what you need to know.

Update: The Centers for Disease Control and Prevention on September 29, 2021, strongly recommended COVID-19 vaccination either before or during pregnancy because the benefits of vaccination outweigh known or potential risks. Read more from the CDC

If someone is pregnant, or trying to get pregnant, should they get vaccinated?

Yes, if you’re pregnant, or thinking of getting pregnant, or even if you’re breastfeeding, this is absolutely the time to get the vaccine. I would not wait one extra day. I would get it today because there’s a lot of data that shows the vaccine is very safe and it’s not associated with miscarriage or infertility. Also, it’s the most important way to prevent COVID-19 infection.

Joanne Stone, MD, MS

Are pregnant people especially at risk for COVID-19?

Pregnant women who get COVID-19 infection are at a much higher risk for adverse outcomes, such as severe disease and even maternal death. There’s also higher risk for complications, including preeclampsia, which is high blood pressure in pregnancy, as well as increased risk for the baby, including preterm delivery. For all these reasons, the risks of COVID-19 infection are much higher for both mom and baby. So it’s extremely important to prevent this disease during pregnancy through vaccination plus other measures like mask wearing and social distancing.

What else should patients know about the vaccines and pregnancy?

Patients should understand there are a lot of myths out there that have not proven to be true. For example, there’s no increased risk of infertility if you get the vaccine prior to getting pregnant. Pregnant people should also know that there are complications associated with COVID-19 in pregnancy, and these complications that can be prevented by getting the vaccine. Also, the vaccine has been studied extensively. All the major organizations involved with women’s health care—including the Society for Maternal-Fetal Medicine and the Centers for Disease Control and Prevention—are strongly advocating that people who are pregnant get the vaccine.

Face Masks Are Still a Fact of Life, Here’s What You Need to Know About Safe Use

Sep 20, 2021 | COVID-19, Your Health

Woman who is alone on street, takes mask off while outside

Now, almost two years into the fight against COVID-19, face coverings have become a necessary addition to our everyday wardrobe. Along with proper hand washing and social distancing, their use has helped to prevent the spread of COVID-19. As the pandemic goes on and the effort to get people vaccinated continues, the U.S. Centers for Disease Control and Prevention (CDC) has issued additional guidance about face coverings. Importantly, the CDC now clarifies that while some outdoor, unmasked activity is relatively safe, both unvaccinated and vaccinated individuals should continue masking when indoors to protect themselves and others from the highly contagious Delta variant.

Krystina Woods, MD, Hospital Epidemiologist, Medical Director of Infection Prevention, and Deputy Chief Medical Officer at Mount Sinai West, explains the care and use of masks over the long haul and why those vaccinated against COVID-19 still need to mask up.

Why is it important that vaccinated people continue to wear face coverings?

We now know that vaccinated people can both become infected with COVID-19 and pass it on to others. And because of that, in certain settings, it is extremely important for even vaccinated people to wear masks.

Is it still less risky to be unmasked while outdoors? If so, why?

When you’re outdoors, there’s better ventilation. So, for example, if there is someone nearby who has been infected with COVID-19, the amount of virus can be diluted by all the freely moving air, making it less likely that others will be infected.

It is also important to remember that part of the thinking about being unmasked outdoors is that you’re unmasked while still being socially distant. If you are in a really, really large crowd; the protection is not going to be as good. You are much safer choosing to take your mask off outdoors if you have the ability to have a little bit of distancing.

So, being unmasked when on an early morning walk through a sparsely populated Prospect Park is okay, but if you’re window shopping on the weekend on a packed street in SoHo, throw on a face covering.

If my risk of severe illness is low, why should I continue to take precautions once I am fully vaccinated?

We need to continue to be careful. You don’t always know what the health problems are of those around you and, there’s a certain amount of civic responsibility that we have to each other.

None of us live completely isolated and, over the last 18 months, we’ve all felt what it is like to have to isolate ourselves from those we care about. So, we need to be careful about the fact that there are still people who have not gotten vaccinated, those who are not eligible for vaccination—like children—, and those who are otherwise vulnerable—like the elderly and immunocompromised. We have a duty to protect those amongst us who do not have the protection of vaccination.

Should I upgrade to a better face mask?

I wouldn’t see this as a necessity. The most important thing is that the face mask is multi-layered and fits well. If you are using a cloth mask, it is a good idea to double mask by using a surgical mask underneath the cloth mask. In place of that, a regular surgical mask is sufficient. However, if someone feels more comfortable wearing an N95 or its international equivalent (the KN95 or KF94), they certainly can—just make sure the masks are legitimate. The CDC has advice on how to identify counterfeit masks.

How do I know if my face mask has a proper fit?

Your mask should not fall off of your nose as you’re talking and it should fully cover your nose and the mouth. Additionally, it should not have large gaps around the perimeter of the mask—around the sides or the top and bottom. And, you should be able to tolerate wearing the mask for an extended period of time without feeling uncomfortable.

How should I take care of my cloth face masks?

Reusable masks should be washed at least daily, by hand or in your regular washing machine. And you can put them in the dryer, or hang them up to dry. If you have a disposable face mask, throw it away after wearing it once. And always wash your hands after handling or touching a used mask. The CDC has a lot more information about masking here.

Get more COVID-19 information from Mount Sinai

What Should I Eat Before and After My Workout?

Sep 16, 2021 | Diet and Nutrition, Your Health

Whether you are just starting to work out or committed to a regular workout program, the right nutrition can help you feel better, recover quicker, and get more out of your workouts. Brittany DeLaurentis, RD, CDN, a Clinical Nutrition Coordinator at Mount Sinai West and Mount Sinai Morningside, provides some valuable tips on what to eat before and after your workout.

Should I eat before a workout?

You definitely don’t want to go into your workout feeling hungry. However, you don’t want to have a large portion or eat the wrong things, otherwise you may feel fatigued or groggy during your workout. It also matters how soon you plan to work out after eating. For example, if you have a light meal or a snack—like a banana, an energy bar, or a smoothie—I’d recommend postponing your workout for one to three hours. If you have a larger meal, you want to wait a full three or four hours, just to make sure that the meal is well digested. In the morning, I’d stick to a small meal or a snack—just so you’re in that shorter window of one to three hours.

What foods would you recommend eating prior to a workout?

Make sure that you’re loading your body with carbohydrates. That said, the type of carbohydrates really matters. So choose complex carbohydrates—like a piece of whole grain toast or some whole grain cereal—over simple carbohydrates—like candy or packaged baked goods. It’s important that you choose complex carbohydrates, because simple carbohydrates can cause your body to crash and burn from the sugar high.

What about the trend of taking a scoop of dry protein before a workout?

Dry scooping is a very dangerous trend. Many protein powders have a large amount of caffeine. For comparison, a single scoop can have 200 mg caffeine as opposed to 65 mg in a small cup of coffee. Ingesting this plain without dilution can cause damage to the heart arteries, which can lead to a heart attack and organ failure. It also should be remembered that protein powders are not regulated by the FDA, so it is difficult to even know what they truly contain.

What foods would you avoid?

High fat foods like fried foods can make you feel bloated and groggy during your workout. And again, avoid simple carbohydrates so you don’t have that sugar high, and then a crash and sudden fatigue.

What drinks would you recommend during a workout?

Water is very important. You want to make sure that you’re going into a workout having had a minimum of two to three cups of water. And throughout the workout, you should also be hydrating. The general recommendation is about a half cup to a full cup every 15 to 20 minutes of working out. And, of course, the amount of hydration needed depends on the weather. If it’s a hot and humid day, you’ll need more.

Also, don’t forget to hydrate after your workout. Avoid sugar-filled beverages like soda or lemonade, and opt for plain water. The recommendation is to drink at least eight ounces of water afterwards. But, if you have completed a more intense workout, such as running, cycling, tennis, you might want to include a beverage that contains electrolytes, like Gatorade.

What foods are best to eat after a workout—and how soon after?

After a workout, you want complex carbohydrates to replenish the glycogen that your body just ran through as well as protein because working out actually breaks down your muscles. The ratio of your post-workout meal should be three to one, with carbohydrates being the majority, and you should eat within two hours of exercising, to replenish your glycogen stores and help your muscles recover.

Examples of post-workout meals could be yogurt and fruit, a peanut butter sandwich, turkey on whole grain bread, oatmeal with protein powder and fruit, or grilled chicken with vegetables. It depends on the time of day—but you want to make sure you’re combining carbohydrates and protein.

How should I change my eating habits, depending on whether I work out in the morning or in the evening?

In the morning, I would recommend sticking to a small meal or a snack. For most people’s schedules, it is probably better to only wait one to three hours before exercising. You also want to make sure that you are drinking water before working out. Also, studies show that drinking caffeine is beneficial before working out, so a cup of coffee is definitely appropriate if you like an early workout.

In the evening, I recommend having a post-workout meal, but make sure that you allow your body time to digest before going to bed. Give your body a good three to four hours before bedtime.

Should I change what I eat depending on whether I’m doing cardio or weightlifting exercises?

If you are doing endurance activities that involve aerobic exercises like running or swimming, your body burns through your glycogen stores more quickly. So you will need more carbohydrates when you are engaging in those types of workouts.

But whether you are doing cardio or weightlifting, you want to have carbohydrates before, and carbohydrates along with protein afterward.

Why Am I So Nervous About Going to the Doctor?

Sep 15, 2021 | Mental Health, Your Health

If you worry about going to doctor’s appointments, you aren’t alone. Many people feel anxious about upcoming medical appointments and tests. This ‘scanxiety’ affects people of all ages and backgrounds.

It is perfectly normal to be anxious in a medical setting, according to Rachel Kaplan, LCSW, a clinical social worker at The Mount Sinai Hospital, who explains why you may feel uneasy and what you can do to counter those feelings.

Why do people get anxious about going to see the doctor?

There are almost as many reasons for being nervous as there are people who worry. For instance, you might anticipate that your doctor will criticize you for your weight, for smoking, or for another habit. Or you could be scared of needles, blood work, or some other medical test. You might dread hearing a certain diagnosis—or you might know your diagnosis but worry about the treatment plan. You might suspect the doctor still won’t know what’s going on or be reluctant to hear that you are better and will have to ‘fly free’ without regular medical oversight.

Sometimes people are concerned not just about the message, but about who is telling it. If you’re not thrilled with how your medical care has been handled in the past, you might be reluctant to go back. You might anticipate feeling rushed and not getting all the information you need. It is also possible you just don’t like a particular doctor or other health care provider.

Any—or all—of these reasons can leave you feeling disappointed, upset, frustrated, scared, annoyed, or just hopeless.

Sometimes people who are nervous about doctor visits walk in the door with sweaty palms or a knot in the pit of their stomach. Others try to treat ailments by themselves in hopes that they will never have to head into the exam room. Still others make appointments, but keep rescheduling for days, weeks, or even months.

Can ‘scanxiety’ affect how my body feels?

Absolutely. Sometimes, in the days or weeks before an appointment, you might find yourself feeling on edge, irritable, or you could have difficulty sleeping. When you actually get to the office, you might notice your muscles are tensing. It’s possible that you will start breathing quickly or taking shallow breaths. You could feel it in the pit of your stomach or in your bladder, with a sudden and urgent need to go to the bathroom. It might even raise your blood pressure. When your blood pressure goes up while you are in the doctor’s office, we use the term “white coat hypertension.” To repeat, all of this is perfectly normal.

Should I ignore these feelings?

No, don’t ignore your emotions. You should acknowledge how you are feeling, realize that it affects a lot of us, and tell yourself that it is okay to feel this way. This may sound simplistic, but paying attention to your emotions and then identifying and acknowledging your feelings can be very powerful. You can say out loud—to yourself or to someone you trust—that you’re feeling really worried about your upcoming appointment.

Some days, it may seem easier to just push your feelings aside and ignore them. It can be uncomfortable or even scary to think about your anxiety. But ignoring your emotions does not make them go away. It just means they will come out in some other way—such as irritability, muscle pain, headaches, and sleep problems.

What do I do about my anxiety?

Once you acknowledge what is going on, you can practice self-compassion. Give yourself permission to worry. If that’s hard to do, think about what you would say to a friend or family member if they were going through what you are experiencing. Often, we are much harder on ourselves than we are on others. So try to show the same patience, empathy, and nurturing to yourself that you would show to someone you care about.

Also, try to figure out what is causing your feelings. If, for instance, you feel uncomfortable with a particular doctor, consider switching to a different health care provider. If you are worried about the possibility of a needle prick, speak with someone in the office when you make your appointment to find out what you can expect. If it’s general anxiety, try some meditation and relaxation tricks to help you cope.

Finally, remember that anxiety is normal and self-care is very important. It’s helpful to remember this for now and in the future, if these issues come up again.

Three Simple Ways to Help Lower Your Anxiety

Sep 15, 2021 | Mental Health, Psychiatry, Your Health

Young man practices deep breathing to lower anxiety

Everyone feels anxious now and then. Sometimes it’s a particular situation that makes your stomach clench, like visiting the doctor or meeting someone you don’t know; other times, you may experience a wave of anxiety for no particular reason.

There are some simple steps you can follow to relax. Rachel Kaplan, LCSW, a clinical social worker at The Mount Sinai Hospital, shares three tools you can use anywhere—without signaling your distress to everyone around you.

Breathe mindfully

You’ve probably heard that breathing can help you relax. But mindful breathing is more than just holding your breath.

What is mindfulness?

Mindfulness involves being aware of the moment and not judging yourself. Just notice how you feel and allow yourself to feel that way. Try not to force yourself to be relaxed as that can backfire and make you feel more stressed. You want to remind your body that you are safe

When you’re anxious, you tend to take shallow breaths. This is part of our ‘fight or fight’ response that kicks in when our brains sense a threat. To counteract this and help relax the body, try a technique called belly—or diaphragmatic—breathing. Start by placing one hand on your chest and one on the lower stomach area. Take a deep breath, inhaling through your nose, for four counts. Hold your breath for three counts. Then exhale slowly, through your mouth, for six counts. Deep breathing helps to ground us and signals to our brains that we are safe, lowering our anxiety level.

As you breathe, watch to see which hand is rising and falling—you’ll want it to be the hand on the belly. Take another deep breath and imagine that you’re pushing air into that lower hand. Repeat this exercise 10 times.

Focus on your senses

Use all your senses to focus on small details of the here. This will help you ground yourself and will take your mind off your anxious thoughts.

Think about the small details of your surroundings:

Start by naming five things you see around you. This could be the table you’re sitting at or your water bottle.
Name four things you can touch: your sweatshirt, hair, necklace, or shoes.
Acknowledge three things you hear, such as a car horn honking outside or the click-click of someone typing.
Name two things you can smell, maybe the remnants of last night’s dinner or your cat’s litter box.
Finally, acknowledge one thing you can taste.

By focusing on the exercise, you don’t have enough brain power to analyze and worry. Your concerns drift away, and you feel calmer.

Use your peripheral vision

This isn’t easy and requires concentration.

Start by looking straight ahead (not on a phone or computer screen) and pick one spot to stare at. It can be a mark on the wall, a doorknob, a tree branch—whatever jumps out at you. Focus your gaze on that spot for 5 to 10 seconds. Keep that focus, then widen your field of view without looking away from your focal point.

Notice what you see in your peripheral vision. Start on the right side and observe what you can see without moving your head or straying from your focal point. You may just see colors and movement or you may see objects. Do this for about 10 seconds. Then, for about 10 seconds, notice what you see on the left without looking away from your focal point.

By focusing on your peripheral vision, rather than your anxiety, your breathing will slow and your face muscles will relax. When you feel calmer, you can bring your attention back to the view straight in front of you.

Vaccine Facts: Immunocompromised People Should Get a Third Dose

Sep 9, 2021 | COVID-19, Featured, Vaccines, Your Health

Immunocompromised people have a reduced ability to fight infections and are more vulnerable to severe COVID-19. That is why the U.S. Centers for Disease Control and Prevention (CDC) is recommending that people with moderately to severely compromised immune systems receive an additional dose of the Pfizer-BioNTech or Moderna vaccine.

In this Q&A, Meenakshi Rana, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, and the Director of Transplant Infectious Disease, explains why immunocompromised people, who make up almost three percent of the U.S. population, should get this third vaccine dose and why it is important to take other protective measures.

What did the CDC recommend?

The CDC and the Advisory Committee on Immunization Practices took an important action to prevent COVID-19 infection in our immunocompromised population and among transplant recipients. They now recommend that people who are moderately to severely immunocompromised receive an additional dose of an mRNA COVID-19 vaccine, either Pfizer or Moderna, at least 28 days after the completion of the initial series. The Food and Drug Administration (FDA) now allows for the additional dose for these people as well.

To be clear, this is not considered a booster dose. A booster dose is given to a patient whose immunity to the vaccine may have waned over time. This is considered an additional dose, given to immunocompromised patients to improve their initial response to the vaccine series. These patients are essentially receiving a three-dose mRNA vaccine series instead of a two-dose series.

Who is considered immunocompromised and should get the third dose?

Meenakshi Rana, MD

Immunocompromised patients are a very large and heterogeneous group. For the purposes of an additional COVID-19 vaccine, the CDC has defined a specific moderately to severely immunocompromised group, which includes:

Patients who have been receiving active cancer treatment for tumors or cancers of the blood
Patients who had a solid organ transplant, such as a heart, lung, liver or a kidney, and currently take immunosuppressive medications
Patients who had a bone marrow transplant within two years or had a bone marrow transplant and are currently taking immunosuppressive therapy, or patients who receive CAR T-cell therapy.
Patients who have advanced or untreated HIV
Patients who have another medical condition that require high-dose steroids or immunosuppressive therapy for that medical condition

If you think you fall within this category, it’s important that you speak to your physician to determine if you are eligible for an additional dose of mRNA COVID-19 vaccine.

Why is the CDC taking this action?

Patients who are considered moderately to severely immunocompromised are more vulnerable to COVID-19. They are more likely to have severe disease, and more likely to be hospitalized with COVID-19. In addition, there has been data suggesting that moderately to severely immunocompromised patients may not have as strong an immune response to the initial COVID-19 vaccine series, and we have seen breakthrough infections in vaccinated immunocompromised patients, occasionally requiring hospitalization. The CDC also now has data suggesting that a third vaccine would be safe.

What should I do if I think I am affected by this action by the CDC?

If you think you are considered moderately to severely immunocompromised, talk to your doctor to see if you are eligible for an additional dose of COVID-19 vaccine. The CDC recommends that you receive a third dose with the same mRNA vaccine. For example, if you received an initial Moderna vaccine series, then you should complete your series with an additional third dose of the Moderna vaccine.

What if I am immunocompromised and I received the Johnson & Johnson vaccine?

When the CDC made this recommendation, they did not have enough data on whether immunocompromised patients who received the J&J vaccine would have an improved response after receiving an additional dose of the same vaccine. For this reason, we are currently awaiting more guidance from the CDC on what to recommend for these patients.

If I am immunocompromised, what else should I do to protect myself?

In addition to receiving an additional dose of an mRNA vaccine, you should continue to practice all those protective precautions that we’ve been discussing: social distancing, hand hygiene, and masking. It’s also very important that all of those around you, your family and your friends, are all vaccinated.

The FDA has also authorized the use of a medication, known as a monoclonal antibody, for what is termed “post- exposure prophylaxis.” That means, if you are exposed to a loved one or family member with COVID-19, this medication can be given to you to prevent COVID-19 and progression to severe disease or hospitalization with COVID-19. You should call your physician to see if you are eligible.

Should I get an antibody test to see if I am eligible for the third dose?

We are not recommending that you get an antibody test for this purpose, because we don’t know what level of antibodies is considered protective. We recommend that if you are considered immunocompromised, you should receive an additional vaccine dose, regardless of antibody response.

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