Should I Tell My Doctor About My Cannabis Use?

Cannabis joint in the hand

Now that New York and many other states around the country have decriminalized medicinal and recreational cannabis, some are interested in partaking. To those people, Yasmin Hurd, PhD, Director of the Addiction Institute of Mount Sinai, advises that marijuana is just like any other drug, even if it’s now legal.

Dr. Hurd is an internationally renowned expert on addiction and related psychiatric disorders who has been at the forefront of research into cannabinoid (CBD), a substance derived from the hemp plant that is now seen in many retail stores. In this Q & A, she explains what you need to know if you are heading to the cannabis dispensary and why disclosing marijuana use to your primary care physician is critical.

What advice do you have for those new to marijuana who are interested in partaking now that recreational use is legal?

You have to really be careful about where you obtain your cannabis. There are bad actors out there, and we have seen that some items which have been marketed as cannabis can actually contain products that are not. Recently, we have seen cannabis that has been laced with fentanyl, which is a highly potent and highly addictive opioid. So, the source from which you obtain your cannabis is critical. For now, the safest way to get marijuana in New York is to get a prescription from a physician and buy it in a state dispensary.

Should I tell my doctor that I am using marijuana? Why?

It is critical to tell your doctor if you are using any cannabis product. Like any drug, cannabis is broken down into various active chemicals that your body can use by liver enzymes. If you are taking any other pharmaceutical drugs, cannabis may interact with the same liver enzymes and either diminish or increase the activity beyond its intended use. So, your doctor absolutely has to know to avoid a potentially dangerous drug interaction.

One of the benefits of legalization is that there should not be any risk in being honest with your doctor about your cannabis use. The more honest that you can be, the better medical care you can receive.

Is it true that marijuana is non-addictive?

Many people don’t realize that you can become addicted to cannabis. In fact, the rate of diagnosis of “cannabis use disorder” is about 30 percent in people who frequently use the drug. That percentage is not much different from highly addictive drugs like cocaine and opioids even though cannabis is not as highly addictive.

The reason that we have such a high prevalence of cannabis use disorder being diagnosed is that a greater number of people use cannabis, so more people can convert into addiction. Often, the higher addiction is due to the higher potency of today’s cannabis.

What specifically is different about today’s marijuana?

Today’s recreational cannabis has a very high concentration of THC (short for delta-9-tetrahydrocannabinol), which is the main psychoactive ingredient in cannabis. It has gone from approximately four percent THC to, in some products, nearly 24 percent. And certain products, even those obtained from dispensaries, could have 70 percent THC. This is much higher than 10 or 20 years ago.

The greater the THC concentration, the greater the potential impact on a user’s mental health, and the greater the potential to become addicted. For a safer, higher-quality product, look for cannabis that has a verified certificate of analysis—this indicates that the product has been thoroughly checked for contaminants, pesticides, and other harmful materials, and it allows you to view its THC levels as well as other ingredients.

Is hemp-based THC safer than cannabis-based THC?

In short, no. THC is the same if purified in a safe manner for human use, whether it is derived from hemp or cannabis. However, the amount of THC that can be produced from hemp is low—the plant contains less than .3 percent THC—, so most THC is obtained from cannabis.

It is important to understand that even though marijuana may be legal for recreational and medicinal purposes in New York, on the federal level it is still a Schedule 1 drug which means that it is considered to have no accepted medical use and a high potential for abuse.

However, CBD—which is derived from hemp—is federally legal. There are some who try to get around cannabis’ federal status by selling a hemp-based THC product under the name ‘delta-8-THC.’ In the cannabis plant, it is delta-9-THC that causes the ‘high’ and, large concentrations of the substance can cause mental health issues. While there is not a lot known about delta-8-THC, we do know that it can cause euphoria, though milder than delta-9-THC.

Many companies are marketing delta-8-THC as the safer—and legal—option, but that is not true. For example, since the amount of THC in the hemp plant is low, some manufacturers try to forego the natural process of deriving the substance and use chemicals to artificially increase the amount of delta-8-THC. Additionally, some bad actor companies are faking their certificate of analysis to say that their product is delta-8-THC, when it turns out that it contains delta-9-THC and harmful materials like lead and heavy metals.

Are there any other drawbacks to frequent cannabis use?

In addition to potentially developing an addiction to cannabis, with use of highly potent cannabis products, we see mental health related problems. For example, issues with attention, memory, and cognition. Those are a side effect of chronic cannabis use, and even occasional use can impair motor issues. We also see the risk for psychosis, especially in certain younger people, when they use cannabis.

And, for any drug that is being consumed by smoking, you also incur the risk of pulmonary issues as smoking which is not good for your lungs.

Has marijuana been proven to alleviate any medical conditions?

There are certain synthetic THC products that have been approved by the U.S. Food and Drug Administration (FDA) for anti-nausea purposes to help increase the appetite of people going through chemotherapy. The FDA has also approved the use of CBD, in particular Epidiolex®, for two rare childhood forms of epilepsy.

Other than that, neither cannabis nor CBD have been approved for anything else. But there are a lot of clinical trials currently being done. So we’ll see how those pan out in a few years.

How does legalizing marijuana benefit the medical community?

Legalizing marijuana is a double-edged sword for the medical community. We want to make sure that people are healthy, and any time you take a drug that you most likely do not need that can have negative effects on mental health, that’s not great. But the legalization of marijuana makes it easier for patients to be honest with their doctors about their cannabis use, which overall gives patients better outcomes because a physician will know exactly what their patient is taking and can, therefore, guide their care in a much better way.

Also, for my fellow researchers, the fact that cannabis is no longer illegal in some states makes it easier for us to investigate what may be the benefits and adverse effects of its use for certain disorders. It also allows us to better guide physicians and their patients about how to use cannabis, if they choose to use cannabis.

Yasmin Hurd, PhD, is the Ward-Coleman Chair of Translational Neuroscience and the Director of the Addiction Institute at Mount Sinai. She is currently the principal investigator on a clinical trial of CBD for treating opioid use disorder, a neuroimaging study of CBD’s effects on the human brain, and a study looking at neurodevelopmental effects of cannabis and its epigenetic regulation.

How Do I Know If My Wisdom Teeth Must Go?

xray of wisdom tooth

The painful appearance of wisdom teeth is a rite of passage for many teenagers and young adults. These third molar teeth often present during the transitional period between childhood and adulthood, thus earning their name, “wisdom teeth.” Their presence can cause many issues, such as pain, swelling, crowding in the mouth, and even cysts and tumors. Many people who develop these problems need to have the teeth extracted, although there are some fortunate individuals who do not develop them or even need to have them removed.

To increase your wisdom about these molars, Michael D. Turner, DDS, MD, Chief of Oral and Maxillofacial Surgery at The Mount Sinai Hospital, answers patients’ most frequently asked questions.

Do we need wisdom teeth?

In our mouths, we typically develop three sets of molars, which are the wide teeth in the back of the upper and lower jaws.  Your “wisdom teeth” are the third set of molars, which are the most posterior teeth. Typically, they fully develop at age 18, although this happens slightly earlier or later for some.

Wisdom teeth were most useful for early humans who, thousands of years ago, had a diet of tough meat, roots, and leaves. Now, most people eat food that has been softened by cooking so the jaws have decreased in size and have become too small to accommodate three sets of molars. Because of this, the third molars, for the most part, do not erupt fully.  We call this an “impaction.”

What are some signs and symptoms that wisdom teeth are coming in?

Symptomatic third molars can present in multiple fashions, including:

  • Jaw pain
  • Swelling overlying the third molar sites
  • Pus and foul odor from the site
  • Halitosis, also known as bad breath

If your wisdom teeth are impacted—not emerging—and causing pain, they should be removed during an individuals’ late teens to their mid-twenties to decrease the amount of complications from the surgery that can occur.

However, if impacted teeth are not causing any symptoms, your dentist may not recommend removal, since extraction of impacted third molars should be based on the clinical and radiographic findings. So, if they are not causing pain, you might be one of the lucky few who will not need to have the teeth removed.

What should I expect during a wisdom tooth extraction?

Wisdom tooth extraction is typically performed as an outpatient procedure. Patients can have the procedure with just local anesthesia or with sedation, depending on their preference. Often the procedure is complete in one hour, although, this depends on both the complexity of the extraction and the number of teeth being removed.

After the removal of the teeth, most people are swollen. This swelling takes three to four days to resolve. Full recuperation generally takes five to seven days, so if parents do not want kids to miss school, the summer or winter breaks are the best times to schedule. Most patient’s pain can be controlled by ibuprofen, although sometimes a small amount of a stronger pain medication is prescribed.

What complications should I look out for following surgery?

Dry socket is a problem that occurs about two to three days after surgery. It happens when the blood clot, which forms at the base of a tooth extraction, is dislodged—or dissolves—before the area can sufficiently heal. Without the blood clot’s presence, the underlying bone is exposed, causing pain and a bad taste and smell. Most patients report that healing is proceeding as normal and then, suddenly, they experience a pulsing sharp pain in the area of the extraction. Fortunately, dry socket can easily be managed by your surgeon by cleaning the area and applying a medicated dressing.

Post-surgical infections are rare and if they occur, are not apparent until three or four weeks following the surgery. Typically, infection is an effect of the bone healing, although food that gets caught in the extraction socket while healing can be the culprit.  Post-operative antibiotics have not been shown to prevent infections from occurring. Patients are only prescribed antibiotics if there is an active infection.

The most significant complication that can occur due to the removal of the lower third molars is a change in nerve sensation to the lower lip, teeth, chin, and gums. Although this side effect occurs at about the same rate regardless of age, the rate of permanent sensation change increases with age.  If you wait until you are older, then you are at a much higher risk.

My wisdom teeth are not causing me any pain. What happens if I never have them pulled out?

If the teeth are completely impacted and surrounded by bone, most likely nothing will occur. Although, occasionally the developmental cyst that is present around the third molar can transform into an aggressive and destructive cyst, or rarely, into a benign tumor.

However, if your wisdom teeth have partially emerged, they can become decayed, cause decay on adjacent teeth, or become infected.

If you, or your child, are experiencing signs that your wisdom teeth are emerging, it’s best to make an appointment with your dentist.

Make an appointment with Dr. Turner at the following locations:

Mount Sinai Union Square
Otolaryngology and Oral and Maxillofacial Surgery
10 Union Square East, Suite 5B
New York, NY 10003
212-844-6881

Mount Sinai Doctors East 85th Street
Otolaryngology and Oral and Maxillofacial Surgery
234 East 85th Street, 4th Floor
New York, NY 10028
212-241-9410

What You Need to Know About Heart Inflammation and the COVID-19 Vaccines

A woman talking to her young male patient in medical office

Researchers at the U.S. Centers for Disease Control and Prevention (CDC) are investigating a link between COVID-19 vaccines from Pfizer-BioNTech and Moderna and heart inflammation in young men and boys.

Kristin Oliver, MD, MHS, a pediatrician and preventive medicine physician at the Mount Sinai Health System and an Assistant Professor of Pediatrics, and Environmental Medicine and Public Health, at the Icahn School of Medicine at Mount Sinai, explains what parents, guardians, and young adults need to know about this rare side effect.

What is the situation as you see it?

The COVID-19 mRNA vaccines from Pfizer-BioNTech and Moderna have been linked to cases of myocarditis, which is an inflammation of the heart, and pericarditis, which is inflammation of the sac-like covering around the heart. Myocarditis and pericarditis can happen after an infection from different viruses, including SARS-CoV-2—the virus that causes COVID-19. They are more commonly seen in males.

How common is this side effect?

Myocarditis and pericarditis can be serious but, fortunately, these side effects to vaccination are very rare. While we don’t know the precise rate of these side effects in relation to COVID-19 vaccines, we do know that it is more commonly seen in men and boys and after the second dose of the vaccine. Signs of myocarditis and pericarditis tend to become visible within four days of the vaccine dose.

Keep in mind that as of July 2021, more than 52 million doses of the COVID-19 vaccines have been administered in the United States to people ages 30 or younger, and the CDC has only confirmed about 600 reports of myocarditis or pericarditis in connection with vaccination in this age group. The cases connected to receiving the COVID-19 vaccine have also been mild. So, the benefits of COVID-19 vaccination in this group still outweigh the risks of getting myocarditis from the vaccine.

What are the signs of myocarditis/pericarditis?

People with heart inflammation experience chest pains, difficulty breathing, heart palpitations, and excessive sweating. These symptoms may also be accompanied by stomach pain, dizziness, coughing, unexplained swelling, and even fainting. If a recently vaccinated person shows symptoms of myocarditis or pericarditis, they should seek medical attention.

The most common side effects from COVID-19 vaccination are pain at the injection site, fatigue, headache, fever, chills, muscle pain, or joint pain. These vaccination side effects can be managed with over-the-counter medication and rest.

What do you say to families who are concerned about this serious, but rare, side effect?

I’m honest with families when I talk about it, and I understand that it’s disappointing to learn about this connection. But because it happens so rarely and because COVID-19 infection can have serious consequences in adolescents and young adults, the benefits of vaccination still outweigh the risks.

In making any medical decision we are weighing the potential risks and benefits. Remember, the risks of COVID-19 infection in this age group are real and so are benefits of COVID-19 vaccination. Data from the CDC estimate that if we vaccinate one million males between the ages of 12 and 17, we will prevent: 5,700 cases of COVID-19, 215 hospitalizations, 71 ICU stays, and 2 deaths in this group.

But I always recommend that parents talk with their pediatrician about any concerns. Pediatricians know what’s important to you and your family and have lots of experience giving vaccines and answering these questions.

Could My Painful Periods Be Endometriosis?

woman with pelvic pain holding stomach

Menstruation can be uncomfortable. But, for some, “that time of the month” is also a period of extreme pain accompanied with heavy bleeding and pelvic discomfort. Affecting 2 to 10 percent of premenopausal women, endometriosis is often difficult to diagnose and can hamper the day-to-day living of those with the condition.

In this Q & A, endometriosis specialist Susan S. Khalil, MD, Assistant Professor of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, explains the condition, its symptoms, and why early  diagnosis and treatment is important.

What is endometriosis?

Endometriosis is a condition in which there is an ectopic implantation of the endometrium. In layman’s terms, the lining of the uterus is implanted in sites outside of the uterus. Implantation can be in the fallopian tubes, the ovaries, or inside the belly. It can also be in areas of the body very distant from the reproductive organs, such as the lungs or even the brain. The condition typically effects women who are still having their period.

What causes the condition, and can it be prevented?

The cause of endometriosis is largely unknown, but there are a few different theories. One is that, in some women, blood from menstruation flows backward into the belly instead of flowing downward, causing incorrect implantation. Another is “de novo” formation, meaning that it just happens on its own. Yet another theory is that local cell changes can lead to endometriosis.

There is no cure for endometriosis, but there are treatments. And early diagnosis leads to less invasive methods of managing the condition.

I think I have endometriosis. What are the symptoms?

The most common symptoms of endometriosis are pelvic pain and painful periods.

If you are wondering how much period pain is too much, remember that your period should not routinely interfere with your ability to go to work or school, or to go about the activities of daily living. If you are missing out on these activities due to your period, please see a gynecologist.

Patients with endometriosis may also experience unexplained painful urination, painful bowel movements, and painful intercourse. Occasionally, women will get evaluated for the condition if they are having difficulty getting pregnant. Based on your symptoms, endometriosis can be suspected, but the condition is confirmed through laparoscopy.

I was diagnosed with endometriosis. Can I still get pregnant?

Yes, you can get pregnant. However, you may require some assistance. For instance, some people with the condition may need to undergo minimally invasive surgery to remove endometrial tissue.

There is a wide spectrum of severity with endometriosis. While many women actively pursue treatment or diagnosis because they are having difficulty conceiving, there are also pregnant women whose diagnosis is only discovered during routine examination.

What are the treatment options for the condition? Will I need surgery?

Generally, the treatment for endometriosis includes medication and, for some, a surgical option.

Common medications prescribed for the condition depend on the patient’s primary goals, which may include pain control or suppression, or pain control while trying to conceive. The medications include hormonal agents with progesterone only, a combination of estrogen and progesterone, and gonadotropin-releasing hormone (GNRH) agonists or antagonists. The treatments are tailored to the patient when they are evaluated.

If patients need surgical intervention, laparoscopy is one option. It can be used to diagnose endometriosis and to remove growths and scar tissue from the reproductive area. The procedure is often regarded as a fertility-sparing operation that also helps to reduce the pain associated with endometriosis and improve quality of life.

How important is early treatment, and diagnosis, of endometriosis?

Early treatment and diagnosis is important to maintain fertility and manage pain symptoms. It also helps with identifying patients who have endometriosis, and patterns in their family history.

At Mount Sinai, we offer a team-based approach that includes various services, such as pelvic floor therapy, acupuncture, dietary management, and pain management. All of these services are intended to make endometriosis a more livable condition for patients as well as to provide them with a good framework for support.

What Is the Delta Variant and Why Is It a Concern for Those Who Are Not Vaccinated

One of the latest terms to emerge from the pandemic is the Delta variant. This variant appears to be more contagious than previous variants and has become more common in the United States.

In this Q&A, Sean Liu, MD, PhD, an Assistant Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine, says the spread of this variant is concerning because of the number of people who remain unvaccinated.  Those who become infected with this variant pose an elevated risk to household members who are not vaccinated and to others they come in contact with, such as those with compromised immune systems—which includes those with chronic medical conditions and the elderly—who are not able to fight infections as easily as most. Dr. Liu is part of the team of experts at Mount Sinai who are at the forefront of research into vaccines and who are also on the front lines treating patients and helping to limit the spread of the virus in the New York metropolitan area.

Sean Liu, MD, PhD

What is the Delta variant?

All viruses, including the SARS-CoV-2 virus that causes COVID-19, will evolve over time. It is normal for a virus to change a little bit when it makes copies of itself, or replicates. These changes are called mutations. The virus with one or more new mutations is referred to as a variant. Genetic variants of SARS-CoV-2 have been emerging and circulating around the world throughout the COVID 19 pandemic. There are six variants of concern circulating in the United States; the Delta variant is one of these circulating variants. The Delta variant was first detected in December 2020, and recently this variant has been detected in more than 80 countries, and in all 50 states.

Why is there a concern over this variant?

The variants of concern show evidence of at least one of the following five properties:

  • The variant may spread more easily from person to person.
  • The variant may lead to more severe disease, including increased hospitalizations or deaths.
  • The variant may be significantly harder to combat by antibodies generated during a previous infection or vaccination.
  • Treatments or vaccines may show reduced effectiveness against the variant.
  • The variant may evade diagnostic detection.

The Delta variant, specifically, has three of these properties, one being increased transmissibility. There is a 1.6-fold increase in the odds of household transmissions for the Delta variant compared with the Alpha variant, also known as the UK variant.

Why is the issue of transmissibility so important?

The fact that this strain can spread so quickly means is that you have a higher likelihood of spreading the Delta variant if infected. As clinicians, we see a lot of COVID-19 spread throughout families. It’s very devastating among households, and this variant specifically has this increased transmissibility within a household. People who are unvaccinated are really putting their family members, or those in their household, at increased risk for severe disease, especially if they too are unvaccinated.

For those who are fully vaccinated, does the Delta variant pose a risk?

It is important to remember that the goal of the COVID-19 vaccines is to prevent severe infections, hospitalizations, and deaths.  The mRNA-based vaccines are about 95 percent effective against hospitalization for COVID-19, with either one or two doses. Studies suggest that the Pfizer-BioNTech vaccine reduced the odds of symptomatic disease from the Delta variant, which means getting mildly sick, by 36 percent after one dose and 88 percent after two doses. There is, however, no available data about asymptomatic or mild infections with the Delta variant in fully vaccinated people, which means that people can get infected but not show any symptoms. Also, we know that people with underlying medical conditions have died from COVID-19, even after being fully vaccinated. As a result, the Delta variant creates a major concern if there are fully vaccinated people who are in close contact with family or household members or with people who are immunocompromised or have not been vaccinated, including children.

What about those who are not vaccinated?

If you have not been vaccinated yet, you should seriously consider doing so now.  People who have not been vaccinated have a much greater risk of getting seriously ill or dying from COVID-19, especially the Delta variant. Meanwhile, people who are not vaccinated, or who are immunocompromised, should continue to use masks, socially distance to avoid infection especially if you don’t know the status of the individuals around you. If you’re unsure of getting vaccinated, I would encourage you to have discussions with medical professionals who may provide reliable information about the benefits of vaccination. Currently, 44 percent of New York City residents of all ages have not been vaccinated and 34 percent of adults have not been vaccinated in New York City. The distribution of people getting vaccinated is not even. Check out the New York City Department of Health website for the latest information about vaccine availability and vaccination rates.

Why are vaccines important?

The COVID 19 pandemic is a global problem. While vaccines are becoming readily available in the United States, the majority of the world remains unvaccinated. And the pandemic will persist for months, and likely years. Vaccination is our primary means of ending the pandemic. Vaccines are safe and effective. Please consider getting vaccinated, if you are eligible.

 

Can the COVID-19 Vaccines Affect My Fertility?

Worried young woman holding pregnancy test

Some men and women may be reluctant to get the COVID-19 vaccination because of concerns about fertility. You may be wondering if any of the vaccines used in the United States can have an effect on your sperm count, or on your eggs, embryo, or the pregnancy itself.

In this Q&A, Alan Copperman, MD, Director of the Division of Reproductive Endocrinology and Infertility and Vice Chair of the Department of Obstetrics, Gynecology, and Reproductive Science at the Mount Sinai Health System, says the evidence shows that the vaccines do not pose a concern.

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

Does the COVID-19 vaccine affect my sperm count?

None of the COVID-19 vaccines in use in the United States affect sperm count or the sperm’s  ability to move toward an egg (motility). It is true that contracting a severe case of COVID-19 can lower sperm count for a time. But studies show that the vaccine itself does not affect sperm. In fact, we recently completed a study looking at sperm donors around the country before and after getting the vaccine. We saw no change in count or motility.

Can the vaccine affect my ability to get pregnant and have a baby?

We have found that the COVID-19 vaccinations do not affect a woman’s fertility.  Pregnancy involves a number of steps:

  • Your ovaries release an egg.
  • The egg travels through the fallopian tube to the womb (uterus).
  • Sperm fertilizes the egg as it travels.
  • The fertilized egg attaches to the inside of the uterus (implantation) and grows.

A problem at any one of these steps can lead to infertility. We’ve been studying women who have gone through several fertility cycles to see if any of the COVID-19 vaccines used in the United States affects any of these steps. We have found that:

  • The vaccine does not decrease egg production.
  • It doesn’t affect the ability to make an embryo.
  • It doesn’t affect a chromosomally normal embryo’s ability to grow in the uterus.
Will the COVID-19 vaccine have any effect on my pregnancy?

This is a good question because we’ve found that pregnant women who get COVID-19 tend to become very ill. That’s why we recommend taking the vaccine. As of now, three billion COVID-19 vaccinations have been administered, have of them to women, and we haven’t heard any reports of them affecting a woman’s pregnancy. We have also seen women getting the vaccine while undergoing in vitro fertilization—and it has had no effect on their outcomes. In fact, we have found that the vaccine not only protects the pregnant woman, but it keeps them safe at vulnerable times, such as when they deliver—and the fetus gets some immunity as well. We hypothesize that the vaccine prevents severe illness in these babies.

Should I get the COVID-19 vaccine if I’m planning a pregnancy in the near future?

The best time to get the vaccine is as soon as it becomes available to you. You may feel tired after the shot, and you may have short-term symptoms like fever. Some people have an allergic reaction to the vaccine, but that is very rare. We definitely recommend getting the COVID-19 vaccine to protect you, your pregnancy, and your infant.

If I’m already pregnant should I get the vaccine?

Safety data from around the world shows that women taking the vaccine during pregnancy have seen no effect on their pregnancy. The vaccine has shown itself to be safe and effective. As a result, 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.

Which vaccine is best for a pregnant woman?

There’s no data suggesting that any one of the vaccines is better than any of the others for pregnant women. We know that the effectiveness against preventing disease seems a little bit higher in the mRNA vaccines (Pfizer-BioNTech and Moderna), but all the vaccines that have been authorized by the Food and Drug Administration (FDA) are up to 99 percent effective in preventing severe disease and death. Get whatever vaccine is most readily available to you.

What should I do if I have questions about the vaccine and my fertility?

If you have any questions, ask your health care provider. You can also check the online guidelines from organizations like the World Health Organization and the FDA. There is a lot of great information out there to help us fight back against this pandemic.