Your Health | Mount Sinai Today

Renowned Microbiologists Explain the Coronavirus

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

The novel coronavirus is transmitted through the air and replicates in the respiratory system and in blood.

The novel coronavirus that began in Wuhan, China, has been labeled a Public Health Emergency by the U.S. government. As confirmed cases of the coronavirus now known as COVID-19 continue to increase in this country and around the world, and additional information unfolds, two renowned microbiologists at the Icahn School of Medicine at Mount Sinai, Peter Palese, PhD, and Adolfo García-Sastre, PhD, recently provided insights into the disease. Dr. Palese is the Horace W. Goldsmith Professor and Chair of the Department of Microbiology, and Professor of Medicine (Infectious Diseases); and Dr. García-Sastre is the Irene and Dr. Arthur M. Fishberg Professor of Medicine (Microbiology, and Infectious Diseases), and Director of the Global Health and Emerging Pathogens Institute.

What is COVID-19?
Dr. Palese: It belongs to a group of viruses known as coronaviruses, to which the SARS (severe acute respiratory syndrome) virus and MERS virus (Middle East respiratory syndrome) belong. It is transmitted through the air and replicates in the respiratory system and in blood.
Dr. García-Sastre: The COVID-19 and the SARS-CoV are closely related and they originated from bats. In the case of the COVID-19, we are not yet sure of its precise origin—whether the virus went directly from bats to humans or whether it went from bats to a host animal and then to humans, which is what happened with SARS. But we believe it originated from bats.

The SARs outbreak in 2003 is different from the novel coronavirus in that it was traced to civet cats and raccoon dogs, which were eaten as a delicacy in some parts of China. The animals were originally infected by bats—either through bites or by breathing in bat urine and feces. MERS, a respiratory illness relatively new to humans and traced to the Arabian Peninsula, is believed to have been spread by camels that were also infected by bats.

How did this novel coronavirus start?
Dr. Palese: Samples of the virus were found in a large fish market in Wuhan where other live animals are kept in cages and sold as food.

Dr. García-Sastre: People went to the market to buy food and were exposed to the virus, which infects through the respiratory tract. Like the flu, it is spread by aerosols.

What are the most important factors to consider as the disease unfolds?
Dr. Palese: The reproduction number, or “R” number, appears to be around 2.5. That means every person who is infected will pass the disease on to 2.5 other people. The influenza virus is a little lower. Measles has a much higher R number of about 18. These are averages. But we have to be vigilant. There are reports that the disease can be transmitted for about 24 hours before symptoms develop. If that is confirmed, it would make it more difficult to contain. The disease caused by the novel coronavirus is accompanied by flu-like symptoms, including very high fever. Fatalities stem from pneumonia and comorbidities, such as old age, asthma, or chronic obstructive pulmonary disease.
Dr. García-Sastre: Don’t panic. The virus does not seem to be associated with very high mortality. It is progressing more quickly than the SARs virus did, but it also appears to be less deadly. The rate of transmission appears to be similar to that of the seasonal flu. That is an estimate because we don’t know for sure whether all of the people who have the disease have been diagnosed. Some may have very mild cases. Another consideration is at what moment does an infected person begin to transmit the virus? With flu, people can transmit the disease before there are symptoms. With SARS, most transmissions happen after there are symptoms.

Are vaccines available?
Dr. Palese: Our government is rapidly developing vaccines and they are in the pipeline, but nothing has been approved as of today.
Dr. García-Sastre: Vaccines may be first available only on an experimental basis.

A New Yorker’s Survival Guide to the Cold and Flu

Updated on Jun 30, 2022 | Cold and Flu, Your Health

You’re on the bus or subway during your morning commute. A fellow passenger near you starts sneezing and coughing. You eye them suspiciously. Are you at risk for catching something?

Matthew A. Weissman, MD, MBA, of the Mount Sinai Health System offers some street-wise strategies for beating the cold and flu in New York City.

As New Yorkers, we ride subways, buses, and elevators—does that increase our risk or build immunity?

I think it does both those things. There’s data that says being exposed to a lot of germs over time increases your immunity to disease. So in general, people who live in New York are more immune to stuff than people who live by themselves on a farm somewhere.

We’re tough here in New York!

Absolutely. The problem is, there are lots of different types of colds and viruses. And the flu virus mutates and changes every year, so even if you have immunity built up, it doesn’t mean you’re not going to catch something. So yes, we’ve got tough exteriors and a tough immune system, but we’re still at risk of catching diseases.

Should people worry about riding crowded subways and buses? If one person coughs in a subway car, are we all going to get sick?

I don’t think so. A lot of fresh air gets into the subway. Doors open all the time. You’re not in an airtight capsule. You might want to give yourself as much space as possible. And if possible, you might want to alter your commute during cold and flu season to a time or a line that’s not as crowded. It’s also a great time of year to bundle up and walk part of the way to work or school. Enjoy the fresh air! But I ride the subway all the time.

What’s the best way to cover your cough?

People should cover their cough with their elbow, not their hands. Because if you cough into your hand, and then grab onto the subway pole that’s not helping anybody. And part of being a good New Yorker is helping each other by not riding the subway or going to work when you’re contagious, which can last 24 hours after your symptoms and fever go away. On the subway, I’m thinking about airborne germs and picking something up with your hands from the subway pole. So keep your hands away from your face while you’re on public transit, and when you get to work, it’s a good idea to wash your hands (and maybe even to carry some hand sanitizer with you).

Why is handwashing so important?

Handwashing is key. It’s one of the most important things you can do, other than get the flu shot. We come into contact with so many contaminated things in the city. And when you touch your face or rub your eyes, that’s a problem. Of course, you should wash your hands before you eat and after using the restroom. But after your commute, or any time you come into contact with dirty things is a good idea. Frequent handwashing throughout the day is smart. We don’t think about all the things we touch that are frequently handled, like computer keyboards, phones, door knobs, or office kitchen appliances like microwaves or refrigerators. When you go to the gym, you should wash your hands after using the treadmill or using weights. At the salad bar, no matter how clean, the utensils are used by a lot of people. In public restrooms, I try to always use paper towels to dry my hands instead of the air blowers, which tend to just spray germs around.

Use soap and warm water to wash your hands. Twenty seconds of scrubbing vigorously on all surfaces is key. Keeping Purell or another alcohol-based hand sanitizer is good, too. That would be convenient after your commute even though it doesn’t kill all kinds of germs.

Is wearing a mask on the subway effective against germs?

It may reduce your exposure but I think masks are actually more useful in preventing your own germs from spreading, since they’re not really air-tight around the sides. A lot of people don’t use them correctly and keep taking them off or reaching underneath with their hands. Is it worth the trouble? Maybe, but I’m not convinced that it’s as effective or useful as the other things we’ve talked about.

How about cabs and car services like Uber? How risky are they?

You’re probably better off in a cab or ride-sharing service than a subway in terms of avoiding germs. I try to keep the windows open as much as possible. And seatbelt buckles and door handles are more things that are frequently handled that we don’t think about. So minimize touching them and wash your hands after.

What about public restrooms? Are they safe during cold and flu season?

Sure, public restrooms are safe. I use them all the time. I think it’s very hard to get anything from a toilet seat, so laying down toilet paper or sanitary guards isn’t really that helpful. Hand dryers are another story. The evidence is that they just spray germs around. I’d much rather use paper towels, given a choice. And once you wash your hands, opening the door with a paper towel is a good idea.

What about salad bars?

While studies show that salad bars may have bacteria, it is not clear how often they actually cause disease. My suggestions are that you want to have a sense that the salad bar is well maintained. The cold food should be kept cold and the warm food kept warm. Is it being replenished regularly, or has it been sitting there for a long time? Does it have a sneeze guard on top? Of course, you can’t avoid using the serving utensils that lots of other people have touched. So especially during cold and flu season, I make sure that washing my hands is the last thing I do before I eat.

Any other advice for New Yorkers?

Living in New York is stressful, and that’s not good for your immune system. We’ve got emotional stress, we’re rushing, we’re busy, we don’t sleep enough—and all of it takes its toll on our immune system. And then you have our exposure to airborne pollutants. It’s always important to get exercise, to eat healthy including lots of fruits and vegetables, to sleep well at night, and to reduce stress as much as you can.

Matthew A. Weissman, MD, MBA, is Chair of the Department of Medicine at Mount Sinai Beth Israel and Senior Faculty in Internal Medicine and Pediatrics at Icahn School of Medicine at Mount Sinai

Beyond Weight Loss: The Benefits of Intermittent Fasting

Updated on Jun 30, 2022 | Diet and Nutrition, Your Health

New Yorkers are born tough, but not Stone-age tough. Our ancestors were hunter-gatherers who often went periods of time without food while foraging. Humans had adapted to the unpredictability of getting their next meal.

But now we have “evolved” to expect three square meals a day, not to mention snacks.

“Weight loss has become a cultural obsession,” says Jennifer Cholewka, RD, CNSC, CDN, Clinical Nutrition Coordinator at The Mount Sinai Hospital. “And intermittent fasting is a trending topic. But it has roots in how we have evolved as human beings.”

Scientists are discovering that our bodies adapt to intermittent fasting in ways that our ancestors did. And according to a recent article in The New England Journal of Medicine, fasting has health benefits that extend far beyond weight loss. It seems that “when” we eat can be just as important as “what” we eat.

What is intermittent fasting?

With intermittent fasting, there are scheduled times when you eat and times when you don’t. Medical researchers have studied three approaches and shown them to be effective.

Daily time-restricted feeding means narrowing the time you eat to a shorter period of time during the day, usually eight hours. The time that you’re fasting is 16 hours each day. So you might stop eating at 8 at night, and not eat again until noon the next day. After 10-12 hours, your body throws a “metabolic switch” and you start burning through the glucose stored in your body. Your liver stores about 700 calories of glucose, and once gone, your body starts burning away that hard-to-get-rid-of belly fat.

5:2 intermittent fasting means that you eat as you normally do, five days a week. On the other two days, you only eat one moderately-sized meal. The two days that you’re fasting should not be consecutive. And your goal should be one 500-calorie meal on those days. You could work up to this gradually, by starting with one day a week. Your meal on that day could be 1,000 calories. Try that for a month, and then extend it during the second month to two days a week. The next month, reduce your meals to 750 calories. And then the next month, shoot for 500 calories.

Alternate day fasting is the most extreme version. On the days that you eat, keep it to a 12-hour window. Then you will fast that night and not eat anything the next day. It’s important to note that you can drink as much water as you want, and also tea and coffee if you don’t add any calories like milk, half-and-half, or sugar. You can also take vitamins, supplements, and of course, your normal meds. Talk to your doctor though, because certain meds and supplements need to be taken with food. So your plan might be to eat Sunday, Tuesday, Thursday, and Saturday. And then the next week, it would be Monday, Wednesday, and Friday.

What’s the payoff?

As if being svelte wasn’t enough, the benefits of intermittent fasting cited in The New England Journal of Medicine include:
• Cancer prevention
• Cellular and DNA repair
• Diabetes prevention and improvement
• Prevention of heart disease and stroke
• Greater mental acuity and brain health
• Greater muscle endurance

Some of these benefits are related to weight loss. Intermittent fasting increases your metabolism so you burn more calories, and it tends to target fat around the central organs. Belly fat is worse for the heart and causes inflammation. And less cholesterol means less heart disease and risk of stroke.

But once your “metabolic switch” kicks in, there are a host of other benefits. Once your body runs out of glucose, it starts converting ketone bodies from the liver for fuel. And this causes a wave of other changes throughout the body, because ketone bodies aren’t just fuel, they give orders to a variety of other cells and molecules that can affect health.

Scientists have been looking at the relationship between intermittent fasting and cancer in animals for quite a while. Calorie restriction or alternate day fasting has been shown to slow the growth of many tumors and increase their response to chemotherapy and radiation. Studies on humans are promising, but care must be taken to avoid malnutrition. Consultation with your doctor is key.

Another process triggered by the ketone bodies is called autophagy, which repairs the normal cells in the body. It’s like cellular house-cleaning, where the cells get rid of old proteins. Studies on both humans and animals demonstrate physical benefits. In one study, young men who fasted for 16 hours lost fat while maintaining muscle mass over a period of two months of resistance training. Balance, coordination, and endurance all improved in animals during fasting studies.

Brain power gets a boost, too. Verbal memory, spatial cognition, short-term and associative memory are all improved with humans in fasting studies. This is powerful news for the prevention of Alzheimer’s and Parkinson’s diseases. Neurological benefits have also been documented for multiple sclerosis and rheumatoid arthritis.

What’s the downside?

To gain the benefits, intermittent fasting isn’t a quick fix; it’s a lifestyle. Maintaining periods of not eating can be hard to stick to. But starting with a gradual program and working up to longer periods of fasting can help. In the beginning, you can expect to feel hungry, but science tells us that this is as much psychological as physiological. Drinking water when you feel hunger pangs can trick your body into feeling full. You might feel a bit foggy—but good news, black coffee and tea are your friend. And of course, if you’re under any type of medical treatment such as chemotherapy, consult your doctor first.

Throughout history, spiritual literature is full of examples of people who fasted for purification. On the basis of the latest research, it seems that the glow of health is here for modern-day fasters.

Are Natural Remedies Safe to Treat the Cold and Flu?

Oct 25, 2019 | Cold and Flu, Your Health

This year, millions of Americans will develop a cold and 5-20 percent of people will develop the flu. While these viral illnesses differ in severity—the flu can lead to hospitalization whereas a cold generally does not cause serious health complications—the best method of prevention is identical for both. To avoid getting sick, wash your hands diligently and—if you happen to get sick—cover your mouth with a sleeve instead of a hand when coughing to prevent your illness. In addition, everyone six months and older should receive a flu shot.

Once you have contracted a cold or flu, are over-the-counter or prescription medications always the best treatment method? Natural remedies—non-medicinal treatments that include vitamins, herbs and herbal supplements, and alternative treatments like acupuncture—may be adequate. Lee Coleman Hinnant, MD, a family medicine physician at Mount Sinai Doctors-Stuyvesant Town, explains when natural remedies are acceptable alternatives and when conventional medicine is the best bet.

What natural remedies can I use to treat a cold?

Zinc lozenges taken within 24 hours of cold symptoms may reduce the duration of a cold in adults. The effectiveness has not been proven in children. While effective for colds, zinc should not be taken long-term due to potential drug interactions and gastrointestinal side effects. Intranasal zinc should not be used as there is a risk of a permanent loss of smell.

Honey may be helpful in reducing nighttime cough in children and adults. It should never be used in children under one due to a risk for botulism.

Keep in mind that while these remedies may be effective in treating your illness, most colds are minor and will resolve within a week.

Since the flu can cause more severe symptoms, is it ever appropriate to treat naturally?

No. No natural or herbal remedies have been proven effective for the flu. The flu can land you in bed for a week or more with fevers, aches, and a severe cough. Within the first 48 hours of these symptoms, you should be seen by a doctor, as you may be a candidate for an antiviral medicine such as Tamiflu which can lessen the duration and severity of the illness.

What other natural remedies have been proven effective?

Studies show that meditation as a daily practice reduces the number of colds and their duration. This is mainly because meditation reduces stress which suppresses the immune system, making you more susceptible to illness. Exercise is also effective in this manner, but less so than meditation.

In healthy people, several studies showed that probiotics may reduce the number of colds a person contracts per year. Patients with health conditions should consult a physician before taking probiotics as there is a potential risk for infections.

Are there natural remedies that have been proven ineffective or harmful?

Yes. Vitamin C has not been proven helpful in the general population for cold prevention or treatment; however, it has been proven to reduce colds in half for those who pursue strenuous exercise like marathons or skiing.

Echinacea, which has commonly been used for cold prevention, is likely safe, but has not been proven effective.

American ginseng may reduce the duration of colds, but it needs to be taken daily over long periods of time and may cause side effects like interfering with blood thinners, so it is generally not recommended.

Lee Coleman Hinnant, MD

Assistant Professor, Family Medicine, Icahn School of Medicine at Mount Sinai

Dr. Hinnant is a family medicine physician at Mount Sinai Doctors-Stuyvesant Town with a specialty in Integrative Medicine and Functional Medicine.

Make an appointment with Dr. Hinnant

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If you remain ill after getting your flu shot or trying these natural remedies, please consult a physician. Mount Sinai Doctors-Stuyvesant Town cares for the whole family and is currently welcoming new patients.

Make a Mount Sinai Doctors Appointment

Is it Time to Take My Child to the Doctor?

Oct 21, 2019 | Children's Health, Cold and Flu, Your Health

Fall is in swing, kids are back in school, and now everyone seems to have the sniffles. While you may be tempted to book an appointment with a pediatrician at the sight of a runny nose, several symptoms can be managed with at-home remedies and over-the-counter medications. Beth B. Kantrowitz, MD, a pediatrician at Mount Sinai Doctors-Brooklyn Heights, explains what can be done at home, when you need to see the doctor, and how best to protect your child during cold and flu season.

Help, my child is sick! What can I do about it?

First off, don’t panic. Many symptoms can be managed or treated at home without taking a trip to the pediatrician.

If your child has nasal congestion with or without cough, try using saline drops or nasal spray along with a humidifier or steam from the shower or bath. The humid and moist air along with the saline help to loosen congestion and allow mucus to drain. For children not old enough to blow their nose, use a nasal aspirator or bulb suction to clear away the mucus.

Should I use over-the-counter medications?

Forgo traditional “cough and cold” medicines as studies show they are neither effective nor safe, especially in children under six years old. Additionally, ingredients in many of these combination medicines overlap, putting children at greater risk for overdosing. If your child has a cough, honey is a helpful soother, although it is not safe in infants under one year.

Fever can be treated with acetaminophen for any child older than two months and ibuprofen for any child older than six months. Be sure to check the medication’s label—or consult a pediatrician—as dosing will depend on your child’s weight.

What is considered a fever? When should I be concerned?

A fever is defined as a temperature of 100.4°F or higher. It is helpful to know your child’s exact temperature as the trend of temperatures can help indicate whether the illness is improving or worsening.

Be sure to accurately check your child’s temperature. Remember, feeling his or her forehead with your hand will not give a sufficient measurement. A rectal temperature should be done for any baby six months of age and under. Rectal thermometers provide the most accurate temperature until age five; however, after six months it is okay to use a forehead (temporal) or ear (tympanic) thermometer. Oral thermometers should only be used after age five.

Seek medical help immediately if your child has a fever above 104°F or one that does not respond to fever-reducing medication.

When does my child need to see the doctor?

If your baby is under two months old and has a fever, they need to be taken to the emergency room. A fever in babies this young is taken very seriously and needs an evaluation that goes past what a doctor can do in the office. Between two and three months old, a baby with a fever should always be seen, but can first be evaluated by a pediatrician rather than going directly to the emergency room. For older babies and children, a fever lasting two days or more should be checked by the doctor.

In addition, although congestion and cough do not always need to be seen in the office, any child with difficulty breathing as well as these symptoms needs to be checked.

When in doubt, it is best to have your child checked by the doctor. Call your pediatrician if there are ever any questions about when to come in.

How can I prevent my child from getting sick?

The best way to protect your child from illness is to keep up to date on immunizations, including the annual influenza vaccine. While immunizations do not prevent all childhood illnesses, they protect against many serious infections as well as the dangerous complications that may arise from some of these infections.

Frequent hand washing, either with soap and water or with an alcohol-based hand sanitizer, is also an important way to prevent illness. When washing with soap and water, scrub for at least 20 seconds and rinse soap fully.

Finally, if your child is in school, preschool, or daycare, please keep them home if they are sick. Coughing, sneezing, and runny noses can linger from an illness so it is not imperative that these symptoms be fully resolved before returning to activities. However, children should be fever-free for 24 hours and back to their usual energy and activity level before returning to school. This will prevent further spread of illness in their classroom.

Beth B. Kantrowitz, MD

Pediatrician, Mount Sinai Doctors Brooklyn Heights

Dr. Kantrowitz has a particular interest in well child-care, newborn medicine, breastfeeding, asthma, childhood nutrition and obesity, infant colic, and developmental screening. She sees patients at Mount Sinai Doctors Brooklyn Heights at 300 Cadman Plaza West from Monday through Saturday.

Make an appointment with Dr. Kantrowitz

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What is a Free Flap?

Oct 15, 2019 | Health Tips, Your Health

Patients who are diagnosed with cancer of the head and neck are often treated with surgery. Removal of tumors in the mouth and the throat can significantly inhibit speech and swallowing. Similarly, removal of the bone involved with cancers of the jaw affects appearance and function of patients. In some cases, the wounds, left as a result of cancer surgery, can be allowed to heal or be covered with the surrounding tissues. Often, however, the wounds are too big, and the tissue removed with the tumor must be replaced. In such circumstances, a “free flap” may be a sound option for repairing the defect.

Local Flaps Versus Free Flaps

A flap is any piece of tissue that is moved to cover a wound. A free flap is a piece of tissue that is disconnected from its’ original blood supply, and is moved a significant distance to be reconnected to a new blood supply. Let us use a lamp as an example. When a lamp has to be moved from one part of the table to another it may not need to be unplugged. This is similar to a “local” flap that is “rotated” into the wound. The electric cord is analogous to the blood vessels delivering blood to the flap. When the lamp must be moved from one side of the room to another, the cord cannot stretch the required distance. In these cases the lamp is unplugged (“free”), brought to its’ new location and plugged into another outlet.

Similarly, a free flap is taken from the body of the patient; the blood vessels that bring the blood in and out of the tissue are cut, and then reconnected to another source of blood (usually in the neck). The artery that comes with the flap is sewn to the artery in the neck to bring the blood in, and the vein is sutured to a vein in the neck, re-establishing the blood flow. The blood vessels feeding the flap are usually very small and the “re-plugging” of the flap is done through microvascular surgery. Microvascular surgery is a technique of sewing two small blood vessels together under a microscope.

The surgeon has to select tissue in the body that will do the best job of restoring the function and the appearance of head and neck tissues destroyed by the tumor. The commonly used free flaps include: forearm or thigh skin (thin skin that can be used to rebuild the inside of the mouth and throat), muscles from the abdomen or the back, and fibula bone (bone on the outer side of the leg).

The success of using a free flap in reconstruction after head and neck cancer surgery is 95-98 percent. The goal of the reconstructive surgeon is to return the patient to a state where they can enjoy eating, swallowing and speaking. With the advancements in the field of microvascular and reconstructive surgery, this goal is often achieved.

Mohemmed Nazir Khan, MD

Assistant Professor, Department of Otolaryngology at Mount Sinai-Union Square

Dr. Khan’s clinical interests and expertise include the medical and surgical management of benign head and neck tumors; thyroid and parathyroid disorders; salivary gland disorders; head and neck cancers; and reconstructive surgery involving the head and neck. In addition to his professorship, he is the Associate Director of the Head and Neck Cancer Research Program at the Icahn School of Medicine at Mount Sinai. Dr. Khan is available for rapid referrals and same day appointments.

Make an appointment with Dr. Khan

More information on ENT services at Mount Sinai

Lee Coleman Hinnant, MD

Beth B. Kantrowitz, MD

Mohemmed Nazir Khan, MD

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