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.

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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.

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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
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COVID-19 and Pregnancy: Answers to Your Questions

May 12, 2020 | COVID-19, OB/GYN, Your Health

As the COVID-19 pandemic continues to impact all facets of life, many have raised questions about the virus’ effect on pregnancy and delivery. Brian Wagner, MD, Medical Director of Labor and Delivery at Mount Sinai West, gives advice to expectant parents and those trying to conceive, and explains how Mount Sinai is creating a safe birthing place for mother, baby, and the extended care team.

Is it safe to get pregnant during the COVID-19 pandemic?

It is unclear whether couples should delay attempts to get pregnant. If you become pregnant now and become sick with the coronavirus, infection would most likely happen during the early part of your pregnancy. Unfortunately, we have limited research on what this could mean, and important questions about an increase in miscarriages or birth defects remain unanswered. Current data suggests that pregnant women are not at any increased risk when compared to non-pregnant individuals. We would recommend you have a conversation with your OB/GYN about your personal medical and obstetric history to help decide if this is the best time to conceive.

How does having COVID-19 complicate pregnancy?

As this viral infection is new, data is limited and just emerging. However, the limited data that exists is reassuring as it indicates that there is no increase in miscarriage or birth defects. With severe disease, there appears to be an increased risk of preterm birth; however, many of these babies were delivered to improve maternal outcomes and were not the result of preterm labor. Additionally, there is no strong evidence that the virus can pass from mom to baby. More information on how COVID-19 may affect pregnancy will emerge as more women deliver.

Are COVID-19 symptoms more severe in pregnant women? Are the symptoms different? Are pregnant women more at risk of contracting COVID-19?

In general, respiratory infections, like the flu, have been thought to be more severe in pregnant women. However, current data suggests the symptoms of COVID-19 appear to be the same as in the non-pregnant population. Symptoms tend to appear between 2 to 14 days from exposure and the most common symptoms appear to be cough, shortness of breath, and fever. In addition, pregnant women also appear to have the same risk for disease severity as non-pregnant individuals. The majority of pregnant women have mild symptoms and recover completely.

Pregnancy itself does not seem to increase the risk of infection or severe reaction to the virus. Pregnant women who have conditions such as diabetes and hypertension may be at increased risk for severe illness, but at the same level as the general population with those conditions.

Are obstetrics appointments being spaced further apart and/or being done via telemedicine appointments?

COVID-19 has necessitated a number of changes in the practice of medicine, in obstetrics and prenatal care. This has included spacing out appointments and grouping components of prenatal care together, including vaccinations and diabetes screening, and utilizing telehealth. As a result, a number of visits are being performed through videoconferencing and telephone. Patients are being asked to self-monitor with blood pressure cuffs and fetal heart rate monitors. This ensures that prenatal care continues to offer all the benefits while reducing the risk of exposure that comes with being out in the community. Of course, some elements of care will continue to require a face-to-face visit, including ultrasound examinations of the fetus.

How do pregnant women stay healthy during this time?

It is recommended that pregnant women take the same precautions as the general public to reduce their risk of COVID-19 infection. We know that the virus spreads from person to person through a number of methods, including droplets created when someone sneezes or coughs, close personal contact, and touching one’s eyes, nose, or mouth before washing one’s hands.

Steps that can help reduce your risk of infection include:

  • Wash your hands with soap and water for at least 20 seconds or clean your hands with hand sanitizer that contains at least 60 percent alcohol
  • Avoid touching your face, eyes, nose, and mouth
  • Avoid people who are sick, and maintain a safe distance of six feet from other people
  • Wear a face cover when leaving your house or apartment

In addition, general tips to stay healthy in pregnancy include eating a healthy diet, and getting regular exercise and plenty of rest.

Is it safe to give birth in a hospital during the pandemic? What is Mount Sinai doing to keep it safe for women to give birth during this time?

A hospital or certified birth center is the safest place to have your baby. Even the most uncomplicated pregnancies can develop problems or complications with little warning during labor and delivery. Being in a hospital allows you and your baby to have access to all the necessary medical care if these problems arise.

Due to COVID-19, at Mount Sinai we are taking extra precautions to ensure that you, your newborn, and your care team are safe and well. This includes extra cleaning and disinfection protocols, and wearing masks at all times and personal protective equipment as necessary. To enhance safety, you and your support person will be required to wear personal protective equipment—including a mask, gloves, and gown. The Mount Sinai Health System is screening all pregnant patients and their support partners for fever and symptoms of COVID-19 prior to admission since we know some people can have the virus yet be asymptomatic. All admitted patients and their support partners also will be tested for COVID-19. This ensures all the correct protective measures can be in place as needed to protect yourself and your newborn.

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I Think I Have COVID-19. How Can I Take Care of Myself At Home?

May 8, 2020 | COVID-19, Your Health

Most people who have COVID-19 can recuperate at home, while remaining in contact with their doctor. Abigail R. Chen, MD, Senior Medical Director at Mount Sinai Doctors Downtown, tells you what you need to know to address COVID-19 symptoms at home.

Can I stay at home if I have COVID-19?

Generally, yes. Most people who test positive for COVID-19 will have mild symptoms–like a cough or sore throat. If you are experiencing mild symptoms, you can certainly recuperate at home by treating with over-the-counter medications.  Below, I outline how to address the most common COVID-19 symptoms at home.

For information on protecting others in your home, read through the CDC guidelines.

How do I treat fever from COVID-19?

The best way to treat fever from COVID-19 is with acetaminophen—the active ingredient in Tylenol and other over-the-counter painkillers. Some early reports suggested that ibuprophen—the active ingredient in Motrin, Advil, and others—may make COVID-19 worse. However, the U.S. Food and Drug Administration has found no link between ibuprofen use and severe COVID-19. Remember to follow the dosage and timing directions on the package.

What should I take for a cough?

Most of the time, coughs that come with COVID-19 are dry and do not bring up phlegm.  They can be severe and may even disrupt your sleep—but may still be able to be handled at home. The best approach to a cough can be a cough suppressant like dextromethorphan –the active ingredient in Robitussin, Nyquil, and other over-the-counter medications. If your cough is making it difficult to sleep, try a semi-reclining position (about a 45-degree angle). Since the cough associated with the virus is dry, you do not need an expectorant—such as guaifenesin—which helps to clear mucus from the airways. If your cough is really making you uncomfortable, talk with your doctor, who can give you a prescription-strength medication, or let you know if you need to go to the hospital.

What can I do about fatigue?

The key is to listen to your body. It is not uncommon to feel fatigued even days or weeks after many other symptoms have resolved.  If your body is telling you to sleep more than usual, you should respect that and lay down rather than getting back on your computer. If you are having difficulty sleeping, try adjusting your position. Many people have some level of insomnia these days, due to the stress of the stay at home orders.

What if I lose my appetite?

Many people with COVID-19 find their appetite has disappeared. It is important to remain hydrated and take in some calories to give your body strength to fight the virus. Many people find that traditional soups—such as chicken soup or rice porridge (also called congee or jook)—can be helpful. These soups are bland, easy to digest, and offer some nutrition to help your body get energy. But soups do not provide all the hydration you need. You should make sure to drink as much water or other liquid as you can. Once you feel better, try to eat a little more to give your body strength to continue to heal.

What if I have a sore throat?

If you find your throat hurts from coughing, acetaminophen may be able to help. Many people find it also helps to drink something warm or very cold; pick what feels best on your throat.

How do I address shortness of breath?

This is the most dangerous of the COVID-19 symptoms. When you are taking care of COVID-19 at home, your doctor will pay careful attention to how you are breathing. Typically, every video appointment will begin and end with questions about shortness of breath. If you notice a change in your breathing—for instance, if you normally have no trouble with a flight of stairs and now find yourself huffing and puffing—it may be time to go to the hospital. Your doctor can advise you.

What if I lose my sense of taste and smell?

This is one of the more unusual symptoms of COVID-19. It can appear even with the mildest of cases. Make sure to tell your doctor if you have lost either your sense of smell or taste. While we cannot give you back your ability to savor chocolate or sniff flowers, these symptoms can help your doctor determine whether you have seasonal allergies or the COVID-19 virus. To learn more about this unusual symptom, read this post from Mount Sinai rhinologist Patrick Colley, MD. 

How often should I check in with my doctor?

You should keep in touch with your doctor regularly. If your doctor does not recommend a follow-up appointment, you should feel comfortable asking for one. It is important to understand that recuperating from COVID-19 is not a linear trajectory. You may start to feel better and then, after a few days, feel worse again. It is important, though, to have a doctor monitor your symptoms; he or she can tell you if what you are experiencing is standard or concerning. These days, many doctors are available by email, as well as phone and video.

Are there certain people who should be extra vigilant?

The elderly and people who have hypertension, obesity, and diabetes should be especially careful about discussing any COVID-19 symptoms with their doctor. These conditions have been closely linked to relatively severe cases of the virus. If you have any of these conditions and are experiencing any symptoms that resemble COVID-19, please keep in contact with your doctor.

What if my doctor tells me to go to the hospital? Do I have to?

If your doctor does advise you to go to the hospital, please do so. These days, many people fear hospitals and doctors’ offices. But health care facilities are taking special care to protect you. If you need hospital-level care, it is important that you get it.

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Is It Safe to Go to the Hospital for Emergency Care?

May 8, 2020 | COVID-19, Your Health

These days, we are all worried about contracting COVID-19. We know people who have symptoms of the virus often go to a hospital’s emergency department—most known to patients as the emergency room—to seek immediate care. For this reason, many people are nervous about going to the hospital for any other reason. But, that is not always the best approach. Brendan Carr, MD, Chair of Emergency Medicine for the Mount Sinai Health System, explains what you need to know about going to the emergency department during the COVID-19 pandemic.

Should I go to the hospital for emergency care?

In a medical emergency, you should seek help—and that means going to the emergency department. If you delay seeking help for conditions that need immediate attention, we may not be able to do as much for you. If you have a problem with your heart or your breathing, if you have chest pains or symptoms of a stroke, it is important to be evaluated as soon as possible, for the best outcome. We want to help, but we cannot do anything for you if we do not know there is a problem.

I am concerned about safety. What is being done at hospitals to ensure that it is safe for patients?

Throughout the Mount Sinai Health System—and at most other hospitals in the country—we have spent a lot of time changing our set-up and workflow to protect against exposure to COVID-19. We are very diligent about how we clean all the high-traffic areas. We make sure that all staff members wear masks and we give patients masks as they go into the emergency room.  We are doing everything we can to protect you from possible exposure.

To help us help you, there are some things that you can bring when you come. Have a list of all your medical problems and the medications you take. It can help to bring the medicines themselves. While this advice is always true, it is especially important during this pandemic. In addition, you might want to bring a cell phone and phone charger so that you can reach out to friends and family about what is happening. You also may end up spending a fair amount of time at the hospital, so it cannot hurt to bring a book or some sort of entertainment to make your wait easier.

Should I go to the hospital, urgent care, or schedule a video visit with a medical provider?

It depends on what is happening. If you are experiencing something that you have been treated for in the past and you have an idea of what is wrong—or it is a minor problem—then it is totally appropriate to go to an urgent care center. You can also call your doctor’s office to arrange for a video appointment. We provide a number of virtual care options through Mount Sinai Now, including virtual urgent care and the ability to text with a physician about your health concerns. If your doctor thinks you need a higher level of care, they will refer you to the emergency department or to a specialist.

Are there special precautions I should take if I have to go to the hospital?

Think about going to the emergency department the way you think about doing all the other important things in your life. There is always a risk of exposure when you leave the house, but we still go to the grocery store and to the pharmacy. Going to the hospital when you are worried that you are ill or injured is another part of taking care of yourself. We are here for you and are doing everything we can to keep you safe. It is important to follow all the safety rules in the emergency department that you would anywhere else. Wear a mask, wash your hands regularly, and practice social distancing.

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