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Is There a Connection Between COVID-19 and IBD?

Mar 27, 2020 | COVID-19, Digestive Diseases, Your Health

COVID-19 is a concern for everyone. But people with inflammatory bowel disease (IBD) may be at increased risk of contracting this virus–or developing a bad case of it. This mostly has to do with medications they may be taking. Ryan Ungaro, MD, Assistant Professor of Gastroenterology at the Susan and Leonard Feinstein Inflammatory Bowel Disease Center, shares information IBD patients need to know about COVID-19.

Is there a connection between COVID-19 and gastrointestinal conditions?

More and more information suggests that the gastrointestinal (GI) system is involved with COVID-19. We are seeing more reports of GI symptoms among COVID-19 patients. For instance, the very first case in the United States noted nausea, vomiting, and diarrhea. In addition, some reports out of China indicate that there are a significant number of COVID-19 patients experiencing GI symptoms. The virus has several ways to get into the human body. This includes the nasal passages, the airway into the lungs, and through the intestines. It may be that contact surfaces in the bathroom could cause transmission. Scientists have found the virus in the stool of some patients.

Are there any special precautious that IBD patients should take?

Any IBD patients who are taking immunosuppressants–drugs that reduce the body’s immune system–should follow the at-risk population guidelines issued by the Centers for Disease Control and Prevention. Take these standard precautions very seriously. Be vigilant with social distancing and limit the number of people you’re in contact with. Be particularly diligent about hand washing and trying not touch your face. Treat yourself as if you’re part of the high-risk population, like the elderly or people with lung disease.

If you are unsure if the medication you take qualifies as an immunosuppressant, check the Crohn’s and Colitis Foundation’s IBD Medication Guide.

If I’m taking any of these medications, should I stop?

In general, you should stay on your medications now. That includes biologic drugs and immunosuppressants. The one exception I would say is steroids. If you are on oral steroids, you should talk to your doctor to see if it’s possible to taper down to a minimum dose or get off them completely. Everyone’s case is individual and if you have any questions, you should raise them with your physician. You want to stay on your medications because the health system is overburdened or is potentially going to become overburdened. You do not want to have a flare-up that requires a trip to the hospital, where there will be increased risk of exposure. If you do need care, we’re trying to do this by telemedicine visits at the IBD Center, except for the most urgent cases.

Is there any research going on about COVID-19 and IBD?

There are several initiatives taking place. The International Organization for Inflammatory Bowel Disease is developing more nuanced guidance for patients and physicians. That should be out shortly. In addition, we, with collaborators at the University of North Carolina, have launched a registry for cases of COVID-19 in IBD patients called SECURE-IBD. The registry will gather information on confirmed cases; medications the patient was receiving; the activity of the disease; and the outcomes, in terms of hospitalizations and disease severity. The goal is to determine which medications may contribute to the risk of developing COVID-19 or having a more severe response to the virus. Gastroenterologists who have patients with COVID-19 are encouraged to report cases directly on the SECURE-IBD website.

What Older Adults and Their Families Need to Know About COVID-19

Mar 26, 2020 | COVID-19, Geriatrics, Your Health

A leader in geriatric medicine, R. Sean Morrison, MD, the Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai, shares information that older people and their loved ones need to know about physical distancing in the time of COVID-19.

Are there any special steps that older people should take?

Because COVID-19 is so contagious–carried in droplets in the air and lingering on surfaces–we should all practice physical distancing. This is the term the World Health Organization (WHO) now wants us to use instead of “social distancing.” The idea is that we want to maintain a physical distance of at least six from the nearest person, to avoid infection. But we also want to maintain social and emotional closeness with friends and family, because that is also crucial to our well-being.

Distancing means that older adults should limit the number of visitors who come into their home or apartment, and this can be particularly hard. It means that children, grandchildren, even young adults, should not be visiting.

And it means that older adults should go out only when they can be assured that they can practice physical distancing and, if at all possible, should avoid going to grocery stores, riding public transportation, or going out for meals or religious services.

What about the emotional toll of this kind of self-isolation?

One of the things that many people worry about, including me, is the risk of depression. What can we do to prevent that from happening? First of all, if an older friend or relative is self-isolating in their home, call them frequently, and don’t just talk about COVID-19, talk about normal things.

Have different people call, so it’s not always the same person. Use video calls whenever possible, so grandparents can see their grandchildren and talk to their grandchildren–hear what’s going on in their lives.

What can older adults do to protect their mental well-being?

Stream movies, and watch TV, but try not to focus on the news. When we are exposed to minute-by-minute coverage of COVID-19, it can really increase our anxiety. Check in a couple times a day as to what’s happening in the United States, your community, and the world, but then turn to something else. Nothing is going to happen that you’re going to need to respond to immediately and that won’t still be there when you turn the television on again in say six or eight hours.

Are there any signs of depression to watch out for?

It’s important to realize that depression presents differently in older adults. Older adults may not experience it as sadness. What they may experience is loss of appetite, weight loss, difficulty sleeping, tiredness and fatigue, and sometimes memory problems. These are the things that both adult children and their parents should be watching for and self-monitoring, and if any of these develop, that’s the time to call your doctor right away so an intervention can be made, and treatment can be started before things progress.

What can I do to boost my immunity to COVID-19?

Unfortunately there is no magic pill that can rapidly boost your immune system. However there are things that you can do: Make sure you’re getting enough rest and sleep. Eat well. Stay well-hydrated. Exercise. This becomes hard in a setting of physical distancing, but there are things you can do. Use a stationary bike or a treadmill if you have them in your home or apartment. Go out for long walks in the community, or out in the park, at a time when few people are around, and make sure you stay six feet away from the nearest person.

Finally do everything you can to minimize your stress and anxiety in this very worrisome time. Steps you can take are limiting your time on social media, particularly the time you’re focusing on COVID-19 on social media. There is a lot of misinformation out there, and there are a lot of very, very scary posts. Instead, keep up-to-date by looking at the data. Look at the websites of the Centers for Disease Control and Prevention, WHO, your state and local health departments, and Mount Sinai, and also your local newspaper and one of the reputable national newspapers or news television shows.

What kind of supplies should I have on hand?

I would recommend that older adults have a 30-day supply of food, medicine, and other essential items. That’s a 30-day supply, not a six-month supply, of toilet paper.

Any more thoughts on the COVID-19 crisis?

We as a community, we as a country, and we as the world have not gone through a global humanitarian crisis like this in our lifetime. But we will get through this. We know what to do to control COVID-19. If we wash our hands thoroughly and often, disinfect high-contact surfaces, and rigorously practice physical distancing, we will get through this, and we will get through this well.

How Should Pregnant People Protect Themselves From COVID-19?

Mar 26, 2020 | COVID-19, OB/GYN, Your Health

The rapidly changing health advisories surrounding COVID-19, the novel coronavirus causing a pandemic, can be confusing. While the elderly and those with severe respiratory illness have been highlighted as high risk populations, the question remains as to whether pregnant people are also at risk.

Frederick Friedman, Jr., MD, Associate Professor of Obstetrics, Gynecology and Reproductive Science, at the Icahn School of Medicine at Mount Sinai, explains what we know about COVID-19 and pregnancy and how pregnant people can protect themselves.

I am pregnant. Am I high risk for COVID-19?

We don’t have a lot of data about coronavirus and pregnancy. There were two studies released about 18 pregnant individuals from China. Sixteen delivered by caesarean section, all delivered at term, and none of the children was affected. As a result of that very small study, it appears that as long as mom is healthy, the baby is likely to be healthy.

As far as we know the coronavirus does not cause problems for the fetus in cases of pregnant women who are exposed in the first trimester. However, it’s important to remember that we do not have much data that will confirm this. That being said, the general philosophy is that once the baby is formed, any virus that might cause birth defects would not have that effect. Whether or not COVID-19 causes developmental problems similarly is not yet known. But, as is the case with prior coronavirus infections, it does not seem to have any damaging effect on the baby.

Unfortunately, there are not enough data to say with certainty what effect the virus has on pregnancy and similarly what effect pregnancy has on progression of the disease. Due to the immune system changes in pregnancy and based on historic data from other viral infections, pregnancy might make women more susceptible to infection. In addition, they might have a more serious response to the virus. However, I emphasize that this is conjecture at present.

Should I put off trying to conceive?

At present, there are no recommendations to delay conception efforts. However, it is important to understand that our knowledge base will continue to expand. Also, it is critical that if one’s partner is ill, safe distances be maintained to prevent spread of the virus; that might delay conception efforts.

What if I have a pre-existing condition? Should I be particularly worried?

Anything that poses a severe risk to the mother—that is if the mom has a severe response to the virus that—could have harmful effects on the entire pregnancy, not just the baby. Such illness would place the mother at risk for preterm labor.

COVID-19 seems to affect most severely those individuals who are over 60, especially those over 80, which would not involve most of our pregnant patients. However, anyone with underlying respiratory ailments or chronic cardiovascular disease, as well as those who are immunocompromised have been affected more severely.

Are there particular precautions I should take after delivery? What about when I return home?

As much as birth is a social event, it’s also one that involves a baby who has a very poorly developed immune system and is highly susceptible to any types of infections. Any individual that handles the newborn should be free of any evidence of upper respiratory tract infection. No coughing, no runny nose, no sneezing, no fever.

Presently, most hospitals have visitation limits to the labor and postpartum floors. Due to the changing nature of the virus, each hospital’s visitation policy is in flux. Be sure to confirm the policy at your birthing location beforehand.

Additionally, while breastfeeding is generally encouraged, mothers who are suspected of having COVID-19 should keep distance from the baby when not feeding. Allow other caregivers to care for the baby and wear a mask while breastfeeding. The good news is that there have been no severe cases of coronavirus in individuals under nine years of age. But, discretion is the better part of valor.

Ultimately, we don’t know with certainty that pregnant or postpartum women are at greater risk for contracting the virus or having a more severe infection. Should they contract it, as is the case with influenza, these women tend to have a much higher risk of serious disorders. I would recommend the same universal precautions: avoidance of individuals with evidence of respiratory ailments like coughing, sneezing, and a runny nose; careful hand washing with soap and water or hand sanitizer; and avoidance of large crowds. Social distancing is difficult for some individuals, but prudent given our current situation.

What You Need to Know About Social Distancing and COVID-19

Mar 24, 2020 | COVID-19, Your Health

In the midst of the COVID-19 pandemic, people around the world have been asked—and at times directed by government officials—to practice social distancing. This public health term calls for avoidance of mass gatherings and maintaining a distance of six feet from other people. How can these fairly simple steps limit the spread of the virus? Waleed Javaid, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, explains social distancing and how the practice aids in the fight against COVID-19.

How does social distancing help limit the spread of COVID-19?

If we are standing close together or talking close together in any setting, it’s possible that our respiratory droplets can be transmitted to the person standing or sitting next to us. Since it appears that respiratory droplets are a primary transmission vehicle of COVID-19, that in itself is a risk.

The other phrase we often hear in relation to ‘social distancing’ is ‘flatten the curve.’ What does that mean?

For coronavirus, the curve is going upward. We have doubling of infections every two to four days, which means there is uncontrolled spread in the community. Through effective use of social distancing, we hope to decrease the overall number of people who get the infection, or flatten that upward curve.

To achieve this, it is important that everyone does their part. So, if I am having a party at home, that will not help this situation. Decreasing the number of transmissions will benefit our community and reduce the stress on the health care system.

If you have an essential job and need to use mass transit to get to work, how can you protect yourself?

I have been using mass transit for several days and, right now, it is easy to maintain social distancing because everything is pretty empty. Since policies have been put in place to reduce staff, crowding has been decreased substantially. However, if you have to get into a more crowded bus or subway, make sure to keep your distance, more than two arms distance apart. If you can’t, try turning around to move your face away from crowded situations

Can I take a walk in the park or a bike ride in an uncrowded area?

It’s really great exercise, but as we are all challenged to sacrifice, if it is not vital for our survival, we should stay home and exercise. We really cannot participate in any activity that increases community risk. We need to think of this from a different angle, not from personal but from the community we live in, which includes the elderly and those who may have a much higher risk of bad outcomes if they get infected.

Are any outdoor activities acceptable while practicing social distancing?

Minimizing all outdoor activities is ideal. Try to do only what is absolutely necessary. This outbreak is like nothing that has been seen before. So, let’s just pause some of our activities. We need to minimize our exposure and think things through. An individual action could have a grave effect on a community.

Health care providers have to come to work because a lot of lives are affected. We have to be in a social situation. We have to do that for everyone’s health. So think, is your activity more important than the community spread of this virus?

What Do Patients with Respiratory Illness Need to Know About COVID-19?

Mar 19, 2020 | COVID-19, Pulmonary Disease, Your Health

COVID-19 is a concern for everyone. But patients with respiratory illnesses are among those at highest risk of contracting this virus—or developing a bad case of it. Louis R. DePalo, MD, Clinical Director of the Mount Sinai-National Jewish Respiratory Institute, shares information that respiratory patients and their loved ones need to know about COVID-19.

How can patients and caregivers protect themselves?

To protect yourself, you should follow the guidelines recommended by the U.S. Centers for Disease Control and Prevention. This includes thorough handwashing, social distancing, avoiding groups of more than 10 people, and trying not to touch your hands to your face.

If you or a loved one has a chronic lung disease, here are some additional things you can do to keep safe:

Screen any visitors or health aides who come into your home. Ask them if they are sick or if they have a fever. Check whether they’ve traveled to one of the COVID-19 hotspots. And ask if they’ve had contact with a COVID-19 patient. If someone answers yes to these questions, you may want to limit their access to your home.
Make sure that you have a robust supply of all the medications and durable equipment that you need.

What should I do if I have symptoms of COVID-19?

The symptoms to worry about are cough, fever, chest congestion, and sore throat. If you or a loved one has these symptoms, you should contact your health care provider. This does not mean to go immediately to the hospital. Instead, take an inventory of your symptoms and contact your doctor. Telemedicine can be a good way to start the conversation. Together, you and your doctor can decide if you need to be tested for COVID-19.

If I need to be tested, what should I do?

Once you and your doctor have decided that you should be tested, your doctor can help you determine where to go. This may be a hospital or a doctor’s office. You want to minimize your travel to the testing facility and wear a face mask, if you have one, to expose as few people as possible. And you should let the facility know you are coming.

Should I keep antibiotics and other medications in the house in case I develop COVID-19?

COVID-19 is a viral disease. It does not respond to antibiotics. You do not need to have antibiotics around to treat COVID-19. But if you or a loved one is susceptible to developing infections for other reasons, that may be a different story. If you are in quarantine and worry that you might not be able to get out to obtain a needed antibiotic, you should discuss this with your primary care doctor.

The same thing could be true for someone with asthma. If you worry about getting sick and not having enough steroids, talk with your doctor. However, do not use systemic corticosteroids to treat COVID-19. Your doctor can advise you on the best approach.

What do I do if I have a doctor’s appointment scheduled?

You should not assume you have to go in for a scheduled doctor’s appointment. Contact your health care provider to find out if you should keep your appointment. For instance, if you are going in for a diagnostic test, it may not be available because of strains on health care facilities. Your doctor will advise you what to do in this case.

If you have a routine medical appointment, there may be other ways to receive your care or consultation. Many health systems are moving toward telemedicine, to help patients and providers maintain social distance. Telemedicine means communicating remotely with your doctor by video conferencing, texting, or other means. For example, Mount Sinai offers a variety of telehealth services at Mount Sinai Now®.

If you need a critical therapeutic medical visit, it may be a different issue. You and your doctor should talk to weigh the pros and cons of a visit. If, for instance, you would be going in for a biological infusion, you want to weigh the risk of coming into contact with people against the risk of missing a medication that is considered therapeutic. Your doctor can advise you best.

How Front-Line Health Care Providers Can Keep Their Families Safe

Mar 18, 2020 | COVID-19, Your Health

As COVID-19 continues to have a dramatic impact around the globe, and front-line doctors, nurses, and health care staff are managing a growing number of cases, there is understandable anxiety.

Waleed Javaid, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, and Director of Infection Prevention and Control at Mount Sinai Downtown, offers a perspective on how health care providers can help keep their families safe.

“Health care workers, like everyone in the community, should remember hand hygiene, be mindful of social distancing on the home front by avoiding large family gatherings, and in times of a pandemic, they need to have a plan for their families,” Dr. Javaid says.

In this Q&A, he provides additional advice to reassure health care providers how they can help keep their families safe.

What kind of issues do I need to discuss with my family?

Health care workers, like everyone in the community, should discuss all aspects of the pandemic with their families. Everyone should have a plan in place for their home should anyone in the family get ill—and most importantly, planning does not mean panic. It’s a simple thing: should somebody become ill, have you identified a place in the home, an extra bedroom, or separated area, for example, where they can remain separated? The vast majority of people who become ill can get better on their own, and with proper social distancing and precautions, family members can remain protected.

What kind of precautions do I need to take as I leave my shift?

Outside of the hospital environment—where you do not have protective equipment—it is important to reinforce that you should use the same precautions as everyone else: hand hygiene and maintain social distancing.,

First, wash your hands before you leave. Then, take a moment to gather your thoughts. Make sure that if you had any exposure, or any concerns of exposure, that you address it with your supervisor so the issue can be followed up immediately. Check your symptoms—How are you feeling? Also, take an additional moment—because in this crisis you have played a very important role. Wipe your work surface with hospital wipe, and remember to clean the surfaces again when you return.

Should I remove my work clothes before I walk into my house?

Before the COVID-19 pandemic, there was the general recommendation from infection prevention that health care workers in procedural areas like the operating room should change into street clothes before leaving the hospital. The recommendation is still true today. Health care workers who are involved in procedures that may lead to contamination of their scrubs with blood and body fluids should change into street clothes before leaving the hospital. For everyone else who does not work in procedural areas, donning and doffing PPE throughout the day may cause you to sweat more. Respiratory viruses, including coronaviruses, are not transmitted through articles of clothing. But it is not unreasonable to change when you get home if that would make you more comfortable.

Should I avoid my family members when I am at home?

If you are feeling well, there is no reason to avoid your family members. Frequent hand hygiene with soap and water or alcohol-based hand sanitizer is recommended. Everyone should make sure that they cover their nose and mouth when they cough or sneeze, but otherwise you may act normally with your family members.

Should I avoid interacting with my pets?

If you are feeling well, there is no reason to avoid your pets. Similar to contact with humans, you need to make sure that you cover your nose and mouth when you cough or sneeze.

Are there any additional precautions I can take at home—for example, wash my clothes separately?

There is no recommendation about separate clothing screening. But, washed clothes should be dried in a dryer because that helps reduce any contamination on the clothing. You should think about wiping the phone and other products with a compatible cleaner, preferably one that has antimicrobial rating. Wash your hands afterwards, and you should be good.

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