Our Finest Moments in the Battle Against COVID-19
On a cold day in February 2020, a patient arrived at The Mount Sinai Hospital with flu-like symptoms. This was the moment that everyone at the Mount Sinai Health System had been bracing for: this was their first patient with COVID-19.
At the time, much was unknown about the virus, but that first patient provided Mount Sinai with crucial insights about the rapidly-unfolding humanitarian crisis. The patient had been traveling in the Middle East with her husband, and both developed symptoms despite minimal contact, indicating that this virus was more transmissible than SARS or MERS. It became apparent that this would be a battle fought on many fronts: treating patients, protecting staff and ensuring that the eight hospitals and 400 ambulatory practices that comprise Mount Sinai had the necessary resources to prevail.
Although the first patient was treated and sent home to quarantine, more patients with more severe symptoms started appearing at Mount Sinai.
“We became the epicenter of the epicenter, and no one knew how to treat this disease,” recalled Dr. Dennis Charney, the Anne and Joel Ehrenkranz Dean of the Icahn School of Medicine at Mount Sinai and president for Academic Affairs of the Mount Sinai Health System. “There are only a few institutions in the world that are capable of developing a better understanding of the biology and progression of a virus such as this. We believed we were one of them, and that if we did not do it, who would?”
Mount Sinai’s pandemic response exemplifies what is possible when a top-tier institution with a legacy of excellence in patient care and scientific innovation rises to the challenge of a once-in-a-lifetime humanitarian crisis that has impacted health care institutions, businesses and people throughout New York City and around the world.
It is a story of uncertainty, struggle and sacrifice, but also one of collaboration, innovation and courage. Working together, Mount Sinai’s boards of trustees, leadership and more than 42,000 staff raised funds, developed protocols and came up with new therapeutics and initiatives that saved thousands of lives and proved to be game changers in the face of a devastating and continually-evolving virus.
PROTECTING THE FRONT LINE
For Dr. Kenneth L. Davis, president and chief executive officer of the Mount Sinai Health System, one of the first priorities was ensuring the health and safety of Mount Sinai’s front-line health workers so they could mount a sustained campaign against the virus. Realizing that United States suppliers could not meet the growing demand for personal protective equipment (PPE), he began working with Mount Sinai-affiliated hospitals in China to procure masks, face shields and goggles.
“We had secured five tons of equipment just as the number of patients we were seeing started to increase,” Davis said. “But at the last minute, Chinese officials refused permission for the cargo plane to take off. We had to find another way to get these supplies out of the country.”
Davis reached out to Richard A. Friedman, co-chairman of the Mount Sinai boards of trustees and chairman of the Merchant Banking Division at Goldman Sachs, for assistance. Friedman engaged the company’s contacts in China to help resolve the impasse and solicited the assistance of Warren Buffett, chairman and CEO of Berkshire Hathaway, to arrange for two passenger planes from NetJets, a Berkshire subsidiary, to fly from Alaska to China to retrieve the PPE.
“My son was a fourth-year resident working in the neurology ICU at The Mount Sinai Hospital, so this was personal for me,” Friedman said. “It took three days to obtain the necessary approvals and clearances, including an emergency call to customs. We had to remove all the equipment from its packaging so it would fit on these smaller passenger planes. We were also concerned that we might have to abort the mission due to an inbound flight to China with COVID-19-positive patients. But we managed to get clearance, retrieve the equipment and help save lives as a result.”
THE FIRST SURGE
Back at Mount Sinai, the front-line battle against the virus was rapidly escalating. The number of patients contracting COVID-19 continued to rise exponentially, peaking at 2,200 in April. Equally concerning, the symptoms were more severe, with one-third requiring critical care and one-half requiring respiratory support. There were no guidelines for how to proceed, and there was a mounting concern that the health system’s resources could be overwhelmed at any given point. Mount Sinai’s management team had to navigate the crisis moment by moment.
“We were fortunate in that we have been working together for 15 years, so we know each other, we trust each other, and we are able to make quick, actionable decisions when faced with a situation like this,” Davis said.
To maximize resources and staff, elective surgeries were canceled, public spaces were co-opted, and inactive wards became makeshift intensive care units and negative pressure rooms. A field hospital was established in Central Park. Medical students received early graduation to join the fight. And Mount Sinai quadrupled its supply of ventilators through donations and a dedicated team tasked with adapting sleep apnea machines. Each measure helped, but the sheer number of patients requiring critical care threatened to overwhelm Mount Sinai’s intensive care unit physicians and nurses.
“Our response was to form ICU teams, each led by a physician with relevant expertise,” Davis said. “At first, we asked for volunteers, and the response exceeded our expectations. We also reassigned specialists, such as orthopedic surgeons and ENT clinicians whose practices had essentially been shuttered by the pandemic, and we brought in per diem nurses. These actions enabled us to keep pace with demand.”
The cancellation of elective surgeries, demands on the health system and acquisition of medical equipment opened a new battlefront for Mount Sinai: securing the necessary finances to continue operating throughout the pandemic and beyond.
“My view was that we needed to raise as much as we could to develop therapeutics and save lives,” Friedman said. “We launched the Relief Fund in mid-March to ensure Mount Sinai could continue the fight, and the response was incredible. We were raising $1 million at a time through emails, and within 45 days, we had raised $70 million. The speed and the amount went beyond any fundraising initiative I have ever been involved with, and it was exciting to be involved in that effort.”
With funding in place, Mount Sinai researchers were able to achieve a series of breakthroughs that rivaled the pace of the trustees’ fundraising campaign. One of the earliest was the development of the first FDA-approved test for antibodies to SARS-CoV-2, the virus that causes COVID-19. That effort was led by Florian Krammer, Mount Sinai professor in vaccinology at the Icahn School of Medicine. The test, which has been shared with more than 200 labs worldwide, identifies the presence of antibodies, which are produced by the immune system in response to the disease in a patient’s blood, making it possible for researchers to track and trace COVID-19. It is the only approved test that measures the quantity of antibodies, which is crucial in the development of vaccines.
Development of the antibody test facilitated a second Mount Sinai breakthrough: the nation’s first convalescent plasma program. Through the program, antibody-rich plasma is collected from recently-recovered patients and used to protect and treat at-risk and infected COVID-19 patients. A third breakthrough was the observation by physicians, including Dr. Valentín Fuster, director of Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital, that patients were developing COVID-19-related blood clots that raised their risk for stroke, heart attack and pulmonary embolism. Following further study of this phenomenon, Mount Sinai became the first institution to implement a system-wide policy of administering anticoagulants to all COVID-19 patients. Mount Sinai was the first institution nationwide to apply artificial intelligence for rapid detection of COVID-19 based on patient imaging and clinical data.
“This is a hospital that gave birth to a medical school,” Davis added. “We have an integrated board and management team, and that integration enables us to be innovative in responding to an emergency like this. Our best clinical scientists were on the front lines of the battle, conducting research, feeding their findings to the entire Mount Sinai community and helping us develop the protocols and tools to treat the virus.”
“Our achievements speak to the culture of collaboration we have here at Mount Sinai and our dedication to recruiting scientists who are focused on discovering new treatments that help patients now,” Charney said. “They also speak to the support of our leadership every step of the way. It was important for me to be here every day providing the resources for our faculty, staff and students to accomplish what they needed to accomplish and inspiring confidence that we could overcome this pandemic together.”
That spirit of collaboration and innovation is also embodied in several new initiatives that Mount Sinai launched at the height of the pandemic to further explore the impacts of COVID-19 on both patients and front-line care professionals. In May, Mount Sinai created the Center for Post-COVID-19 Care, a first-of-its-kind undertaking that will provide comprehensive, multi-specialty care and systematic evaluation of the long-term impacts of COVID-19 among discharged patients. The Center for Clinical Intelligence brings together Mount Sinai data scientists, engineers, clinical physicians and researchers to develop data-driven solutions for the pandemic and ensure the health system is prepared to take on future health crises. The psychosocial impacts of the pandemic on health workers are the focus of the Center for Stress, Resilience and Personal Growth, which will conduct related research and offer access to treatment through support groups, psychoeducation and resilience training. And philanthropic support from the boards of trustees has led to the creation of the Institute for Health Equity Research, which will explore the disproportionate risk of COVID-19 infection and other health issues among at-risk communities, including those that are non-white, low-income, immigrant, uninsured and LGBTQ+.
“Our goal from the outset was to go beyond treating our patients and protecting our people to develop solutions that address both the long-term impacts of this pandemic and the factors that contributed to it being extra-lethal among, for example, Black and Latinx communities,” Davis said. “Through these initiatives, we will address disparities among underserved communities, provide treatment for our COVID-19 long-haulers and strengthen the resilience of our front-line workers. In doing so, we believe they will provide a model for institutions and communities around the world to effectively address the same issues.”
WHO WE ARE
The first wave of the pandemic ebbed in late spring for New York City, and by fall 2020, more than 8,500 COVID-19 patients had been discharged. Although a second surge is underway, the fear and uncertainty that gripped Mount Sinai following the first confirmed cases have given way to increased confidence, efficiency and effectiveness in responding to the crisis. The insights, innovations and exceptional leadership that led to positive outcomes at the height of the pandemic created a strong foundation for facing future crises.
“Our achievements demonstrate that Mount Sinai is a resilient, flexible organization where collaboration is valued, challenges are seen as opportunities for improvement, and praise is shared for a job well done,” Davis said. “The people who work here entered this profession because they care and want to help. They never anticipated they would have to put their lives on the line, but they did that every day, and it was truly inspiring to see how they rose to the occasion.”
“All the things we were before the pandemic hit enabled us to accomplish what we did,” Charney added. “We are entrepreneurial and innovative, and we have extensive expertise in all the areas —biology, cardiology, immunology — necessary to do the research, deliver the quality care and raise the funds to meet this challenge like this head on. These are the strengths that will ensure we continue to innovate and prevail no matter what crises we face.”