Health

Photo from SBU

The coronavirus pandemic is a time like no other in U.S. history. The virus, which hit the New York area particularly hard, had Stony Brook University and Stony Brook University Hospital on high alert for months on end.

The hospital not only saw the heroic actions of doctors and nurses already on Stony Brook Medicine’s staff, but was also assisted by visiting nurses; medical students who graduated early to help fight on the frontlines; doctors and researchers jumping on ways to find a possible cure as quickly as possible; and essential workers who played an integral role in ensuring every process and procedure ran as smoothly as possible.

Students on the Stony Brook University campus during the Fall 2020 semester are wearing masks as a precaution against COVID-19 spread. Photo from SBU

On the University’s main campus, 3-D shields were printed as a PPE shortage was looming; hand sanitizer was created by several chemists in the Chemistry laboratory; and a prototype of a respirator was put together by a team from the College of Engineering and Applied Sciences which could be assembled quickly and used if necessary.

Now, Stony Brook University Libraries has announced the development of “Documenting COVID-19: Stony Brook University Experiences,” a new digital archive project established to collect, preserve, and publish the institutional history of Stony Brook University during this unprecedented moment in history.

“The archive will primarily be formed from submissions received directly from students, faculty, staff, and alumni that document life during the COVID-19 pandemic. Interviews, first-hand accounts, flyers, photographs, and more will be important sources to consult in the future to study, interpret, and derive meaning from this historic time period,” said Kristen Nyitray, University Archivist and Director of Special Collections and University Archives at Stony Brook University.

All from the Stony Brook University community are invited to contribute to the archive by submitting content or participating in an interview via a dedicated web page, “Documenting COVID-19: Stony Brook University Experiences” from which the library project team will collect information, photos, videos, personal stories and other COVID-19 related information.

For more information, visit www.library.stonybrook.edu/special-library-initiatives/documenting-covid-19/.

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*Update* On Sunday, the Port Jefferson School District updated parents saying that after the middle school student was determined as positive for COVID, the Department of Health has quarantined a number of other students and staff who were determined to be in contact with the individual. All the individuals have been notified by the district.

The Department of health has determined students are cleared to return to the building on Monday. Staff not made to quarantine are supposed to report Monday as well as the students scheduled to be in school for learning that day. 

“The situation today is a reminder about the importance of social distancing,” said Superintendent Jessica Schmettan in a letter to parents. “The community needs to remain vigilant to avoid closures in the future.”

Original Story

The evening of Friday, Sept. 18, both the Rocky Point and Port Jefferson school districts reported positive COVID cases among a single student each.

Rocky Point Superintendent Scott O’Brien wrote in a letter to parents Sept. 18 that a student at the high school had tested positive for COVID-19. The district said they were in contact with the Suffolk County Department of Health, and “all appropriate areas are being cleaned and disinfected over the weekend.” The school is planned to reopen Monday to follow the school’s hybrid schedule.

“As per the Suffolk County Department of Health, the individual who has tested positive for COVID-19 was last in the building Thursday, Sept. 17 and will not be allowed to return to school for at least 10 days after a negative test result has been provided to the district,” the school’s statement read.

The district is assisting the county DOH in contact tracing. Those contacted by the DOH will need to remain quarantined for 14 days from last exposure to the individual.

PJSD

Following another case Monday where Port Jefferson School District officials said an elementary student had tested positive, the district again sent a message to parents Friday saying that, after dismissal, the district was notified a middle school student had tested positive.

“We have been in contact with the Department of Health and have begun contact tracing procedures,” the district said in its notice to parents. “Students or staff members that were in contact with this student will receive a separate correspondence and a possible quarantine from the Department of Health.”

The district asked that people be mindful of their interactions with people as the investigation by the DOH is ongoing. The district said it will update parents of any further details once they recieve more guidance from the department of health.

Doctor Says People Can Be Impacted by Califorinia Fires as Far as Long Island

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Scenes of the ash and smog from wildfires in the West Coast not only trigger sympathy for those with friends and family living in a paradise under siege, but also are a cause for concern for doctors who specialize in the lungs.

Dr. Norman Edelman. Photo from SBU

While doctors don’t know how far and wide the effects of these fires might be for those who are already struggling with their breathing, such as people with asthma, chronic obstructive pulmonary disease or chronic bronchitis, physicians said the effect could spread well beyond the areas battling these blazes.

The danger is “not just at the site of the fire,” said Dr. Norman Edelman, a professor of medicine at Stony Brook University and a core member of the program in public health at Stony Brook. “I’m sure [the effect of the fire] is pretty wide.”

Indeed, at some point down the road, the small and large particles that are aerosolized during the fire could reach as far away as Long Island.

“We know quite firmly that air pollution from coal burning generator plants [in the Midwest] emits pollution that makes its way all the way to the East Coast,” Edelman said.

The current use of masks may offer some protection for residents on the West Coast.

Particulates, which are aerosolized particles that can get in people’s lungs and affect their breathing, come in various sizes. The larger ones tend to get lodged in people’s noses, throat and eyes and can cause coughing, hacking, and watery eyes. An ordinary mask can filter some of those out, although masks are not completely effective for these bigger particles.

The smaller ones are more dangerous, Edelman said. They can get further into the lungs and can exacerbate asthma, chronic bronchitis and emphysema. They can even contribute to increased incidence of heart attacks.

“Nobody really knows” why these smaller particles contribute to heart attacks, Edelman said. Anecdotal evidence suggests that a reduction in pollution improves the health of a population.

When New York banned smoking in all public places, the level of heart attacks dropped by 15 to 20 percent.

“This level of pollution is nothing like what we’re seeing in the area of the wildfires,” Edelman said.

Additionally, lower pollution can improve the health of people with lung problems.

At the Summer Olympics in Atlanta in 1996, officials put in alternate day driving restrictions, which allowed people to drive every other day. By cutting down the pollution from traffic, doctors noticed a 25% reduction in admission to the emergency room for asthma.

If he were a doctor on the West Coast, Edelman said he would make sure his patients had all their medications renewed and available. He would also check in with his patients to make sure they had emergency instructions in case they need to boost the amount of any pharmacological agents.

The effect of the pollutants on people with asthma or other lung issues can be more severe if they are already dealing with an inflamed airway.

“The effects of various irritants are probably synergistic,” Edelman said. “If this is your allergy season, you become much more susceptible to the inflammatory effects of air pollution.”

COVID and the Lungs

As for the pandemic, Edelman said he didn’t come to the emergency room to work at the Intensive Care Unit during the pandemic.

His colleagues did, however, ask him to take care of patients who didn’t have to come in by telehealth. He’s continued to see many patients over the last three or four months.

One surprise from the data he’s seen related to the pandemic is that asthma does not seem to exacerbate the effects of COVID-19.

People with asthma “are not dying with COVID at any greater rate than the general population,” Edelman said.

He hasn’t yet seen the data for people with chronic bronchitis or COPD.

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State Dashboard Shows Comsewogue HS With Two Positive Tests, But District Says Not to Worry

PJSD said the Edna Louise Spear Elementary School has been temporarily closed and all students moved online after on student was tested positive. Photo from Google maps

*Update* The night of Sept. 16, Port Jeff Superintendent Jessica Schmettan released a follow up letter about the student who was confirmed positive. She said the elementary school was “thoroughly” cleaned after the district received the news. The New York State Department of Health interviewed the family and district, and has since advised the district that classrooms are cleared to reopen, saying the student was not infectious while on school grounds.

Students who had close contact with the student have been contacted, and contact tracing is underway. 

“The situation today is a reminder about the importance of social distancing, the use of masks, and proper hygiene,” Schmettan said in the letter. “The community needs to remain vigilant in order to avoid closures in the future.”

Original story:

Parents in the Port Jefferson School District received a message Wednesday morning saying a student was tested positive for COVID-19 and that the Edna Louise Spear Elementary School would be closed for the meantime.

“This morning the Port Jefferson School District was notified that a student at the elementary school tested positive for COVID-19,” Superintendent Jessica Schmettan wrote in a message to district parents shared with TBR News Media. “Following our procedures and protocols and guidance from the [New York State] Department of Health, the elementary school is closed today for distance learning.”

The district added they will be conducting contact tracing and disinfecting the elementary school. Parents will be updated as the situation develops.

As of Sept. 15, Comsewogue High School has been listed by the New York State dashboard as having two positive cases in the Comsewogue High School. 

Comsewogue Superintendent Jennifer Quinn described the situation as two siblings who had tested positive for COVID in another country, though she said the name of the country was not released for fear of the students being outed to their peers. They were cleared by the New York State Department of Health to come back to school, though while in school another test taken in the states came back positive.

Quinn said the Department of Health was aware of the situation, and health officials told the district the two students were likely positive because of the viral load still in the body, though they were not infectious. Both students have volunteered to stay home in the mean time.

 

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Dr. Nick Fitterman said they wouldn't necessarily endorse a COVID-19 vaccine immediately without first getting all the information. Photo from Huntington Hospital

Huntington Hospital won’t automatically endorse a COVID-19 vaccine, even if it receives approval from the federal government.

The hospital plans to evaluate the data from the vaccine’s phase 3 trials to ensure that the vaccine is safe and effective.

“We’ll see if things are starting to uptick long before it’s more obvious to the public.”

— Nick Fitterman

“It’s part of our oath, ‘Do no harm,’” said Dr. Nick Fitterman, executive director at Huntington Hospital. “If we don’t think the safety is there, I will scream it from the rooftops. It has to be a combination of safety and efficacy.”

Fitterman said at least seven vaccines are in phase 3 trials, with over 250 experimental vaccines in the works in total.

Fitterman was pleased to see that nine vaccine makers signed a pledge to uphold medical standards and not succumb to governmental pressure for rapid approval.

At this point, Fitterman would only take a vaccine after publication of the evidence from the clinical trials.

Once he is convinced that a vaccine is safe and effective, he said he would feel an urgency to take it as a health care worker.

“If you take care of people who are high risk, you’re going to need to take it,” Fitterman said.

The hospital would likely have the same policy for a COVID vaccine that it does for a flu vaccination: if workers choose not to get a vaccine, they will be required to wear a mask.

For the flu, hospital workers with purple badges on their name tags have had a flu shot.

At this point, it is unclear how long a COVID-19 vaccination might provide potential protection. Like tetanus or mumps, no vaccine wards off infection indefinitely, which means people will likely require boosters.

“I’m more worried about people getting complacent because they have been vaccinated,” Fitterman said.

Years down the road, the virus could return.

Asked whether those people who have antibodies for the virus would need a vaccine, Fitterman highlighted a recent case in Hong Kong. Published in the journal Lancet, doctors shared the story of one patient who contracted COVID-19 and then tested positive again.

The virus currently has several strains, so a vaccine might provide greater protection than natural antibodies against a single type of COVID-19.

The man who contracted the virus twice had antibodies that “didn’t protect him from another infection,” but he did not have any symptoms during the second positive test.

An infection in which a person develops antibodies could “protect you from the disease, but it doesn’t [necessarily] protect you from getting infected again,” Fitterman said.

A health care worker in particular would benefit from a vaccine that prevented infection from numerous strains to prevent that worker from spreading a disease to which he or she would likely be exposed during the course of any increase in cases.

With the possibility of a second wave of COVID-19 overlapping with the flu, Fittterman strongly urged residents to get a flu shot, which would help prevent the virus from overwhelming a health care system that might again face an influx of hospitalizations from the coronavirus.

“It’s part of our oath, ‘Do no harm.'”

— Nick Fitterman

Huntington Hospital recently started making the flu vaccine available to frontline workers and urged people to get flu shots this month. He reminded people that the vaccine only works two weeks after an injection after the immune system has had a chance to recognize the virus.

Fitterman is encouraged by the range of current vaccines in trials for COVID-19, including those that use messenger RNA.

Fitterman said Huntington Hospital is prepared for a potential second wave of COVID-19. He monitors the data every day.

“We’ll see if things are starting to uptick long before it’s more obvious to the public,” Fitterman said.

As a part of Northwell Health, Huntington Hospital has stockpiled personal protective equipment. Northwell also gave Huntington $4 million to be prepared, which includes having more ventilators, dialysis machines, and negative pressure rooms ready. Huntington can handle 10% more than the number of patients who needed medical help in the spring.

“We are beyond ready [but we] hope we don’t have to exercise any of that,” Fitterman said.

Fitterman urged those people who need other hospital services, such as cancer screenings, to come to the hospital.

When the spring surge for COVID-19 occurred, the hospital told people who were dealing with nonemergency situations not to come to the hospital because they needed the beds, and not because they felt patients would be exposed to the virus.

Indeed, after the viral numbers declined, the hospital tested its staff for the presence of the antibodies. They found that 9% of the staff had antibodies to the virus, which is below the 14% for the surrounding community.

“What we did works,” Fitterman said, which included PPE and procedures to protect the staff. The hospital is a “safe place to be,” he said.

In monitoring the daily changes in infection in Suffolk County, Fitterman said positive tests have been rising and falling during the last few weeks. So far, he has not seen an increase in hospitalizations.

“Our numbers continue to go down,” Fitterman said, as the hospital had three people with COVID-19 as of Sept. 8.

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The Visiting Nurse Service will administer annual flu shots by appointment in the Parish Outreach office of St. Anthony of Padua Church, 1025 Fifth Ave., East Northport on Wednesday, Sept. 16 from 10 a.m. to noon. Traditional Medicare (Part B) and Medicaid are accepted (not Medicare HMO or managed care Medicaid); others can pay $35 by cash or check. Private insurance is not accepted, but a consent form can be submitted to most insurers. Please bring your insurance card. Recipients will be required to wear masks and practice social distancing. Call 631-261-1695 to make an appointment.

Photo from Northwell Health

Empire Subaru of Huntington has once again selected Huntington Hospital as the recipient of Subaru’s Share the Love program. The dealership donated more than $50,000 to Huntington Hospital’s award-winning neurosurgery department. This is the second year the dealership has donated to the hospital. Pictured at the check presentation on Aug. 7, from left, are Dr. Robert Kerr; Empire Subaru Sales Manager Vinny Rizzo; Vice Chair of Huntington Hospital’s board Thomas Lederer; Empire Subaru General Manager Gary Farley; and Huntington Hospital’s Executive Director Dr. Nick Fitterman.

White fleshy fruits like apples, pears and bananas have shown to decrease ischemic stroke risk. Stock photo
Medications and lifestyle play important roles

By David Dunaief

Dr. David Dunaief

Stroke remains one of the top five causes of mortality and morbidity in the United States (1). While some risk factors are out of our control, like family history and age, many of our risks can be altered by making lifestyle changes and managing contributing diseases, like hypertension and diabetes.

We have a wealth of studies that inform us on the roles of medications and lifestyle in managing risk. Of particular importance are medication guidelines that balance the risks and benefits of different stroke prevention regimens.

Medications can be protective

Two medications have shown positive impacts on reducing stroke risk: statins and valsartan. Statins are used to lower cholesterol and inflammation, and valsartan is used to treat high blood pressure. Statins do have side effects, such as increased risks of diabetes, cognitive impairment and myopathy (muscle pain). However, used in the right setting, statins are very effective. Some studies have shown reduced mortality from stroke in patients who were on statins at the time of the event (2). Patients who were on a statin to treat high cholesterol had an almost six-fold reduction in mortality, compared to those with high cholesterol who were not on therapy.

There was also significant mortality reduction in those on a statin without high cholesterol, but with diabetes or heart disease. The authors surmise that this result might be from an anti-inflammatory effect of the statins. Of course, if you have side effects, you should contact your physician immediately.

Valsartan is an angiotensin II receptor blocker that works on the kidney to reduce blood pressure. However, in the post-hoc analysis (looking back at a completed trial) of the Kyoto Heart Study data, valsartan used as an add-on to other blood pressure medications showed a significant reduction, 41 percent, in the risk of stroke and other cardiovascular events for patients who have coronary artery disease (3).

It is important to recognize that high blood pressure and high cholesterol are two of the most significant risk factors for stroke. Fortunately, statins can reduce cholesterol, and valsartan may be a valuable add-on to prevent stroke in those patients with coronary artery disease.

Use caution with medication combinations

There are two anti-platelet medications that are sometimes given together in the hopes of reducing stroke recurrence — aspirin and Plavix (clopidogrel). The assumption is that these medications together will work better than either alone. However, in a randomized controlled trial, the gold standard of studies, this combination not only didn’t demonstrate efficacy improvement but significantly increased the risk of major bleed and death (4, 5).

Major bleeding risk was 2.1 percent with the combination versus 1.1 percent with aspirin alone, an almost twofold increase. In addition, there was a 50 percent increased risk of all-cause death with the combination, compared to aspirin alone. Patients were given 325 mg of aspirin and either a placebo or 75 mg of Plavix. The study was halted due to these deleterious effects. The American Heart Association recommends monotherapy for the prevention of recurrent stroke. If you are on this combination of drugs, please consult your physician.

Managing aspirin dosing

Greater hemorrhagic (bleed) risk is also a concern with daily aspirin regimens greater than 81 mg, which is the equivalent of a single baby aspirin. Aspirin’s effects are cumulative; therefore, a lower dose is better over the long term. Even 100 mg taken every other day was shown to be effective in trials. There are about 50 million patients who take aspirin chronically in the United States. If these patients all took 325 mg of aspirin per day, an adult dose, it would result in 900,000 major bleeding events per year (6). Do not take an aspirin regimen — even a low-dose aspirin regimen — for stroke prevention without consulting your physician.

Protection from fruits and vegetables

A prospective study of 20,000 participants showed that consuming white fleshy fruits — apples, pears, bananas, etc. — and vegetables — cauliflower, mushrooms, etc. — decreased ischemic stroke risk by 52 percent (7). Additionally, the Nurses’ Health Study showed that foods with flavanones, found mainly in citrus fruits, decreased the risk of ischemic stroke by 19 percent (8). The authors suggest that the reasons for the reduction may have to do with the ability of flavanones to reduce inflammation and/or improve blood vessel function. I mention both of these trials together because of the importance of fruits in prevention of ischemic (clot-based) stroke.

Fiber’s role

Fiber also plays a key role in reducing the risk of a hemorrhagic stroke. In a study involving over 78,000 women, those who consumed the most fiber had a total stroke risk reduction of 34 percent and a 49 percent risk reduction in hemorrhagic stroke. The type of fiber used in this study was cereal fiber, or fiber from whole grains.

Refined grains, however, increased the risk of hemorrhagic stroke twofold (9). When eating grains, it is important to have whole grains. Read labels carefully, since some products that claim to have whole grains contain unbleached or bleached wheat flour, which is refined.

Fortunately, there are many options to help reduce the risk or the recurrence of a stroke. Ideally, the best option would involve lifestyle modifications. Some patients may need to take statins, even with lifestyle modifications. However, statins’ side effect profile is dose-related. Therefore, if you need to take a statin, lifestyle changes may help lower your dose and avoid harsh side effects. Once you have had a stroke, it is likely that you will remain on at least one medication — typically low-dose aspirin — since the risk of a second stroke is high.

References:

(1) cdc.gov. (2) AAN conference: April 2012. (3) Am J Cardiol 2012; 109(9):1308-1314. (4) ISC 2012; Abstract LB 9-4504; (5) www.clinicaltrials.gov NCT00059306. (6) JAMA 2007;297:2018-2024. (7) Stroke. 2011; 42: 3190-3195. (8) J. Nutr. 2011;141(8):1552-1558. (9) Am J Epidemiol. 2005 Jan 15;161(2):161-169.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

Dr. Elena Maresca

Dr. Elena L. Maresca has been selected for inclusion in the forthcoming Trademark Top Doctors of America 2020 Honors Edition for demonstrating dedication, leadership and professional excellence. During the vetting process it was noted along with her exceptional reputation that she has also maintained a positive peer rating.“Representing the state of New York as one of the best is truly an honor,” said Dr. Maresca. “I am dedicated to providing my patients with the very best care and I am humbled by this selection.”

Dr. Maresca has been practicing audiology for 25 years. Prior to establishing a private practice in 2004 she was the Director of Audiology for Beverly Hospital in Massachusetts. In 2013, Dr. Maresca opened Hearing & Tinnitus Management in Stony Brook where she specializes in hearing healthcare, hearing aids, tinnitus and hyperacusis management.

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The Centers for Disease Control and Prevention has recommended that people wear cloth face coverings in public settings where social distancing measures are difficult to maintain. Even as the world begins to unpause, wearing masks seems likely to continue.

Masks are designed not to prevent the wearer from getting ill, but to protect other people from getting the virus. Masks protect others from your germs when you cough or sneeze. They’re also an effective way to help people to avoid touching their faces.

Masks are exposed to the elements and germs each time they are worn, meaning they will require cleaning. Even though Harvard Health suggests COVID-19 may live more readily on hard surfaces than fabric, the CDC urges people to give cloth face masks the same level of care as regular laundry. Masks should be washed and dried often. The CDC offers these tips on how to clean most cloth and fabric masks.

• Fabric face masks should be washed depending on the frequency of use. More frequent use necessitates more frequent washing.

• A washing machine should be adequate for properly washing a face covering. Choose a warm setting for water temperature. Place masks in the dryer afterward.

• More delicate, hand-sewn masks may be washed by hand, suggests The Good Housekeeping Institute Cleaning Lab. Lather masks with soap and scrub them for at least 20 seconds with warm or hot water before placing in the dryer.

• For additional sanitation, iron masks on the cotton or linen setting for a few minutes to kill remaining germs.

• If masks are fortified with a filter, such as a coffee or HVAC filter, keep in mind that these filters are designed for single use. Paper filters should be replaced after each use. HVAC filters are washable, but manufacturers warn that their effectiveness decreases with each wash. Medium weight nonwoven interface used as filter material is typically washable.

Various health agencies do not condone using steam or microwaves to clean cloth face masks, as these sanitizing techniques are not as effective as regular laundering. Also, never microwave non-fabric dust or N95 respirator masks if you are using them. They can catch fire or be rendered useless.