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Dr. Sharon Nachman

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Pixabay photo

By Daniel Dunaief

For many local health care workers, the pandemic transitioned from triggering uneasiness about reports of a respiratory illness coming out of China to a significant threat to area residents.

Dr. Susan Donelan, Photo from Stony Brook Medicine/Jeanne Neville

Health care workers were in an all-out scramble to save lives even as information about the disease, its course and treatment, changed.

Five years after the start of a world-altering pandemic, infectious disease experts and emergency medicine specialists shared a range of thoughts about their initial reactions and concerns about this illness as well as insights about lessons learned and readiness to manage through future significant health threats.

Dr. Susan Donelan, Medical Director of Healthcare Epidemiology at Stony Brook Medicine, remembers raising questions about this virus towards late December of 2019. People urged her to go home and have a nice Christmas.

When Hospital CEO Carol Gomes called her on a Sunday and told Donelan she had an hour to get back to her, she recognized the approaching storm.

“I remember saying, ‘It’s a Sunday and she needs me in an hour,’” Donelan recalled. “We’re in it.”

Indeed, over the following months and, as it turned out, years, doctors dealt with numerous unknowns amid a fluid situation that threatened the population and, in particular those who were immunocompromised, had diabetes or respiratory or cardiac issues.

“People forget how bad things were,” said Dr. Gregson Pigott, Commissioner of the Suffolk County Department of Health Services. “So many people were dying” that hospitals needed to figure out where to put the deceased.

Residents also lined up to get the scarce tests for the presence of the virus and often waited days or longer for a result.

Fluid situation

Health care professionals were reacting to a fluid situation in which best practices in terms of treatment and prevention changed even as the virus was mutating.

“It seems like a blur, going back and thinking about those moments,” said Dr. Jennifer Goebel, emergency room doctor at Huntington Hospital. “It was very surreal, taking care of a disease process you knew nothing about and attempting to be the expert when we were still learning.”

Federal, state and county health officials were unsure of the best guidance for a range of safety measures, including the use of masks.

Additionally, health care experts struggled with the level of contagion based on different environments.

“I don’t think anyone really knew about the continuum that could occur depending on the ambient circumstances,” said Donelan. “I think we probably could have done a better job of letting the public know that our communications would evolve as our knowledge evolved.”

Sharing safety messages

During the worst of the pandemic, health care professionals struggled to share messages that would help people make informed decisions about protecting themselves, their families and their communities.

Dr. Sharon Nachman. Photo frm SBU

“Trust in public health was completely undermined,” said Dr. Sharon Nachman, Chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital “That hurt all of us.”

Nachman also listened to health care professionals on national TV who were discussing the health crisis. These pundits were sharing information that included far too many inaccessible words and concepts.

“Smart professionals were talking” but people weren’t understanding them, she said.

Additionally, the echo chamber of social media distorted messages, often questioning the developing science and best practices, suggesting conspiracy theories as well as treatments that were either unproven or ineffective.

Having local professionals from area hospitals made a difference on Long Island, Nachman said.

Whenever Nachman went to ShopRite, people who knew she was a part of their community saw her and asked questions.

“When it’s someone local from Northwell, Stony Brook, NYU Winthrop or others, [local communication] really works better,” she said.

Goebel added that she continues to share her medical knowledge not only with patients, but also with family members who have come to the hospital to provide support.

Hospitals, for their part, learned their lesson about stocking personal protective equipment.

“People have learned their lessons” at hospitals, said Pigott. “We need a more adequate stock of PPE.”

Health care provider PTSD

During the worst of the pandemic, one in five doctors who responded to an American Medical Association poll in 2022 said it was likely they would leave their practice within two years.

Dr. Jennifer Goebel. File photo from Northwell Health

“It was so staggering to hear some of these numbers,” said Goebel. Doctors go through over a decade of training. Seeing so many people leave was difficult.

Health care workers struggled, and continue to struggle, with memories and experiences in the midst of a crisis that killed millions around the world.

“I remember going to room nine, intubating a patient and being called to bed 12 and intubating another patient, within a matter of minutes,” said Goebel. 

As the director of wellness in the Emergency Medicine Service Line, Goebel has created new initiatives to help reduce burnout and provide support.

She developed a peer to peer pilot program that started in September in which new physicians, physician’s assistants and nurse practitioners were matched with a more experienced professional from day one.

The effort is designed to help new staff navigate the health system and address any questions or concerns.

“We’re looking to put these processes in place” throughout Northwell, Goebel said. 

Remote medicine

While remote medical choices, such as telehealth, predated the pandemic, these options have become increasingly common, particularly for residents who might struggle to get to a medical visit.

“Because people were forced to use it, with practice, they got better at it,” said Pigott.

Many organizations invested more in telehealth, which also reduces the burden on Emergency Departments.

Teleheatlh has its “risks and benefits,” said Goebel, as it can keep patients who might be vulnerable out of an environment where they might otherwise be exposed to other pathogens.

Goebel appreciates the importance of a visit with a doctor, who can differentiate between an ear ache and a potential indication of shingles.

Fortunately, for many people, Covid has become a much more manageable infection.

Pigott contracted Covid in September. He took Paxlovid, which helped knock out the symptoms within three days.

Pigott is also grateful for vaccines, which provided a dramatic reduction in mortality during the worst of the pandemic, particularly for people who are over 65.

The vaccine was “saving lives,” said Pigott. “There was real evidence that these are doing their jobs and are working out.”

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Dr. Aleena Zahra/St. Charles Hospital

By Daniel Dunaief

Bird flu, which is a virus that has so far primarily infected animals, has affected a duck farm in Aquebogue.

Amid concerns about transmission, Crescent Duck Farm, which has operated as a family business since 1908, has had to put down close to 100,000 ducks.

At this point, health officials haven’t reported any cases of humans contracting the virus, although the farm, its workers and doctors have been looking out for signs of illness.

Local doctors suggested that the risk to humans from bird flu is limited to those people who have worked with or handled sick birds.

Dr. Adrian Popp, chair of Infection Control at Huntington Hospital/ Northwell Health. File photo

The virus “transmits easily from bird to bird, but so far transmission to humans has not occurred to my knowledge,” Dr. Adrian Popp, chair of Infection Control at Huntington Hospital/ Northwell Health and associate professor of medicine at Hofstra School of Medicine, explained in an email. “There is a theoretical possibility that this can occur, but so far, I think we are safe,” as New York State is monitoring exposed workers.

Doctors urged residents to see a healthcare worker if they have any contact with birds and they develop symptoms such as a fever, conjunctivitis (an eye infection that can include redness or watery eyes), or breathing issues.

“Monitor yourself for 10 days after exposure,” urged Dr. Aleena Zahra, infectious disease physician at St. Charles Hospital. “If you develop any symptoms, seek medical attention.”

The treatment for bird flu, which can affect people in ways that are similar to influenza, is to take tamiflu, which is more effective in the earlier stages of an infection.

“If you’re in contact with an animal that is sick, then that would be a potential risk factor,” added Zahra.

Zahra advised residents to avoid picking up a dead bird in their yard without gloves and other safety measures.

Dr. Sharon Nachmann, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, added that the jump to humans from other animals is rarely happening.

People who have become infected are typically recovering, although one person in Louisiana died from the virus.

Despite the relatively low risk, viruses have the ability to mutate, which could make them more transmissible and more dangerous.

CDC silence

At the same time, local doctors are concerned that the Centers for Disease Control and Prevention has stopped publishing information on infectious diseases.

“This is an unprecedented attack on timely access to reports about transmission of various infectious diseases in the country and worldwide,” Popp explained. “It will lead to delayed prevention measures, poor health care, and potentially allowing infectious disease outbreaks to get out of control.”

Dr. Sharon Nachmann/Stony Brook Children’s Hospital

The CDC has created travel bans in the past, but has not closed its reporting on outbreaks, Nachmann said.

“It’s incredibly stressful,” said Nachmann.

Doctors added that they were missing the bigger picture that might offer important information about the source of an illness and the best possible treatment.

“We want to do the best for our patients. We want to tell them that this is working or that is not working and you need a different medication,” Nachmann said.

For right now, doctors are gathering information from state and local officials, said Zahra.

The CDC typically shares details about the specific type of infections in an area or region, its responsiveness to various treatments and its differential impact on any specific subgroup, such as children.

“It is sad to see how political, partisan measures are used to suppress sharing of scientific information between healthcare professionals,” Popp added.

Doctors are hoping for more and better information before too long.

“All we have now is a stop,” said Nachmann. “We don’t know what happens after the stop.”

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METRO photo

By Daniel Dunaief

They don’t always follow the same path with any two sufferers, but people who have migraines can and often do find themselves with symptoms including head pain, discomfort, numbness and nausea that make working, caring for family members or functioning difficult.

Dr. Sharon Nachman. Courtesy Stony Brook Medicine Facebook page

Among the first symptoms listed when COVID-19 became a pandemic in 2020, headaches can and have become more severe for people who become infected and then endure additional symptoms in the ensuing weeks and months.

People with migraines often suffer from a throbbing headache, nausea, sensitivity to light and loud noises that worsen with movement.

The other associated features can be “just as disabling as the pain,” said Dr. Noah Rosen, director of the Headache Program for Northwell Health. “Now that we see some of the symptoms cross over with long COVID symptoms, that becomes more salient.”

At this point, amid anecdotal evidence of migraines and long COVID, health care providers can’t say conclusively whether an infection with the current strain of the virus presents any more risk of developing migraines sometime after an infection than they were with earlier strains of the SARS-CoV-2 virus.

“There’s no central reporting of symptoms,” said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “If you get a vaccine and you have an adverse event, you can report it. There’s no such thing for long COVID.”

Indeed, with people continuing to pass along the virus in schools, workplaces, crowded subways and other places where people gather in confined indoor spaces, the long COVID population has “overtaken any ability to track those symptoms,” Nachman said.

Nachman added that migraines could be a symptom of something else.

“It’s hard to say a true cause and effect” with regard to a particular symptom, as some immune systems may have such a strong response that they are creating autoimmune problems.

Migraines are also seen in patients with autoimmune diseases, Nachman said.

For some patients, doctors may want to do a full immune workup to make sure they are not having an autoimmune reaction.

As for long COVID symptoms, people “across the board” are developing various maladies after contracting the illness that caused the pandemic, Nachman said.

While it’s unclear at this point whether migraines or other specific symptoms increase amid the current strain of long COVID, doctors urged people who have underlying medical conditions to get tested when they develop symptoms.

“Fewer people are actually treating the acute phase,” said Rosen. “There was some evidence that early treatment with Paxlovid can reduce the risk of long-term COVID.”

Indeed, people in high-risk groups can lower the chance of dealing with additional symptoms, called sequelae, after an initial infection.

Treatments

While numerous treatments are approved for migraines, it is unclear which might be best for people who develop these extreme and potentially debilitating headaches in the aftermath of COVID.

“Many of the new treatments haven’t been specifically looked at for post-COVID” migraines, said Rosen.

Migraines can become enough of an interruption to daily life that people alter their behaviors in between episodes, during the so-called interictal period.

Even without the pain, migraine sufferers can avoid activities because they are afraid of a trigger.

This can affect people’s social interactions or their job choices, among other decisions.

“If people are noting that they are unable to do things that they were doing before or are avoiding certain tasks, they need to step up in treatment,” said Rosen.

In terms of treating migraines, Rosen suggested that beneficial pharmacological options, such as triptans, have been around since the 1990s.

Triptans are a group of medicines that treat migraines by changing how blood circulates in the brain and how the brain processes pain signals, according to the Cleveland Clinic.

Rosen said Imitrex and Maxalt are used to treat migraines during the mild phase.

“Early treatment can lead to shorter symptoms or less medicine being used and less disability,” Rosen said.

The average migraine lasts about four hours. A migraine that lasts more than 72 hours is described as “migrainosis,” which can be disabling and can require a combination of medications.

People can reduce the risk of migraines through some lifestyle modifications, such as ensuring sufficient hydration, not skipping meals, getting regular sleep, avoiding stress or engaging in behaviors that improve resilience to stress, and exercise, Rosen said.

Migraines affect about 12 percent of the population. Additionally, anyone with a migraine has about a 70 percent chance of having a first-degree relative — a parent, sibling or child — who also has migraines, according to Rosen.

Researchers have identified over 40 genes associated with migraines, which makes determining a specific genetic link complex, Rosen said.

With a link between migraines and hormones, women suffer from them at about a three-to-one ratio to men.

Other triggers

Migraine sufferers often try to identify triggers that can bring on these painful and disturbing episodes that can cause fatigue and discomfort even after the episodes end.

Many people are sensitive to environmental changes, like low barometric pressure from storms or excessive changes in temperature.

All of those are increasing amid climate change, which has had a significant effect on migraine sufferers, Rosen said.

Obesity, which is a health issue for the country, can also affect migraines.

“That places an additional burden on the health of people who suffer” from migraines, said Rosen.

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Photo courtesy Metro Creative Graphics

By Daniel Dunaief

While the fall provides a break from the summer heat and a respite for exhausted parents who coordinate and carpool for recreational activities, it also can trigger a return to more concentrated time indoors.

Dr. Sharon Nachman, Chief of the Division of Pediiatric Infectious Diseases at Stony Brook Children’s Hospital.
File photo

That can trigger the beginning of the flu season, as students and their families share much more than the lessons of the day and stories about teachers and classmates.

Timing shots can be a delicate balance, as the antibody coverage from these shots is typically about three months.

With the peak flu season often occurring during December and January and even into February, Dr. Sharon Nachman, Chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, suggested that residents receive their vaccines in a few weeks.

“Getting a vaccine in October is probably the right time,” Nachman said.

Dr. Gregson Pigott, Commissioner of the Suffolk County Department of Health Services, added that the timing for Covid vaccinations is somewhat trickier.

“Because the evolution of new variants remains unpredictable, SARS-CoV2 [the virus that causes the disease] is not a typical ‘winter’ respiratory virus,” Pigott explained in an email.

The county health department recommends that residents stay up to date with their vaccinations.

“Individuals should speak with their healthcare providers for advice that is specific to them,” Pigott added.

Simultaneous shots

Doctors generally recommend receiving both shots at the same time, if people are eligible and the timing for each vaccine is right. Residents who are unsure about their eligibility should speak with their healthcare providers, Pigott explained.

Dr. Gregson Pigott, Suffolk County Health Services commissioner. File photo

The flu and Covid are viruses that change over time, creating a battle between the pharmaceutical companies that manufacture vaccinations and the viruses that attempt to evade them.

Each year, the vaccines attempt to provide the best match against the dominant or most likely strains.

The Centers for Disease Control and Prevention “determines if the vaccine will protect against a circulating virus by conducting laboratory studies on circulating flu viruses,” Pigott explained in an email. “Updated 2024-2025 flu vaccines will be trivalent” and will protect against H1N1, H3N2 and a B/ Victoria lineage virus.

Vaccine manufacturers create immunizations based on the flu strain circulating in the southern hemisphere during the recent season.

“We expect that those are what’s going to hit us in our winter,” Nachman said. “The science is there. We know generally what types will be rolling around. We could hit or miss it by a subtype.”

Nachman added that the flu vaccines represent educated guesses about the type of microbe that might cause illnesses.

“The educated guesses are still better than no vaccine, which will, for sure, not cover you at all,” Nachman said

As for the Covid immunization, doctors added that it is also likely to change as the virus that caused the pandemic mutates.

Nachman said people should plan to get the Covid shot around once a year.

“I don’t think we’re going to go to more often” than that, Nachman said.

During the summer, when an infectious strain of Covid surged across the county, state and country, Nachman said the data is not available to determine how much protection a vaccine provided.

“Only on TV do computer models work instantly,” Nachman said.

She suspects that the Covid shot offered some protection for residents, who may not have been as sick for as long as some of those who dealt with a range of symptoms.

Concussion awareness

With the start of a new school year and the beginning of contact sports like football, school districts are continuing to ensure that coaches and athletes follow concussion protocols.

“Schools have done a nice job thinking and talking about it,” said Nachman. “Coaches know you can’t throw [student athletes] out and say, ‘You’ll do fine,’” after a head injury.

Nachman suggested that area athletes may engage in activities that are not connected to the schools and that may involve head injuries that people ignore.

“We know what’s happening with school-regulated” sport, but not with those that are outside the academic umbrella, she added.

As for the emotional or psychological impacts of a divided and bitter electorate during an election year, Nachman said people are under considerable emotional stress.

“The social media echo chamber is making it worse,” she said. The abundance of misinformation on both sides is causing mental anguish.

“Election times are very stressful and I think, in particular, this election may be even more stressful,” Nachman said.

Nachman urges people to minimize their time on social media and to create down time from electronics during meals.

As students move up a grade and into new places, they also can endure stressors, peer pressure and bullying. She suggests that parents understand what their children are seeing online.

Newborn RSV protection

Children born in March or later are eligible to receive an approved shot called Beyfortus, which, in 80 percent of cases during clinical trials, prevents the development of respiratory syncytial virus, or RSV.

The Beyfortus monoclonal antibody will make a “huge difference” for newborns and their parents, Nachman said. Last year, Stony Brook had numerous hospitalizations in children under one year of age.

“We’re not going to have those children coming into the hospital,” Nachman said. “That’s amazing and is a huge step forward.”

When newborns get RSV, doctors don’t have an effective treatment for the virus and typically treat the symptoms.

The mortality rate from RSV is low, but the morbidity is high. Newborns who contract RSV can end up developing chronic asthma.

As with any shot, Beyfortus can have side effects, with the most common including rash and pain, swelling, or hardness at the site of the injection, according to AstraZeneca and Sanofi, which manufacture the antibody.

Beyfortus is covered by insurance and is under the vaccine for children program and numerous private health insurance plans. Parents can opt out of the shot. Nachman suggested they should understand what they are opting out of when they make that decision.

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Stony Brook doctor, tending to a newborn baby. Courtesy Stonybrookchildrens.org

By Daniel Dunaief

Water inside a house isn’t just bad for the structure, it can also be damaging to your health.

Local health care professionals suggested that Stony Brook residents whose basements flooded from this weekend’s heavy rainfall should be careful about the growth of mold or mildew, which can be especially problematic for anyone with chronic breathing issues.

“People can inhale spores over a period of time and can develop respiratory symptoms,” said Dr. Sunil Dhuper, Chief Medical Officer at Port Jefferson’s St. Charles Hospital.

People with asthma, chronic obstructive pulmonary disease, bronchitis and emphysema “need to be particularly concerned about some of these issues,” he continued.

Dr. Sharon Nachman, Chief of Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, suggested that residents of Stony Brook, who experienced a localized 10 inches of rain this weekend, should “aggressively clean” their basements, from any standing water, as mold and mildew can start growing within a few days.

“You won’t see it because it’s small,” but people should dry the walls and under the floorboards and carpet, she said. “You want to get the water out.”

Local doctors, also, recommended dumping standing water off any surface that might become a breeding ground for mosquitoes, who can carry the West Nile virus.

At this point, the County Department of Health believed the West Nile threat wasn’t likely particularly high.

“The heavy rains and wind might have washed away adult larvae and adult mosquitoes,” Dr. Scott R. Campbell, Laboratory Chief in the Arthropod-Borne Disease Laboratory at the Suffolk County Department of Health Services, explained in an email.

“Wet springs and hot, dry summers — in which mosquitoes and birds may congregate at limited sources of water — may be conducive to higher West Nile virus transmission.”

The heavy rain, which was triple the usual average for the entire month of August, according to Weather Spark, likely reduced area mosquitoes.

Local medical care professionals suggested that residents should still remove standing water as a way to protect themselves against any remaining mosquitoes.

Congenital viral infection

Apart from the impact of local flooding, doctors discussed a host of other medical issues.

New York State has been testing newborns, since last fall, for congenital cytomegalovirus, or CMV, which infected mothers can give to their unborn children.

The testing so far has shown that CMV is less prevalent than previous estimates.

The state started the one-year study of the virus to track children who might develop symptoms, such as hearing loss or learning challenges, later on.

“The earlier you identify babies with hearing deficits, the sooner you can act, and there will be fewer ramifications on their intellectual development, as a result of it,” said Dr. Andrew Handel, pediatric infectious diseases expert at Stony Brook Children’s Hospital, and a co-leader, along with Dr. Nachman, of one of the 11 units across the state.

Dr. Sharon Nachman. Courtesy Stony Brook Medicine Facebook page

Earlier medical sources estimated that the infection rate for newborns was about one in 200 babies. But, with about 300 newborns testing positive, the rate is closer to one in 325.

The percentage of symptomatic babies is tracking with previous expectations, at around 10 percent. Symptoms of congenital CMV at birth include hearing loss, jaundice, low birth weight, seizures and retinitis.

“Our numbers are matching up with the 90 percent” of those who have the virus, but are asymptomatic, Handel added.

“That’s why we feel screening is so important.”

For the asymptomatic newborns, about 10 percent will develop permanent hearing loss, which is why doctors are tracking them so closely.

The virus, which is a relative of the Epstein Barr virus, which causes mononucleosis, is spread through direct contact with body fluids, such as tears, saliva or urine. Over half of all adults have had a CMV infection, with some studies estimating the rate as high as 80 percent.

Adults can shed the virus for a few weeks after contracting it, while children can shed it for a few months.

While all newborns will receive CMV screening after birth, parents have five days to opt out of any link to a report of the presence of the virus in their children.

At this point, fewer than one percent of parents are opting out of the testing. Some of the parents aren’t interested in the test, others don’t believe it’s useful, while some believe their babies look fine, and don’t want the additional test.

Most parents appreciate the opportunity to gather information about their children’s health. Patients are “grateful the state has this program,” said Dr. Sunil Sood, Systems CMV specialist at Northwell Health.

At Stony Brook and other hospitals, doctors are monitoring those babies who test positive.

The County Department of Health supports the testing, as well.

“Routine screening of newborns for [congenital CMV] will help identify affected infants early on so they can receive appropriate follow-up and treatment,” Cynthia Friedman, Director of Public Health Suffolk County Department of Health Services, explained in an email.

“Infants who screen positive … should be followed closely by their pediatricians and referred to specialists as needed to ensure early detection of problems with hearing, vision or development so that appropriate care and support can be implemented.”

Once the funding for the testing runs out, which will be around October, hospitals around the state will no longer perform the test.

Parents can ask for a urine test, which doctors estimate could cost between $50 and $100, but which insurance, likely, won’t pay for — especially if the child is asymptomatic.

Legislators, including Assemblymember Linda Rosenthal (D-NYC) plan to introduce a bill in January that would fund tests, in future years.

“We would advocate that that become a permanent part of infant testing,” said Sood. “There are diseases that are far less common than CMV that have made it into the newborn testing programs.”

Immunization

Amid pushes by some pharmacies to encourage people to get flu shots, health care experts suggest waiting until closer to late September, or early October, for the inoculation.

“Vaccine efficacy is about three to four months,” said Nachman. “If you get it in August, when the flu season hits in January, you may not have much protection.”

The Centers for Disease Control and Prevention recommends similar timing, around September or October.

At the same time, Nachman expects a new batch of Covid vaccines will be available around September.

She recommends getting both shots at the same time, which increases both vaccines’ effectiveness.

Pharmaceutical giant, Pfizer, and BioNTech, recently reported that a single combined shot for Covid and flu was not effective against influenza B, which means that people interested in receiving vaccines this fall should plan to get two shots.

Covid numbers

As for Covid, the current strain has made the rounds this summer.

“Everybody and their neighbor had Covid,” said Nachman, who added that the virus has spread across all ages. Covid was “clearly more infectious than what we had in the spring” and people were sicker for longer.

While the number of infected people has decreased, the start of the fall semester could trigger an increase.

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An aedes albopictus mosquito, better known as the Asian tiger mosquito. Pixabay photo

By Daniel Dunaief

Mosquitoes can be much more than a nuisance as they search for their next blood meal: they can also pass along potentially dangerous viruses.

Long considered a tropical and subtropical health threat, dengue fever has reached record levels in the Americas this year. The illness has been traveling with Aedes mosquitoes that have been moving further north amid global climate change.

As of early July, mosquitoes in Texas, Florida and California have had one of the four viruses associated with the disease. Through early July, Florida reported 10 cases from local spread, according to an American Medical Association update.

Suffolk County residents who have traveled into areas that have dengue have contracted the illness, which has symptoms that are similar to the flu, such as high fever, headaches, body aches, nausea, vomiting and a rash.

Suffolk County has reported 12 cases of travel-related dengue so far through early July, which is more than all of last year and is the highest level since 2013, when 13 cases were reported for the entire year.

“We do have a fair amount of concern with global warming,” said Dr. Sharon Nachman, Chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “Even if people do not believe in it, mosquitoes have changed where they’re located. There is concern that the mosquitoes” will continue their trek farther north.

Suffolk County is one of many places throughout the country and the Americas that have reported an increase in cases for a disease for which residents have generally had no exposure and, as a result, no natural immunity.

New York State Department of Health alerted medial professionals to consider dengue as a diagnosis if people who are sick have a travel history and related symptoms, Dr. Gregson Pigott, Suffolk County Health Commissioner, explained in an email.

Symptoms of dengue typically begin within two weeks of being bitten by an infected mosquito.

From January 1 through June 24, countries in the Americas reported more than 9.7 million dengue cases, twice as many as in all of 2023, according to the Centers for Disease Control and Prevention.

Indeed, in Puerto Rico, infection levels climbed so high in early April that the Puerto Rico Health Department declared a public health emergency.

While a majority of dengue infections are asymptomatic or produce mild illnesses, the virus can cause severe cases and can be fatal, according to the World Health Organization.

“Anyone who lives in or travels to an area with risk of dengue is at risk for infection,” Pigott explained. “Children and those who are elderly are at higher risk for serious illness.”

People with dengue typically receive supportive care, which includes rest, pain medications and fluids.

Protection

Health professionals urged people traveling to areas with dengue to take a number of steps to protect themselves.

EPA-registered insect repellents, coupled with loose-fitting, long-sleeved shirts and pants can keep mosquitoes away.

Additionally, people can treat their clothing and gear, including hats, shoes and socks, with permethrin.

“Don’t be around standing water, which is a wonderful place for mosquitoes to breed,” advised Nachman.

In Suffolk County, the arthropod-borne disease lab collects mosquitoes and sends them to the New York State Department of Health lab in Wadsworth, New York. Asian tiger mosquitoes, which have carried dengue, zika and chikungunya viruses, have been found in Suffolk County, Pigott added.

“No samples of Aedes albopictus mosquitoes that have been sent to the lab have tested positive for those viruses,” Pigott wrote.

While health professionals are on the lookout for potential cases of dengue among residents who have traveled, they are more concerned currently with West Nile virus, which people can contract locally.

Other local illnesses

As for illnesses in the county, Nachman has seen patients who have been battling a collection of viruses, including enteroviruses and Covid.

Residents who are staying around Long Island should continue to be careful about ticks that can carry Lyme disease. Anyone who is going hiking should consider long pants and long sleeves, as well as dirt on their clothing.

“If you take your kids out to hike, check them and you for ticks,” said Nachman.

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Photo from Deposit Photos

By Daniel Dunaief

In a nod to the herd immunity from a combination of illnesses and vaccinations in the population, the Centers for Disease Control and Prevention is widely expected to reduce the recommended number of days of isolation after a positive test to one day from five days.

Even as most of the population has returned to a normal life after the pandemic — toughing through colds with relatively mild symptoms at work and staying home, for the most part, when symptoms become severe — the CDC had urged Americans to remain isolated for five days.

“Covid has diminished as a real threat for the majority of people,” said Dr. Sharon Nachman, Chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “The responsiveness between vaccinations and multiple events [such as infections] is reasonable to prevent hospitalization and death in most people.”

In addition, Covid treatments, such as Pfizer’s Paxlovid, have become effective in reducing the severity and duration of symptoms.

The CDC likely couldn’t have provided such guidance a year ago, but, for most people, the consequence of contracting the virus that altered the course of life for people for several years, has been less problematic for their health, doctors said.

Despite ongoing illnesses and symptoms, people have become less likely to test for Covid.

“Insurance companies used to pay for eight per month, but now, people just buy one [test box] at a time,” said Michael DeAngelis, the owner of Village Chemist in Setauket.

Dr. Sunil Dhuper, chief medical officer at Port Jefferson’s St. Charles Hospital, understood the CDC’s decision, with an important warning.

“The rationale behind changing the timing of isolation guidelines is based on looking at the evolving severity of cases,” Dhuper said.

“People who are younger get more mild levels of illness and recover,” he added.

Concerns for the elderly

“The disease is beginning to behave more and more like other respiratory viruses, but we are not there yet,” Dr. Dhuper cautioned, particularly for those who are over 65.

Hospitalization for people who contract Covid is 11.2 per 100,000 for people over 65, compared with 6.9 per 100,000 in the week ending Feb. 10, according to data from the Centers for Disease Control and Prevention. 

The mortality for those over 65 from Covid is higher than for the flu, Dr. Dhuper said.

“We have to be a little cautious, sending a message to the community that you can continue to do what you want to do,” Dr. Dhuper said. “When they are around the elderly” people, particularly those who might have symptoms even if they haven’t been tested, should consider wearing masks or keeping their distance.

The incidence of Covid, among other illnesses, climbed after the December holidays and the start of 2024, as people traveled to visit with family or on vacations. Those numbers have come down, although the upcoming spring break from secondary schools and colleges raises the possibility that illnesses could climb again, doctors predicted.

Be careful of grandkids

While the public may not want to hear it, Dr. Dhuper expected that it might take another five years before Covid reaches a comparable level of potential risk to the elderly as the flu, which could also present a risk to people’s health.

Dr. Dhuper urged those who have symptoms to test themselves for Covid. Even if they don’t isolate themselves for more than 24 hours, they should be cautious around vulnerable groups.

Dr. Dhuper’s advice to grandparents is to “be careful when you’re around your grandkids, because they are like petri dishes, harboring tons of infections.”

While for many people in the community, Covid has become like white noise, it’s still causing medical problems and leading to some hospitalizations, the St. Charles doctor added.

Any change in isolation guidance from the CDC should come with an asterisk that “yes, we are changing the guidelines, but people should still exercise precautions,” Dr. Dhuper said.

Vaccination research

Amid discussions related to vaccines, Dr. Nachman added that several compelling papers have demonstrated that people who are up to date on their vaccines, including flu, are at lower risk for dementia.

The link between vaccinations and overall brain health is unclear, and it is possible that people who receive vaccines also have a lifestyle that reduces the risk of developing dementia.

“We have an aging population in New York, particularly on Long Island,” said Dr. Nachmman. “If we want to keep them healthier longer, getting appropriate medical care, including vaccines, is probably helpful.”

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By Daniel Dunaief

Like the rest of the state and country, Suffolk County is grappling with a shortage of pediatric amoxicillin, the drug most often used to treat bacterial infections such as strep throat and ear infections.

In the last few weeks, parents have gone to their local pharmacies, only to find that the liquid form of the medicine that’s suitable for their children is out of stock.

“There is a shortage,” said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, who estimates that the medicine isn’t available about half the time the hospital prescribes it. “We worry that it’s going to continue to happen.”

As more children are around their friends and family before and during the holidays “it’s going to get worse,” she added.

This, doctors said, is not a Long Island or even a New York state problem. It’s national.

Nachman’s granddaughter needed amoxicillin in Florida. Her daughter drove around from pharmacy to pharmacy until she found one that had the medicine.

Doctors suggested that a number of factors have contributed to the shortage. For starters, some urgent care centers and doctors around the country are prescribing amoxicillin when children have viral infections. The medicine not only isn’t helping with sore throats or other viral symptoms, but it also isn’t as available for the children who have bacterial infections.

Nachman urges parents to make sure their children have an infection for which amoxicillin or any other drug works before picking it up from the pharmacy.

“When the pediatrician does a viral test and you get a positive, you know what it is,” she said. “When they do a throat swab for strep and it’s negative, you know what it’s not.”

Nachman told parents to ask whoever is prescribing antibiotics like amoxicillin if their children really need the medicine.

“If there is a silver lining, it’s forcing clinicians to try not to over prescribe it,” said Dr. James Cavanagh, director of Pediatrics at Port Jefferson’s St. Charles Hospital.

Finally, the stock of amoxicillin is low nationally.

For parents, the effect of the shortage has ranged from the expected anxiety over a limited resource to an awareness of a new reality.

Indeed, earlier this year, parents struggled to find baby formula.

“They are accepting of it, given the climate we’ve been in with formula,” Cavanagh said. “Parents are unfortunately getting used to it.”

Other infections

With viruses like respiratory syncytial virus, the flu, and COVID-19 prevalent and increasing in communities around Long Island, children and adults are increasingly getting sick and exhibiting the kind of general symptoms that could be viral or bacterial.

Stony Brook Children’s Hospital continues to have a steady stream of patients.

“We were full before Thanksgiving, full on Thanksgiving and full after Thanksgiving,” Nachman said. “As soon as a bed opens, another child comes in.”

While strep throat is easy to diagnose, ear infections can be either viral or bacterial.

Pediatric associations offer various guidelines. For children who are 9 and over, parents can do watchful waiting, but for children who are younger, like 4 months old, parents should use antibiotics.

While childhood forms of amoxicillin are limited, adult supplies, in the form of pills and capsules, are not. Children as young as 7 years old can take pills as long as the milligrams of the pills to the kilograms of the child’s weight are appropriate for
the dosage.

Nachman said Stony Brook Children’s Hospital has been doing a lot more calling to pharmacies near where patients live to ensure they have amoxicillin.

“That takes extra time,” she said. Those efforts could mean that families may have to wait longer in the emergency room.

The amoxicillin shortage can be worse for families that don’t have cars.

“How are they getting their prescriptions filled?” Nachman asked. “This is just one more worry.”

Alternatives

Area doctors and pharmacists suggested that there are alternatives to the pediatric form of amoxicillin. Children who are old enough and meet weight requirements can take a pill.

Alternatively, with careful medical guidance, parents can open up the right dose for capsules and mix it with applesauce or some other foods, according to the American Association of Pediatrics.

Doctors can also prescribe other broad spectrum antibiotics, such as augmentin and omnicef. 

Using these other antibiotics, however, increases the risk of developing antibiotic resistant infections later.

“The next infection may be harder to treat,” Cavanagh said.

These other antibiotics also may eliminate some of the good bacteria in the gut,
causing diarrhea.

As doctors have increasingly prescribed some of these other medicines, pharmacies have seen the supply of alternatives decrease as well.

“Everyone follows the same algorithm” in prescribing medicine, which means the demand for other prescriptions is increasing, Cavanagh added.

Immune boost

Doctors said children can enhance their overall health and immune systems with healthy eating and sleeping habits and by making sure they are up to date with available preventive measures.

“Get vaccinated,” Cavanagh said. He also urged good hand washing routines.

Cavanagh added that children exposed to cigarette smoke in a house are also at a higher risk of ear infection. As for what constitutes enough sleep for a child, doctors recommend between eight and nine hours per night. That, doctors said, is tough to get for children who sleep with a cell phone near their beds.

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Aleida Perez during BNL's virtual teaching sessions this summer

By Daniel Dunaief

For well over two years, herd immunity, vaccination status, social distancing, masking and airborne particles became regular topics of conversation. 

People have a range of understanding of these terms and how to apply them to understanding the fluid conditions that are an evolving part of the pandemic.

Aleida Perez

This summer, with funding from the National Science Foundation, a group of scientists and doctors from Brookhaven National Laboratory, Stony Brook University, New York University and MoMath, the National Museum of Mathematics, worked together with middle school and high school teachers around Long Island to prepare lesson plans on how to use and understand the application of statistics to the pandemic.

“It was a wildly successful summer,” said Dr. Sharon Nachman, Chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “We spent hours and hours of time” working with teachers who developed lessons that addressed a host of issues related to COVID-19.

It was “an amazing experience” and the teachers “were the best part,” said Dr. Nachman.

Allen Mincer, Professor of Physics at New York University, has been working on and off with BNL for over two decades on various educational programs. He has been more actively engaged in the last four years.

As he and his collaborators were discussing possible educational outreach topics, they focused on the disruptive disease that changed the world over the last few years.

“This year, we were talking about it and, instead of doing random applications of statistics, we figured, why not do something that’s very practical in everyone’s mind,” Mincer said.

The projects and discussions, which were all conducted virtually, centered on numerous misconceptions people have about the pandemic. Teachers focused on questions including: what is the “efficiency” of a vaccine and how is it determined, what does a positive virus test result mean, if I am vaccinated, why do I care if others are, why take a vaccine when there are side effects, and I have to go to school and mix with people, so why shouldn’t I also let down my guard in other ways, among others.

“The challenges that this virus brings concerning topics like herd immunity was very interesting,” said Scott Bronson, manager of outreach to K-12 teachers and student for BNL’s Office of Educational Programs.

Scott Bronson during the BNL virtual teaching sessions this summer.

For teachers and their students, the realities of the pandemic were the backdrop against which these teachers were seeking to provide guidance. “It was happening live,” said Bronson. “What is herd immunity? That’s where the work of [Dr. Nachman and Mincer] came together beautifully.”

Bronson added that students will have a chance to explore the kinds of questions pharmaceutical companies are addressing, such as “What would you want the next vaccine to do” and “What would you do to make the vaccine better at preventing infection.”

The organizers put together teams of three to four high school and middle school teachers who created statistics lessons plans for the group.

“The way we worked it out, we put teachers in groups,” said Aleida Perez, supervisor of student research and citizen science programs for Brookhaven National Laboratory’s Office of Educational Programs. “We wanted to have different teachers with different courses and different perspectives on how to do things.”

One of the overarching goals was to help students understand such lessons as what it means to have a negative result on a virus test or what it meant when scientists and pharmaceutical companies described a vaccine’s efficacy.

The teachers explored the probability of side effects like myocarditis and whether the “benefit outweighs the risk of taking the vaccine,” Perez said.

For many of the teachers, the discussion expanded beyond COVID to an analysis of any infectious agent. Indeed, one of the groups of teachers described a zombie apocalypse.

The teachers provided a “nice overview to look at the education of public students,” said Perez.

The group hopes to make these lessons available for other teachers, although they haven’t determined where or how to post them.

The scientific team also hasn’t determined yet how to measure the long term impact or effectiveness of these lessons.

ATLAS project

As a part of the team involved in the ATLAS physics program at the Large Hadron Collider in Geneva, Switzerland, Mincer uses statistics to design, test and implement the tools to pick and choose from numerous reactions and then to study the data collected.

“We actually keep about a billion events out of the 100 trillion or so interactions the LHC produces in a year,” Mincer explained.

In previous years, Mincer has taught about statistics in general and its use in ATLAS. This year, he focused on statistics and its application to pandemic questions.

Several years ago, Mincer taught a freshman seminar called “Great science, fabulous science and voodoo science,” in which he described what students could learn from statistics, how the media covers science, science and government policy and how lawyers use science in the courtroom.

“After explaining statistics [and sharing] why we can only say we have evidence down to this level, I had a student tell me he’s dropping out of science as a major because he wanted certainty and I disillusioned him,” Mincer said.

As for the work with the high school teachers, Mincer said it was “great what they have been able to do” in preparing lessons for their students and sharing information about statistics.

Mincer has received some additional funds from the NSF to support two more such educational outreach programs, one of which will tentatively cover climate change.

“Statistics can be used to quantify the likelihood of events in the absence of climate change,” he explained.

Statistics provide a tool to document subtle but potentially significant changes in climate.

While Bronson wouldn’t commit to a discussion of climate change for the next group of teachers, he said he “wouldn’t be surprised if we look at climate change” and that “there’s a lot of interesting areas to explore in this field.”

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Many doctors are suggesting people learn to live with the virus and begin returning to usual activities such as going to the movies. Photo from Pixabay

Dr. Gregson Pigott went to the movies this week.

While the activity would be considered mundane in 2019, the decision to go to the theater to catch a flick is yet another example of how local doctors, or, in this case, commissioner of the Suffolk County Department of Health Services, is practicing what he preaches.

“We need to learn to live with the virus,” said Pigott, who has also been to a few Brooklyn Nets basketball games. Pigott, who is not using a mask except in situations where it is required, such as on a plane or on public transit, suggested people are “trying to resume life as it was pre-COVID.”

While the percentage of positive tests has risen, the numbers haven’t raised any alarm bells.

The percentage of COVID positive tests increased to a seven-day average of 2.6% as of April 2, according to figures from the New York State Department of Health.

That figure is higher than it had been in the weeks prior, when the percentage dipped below 2%.

“I certainly expected this,” Dr. Sean Clousten, associate professor of Public Health at Stony Brook University explained in an email. “I suspect this increase is due to unmasking at public schools because many kids who are infected are asymptomatic or the symptoms are different.”

Pigott said the current symptoms for the newer variant of omicron, called BA.2, which is becoming the dominant strain across the country and through much of the world, includes stuffy noses, scratchy throat and a slight cough.

Clousten added that the symptoms can also appear more like a bad stomach bug.

Second booster

Recently, the Food and Drug Administration approved a second booster for people over 50 and for those who are immunocompromised and who had a first booster more than four months ago.

Pigott said he would urge people who are over 65 or those who are immunocompromised to consider getting another jab.

“Most of the general population is fine with the three-shot regimen,” Pigott said. “Your body will recognize any kind of COVID infection and deal with it quickly.”

Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, indicated in an email that Stony Brook has been “advocating for switching vaccines.”

Switching vaccines could mean triggering a different response to the shot for the second booster, Nachman added.

Data about a second booster shows that the shot provides “good protection” against serious COVID, Nachman said. “Will it protect against any infection (meaning you might get a runny nose, cough or upper respiratory infection)? Not really.”

Nachman urged people to consult with their primary care doctor to decide whether to take a booster. What people are doing and where they are going can and should affect that decision.

Finally, daily activities such as going back to a crowded office or starting to take New York City transit could be “excellent reasons” to get a booster, she said.

Nachman plans to get a booster, although she is working on the best timing for another shot.

“Before I travel abroad is key to making sure I have my booster and am protected,” Nachman added.

Conferences

Nachman is encouraged that people are returning to in-person conferences and other activities.

“It will be great to have people starting to get back to routine living, and that means being with other people,” she explained in an email.

She urged people to stay at home if they don’t feel well.

“Now is not the time to push to go to that meeting or get together with extended family, since you might just be responsible for getting someone else sick,” she explained.

She suggested people should be patient and understanding of others who choose to wear masks or continue to practice social distancing.

“Don’t shame anyone who is wearing a mask,” Nachman advised. “If that is what it takes to get them together with you in public, go for it.”

In another sign of a return to a pre-pandemic life, Pigott suggested that the Health Department was planning to direct more resources to tracking illnesses like Lyme disease.

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