COVID-19 - Mount Sinai Health System - Internal Broadcast Communications

COVID-19 March 2020 - March 2021

Mount Sinai Health System • Internal Broadcast Communications Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

Subject: Date: From:

March 17, COVID-19 Health System Updates Tuesday, March 17, 2020 at 9:11:50 AM Eastern Daylight Time Broadcast NoJficaJons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

March 17, 2020

RE:

COVID-19 Health System Updates, March 17

Good morning. As we enter the third week of our region’s COVID-19 health care crisis, I want to tell you how many stories I am hearing about your efforts that leave me in awe. You are displaying true heroism at a moment when our neighbors need us most. I will be sharing some of those stories with you in the coming days.

In the meantime, I want to assure you that your well-being matters more than ever. As the regional situation continues to change, we must adapt and evolve. That’s why you will see changes to our masking, visitation, and volunteer policies across the system.

We are making these changes with your and your patients’ health in mind as we all continue to adjust to new realities and work to keep everyone safe.

As a reminder, more detailed information on these changes and all employee resources are now available on a public website that doesn’t require a password: http://www.mountsinai.org/covid19staffresources.

Additionally, we want to be as transparent as possible with all of you and give you the information you need to do your jobs but also to have peace of mind. Not surprisingly, we have received many questions about the volume of patients with COVID-19 in our health system and we want to address those questions. As of yesterday, across all of our hospitals we had 25 inpatients who were tested and found to be positive. We had another 103 patients who were under investigation and monitoring for possible COVID19 infection.

New Masking Policy Due to the increase in community spread, starting today, we recommend that all staff who provide direct patient care wear a mask. Any masks that become wet or soiled should be replaced, but we also ask that everyone does their best not to be wasteful and to preserve resources as much as possible.

New Visitation Policy Page 1 of 3

We are prohibiting all visitors across the Mount Sinai Health System. This includes visitors to the emergency departments, inpatient units, ambulatory sites, and other facilities.

While these are difficult changes, they are necessary steps aimed at achieving our top priority: the safety and health of our staff and patients. There will, however, be a few important exceptions, which apply only to healthy visitors. Those include: · · · · · ·

Pediatrics/NICU: One healthy visitor allowed.

Maternity and Postpartum: One healthy partner allowed.

End of Life/Palliative Care: One healthy visitor allowed.

Ambulatory Geriatrics: One healthy visitor allowed.

Discharge: One healthy visitor allowed to pick up discharged patients.

For the Emergency Departments: For patients requiring assistance, one healthy visitor is allowed. Only one visitor per pediatric patient is allowed in the pediatric ED (parent or caregiver only).

If visitors show any COVID-19 symptoms, staff should politely ask them to leave and provide them with follow-up information. We also know there may be unique situations depending on patient need. If you believe an exception to the above policy should made, please speak to your supervisor. Above all, let’s use our common sense and good judgment to do the right thing.

Volunteer Policy Effective Thursday, March 19, volunteer assignments in patient care areas will be temporarily suspended. Processing of new volunteers will also be temporarily suspended. Please visit the policy page on the employee website for additional details.

Employee Health Monitoring Guidelines Finally, we have created a new Mount Sinai Employee Testing, Monitoring, and Clearance Process. This new guide directs you on what symptoms to look for in yourself, what to do if you do become sick, how to get tested, and when you could return to work if you do get sick. This document and all health system COVID-19 Employee Resources can now be found on our new website.

If there are any questions on the steps we are taking, please do not hesitate to reach out and contact us at CovidQuestions@mountsinai.org I want to say again that I have never been prouder to be your colleague and to wear the Mount Sinai badge.

Page 2 of 3

COVID-19 Headlines March 17, 2020 NEW MASKING POLICY: Due to the increase in community spread, starting today, we recommend that all staff who provide direct patient care wear a mask. Any masks that become wet or soiled should be replaced, but we also ask that everyone does their best not to be wasteful and to preserve resources as much as possible.

NEW VISITATION POLICY: We are prohibiting all visitors across the Mount Sinai Health System. This includes visitors to the emergency departments, inpatient units, ambulatory sites, and other facilities. There will, however, be a few important exceptions, which apply only to healthy visitors. Those include:

• Pediatrics/NICU: One healthy visitor allowed.

• Maternity and Postpartum: One healthy partner allowed.

• End of Life/Palliative Care: One healthy visitor allowed.

• Ambulatory Geriatrics: One healthy visitor allowed.

• Discharge: One healthy visitor allowed to pick up discharged patients.

• For the Emergency Departments: For patients requiring assistance, one healthy visitor is allowed. Only one visitor per pediatric patient is allowed in the pediatric ED (parent or caregiver only).

We also know there may be unique situations depending on patient need. If you believe an exception to the above policy should be made, please speak to your supervisor. Above all, let’s use our common sense and good judgment to do the right thing.

N EW GUIDE ON MONITORING AND MANAGEMENT OF YOUR OWN HEALTH: There is a new guide to the Employee Testing, Monitoring, and Clearance Process.

This directs you on what symptoms to look for in yourself, what to do if you do become sick, how to get tested, and when you can return to work if you do get sick. This document and all health system COVID-19 Employee Resources can now be found on our new website.

Subject: Date: From:

March 18, COVID-19 Health System Updates Wednesday, March 18, 2020 at 8:59:42 AM Eastern Daylight Time Broadcast NoKficaKons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

March 18, 2020

RE:

COVID-19 Health System Updates, March 18

COVID-19-positive cases continue to rise significantly each day. Governor Cuomo said yesterday that state modeling predicts that the number of cases, and the pressure on the health care system, will peak in about 45 days. These models are not perfect, but they do give us insight into what we need to prepare for. It is likely that we will need to massively expand our capacity to meet the need in the coming weeks. City, state, and federal regulations are being modified to make it easier for us to do that.

As the city and state take new steps to promote social distancing among the public, we are working to amplify that message across our communities in every way possible.

And we need your help. Everyone—family, friends, and neighbors—needs to heed the warnings so we can slow down the rate of infection.

As of this morning there are 63 COVID-19 positive inpatients in our hospitals.

Employee resource website redesign The easy-to-access COVID-19 employee resource website redesign went live overnight. As a reminder, this doesn’t require any password or access to the intranet. It is now designed to make it easier for you to find what you need.

Keeping your Mount Sinai ID badge with you at all times As the region’s social distancing efforts continue to increase, it is important that you keep your Mount Sinai ID badge with you at all times. It is a means of demonstrating that you are in an essential function, and you may need it to ease your movement within the region and within our health system.

Guide to personal protective equipment (PPE) practices Page 1 of 2

There is a terrific new guide that will help you know when to wear what and how to use it. You can find it here.

I want to end on this note. I know that many of you are managing disruption and anxiety in your home lives in addition to the challenges that you face at work. You have partners and spouses and friends who are facing economic distress, job loss, and illness. You have children home from closed schools, and they may be scared and confused. There is nothing easy about your work or home lives right now. We have to remember that, as hard as things are, and as hard as they become, we will get through this. The pandemic will end. We will get back to normal. In the meantime, let’s remember to take the best care of each other that we possibly can. Each and every act of kindness and patience and decency will make us more resilient in the coming days.

Page 2 of 2

COVID-19 Headlines March 18, 2020 EMPLOYEE RESOURCE WEBSITE REDESIGN The easy-to-access COVID-19 employee resource website redesign went live overnight. As a reminder, this doesn’t require any password or access to the intranet. It is now designed to make it easier for you to find what you need.

K EEPING YOUR MOUNT SINAI ID BADGE WITH YOU AT ALL TIMES As the region’s social distancing efforts continue to increase, it is important that you keep your Mount Sinai ID badge with you at all times. It is a means of demonstrating that you are in an essential function, and you may need it to ease your movement within the region and within our health system.

G UIDE TO PERSONAL PROTECTIVE EQUIPMENT (PPE) PRACTICES There is a terrific new guide that will help you know when to wear what and how to use it. You can find it here.

Subject: Date: From:

March 19, COVID-19 Health System Updates Thursday, March 19, 2020 at 9:02:08 AM Eastern Daylight Time Broadcast NoIficaIons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

March 19, 2020

RE:

COVID-19 Health System Updates, March 19

Predictive models suggest that the number of COVID-19 cases here in our region is likely to grow for the next 45 days or so before tapering off. We are working to build new capacity in our health system to meet the growing demand. And the city, state, and federal governments are mobilizing to help. As an example, just yesterday it was announced that the USS Comfort, a floating hospital capable of treating 1,000 patients at a time, will be brought to New York Harbor to help. Regulations are also being modified to make it easy for doctors and other clinical staff to cross state boundaries to pitch in. These are encouraging developments.

Here in our own Health System, we need to mobilize each and every member of the Mount Sinai family to aid in the fight. No matter your current role, no matter your job title, no matter your location, you will have a critical role to play in helping Mount Sinai save as many lives as possible and in providing aid and comfort to our communities and our colleagues. Whether you are at the front lines in the fight, or helping to supply the front lines, or fielding calls from frightened and isolated members of our communities, or participating in one of the many other jobs that are needed, you are absolutely vital. Stay tuned to this channel for more information in the days ahead.

Here are the latest stats on where things stand: As of yesterday afternoon, there were 83 COVID-19-positive inpatients in our hospitals, and 27 of those patients were in ICUs. There were an additional 172 patients under investigation (PUI).

Guide to Personal Protective Equipment (PPE) Practices Yesterday we sent you a new PPE guide to help you know what equipment to wear and when. New updates have been made to that document, which can be found here.

New Parking Policy

Page 1 of 2

Daily parking for staff at many of our sites is now free. Information can be found here.

Updates to Lectures, Events, and Meetings Policy Effective today, Thursday, March 19, we are expanding our restrictions on lectures, events, and meetings. Information can be found here (click this link and then click on “Lectures, Events and Meetings Policy”).

The reality of COVID-19 in the region is settling in; it is here, and it is serious. Every community we serve is now impacted. Our nearly 50,000-person-strong Mount Sinai family will work as one to see this through.

Page 2 of 2

COVID-19 Headlines March 19, 2020 ALL HANDS ON DECK: Here in our own Health System, we need to mobilize each and every member of the Mount Sinai family to aid in the fight. No matter your current role, no matter your job title, no matter your location, you will have a critical role to play in helping Mount Sinai save as many lives as possible and in providing aid and comfort to our communities and our colleagues. Whether you are at the front lines in the fight, or helping to supply the front lines, or fielding calls from frightened and isolated members of our communities, or participating in one of the many other jobs that are needed, you are absolutely vital. Stay tuned to this channel for more information in the days ahead.

Subject: Date: From:

COVID-19 Health System Updates, March 20 Friday, March 20, 2020 at 9:36:06 AM Eastern Daylight Time Broadcast NoJficaJons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

March 20, 2020

RE:

COVID-19 Health System Updates, March 20

Personal protective equipment is the lifeblood of a pandemic fight. I am seeing a massive response to our efforts to acquire as much of it as we will need. Everyone is stepping up. Members of our Boards of Trustees are using every available relationship to find solutions, and we are already seeing significant donations as a result of those efforts. Our connections to companies and hospitals in China are helping us identify additional sources. Our city and state leaders are using every mechanism available.

And most recently, the companies in China that were shut down while they fought COVID-19 were reopened and are now mass-producing what we need. It is important that you know we are doing everything possible—and I mean everything—on this front so that you can support your patients and communities.

In addition, the city and state continue to make measures to reduce the spread and flatten the curve. Governor Cuomo just announced that he is requiring 75 percent of employees in nonessential businesses to work from home—a positive step in reducing density and promoting distancing. This is a welcome development.

For Mount Sinai, our testing capacity is expanding significantly as well. As we work to bring all of our COVID-19 testing in-house, results are coming back faster, which will help us move patients appropriately and create more space in our hospitals for additional patients in need.

As of yesterday afternoon, we had 151 COVID-19-positive patients in our hospitals.

That includes 38 patients in our ICUs, with another 155 inpatients under investigation (PUIs).

Employee Resource Website Our COVID-19 employee resource website was recently overhauled and is now live. It is much more navigable and contains additional resources to answer your questions.

You are one click away—with no password or intranet access required.

Page 1 of 2

Broadcast This Saturday This Saturday, I will send you a special edition of my morning update asking you to go to our webpage and register for the fight. There will be important ways to contribute, and we will need everyone, so please look out for that communication this weekend.

New Guidance on Mental Health Self-Care There is a new letter up on the employee resource website that I hope you will take a few minutes to read. It provides useful advice from our experts on what you can do to stay mentally strong and focused throughout this crisis. I haven’t met too many people who aren’t struggling in one way or another with the enormity of what we are facing.

This guidance can make a difference. It can be found here.

Donation Information There has been an outpouring of people wanting to donate goods or money to Mount Sinai during this crisis. If you are receiving calls or emails about donations, please contact Development at DevMSHS@mountsinai.org.

Monetary donations can be made online to the special COVID-19 fund by clicking here.

Appreciation Video I also want to draw your attention to a special message to health care workers from some of New York’s most famous. The world continues to recognize your heroism.

One last message for today. What we’ve weathered—and overcome—so far is just the beginning. We know this already has been and will be an arduous journey in the days and weeks to come. But at this moment in human history, we remember why we went into health care in the first place: to make a difference. Every one of us, no matter who you are or what you do, is playing a critical role in saving our fellow New Yorkers. In this all-hands-on-deck moment, we are going to continue to be challenged, personally and professionally. But we are going to forge ahead and succeed in this fight … together.

Page 2 of 2

COVID-19 Headlines March 20, 2020 PERSONAL PROTECTIVE EQUIPMENT

Personal protective equipment is the lifeblood of a pandemic fight. We are seeing a massive response to our efforts to acquire as much of it as we will need. Everyone is stepping up. Members of our Boards of Trustees are using every available relationship to find solutions, and we are already seeing significant donations as a result of those efforts.

Our connections to companies and hospitals in China are helping us identify additional sources. Our city and state leaders are using every mechanism available. And most recently, the companies in China that were shut down while they fought COVID-19 were reopened and are now mass-producing what we need. It is important that you know we are doing everything possible—and we mean everything—on this front so that you can support your patients and communities.

BROADCAST THIS SATURDAY This Saturday we will ask you to go to our webpage and register for the fight. There will be important ways to contribute, and we will need everyone, so please look out for that communication this weekend.

DONATION INFORMATION There has been an outpouring of people wanting to donate goods or money to Mount Sinai during this crisis. If you are receiving calls or emails about donations, please contact Development at DevMSHS@mountsinai.org. Monetary donations can be made online to the special COVID-19 fund by clicking here.

Subject: Date: From:

COVID-19 Health System Updates, March 21 Saturday, March 21, 2020 at 9:12:14 AM Eastern Daylight Time Broadcast NoIficaIons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

March 21, 2020

RE:

COVID-19 Health System Updates, March 21

New York now represents approximately half of all COVID-19-positive cases nationwide. To better slow the rate of transmission, yesterday Governor Cuomo signed an executive order requiring, by 8 pm tomorrow, the closure of all nonessential businesses statewide.

This order excludes health care facilities and does not affect our health system. All Mount Sinai employees and voluntary and affiliated doctors and medical practices are deemed essential workers.

Here in our own health system it is All Hands on Deck.

Every single person, in every corner of our organization, has a role to play at this critical moment in the fight against COVID-19. That’s why today’s update is so important.

All Hands on Deck Sign-ups If you are not already fully engaged in COVID-19 response, please click on this link to learn how you can help and to provide us with information that will enable us to identify a vital role for you in this work. This is a mission-critical step in our ability to save as many lives as possible.

Day Care and NYCDOE Regional Enrichment Center Enrollment For those staff who require care for their children and live in the five boroughs, the NYC Department of Education will open Regional Enrichment Centers and early childhood centers starting on Monday, March 23rd from 7:30am to 6:00pm, MondayFriday. Regional Enrichment Centers are only open to children whose parents or guardians are in essential fields – like health care and emergency services – and children who are enrolled can attend anytime during open hours. You can enroll your Page 1 of 2

children by clicking here.

Employee Health Services Update Mount Sinai Health System employees who are ill, are concerned about COVID-19 exposure, or who need clearance to return to work can contact Employee Health Services this weekend for telephonic consults. This service is available between 7:30 am and 7:30 pm on Saturday, March 21, and Sunday, March 22. If you have COVID-19 related questions about your health, please call 212-844-1100 for a consultation.

Physicians will be on hand for a symptom check and advice on next steps.

Keeping Your Mount Sinai ID Badge With You at All Times As New York’s social distancing efforts continue and with nonessential businesses closing on Sunday, it is important that you keep your Mount Sinai ID badge with you at all times. It demonstrates that you are in an essential function to the city at a time when nonessential organizations are closing and the public is largely expected to remain at home. Having your ID badge with you may be needed to ease your movement within the region and within our Health System.

I want to end on this note. There are so many questions that you must have right now.

We have many answers up on the employee resource website. And we will be adding much, much more in the coming days. We get asked a lot about how we will help people who are redeployed into new roles know how to work in those new roles. That is a big focus of our own efforts right now – making sure that everyone will be ready for what we ask of them.

Page 2 of 2

COVID-19 Headlines March 21, 2020 ALL HANDS ON DECK SIGN-UPS If you are not already fully engaged in COVID-19 response, please click on this link to learn how you can help and to provide us with information that will enable us to identify a vital role for you in this work. This is a mission-critical step in our ability to save as many lives as possible.

D AY CARE AND NYCDOE REGIONAL ENRICHMENT CENTER ENROLLMENT For those staff who require care for their children and who live in the five boroughs, the New York City Department of Education will open Regional Enrichment Centers and early childhood centers starting on Monday, March 23, from 7:30 am to 6 pm, Monday-Friday.

Regional Enrichment Centers are only open to children whose parents or guardians are in essential fields – like health care and emergency services – and children who are enrolled can attend anytime during open hours. You can enroll your children by clicking here.

EMPLOYEE HEALTH SERVICES UPDATE Mount Sinai Health System employees who are ill, are concerned about COVID-19 exposure, or who need clearance to return to work can contact Employee Health Services this weekend for telephonic consults. This service is available between 7:30 am and 7:30 pm on Saturday, March 21, and Sunday, March 22. If you have COVID-19 related questions about your health, please call 212-844-1100 for a consultation. Physicians will be on hand for a symptom check and advice on next steps.

Subject: Date: From:

COVID-19 Health System Updates, March 23 Monday, March 23, 2020 at 9:19:27 AM Eastern Daylight Time Broadcast NoIficaIons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

March 23, 2020

RE:

COVID-19 Health System Updates, March 23

This weekend, Drs. Davis and Charney sent out a call to action for those not already fully engaged in the fight against COVID-19. The response has been extraordinary. If you haven’t already signed up, you can do so here. I want to answer a few questions about this that I know you must have.

What if I don’t have a clinical background? We have many mission-critical jobs that don’t require any clinical training at all.

What if I am at a higher risk for complications from COVID-19 infection? We can make accommodations to keep you safe. Many critical jobs can even be performed from your own home or a remote location.

What if I have a clinical background and am redeployed to a role that I am not trained for? We have you covered. We will provide training to make sure you are ready for your new role and will make sure you have the support you need while you are performing that role.

Current Status of COVID-19 in Our Hospitals As of Sunday afternoon we have 393 COVID-19 positive patients in our hospitals. That includes 89 patients in our ICUs. We have another 91 inpatients under investigation (PUIs). We have 60 open ICU beds. Our predictive models continue to show increasing volumes for another 40 days or so before they start to drop again.

The Governor and the New York State Department of Health are calling on all hospitals to develop the capability to care for 50 percent more inpatients than under normal circumstances. We are aggressively working toward that goal and have a lot of work ahead of us.

Regional Response Governor Cuomo accepted the Army Corps of Engineers’ recommendations for four Page 1 of 3

temporary hospital sites: the Javits Convention Center, SUNY Stony Brook, SUNY Westbury, and Westchester Convention Center. The city and state are also working aggressively to get us additional equipment and supplies, including personal protective equipment (PPE).

Personal Protective Equipment To get you what you need to be safe for the duration of this crisis, the entire organization—including the Boards of Trustees—has mobilized and they are leaving no stone unturned. I am beyond impressed with the creativity and the bold risk-taking that is being applied to ensure that you have what you need to do your best for our patients, yourselves, and each other. It feels great to work for an organization that gets it: we can’t take care of our patients if we don’t take care of our people. This effort has been awe-inspiring. And it is working. More on this in the coming days.

Medline Reprocessing of N-95s and Face Shields On a related note, Medline, Inc., will soon be reprocessing our used N-95 masks and face shields using an FDA-approved process to get them back to us so that we can reuse them. The process includes many steps, and they will carefully examine each N95 and face shield to ensure that all equipment is fully sterilized, functional, and not damaged or torn. Many of the masks that they work to reprocess won’t be acceptable to reuse and Medline will throw them out. But the ones that do get through their entire process will be 100 percent safe to use and meet all FDA and regulatory requirements that a new mask meets. We will not allow any faulty or unsafe PPE to pass to you under any circumstances. Tomorrow I will update you on where to place your used N95s and face shields so that they can be shipped to Medline.

Offers of Supplies and Equipment If you receive offers to donate supplies and equipment, or offers from vendors looking to sell us supplies and equipment, or offers of monetary donations, redirect them to this webpage. If you lose track of the webpage you can find it on the COVID-19 employee resources site. By the way, the offers are being managed by a team of our Health System colleagues, including our graduate students and others, who have signed up for the fight. Huge thanks to them for playing this vital role.

Proper Eye Protection We have noted in past updates when and in what circumstances the use of N-95 respirators is appropriate. Today, I want to remind everyone about proper eye protection for COVID-19. Eye protection, plus surgical mask or N-95 respirator, should be worn when caring for COVID-19-positive patients and PUIs who are on Special Droplet Precautions. Acceptable eye protection includes a surgical mask with an attached face shield, a full face shield, or goggles, which, according to the CDC, offer an effective alternative to face shields. A full face shield is preferable as it helps with the conservation of surgical masks or N-95 respirators, which are less likely to be contaminated during any encounters with COVID-19 patients and PUIs. Finally, I wanted to share a must-read article by Atul Gawande on the lessons learned from the outbreak in Asia. I guarantee that you will find it worth the time.

Amidst all the work of the last few days I found myself reflecting on what we have already accomplished together and on your awe-inspiring bravery. It left me profoundly humbled. God bless you all.

Page 2 of 3

COVID-19 Headlines March 23, 2020 This weekend, Drs. Davis and Charney sent out a call to action for those not already fully engaged in the fight against COVID-19. The response has been extraordinary. If you haven’t already signed up, you can do so here.

What if I don’t have a clinical background?

We have many mission-critical jobs that don’t require any clinical training at all.

What if I am at a higher risk for complications from COVID-19 infection?

We can make accommodations to keep you safe. Many critical jobs can even be performed from your own home or a remote location.

What if I have a clinical background and am redeployed to a role that I am not trained for?

We have you covered. We will provide training to make sure you are ready for your new role and will make sure you have the support you need while you are performing that role.

Subject: Date: From:

COVID-19 Health System Updates, March 28 Saturday, March 28, 2020 at 12:02:23 PM Eastern Daylight Time Broadcast NoJficaJons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

March 28, 2020

RE:

COVID-19 Health System Updates, March 28

We’ve been through a tough stretch, but we’ve made tremendous progress in being able to serve more patients in need at one time than we have ever served before. New units continue to open, you and your colleagues continue to inspire the world with your heroism, and the supply lines are opening up. We are moving patients between hospitals to try and relieve any pressure points while we still have the capacity to do so. It is an amazing amount of progress in a short time.

The city and state continue to add critical medical capacity. The U.S. Navy hospital ship, the USNS Comfort, will be docking in New York on Monday, bringing 1,000 more beds and 1,200 medical personnel to the mission.

The Javits Center’s physical retrofitting is now complete, adding 1,000 new beds. And officials are considering additional sites to bring thousands of new beds online, including the Brooklyn Cruise Terminal, the Aqueduct Racetrack, CUNY Staten Island, and the New York Expo Center. Governor Cuomo said the state is also considering converting dormitories at City College and Queens College into hospital rooms, as well as rooms at the Marriott Brooklyn Bridge Hotel. This added capacity will help alleviate the burden on all of us and ultimately save lives.

Incredibly, our Health System has 400 more ventilators available for use than we had just a few weeks ago. Each of them will help save many lives.

As of yesterday afternoon, we had 1,014 COVID-19 positive patients in our hospitals.

That includes 184 patients in our ICUs. We had another 128 inpatients under investigation (PUIs).

Your City Applauds You Page 1 of 2

Yesterday evening, in a display of support and gratitude for the work you and partners across the city are doing, New Yorkers across the five boroughs conducted a citywide, simultaneous clap at 7 pm. You can read about the #ClapBecauseWeCare campaign and see video of it here.

New Way to Recognize Your Colleagues There is a new web portal to submit stories about selfless, above-and-beyond or otherwise remarkable acts by your colleagues engaged in the COVID-19 response: mountsinai.formstack.com/forms/covid19_stories Updated Employee Testing, Monitoring, and Clearance Process This weekend, from 7:30 am - 7:30 pm, an Employee Health Services (EHS) hotline can be reached at 212-844-1100. Anyone who has questions should take advantage of it. Providers will be on hand for a symptom check and advice on next steps.

Likewise, the new employee testing, monitoring, and clearance process can be found here. This new guide is easy to understand and follow and will be useful to you.

COVID-19 Labor/HR Frequently Asked Questions (FAQs) This FAQ has been updated and can be found here.

Fundraising News In another encouraging development, more than $20 million in philanthropy has already been raised to support our COVID-19 efforts. Your work is inspiring people across the world to donate, which will help ensure that we have the tools we need in this humanitarian mission of our lifetimes. As you encounter those who want to be supportive to our cause, please share the link to our giving site. giving.mountsinai.org/.

Finally, I just want to reiterate what your work means to your city, country, and to the world. This is a moment in human history and once-in-a-lifetime battle. I couldn’t be prouder to be your colleague, and I couldn’t be prouder to wear the Mount Sinai badge.

Page 2 of 2

COVID-19 Headlines March 28, 2020 A New Way to Recognize Your Colleagues There is a new web portal to submit stories about selfless, above-and-beyond, or otherwise remarkable acts by your colleagues engaged in the COVID-19 response.

U pdated Employee Testing, Monitoring, and Clearance Process This weekend, from 7:30 am - 7:30 pm, an Employee Health Services (EHS) hotline can be reached at 212-844-1100. Anyone who has questions should take advantage of it. Providers will be on hand for a symptom check and advice on next steps. Likewise, the new employee testing, monitoring, and clearance process can be found here. This new guide is easy to understand and follow and will be useful to you.

COVID-19 Labor/HR Frequently Asked Questions (FAQs) This FAQ has been updated and can be found here.

Subject: Date: From:

COVID-19 Health System Updates, March 29 Sunday, March 29, 2020 at 11:16:34 AM Eastern Daylight Time Broadcast NoKficaKons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

March 29, 2020

RE:

COVID-19 Health System Updates, March 29

It is the weekend but it sure doesn’t feel like the weekend.

Before COVID-19, for our many weekday work colleagues, the weekend provided time to pause and reflect; to recover physically and emotionally; to connect with others at home, in the community, or perhaps in houses of worship; and to restore ourselves in preparation for the coming week. For our colleagues who work weekends, this restoration may similarly occur on weekday days off.

In the time of COVID-19, the opportunity to strengthen personal connections, reflect, recharge, and recover has become much rarer, but it has never been more important.

Many of you are so deeply engaged in the mission right now that the idea of taking time for yourself to reflect and recover perhaps feels unwarranted or simply impossible.

Even taking just a couple of minutes to go to the wellness resources on the employee resource website might feel like a stretch given the pace and intensity of the work.

But here is the catch. Finding time to care for ourselves allows us to better care for others. At times the work is overwhelming and prevents us from finding time for selfcare. But just like on an airplane in an emergency, we’ve got to put on our oxygen masks first, so we can have the strength to put them on others.

There are no easy answers for this and no quick fixes. The loss and the suffering that you are experiencing can be totally overwhelming at times. That is a normal human response.

And while we keep working, we do in fact work to stay connected and are reminded of all the good we are doing.

One of our colleagues, Donald, sent me an idea that hit home. It reminds me of similar Page 1 of 2

practices stretching back thousands of years during times of great duress.

He writes...

Mount Sinai is a very special place. Day in and day out, an outsider looking in would be amazed by the teamwork and camaraderie that exists around the health care system.

Sitting at home this weekend, I am thinking about my colleagues, and thinking about how we can honor our own health care workers, honor health care workers around the United States, and honor health care workers globally.

I would like to start the Mount Sinai Miracle Minute.

At 12 noon, every day, I would like us to stop and pray, or reflect, or simply offer silence for just one minute... for each other, for our families, for health care workers worldwide, and for our patients and communities… In these extraordinary times, I believe this exercise will help give people a feeling of pride, and connection to each other, and the fortitude to go on.

I believe that the Mount Sinai Miracle Minute will give us strength, because together, nothing can beat us.

The world is taking a moment for all of us at 7 pm each day, clapping and cheering, applauding our bravery.

We can do the same for ourselves.

Donald, count me in. Starting today, I will be setting my smartphone alarm for 12 pm every day and, in that moment, doing exactly as you suggest.

It might just be me and Donald doing this.

But I hope it will be you too.

Page 2 of 2

Subject: Date: From:

COVID-19 Health System Updates, April 13 Monday, April 13, 2020 at 9:08:15 AM Eastern Daylight Time Broadcast NoJficaJons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

April 13, 2020

RE:

COVID-19 Health System Updates, April 13

Throughout this pandemic, I have promised you transparency and honesty. That includes being honest about setbacks we encounter along the way, which is what I want to do today.

The first is that our inpatient COVID-19 census actually increased a bit over the weekend. This was a small change in volume but an increase nonetheless. We are not seeing a significant uptick in admissions, however, so this was most likely due to a relatively light number of discharges over the weekend. We should catch up now that the week has started and will keep a close eye on this.

The second relates to our personal protective equipment. In the early phase of this pandemic, our biggest concern was sourcing enough N-95 respirators. As I have mentioned in some prior notes, we have met with considerable success in that area, as well as in sourcing face shields, surgical masks, and gloves. We have not been quite as successful in sourcing gowns. We definitely have enough gowns to keep you safe for now, and we are doing everything possible to make sure that we have enough for the duration of this mission no matter how long it lasts. But we are not out of the woods yet on this one.

On a related note, this week you may see some gowns that you are unfamiliar with.

These have been evaluated as safe and effective by our infection prevention, life safety, and other clinical experts. There is information about them here, and you can find information about all the PPE that is currently in use around the system here.

As of yesterday afternoon, we had 1,962 COVID-19-positive patients in our hospitals.

That included 452 patients in our ICUs. We had another 127 inpatients under investigation (PUIs).

LIVING WITH UNCERTAINTY There is a brief new message, here, that offers guidance on dealing with the unknown.

Page 1 of 2

In many ways we are in uncharted territory. We are heartened that our patient volumes have stabilized and in knowing that we are helping so many to recover. Yet, in all aspects of our lives, we still face uncertainty. We will continue to see both progress and setbacks as we work our way back to normal. Managing through uncertainty can be aided by using a number of tips found in this new message.

HOUSING AND HOTELS FOR OUR MOUNT SINAI FAMILY Through the Bone Marrow & Cancer Foundation (BMCF) and AirBnB Open Homes program, Mount Sinai health care workers and first responders have been offered free accommodations for this month. These offers are in addition to the many other hotel accommodations that were previously announced in Dr. Davis’s emails. You can find more information on the Employee Resources site under HR Information's Hotel Accommodations for Mount Sinai Employees section, and on the Well-Being Basic Needs page under Housing and Accommodations.

THANKS TO YOU… Yesterday, to recognize your work, compassion, and dedication, as well as that of your loved ones who make your work possible, we said “thank you” in a full-page ad in The New York Times Magazine. It ran yesterday, and this is what it looked like:

FINAL THOUGHT I hope you will turn up the volume on your phone or computer and watch this slideshow of “What N.Y.C. Sounds Like Every Night at 7.” Across the five boroughs, your neighbors are clapping, banging pots and pans, and celebrating you and your work each night. The world continues to recognize your heroism, and it is the honor of my life to wear the Mount Sinai badge along with you.

Page 2 of 2

Subject: Date: From:

COVID-19 Health System Updates, April 14 Tuesday, April 14, 2020 at 9:51:16 AM Eastern Daylight Time Broadcast NoKficaKons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

April 14, 2020

RE:

COVID-19 Health System Updates, April 14

Yesterday I wrote you that our inpatient COVID-19 census had increased a bit over the weekend. Today I am heartened to report that we are moving in the right direction again. We continue to have enough PPE and ventilators to keep you and your patients safe. And we are turning over every stone to ensure that we have enough of all of these things for as long as we need. We are still not satisfied with our supply of gowns.

But we are sourcing more almost every day, and we certainly have enough for the time being.

After a wet and windy Monday, the sun is out again.

How do we put into words what your work means to the 2,400 patients you have healed and successfully discharged from our hospitals? Or what your work means to their family members, friends, and other loved ones? How do we put into words the compassion, and kindness, and care that you have shown to those we haven’t been able to save? Sometimes words aren’t enough.

As of yesterday afternoon, we had 1,955 COVID-19 positive patients in our hospitals.

That included 453 patients in our ICUs. We had another 156 inpatients under investigation (PUIs).

Updates to the Visitor Policy The State of New York recently issued new guidance regarding visitors, and we have updated our policies accordingly. You can find more information here.

PPE Update In addition to the new gown I mentioned yesterday, two more will be introduced this Page 1 of 2

week. These have been evaluated as safe and effective by our infection-prevention, life-safety, and other clinical experts. You can find more information about them here, and you can find information about all our PPE items here.

New Ad Campaign There is a new ad campaign honoring members of our Mount Sinai family. The campaign, which you can see here, is an acknowledgement of your heroism and your humanity.

Photographic Record There is also a new photo project capturing Mount Sinai during the pandemic, which you can see here. We are continuing to collect additional photos here and hope you will share yours.

Extraordinary Contributions From Our Students I’d like to highlight the students of the Icahn School of Medicine, who together have volunteered thousands and thousands of hours in this humanitarian mission of our lifetimes. You can learn more about their extraordinary contributions here.

Final Thought One month ago, I wrote this...

“I want to end on this note. I know that many of you are managing disruption and anxiety in your home lives in addition to the challenges that you face at work. You have partners and spouses and friends who are facing economic distress, job loss, and illness. You have children home from closed schools, and they may be scared and confused. There is nothing easy about your work or home lives right now. We have to remember that, as hard as things are, and as hard as they become, we will get through this. The pandemic will end. We will get back to normal. In the meantime, let’s remember to take the best care of each other that we possibly can. Each and every act of kindness and patience and decency will make us more resilient in the coming days.”

It all remains true. Even more so, we have grown closer together as a family. We are more trusting of each other. We are more forgiving of each other’s faults and mistakes.

We are quicker to ask for and to offer help.

And we are another month closer to being on the other side of all this.

It is the honor of my life to be your colleague and to wear the Mount Sinai Badge with you.

Page 2 of 2

COVID-19 Headlines April 14, 2020 UPDATES TO THE VISITOR POLICY The State of New York recently issued new guidance regarding visitors, and we have updated our policies accordingly. You can find more information here.

PPE UPDATE New gowns will be introduced this week. These have been evaluated as safe and effective by our infection-prevention, life-safety, and other clinical experts.

You can find more information about them here, and you can find information about all our PPE items here.

NEW AD CAMPAIGN There is a new ad campaign honoring members of our Mount Sinai family.

The campaign, which you can see here, is an acknowledgement of your heroism and your humanity.

Subject: Date: From:

COVID-19 Health System Updates, April 15 Wednesday, April 15, 2020 at 9:17:44 AM Eastern Daylight Time Broadcast NoKficaKons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

April 15, 2020

RE:

COVID-19 Health System Updates, April 15

Today I want to once again call attention to many of our colleagues who may sometimes go unmentioned or unrecognized publicly, but whose work never goes unnoticed. In this all-hands-on-deck effort, there are so many individuals who make life-saving care possible every day.

Our radiology technicians are one example. They stand shoulder to shoulder with our nurses, doctors, nurse practitioners, physician assistants, respiratory therapists, patient care associates, and others to treat every patient. They are often critical to helping caregivers to “see” a patient’s condition, and offering a roadmap to treatment.

Where would we be without our radiology technicians?

And where would we be without our laboratory, security, information technology, environmental services, engineering, materials management, food and nutrition, finance, and operations teams and so many countless others across the Health System?

And where would we be without our scientists who are blazing new trails in treating and ultimately preventing COVID-19 infection?

I know I am missing so many others who are equally vital.

But you get the idea.

The truth is, in this humanitarian mission of our lifetimes, we all need each other, and we all matter.

As of yesterday afternoon, we had 1,913 COVID-19-positive patients in our hospitals.

That included 452 patients in our ICUs. We had another 142 inpatients under investigation (PUIs).

Page 1 of 2

Housing Available for Self Isolation In addition to all the other hotel options that Dr. Davis has shared, there is a new one that you can use if you wish, or need, to self-isolate from your family and/or others at any point. Reference information can be found here and here on the employee resource site, and the required form can be found here.

Town Hall on Thursday This Thursday at 2 pm, Dr. Davis and Dr. Charney will be hosting an all-Health System town hall via Zoom. If you have a question you would like to ask, please scan the QR code below with your smartphone. It will open a form where you can type in your question. They, and some special guests, will answer as many questions as time allows.

To watch the Town Hall, please click here (use password 672243 if needed), or dial (929) 436-2866, webinar ID 427 734 865, password 672243.

FINAL THOUGHT Ugoeze Onyekelu-Eze, RN, a Nurse Clinical Coordinator at the Derald H. Ruttenberg Treatment Center, sent me a note recently and closed it with an African proverb that I want to share with you.

No matter how long the night is, the morning is sure to come.

Page 2 of 2

COVID-19 Headlines April 15, 2020 HOUSING AVAILABLE FOR SELF-ISOLATION In addition to all the other hotel options that Dr. Davis has shared, there is a new one that you can use if you wish, or need, to self-isolate from your family and/or others at any point. Reference information can be found here and here on the employee resource site, and the required form can be found here.

TOWN HALL ON THURSDAY This Thursday at 2 pm, Dr. Davis and Dr. Charney will be hosting an all-Health System town hall via Zoom. If you have a question you would like to ask, please scan the QR code below with your smartphone. It will open a form where you can type in your question. They, and some special guests, will answer as many questions as time allows.

Subject: Date: From:

COVID-19 Health System Updates, April 21 Tuesday, April 21, 2020 at 9:13:30 AM Eastern Daylight Time Broadcast NoIficaIons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

April 21, 2020

RE:

COVID-19 Health System Updates, April 21

Thanks to you, more than 3,300 patients with COVID-19 infection have been treated and discharged from Mount Sinai Health System hospitals.

Behind that headline is more heroism, and teamwork, and grit, and sweat, and tears, than can ever be repaid. Each day brings more stories of your compassion, your excellence, and your humanity.

It is awe-inspiring.

As of yesterday afternoon, we had 1,606 COVID-19-positive patients in our hospitals.

That included 395 patients in our ICUs. We had another 140 inpatients under investigation (PUIs).

PPE New Product Announcement We have a new gown in our PPE directory, evaluated as safe and effective by our infection-prevention, life-safety, and other clinical experts. You can find information about it here. As always, you can find information about all of our PPE items here.

Extensions to PTO and Travel Policies When COVID-19 arrived in our region, we placed limitations on paid time off and travel to ensure adequate and safe staffing during this pandemic. These limitations have now been extended through the end of May. We will reassess these policies on an ongoing basis and adjust as needed. Please see this link for details.

Reminder on Governor Cuomo’s Executive Order As a reminder, the Governor’s Executive Order, instituted last Friday, stated that all individuals must wear a face mask in public when they are unable to maintain a distance of six feet from other people. For example, in an elevator, if there is more than one person, all riders must use a mask. Riders may also consider waiting for the next elevator or taking the stairs.

Page 1 of 2

The Mount Sinai Medical Corps As part of the Mount Sinai Health System’s COVID-19 response, a group of 29 early graduates from medical school will be joining the Mount Sinai Medical Corps, working on medical teams at Mount Sinai Beth Israel, The Mount Sinai Hospital, Mount Sinai Morningside, and Mount Sinai West prior to starting residency later in June. We welcome them with open arms.

Final Thoughts Our Dean, Dennis Charney, MD, sends out a weekly COVID-19 Medical School Update. He closed his most recent one with the following words that I now share with you.

“The countless stories of courage, compassion, creativity, and hard work by members of the Mount Sinai community need to be remembered. We are committed to creating a permanent record of the individual and collective heroism of this period, so that you can marvel at your contributions and the new generations of Mount Sinai faculty, students, trainees, and staff can learn what we have done.

You amaze me every day with your commitment to triumph over the worst medical crisis that we have ever seen. I am so thankful for your efforts.”

Page 2 of 2

COVID-19 Headlines April 21, 2020 PPE NEW PRODUCT ANNOUNCEMENT We have a new gown in our PPE directory, evaluated as safe and effective by our infection-prevention, life-safety, and other clinical experts. You can find information about it here. As always, you can find information about all of our PPE items here.

EXTENSIONS TO PTO AND TRAVEL POLICIES When COVID-19 arrived in our region, we placed limitations on paid time off and travel to ensure adequate and safe staffing during this pandemic. These limitations have now been extended through the end of May. We will reassess these policies on an ongoing basis and adjust as needed. Please see this link for details.

REMINDER ON GOVERNOR CUOMO’S EXECUTIVE ORDER As a reminder, the Governor’s Executive Order, instituted last Friday, stated that all individuals must wear a face mask in public when they are unable to maintain a distance of six feet from other people. For example, in an elevator, if there is more than one person, all riders must use a mask. Riders may also consider waiting for the next elevator or taking the stairs.

Subject: Date: From:

COVID-19 Health System Updates, May 1 Friday, May 1, 2020 at 10:24:56 AM Eastern Daylight Time Broadcast NoKficaKons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

May 1, 2020

RE:

COVID-19 Health System Updates, May 1

As we work our way step by step down the COVID-19 mountain it is important that we recognize everyone’s contributions to this mission. Never before have our Health System and School been more united in addressing a challenge of this magnitude. As it says on every dollar bill, “E Pluribus Unum”—out of many, one.

Today we celebrate our Physician Assistants.

PAs have general board certification and training in all fields of medicine, which helps make this particular group of professionals extremely versatile in our COVID-19 mission. When it came to restructuring staffing models for the Emergency Department, Medicine, and Critical Care, the PAs have contributed at their very highest potential.

PAs were frequently the first ones in for redeployments. They were very quick to sign on and stepped into new roles as early as March 15.

In total, more than 600 PAs have played critical roles in our COVID-19 mission. They have performed brilliantly, and we could not be more honored to have them as colleagues and team members.

Here are some representative comments from our PAs and those who work with them: “I have worked a few inpatient shifts because our transplant ICU is currently being run by anesthesia as opposed to our regular intensivists. It has been a few years since I’ve been in an inpatient role but as I’m sure everyone has been telling you, the teamwork and camaraderie is incredible. I was petrified driving up to the hospital that first night, afraid of what I would encounter, but the nurses, anesthesiologists, and other colleagues pitching in were so helpful and it truly felt like everyone was there to help the patients as much as possible. It also reminded me how fantastic it is to be a PA because we are resilient, flexible, and can truly do it all! I’m sure our roles will continue to change as the situation evolves and I’m confident we will all step up to the plate.”

Page 1 of 3

“I am so proud of the PAs for being flexible and proactive. Even within the ED, there have been staffing modifications and unprecedented expectations and I am proud of our PAs for stepping up. I am also extremely proud of the offservice PAs. There were orthopedics PAs that were redeployed to the ED, and not only served in the tent, but also helped nurses draw labs and put in IVs. This week, there were neurosurgery PAs that had been redeployed to the ED and took it upon themselves to help out seeing patients even with non-COVID-19 related symptoms. I am sure that an orthopedics PA putting in IVs and a neurosurgery PA seeing ED patients is not what they do normally, and I applaud them for stepping up to the task and doing a fantastic job.”

“I just wanted to reach out about our PAs during this pandemic. I could not be more proud of their resilience, empathy, courage, and flexibility. We had patients literally all over. Lining hallways, doubling and tripling up in rooms, outside in tents and basically anywhere we could fit. The PAs handled these critical patients and large volumes with ease. They kept up with the treatment changes and developments with COVID-19 and treated patients appropriately. The ED PA staff had to overcome staffing issues due to several of them contracting COVID-19. Everyone was willing to work overtime in order to fill all gaps. We are a family, which is the reason we get up every morning and come to work. You know you are never alone and this is how we are able to make it through these trying times. I could not be more honored to work with such a great group of PAs during this mission.”

We are so grateful to each and every physician assistant in our Mount Sinai family.

As of this afternoon we had 975 COVID-19-positive patients in our hospitals (a 4 percent decrease from the prior day). That included 272 patients in our ICUs. We had another 118 inpatients under investigation (PUIs). That was the first day we were under 1,000 COVID-19-positive inpatients in a very long time.

Here is an update of our inpatient census trend:

Overnight Subway Service Suspended Beginning Wednesday, May 6, the MTA will be suspending all subway service nightly, from 1 am to 5 am, to enhance disinfection efforts on the city’s trains. Metro-North and Long Island Rail Road train cars will also be disinfected daily. The MTA says it will work Page 2 of 3

to fill the transportation gap for essential workers with additional buses, dollar vans, and perhaps free Uber and Lyft vehicles.

With subways not running in those windows, we are evaluating how this change may affect staff and shifts. We’ll communicate any additional details or potential scheduling modifications as they arise.

Meet Our COVID-19 Scientists: Creating a ‘Pseudo Virus’ to Assess Antibodies As governments, and hospitals, seek to get people safely back to work, high-quality antibody tests will be needed to determine if individuals are protected against SARSCoV-2, the virus that causes COVID-19. To help answer that need, a team led

by Benhur Lee, MD, has built a pseudo virus—an identical replica of the outer portion of the SARS-CoV-2 virus. The pseudo virus, which has now been independently tested by academic and national labs in the United States and abroad, could allow researchers to test the quality of an individual’s antibodies and serve as a platform for creating and optimizing potential vaccines. Read more about it here.

Final Thought We will soon be launching an email address to allow everyone in the Mount Sinai family to send memories and stories, photos and documents, and anything that captures life across our Health System during this pandemic. We hope you will contribute to it once it is up and running. I will keep you posted.

Page 3 of 3

Subject: Date: From:

COVID-19 Health System Updates, May 4 Monday, May 4, 2020 at 9:32:16 AM Eastern Daylight Time Broadcast NoJficaJons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

May 4, 2020

RE:

COVID-19 Health System Updates, May 4

The overall trends continue to move in the right direction, and our COVID-19 hospitalizations are well under half of what they were at the peak. We continue to be in good shape on PPE and other supplies. It is such a relief to see our care ratios returning to pre-COVID levels.

Now that the surge in COVID hospital admissions is reaching manageable levels, we will stop admitting new patients to the Central Park field hospital as of today. We anticipate that it will take about two weeks to treat the patients currently there and subsequently decontaminate and remove the tents. The Samaritan’s Purse staff will also wind down their support of Mount Sinai Beth Israel over the next two weeks. So far, the teams from Samaritan’s Purse have cared for more than 300 of our patients, and they have saved many, many lives. In another ray of hope, the last patient seen at the Javits Center, who came from Mount Sinai, was discharged on Friday.

One note of concern is that some people in our communities aren’t doing quite as well with social distancing as they were even a few weeks ago. I hope you will help continue to get the message out about how important this is to preventing a second wave of infections.

Governor Cuomo announced yesterday that a consortium of eastern states, including New York, will work together to jointly purchase and allocate PPE, tests, ventilators, and other medical equipment. With a regionalized approach, states in this consortium will have stronger buying power and hopefully more reliable access to PPE and supplies from across the globe. He also announced that hospitals in the state will need to carry a 90-day supply of PPE on an ongoing basis.

As of yesterday afternoon, we had 815 COVID-19-positive patients in our hospitals (a 4 percent decrease from the prior day). That included 247 patients in our ICUs. We had Page 1 of 2

another 167 inpatients under investigation (PUIs).

New Wellness Letter There is a very useful new wellness letter on the COVID-19 Employee Resources website. It turns out that there are common reasons why we don’t always seek out support, even when we need it. This letter addresses those reasons and helps dispel some myths and misperceptions. I think you will find it worth your time to read.

New Gowns Thanks to the tireless work of many, we have seven new gowns that will be in use at our hospitals. They have been validated as safe and effective by our infection prevention, life safety, and other clinical experts. You can find information on them here.

Final Thought Here is something worth sharing.

Jamieson Webster, a clinical psychologist, volunteered to help at Mount Sinai Brooklyn through the NYC Medical Reserve Corps. She was recognized yesterday as a New York Post “Hero of the Day.” An excerpt: The hospital needed someone who could speak with families and connect them to their ailing loved ones in the last moments of their life amid the coronavirus pandemic.

But no one else had applied—so she did.

“I thought, no one will do this if I don’t do it, so what do I do?” Webster, 40, told The Post.

“I can’t imagine in this situation if there’s an actual need not filling it,” added the Brooklynite, who’d been checking the MRC’s website every day for openings. “I would risk my life because it feels like a call of duty.”

Page 2 of 2

Subject: Date: From:

COVID-19 Health System Updates, May 6 Wednesday, May 6, 2020 at 9:16:33 AM Eastern Daylight Time Broadcast NoJficaJons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

May 6, 2020

RE:

COVID-19 Health System Updates, May 6

National Nurses Week officially begins today, and I’d like to acknowledge just how grateful we are for our incredible community of nurses. Today, and every day, we are in awe of you and your dedication to your patients and colleagues. To commemorate National Nurses Week, we ran a full-page ad in The New York Times to recognize your efforts and say thank you. If you didn’t see it in my note yesterday, you can find it here.

And there are all sorts of other ways we are celebrating you at each of our campuses this week.

We have entered a new phase in this pandemic. Our inpatient and ED volumes of COVID-19 patients are significantly lower than at the peak, and we are working to reexpand medically necessary non-COVID care. This is critically important. Many patients with serious medical conditions need us. We have worked out extensive processes and protocols for keeping those patients safe when they visit us in our ambulatory practices, our emergency departments, our operating rooms, and our inpatient units. I am so impressed with the care and diligence that our colleagues have put into getting this right.

Our new normal will be doing two things at once—caring for all the patients and conditions we typically cared for pre-COVID, while also providing care for those with COVID-19 infections. No matter what the need is, our communities can count on us to be there for them.

As of yesterday afternoon, we had 769 COVID-19-positive patients in our hospitals.

That included 226 patients in our ICUs. We had another 145 inpatients under investigation (PUIs).

Here is an update on our day-by-day inpatient census trend: Page 1 of 2

Songs for Mount Sinai Today the second “Songs for Mount Sinai” playlist went live. As a reminder, this is a gift from Broadway actors, singers, and other performers who come together each week to support us with a video playlist. I hope you’ll take a few moments to watch it, and I hope it lifts your day. You can find the new installment here, and the previous installment on Mount Sinai’s YouTube page here.

Where to Get Answers As always, if you have questions or suggestions, you can get them to us at CovidQuestions@mountsinai.org. And the COVID-19 Employee Resources website continues to be a rich source of information.

Final Thoughts I mentioned last week that we would be launching an email address dedicated to collecting memories and stories from this moment in history. That email address is now live at covidmemories@mountsinai.org. We hope you will email us your memories and stories, photos and documents, and anything that captures life across our Health System during this unique time. This information will help our archivists build a permanent record and lasting legacy for us and for future generations.

Page 2 of 2

Subject: Date: From:

Returning Toward a New Normal Thursday, May 7, 2020 at 11:59:41 AM Eastern Daylight Time Broadcast NoDficaDons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

May 7, 2020

RE:

Returning Toward a New Normal

The work that you all have put in over the last two months to battle the COVID-19 pandemic has been awe-inspiring. Now, with COVID-19 cases declining, we are turning our focus toward safely rebuilding our practices and our patient base. Our patients need us. And we need them.

COVID-19 is not going away overnight; we will be seeing patients with this disease for quite some time. Nevertheless, it is possible to do two things at the same time—safely care for patients with COVID-19 and safely care for non-COVID-19 patients.

Today, we launched a “safety hub” on our website where we will document all the things we are doing to keep all of our patients and staff safe. We know that many patients—and even many of us—feel anxious about exposure to COVID-19, and that this anxiety is causing some patients to put off needed care. Through the safety hub, we intend to address and work to allay those fears and show Mount Sinai’s commitment to the health and safety of all.

Among the materials that will be posted there: · Specific details, including photos and videos, about how our facilities are cleaned and sanitized every day · Instructions for screening all patients for COVID-19 symptoms before arriving for their visits · Requirements that all patients and staff wear a mask or face covering · Instructions and materials to facilitate social distancing in our waiting rooms and elsewhere in our facilities Page 1 of 2

· Details about how patients with COVID-19 infection will be kept separate from nonCOVID-19 patients · Information about how our staff are tested and screened for COVID-19 · Resilience and wellness resources for our faculty and staff Through the hub, we will provide talking points for physicians and staff to use in your contacts with your own patients, as well as scripts for the call center, webinars for patients, a social media campaign, and an advertising campaign with the theme “Don’t Put Your Health Care on Hold.”

In addition, we have established an email address, safetyhub@mountsinai.org, where you can send specific questions that you or your patients might have and receive a quick answer.

I hope you find these materials helpful. Together, we can allay patients’ fears, keep them safe, and help them feel comfortable coming to see us for the care they need.

Page 2 of 2

Subject: Date: From:

COVID-19 Health System Updates, May 11 Monday, May 11, 2020 at 10:14:34 AM Eastern Daylight Time Broadcast NoIficaIons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

May 11, 2020

RE:

COVID-19 Health System Updates, May 11

Just one month ago, our inpatient census of patients with COVID-19 infection was about 2,000. Just two weeks ago, that number was closer to 1,100. And now, that number is closer to 550. When we stop even for a brief moment and turn and look back at the mountain we just climbed, it is almost impossible to fathom how we did it. And yet here we are. Step by step, we are working our way down the mountainside.

There is endless speculation about how long COVID-19 will be with us and about what happens next. Will the virus disappear on its own without the need for a vaccine? If a vaccine is needed, when will one be available? Will there be a second wave or even a third wave after that?

There is so much we don’t know.

But here is something we do know. This pandemic is a test of our endurance. And, no matter what the future holds, we are more resilient and adaptable when we treat each other with kindness and compassion; when we forgive our colleagues’ mistakes and faults, and our own; and when we take the time to express our gratitude and appreciation for each other’s contributions. Let’s rededicate ourselves to taking the best possible care of each other as we continue on this mission together, no matter how long the journey or how many hills and mountains lie ahead.

As of yesterday afternoon, we had 559 COVID-19-positive patients in our hospitals. That included 155 patients in our ICUs. We had another 143 inpatients under investigation (PUIs).

Testing You for COVID-19 Infection We have received many questions about opportunities for antibody testing and also about nasopharyngeal swab (PCR) testing. Today we have a significant update to share.

Page 1 of 3

We are offering two testing programs to employees who want to know their COVID-19 health status. Both programs are voluntary, and your work status will not be affected by your decision to take or not take the test. More information about our testing programs can be found here and below.

Antibody Testing We are offering all faculty, staff, and students an opportunity to be tested for COVID-19 antibodies. A positive test result indicates that, at some point since this pandemic came to our region, you have been exposed to SARS-CoV-2, the virus that causes COVID19. We do not yet know whether having antibodies means you are immune to COVID19. More information about this test can be found here and here.

If you are in a front-line role, we will contact you about scheduling your antibody test.

Once front-line colleagues have had a chance to take the test, we will also make it available to everyone else.

Nasopharyngeal Swab (PCR) Testing Faculty, staff, and students who are concerned that they may have SARS-CoV-2 but have not developed symptoms of COVID-19 may request a nasopharyngeal swab test, also known as a PCR test. This test will show if you have active COVID-19 infection.

This test is available to all health care workers (including corporate employees) once every 28 days, except for employees who have previously tested positive for SARSCoV-2 antibodies (unless they are experiencing new symptoms of COVID-19). If your PCR test is positive, we will need you to remain away from work for at least 10 days— and possibly longer if you develop COVID-19 symptoms.

PCR testing can be arranged through Employee Health Services via their EHS Redcap form.

Please note: If you develop new symptoms consistent with COVID-19 or believe you have had a high-risk exposure we still need you to register with EHS via EHS Redcap.

PPE Recycling In another sign of progress, we are now able to discontinue our recycling program for N-95 respirators and face shields. All collection boxes will be removed from our sites over the next two weeks.

Language and Communication Access Services Care of patients with COVID-19 is challenging in so many ways. As a reminder, we have many communication and translation services available to patients and/or family members who prefer to communicate in a language other than English. Assistive devices are also available to people with disabilities to help them communicate with providers and staff during their visit. All services are provided free of charge.

To view a list of assistive devices and services available through the Health System, along with other resources for our patients, please click here.

Meet Our Scientists A team led by Valentin Fuster, MD, PhD, the Mount Sinai COVID Informatics Center, and the Hasso Plattner Institute for Digital Health at Mount Sinai made the Page 2 of 3

groundbreaking discovery that treating hospitalized COVID-19 patients with anticoagulation therapy may improve their chances of survival. The study, just published in the Journal of the American College of Cardiology, is based on an analysis of data from more than 2,700 patients treated in our hospitals. In Dr. Fuster’s words, “This research demonstrates anticoagulants taken orally, subcutaneously, or intravenously may play a major role in caring for COVID-19 patients, and these may prevent possible deadly events associated with coronavirus, including heart attack, stroke, and pulmonary embolism,” You can read more here.

Final Thought I received the following note from Malorie Meshkati: My name is Malorie and I am a NICU fellow who just completed a month of deployment in the COVID ICU. It is almost hard for me to describe the experience but words that come to mind are humbling, testing, and rewarding.

I am writing you because I read an article in the Times this evening about nonmedical workers.

I do believe that Sinai has done an amazing job of appreciating ALL hospital workers and I believe everyone greatly appreciates it. After reading this moving article, I was wondering if there was any way we could specifically thank our nonmedical workers who have been working tirelessly in our units.

Over the past month on my unit, I noted how our business associates would work tirelessly and even would do things that were not often in their job description in order to help the teams, how tirelessly environmental services team members worked to empty garbage bins full of PPE to help keep us safe in the unit, how security guards at the doors are keeping us safe, and how the transporters are moving our COVID patients between units or off-unit for their studies allowing their medical plans to be carried out.

I was wondering if there was any way to show special appreciation for our nonmedical workers as well who are so integral to this mission.

Thank you so much for taking the time to read my email.

I whole heartedly agree with you, Malorie, and am so grateful that you took the time to share your thoughts and observations. I am sure they will resonate as strongly with our entire Mount Sinai family as they do with me.

Page 3 of 3

COVID-19 Headlines May 11, 2020 TESTING YOU FOR COVID-19 INFECTION

We are offering two testing programs to employees who want to know their COVID-19 health status. Both programs are voluntary, and your work status will not be affected by your decision to take or not take the test.

More information about our testing programs can be found here and below.

Antibody Testing We are offering all faculty, staff, and students an opportunity to be tested for COVID-19 antibodies. A positive test result indicates that, at some point since this pandemic came to our region, you have been exposed to SARS-CoV-2, the virus that causes COVID-19. We do not yet know whether having antibodies means you are immune to COVID-19. More information about this test can be found here and here.

If you are in a front-line role, we will contact you about scheduling your antibody test. Once front-line colleagues have had a chance to take the test, we will also make it available to everyone else.

Nasopharyngeal Swab (PCR) Testing Faculty, staff, and students who are concerned that they may have SARS-CoV-2 but have not developed symptoms of COVID-19 may request a nasopharyngeal swab test, also known as a PCR test. This test will show if you have active COVID-19 infection. This test is available to all health care workers (including corporate employees) once every 28 days, except for employees who have previously tested positive for SARS-CoV-2 antibodies (unless they are experiencing new symptoms of COVID-19). If your PCR test is positive, we will need you to remain away from work for at least 10 days—and possibly longer if you develop COVID-19 symptoms.

PCR testing can be arranged through Employee Health Services via their EHS Redcap form.

Please note: If you develop new symptoms consistent with COVID-19 or believe you have had a highrisk exposure we still need you to register with EHS via EHS Redcap.

PPE RECYCLING

In another sign of progress, we are now able to discontinue our recycling program for N-95 respirators and face shields. All collection boxes will be removed from our sites over the next two weeks.

LANGUAGE AND COMMUNICATION ACCESS SERVICES

Care of patients with COVID-19 is challenging in so many ways. As a reminder, we have many communication and translation services available to patients and/or family members who prefer to communicate in a language other than English. Assistive devices are also available to people with disabilities to help them communicate with providers and staff during their visit. All services are provided free of charge.

To view a list of assistive devices and services available through the Health System, along with other resources for our patients, please click here.

Subject: Date: From:

COVID-19 Health System Updates, June 10 Wednesday, June 10, 2020 at 12:28:45 PM Eastern Daylight Time Broadcast NoMficaMons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

June 10, 2020

RE:

COVID-19 Health System Updates, June 10

These recent months have been unlike any others in our lifetime. For months, the COVID-19 pandemic overwhelmed our city. Then, the senseless murders of Black Americans, caught in images for the world to witness, shocked our collective conscience. Now, protests against bigotry, brutality, and racism have inspired a search for our nation’s soul. One transformational moment has intersected with another—this once-in-a-century public health crisis overlapping with a nationwide movement aimed at eliminating a pervasive social ill that has infected America since its founding: racism.

Of course, these two moments are connected. Because when it comes to health outcomes across America, shocking disparities abound. Race and socioeconomic status are strong predictors of life expectancy, and existing inequities in health care have been magnified by the recent devastation of COVID-19. Communities of color are disproportionately weathering the impacts of COVID, and the realities of COVID are reminding us, yet again, of disparities that have always existed in medicine and in health. It must change.

As you know, we stand in solidarity with the protests across the country and with their inarguable message: Black Lives Matter. It has been just over 100 days since our region’s first COVID case, and as New York City has begun its first phase of reopening, we’re at a hopeful moment during which we must all strive to do more. Peaceful protests continue to sound the clarion call for social justice across America, and we too must reflect on the gaps that exist in our own industry, and act. Where there are disparate outcomes, we must do everything in our power to close them. Where there are unequal trends, we must redouble our efforts to reverse them. We will be working to address these issues in a transformative and sustainable manner, and as a component of that, the Office for Diversity and Inclusion is developing more resources to help guide all of us and provide opportunities for dialogue. We must aim for and Page 1 of 3

achieve meaningful and lasting change.

As of yesterday afternoon, we had 142 COVID-19-positive patients in our hospitals.

That included 45 patients in our ICUs. We had another 96 inpatients under investigation (PUIs).

PTO/Travel Policies Especially in light of the toll that this pandemic has exerted on our Mount Sinai family, we encourage you to reach out to your supervisors and managers to plan some time off. We have updated our COVID-19 PTO and Travel Policies to reflect the lower volume of COVID-19 patients in our Health System. We have resumed our standard PTO policy and are relaxing certain travel restrictions. Personal travel is now permitted, while work-related travel is still limited. At this time, PTO is welcomed and encouraged with pre-approval from supervisors. More information on these policies can be found here.

Meeting Policy We want to remind everyone that the COVID-19 meeting policy is still in effect and likely will be throughout the summer. As such, all in-person large group lectures, events, and meetings across the Health System should be canceled or offered virtually, and all in-person meetings are restricted to less than 10 people. Please visit here for more information.

Parking To make things a bit easier for everyone as New York City reopens, Mayor de Blasio announced this week that alternate-side parking will be canceled for the next two weeks, until June 21. As the city moves toward a complete reopening, we can expect parking enforcement to come back to normal levels, so we encourage you to be mindful of that as well.

MTA Updates As MTA service ramps up, the most updated information about service for subways and buses can be found here, the Long Island Rail Road here, and Metro North here.

The MTA will be routinely deep-cleaning and disinfecting stations and vehicles, reminding riders about precautions to keep everyone safe, including floor decals and station announcements, and offering hand sanitizer, masks, and other protective equipment in stations. When you ride with the MTA, please remember to wear a mask, travel during less busy times if possible, and practice hand hygiene. You can see more about the MTA’s ramp-up efforts here, and can plan your trip here. #FitForTheFrontLine From now until Sunday, June 14, you can still participate in #FitForTheFrontLine, a nationwide event led by Mount Sinai with participation from more than 20 major hospitals, to benefit our nurses, physicians, and first responders on the front lines of the COVID-19 pandemic. All you need to do is pick an activity that fits with your lifestyle—meditation, running, walking, yoga—and post it to your network on social media using #FitForTheFrontLine, along with the donation link.

There is no obligation or expectation that you use the event to raise money for Mount Sinai, but if you choose to do so, all donations received from the #FitForTheFrontLine Page 2 of 3

initiative will support the Mount Sinai Center for Stress, Resilience, and Personal Growth. This one-of-a-kind center was created to address the psychosocial impact of COVID-19 on the mental health and lives of our health care heroes at Mount Sinai and will serve as a model for institutions and communities around the globe.

Your Questions and Concerns As a reminder, our COVID-19 Employee Resources website is here. And you can always email CovidQuestions@mountsinai.org if you have any other questions or suggestions for us.

Final Thought Several weeks ago, amid the growing fear around COVID-19, Vivian Choi, a teacher at P.S. 22Q, the Thomas Jefferson Elementary School in Flushing, Queens, asked her third-graders: What is courage? They responded with personal definitions of courage, and later expressed their ideas in the form of mythical creatures you can see here. Ms. Choi sent them to one of our colleagues to share with our staff, writing: “These Emblems of Courage are expressions of our students’ sincere gratitude to you—the Hospital Heroes who embody intelligence, compassion, and valor in your everyday actions to care for our community. We appreciate you, and we are inspired by your courage.”

Page 3 of 3

COVID-19 Headlines June 10, 2020 PTO/TRAVEL POLICIES Especially in light of the toll that this pandemic has exerted on our Mount Sinai family, we encourage you to reach out to your supervisors and managers to plan some time off.

We have updated our COVID-19 PTO and Travel Policies to reflect the lower volume of COVID-19 patients in our Health System. We have resumed our standard PTO policy and are relaxing certain travel restrictions. Personal travel is now permitted, while work-related travel is still limited. At this time, PTO is welcomed and encouraged with pre-approval from supervisors. More information on these policies can be found here.

PARKING To make things a bit easier for everyone as New York City reopens, Mayor de Blasio announced this week that alternate-side parking will be canceled for the next two weeks until June 21. As the city moves toward a complete reopening, we can expect parking enforcement to come back to normal levels, so we encourage you to be mindful of that as well.

MTA UPDATES As MTA service ramps up, the most updated information about service for subways and buses can be found here, the Long Island Rail Road here, and Metro North here.

The MTA will be routinely deep-cleaning and disinfecting stations and vehicles, reminding riders about precautions to keep everyone safe, including floor decals and station announcements, and offering hand sanitizer, masks, and other protective equipment in stations. When you ride with the MTA, please remember to wear a mask, travel during less busy times if possible, and practice hand hygiene. You can see more about the MTA’s rampup efforts here, and can plan your trip here.

Subject: Date: From:

COVID-19 Health System Updates, July 8 Wednesday, July 8, 2020 at 11:14:13 AM Eastern Daylight Time Broadcast NoMficaMons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

July 8, 2020

RE:

COVID-19 Health System Updates, July 8

As we head into the heart of the summer, I want us all to take a timeout and talk about masks.

I know you’ve already heard a lot about them, from me and others. You know that it is Mount Sinai Health System policy that you must fully cover your mouth and nose with a Mount Sinai-issued surgical mask when you enter and leave our campuses, and when you are in our public areas, corridors, and elevators.

And most of you are doing a fine job with your masks. Just as I wear my mask for you, you wear your mask for me. I thank you for that. But there are some who still aren’t wearing masks all the time, or not wearing them properly.

We all work in health care. In health care, we follow the science. And the science about mask-wearing is clear: Wearing masks slows the spread of COVID-19 and saves lives.

One peer-reviewed study in Health Affairs compared states with mandatory masking orders to those without. It found statistically significant declines in the daily COVID-19 case growth rate and projected that between 230,000 and 450,000 cases had been avoided by these orders.

Why does mask-wearing help? Mainly because it keeps people who have SARS-CoV2—the virus that causes COVID-19—from spreading it to the people around them. We know that many people with COVID-19 can spread it while asymptomatic or presymptomatic. (Here is a roundup of studies on this point.) The CDC is currently recommending that every person who is able to wear a face covering should wear one in common areas, and the CDC website has a long list of studies supporting this recommendation.

Page 1 of 2

I know masks aren’t easy for everyone to wear. You may think that it’s hard to breathe while wearing one, or that it makes you feel sweaty in the summer heat, or that your glasses fog up. These are all sincerely felt concerns, and over the next several weeks, we’ll address each of them on Mount Sinai’s digital news site, Mount Sinai Today. As a reminder, our COVID-19 Employee Resources website is here. And if you have a concern that we don’t address, you can always email CovidQuestions@mountsinai.org. We want to hear you, and we want to set your fears and concerns to rest.

I also know that many of us want to do the right thing, but during a busy day, sometimes we slip, or forget. Let’s make mask-wearing the same as hand hygiene. If you see a colleague not wearing a mask properly—fully covering the nose and mouth —gently remind them. It’s for everybody’s good.

Our COVID-19 numbers continue to be among the lowest we’ve seen, with 45 admitted inpatients across the system. We can all be grateful and proud about that. But we’ve all seen what is happening in other states, and we can’t let that happen here. The most important thing we can do, as health care workers and New Yorkers, is to properly wear our masks whenever they’re required and encourage others to do the same.

I will wear my mask for you. Please wear yours for me. Together, we will get through this.

Page 2 of 2

COVID-19 Headlines July 8, 2020 It is Mount Sinai Health System policy that you must fully cover your mouth and nose with a Mount Sinai-issued surgical mask when you enter and leave our campuses, and when you are in our public areas, corridors, and elevators.

The science about mask-wearing is clear: Wearing masks slows the spread of COVID-19.

Treat masking like hand hygiene. If you see a colleague not wearing a mask properly—fully covering the nose and mouth— gently remind them. It’s for everybody’s good.

Subject: Date: From: To:

COVID-19 Health System Updates, September 29 Tuesday, September 29, 2020 at 9:58:16 AM Eastern Daylight Time Broadcast NoLficaLons Broadcast NoLficaLons

TO:

All Faculty, Staff, and Trainees

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

September 29, 2020

RE:

COVID-19 Health System Updates, September 29

As you may have read or heard, the New York metropolitan region is currently seeing a modest uptick in COVID-19 cases. In our own Health System hospitals, we currently have about 50 inpatients with COVID-19 infection. This is up from our low of about 25 cases a few weeks ago.

This should not surprise any of us. We have said all along that we would likely see periods of rising caseloads as the pandemic ebbs and flows. These numbers are far smaller than we handled, with all of your help, through March, April, May, and June. At the region’s peak, our hospitals had more than 2,000 COVID-19-positive inpatients.

Over the past months, the Health System and the hospitals have developed contingency plans that can be put into operation should the surge continue. We have adequate stocks of personal protective equipment, supplies, and other equipment to meet all of our needs. Our Clinical Command Center is closely monitoring all of our hospitals, and we have developed triggers and plans for cohorting patients and for transfers based on each hospital’s capacity if and when needed. At this time, we expect to continue all elective procedures and other work without any disruption. If you have a concern that we haven’t addressed, you can always email CovidQuestions@mountsinai.org.

At the hospital and practice level, please continue to observe the tenets of COVID-19 protection. Wear a Mount Sinai-issued mask whenever you are in any of our facilities; perform hand hygiene frequently; maintain six feet of distance from your colleagues to the extent possible; and wear eye protection whenever you are with a patient. And please be especially vigilant in break rooms and when eating. With these steps, we can avoid infecting ourselves and each other, and care for our patients as we know so well how to do.

Updated Visitor Policy Page 1 of 2

On Thursday, October 1, we will tighten our visitor policy slightly. This is part of our continuing efforts to keep you and our patients as safe as possible.

Starting on Thursday, patients will be allowed only one visitor at a time and a total of two visitors per day. Inpatients will be allowed a total of four hours of visitation per day, while Emergency Department patients will be allowed a total of two hours.

The complete new visitor policy can be found here.

Free Admission to the Guggenheim Museum The Guggenheim Museum is reopening to the public this week and wants to welcome us for a special socially distanced and masked “early access day” as a thank-you for your hard work during the pandemic. The event will take place this Wednesday, September 30, from 11 am to 6 pm. All Mount Sinai Health System faculty, staff, trainees, and students may sign up for a pair of free, timed entry tickets here. Use your Mount Sinai email address to register, and bring your Mount Sinai Health System ID with you to the museum.

Meet Our COVID-19 Scientists As the development of COVID-19 vaccines races on, a team led by Avi Ma’ayan, PhD, is doing other vital work—looking for drugs already approved for other diseases that could be repurposed for COVID-19. The team has created the COVID-19 Drug and Gene Set Library, a crowdsourced database and website that consolidates information from labs worldwide that are testing potential COVID-19 drugs in vitro. An article on this collaborative effort was recently published in the Cell Press journal Patterns. When considering promising drugs, Dr. Ma’ayan points to the example of HIV, a virus for which there is no vaccine, but many drug “cocktails” that keep the viral load very low and prevent new infections. Dr. Ma’ayan says, “If people get sick from COVID-19, and you have drugs that can treat them, you could turn it into a disease that more people can recover from.” Read more about the research here.

Since the beginning, the Mount Sinai Health System and the Icahn School of Medicine at Mount Sinai have not stopped planning, preparing for, and studying the COVID-19 pandemic to develop better treatment protocols and processes. I am confident that if this uptick continues, we are in a much better place to handle it than we were in the spring. We know more about which treatments work and when to give them, and we know what each of us is capable of. The next few weeks may bring new challenges, but I know that we’ll get through them—together. Thank you once again for all you do.

Page 2 of 2

Subject: Date: From: To:

COVID-19 Health System Updates, October 7 Wednesday, October 7, 2020 at 1:34:51 PM Eastern Daylight Time Broadcast NoMficaMons Gordon, Vanessa

TO:

All Faculty, Staff, Trainees, and Students

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

DATE:

October 7, 2020

RE:

COVID-19 Health System Updates, October 7

As you are likely aware, we are seeing some increases in COVID-19 case numbers, both in the community and in some of our hospitals. To put this into proper context, today we have about 4 percent of the total number of COVID-19-positive inpatients that we had in our hospitals at the peak back in April.

We do not expect anything like the kind of volumes we saw back then. And we are so much better prepared to deal with whatever we do see. That is for sure. We have surge units fully built out and at the ready; we have massive stockpiles of PPE and other equipment; we have more sophisticated and effective clinical protocols and treatments; and we have deep insights into how to keep ourselves safe. We’ve got this.

Our leadership teams are watching closely to make sure we remain prepared and ready for whatever may come at us. At some of our sites, we will be shifting units around to cohort COVID-19 patients together. Your local leadership will tell you if that’s the case. Beyond the cohorting, we see no need at this time to alter our operations. All services, including elective procedures, are still good to go.

But we need all of you to help in one critically important way: Now that we are seeing this uptick in our community, it is even more urgent that each of us do our part by following the Mount Sinai Health System Code of Conduct around COVID-19. This Code includes six points: 1. Check your temperature and for other COVID-19 symptoms, and complete the electronic self-attestation form on your phone or at a screening station, before the start of each shift.

2. Contact Employee Health Services (EHS) before reporting to work if you have a Page 1 of 3

3.

4.

5.

6.

new onset of COVID-19 symptoms, or if anyone in your household or a close contact has been diagnosed with COVID-19 or develops symptoms of COVID19.

Wear a Mount Sinai-issued mask at all times while in public areas such as hallways, shared office spaces, elevators, meeting rooms, and restrooms.

Maintain social distancing in elevators and common areas, and especially when eating and you cannot wear a mask.

Practice frequent hand hygiene.

Wear eye protection when you are providing direct patient care at the bedside or in a treatment room.

Managers and supervisors will be working hard to ensure that we follow these rules.

But it is really up to each of us hold ourselves and each other accountable. Following these rules helped us get through the crisis in the spring, and we can’t let our guard down now. And it’s important not to let your guard down in your personal life as well— so please be careful and use good judgment about attending events or participating in non-distanced indoor activities. As we’ve seen repeatedly, activities like that pose a risk not just to you, but to everyone around you.

With regard to break rooms, a couple of additional points. We often think of our colleagues as our “work family,” but when it comes to possible disease transmission, they’re not the same as the family you live with.

So we are tightening up the rules for break rooms. First, you may only take your mask off in a break room if you are eating or drinking something at that moment and only if you are at least 6 feet away from others. We’re also asking managers to schedule people for specific times in break rooms, to keep the crowding down. If you do go to the break room, you must keep your distance and wear a mask. This is to protect you, your colleagues, and our patients. And we will be working hard to reorganize furniture, to find additional break room space, and to organize break schedules—all in the service of keeping you safe.

As of this morning, we have 83 COVID-19 cases in Mount Sinai Health System hospitals. Six months ago, we had about 2,000. All of us, working together as a team, coped successfully then with New York City’s greatest health crisis in a century. We can absolutely handle this one.

COVID-19 Contact Tracing App Available The New York State Department of Health has launched a new app, COVID Alert NY, which allows for voluntary, anonymous COVID-19 contact tracing. If you sign up, you will get an alert if you were in close contact with someone who tests positive for COVID-19. To learn more, visit the Department’s information page.

Please note that this app is different from the Stop COVID NYC app that Mount Sinai launched in April to track the pandemic’s spread; the Mount Sinai app uses only anonymized data and cannot trace individuals’ contacts.

Meet Our COVID-19 Scientists Multisystem inflammatory syndrome in children (MIS-C) is a rare, potentially lifePage 2 of 3

threatening syndrome that occurs about five weeks after some young patients have been infected with the SARS-CoV-2 virus, which causes COVID-19. There are widely accepted protocols for treating MIS-C, but just what causes it remains a mystery. Now, a team led by Dusan Bogunovic, PhD, has identified a unique pattern of immune responses that characterize MIS-C and could eventually serve as a biomarker, or reliable indicator that would help diagnose the disease. The findings were recently published in the journal Cell. “In order for us to really understand MIS-C, we had to describe the disease, and this is the first in-depth mapping of what the disease looks like,” Dr. Bogunovic says. Read more about the research here.

Reminder About Wellness Resources Many of us are feeling increasingly stressed and overwhelmed these days, and not just because of the COVID-19 pandemic and current uptick in cases. We are worried about coping with school reopenings (and for some, reclosings), family issues, the approach of cooler weather, less opportunity for outdoor gatherings and impending social isolation, and all else going on in the world. It can feel overwhelming. Now is a good time for all of us to remember the faculty, staff, and trainee wellness resources that we have put together. They are here to help you meet your emotional, mental health, and spiritual needs. Please consider reaching out and exploring these resources.

I’ll be updating you weekly while the current uptick continues. As long as we keep working together, we will overcome it as we have so many times before. I remain proud to be working by your side.

Page 3 of 3

COVID-19 Safety Code of Conduct Everyone must take these six actions to make Mount Sinai Health System a safe workplace: 1. Check your temperature and for other COVID-19 symptoms, and complete the electronic self-attestation form on your phone or at a screening station, before the start of each shift.

2. Contact Employee Health Services (EHS) before reporting to work if you have a new onset of COVID-19 symptoms, or if anyone in your household or a close contact has been diagnosed with COVID-19 or develops symptoms of COVID-19.

3. Wear a Mount Sinai-issued face mask at all times while in public areas such as hallways, shared office spaces, elevators, meeting rooms, and restrooms.

4. Maintain social distancing in elevators and common areas, and especially when eating and you cannot wear a mask.

5. Practice frequent hand hygiene.

6. Wear eye protection when you are providing direct patient care at the bedside or in a treatment room.

COVID-19_Update: 10-7_2020

COVID-19 Headlines October 7, 2020 I f you go to a break room, you must keep your distance from colleagues and wear a mask. ou may only take your mask off in a break room if you are Y eating or drinking something at that moment and are at least 6 feet away from others.

Managers should schedule people for specific times in break rooms, to keep the crowding down.

For more details, see the new Code of Conduct here.

Subject: COVID-19 Health System Updates, October 21 Date: Wednesday, October 21, 2020 at 12:10:09 PM Eastern Daylight Time From: Broadcast NoIficaIons To: Gordon, Vanessa

TO: All Faculty, Staff, Trainees, and Students FROM: Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

October 21, 2020 COVID-19 Health System Updates, October 21 As our region works its way into further into autumn, COVID-19 cases continue to be elevated compared with the past summer. However, in our own hospitals, the growth in the number of COVID-19 patients has flattened. And in the Brooklyn and Queens hot spots, test positivity rates are decreasing.

That is good news. Additional good news is that, thanks to our Transfer Center and the clinicians and administrators that they work with, we’ve been able to do a remarkable job of balancing demand and capacity across the Health System. They’ve been especially helpful at transferring patients out of The Mount Sinai Hospital’s emergency room to other locations. This means that even when the overall number of patients across the System goes up, we are Page 1 of 3

able to care for them better. I want to praise everyone involved in this effort, and encourage you to keep up the good work.

I also want to commend everyone who is following our COVID-19 Code of Conduct and being scrupulous about masking, hand hygiene, social distancing, and self-screening for symptoms. I know there have been some start-up glitches at sites that are doing temperature and attestation checks at the doors, and I appreciate your patience as those are resolved.

My colleagues and I also know that it can be challenging to find a place to eat where you are safely distanced from your colleagues. We’re working hard to identify additional spaces at each of our sites that can be used as break rooms, including conference rooms and auditoriums. We’re also looking into better staggering meal breaks so that fewer people are looking for a place to eat at the same time. Your site leadership will let you know what arrangements have been made in that regard. It’s important to maintain at least six feet of distance from everyone else when you take your mask off to eat. We will do everything we can to help you do that, especially as colder weather arrives and eating outdoors is no longer an option. Likewise, when you are in break rooms, please make sure to keep your mask on except when you are eating. This will help keep you and your colleagues safe.

While we’re seeing some good news out of the hot spots in New York City, COVID-19 cases are rising in New Jersey and Connecticut. Wherever you live —but especially in those states—please be careful when you’re not at work to mask, keep a safe distance, wash your hands, and limit your interactions with people outside your immediate household. Your family, your colleagues, and your patients need you to stay safe and healthy.

As of this morning, we had 120 COVID-19-positive inpatients in our hospitals.

Planning for a Vaccine Although a COVID-19 vaccine is likely a few months away, there’s a lot of preparation and planning to do before we can receive and distribute it to our staff and the public. We’ve established a committee led by Susan Mashni, PharmD, our Vice President and Chief Pharmacy Officer, to ensure that we do all of this safely.

Page 2 of 3

This committee will be guided by plans that Governor Cuomo and Mayor de Blasio are drawing up for storing, distributing, and prioritizing access to the vaccine across New York City and New York State. Those plans are still very preliminary, but we expect that the initial wave of vaccinations would include front-line health care workers in high-risk areas like emergency departments, critical care, and emergency medical services. Other health care workers and those with high-risk conditions will likely be prioritized as well.

Governor Cuomo has also appointed a Clinical Advisory Task Force that will review every COVID-19 vaccine authorized by the federal government and provide an independent opinion about whether it is safe and effective. One of our own eminent virologists, Adolfo García-Sastre, PhD, is among the seven members.

I know you will have a lot of questions about the COVID-19 vaccine plans, and we do not yet have a lot of answers. But you can email COVIDQuestions@mountsinai.org with your concerns, and we will address them as best we can. I will keep all of you updated in these weekly emails, as well.

Finally, I know that it can be hard at times to keep doing what we need to do.

Pandemic fatigue is very real, and the news from our neighboring states this week doesn’t help. We all want to be able to go out in public without a mask and without worrying about crowds or indoor spaces. I want that just as much as you do.

But remember that we know how to avoid transmitting COVID-19, and we are learning more and more every day about how to treat it. This means that sooner or later, we’ll be able to bring this pandemic to an end. And it will be sooner if we all do what we know we have to do now. So wear your mask, practice hand hygiene at every opportunity, observe social distancing, use our wellness resources, and be there for your colleagues. Every day we do this gets us closer to the finish line and decreases our personal and collective risk. .

Page 3 of 3

Subject: COVID-19 Health System Updates, November 18 Date: Wednesday, November 18, 2020 at 11:00:04 AM Eastern Standard Time From: Broadcast NoKficaKons To: Broadcast NoKficaKons A7achments: MSHS_COVID-19_Todays_Updates_Nov_18.pdf

TO:

All Faculty, Staff, Trainees, and Students

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

November 18, 2020 COVID-19 Health System Updates, November 18 After a few weeks of relative stability, this week we saw an increase in COVID19 inpatient admissions. We have been prepared for this for a long time, and in fact, we’re prepared to care for significantly more COVID-19 patients should that need grow.

We have opened some of our surge spaces to help care for these patients, and there is much more available if we need it. We are also continuing to transfer patients among our hospitals so that we make sure every patient gets the right care, and no hospital becomes overwhelmed. Our warehouses are still stocked with many months’ supply of PPE. We’ve welcomed traveling Page 1 of 5

nurses to help us with caring for this increase in COVID-19 patients in our hospitals, and we’re working with both the nursing agencies and our own union leaders to line up more help.

We need your help, too. It is quite clear that there is a wide spectrum of severity of COVID-19 infection. This includes people who have acute COVID19 infection, yet with little or no symptoms. This, along with the return of cold weather and people becoming less careful with their behaviors, helps explain why we are seeing the return of higher rates of COVID-19. People feel fine, so maybe they let down their guard a little bit—either in the break room with their colleagues, or after work with their friends. It’s understandable, but it’s dangerous, too.

I wish I didn’t have to say this, but right now, with rising community spread, you really need to assume that anyone you work with or see socially might have COVID-19, even if they look and feel fine, and even if you’ve known them for years. Keep masked, keep social distancing, and wash your hands frequently.

Now more than ever, it’s important to observe our COVID-19 Code of Conduct.

It’s important partly because a significant and growing number of your colleagues are now on home isolation after confirmed or suspected exposure to COVID-19. Many of them didn’t realize they were risking exposure until it was too late. And now their health may be at risk, and they are unavailable to help you take care of our patients. Please don’t add yourself to that list.

It’s also a reminder that this situation could get much worse over the holidays if we’re not careful. As you may have seen, Governor Cuomo has limited gatherings to 10 people, even at private homes. And even that many people together poses significant risks because of the nature of how the COVID-19 infection can spread. Being around large groups, particularly if you’re eating or drinking and have your mask off, is just too risky.

As of this morning, we had 126 COVID-19-positive inpatients in our hospitals, 31 of whom were in critical care. This is the highest number we have seen in several months.

The New York State seven-day average test positivity rates stood yesterday at 2.5 percent for New York City, 3.2 percent for Long Island, and 3.7 percent for Page 2 of 5

the Mid-Hudson region. All three are up significantly since last week.

Travel and Visitor Policy Reminders As I mentioned a couple of weeks ago, New York State has updated its travel policy to apply to all travel outside New York and our five neighboring states— New Jersey, Pennsylvania, Connecticut, Massachusetts, and Vermont. If you’re planning to travel outside the region for Thanksgiving, please review the Mount Sinai travel policy, and be sure you have enough PTO available to quarantine when you get back.

The details are really complicated, but it comes down to this: • You cannot come back to work until you’ve either quarantined for 14 days, or received a negative COVID-19 nasal swab (PCR) test after you return. While you can take this test for return-to-work purposes as soon as you’re back, you will need to quarantine while you wait for the results.

• That negative PCR test can clear you to go back to work, but you might still have to quarantine for additional days whenever you’re not working, depending on where you live.

• The only way to avoid quarantining after you travel is to travel only within New York and our five neighboring states.

The New York State rules also apply to visitors who come from outside the region to see patients at our hospitals. Visitors must obey the state’s quarantine and testing rules before they can enter our hospitals. Details are in the visitor policy on our website. And please remember that strict limits on the number of visitors per patient are still in effect, including on Thanksgiving Day. How to Get Tested Since the travel policy now includes a testing component, here is some helpful information. We are working to improve access to testing for all Mount Sinai employees, and in the meantime, you can get information here on how to get an asymptomatic nasal swab (PCR) or antibody test for COVID-19 at a Mount Sinai facility. In addition, many urgent care practices, including CityMD, offer testing without an appointment.

Page 3 of 5

Vaccine Update If you read the news, you saw this week that a second vaccine, by Moderna, is also showing a lot of promise in early test results. This is more good news, and more evidence that someday soon, this crisis will be behind us.

Behind the Scenes “I did not anticipate how difficult it was—both for me and for the people who were turning to me for answers—to hear myself saying, ‘I just don’t know’ as often as I did during the early days of the pandemic.”

Candid insights like this, and a look at the progress of COVID-19 vaccines, are offered by a central figure in our COVID-19 response, Judith Aberg, MD, the Dr. George Baehr Professor of Clinical Medicine, Chief of Infectious Diseases, and principal investigator of multiple COVID-19 prevention and treatment trials at Mount Sinai. Read it here.

It can be heartbreaking to watch the news these days. So many places, especially in the Midwest, are now going through what we experienced in March and April—the tent hospitals, the halts in elective surgery, the fears about PPE supplies, and the need for refrigerated morgue trucks. We feel for our health care colleagues elsewhere in the country. No one should have to experience that.

But I do want you to know that, despite our increased number of COVID-19 patients and the talk about reimposing some more stringent social distancing rules, we are a long way from going back there ourselves. We have some of the best predictive modelers anywhere. Their models are built on rich datasets from our hard-won experience. And they show that the current wave in New York City will likely peak far lower than what we experienced before—and well within our current capacity.

New Yorkers know what some parts of the country are only now discovering: that hand hygiene, masking, and social distancing, if rigorously observed, make a real difference in slowing the spread of COVID-19. Let’s rededicate ourselves to those simple but effective techniques. Let’s try our best to avoid becoming overwhelmed with the news of the day, and to use our wellness Page 4 of 5

resources whenever they might be helpful. Let’s make time to connect with extended family, virtually and in a safe way, next week for Thanksgiving. And let’s be proud that we are Mount Sinai, and we can overcome this, together.

Page 5 of 5

COVID-19 Headlines November 18, 2020 PROTECT YOURSELF With the current rising rates of community spread, assume that anyone you meet might have COVID-19. Keep masked and at least six feet away from them, and wash your hands frequently. Now more than ever, it’s important to observe our COVID-19 Code of Conduct.

KEEP TO SMALL GROUPS Governor Cuomo has limited gatherings to 10 people, even at private homes. And even that many people together poses significant risks because of the nature of how the COVID-19 infection can spread. Being around large groups, particularly if you’re eating or drinking and have your mask off, is just too risky.

THINK CAREFULLY ABOUT TRAVELING New York State’s travel restrictions now apply to all travel outside New York and our five neighboring states—New Jersey, Pennsylvania, Connecticut, Massachusetts, and Vermont. If you’re planning to travel elsewhere, please review the Mount Sinai travel policy, and be sure that you have enough PTO available to quarantine when you get back.

Subject: Date: From: To:

COVID-19 Health System Updates, December 16 Wednesday, December 16, 2020 at 12:29:43 PM Eastern Standard Time Broadcast NoKficaKons Broadcast NoKficaKons

TO: All Faculty, Staff, Trainees, and Students FROM: Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

December 16, 2020 COVID-19 Health System Updates, December 16 It is probably the most complicated week of this latest surge, at least so far.

We started offering COVID-19 vaccinations to some of our faculty and staff yesterday, yet at the same time, we—including many of the very people who are getting vaccinated—were taking care of the largest number of COVID-19 patients we have seen since the end of May. It is hope, paired with frustration. It’s not an easy combination, especially for those caught in the middle of it. But I am pleased to report that thanks to all of you, and the extraordinary work you do, we are holding our own on both fronts.

Hope is winning out. The tunnel is long, but there is light at the end.

Page 1 of 3

While I can’t go into too many details right now, I can tell you that we are off to a very good start in vaccinating faculty and staff in our Emergency Departments and others who regularly treat COVID-19 patients or work in high-risk settings. Over the next days and weeks we will continue to offer vaccine to faculty, staff, trainees, and students in these areas, and we will continue to expand the areas included consistent with the New York State guidance. We have created a Vaccine Information website to help answer your questions; please see the attachment.

We will let each of you know when it is your turn to be scheduled for the vaccine. If your colleague is offered vaccine and you are not, please be patient. We are following a strict process and will get to you as soon as we can. If you are offered vaccination, you cannot give your spot to another person. While that is a very generous impulse, unfortunately we cannot allow it, as that could violate New York State rules and would work against our efforts to ensure a fair and equitable distribution.

We are already planning for the next group and hope to be able to announce those details soon. We also hope to learn soon whether Moderna’s vaccine will be granted emergency use authorization and whether, if so, we will be allocated some of that for our staff and patients. That vaccine looks to be as promising as Pfizer’s, to judge by the FDA data released yesterday. Whatever happens next, we will not stop until all of our employees, and then our patients, have the opportunity to receive COVID-19 vaccination.

On the treatment side, our biggest challenge right now is staffing. We have a significant number of nurses and other clinical staff on home isolation due to COVID-19 infection or exposure, which reduces the number available to help care for our growing numbers of patients. We are taking a number of steps to try to address this challenge and are grateful to everyone’s agility and teamwork. You can help by continuing to follow the Mount Sinai COVID-19 Safety Code of Conduct, and its masking and social distancing protocols, as strictly as you can.

As I mentioned last week, the state has directed us to increase our bed capacity by 25 percent in order to continue to meet the needs of our surgical patients. I am pleased to tell you that every Mount Sinai hospital is meeting Page 2 of 3

that demand.

As of this morning, we had 305 COVID-19-positive inpatients in our hospitals, 53 of whom were in critical care. The New York State seven-day average test positivity rates as of yesterday were 4.0 percent for New York City, 5.7 percent for Long Island, and 6.1 percent for the Mid-Hudson region. These positivity rates are ever so slightly down since last week. It’s too early to call it a trend, but it’s another reason for hope.

We don’t have any policy changes to announce this week, and I know you’re extremely busy, so I’ll wrap this up with a thought.

This week, you achieved something entirely new. You treated more than 300 COVID-19 patients at a time while setting up a complicated and robust vaccination operation and handling a normal, even busy, surgical schedule and non-COVID-19 medical caseload. You’ve done each of those things before —in fact, in March and April, our system treated more than seven times as many COVID-19 patients. But to do all three at the same time is extraordinary.

Time after time, the world has thrown new challenges at you, and you’ve responded admirably. You’ve shown again that there is nothing you cannot do.

This is why it remains the honor of my life to wear the Mount Sinai badge with you.

Page 3 of 3

What YouWhat Need You to Know About

COVID-19 Vaccines Need to Know About

The first vaccines for COVID-19 are expected to receive emergency use authorization (EUA) from the FDA in the near future. We expect to start offering them to some of our front-line health care workers shortly after the EUA. The clinical trials for both vaccines that have applied for EUA involved more than 70,000 people in the United States and thousands more worldwide. No serious safety concerns have been reported in these trials.

These vaccines have been shown to work exceptionally well at protecting people from COVID-19.

They have an efficacy rate of 94 to 95 percent, which is very high. This means that there were 94 to 95 percent fewer cases of COVID-19 in those who received the vaccine, versus those who received a placebo (shots without any vaccine in them).

The trials have included at least 25,000 people from population groups most affected by COVID-19, including Black, Hispanic/Latinx, and older Americans.

The U.S. Advisory Committee on Immunization Practices has recommended that health care workers, and residents and staff of nursing homes and other long-term care facilities, be offered the vaccine first. We are waiting for additional guidance from New York State and New York City before we know exactly which groups of health care workers we can offer vaccines to first. We will let you know when you will be offered a vaccine.

We strongly encourage all eligible Mount Sinai Health System faculty, staff, trainees, and students to get the vaccine when they are offered. However, at this time, it is not mandatory.

For more information about the new COVID-19 vaccines, visit https://www.mountsinai.org/about/covid19/vaccine-information or use your smartphone to click on this QR code.

If you have additional questions, please send them to COVIDQuestions@mountsinai.org.

COVID-19_12-7-2020

Subject: COVID-19 Health System Updates, December 30 Date: Wednesday, December 30, 2020 at 10:35:02 AM Eastern Standard Time From: Broadcast NoJficaJons To: Broadcast NoJficaJons

TO: All Faculty, Staff, Trainees, and Students FROM: Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

December 30, 2020 COVID-19 Health System Updates, December 30 It was two weeks ago yesterday when our Health System hospitals received the very first shipments of the Pfizer COVID-19 vaccine. We had been preparing for that day and had assembled a scheduling and distribution system, in accordance with the New York State Department of Health guidelines, to start vaccinating our front-line hospital-based caregivers at significant risk of exposure to patients with COVID-19 infection. Your colleagues, who comprise that herculean scheduling and distribution system, are now vaccinating nearly 1,000 members of the Mount Sinai family each day.

What an extraordinary accomplishment.

And we received more good news this week. The DOH has issued new guidance that will allow us, starting on Monday, January 4, to expand our Page 1 of 3

vaccination efforts to include ambulatory care. We are assembling our lists and getting ready for that, as well. And that includes our voluntary physicians. They are vital members of our Mount Sinai family and community.

The vaccine eligibility guidance is still specific to those who have exposure to patients or to infectious materials. And that means we are not yet permitted to vaccinate every member of our Mount Sinai family working in non-patientfacing roles, who we know are also critical to our mission. But we know that it is a matter of time, hopefully a short time, before we receive the DOH guidance we need, and the amount of vaccine that we need, to offer vaccination to every member of our incredible Mount Sinai family. And in coming months we expect to be able to offer vaccine more widely to the public.

The vaccination process is very much on schedule, with your colleagues working as quickly as possible, balancing the DOH directives on eligibility as well as supply of vaccines. If you haven’t been offered vaccine yet, we appreciate your understanding and your patience.

New York City has seen a steady increase in reported COVID-19 cases over the last two weeks, and the number of cases is expected to continue to increase in the coming days. As of this morning, we had 416 COVID-19positive inpatients in our hospitals, 54 of whom were in critical care. The New York State seven-day average test positivity rates as of yesterday were 5 percent for New York City, 6.8 percent for Long Island, and 6.3 percent for the Mid-Hudson region.

Parking Permits Extended The New York City Department of Transportation has again extended the validity of the parking permits it issued earlier this year to health care professionals working on COVID-19 response. The permits were to have expired on Thursday, December 31, but will now be valid until June 30, 2021.

If you have one of these permits, you do not need to do anything; the validity date has been extended, but you will not receive a new document. As a reminder, these permits do not allow parking in “No Standing” zones or bus lanes.

Gift of Song From Lincoln Center Page 2 of 3

Henry Timms, President and CEO of Lincoln Center, has sent us a special message of gratitude. Throughout the pandemic, Jeremy Boal, MD, and Judith Aberg, MD, have been advising Mr. Timms and his team on keeping the Lincoln Center staff safe. In return, he says, “Thank you for your partnership and guidance this year. Until we can properly thank you on campus, please enjoy this special message, which includes a festive performance by the pianist Llewellyn Sanchez-Werner. The New York Times has lauded his talents as ‘sensitive and lyrical,’ and I am so pleased he could record something special for us.” You can view this gift of song here.

There are 100 more COVID-19 patients in our hospitals now than there were two weeks ago, and as I said, we expect this census to keep rising in the near future. To stay ready, we are taking strategic steps, such as transferring patients and moving some procedures to hospitals with more capacity, and continually looking for opportunities to provide cross-training and support. Our most important asset in caring for our patients is all of you, and the selflessness and skill that you bring to your work every day.

Mount Sinai is a very special place, and we are about to show how special yet again during the marathon of the pandemic.

Page 3 of 3

Subject: Date: From: To:

COVID-19 Health System Updates, January 6 Wednesday, January 6, 2021 at 2:11:40 PM Eastern Standard Time Broadcast NoKficaKons Broadcast NoKficaKons

TO: All Faculty, Staff, Trainees, and Students FROM: Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

January 6, 2021 COVID-19 Health System Updates, January 6

Since receiving our first doses of COVID-19 vaccine on December 15, we have been able to vaccinate so many of members of our Mount Sinai family. We have been following the New York State Department of Health eligibility guidelines closely. Recently those guidelines allowed for expansion of eligibility to include ambulatory care sites. So, as of Monday, January 4, ALL patientfacing employed and voluntary physicians, staff, students, and trainees throughout the Mount Sinai Health System, and those who work with potentially infectious materials, are eligible for vaccination. This means clinical and nonclinical faculty and staff in any patient-facing role, including receptionists and other people who greet or interact with patients, in both Page 1 of 3

Mount Sinai-owned and voluntary/affiliated practices.

This is great news, and a very happy way to start the New Year. I know that so many of you have been eager to get the vaccine, and I’m sorry that until now, we haven’t always been able to explain exactly when you might be able to, because we were waiting for the guidance from the Department of Health. We have been moving forward very quickly. Yesterday, we vaccinated more than 2,100 people, and we aim to reach even larger numbers later this week.

Everyone who is now eligible for vaccination should have received an email with instructions about how to schedule an appointment. The email was sent from the address donotreply@mountsinai.org, and the subject was “SCHEDULE YOUR COVID-19 VACCINATION APPOINTMENT.” If you didn’t receive that email, and haven’t been notified of your eligibility or given scheduling instructions in other ways, and you believe you’re eligible for vaccine, please speak with your manager or clinical chief. Appointments can be scheduled at our hospitals, and we will be setting up temporary vaccination pods at many of our larger ambulatory sites as well.

If you are in a role that does not have exposure to patients or infectious materials, we will notify you as soon as we receive final Department of Health approval that you are eligible. And of course we are all eagerly anticipating final guidance on when vaccination can be offered more widely to the public.

It is so important that each of us gets vaccinated, to protect ourselves, our families, and our patients, and to help bring this pandemic under control. If you’ve already received your first dose, thank you—and be sure to come back when scheduled for your second dose. You need that second dose to have the best possible protection against COVID-19.

If you are eligible and have not yet been vaccinated, please schedule your appointment as soon as you can. Many of our sites are accepting walk-ins as well.

I want to again thank everyone who has been working on the vaccination rollout. It is an unprecedented and complex effort. And it’s especially impressive in light of the continuing increase in COVID-19 caseloads across the system, which is also taking up so much of our time and energy. As of this Page 2 of 3

morning, we had 472 COVID-19-positive inpatients across the system, 67 of whom were in critical care. We can expect these numbers to continue to increase over the next couple of weeks as people who contracted COVID-19 at holiday gatherings become symptomatic and need our care.

We are continuing to make changes as needed to accommodate these patients, including by adjusting services at some of our sites, transferring patients around the system to balance the load while providing them the best care possible, and adding bed capacity wherever we can. I am so grateful for the cooperation everyone has shown as we do this.

COVID-19 Vaccine and Pregnancy I know that many of you who are of child-bearing age have questions about whether to get COVID-19 vaccine. If you are in that group, I highly recommend this short video by Angela Bianco, MD, Associate Professor of Obstetrics, Gynecology and Reproductive Science. The bottom line is that while everyone should discuss this with their health care provider, it is very important to stay healthy while you are pregnant or considering becoming pregnant, and the vaccination can help you do that.

Busting More Vaccine Myths In a previous broadcast I told you about NewsGuard, a company we’re working with that tracks down and debunks myths and falsehoods circulating on the internet about COVID-19 vaccines. We’ve now prepared our own list of the top vaccine myths and the truth about them. Please feel free to print it out, pass it around, and give it to whoever needs to see it. And don’t forget that you can find answers to questions you may have about the vaccines on our public and employee web sites.

The next few weeks will be hard. I’m not going to try to hide that. There’s no break yet from COVID-19. But there is more and more hope. If each of us does our part, by wearing our masks, keeping our distance, washing our hands, and getting the vaccine when it’s our turn, we will overcome this before too long.

I’m confident of it. Because I’m confident in you: the remarkable people who wear the Mount Sinai badge. You’ve met every challenge this pandemic has

Page 3 of 3

COVID-19 Vaccine Is Available ALL patient-facing employed and voluntary physicians, staff, students, and trainees throughout the Mount Sinai Health System are now eligible for COVID-19 vaccination.

et

Ma

sk

y

Please check your email for instructions about how to schedule an appointment. If you did not receive an email, please speak with your manager.

u p fo r s a

COVID-19_01-05-2021

f

Subject: COVID-19 Health System Updates, January 13 Date: Wednesday, January 13, 2021 at 1:05:35 PM Eastern Standard Time From: Broadcast NoKficaKons To: Broadcast NoKficaKons

TO: All Faculty, Staff, Trainees, and Students FROM: Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

January 13, 2021 COVID-19 Health System Updates, January 13 We are now in phase 1B of the COVID-19 vaccination project, and the list of who is eligible for vaccination continues to grow rapidly. Yesterday, Governor Cuomo authorized people between 65 and 74 years old to receive the vaccine, just a couple of days after authorizing those 75 and over and certain categories of essential workers. And we expect that the state will issue additional guidance shortly on the eligibility of those who are immunocompromised and younger than 65.

Meanwhile, health care workers remain the top priority, so I encourage everyone who works onsite at our facilities, and now also those who are working remotely and are age 65 and older, to get scheduled for vaccination.

This expansion of vaccine eligibility to members of the public is an important Page 1 of 5

development since the vaccines were first launched last month, and another major step toward ending this pandemic. But exactly what it means for us depends on how much vaccine we receive from the state and the city. This means that, at times, we may need to pause scheduling of members of the public, as the amounts of vaccine allocation that we receive have been and will likely continue to change. We are working to get clarity on that.

Earlier this week, we wrote to leaders and managers across the Health System to ask that staff be redeployed to help run the vaccination pods. Exactly what and how many people we need will depend on the vaccine supply, but in addition to providers who will actually give the vaccinations, we may need to fill a variety of nonclinical roles, including registrars, wellness monitors, and lobby screeners. If you are interested in volunteering for any of these roles, please talk to your manager. If you are asked to redeploy, we are grateful for your cooperation. We very much also appreciate the efforts of everyone who is not redeployed but will now have to cover for colleagues who are. This will be a new challenge for all of us, but I am confident we can meet it.

The response by patients to news that they are eligible for vaccine has been fantastic. Yesterday, we vaccinated about 4,000 people, including employees and patients. We want to offer these vaccines to as many as we can while remaining committed to ensuring that vaccination of our health care workers is our most important goal.

As of this morning, we had 500 COVID-19-positive inpatients in our hospitals, 83 of whom were in critical care. This is the first week since May that we have hit 500 cases, and I want to say a few things about that.

First, even with 500 cases, we are still at only one-quarter of the peak we hit last year. And not only that, this time the curve is much flatter, as the graph below shows. We are seeing steady increases, but not rapid ones. It’s likely that everything New Yorkers have learned since March about wearing masks, social distancing, and hand hygiene is really making a difference.

Page 2 of 5

Second, we are treating them much more successfully. Our death rates from COVID-19 are far below where they were in the spring, and that’s due to you— all of you—who have learned so much about, and taught the world, how to treat COVID-19. This is why we all got into health care. Every day we are saving lives, and we’re still learning more about how to do it.

But I do acknowledge that our current situation adds some significant complexity compared to last spring. We have to set up and run an enormous vaccination operation even as we treat a higher number of COVID-19 patients and still care for as many of our non-COVID-19 patients as we possibly can.

They need us too. It’s a challenge, to be sure. But we are turning the tide. And that light at the end of the tunnel grows closer by the day.

An Update on the Travel Policy If you travel outside New York and our five neighboring states, under updated state rules you must now get tested twice—on the first and fourth days after your return—in order to avoid the mandatory 14-day quarantine. We have updated our travel policy to reflect this, and as a reminder, here is the list of employee testing sites where you can get SARS-CoV-2 nasal swab (PCR) tests.

Behind the Scenes This week, I’d like to spotlight another leader who has been working behind the scenes to keep us all safe: Susan M. Mashni, PharmD, Vice President and Chief Pharmacy Officer, and the head of our COVID-19 vaccine planning committee. In her own words: Page 3 of 5

I think my most challenging day during the pandemic was in late March: We were running out of sedative medications for our COVID-19 patients, and we’d reached out to the FDA, pharma, our wholesalers, and partners everywhere with a cry for help. We were able to procure some drug to be brought on a Sunday, but our loading dock wasn’t available. We didn’t realize the issue, and had to deal with it on the spot. The medication was loaded onto the street, and our pharmacy team, including their family members, all came in and helped to move the medication into the pharmacy. It was amazing—all got on board and got it done.

In the last few months, I’m so proud of the great work our multidisciplinary team is doing as we plan every aspect of administering the COVID-19 vaccines. We have to make sure to align with the state and city on the employees and patients who are within the guidelines to be vaccinated. This is so hard! We want to give vaccine to all, but some will have to wait. It is not personal—it has nothing to do with how much we value our people, appreciate them, care about their welfare, or how vital they are to our Mount Sinai family.

Then there is this issue: The decision to be vaccinated is so personal for many.

I want to help everyone get the answers they need from the parties that they respect and understand. Trying to accommodate each of our employees and patients—and give them the personal attention they need and deserve to make the best decision for them—is difficult and tough for our team.

As a pharmacist, I can say that large clinical trials have shown that the vaccines we have so far—from Pfizer-BioNTech and Moderna—are remarkably safe and effective. I volunteered at The Mount Sinai Hospital vaccine pod last weekend and therefore was eligible for vaccination. I did get vaccinated, and am advising my friends, family, and all who ask my opinion to do the same!

A Note About Your Well-Being This has been an extraordinarily challenging year for us all, not just in our work lives but in our personal lives as well. In addition to working harder than ever before in a more stressful environment, many have dealt with significant challenges related to child care, elder care, financial stress, and work-life balance. Many have lost friends and family. Others have experienced physical Page 4 of 5

and mental health challenges of our own. At the same time, we have had to restrict some of the ways that we normally cope, such as surrounding ourselves with friends and family.

While our colleagues who provide support to the workforce have made a significant effort to create resources to meet some of these increased needs, we all know that challenges remain. I want to acknowledge these struggles and to let you know that we—this institution and all of us who help lead it—care about you and see you as the people you are. We know that you are more than just the remarkable work you do for Mount Sinai and our patients.

Before and during the pandemic, we gathered, created, and expanded resources for basic needs and mental health, well-being, and spiritual care. It takes strength to recognize that some of these resources might help you and to take advantage of them when needed. As we move into this exceptionally challenging phase—not just “the end of the beginning” but really, we can now hope, the beginning of the end—please know that you are not alone. You are part of a community that cares about you. I really hope that you will use these resources if and when the need arises.

Every week I tell you how proud I am of the work you all are doing. And then the next week, you go and outdo yourselves. This week is no exception. As we get closer to the end of this terrible ordeal, the work will only get harder. But seeing the end, even in the distance, gives us the strength to go on. Thank you once again for everything. I am proud to wear the Mount Sinai badge alongside

Page 5 of 5

Subject: COVID-19 Health System Updates, January 27 Date: Wednesday, January 27, 2021 at 12:19:21 PM Eastern Standard Time From: Broadcast NoJficaJons To: Broadcast NoJficaJons

TO: All Faculty, Staff, Trainees, and Students FROM: Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

January 27, 2021 COVID-19 Health System Updates, January 27 I’m glad to report that we continue to see bits of good news on both the COVID-19 case count and vaccination fronts. We are still not out of the woods, and the path to get there zigzags a bit, but on balance we are going in the right direction.

Let’s talk about vaccination first. The vaccine supply continues to be highly variable, but as of now, we have received enough vaccine to take care of every patient on our schedule through the rest of this week. What happens from there on out is still uncertain. In some cases, we have even been able to get patients vaccinated earlier than they expected. We have also offered new appointments to every patient whose appointment from the January 16 weekend had been canceled and whom we were able to contact.

Page 1 of 4

The big picture is that there is still not enough vaccine right now for every eligible patient in this country who wants it. Every other health system and every state and city health department is grappling with this. Ultimately, it is up to the federal government and the vaccine manufacturers to figure out how to meet the demand, and we will need to be patient while they do so.

In the meantime, I want to make three commitments about COVID-19 vaccines: 1. Whenever we do not have enough vaccine to serve patients who have made appointments, we will reschedule those patients just as soon as we can.

2. Every person—patient and employee—who gets their first dose of vaccine from Mount Sinai will be able to get their second dose here as well.

3. Whatever happens with the patient vaccine supply, we will always have enough vaccine for any eligible employee who wants it.

That is our commitment to each of you and to the patients we serve.

One further note on second doses: We will, as I just said, offer second doses to anyone who gets their first dose from us. But under state guidelines, we cannot give second doses to people who got their first dose elsewhere, even if their first-dose location is no longer operating. If any patients or members of the public call you or your practice with this situation, please refer them to these numbers to find a location for their second dose: New York City: 311 or 877-VAX-4NYC (877-829-4692) New York State: 833-NYS-4VAX (833-697-4829) Also, as a reminder, you are currently eligible for vaccination if you are a Mount Sinai faculty or staff member who works onsite, or if you are a voluntary physician or a patient-facing member of a voluntary practice’s staff, or if you are a remote worker who is 65 or over.

I know that some of you who are eligible are still trying to decide whether to get vaccinated. You may have concerns about the vaccine approval process or whether vaccination is right for you, given your medical or family situation.

Page 2 of 4

There is a legacy of racism and bias in health care that has also contributed to uncertainty about whether new vaccines like these can be trusted.

To address concerns like these, we have launched a new website, mountsinai.org/vaxfacts. It contains questions and answers about the vaccines and personal stories from members of our Mount Sinai family who chose to get vaccinated. It’s intended as a resource to help each of you decide for yourselves. We’ll be adding to it as we go along, so please check back there often. I do strongly encourage everyone to get the vaccine if appropriate, but I also know this is not an easy choice for many, and we are here for you when you want to talk or you are ready for the vaccine.

One of our own—Ugo A. Ezenkwele, MD, MPH, FACEP, Chief of Emergency Medicine at Mount Sinai Queens—will be a featured expert at a town hall hosted by WABC Eyewitness News tonight at 5 pm to answer questions from viewers and the public about the COVID-19 vaccines. I highly recommend tuning in if you are able to, especially if you or someone you know still have questions about these vaccines.

Now, here’s an update on COVID-19 case counts.

The good news is that, as you heard on Friday, New York State test-positivity rates appear to have peaked earlier this month and are now steadily declining.

As of yesterday, the seven-day moving averages are 5.6 percent for New York City, 6.9 percent for Long Island, and 6.8 percent for the Mid-Hudson region.

All three are down even further since Drs. Davis and Charney reported on them in their Friday message.

As of this morning, we had 509 COVID-19-positive inpatients across the system, 93 of whom were in critical care. These numbers are holding roughly steady, but we know that changes in hospitalizations lag the changes in positive tests by a couple of weeks. So we are cautiously optimistic that they will come down over the next few weeks.

This can’t come too soon for all of you who have been working to take care of both our COVID-19 and non-COVID-19 patients. I want to acknowledge just how hard this has been and continues to be, as well as the personal toll it exerts on so many members of our Mount Sinai family. All of us in leadership Page 3 of 4

want to say thank you again for your efforts. And we don’t just want to tell you how thankful we are; we want to show you. We’re working on some events and activities around this, in conformance with COVID-19 restrictions; stay tuned for details.

The larger community continues to be grateful as well, as shown most recently by this “Hopeful Images From 2020” photo essay in The Atlantic. The third photo shows nurses and other health care workers at Mount Sinai Queens celebrating National Nurses Week back in May. The magazine said they chose this image as part of “an effort to seek out and recognize some of the abundant joy and kindness present in the world around us, even in the midst of a truly awful year.” If you can’t see the page because of the paywall, a similar photo along with some of the backstory is on Mount Sinai Today.

National Nurses Week seems like a lifetime ago, doesn’t it? So much has happened since May. But The Atlantic and its readers haven’t forgotten the extraordinary role you have played in healing our communities. Neither have the city or the world. And they never will.

Page 4 of 4

Subject: COVID-19 Health System Updates, February 17 (corrected) Date: Wednesday, February 17, 2021 at 12:22:19 PM Eastern Standard Time From: Broadcast NoMficaMons

TO:

All Faculty, Staff, Trainees, and Students

FROM:

Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

February 17, 2021 COVID-19 Health System Updates, February 17 I want to start by wishing everyone a happy Lunar New Year, and a good Year of the Ox to those who observe it. Today is, of course, Ash Wednesday, and as I mentioned last week, we have set up COVID-19-compliant procedures for our colleagues who observe today’s rites.

Whatever your faith or background, I hope you were able to have a refreshing break this weekend. There have been so many false starts and changes that I want to be a bit cautious here, but this week we are seeing increasing evidence that we are past the worst of this latest COVID-19 surge.

As of yesterday, the New York State seven-day test positivity rates were 4.4 percent for New York City, 4.6 percent for Long Island, and 4.5 percent for the Page 1 of 5

Mid-Hudson region. These numbers have now been declining for a solid month. As of this morning, we had 494 COVID-19-positive inpatients in our hospitals, 96 of whom were in critical care. This is the third straight day we have been below 500 total cases. While we have not yet decisively broken out of the range in which these numbers have fluctuated in this year, that is an encouraging sign.

If we see a bit more progress in our caseloads, it is likely that we will move to restart some procedures at some of the sites that we put on hold several weeks ago because of the surge. We have set up triggers for this decision based on what we hope will be continuing declines in the number of COVID-19 patients we are treating. We are cautiously hopeful that this could begin as early as next week.

The news is not as encouraging with respect to offering vaccinations, unfortunately. As I announced on Sunday, we have received no new supplies of first-dose vaccine this week and, as a result, have had to cancel all patient first-dose appointments, except at Mount Sinai South Nassau. We continue to have enough vaccine on hand for scheduled employee first doses through Tuesday, February 23, but we cannot schedule new employee appointments or accept walk-ins.

All patient and employee second doses are proceeding as scheduled.

We are keeping a waiting list for Mount Sinai onsite employees, trainees, students, and voluntary physicians who would like to schedule their first vaccinations, but as I said on Sunday, we are sadly not able to use that list for employees who work remotely and are 65 or over, or have one of the medical conditions listed by the state last week that make them eligible for vaccine.

I strongly recommend that all employees who are eligible for vaccine, and who do not have a first-dose appointment scheduled with us on or before February 23, try to get an appointment via the New York State or New York City websites. This may well be quicker than waiting for vaccine to be available through Mount Sinai.

Again, this is because an ongoing expansion of city and state vaccination sites has put pressure on continued supplies to hospitals. We do not know how long Page 2 of 5

this will last or whether we will eventually get new vaccine supplies. This is the best information we have right now. We are very sorry that we cannot offer vaccines to our patients at present.

One final note on vaccines, and this applies to everyone who has already had their shots as well as those who are still waiting: The COVID-19 vaccines are free for everyone, whether or not you have insurance. If you do have insurance; your insurance may be billed, but you will not be charged a co-pay or other fee.

If you get a bill in error, you do not need to pay it. Per federal law, there is no out-of-pocket cost to the patient. Contact the phone number on the bill to resolve the issue. If you are an employee and you get a bill for the vaccine in error, please email Covidvaccinebilling@mountsinai.org.

New Policy on Work and Pay in an Emergency The Health System has updated its policy on work and pay in an emergency.

The new policy applies system-wide and replaces policies that were in place at individual sites. It covers topics that include emergency procedures and crisis pay. Please review it when you have a chance.

Speaking Our Patients’ Languages It is so important to make information available to our patients in their preferred language, and we recently added a toolbar to the mountsinai.org website that enables site visitors to convert the webpage to one of 100 languages, including Spanish, Russian, and Chinese. With content related to COVID-19 evolving quickly, this tool will ensure all patients have access to the latest information since the translation takes place instantaneously.

From the homepage or any page within the Patient Care and COVID-19 sections, users are able to choose a language by clicking on the “Select Language” menu featured at the top of the site. Once the user chooses a language, the site will continue to be translated throughout their visit to mountsinai.org.

Meet Our Scientists Page 3 of 5

The search for better treatments for COVID-19 has led a team of our scientists, with colleagues in San Francisco, to plitidepsin (pli-tee-DEP-sin)—an antiviral drug derived from a sea organism. Their study, which was just published in Science, found that when tested in human lung cells, plitidepsin was 28-fold more effective than remdesivir, the only antiviral drug currently approved by the U.S. Food and Drug Administration to treat COVID-19. “Plitidepsin is quite unique in its potency,” says one of the study’s corresponding authors, Kris M. White, PhD, Assistant Professor of Microbiology, and a member of the Global Health and Emerging Pathogens Institute at the Icahn School of Medicine at Mount Sinai. “It is likely going to be able to work against any variant of SARSCoV-2 and other coronaviruses.”

Plitidepsin is approved in Australia under the name Aplidin as a treatment for multiple myeloma. The maker of the drug, PharmaMar, in October released results of a phase 1,2 clinical trial of Aplidin, finding that it was safe and effective in helping hospitalized patients recover from COVID-19. The company is now establishing phase 3 trials.

“The ongoing pandemic created the immediate need for us to find antiviral therapeutics that could be moved into the clinic. This led us to screen clinically approved drugs with established data and safety profiles, says corresponding study author Adolfo García-Sastre, PhD, Irene and Dr. Arthur M. Fishberg Professor of Medicine and Director of the Global Health Emerging Pathogens Institute. “We found that plitidepsin was a very promising therapeutic candidate.” Read more here.

A Campaign Launches: This Jab’s for You Mount Sinai Health System is joining medical centers across the United States in a grassroots effort to encourage public participation in vaccinations against COVID-19. The vaccination challenge known as “This Jab’s for You” will also honor the lives lost during the global pandemic and the countless health care workers, families, and loved ones who have been impacted by the spread of the disease. It is led in part by Steven Arsht, MD, Assistant Professor of Orthopedics. Dr. Arsht was inspired to help start the vaccination challenge as a tribute to his brother-in-law Louis Sarrel, who lost his battle with COVID-19 in April just three days after his 58th birthday and shortly after going into Page 4 of 5

remission from treatment for lymphoma.

If you are getting vaccinated and want to share your experience on social media, you can participate in this campaign by using the hashtag #ThisJabsForYou and tag @thisjabsforyou. A template is available online to download and fill out listing the name of the person the vaccination is in remembrance, and more information can be found here.

I want to close by thanking you for your attention today, and for your hard work over these last several weeks. We are not at the end of this surge but we can, we hope, see the end from here. A separate announcement will go out soon with additional details about the gratitude program we are in the process of launching. I would add to that message that I am truly grateful for the honor of being your colleague and wearing the Mount Sinai badge alongside you through these challenging times.

Page 5 of 5

Subject: COVID-19 Health System Updates, February 24 Date: Wednesday, February 24, 2021 at 10:58:33 AM Eastern Standard Time From: Broadcast NoNficaNons To: Broadcast NoNficaNons

TO: All Faculty, Staff, Trainees, and Students FROM: Vicki R. LoPachin, MD, MBA Senior Vice President Chief Medical Officer Mount Sinai Health System

February 24, 2021 COVID-19 Health System Updates, February 24 I have good news to report this week. We have received new supplies of COVID-19 vaccine, which will allow us to resume vaccinating patients and eligible staff.

Based on current guidance, we are going to concentrate on vaccinating our eligible employees, people who are 65 and older, and the most vulnerable eligible patients, including those with complex diseases, members of minority groups, and residents of Brooklyn and Queens. We are reaching out to these patients directly—and through community groups—to offer appointments by phone and text message. We know that not everybody has internet access or is comfortable using it. We are determined to make it easy for patients and community residents to make appointments.

Page 1 of 5

This new shipment means that we will be able to resume vaccinating our eligible onsite faculty, staff, students, and trainees, as well as voluntary physicians and their staff. We emailed everyone on our waiting list yesterday to offer them appointments. If you are an eligible employee and have not yet put your name on the waiting list, you can do so here.

If you are working remotely and are 65 and over or have a qualifying medical condition, I am sorry but we cannot yet add you to the waiting list. I will let you know as soon as that changes, but would also encourage you to try to get an appointment via the New York State or New York City websites.

And please remember that none of this affects the schedule for second doses.

Those come from a separate supply, and everyone who got their first dose from a Mount Sinai location will get their second dose from us, at the same location as the first dose, whenever they are scheduled to.

The news around COVID-19 caseloads and testing continues to be somewhat encouraging this week as well. As of this morning, we had 453 COVID-19positive inpatients in our hospitals, 83 of whom were in critical care. The number for total COVID-19 inpatients is the lowest it has been so far this year.

It increased slowly over a long period of time and will likely decline the same way, but this is definitely movement in the right direction.

At the same time, I want to acknowledge that the work remains very challenging and frequently exhausting. If you are a nurse or patient care associate in one of our ICUs or on one of our COVID-19 units, it is likely that you aren’t seeing and feeling much, or any, relief yet. This is a painful and heart-wrenching reality. Day by day, and week by week, we anticipate that the situation will indeed improve. But we know that, for many, it isn’t the case yet.

The New York State seven-day average test positivity rates as of yesterday were 4.5 percent for New York City, 4.3 percent for Long Island, and 4.2 percent for the Mid-Hudson region. This is a slight increase for the city and a small decline for the other two regions.

There is one other number worth noting: the number of Mount Sinai staff on home isolation because of confirmed or suspected COVID-19 is now the lowest since early November. This is definitely something to be grateful for.

Page 2 of 5

Noticed by the NIH A study by two Mount Sinai scientists—Florian Krammer, PhD, and Viviana Simon, MD, PhD—was highlighted yesterday on the blog of Francis Collins, MD, PhD, Director of the National Institutes of Health. In the study, published on medRxiv, Drs. Krammer and Simon reported that people who previously had COVID-19 showed a robust immune response after just one dose of vaccine. Dr. Collins said that if this finding is borne out by more studies, the Food and Drug Administration might consider whether to require only one vaccine dose for people who previously had COVID-19. This could help extend vaccine supplies and get more people vaccinated sooner.

However, as of right now, and always, it is still vitally important that we continue to follow the CDC recommendations on vaccine dosing, and that has not changed. If it does, we will be ready to adapt to that new guidance.

Reminder About the Travel Policy It has been awhile since I mentioned the Mount Sinai travel policy, but as we come up on spring break season, it’s a good time to remind you. The travel policy is based on New York State law and applies to everyone who travels outside New York and our neighboring states—New Jersey, Pennsylvania, Connecticut, Massachusetts, and Vermont—for more than 24 hours, even if you are already fully vaccinated. If you take such a trip, you need to read the full policy, but in short, you need to be cleared to return to work in one of three ways: Take a COVID-19 nasal swab (PCR) test immediately upon your return. If it is negative, you can return to work as soon as you receive the result, but you still must take a second PCR test on day 4 after your return, and that test must also be negative.

Stay home when you return, and take a PCR test on day 4. If it is negative, you can return to work.

Stay home for 10 days after you return; if you have had no COVID-19 symptoms, you can then return to work without a test.

If you are approved to work remotely, you can do so during any of these “stay Page 3 of 5

home” periods, but otherwise you will need to take paid leave time, if available, and your manager must approve that paid leave in advance. That may limit your choices, so please discuss this with your manager before scheduling a trip.

All personal travel, as well as the rare cases where essential work travel is approved, must be registered with Mount Sinai before you leave. PCR test results must be reported. If you live in New York State, you may also have to fill out this form upon your return.

For more information, click here and scroll to “Travel Policy.”

Resident Appreciation Day This Friday, February 26, is Resident Appreciation Day, and I. Michael Leitman, MD, FACS, our Dean for Graduate Medical Education, writes: “Residency is a key component of graduate medical training, offering an indepth exposure to medical practice. It can often lead to long working hours matched with many responsibilities. Residents serve as the “house staff” of the hospital and are an integral part to the health care team. They also serve as an indispensable resource for medical students, especially during their clinical clerkships.

Mount Sinai recognizes the importance of our residents and fellows. Resident Appreciation Day is celebrated by medical schools around the nation to show our gratitude and appreciation.”

I would add that our current group of residents are experiencing a year like no other. They have been a backbone of care for our COVID-19 and other patients, and I, for one, have never appreciated them more than I do now.

Thank you to all our residents for everything you do.

More Tips of the Cap We are now entering the third week of our “Connect/Appreciate/Pause” employee recognition campaign, and “CAPs” have been tipped at many sites around the Health System. Here is a brief video collage. I hope you’ve had the Page 4 of 5

chance to participate in an event by now; if not, one will be coming your way soon, so please look out for emails from your local leadership.

Thank you again for everything you do for your colleagues, our patients, and our community. It has taken a long time, but at last we are again seeing consistently good results from all your hard work. Please take a moment when you can to appreciate everything we have accomplished together in recent weeks. There is much more to do, and more hard work ahead. But we all got into health care to make a difference in the world, and it’s nice to know that in that regard—and especially in the lives of the thousands of patients we have cared for, healed from, or vaccinated for, COVID-19—we are succeeding.

Page 5 of 5