In January 2020, before COVID-19 was officially declared a pandemic, Cedars-Sinai treated one of the first COVID-19 patients in the U.S. Although it was a fearful time full of unknowns, physicians and investigators also knew it was an extraordinary moment in history.

“Working with that first patient on an unknown virus was tremendous,” said Jonathan Grein, MD, director of Hospital Epidemiology. “There was so much to learn. I remember wondering when I might develop symptoms and sleeping in the garage to avoid exposing others. When the first COVID-19 vaccine arrived later that year, we all paused to reflect on the effort and science that went into developing it. It was a remarkable time.”

But getting there was months in the making. Early on, a special Cedars-Sinai task force was meeting multiple times every day, strategizing about how to increase the hospital’s critical care capacity.

Michael Nurok, MB, ChB, PhD, now co-chair of the Department of Anesthesiology, was on the task force as director of the Cardiac Surgery Intensive Care Unit.

“We were seeing the news out of Italy about the surge in patients with COVID-19, and we were asked to prepare for 1,000 critically ill patients on ventilators,” Nurok said. “We had to think about how we might use ventilators for multiple patients. Luckily, we never had to do that, but we had to prepare for the worst.”

Standout Memories

There was fear among patients, loved ones and providers alike, physicians said.

“Fear about not being able to manage all our patients, fear of running out of supplies, fear of colleagues getting sick, fear of my family or me getting sick,” said pulmonologist Isabel Pedraza, MD, director of the Medical Intensive Care Unit and a member of the hospital’s Special Pathogens Response Team.

In addition, hospitalized patients were isolated. Rabbi Jason Weiner, PhD, BCC senior rabbi and director of the Spiritual Care Department, said the situation reminded him of the importance of human connection.

“The lockdown happened around Easter and Passover,” Weiner said. “We made signs for the glass doors of the Intensive Care Unit, wishing patients happy holidays. Later they told us it was grounding to know what was happening in the outside world.”

In the beginning, the number of infected patients was overwhelming, said Peachy Hain, MSN, RN, executive director of Nursing, Surgical Services and Clinical Support Programs.

“We were running out of beds and low on supplies,” she said. “But nurses are resilient, adaptable and supportive. We acted quickly to convert recovery rooms into shared spaces. We made sure every mask, gown and piece of equipment lasted. It reinforced how creative and innovative we are, and, in the end, it made nurses closer. We are one team, one family.”

For Sam Torbati, MD, medical director of the Ruth and Harry Roman Emergency Department, the early days were marked by a constant reminder there was no script for how to handle a pandemic.

“We’re prepared for any situation, but COVID-19 didn’t come with a playbook,” Torbati said. “So, every day we were in battle mode and every day, at every level, we came with a strategy, a plan, and strong communication and team support.”

Lessons Learned

Rita Shane, PharmD, vice president and chief pharmacy officer, recalled various lessons learned in the wake of the pandemic; among them, using protocols developed during COVID-19 for other emergency situations. For example, last September, after Hurricane Helene damaged a manufacturing facility and severely limited the national supply of IV bags and fluids, Shane’s team used pandemic learnings to help manage the shortage.

“COVID-19 taught us we can more efficiently respond to any emergency going forward,” Shane said. “Our real-time response time is more accelerated, and our experts can navigate any situation.”

Shane also recalled that Cedars-Sinai was one of the first hospitals to get the COVID-19 vaccine in December 2020—another opportunity to navigate a new situation.

“We needed a specific storage plan, and we needed a rollout plan since we were one of the local sites coordinating public vaccination,” she said.

Pedraza called the rapid development of the vaccine “an incredible breakthrough that likely will be one of the top achievements of our time. Prior to this, it could take as long as a decade for a new vaccine. The COVID vaccine gave us hope that there was an end to the pandemic. I hope we don’t forget the power of vaccines to stop human suffering.”

Equally rapid and transformative was COVID-19 research, said Susan Cheng, MD, MMSc, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science in the Department of Cardiology in the Smidt Heart Institute.

“We pivoted to focus on understanding how the virus affected people differently, as well as mitigation and prevention, and later, vaccine response,” said Cheng, a professor of Cardiology. “People in every corner of Cedars-Sinai helped us in what was the most fast-paced clinical research study I’ve ever been a part of. We learned how quickly research can answer impactful questions, and I hope our findings inform future policy and clinical practice. It was a testament to how people can stretch above and beyond to improve and protect the health of humanity.”

A Medical Landscape Altered

Grein, director of Hospital Epidemiology and head of the medical center’s Special Pathogens Response Team, said the pandemic gave him a glimpse into the future of healthcare.

“Medicine can be very conservative, and it often takes years for new guidelines to come out and change clinical practice,” he said. “COVID taught us how to more quickly respond to emerging science and adapt protocols to benefit patients and staff.”

Torbati, associate professor and co-chair of the Department of Emergency Medicine, agreed.

“We rapidly readjusted safety protocols during the pandemic, determined how to isolate patients, built treatment tents and created safe environments with adequate ventilation,” Torbati said. “We had to figure out how to do things differently while also responding to heart attacks, strokes, car accidents and other common Emergency Department situations. If a similar situation happens again, we’re very prepared.”

COVID-19 changed healthcare in many ways, Hain said, such as an increasing use of telehealth visits.

“We also use home health more effectively now, which frees up beds in the hospital for patients with more immediate needs,” she said. “We also expanded our mental health programs for staff. And we expanded community resources and outreach to improve care among Black, Hispanic and Asian patients, who faced the highest COVID death rates.”

Lasting Takeaways

David Marshall, JD, DNP, RN, senior vice president, chief nursing executive and chair of the Department of Nursing, offered three pandemic takeaways that he still relies upon daily.

“It’s critical to protect health providers so they can take care of the community, and as providers, we must pace ourselves and protect ourselves,” he said.

But heavy emotions still surface when he remembers the distress of COVID-19.

“A patient’s family shared with me that they watched on their iPhone during the lockdown and isolation as their loved one passed away while a nurse held their hand and stroked their brow,” he said. “There were moments of tragedy. There were moments of fear. There were moments of joy. COVID-19 was a moment when our institution shined while we took care of our community … and while we took care of each other.”

Read more on the Cedars-Sinai Blog: New COVID-19 Vaccines Hit the Market  

The Cedars-Sinai Newsroom spoke to two infectious disease specialists—Jonathan Grein, MD, director of Hospital Epidemiology, and Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s—to get the facts about how to protect yourself and your family.

Why is measles so dangerous?

Priya Soni, MD: Many people think that measles is just a rash, but it can be life threatening. One in 5 children who develop measles end up in the hospital. One in 20 children develop pneumonia, and this is the leading cause of measles-related deaths. In addition, 1 in 1,000 children can develop a rare complication of brain swelling—encephalitis—that can cause permanent brain damage.

How does measles spread?

Jonathan Grein, MD: Measles is one of the most infectious diseases that we know of, and it's spread very easily through the air, particularly for people who are not immune or have not received the vaccine. It's so infectious that you don't even need to be in the same room at the same time with someone who has measles to potentially get infected.

What are the telltale signs of measles?

Grein: The symptoms of measles can begin like any other viral illness. You may feel feverish, have muscle aches, headaches, very nonspecific symptoms. Patients may then go on to develop cough, runny nose, sometimes redness of the eyes. That all precedes the classic rash that you may be familiar with that typically starts on the face and spreads throughout the body. I think it’s important to know that it is possible to be infectious several days before that rash begins, which is one of the real challenges with trying to control measles from being spread person to person.

What should you do if you think your child has measles?

Soni: If you think your child has measles, the first thing to do is call your pediatrician, but do not go directly to their offices or the Emergency Department without speaking to someone on the phone first. The virus is extremely contagious, so you want to call ahead to let the healthcare providers know what’s going on. Showing up without calling ahead can cause other children in the waiting room to be infected. In addition, you should immediately isolate your child from other children, especially infants who are less than a year of age, as they may not have protection from the virus. You should also isolate your child from any immunocompromised family members.

How is measles treated?

Grein: The treatment for measles is solely supportive. There is no specific measles treatment, but you want to try to control the fever and make sure the patient is hydrated and resting in isolation.

How do we protect against measles?

Soni: Vaccination is the best protection against measles. The MMR vaccine, which is inclusive of measles, mumps and rubella, is 97% effective after two doses. It's one of the most effective vaccines that we have. And it protects children in outbreak situations and other vulnerable community members as well.

Typically, the first dose of the measles vaccine is given at 12-15 months of age. The second dose is given around 4-6 years of age.

If your child is 6-12 months old, they can receive an early dose of the measles vaccine if they're in a high-risk situation such as an outbreak or if they’ve been exposed to the virus. This additional dose that's given earlier than the recommended schedule does not count toward their two-dose series.

Do adults need to get vaccinated against measles?

Grein: Most adults will not need an additional booster dose if they were previously vaccinated. There is a small number of adults who may have received a different version of the measles vaccine between 1963 and 1967. This vaccine was later found to be less effective, and it doesn't provide as long-lasting immunity as the current vaccine. So if you did receive that vaccine, it is recommended that you receive a booster dose with the current MMR vaccine to achieve appropriate immunity.

Read more on the Cedars-Sinai Blog: Why Some Vaccines Last A Lifetime and Others Don't 

Vaccination clinics begin Sept. 9 and are scheduled through November across Los Angeles County.

“Cedars-Sinai is committed to keeping our community as healthy as possible during this upcoming flu season,” said Jonathan Vickburg, LMFT, associate director of Community Health Improvement at Cedars-Sinai. “Influenza is a serious disease, especially for young children and older adults. If you haven’t gotten your vaccination yet, please come see us at one of our clinics.”

Influenza can cause severe illness that can lead to hospitalization and even death. Symptoms include fever, chills, cough, sore throat, fatigue, nausea, diarrhea, runny nose and muscle aches. Flu activity often accelerates in October, making it critical to get vaccinated now. Infectious disease experts  from Cedars-Sinai strongly urge adults, children and infants to get the flu vaccine.

“You think it will never happen to your family, but every year, thousands of people in the U.S. die from flu complications,” said Jonathan Grein, MD, Cedars-Sinai’s director of Hospital Epidemiology and associate professor in the Department of Medicine. “It takes only a couple of seconds to get a shot and protect yourself and everyone in your family who is eligible for the shot, including babies 6 months and older and pregnant women.”

The flu vaccines formulated for the 2024-25 flu season protect against three different flu viruses that are circulating this year. Infectious disease experts recommend that everyone 6 months old and up get vaccinated. All ages are welcome at the community flu shot clinics, and children must be accompanied by a parent or guardian.

Scheduled Clinics:

Monday, Sept. 9
10 a.m.–1 p.m.
Roxbury Park 
471 S. Roxbury Dr. 
Beverly Hills, CA 90212

Sunday, Sept. 15
11 a.m.–2 p.m.
Saint Basil's Church
3611 Wilshire Blvd.
Los Angeles, CA 90005

Thursday, Sept.19
7:30–10 a.m.
Hope on Union – United University Church
2208 S. Union Ave. 
Los Angeles, CA 90007

Sunday, Sept. 29
8–11 a.m.
St. Kevin Catholic Church
4072 Beverly Blvd.
Los Angeles, CA 90004

Tuesday, Oct. 1
10 a.m.–1 p.m.
Plummer Park Community Center
7377 Santa Monica Blvd. 
West Hollywood, CA 90046

Friday, Oct. 4
9 a.m.–noon
Immanuel Presbyterian Church
3300 Wilshire Blvd.
Los Angeles, CA 90010

Sunday, Oct. 6
9 a.m.–noon
Cedars-Sinai Medical Center – Steven Spielberg Parking Lot
8723 Alden Dr.
Los Angeles, CA 90048

Saturday, Oct.19
7 a.m.–noon
Children's Institute Inc. – Otis Booth Campus
2121 W. Temple St.
Los Angeles, CA 90026

Wednesday, Oct. 23
10 a.m.–noon
Watts Labor Community Action Committee (WLCAC)
2528 West Blvd. 
Los Angeles, CA 90016

Saturday, Nov. 2
7 a.m.–noon
Michelle and Barack Obama Recreation Center
5001 Obama Blvd.
Los Angeles, CA 90016

Sunday, Nov. 10
9–11 a.m.
Young Israel of Century City
9317 W. Pico Blvd.
Los Angeles, CA 90035

Tuesday, Nov. 12
Noon–2 p.m.
Fairfax Senior Citizens Center 
7929 Melrose Ave.
Los Angeles, CA 90046

Read more on the Cedars-Sinai Blog: Flu and RSV: How to Protect Yourself Now

Flu shots are available now at Cedars-Sinai medical offices—even as much of the U.S. continues to cope with unusually high levels of COVID-19 infections from that virus’ summer surge.

Though COVID-19 tends to taper off in the autumn—when flu and RSV (respiratory syncytial virus) are beginning to set in—whether the U.S. will have a tough virus season is unpredictable at this point.

“Only one thing is certain,” said Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai and associate professor in the Department of Medicine. “We will definitely see influenza, COVID-19 and RSV circulating at the same time this winter.”

The most important advice Grein has for surviving this year’s respiratory virus season: Get vaccinated.

“The flu shot is still our most powerful tool to avoid influenza-related hospitalizations and deaths and keep our community safe,” Grein said. “The flu is linked to tens of thousands of deaths every year in the U.S. in addition to hospitalizations and clinic visits.”

The Cedars-Sinai Newsroom spoke with Grein for more information on vaccines, where to get medical care and other helpful advice for getting through flu season.

If someone gets sick, how can they tell which virus they have, and does it matter?

It can be tricky to tell these three illnesses apart because the flu, COVID-19 and RSV all can share similar symptoms—nasal congestion, headaches, fatigue, muscle aches, sore throat, cough and fever, and shortness of breath in more severe cases. Vomiting and diarrhea also can occur with COVID-19 or the flu. Only loss of taste and smell is more specific to COVID-19, though that occurs less often than it did early in the pandemic.

It’s important to get tested quickly to determine which illness—or illnesses—are causing your symptoms. Depending on which virus you have, you might need to start a particular treatment soon after symptoms appeared. If you’re considered high-risk—an older adult, someone who is immune-compromised or has a chronic health condition—your provider might recommend Paxlovid if you have COVID-19 or Tamiflu if you have the flu. To have the most benefit, Paxlovid should be taken within five days of symptom onset and Tamiflu within 48 hours, so it’s important to act quickly.

Who should get vaccinated against the flu, COVID-19 and RSV?

We strongly encourage adults and children older than 6 months to get the flu and COVID-19 vaccines. Ideally, you would get the flu shot in September or October and the updated COVID-19 vaccine when it becomes available shortly. Remember that it takes a couple of weeks for your immune response to develop after getting a shot.

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment through My CS-Link at locations in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

To make an appointment for a COVID-19 vaccination, visit the My Turn website from the California Department of Public Health.

We also now have an RSV vaccine for older adults, a shot for pregnant people and an immunization for babies. If you or a loved one is in one of these groups, we recommend speaking with your physician to determine if the immunization or the vaccines are appropriate. 

When should someone seek treatment for flu-like symptoms?

Most mild symptoms can be managed at home with supportive care—fluids, Tylenol, rest. A humidifier can help with congestion and a saline nasal rinse can help clear mucus. Little kids might also benefit from a nasal suction device.

If you’re not sure if your symptoms are more serious, a virtual appointment is an easy way to get an expert opinion. Cedars-Sinai Connect offers quick access to Cedars-Sinai providers—available 24/7 for urgent issues—for those in California, including kids aged 3 and older, Spanish-speaking adults and patients new to Cedars-Sinai. Individuals with immediate concerns that are not life threatening—prolonged dizziness, not tolerating food or fluids—should visit urgent care. If symptoms truly are life threatening—difficulty breathing, pain or pressure in the chest or abdomen—go to the nearest emergency department. 

How long is someone contagious after getting sick with a virus?

Every virus is a little different, but in general people start becoming infectious with a respiratory virus shortly before their symptoms start, and then remain infectious for several days afterward when their symptoms are improving. With the flu, you’re infectious a day before symptoms start and until after a fever has resolved and symptoms are improving, as long as five to seven days after getting sick. It’s helpful to think of infectiousness as more of a gradient than an on or off switch. It’s also not unexpected for a cough to linger for many days or weeks after you’ve recovered, but it does not always imply you’re infectious for that period of time.

Is there anything unusual about this year’s flu season?

We should keep a close eye on what happens with the “bird flu,” the avian influenza A(H5N1) virus. Multiple outbreaks in cattle and poultry since the spring have been connected to more than a dozen infections in humans in the U.S. Even if you don’t work on a farm, it’s still relevant information. Families tend to visit farms in the autumn, and raw milk—which is sold in some health food stores—is another potential risk factor.

The good news is that we haven’t seen any human-to-human transmission of H5N1 with these recent cases in the U.S., but public health authorities are watching these outbreaks closely. If you’re someone who has been in close contact with cattle or poultry—even if it’s at a petting zoo or county fair—and you develop flu-like symptoms, alert your physician about your exposure to animals. I’d recommend washing your hands after being in contact with these animals and avoiding raw milk.

Read more on the Cedars-Sinai Blog: Tips to Survive Peak Flu Season from a Cedars-Sinai Expert