Acute Massive Thrombus Following Fontan Procedure

Background Patients with hypoplastic left heart syndrome (HLHS) undergo a Fontan procedure as part of single ventricle surgical palliation. Post-Fontan, sluggish blood flow and an imbalance in coagulant factor proteins may predispose to thrombus formation. Other risk factors may include chylothorax as well as acute and chronic inflammation. Currently, there is no standardized surveillance strategy to detect thrombus in Fontan patients. Case A 34-month old male with HLHS underwent an extracardiac non-fenestrated Fontan complicated by chylothorax treated with 5 days of IV steroids and diuretics. He was on therapeutic aspirin. After progressive worsening of right pleural effusion, a chest tube was placed three weeks post-Fontan with continued chylous output. Stool alpha 1 antitrypsin was negative. Decision-making Given persistent chylothorax, a repeat echocardiogram was performed revealing a large mass in the Fontan circuit less than one month post-op. Cardiac CT showed occlusive thrombus filling the entirety of the Fontan conduit extending into hepatic veins and bilateral pulmonary arteries. He underwent extensive surgical thrombectomy and Fontan conduit revision. Hypercoagulable work-up revealed elevated factor 8 and von Willebrand factor activity which persisted more than one month post-op. Patient's history was also significant for COVID-19 infection 6 months prior. He was initially anticoagulated with bivalirudin with tirofiban initiated for antiplatelet therapy. He was ultimately transitioned to rivaroxaban, pentoxifylline and aspirin with chylothorax resolution over one month without thrombus recurrence. Conclusion Development of risk stratification tools to identify patients at higher risk for thrombi formation post-Fontan may facilitate patient selection for more aggressive anticoagulation. Consideration of elevated factor 8 as well as persistent or recurrent chylothorax may be beneficial, as increased thrombosis risk has been reported for both conditions in Fontan patients.Copyright © 2023 American College of Cardiology Foundation

Vasculitis post COVID-19 vaccinations in an infection naive population: A temporal association?

Background/Purpose: To date, isolated cases of vasculitis linked to COVID-19 vaccinations have been reported. Western Australia (WA), a state of 2.8 million habitants, had largely been shielded initially from COVID-19 infections with only 3.7 cases/1,000 people identified prior to March 2022. In addition, there were only 3.4 cases/1,000 people detected between July 2021 and March 2022(1). Vaccination rates during this period were high with an adult double vaccination rate recorded at over 95%(2). The combination of these has led to a unique study population. We describe a case-series of patients who developed a medium or large vessel vasculitis post-COVID- 19 vaccination. Method(s): Patients who developed a medium or large vessel vasculitis with symptom onset within four weeks of a COVID-19 vaccine were identified from public and private Rheumatology departments in WA between July 2021 and March 2022. Result(s): The clinical features and diagnosis of 10 identified patients are presented in Table 1. Ages ranged between 41-83 and a various subtypes of vasculitis were observed. Nine patients had symptom onset within two weeks post vaccine. All patients received high dose corticosteroids and seven received steroid-sparing therapies with initial good outcomes. Conclusion(s): The link between vaccinations and induction of autoimmunity remains disputed. It must be emphasised that COVID-19 vaccinations have been critical in this pandemic. The reporting of such cases serves to expand the literature base and generate discussion. Biases (recall and observer) and coincidence could account for these observations. However, the time interval between symptom onset and characteristic features of certain cases in an infection naive population should raise further questions. (Table Presented).

Click Analysis: How E-ommerce Companies Benefit from Exploratory and Association Rule Mining

Electronic commerce (henceforth referred to as e-commerce) has attracted many people to buy things online because of its convenience. With Covid-19 pandemic, the popularity of e-commerce increases as many people are working from home. Ability to understand customers' surfing and buying behavior on the e-commerce platform provides competitive advantage to e-commerce companies by being able to devise specific marketing plans to increase their market coverage and subsequently revenues from online sales of products. This paper discusses how the results derived from both, the exploratory data analysis (EDA) and association rule mining (ARM) can assist e-commerce companies to design specific marketing plans. The methodology consists of data understanding, data pre-processing, EDA, ARM, and analysis of results. A public dataset that is made available in the year 2020 consisting of clickstream data that are collected in 2018 from a popular fashion e-commerce website is used as a case study to prove the viability of the methodology in deriving results that can be used to design specific marketing plans. This study proves that it is possible to use clickstream data consisting of customers' surfing and buying behavior and apply the methodology to derive analysis and devise better marketing plans. © 2022, Success Culture Press. All rights reserved.

Unconditional self-acceptance among the psychology students of University X, Malaysia: the role of mattering, perceived social support and state self-esteem

Unconditional self-acceptance (USA) is important for mental health. Studies reported that university students would develop the USA when they feel socially supported, included, and matter. Nevertheless, those factors are dependent on social feedbacks. Amidst the COVID-19 outbreak is, they had to follow the social distancing protocols and interact online with each other. This change might have altered the way they perceive the social support and mattering. It is hypothesized that these alterations predicted their USA through their perceived social support (PSS) and the sense of social inclusion (state self-esteem). To test the hypothesis, 214 young adults (85 men, 129 women), aged between 18 to 25 (M=22.80, SD=1.92) were asked to complete a demographic form and the scales of each variable. Students from University X, Malaysia were chosen as the population as they studied fully online when we started this study;unfortunately, the university went back to physical study before we managed to collect our target sample size. The results of Bootstrapping with 5,000 samples and 95% confidence interval showed that state self-esteem (SSE) fully mediated the relationship between mattering and USA, while PSS did not. Therefore, the hypothesis of serial mediation was not supported. © 2023, Intelektual Pustaka Media Utama. All rights reserved.

Impact of COVID-19 on pancreatic cancer outcomes in Florida

Introduction: Pancreatic cancer (PC) is currently the third-leading cause of cancer deaths in the United States. African Americans with PC have an increased incidence and worse survival outcome when compared to other racial groups. During the COVID-19 pandemic, there is evidence that hospital resources were allocated to treating immediate life-threatening conditions. Some of the daily highest case numbers were reported in the state of Florida with several peaks throughout 2020 and 2021. Additionally, the state of Florida has the second-highest rate of new cases of PC within the United States with an incidence of 4860/100,000. Our specific aim is to define the impact of COVID-19 between race, age, income, and gender on the survival time of newly diagnosed patients with pancreatic cancer in Florida. Material(s) and Method(s): Patients with pancreatic adenocarcinoma diagnosed from January 1st, 2017 to October 31st, 2020 were identified through the statewide clinical research and network database called OneFlorida Clinical Consortium by using the ICD10 diagnosis code for pancreatic cancer. Patients were then placed into 3 cohorts based on date of pancreatic cancer diagnosis: pre-pandemic (01/01/2017- 09/30/2019), transition (10/01/2019-02/28/2020), and pandemic (03/1/2020-10/31/2020). Patients with a diagnosis of neuroendocrine carcinoma were excluded. Patients were followed for at least one year unless a death occurred. Summary statistics were reported for demographic variables (age, sex, income, gender). Kaplan-Meier analysis with log-rank test was performed to compare the difference in overall survival time among groups. Result(s): This retrospective study had a total of 934 unique patients available for analysis. Of the 934 patients, 81.3% were in the pre-pandemic cohort (n= 759), 8.2% transition cohort (n=77), and 10.5% pandemic cohort (n=98). There was a decrease in the rate of diagnosis from the pre-pandemic (23 per month) to pandemic cohort (12.2 per month). The demographic distribution of the sample was 23.4% Black, 68.7% White and 7.9% Other. The median age was 67 years (27-89). There were 49.8% women and 50.2% men. The median income was $52,915 ($23,704-$124,821). The differences in overall survival time were not significant for age and gender across the 3 cohorts. Income <;$53,000 had significantly lower survival time across the 3 cohorts. African Americans had significantly lower survival time for pre-pandemic and transition cohort (p<;.005), but Caucasians had the lowest survival time for the pandemic cohort (p <;.005). When stratified for stage, the mean survival (in months) for White vs. Black populations was 37.8 vs. 26.1 for stage I, 37.6 vs. 27.3 for stage II, 28.5 vs.18.77 for stage III, and 20.7 vs. 21.7 for stage IV. Discussion(s): This study demonstrated a decrease in diagnosis & survival rate during the COVID-19 pandemic in Florida. Dissemination of resources should target these disparities in income and race.

A Rare Case of T-Cell Chronic Active Ebstein-Barr Virus (Caebv) Complicated by Development of Hemophagocytic Lymphohistiocytosis (Hlh), T Cell Lymphoproliferative Disorder (Lpd) and Ebv Meningitis

Background: T-cell chronic active Epstein-Barr virus infection (CAEBV) is a rare disease in which patients have the Epstein-Barr virus (EBV) present mainly in the T-cells, which infiltrate tissues like the liver, and bone marrow. Patients eventually develop liver failure, hemophagocytic lymph histiocytosis (HLH), coronary artery aneurysms, EBV infiltrating T-cells impairing organ function, or T-cell lymphomas. Prognosis is poor. The current treatment of choice is an allogeneic hematopoietic stem cell transplant. A study by the NIH and Baylor College of Medicine, which reviewed 28 years of data, only found 19 cases of CAEBV. We aim to report a rare case of T-cell chronic active Ebstein-Barr Virus (CAEBV) complicated by the development of HLH and T-Cell LPD. Method(s): A chart review of the CAEBV patient was performed, focusing on disease progression, treatment plans, and complications. Result(s): A 45-year- old Latin American woman from Mexico initially presented with abnormal liver enzymes after taking herbal medications. The patient underwent a liver biopsy and was initiated on prednisone for possible autoimmune hepatitis pending the biopsy report. The liver biopsy showed EBV hepatitis with EBV positive atypical T-cell infiltrate with steatohepatitis and marked steatosis. Prednisone was stopped, and the patient was referred to Hematology. Plasma EBV level was elevated to 3300 IU/mL. The patient was readmitted for sepsis and pancytopenia prior to being seen by Hematology. Bone marrow biopsy showed EBV+T-cell LPD and HLH, and the patient was started on dexamethasone and rituximab. The patient improved, and dexamethasone was weaned off. Subsequently the patient has had numerous hospital admissions for ESBL UTI, CoNS bacteremia, aspiration pneumonia, vocal cord dysfunction, EBV pneumonia, PCP pneumonia, chemotherapy-induced neuropathy, neutropenic fever, chronic respiratory failure and EBV reactivation. The patient underwent multiple rounds of chemotherapy with rituximab and R-CHOP regimen for persistent HLH. In spite of the treatment, the patient developed EBV encephalitis, further complicated by COVID -19 infection. Her family opted for comfort care, and the patient passed away in the hospital. Conclusion(s): Approximately 95% of adults are infected with EBV at some point in their lives and are asymptomatic in most cases. Very rarely do patients develop CAEBV -a life-threatening disease. Allogeneic stem cell transplant should be considered early on in the disease. Unfortunately, our patient had social factors such as lack of insurance and social support that prevented her from getting a timely stem cell transplant. (Figure Presented).

Click Analysis: How E-commerce Companies Benefit from Exploratory and Association Rule Mining

Electronic commerce (henceforth referred to as e-commerce) has attracted many people to buy things online because of its convenience. With Covid-19 pandemic, the popularity of e-commerce increases as many people are working from home. Ability to understand customers' surfing and buying behavior on the e-commerce platform provides competitive advantage to e-commerce companies by being able to devise specific marketing plans to increase their market coverage and subsequently revenues from online sales of products. This paper discusses how the results derived from both, the exploratory data analysis (EDA) and association rule mining (ARM) can assist e-commerce companies to design specific marketing plans. The methodology consists of data understanding, data pre-processing, EDA, ARM, and analysis of results. A public dataset that is made available in the year 2020 consisting of clickstream data that are collected in 2018 from a popular fashion e-commerce website is used as a case study to prove the viability of the methodology in deriving results that can be used to design specific marketing plans. This study proves that it is possible to use clickstream data consisting of customers’ surfing and buying behavior and apply the methodology to derive analysis and devise better marketing plans. © 2022, Success Culture Press. All rights reserved.

Impact of Immunosuppression on T-cell Responses After mRNABased Sars-CoV-2 Vaccination

Purpose: Administration of mRNA-based SARS-CoV-2 vaccines confers protection from SARS-CoV-2 infection and reduces its severity in the general population. It has been suggested that mounting a coordinated adaptive immune response characterized by production of neutralizing antibodies and SARS-CoV-2 spike proteinspecific T-cells correlates with protection from infection. Studies in organ transplant recipients have demonstrated suboptimal responses after 2 doses of SARS-CoV-2 vaccination;however, the impact of different immunosuppressive regimens (IS) on T-cell responses is not well described. This study prospectively evaluated the impact of IS on T-cell responses in a kidney transplant (KTx) population and compared these to 26 healthy controls. Method(s): In this single-centre, prospective study, 92 KTx on follow-up at our centre were enrolled after informed consent. T-cell responses were evaluated before and after each of 2 doses of BNT162b2 SARS-CoV-2 vaccine administered 21 days apart: before each dose, 10-14 days after Dose1 and 21-24 days after Dose2. The study population included 69.6% Live-Donor and 30.4% Deceased-Donor KTx. Longitudinal assessment of the quantity of spike-specific T-cells was performed by stimulating whole blood with peptides covering the SARS-CoV-2 spike protein, followed by cytokine (IFN-gamma, IL-2) measurement (JCI, Tan et al, 2021). KTx were stratified by maintenance IS into 4 groups and T-cell responses compared between groups. Result(s): As shown (Figures 1A, 1B), in comparison to healthy controls, KTx displayed poor spike-specific T-cell responses as measured by IFN-gamma and IL-2 release. Percent responders were significantly lower for KTx vs. healthy controls: 6.5% vs. 92.3% after Dose1 (P<0.00001) and 27.2% vs. 100% after Dose2 respectively. There was a significant impact of different IS regimens (Figure 1C);percent responders after Dose2 were 19%, 43%, 40% and 71% for KTx receiving CNI-MPA-Pred, CNI-Aza-Pred, mTORi and Other regimens respectively (P=0.013). Conclusion(s): Our results highlight the critical role of IS on T-cell responses to SARS-CoV-2 vaccination. In the context of the COVID-19 pandemic, monitoring T-cell and antibody responses over time after vaccination, modulating IS and modifying vaccination strategies are clearly needed to protect this vulnerable population.

Adverse Renal Events After BNT162b2 Pfizer/BioNTech COVID-19 Vaccine in Kidney Transplant Recipients

Purpose: Adverse events of a novel mRNA vaccine are not well described in Kidney Transplant Recipients(KTR), especially the risk of immune activation or recurrent glomerulonephritis(GN), which has been described in native GN after COVID-19 vaccines. Method(s): In this single-center prospective study, 147 KTR were enrolled after informed consent and administered 2 doses of Pfizer/BioNTech vaccine 21 days apart. Follow-up was 3 weeks after Dose2. Result(s): Mean age of KTR was 51 years;55.1% male;65.3% Chinese, 19% Malay, 11.6% Indian;69.5% Living donor, 29.9% Deceased donor, 0.7% Pancreas-kidney transplants;71.5% had biopsy-proven or presumptive chronic GN(CGN), 12.9% diabetic nephropathy, 15.6% other causes. 11(7.5%) KTR had delayed Dose2 administered at median 29 days(range 24-93) after Dose1. 7(4.8%)were delayed due to renal events: rise in creatinine(n=3), or proteinuria(n=2), or both creatinine and proteinuria with allograft biopsy showing acute T-cell and antibody-mediated rejection(n=1), new BK viraemia(n=1). Other reasons were possible anaphylaxis(n=1), intercurrent infection(n=2), and inability to attend due to quarantine(n=1). 27 KTR had new microhaematuria(MH) after Dose1;9 persisted after Dose2. Additional 18 had new MH after Dose2. Of 45 KTR with new MH, 7 had underlying IgAN, 5 had other biopsy-proven-CGN and 22 had presumed CGN, suggesting 34/45 with possible immune activation. 12 KTR had new onset proteinuria (rise in urine protein:creatinine ratio (UPCR) <=30 to >30mg/mmol);5/7 who developed a rise after Dose1 remained elevated;additional 5 had a rise after Dose2. 7 KTR had rise in proteinuria from UPCR <=100 to >100mg/mmol. Conclusion(s): Subclinical changes in allograft monitoring parameters are frequent after COVID-19 mRNA vaccines with up to 40.1% of KTRs showing rises in creatinine, proteinuria or new MH. Although overt recurrent GN and acute rejection are infrequent, high vigilance and monitoring for these occurrences should be undertaken in KTRs receiving mRNA vaccines.

Consumer Food Demand Shifts in the COVID-19 Pandemic: An Empirical Study Based on Retail Sales Data

The COVID-19 outbreak and the resulting mobility controls have led to profound changes in consumers’ grocery purchase preferences. This study explores the consumer demand response to the spread of the coronavirus and its variants. We establish a regression model, apply it to sales history data from a major North American retailer, and study the consumer preference in what food they buy and through which channel. While our empirical results provide data-driven support to several academic and industry viewpoints, and some counterexamples, a systematic implementation of the model can automatically provide managerial insights on future trends across vendors, brands and specific products. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Were Consumers Less Price Sensitive to Life Necessities During the COVID-19 Pandemic? An Empirical Study on Dutch Consumers

This research investigates if consumers were less price sensitive to life necessities during the COVID-19 pandemic via a demand modeling system. Consumers’ price sensitivity was explicitly quantified by the price elasticity of demand. Consumer behavior in nine categories of products considered as life necessities were studied in two non-overlapping time periods: a year before the onset of the COVID pandemic and a year following the initial panic buying caused by the declaration of the COVID pandemic. The changes in price elasticity of demand between the two periods across the nine product categories were determined from the weekly sales data of a Dutch retailer. Using the proposed demand modeling system applied to available data, it was empirically found that the majority of essential food products were price inelastic, while the majority of non-food products were price elastic during the COVID period. Among the nine product categories, four categories were identified to have significantly different elasticities across the two time periods, while eight categories were observed to have practically smaller magnitudes in elasticities. These insights not only prove the usefulness of the proposed demand modeling system, but also provide valuable theoretical and managerial implications for retail business practitioners, particularly in pricing and inventory planning. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Effect of Lockdown on Food Security during the COVID-19 Pandemic in the Philippines: Two Months after Implementation

The alarming presence of COVID-19 challenged the United Nations’ (UN) Sustainable Development Goal 2 and made the World Health Organization (WHO) declare a public health emergency of international concern. Imposed lockdowns disrupted the supply and demand chain of the food systems, hence affecting food security. This research would like to know and assess the early effect (two months after the lockdown) of the enhanced community quarantine on food security in the Philippines. An online survey was employed participated by 331 household representatives using a survey instrument containing food security assessment, household socio-demographic characteristics, behavioral responses covering food purchase and consumption behavior, and emergency measure adoption. Statistical tests were applied: Mann-Whitney U test to know the behavioral response of the food secure vs. food insecure households, as well as the phi coefficient and Cramer’s V test to determine and assess the parameters that plays important role in food security during this period. Results showed that 73% of the respondents were food insecure. The early effect of the lockdown was seen in the behavioral responses, significant differences between food secure and insecure households were found in age, income, and food purchase behavior. Parameters associated with food security are age, income, food allocation, expectations on the livelihood impact and change in expenditure, and the adoption motivations in practicing backyard gardening. The stress evaluation revealed that while Filipinos tried to cope, an increased level of anxiety was experienced. The need for clear measures in terms of preparedness in any pandemic situation was heightened. These findings are significant in providing benchmark information on food security during a pandemic. © 2022, Department of Science and Technology. All rights reserved.

Low SARS-CoV-2 seroprevalence and no active infections among dogs and cats in animal shelters with laboratory-confirmed COVID-19 human cases among employees

Human-to-animal and animal-to-animal transmission of SARS-CoV-2 has been documented;however, investigations into SARS-CoV-2 transmission in congregate animal settings are lacking. We investigated four animal shelters in the United States that had identified animals with exposure to shelter employees with laboratory-confirmed COVID-19. Of the 96 cats and dogs with specimens collected, only one dog had detectable SARS-CoV-2 neutralizing antibodies;no animal specimens had detectable viral RNA. These data indicate a low probability of human-to-animal transmission events in cats and dogs in shelter settings with early implementation of infection prevention interventions.

Management of cutaneous malignancies impacted by COVID-19 delays

Introduction: Coronavirus disease 2019 affected the timing of management of patients with cutaneous malignancies, delaying their surgical care by several months. The study objective is to determine the impact of delays on patients' oncologic and reconstructive management in comparison to 2 standard years. Method: A retrospective review of all patients with surgical management for their cutaneous malignancies at a single institution in the departments of otolaryngology and plastic surgery was conducted from January 2018 to January 2021. The 2020 group was considered to have delayed care due to the health care restrictions. Demographics, malignancy characteristics, ablative and reconstructive surgery, and adjuvant management were all evaluated comparing the pre-2020 and 2020 groups. Univariate analysis was performed using a 2-sample t test for continuous variables and chi-squared test and Fisher exact test for categorical variables. Significance was determined if P < .05. Results: In total 80 patients underwent cutaneous malignancy management and reconstruction during the time period, in which the squamous cell carcinoma was the most common pathology (38.75%) and the nose was the most common subsite (38.75%). In 2020 there were no cutaneous cases that were managed surgically between February and June compared with cases occurring monthly during the prior standard years, suggesting a delay in care anywhere from 1 to 4 months during this time. Despite delays, there was no significant difference between the pre-2020 and 2020 groups in terms of staging, oncologic management, or reconstruction. There were no differences in the variables between the groups. Conclusion: There was no significant difference in presentation, oncologic management, or reconstruction required for patients requiring a several-month delay in care for the management of cutaneous malignancy compared with the 2 prior standard years. This suggests that this delay did not significantly affect management of cutaneous malignancy in this subset of patients, leading us to understand more about urgency of management in patients with cutaneous malignancies.

Covid-19 patients that successfully recover elicit antigen specific Tbet+CXCR3+ T regulatory cells in tandem with parallel T effector subsets

Background/Purpose: The global coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulted in significant mortality, social disorder and economic hardships. We set out to understand why certain individuals could resolve the disease successfully without serious complications by immune profiling of PBMCs from convalescent COVID-19 patients (n = 14) with mild disease trajectory. Methods: We designed 7 peptides targeting the receptor binding region (RBD) of the spike protein of SARS-CoV-2, that encompass broad HLA class I / II alleles, with the aid of the Immune Epitope Database and Analysis Resource (IEDB) website. The RBD site was chosen as it was shown to be protective when neutralising antibodies against this region could negate binding of viral spike protein to host cell ACE-2 receptor. Convalescent COVID-19 patients enrolled in this study were screened and selected for positive antibody titre against the RBD region. PBMCs from convalescent COVID-19 patients were stimulated with/without the peptides for 72hrs and immune profiled (n = 70 markers across two panels) with the high dimensional single cell mass cytometry platform (CyToF). Results: Convalescent COVID-19 patients elicited a robust recall memory T follicular helper response (CD3 + CD4 + CD45RO + CXCR5 + Tigit + ;∗∗∗∗ p < 0.0001) demonstrating peptide efficacy. Unsupervised clustering (FlowSOM) of the CD4 T cell immune landscape reaffirmed increase in memory T follicular subsets and additionally CD4 + CD45RO + CXCR5 -subsets. Further gating of antigen specific memory cells (CD45RO + CD69 + ) revealed an increase in Tbet + CXCR3 + T effectors in both CD4 and CD8 compartments. Strikingly we detected a parallel increase in CD4 + Treg (CD25 + FoxP3 + ) CXCR3 + Tbet + CD45RO + CD152 + Tigit + expression. Conclusions: COVID-19 patients that successfully resolve the viral infection not only mount a robust T effector and follicular response but also in tandem a similar T regulatory profile.

A bittersweet memoir glimpses of care in the early days of the pandemic

I wrote this journal in March 2020 prior to the World Health Organization declaring the COVID-19 infection as a worldwide pandemic on March 11. The situation in Singapore was unfolding even as public healthcare institutions were tasked to lead the charge to contain the novel coronavirus as it was then called. This journal describes my experiences and impressions during my work in an isolation ward at the National University Hospital during this early period. I was to be catapulted into Pandemic Team 3 in the second and third weeks of February 2020. The urgency of hospital measures to respond to the novel coronavirus meant that the general medicine consultant roster which I was on was hijacked to support the pandemic wards. I thought wryly to myself that it was a stroke of genius to commandeer the ready-made roster of senior physicians;it would have been difficult for the roster monster to solicit senior physicians to volunteer when there were still so many unknowns about this virus. Graphic images of the dire situation in Wuhan, China, were circulating widely on social media. It was heart-wrenching to read of Dr. Li Wen Liang’s death. He had highlighted the mysterious pneumonia-causing virus. The video clip of him singing at a karaoke session that went viral underscored the tragedy of a young life cut short. Questions raced in my mind. “Are we helpless to prevent the spread of this virus?” “Is the situation in China to be replicated here in Singapore?” This seemed incredulous, yet, might it be possible? The immediate responses that jumped up within me was “yes, it’s possible, but let’s pray not. Whatever has to be done, must be done.” © Koninklijke Brill NV, Leiden, 2021.