Personalized Mechanical Ventilation: Improving Quality of Care

In dealing with the unprecedented COVID-19 pandemic, there are an increased number of patients requiring personalized management as the disease pathology varies. With variable lung compliance and airway resistance as well as the severity of the disease, one size will not fit all patients. This book is problem-oriented with evidence-based discussions of the daily encountered scenarios in the ICU for mechanically ventilated patients, dealing with the pathology, monitoring and troubleshooting facing intensivists daily. These scenarios are managed utilizing a goal-directed approach and algorithms to achieve these goals. All chapters contain an explanation of a different solution illustrating the respiratory mechanics, physiology and pathology involved in such a scenario. Each chapter also closes with a take-home message to summarize the content. In addition to describing the ventilation of different patient categories, this text also features ventilation cases specific to COVID-19 including airway management in the enhanced air born isolated patient, pulmonary embolism, different states of shock and differential lung ventilation. There is also a specific chapter on monitoring mechanical ventilation with point of care ultrasound, which is an available modality in most ICUs. Another unique chapter describes how to connect more than one patient to one ventilator in case of a shortage of machines. Written by experts in the field, Personalized Mechanical Ventilation is a timely and valuable resource for critical care physicians, nurses and respiratory therapists on the front lines of both COVID-19 and day-to-day care of mechanically ventilated patients in the ICU. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Correction to: Respiratory Physiology and Mechanics at the Bedside(Respiratory Physiology and Mechanics at the Bedside, (2023), (1-17), 10.1007/978-3-031-14138-6_1

The affliation of frst author Ahmed Mohamed Reda Taha was incorrectly printed in Chapter 1 (Respiratory Physiology and Mechanics at the Bedside) as Intensive Care and COVID 19 Unit, Belize Healthcare Partners, Belize, Belize. It has now been corrected to "Critical Care Institute, Cleveland Clinic, Abu Dhabi, UAE” on pages iv and 1. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

CRT-200.04 In-Hospital Cardiovascular Outcomes of Coagulation Disorders on Covid-19 Hospitalization: A Nationwide Analysis

Introduction: COVID19-associated cardio complications occur through different mechanisms including the inflammatory response causing severe issues such as ARDS, sepsis, and coagulopathy. Many points remain unclear regarding the impact of coagulation disorder in patients who are admitted with COVID19 infection. We present an analysis of the cardiovascular outcomes of coagulation disorders in COVID19-related hospitalizations. Method(s): The Nationwide Inpatient Sample database from 2020 was queried to identify COVID-19 patients. Subsequently, we classified COVID hospitalization based on the presence or absence of coagulation disorder. The primary outcome measure was in-hospital mortality. Secondary outcomes were in-hospital cardiovascular outcomes, ICU admissions, bleeding, Stroke, and resource utilization. Result(s): Out of 1,060,885 patients with a diagnosis of COVID, 43905 had coagulation disorder. On adjusted analysis, patients with COVID and coagulation disorder had significantly higher odds of MACCE (aOR 1.57, 95% CI 1.47-1.67, p<0.001), in-hospital mortality (aOR 1.56, 95% CI 1.46-1.67, p<0.001), cardiac arrest (aOR 1.38, 95% CI 1.28-1.57, P<0.001), acute MI (aOR 1.32, 95% CI 1.19-1.47, P<0.001), stroke (aOR 2.11, 95% CI 1.76-2.52, P<0.001), cardiogenic shock (aOR 2.19, 95% CI 1.78-2.70, P<0.001), MCS (aOR 3.98 CI 2.31-6.85 p<0.001), and bleeding (aOR 1.64 CI1.40-1.92 p<0.001) compared to patients without coagulation disorder. The length of stay (11.43 vs 7.27) and mean in-hospital cost was increased ($150,759.70 vs $75321.1) in patients with and without coagulation disorders. Conclusion(s): COVID patients with coagulation disorder have a significantly higher risk of MACCE, in-hospital mortality, cardiac arrest, AMI, stroke, shock, MCS, and bleeding. Large prospective trials are needed to further study these findings. [Formula presented]Copyright © 2023

CRT-200.08 In-Hospital Outcomes of Atrial Fibrillation in COVID-19 Hospitalizations: An Insight From the National Inpatient Sample Database

Introduction: It is known that patients with COVID-19 infection have a significant incidence of arrhythmias. According to a study from Wuhan, China in 2020, approximately 17% of hospitalized COVID-19 patients suffered from arrhythmia, including Atrial Fibrillation (AF). Here we present a study of the outcomes of AF in COVID admissions at the national cohort registry. Method(s): Utilizing the NIS of the year 2020, we identified patients with diagnosis of COVID-19 and subsequently classified COVID-admission into with and without AF. Multilogistic regression analysis (OR) was done to compare in hospital outcomes. Result(s): Of 1,060,976 patients with diagnosis of COVID, 57,011 (5.37%) had AF. On adjusted analysis, COVID-AF patients had significantly higher odds of heart failure (aOR 1.25, 95% CI 1.19-1.31, P=0.001). On the contrary, there was no statistically significant difference in the odds of MACCE (aOR 0.97, 95% CI 0.91-1.01, P=0.19), in hospital mortality (aOR 0.93, 95% CI 0.88-0.09, P=0.07), AMI (aOR 1.12, 95% CI 1.03-1.22, P=0.08), MCS (aOR 0.86, 95% CI 2.08 - 2.60, P= 0.789), cardiogenic shock (aOR 1.15, 95% CI 0.90-1.45, P=0.257), major bleeding (aOR 1.12, 95% CI 0.96-1.30, P=0.136), PCA (aOR 0.30, 95% CI 0.87-1.93, P=0.205), PCI (aOR 0.10, 95% CI 0.49-2.40, P= 0.82), stroke (aOR 1.02, 95% CI 0.84-1.23, P=0.871) between the two cohorts. The presence of AF in COVID-19 hospitalizations was associated with higher length of stay (9.25 +/-9.05 vs 7.35 +/- 8) and higher adjusted total charge(97,321 155,117+/- vs 77,372+/- 149,354) compared to COVID without AF association. Conclusion(s): COVID-19 patients with AF can have higher odds of heart failure compared to COVID-19 patients without AF. The odds of in hospital mortality, MACCE, MCS, AMI, major bleeding, PCI, PCA and stroke were similar. Large prospective trials are needed to validate these findings. [Formula presented]Copyright © 2023

Role of SARS-COV2 antigen as a diagnostic test for COVID-19

Background: Successive waves of SARS-CoV-2 infections with increasing transmission rates may burden the laboratories performing molecular diagnostic testing. Alternative diagnostic methods may provide additional diagnostic capacity. Chemiluminescent totally automated antigen detection test for SARS-CoV-2 (Ortho VITROS SARS-CoV-2 antigen test) could be satisfactory replacement for reverse-transcription quantitative polymerase chain reaction (RT-qPCR) for mass screening during outbreaks. Methods: RT-qPCR and the VITROS® SARS-CoV-2 antigen were compared. Antigen detection test was assessed using clinical samples (nasopharyngeal swabs in viral transport medium) withdrawn from 668 patients suspected to have SARS-CoV-2 infection. Results: From 668 samples, 303 showed SARS-CoV-2 antigens positive and 365 SARS-CoV-2 antigens negative in comparison with RT-qPCR, the sensitivity was 89.11% and the specificity was 100.0% (PPV 100.0 and NPV 91.7). Ct value of 16.0 was the limit of detection of the assay. Conclusion: The given results show that VITROS® assay was acceptable for the detection of patients having contagious COVID-19 in the clinical setting. This test showed high sensitivity and specificity in the SARS-CoV-2 detection in samples with a Ct value of 32 or less. Chemiluminescent full automated antigen detection test for SARS-CoV-2 is a feasible substitute to (RT-qPCR) for mass screening. © 2020 The author (s).

CRT-200.06 Cardiovascular Outcomes of Congestive Heart Failure on COVID-19 Hospitalizations: A Nationwide Analysis

Introduction: Congestive heart failure (CHF) is the most common cardiac admission diagnosis worldwide with high risk of morbidity and mortality. The data on the clinical impact of CHF on COVID-19 hospitalizations is limited. Here we present a study of the cardiovascular outcomes of baseline CHF on COVID-19 admissions at a national level. Method(s): The National Inpatient Sample database from 2020 was queried to identify patients with a primary diagnosis of COVID-19 and stratified based on the presence of congestive heart failure. Multivariate regressions analysis was done to compare inpatient outcomes among COVID patients with and without CHF. The primary outcome measure was in-hospital mortality. Secondary outcomes were in hospital cardiovascular outcomes. The adjusted odds ratios (aOR) of in-hospital outcomes were calculated using chi-square statistics in software STATA v.17. Result(s): 1,060,885 weighted COVID-19 hospitalizations were identified, of which 115,685(10.9%) were associated with CHF. On adjusted analysis, patients with COVID-CHF had significantly higher odds of MACCE (aOR 1.23, 95% CI 1.182-1.28, P<0.001), MCS ( aOR 3.22, 95% CI 2.26-3.26, P<0.001), cardiogenic shock ( aOR 2.72, 95% CI 2.26-3.26, P<0.001), AMI (aOR 2.72, 95% C. On the contrary, patients with COVID and baseline CHF had a lower incidence of inpatient AKI (aOR 0.64, 95% CI 0.49-0.84, P<0.001). The odds of in-hospital mortality, major bleeding and cardiac arrest between the two cohorts were similar. Additionally, presence of CHF in COVID hospitalization was associated with higher length of stay (8.81+/- 8.91 vs 7.28 +/-7.9) and adjusted total charge ($96,640 +/- 177,439 vs $76,214 +/-145,830) compared to COVID without CHF Conclusion(s): COVID 19 patients with CHF have increased odds of MACCE, MCS, cardiogenic shock, AMI, PCA and PCI. Out of hospital outcomes need further studies. [Formula presented]Copyright © 2023

CRT-200.07 Cardiovascular Outcomes of Long-Term Anticoagulation in COVID-19 Hospitalizations: A Nationwide Analysis

Introduction: It is now evident that anticoagulation plays a key role in the management of COVID-19 infection, however the significance of previous long-term oral anticoagulation in patients who later presented with COVID-19 is still unknown. Here we present an analysis of the impact of long-term oral AC on COVID-19 hospitalizations at the national cohort registry. Method(s): The NIS database from 2020 was queried to identify COVID-19 patients on long term AC use. Multivariate regression was done to compare inpatient outcomes among COVID-19 patients with and without AC. Result(s): Of 1,060,925 patients with primary diagnosis of COVID, 102, 560 (9.6%) were on AC. On adjusted analysis, patients with COVID-19 and AC use had significantly lower odds of MACCE (aOR 0.63, 95% CI 0.6-0.66, p<0.001), in-hospital mortality (aOR 0.61, 95% CI 0.58-0.64, p<0.001), cardiac arrest (aOR 0.67, 95% CI 0.6-0.75, P<0.001), acute MI (aOR 0.72, 95% CI 0.63-0.83, P<0.001), stroke (aOR 0.79, 95% CI 0.66-0.95, P=0.002), cardiogenic shock (aOR 0.58, 95% CI 0.44-0.75, P<0.001), ICU admission, (aOR 0.53, 95% CI 0.49-.57, p<0.001) mechanical ventilation,(aOR 0.54, 95% CI 0.51-.58, p<0.001) tracheostomy, (aOR 0.4, 95% CI 0.32-.5, p<0.001) and septic shock, (aOR 0.53, 95% CI 0.48-.58, p<0.001) compared to patients without AC. Additionally, lower adjusted total charge ($70,987+/-109,234 vs 79,239+/-153,418, p<0.001) in patients taking AC was observed. However, the adjusted OR of major bleeding, MCS, PCI, new HD and length of stay were similar between the two groups. Conclusion(s): Patients with COVID-19 infection who are on long term AC use have lower risk of MACCE, in-hospital mortality, cardiac arrest, acute MI, stroke cardiogenic shock and ICU admissions with no significant increased risk of major bleeding. Large prospective trials are needed to validate these findings. [Formula presented]Copyright © 2023

CRT-100.87 Impact of COVID 19 on Patients Admitted for ACS: A Nationwide Inpatient Sample Database Study

Background: COVID rapidly became a multisystemic infection with varied cardiovascular complications including Acute Coronary Syndrome. Current literature is limited on the impact of COVID on ACS patients. Methods: We queried the national inpatient sample (NIS) from 2020 to identify patients who were admitted for ACS and stratified them based on the presence or absence of COVID. The adjusted odds ratios (aOR) of in-hospital outcomes and resource utilization were calculated using chi-square statistics in the software STATA v.17. Results: Out of 883940 patients analyzed, who were admitted for ACS, 3900 patients had COVID. On adjusted analysis, patients with COVID had significantly elevated In-Hospital mortality (aOR, 2.91 CI 2.25-3.79), MACCE (aOR 2.53, CI 1.90-3.10), cardiac arrest (aOR 3.34, CI 1.1-10.1) with longer length of stay (6.34 ± 0.39 vs 4.48 ± 0.02). Interestingly, the outcome PCA (aOR, 0.39 CI 0.33-0.46) showed significant improvement. Interestingly, mean costs were elevated in patients without COVID at $105,550.8 vs $98597.7 in patients without COVID. In terms of trends, as exposure increased through the year with the highest levels in December, the mortality also increased (April 18.52% vs 25.64%). Interestingly, the cardiac arrest percentage decreased from April 2020 (7.4%) to Dec 2020 (1.98%) as well as MCS in April 202 (11.11%)vs December 2020 (3.47%) in patients exposed to COVID. Conclusions: In patients admitted for ACS, the presence of COVID significantly increases the risk of MACCE, in-hospital mortality, and cardiac arrest. Prospective trials are necessary for the identification of risk factors to improve clinical outcomes in these patients. Key words: COVID, Sars-2 coronavirus. Coronavirus. ACS. Acute Coronary Syndrome. [Formula presented]

SENTIMENT RETRIEVAL OF HEALTH RECORDS USING NLP-BASED ALGORITHM

This paper presents a sentiment retrieval based on natural language processing NLP-based Word2Vec method for health records in medical institutions of Iraq especially for Covid-19 patients. Sentiment retrieval of medical records has gained significant attention worldwide to understand the behaviors of both clinicians and patients. However, Sentiment retrieval of medical notes still not provides a clear picture of information retrieving from these summaries. Covid-19 Pandemic urges researchers in the field of medical records and AI modelling to establish a sentiment analysis based on discharge summary notes. The study is performed on 10000 medical notes from general hospitals with total of 8500 patients and a 15000 medical notes from general clinics with total of 12000 patients. The study is conducted in Iraq during May 2021 to May 2022. The main intensity of measured sentiment is captured with positive or negative in the health records. The SentiWordNet platform is used to standardize a gold sentiment dataset and the performance is evaluated using Word2Vec method. The Welch's t-test is used to validate the significance of the obtained results. It has been found that the statistical significance between Covid-19 health records reaches to 94.6% with p-value of 0.054. © 2022, International Organization on 'Technical and Physical Problems of Engineering'. All rights reserved.

The severity of clinical symptoms and paranasal sinuses CT-scan finding in COVID-19 patients in Kirkuk Province

Introduction: COVID-19, first detected in Wuhan, China in December 2019, fast spread across the globe, causing a pandemic affecting many countries around the world. Objectives: The aim of this study was to assess the severity of clinical features and paranasal sinuses computed tomography (CT)-scan findings in COVID-19 patients and find the relationship between smoking and severity of COVID-19 symptoms. Materials and Methods: A cross-sectional study was achieved on a cohort of 399 patients, who clinically suffer from COVID-19 symptoms. The collected data for those patients included COVID-19 polymerase chain reaction (PCR) tests, presence of the IgG and IgM antigens, and paranasal sinuses CT-scan images. Results: This was a cross-sectional study of 399 patients infected with COVID-19. The mean age of the patients was 39 ± 11 years. Approximately 53.6% of them were males, whereas 46.4% were females. 55.6% of them performed CT scan for sinuses. 28.6% of the patients were with severe clinical features. 51.1% of them were smoking. 77.4% of them were of positive PCR, 57.9% positive IgG, and 86.7% positive IgM. 27.8% of patients were of the age group of 40-49 years. There was a significant association between the severity of COVID infection and age group. There was a significant association between the severity of COVID infection and sinus CT-scan findings. There was a significant association between the severity of COVID infection and positive PCR. There was a significant association between the severity of COVID infection and positive IgM. There was a significant association between smoking and sinus CT-scan findings. Conclusion: At the time of COVID infection, the severity of infection ranged from mild to moderate. More severe infection with COVID-19 associated with significant finding in sinus CT scan in patients at age group 50-59 years, and sinus also more severe COVID infection associate with positive CT scan finding that occur more in smocking patients. © 2022 Medical Journal of Babylon ;Published by Wolters Kluwer-Medknow.

Overlapping Presentations of HELLP Syndrome and COVID-19.

Introduction: Haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome is a leading cause of maternal mortality. The emergence of coronavirus disease 2019 (COVID-19) has led to challenges in diagnosing HELLP syndrome due to overlapping clinical and laboratory presentations. We report a case of HELLP syndrome complicated by COVID-19 infection. Case Description: An otherwise healthy pregnant 31-year-old woman presented with fever, myalgia and headache. She was found to be COVID-positive with laboratory signs of HELLP syndrome. Symptoms and laboratory findings trended toward normal after delivery confirming the diagnosis of HELLP syndrome. Discussion: A prompt diagnosis of HELLP syndrome is essential to avoid maternal and fetal complications. Clinicians should be aware of the similarities in presentation between HELLP syndrome and COVID-19 for timely diagnosis and treatment. LEARNING POINTS: SARS-CoV-2 preferentially binds to ACE2 which is expressed in extrapulmonary tissue including placental tissue.COVID-19, HELLP syndrome and preeclampsia may have similar characteristics including elevated blood pressures, liver dysfunction, cardiopulmonary complaints and hypercoagulability.The temporal relationship of symptomatic improvement with delivery and after delivery may better differentiate HELLP syndrome from COVID-19.

An Implementation of Real-time Activity Sensing using Wi-Fi: Identifying Optimal Machine Learning Techniques for Performance Evaluation

The elderly population is growing, and the health care system is experiencing a strain on services provided to the elderly. The recent COVID-19 pandemic has increased this strain and has resulted in an increased risk of exposure during visits to elderly homes. Increasing the desire to provide technological solutions to counteract this. Currently, there lack reliable real-time non-invasive sensing systems. This paper makes use of Radio Frequency sensing, where signal propagation is observed in Channel State Information (CSI) reports on Activities of Daily Living (ADLs). Real-time data has been collected for three classifications, “movement”, “empty room”, and “no activity”. A filter is applied to reduce the noise of the CSI data. Then the mean, max, min, kurtosis, skew and standard deviation features are extracted from the CSI data. A machine learning model provides classification for the real-time monitoring system allowing detection of abnormalities in the expected ADLs of the elderly. The timing of classifications gives insight into the real-time capabilities of the system. The Random Forest algorithm is chosen to create the machine learning model based on accuracy and timing capabilities. The model was able to achieve an accuracy of 100 % on new unseen testing data with an average classification time of 7.31 milliseconds. IEEE

Energy Management in an Agile Workspace using AI-driven Forecasting and Anomaly Detection

Smart building technologies transform buildings into agile, sustainable, and health-conscious ecosystems by leveraging IoT platforms. In this regard, we have developed a Persuasive Energy Conscious Network (PECN) at the University of Glasgow to understand the user-centric energy consumption patterns in an agile workspace. PECN consists of desk-level energy monitoring sensors that enable us to develop user-centric models that can be exploited to characterize the normal energy usage behavior of an office occupant. In this study, we make use of staked long short-term memory (LSTM) to forecast future energy demands. Moreover, we employed statistical techniques to automate the detection of anomalous power consumption patterns. Our experimental results indicate that post-anomaly resolution leads to 6.37% improvement in the forecasting accuracy. © 2022 IEEE.

Urdu English Foreign Language Learners Voices Learning English Online During the COVID-19

The unprecedented closure of institutions and schools due to the current epidemic has renewed interest in entirely online education. During the COVID-19 outbreaks, this survey aimed to discover how Urdu EFL students felt about online learning. Written reflections were used to collect qualitative data from 40 Pakistani undergraduate students majoring in English, with five of them selected for a semi-structured interview on purpose. Because it was regarded appropriate during the current epidemic, the student participants had positive attitudes toward online learning. However, according to qualitative data analysis, they preferred to learn English in face-to-face classrooms. In addition, an unstable internet connection, a lack of contact and teacher explanations, and potential distractions impeded their online English learning. Participants also made recommendations, and a debate was held on the educational implications.

Feasibility and Performance of Hemoglobin A1C Self-Testing During COVID-19 Among African Americans With Type 2 Diabetes.

PURPOSE: The purpose of the study was to determine the feasibility of implementing A1C self-testing at home using the A1CNow® Self Check and to compare the accuracy of the A1CNow to a reference standard in African Americans with type 2 diabetes (T2D). METHODS: African American adults with T2D were recruited from 13 different churches (N = 123). Phase 1, conducted during the early phase of the COVID-19 pandemic, examined the feasibility of A1C assessment using the A1CNow performed at home by untrained participants. Phase 2, conducted when in-person research resumed, compared A1C values concurrently measured using the A1CNow and the DCA Vantage™ Analyzer (reference standard) collected by research staff at church testing sites. RESULTS: In Phase 1, 98.8% of participants successfully completed at least 1 at-home A1C test; the overall failure rate was 24.7%. In Phase 2, the failure rate of staff-performed A1CNow testing was 4.4%. The Bland-Altman plot reveals that A1CNow values were 0.68% lower than DCA values, and the mean differences (A1CNow minus DCA) ranged from -2.6% to 1.2% with a limit of agreement between -1.9% to 0.5%. CONCLUSIONS: A1C self-testing is feasible for use in community settings involving African American adults with T2D. The A1CNow Self-Check underestimated A1C values when compared with the reference standard. Ongoing improvements in point-of-care devices have the potential to expand research and clinical care, especially in underserved communities.

Genetic Sequence of Coronavirus Strains Isolated from Iraqi Patients and their Relationship with some Liver Enzymes and Interleukins.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is a positive-sense single-stranded RNA virus from the genus Betacoronavirus causes COVID-19 (coronavirus disease 2019). According to daily reports issued by the Iraqi Ministry of Health, the SARS-COV-2 was firstly detected in Al-Najaf city in February 2020 and identified in the Central Public Health Laboratory (CPHL) in Baghdad, Iraq. The outcomes of this study were based on 100 nasopharyngeal swaps and venous blood samples from hospitalized patients in Al-Kindy and CPHL. Patients were assigned to five groups (Asymptomatic, Mild, Moderate, Severe, and Deceased) based on disease severity as indicated by World Health Organization (WHO). The positive samples were identified by real-time quantitative polymerase chain reaction (RT-PCR) and subjected to some liver enzyme assays and interleukins measurements, and the correlation with the genetic sequence was determined by Illumina Miseq technology. Liver enzymes levels of Aspartate aminotransferase (AST), Alanine aminotransferase (ALT), and lactate dehydrogenase (LDH) showed statistically significant differences, especially between the deceased groups. Interleukins (IL-10, IL-18, and TNF- α) significantly differed among groups. This study revealed that three isolates belonging to the original strain isolated from Wuhan (A19) and characterized by their virulence caused severe symptoms and led to admission to isolation hospitals and intensive care units, and the last two isolates of (UK alpha V1) appeared in Iraq in early 2021. These strains which were less virulent than the Wuhan strain spread faster and appear in moderate and asymptomatic patients.

TRAVEL DURING COVID-19 IN MALAYSIA: THE EFFECTS OF COVID-19 RISK KNOWLEDGE, DESTINATION IMAGE AND VALUE

The influence of the COVID-19 pandemic on travel behaviour is currently devastating the tourism sector. In this paper, we investigate the influence of destination image, COVID-19 risk knowledge, destination value and tourist intention to revisit. Empirical data were collected using an online survey distributed via social media platforms (Facebook, WhatsApp) and email. Our sample consisted of Malaysians who travelled several times during the movement control order periods (after February 2020) in Malaysia. The results of structural equation modelling reveal that destination value significantly mediates the relationship between both components of destination image and tourist intention to revisit. Most importantly, we probed the interaction effect of COVID-19 risk knowledge on affective destination image. The results indicate that even a moderate level of understanding and knowledge of COVID-19 risks significantly strengthens the influence of affective destination image on destination value.

The severe acute respiratory syndrome coronavirus-2 pandemic: an overview to control human-wildlife and human-human interactions

Prevention of high-risk human-wildlife and human-human interactions, which can accelerate the occurrence of future outbreaks, epidemics or pandemics, requires global efforts. These efforts should focus on reducing the risk of contact with wildlife, pre-outbreak surveillance of wildlife and high-risk people, improvement of wildlife trade biosafety, and learning lessons from the previous attacks. International collaborations, building on the experiences learnt during facing the attacks by severe acute respiratory syndrome-coronavirus (SAR-CoV), Middle East respiratory syndrome-coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), will accelerate implementation of novel anti-viral prevention and control measures to avoid occurrence of such devastating viral outbreaks, epidemics and pandemics in the future.