Multidisciplinary Virtual Tumor Boards (VTB): A Single Center Satisfaction Survey

INTRODUCTION: With the onset of the COVID-19 pandemic, many cancer centers pivoted to a completely virtual multidisciplinary tumor board (VTB) format. We previously published a significant rise in number of attendees and cases presented with the transition from in-person to VTB at our institution. The aim of the current study was to measure the satisfaction of participants regarding the virtual format. METHOD(S): We developed a 21-question survey including 10 questions that directly compared virtual to in-person tumor boards using a 5-point Likert scale. The survey was imported into REDCap and sent via email to all tumor board participants. Responses were collected for approximately 4 weeks (reminder email at 2 weeks) and categorized. RESULT(S): There were a total of 83 respondents, 53 of whom (64%) attended both in-person and VTB. Specialties with highest response rates were Surgical Oncology (n=24) and Medical Oncology (n=18), and tumor boards with highest participation in the survey were Breast (n=26) and Gastrointestinal (n=21). Most respondents accessed the virtual platform from the hospital or office (67%) with some participation from home (19%). Most (77%) participants were either satisfied or very satisfied with the VTB format compared with 70% for in-person tumor board. Additionally, the majority of respondents (95%) felt that VTBs had great value for discussions with community-based clinicians. In terms of direct comparison to in-person tumor boards, 40% felt that the level of distraction was higher for VTB. The large majority of respondents felt that they were somewhat more (24%) or significantly more (44%) available for VTB format. Finally, when asked regarding their preference going forward, 52% favored virtual, 6% favored in-person, and 42% favored some sort of hybrid variety type of tumor board. CONCLUSION(S): The majority of multidisciplinary tumor board participants expressed satisfaction with the virtual format and prefer it to in-person meetings going forward. VTB allows increased accessibility, opportunities to engage community oncologists, and the ability to present more cases. Drawbacks to this format included less face-to-face interaction and increased levels of distraction. Our institution is currently considering completely virtual and hybrid options moving forward.

Respiratory viruses in medicolegal autopsies during the winter season 2021/2022: observations after reduction of coronavirus disease-19 (COVID-19) pandemic restrictions.

In the context of the coronavirus disease (COVID-19) pandemic, measures were taken to protect the population from infection. These were almost completely lifted in several countries in the spring of 2022. To obtain an overview of the spectrum of respiratory viruses encountered in autoptical routine case work, and their infectivity, all autopsy cases at the Institute of Legal Medicine in Frankfurt/M. with flu-like symptoms (among others) were examined for at least 16 different viruses via multiplex PCR and cell culture. Out of 24 cases, 10 were virus-positive in PCR: specifically, 8 cases with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), 1 with respiratory syncytial virus (RSV), and 1 with SARS-CoV-2 and the human coronavirus OC43 (HCoV-OC43), as a double infection. The RSV infection and one of the SARS-CoV-2 infections were only detected due to the autopsy. Two SARS-CoV-2 cases (postmortem interval of 8 and 10 days, respectively) showed infectious virus in cell culture; the 6 other cases did not show infectious virus. In the RSV case, virus isolation by cell culture was unsuccessful (Ct value of 23.15 for PCR on cryoconserved lung tissue). HCoV-OC43 was measured as non-infectious in cell culture, with a Ct value of 29.57. The detection of RSV and HCoV-OC43 infections may shed light on the relevance of respiratory viruses other than SARS-CoV-2 in postmortem settings; however, further, more extensive studies are needed for a robust assessment of the hazard potential due to infectious postmortem fluids and tissues in medicolegal autopsy settings.

FORMAL CAREGIVER BURDEN IN NURSING ASSISTANTS IN NURSING HOMES: A FEASIBILITY STUDY

Formal caregivers are the direct care workforce that aid residents in nursing homes. Providing care to residents is hazardous and physically demanding. Formal caregiver burden encompasses five attributes – perceived stress, caring for another, dependency of the older adult, responsibility, and competence. Exploring the five attributes of formal caregiver burden using a mixed-methods approach will determine if the attributes are present and how the nursing home setting contributes to formal caregiver burden. The purpose of this feasibility study is to describe formal caregiver burden of nursing assistants who provide direct care to residents in a nursing home setting in the Midwest United States. Study site one was only able to enroll three participants;therefore, results were limited. However, study site two was able to recruit and enroll the desired sample size (N=9). Interviews and self-report measures (Background/COVID-19 Questionnaire, Perceived Stress Scale, Caring Behaviors Inventory, and Nursing Home Staff Competency Assessment) were completed, and the PI compared integrated mixed methods results. Results suggest all the attributes of formal caregiver burden were present, and no additional attributes were identified. The feasibility of virtual recruitment, enrollment, and data collection procedures were confirmed. Multiple challenges played a role in the unsuccessful recruitment of this feasibility study at site one;however, virtual recruitment was successful at site two. Further exploration will inform identification and measurement of formal caregiver burden to ensure support for nursing assistants, continue the vitality of the nursing assistant workforce in nursing homes/long-term care, and improve the lives of nursing assistants.

Theme 01 - Epidemiology and Informatics

The incidence of amyotrophic lateral sclerosis in Ohio 2016-2018: the Ohio population-based ALS Registry. Environmental and occupational risk factors of amyotrophic lateral sclerosis: a population-based case-control study. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. [Extracted from the article]

A Metaphorical Approach to Developing Behavior Within the Context of the Covid-19 Pandemic

Although the COVID-19 Pandemic is a global health crisis, it is an epidemic that re-regulates many areas of life and profession. This study focused on designs made by independent designers to protect and help protect people from disease. So, the relevant tendency is important in raising awareness and improving the desired behavior during the current COVID-19 pandemic. For this reason, the iconic designs of an independent designer in Turkey were examined to raise awareness at the point of the pandemic. Thus, it is aimed to understand the role of visuals in raising awareness and creating behavior. In the analysis, the semiotic analysis method was used. According to the analysis, it is seen that the examined visuals are quite remarkable often calling for protection from the new Coronavirus through euphemism and often using metaphors. On the other hand, it may be thought that the visuals examined may not convince everyone to be careful and avoid exposure to the virus. In the study, a social network analysis was also conducted to understand the appearance and interaction status of the pandemic in social networks, and the networks '#evdekal' (stay at home) and '#hayatevesigar' (life fits into the home) on Twitter were examined. The results of the social network analysis show that the course of the pandemic did not arouse public reaction (in the scope of the analysis period). However, the fact that close connections cannot be established between different networks and the presence of the government party and the Minister of Health in the networks is also important in terms of public opinion and interaction.

Virtual and in-person co-design workshops: From alternative to complementary approaches

Co-design methods and toolkits are commonly used to involve people from diverse backgrounds and disciplines in design processes, promoting collaboration, design thinking, shared decision making, and creativity. These methods and toolkits are generally tailored to in-person workshops supported by different physical artifacts (e.g. card-sets) in a shared physical location. Physical co-location and artifacts allow participants to interact in seamless ways, relying on everyday modalities of interaction. The CoViD-19 pandemic has forced many of such workshops online. This required transforming location, methods, toolkits and to rethink interaction among participants. With this workshop we aim to look back at these experiences of transformation and to reflect on the affordances of the physical and the virtual in co-design workshops. What are the challenges of transforming location, methods, and toolkits that are designed for in-person workshops into the digital? In which ways can in-person and virtual workshops co-exist and complement each other? We invite participants to share their experiences and reflect on how to bring together virtual and in-person co-design workshops. © 2022 Owner/Author.

Pharmacologic inhibition of SUMOactivating enzyme potentiates interferon response and T cell-mediated anti-tumor immunity in chronic lymphocytic leukemia (CLL) and lymphoma models

Introduction: CLL is characterized by deficient immunity which clinically manifests as an increased predisposition toward malignancies and infectious complications. T-cells from patients with CLL exhibit a skewed repertoire with a predominance of Tregs as well as impaired immune synapse formation and cytotoxic function. Unlike chemotherapy, novel targeted agents may have beneficial immunomodulatory effects, which may be particularly relevant in the COVID-19 era. Small ubiquitin-like modifier (SUMO) family proteins regulate a variety of cellular processes, including nuclear trafficking, gene transcription, and cell cycle progression, via post-translational modification of target proteins. Sumoylation regulates NFjB signaling, IFN response, and NFAT activation, processes indispensable in immune cell activation. Despite this, the role of sumoylation in T cell biology in the context of cancer is not known. TAK-981 is a small molecule inhibitor of the SUMO-activating enzyme (SAE) that forms a covalent adduct with an activated SUMO protein, thereby preventing its transfer to the SUMO-conjugating enzyme (Ubc9). Here, we investigated the immunomodulatory effects of TAK-981 in CLL. Methods: T cells from patients with CLL were purified using Dynabeads. Activation, proliferation, and apoptosis of CD3+ T cells were studied following T-cell receptor engagement (TCR;aCD3/CD28) with/without 0-1 lM TAK-981. Cytokines were measured after in vitro stimulation. For polarization assays, FACS-sorted naïve CD4+ T cells were cultured for 7 days in control or differentiation media. For gene expression profiling (GEP;Clariom S), RNA was harvested after 3 and 24 h of TCR engagement from FACS-sorted naïve CD4+ T cells. For in vivo immunization experiments, CD4+KJ1-26+ cells were inoculated IV into BALB/cJ mice. Mice received 100 mg IV ovalbumin ± R848 followed by TAK-981 7.5 mg/kg or vehicle control IV twice weekly for 10 days before spleen collection. Both recipient and transplanted splenocytes were analyzed. For analysis of tumor-infiltrating lymphocytes (TILs), BALB/c mice were injected with 1×106 A20 lymphoma cells and treated as above. TAK-981 was provided by Millennium Pharmaceuticals, Inc. (Cambridge, MA, USA). Results: T cells from patients with CLL demonstrated high baseline protein sumoylation that slightly increased following TCR engagement. Treatment with TAK-981 significantly downregulated SUMO1 and SUMO2/3-modified protein levels, yet did not disrupt early TCR signaling as evidenced by sustained ZAP70, p65/NFjB, and NFAT activation detected by immunoblotting, immunocytochemistry, and GEP. Treatment with TAK-981 resulted in dose-dependent upregulation of the early activation marker CD69 in CD4+ T cells following 72 and 96 h of TCR stimulation vs. control. Meanwhile, the expression of CD25, HLA-DR, and CD40L was delayed in the presence of TAK-981. Interestingly, CD38, an IFN response target, was induced 2-fold in TAK-981-treated cells after 24 h and persisted at high levels at subsequent timepoints. T cell proliferation was reduced in the presence of high (1 lM) but not low/intermediate concentrations of TAK-981, accompanied by reduced S phase entry and decreased synthesis of IL- 2. However, T cells did not undergo apoptosis under those conditions. Targeting SAE in either control or Th1/Treg polarizing conditions facilitated an increase in IFNc and loss of FoxP3 expression (accompanied by decreased IL-2/STAT5), suggesting a shift toward Th1 and away from Treg phenotype, respectively. GEP (Reactome, GSEA) confirmed a dramatically upregulated IFN response in TAK-981-treated CD4+ naïve T cells. Furthermore, targeting SAE enhanced degranulation (CD107a), IFNc, and perforin secretion in cytotoxic CD8+ T cells and potentiated T cell cytotoxicity in allogeneic assays with lymphoma cells (OCI-LY3, U2932) as targets. Consistent with our in vitro data, OVA-stimulated transplanted transgenic KJ1-26+ splenocytes, as well as total CD4+ T cells from recipient mice treated with TAK-981 in vivo exhibited a significant reduction in express on of FoxP3 and an increased production of IFNc. In the A20 syngeneic model, treatment with TAK-981 similarly downregulated FoxP3 expression in CD4+ TILs and induced IFNc secretion in CD8+ TILs. Conclusion: Using a combination of in vitro and in vivo experiments, we demonstrate that pharmacologic targeting of sumoylation with TAK-981 does not impair proximal TCR signaling in T cells obtained from patients with CLL, but leads to rebalancing toward healthy immune T cell subsets via induction of IFN response and downmodulation of Tregs. These data provide a strong rationale for continued investigation of TAK-981 in CLL and lymphoid malignancies.

Sustained Control and Prevention of COVID-19 Outbreaks in Detroit Skilled Nursing Facilities

Background. Nursing home residents, a vulnerable population, experienced an extraordinary surge of COVID-19 cases and deaths at the beginning of the pandemic. Multidisciplinary collaboration from the Detroit Health Department (DHD), academic centers, along with interim guidance from the CDC provided a structured approach to control SARS-CoV-2 in Detroit skilled nursing facilities (SNF). We aim to describe this model. Methods. There were 26 SNF prioritized by the DHD over a 13-month period from 3/2020 - 4/2021. Testing for SARS-CoV-2 occurred biweekly, on average, at each facility for staff and residents. Any staff or resident cases were investigated by a specialized investigations team to determine outbreak status. Any resident that was identified as positive for SARS-CoV-2 was moved to a designated in-house quarantine unit or specific COVID-19 designated nursing homes within the City of Detroit, and cohorting guidance was provided. Facilities were evaluated for environmental controls, PPE provided as needed and infection prevention guidance was provided. COVID-19 vaccination was conducted by pharmaceutical chains or the DHD and vaccine education sessions were conducted for nursing home staff and residents. Results. On average, SNF facilities served a total of 2,262 residents (2031-2367 range) and employed a total of 2,965 staff (1034-3124 range) during the period from 7/2020 - 4/2021. SARS-CoV-2 cases overall for Michigan and Detroit are shown in Figure 1. In SNF facilities, cases ranged from zero to 279 cases in residents and zero to 115 cases per week in staff (Figure 1). Beginning 3/2020, the majority of cases were residents, whereas after 10/2020, staff cases exceeded resident cases. Immunization rates were 63% (partial) and 58% (complete) for residents, and 26% and 23% for staff, respectively. Measures to reduce vaccine hesitancy included organized education sessions, messaging from trusted leaders and organized mass vaccination schedules. Conclusion. We describe the effectiveness of multidisciplinary interventions to control dissemination, morbidity and mortality of SARS-CoV-2 amongst SNF residents in Detroit. We emphasize the continued need to address vaccine hesitancy and importance of this model as successful interventions to decrease infection rates.

Detection and monitoring of the SARS-CoV-2 virus in Diluvio stream, Porto Alegre, RS, associated with parameters of environmental quality

Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), which causes COVID-19 disease, is accompanied by the presence and dissemination of the virus in the feces of symptomatic and asymptomatic individuals. Several studies have pointed out the presence of virus fragments in the environment and viral loads for long periods in sewage systems and wastewater. The rapid spread of the infection has severely impacted public health and the global economy, demanding coping strategies and solutions for the pandemic. In this study, sewage-based epidemiology (WBE) was adapted as a complementary methodological strategy to clinical monitoring of the occurrence of COVID-19 in Porto Alegre. For 12 months, starting in August 2020, biweekly composite collections of water, flow determination and field parameters were carried out at the mouth of the Diluvio stream. From these samples, analyzes of quantitative viral RNA and water quality parameters associated with sewage discharges were performed. During the period evaluated, a correlation was observed between the concentration values of virus particles at the mouth of the stream and the number of clinical cases of COVID-19 officially notified by the State Health Department for Porto Alegre. The results, partially presented here, demonstrate the efficiency of the WBE strategy applied to the urban watercourse, in monitoring the SARS-CoV-2 pandemic.

Stress myocardial blood flow reduced after severe COVID-19, not related to symptoms

Introduction: Persistent cardiopulmonary symptoms after COVID-19 are reported in a large number of patients and the underlying pathology is still poorly understood. (1) Histopathologic studies revealed myocardial macrophage infiltrates in deceased patients, likely an unspecific finding of severe illness, and increased prevalence of micro- and macrovascular thrombi. (2) We examined whether microvascular perfusion, measured by quantitative cardiac magnetic resonance under vasodilator stress, was altered post COVID-19. Methods: Our population consisted of 12 patients from the Pa-COVID- 19-Study of the Charité Berlin, which received a cardiac MRI as part of a systematic follow up post discharge, 10 patients that presented at the German Heart Center Berlin with persistent cardiac symptoms post COVID-19 and 12 patients from the Kings College London referred for stress MRI and previous COVID-19. The scan protocol included standard functional, edema and scar imaging and quantitative stress and rest perfusion to assess both macro- and microvascular coronary artery disease. The pharmacological stress agent was regadenosone in 20 and adenosine in 13 of the patients. To control for the higher heart rate increase under regadenosone compared to adenosine, we calculated the myocardial blood flow per heartbeat (MBFΔHRi) under stress. Results: The median time between first positive PCR for COVID-19 and the CMR exam was 2 months (Range 0 to 12). None of the 33 patients exhibited signs of myocardial edema. One patient with a previous history of myocarditis had focal fibrosis. Three patients with known coronary artery disease showed ischemic Late Enhancement. Five patients had a small pericardial effusion;one of these four patients showed slight focal pericardial edema and LGE, consistent with mild focal pericarditis. Five Patients had a stress-induced focal perfusion deficit. Mean Stress MBFΔHRi was 32.5±6.5 μl/beat/g. Stress MBFΔHRi was negatively correlated with COVID-19 severity (rho=-0.361, P=0.039) and age (r=-0.452, P=0.009). The correlation with COVID-19 severity remained significant after controlling for age (rho=-0.390, P=0.027). There was no apparent difference in stress MBFΔHRi between patients with and without persistent chest pain (34.5 vs. 31.5 μl/beat/g, P=0.229) Conclusion: While vasodilator-stress myocardial blood flow after COVID- 19 was negatively correlated to COVID-19 severity, it was not correlated to the presence of chest pain. The etiology of persistent cardiac symptoms after COVID-19 remains unclear. (Figure Presented).

Outcomes of acute gastrointestinal bleeding in patients with covid-19: A case control study

Introduction: COVID-19 patients are at high risk of acute gastrointestinal (AGIB) bleeding due to higher use of steroids, mechanical ventilation and use of anti-coagulation. Limited studies are available that evaluated the differences in outcomes of AGIB in COVID-19 patients with non-COVID-19 patients. The purpose of the study was to describe the characteristics and outcomes of COVID-19 positive patients with AGIB compared to matched controls with AGIB without COVID-19. Methods: This was a case control study including patients admitted from March 2020 to February 2021 with the diagnosis of AGIB. Patients were divided into two groups, COVID-19 positive and non-COVID patients. Our primary outcomes were in-hospital or 30 days mortality and length of stay. Secondary outcomes were rate of rebleeding, need for ICU level of care and need for blood transfusion. We performed matching without replacement by age (6 10 years) and sex. Patient's characteristics are summarized using means and standard deviations or medians and interquartile ranges for continuous variables and frequency counts and percentages for categorical variables. The association between outcomes and AGIB in COVID-19 positive patients was estimated using conditional logistic regression models and odds ratios (OR) and 95% confidence intervals (CI) are reported. SAS. 9.4 was used for analysis. Results: Eighteen COVID-19 positive patients and 54 matched non-COVID-19 patients were included. Mean age was 69.7 years and 66.7% were male. Melena was the most common presentation and there was no significant difference in the hemoglobin on presentation between the two groups. The COVID-19 positive patients less frequently had endoscopies performed (33.3% vs 74.1%, p=0.0059) and had greater steroid use (83.3% vs 14.8%, p<0.0001) compared to non-COVID-19 patients. COVID-19 patients were more likely to have had an ICU stay (OR 20.41;95% CI 2.59, 160.69;p=0.004) and had longer hospital length of stays (OR 1.08;95% CI 1.03, 1.13;p=0.002). Mortality, readmission within 30 days, need for blood transfusion, and having rebleeding during the admission did not differ for COVID-19 and non-COVID-19 patients. Conclusion: COVID-19 patients with AGIB are more likely to require ICU admission and had longer length of stay. Despite significantly lower rate of endoscopic procedures performed in COVID-19 patients need for blood transfusion, mortality and rebleeding were not significantly different.

Adjuvant nivolumab in high-risk stage IIb/IIc melanoma patients: Results from investigator initiated clinical trial

Background: Recent studies have shown 5-yr recurrence rates for Stage IIB and IIC melanoma of up to 46%. These high-risk patients currently have few options for adjuvant therapy to prevent this inevitable recurrence, with the only FDA approved therapy being high-dose interferon-alfa, which is quite toxic. However, there are now immunotherapies (anti-PD1) and targeted therapies (anti-BRAF and anti-MEK combinations) which are approved as adjuvants for Stage III patients, some of whom will have a lower baseline recurrence risk than those with Stage IIB/IIC melanoma. We sought to determine if adjuvant PD1 inhibition with nivolumab (N) would improve the recurrence free survival (RFS) compared to historical RFS rates. Methods: Our study (NCT03405155) is a single-arm, open label, multicenter, phase 2 clinical trial evaluating RFS at 24 months in patients with Stage IIB/IIC melanoma on treatment with N at 480 mg IV every 4 weeks for 12 cycles. Overall survival is a secondary endpoint. Associated translational research includes circulating tumor cell DNA and immune correlates. Results: Twenty three patients with Stage IIB and three patients with Stage IIC melanoma were enrolled onto the study and received at least one dose of N. At data cutoff, 22 patients remain in follow up, as four patients withdrew consent at different time points in the study - one patient after one dose who wished to discontinue, one due to concern for COVID and need for repeat visits, one due to insurance issues, and one due to recurrence and wish to discontinue (which was captured in study data and RFS calculations). Seventeen patients have been on the clinical trial for at least two years with nine patients having finished treatment but with less than two years follow-up;the median follow-up is currently 21.9 months. Two patients demonstrated melanoma recurrence, one after receiving cycle six of N and another one year after completing treatment, resulting in a 87.8% RFS (90% CI (64.2%-96.3%) at 2 years, compared to the historical RFS at 2 years of 70%. No N related serious adverse events (SAEs) were observed, with only 2% Grade 3 AEs observed (varied and unrelated to treatment) and all others were Grade 1-2, including 21% GI, 18% cutaneous, and 10% musculoskeletal, respiratory, and fatigue, each;overall, 2% of these Grade 1-2 AEs were treatment related. Conclusions: Our preliminary results show a trend towards improved RFS in patients with Stage IIB/IIC melanoma treated with nivolumab. The cohort has not reached a minimum follow up of at least 2 years for RFS;patients are continuing to be monitored. On study, we observed the expected adverse events, without evidence of new toxicities. Data maturation will reveal the full effect of adjuvant N on disease relapse and overall survival and distant metastasis-free survival in stage IIB/IIC melanoma patients.

Design as a positive stimulus in a Brazilian hospital environment

The new coronavirus pandemic has put healthcare professionals, patients, and family members under pressure and stress, causing mental health issues, especially in the healthcare community. Studies show that a positive environment plays an important role in the well-being of individuals, impacting the physical and psychological security of people. This article presents a project developed for the Hospital de Clínicas de Porto Alegre, that through graphic interventions softened the effects of combating COVID-19 for the healthcare staff and patients throughout the pandemic. The project is detailed and the discussion presents the main points considered in the process of decision making. Results show how design can play an important role in helping, not only the Covid-2019 pandemic but also in making hospitals more hospitable places. © 2020 Universidade do Vale do Rio dos Sinos. All rights reserved.

Infectivity of deceased COVID-19 patients.

The duration of infectivity of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) in living patients has been demarcated. In contrast, a possible SARS-CoV-2 infectivity of corpses and subsequently its duration under post mortem circumstances remain to be elucidated. The aim of this study was to investigate the infectivity and its duration of deceased COVID-19 (coronavirus disease) patients. Four SARS-CoV-2 infected deceased patients were subjected to medicolegal autopsy. Post mortem intervals (PMI) of 1, 4, 9 and 17 days, respectively, were documented. During autopsy, swabs and organ samples were taken and examined by RT-qPCR (real-time reverse transcription-polymerase chain reaction) for the detection of SARS-CoV-2 ribonucleic acid (RNA). Determination of infectivity was performed by means of virus isolation in cell culture. In two cases, virus isolation was successful for swabs and tissue samples of the respiratory tract (PMI 4 and 17 days). The two infectious cases showed a shorter duration of COVID-19 until death than the two non-infectious cases (2 and 11 days, respectively, compared to > 19 days), which correlates with studies of living patients, in which infectivity could be narrowed to about 6 days before to 12 days after symptom onset. Most notably, infectivity was still present in one of the COVID-19 corpses after a post-mortem interval of 17 days and despite already visible signs of decomposition. To prevent SARS-CoV-2 infections in all professional groups involved in the handling and examination of COVID-19 corpses, adequate personal safety standards (reducing or avoiding aerosol formation and wearing FFP3 [filtering face piece class 3] masks) have to be enforced for routine procedures.

SARS

Severe acute respiratory syndrome (SARS) emerged in southern China in late 2002. It first spread within Guangdong Province and then to other parts of China. Via air travelers, it quickly reached various countries around the globe, causing several major hospital outbreaks.Within weeks, the causative agent, a previously unknown coronavirus (SARS-CoV), was identified, thanks to an unprecedented international effort led by the World Health Organization (WHO). Its origin was quickly traced to wild animals traded locally for culinary purposes. Masked palm civet and some other species seem to have acted as intermediate hosts. Since then, SARS-like coronaviruses were found in different bat species in China and elsewhere, and bats are now regarded as the wildlife reservoir for SARS-CoV.Fortunately, the SARS outbreak could be contained within months. Until July 2003, it had caused 8096 cases, with 774 deaths. Once adequate measures such as isolating patients and quarantining their contacts were strictly adhered to, further transmission between human beings could be interrupted.SARS is an example of how rapidly an infectious agent can spread in the modern world. At the same time, it should serve as a showcase of how international cooperation and modern science can help to combat the spread of infectious diseases. FAU - Berger, A.