No. 134 (September 2020)
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APSR News

Thank you!


Dr Nakanishi

Our gratitude for your help with APSR Assembly Education Awards for Young Investigators

Dear APSR members,

On behalf of the Society, we would like to express our gratitude from the bottom of our hearts to you for your generous donations to help with APSR awards for young investigators.

By the end of June 2020, $19,705 had been collected thanks to your kind support. It can contribute to increase our educational opportunities to young researchers and enrich the contents of seminars or make them more attractive than before. This will also increase the amount for activities in promoting healthcare training, research, education and advocacy in the Asia-Pacific region.

We would like your continuous support for young doctors, and the details can be seen at apsresp.org/donation/recent-donations.php.

Again, thank you very much for your great cooperation.

Sincerely yours,

Yoichi Nakanishi
President, APSR

APSR Short-Term Research/Training Scholarship

Post-training report by Dr Arvindran Alaga
Respiratory Department
Hospital Sultanah Bahiyah,
Alor Setar, Kedah
Malaysia

Research/training:Visiting and Attending Researcher on Bronchoscopy and other related areas (Interventional Pulmonology Fellowship – Adult Respiratory Medicine)
1 April 2020 – 31 July 2020
Host institute:Department of Respiratory Medicine
National Hospital Organization, Nagoya Medical Center
Host supervisor:Dr Hideo Saka MD, FCCP
Dr Masahide Oki MD, PhD, FCCP

It was an honour to be awarded APSR short term Research/Training Scholarship which aided me in enrollment for my attachment in Respiratory Department of Nagoya Medical Center, Japan. Nagoya Medical Center is a tertiary referral centre for interventional pulmonology procedures. It was a blessing to have Dr Hideo Saka and Dr Masahide Oki (both are well known interventional pulmonologists regionally and internationally) who directly supervised and coached me.

During my attachment in the department, I had an opportunity to participate in a wide range of interventional pulmonology procedures such as radial EBUS, linear EBUS, EUS, EUS-B, rigid bronchoscopy, peripheral bronchoscopy, navigational bronchoscopy, stenting (silicone/metallic including complex stenting procedures), cryobiopsy, medical thoracoscopy, flexible bronchoscopy and bronchial thermoplasty.

Besides that, I had the opportunity to take part in Department CME and teachings, daily X-ray conference, weekly follow-up conference on research and grand ward rounds. I had the opportunity to co-author a paper on Relapsing Polychondritis and broaden my skills on reviewing the journals.

The department has wonderful fellows and consultants who were friendly and helpful throughout my stay in Japan. I would like to convey my gratitude to APSR for the Short-Term Research/Training Scholarship which enabled me to gain invaluable experience which can be used to give excellent care for patients in North Malaysia.

My sincere thanks to my Home Supervisor Dr Razul Md Nazri who has been supportive in my endeavours. In a nutshell, it was a lifetime experience for me in Nagoya, a city which is rich in culture, history and definitely a beautiful place with kind souls.

Click any photo to enlarge


With Dr Hideo Saka in the operation theatre (Nagoya Castle in the background)


With the respiratory department team of Nagoya Medical Center

With Dr Masahide Oki

"A good teacher / supervisor can inspire hope,
ignite the imagination and instil a love of learning"

If you would like to be considered for an
APSR Short-Term Research/Training Scholarship,
click here for details.

New Respirology articles on the coronavirus

  • Letter from Singapore: The clinical and research response to COVID-19
    Sanjay H Chotirmall MD, PhD; Lin-Fa Wang PhD; John A Abisheganaden MD; DOI: 10.1111/resp.13929
    First published 17 August 2020
  • Medical ethics in the era of COVID-19: Now and the future
    Christopher Chew MBBS (Hons), BMedSc (Hons), MBioethics; Danielle Ko LLB (Hons), BA, MBBS (Hons), FRACGP, FAChPM; DOI: 10.1111/resp.13927
    First published 5 August 2020
  • Laboratory performance of oronasal CPAP and adapted snorkel masks to entrain oxygen and CPAP
    Shane A Landry, Dwayne L Mann, Lee Djumas, Ludovico Messineo, Philip I Terrill, Luke D J Thomson, Caroline J Beatty, Garun S Hamilton, Darren Mansfield, Bradley A Edwards, Simon A Joosten; DOI: 10.1111/resp.13922
    First published 3 August 2020

Recent Respirology Case Reports on the coronavirus

  • Haemorrhagic bronchial casts causing complete ventilatory failure in a COVID-19 patient on ECMO
    Samantha Herath, Natalie Kruit, Adam Eslick, Nicole Giroy; DOI: 10.1002/rcr2.631
    First published 28 July 2020

More...

See a collection of COVID-19 material on the dedicated COVID-19 page on the APSR website.

Important roles


Dr Madegedara

In the current pandemic, where face-to-face meetings and conferences cannot be held, the value and importance of journals is greatly increased.

Therefore we are pleased to relay the news that Dr Madegedara, Head of the APSR Clinical Respiratory Medicine Assembly, has recently taken up the post of associate editor of ERJO, in addition to his role as Scientific Chair and Editor in Chief of Respire (the official journal of the Sri Lanka College of Pulmonologists) and President of the Kandy Society of Medicine.

Please continue to support him and all others working hard to publish high quality content, by submitting your articles for consideration.

The APSR's own Respiratory Updates is taking a short break during the pandemic, but Respirology and Respirology Case Reports continue to flourish and accept submissions.

The latest issues follow:

Inside Respirology

Respirology Vol. 25 Issue 9 - Interventional Pulmonology Pearls

Show / Hide

Interventional Pulmonology Pearls

EDITORIAL
909Interventional pulmonology: There is no going back, only forward
David Feller-Kopman MD, FCCP
10.1111/resp.13896
PROLOGUE
911The changing field of interventional pulmonology
Phan Nguyen MBBS, FAPSR, PhD, FRACP; Pyng Lee MBBS, FRCP(UK), PhD; Noriaki Kurimoto MD, PhD
10.1111/resp.13821
INVITED REVIEWS
914Technologies for targeting the peripheral pulmonary nodule including robotics
David Fielding, Masahide Oki
10.1111/resp.13791
924Lung cancer staging: State of the art in the era of ablative therapies and surgical segmentectomy
Alexander Gregor, Terunaga Inage, Bin Hwangbo, Kazuhiro Yasufuku
10.1111/resp.13827
933Is tissue still the issue in detecting molecular alterations in lung cancer?
Chong-Kin Liam, Sugamya Mallawathantri, Kwun M Fong
10.1111/resp.13823
944Bronchoscopic treatments for early-stage peripheral lung cancer: Are we ready for prime time?
Daniel P Steinfort, Felix J F Herth
10.1111/resp.13903
953Airway stenting: Technological advancements and its role in interventional pulmonology
Nicolas Guibert, Hideo Saka, Hervé Dutau
10.1111/resp.13801
963Pleural effusions and pneumothorax: Beyond simple plumbing: Expert opinions on knowledge gaps and essential next steps
Rajesh Thomas, Najib M Rahman, Nick A Maskell, Y C Gary Lee
10.1111/resp.13881
972Bronchoscopic interventions for severe emphysema: Where are we now?
Pallav L Shah, Dirk-Jan Slebos
10.1111/resp.13835
981Bronchial thermoplasty: Redefining its role
David Langton, Pyng Lee
10.1111/resp.13887
987Lung cryobiopsy and interstitial lung disease: What is its role in the era of multidisciplinary meetings and antifibrotics?
Lauren K Troy, Juergen Hetzel
10.1111/resp.13822
997Training in interventional pulmonology: What we have learned and a way forward
Henri G Colt, Jonathan P Williamson
10.1111/resp.13846
EPILOGUE
1008Interventional pulmonology: Moving forward
Phan Nguyen MBBS, FAPSR, PhD, FRACP; Pyng Lee MBBS, FRCP (UK), PhD; Noriaki Kurimoto MD, PhD
10.1111/resp.13923

Inside Respirology Case Reports

Respirology Case Reports Volume 08 Issue 7

Show / Hide
Case Series
Tracheobronchial amyloidosis: an uncommon disease with a common presentation
Loveleen Mangla, Rohit Vadala, Shirish Kumar Kadli, Deepak Prajapat, Deepak Talwar
DOI: 10.1002/rcr2.630

We describe three cases who presented with haemoptysis, which on further evaluation were diagnosed as isolated tracheobronchial amyloidosis, and a review of literature.

Melioidosis—role of endobronchial ultrasound
Santhakumar Subramanian, Venugopal Jaganathan, Deepak T. Hari, Deepak Thangaraju
DOI: 10.1002/rcr2.634

Melioidosis is an emerging disease in India. Mediastinal abscess is rare in melioidosis. We have reported three such cases. Endobronchial ultrasound helped in diagnosis.

Case Reports
Bronchial varices in a child with tricuspid atresia six years post Fontan correction
Shreya Bhushan, Vikas Goyal, Cameron Ward, Muddassir Rashid, Nitin Kapur
DOI: 10.1002/rcr2.620

Tracheal and bronchial varices are rare, especially in children. We report the first presentation of bronchial varices and haemoptysis in a child, six years after a Fontan procedure for tricuspid atresia. She had tortuous mediastinal and transpleural arterial collaterals on imaging and subsequently underwent embolization of these collaterals with haemoptysis settling after this.

Indwelling pleural catheter and successful autopleurodesis of refractory inflammatory lupus effusion
Boon Hau Ng, Nik Nuratiqah Nik, Abeed Mohamed Faisal Abdul Hamid, Chun Ian Soo, Hsueh Jing Low, Andrea Yu-Lin Ban
DOI: 10.1002/rcr2.621

Indwelling pleural catheter (IPC) is a useful tool for refractory malignant pleural effusions (MPEs). Its use in benign pleural effusions comes mainly from retrospective studies, case series, and case reports. Lupus effusion is common, causes minimal symptoms, and usually responds to either steroid therapy or immunosuppressants. We describe a 52-year-old woman whose first presentation of systemic lupus erythematosus (SLE) was a pleural effusion refractory to steroids and immunosuppressants. She successfully achieved spontaneous pleurodesis with intermittent IPC drainage at three months.

A case of non-severe COVID-19 complicated by pulmonary embolism
Yuto Akiyama, Kohei Horiuchi, Yasushi Kondo, Hiroki Kabata, Makoto Ishii, Koichi Fukunaga
DOI: 10.1002/rcr2.622

Here, we report a case of non-severe coronavirus disease 2019 (COVID-19) complicated by pulmonary embolism (PE), which indicates that the possibility of PE should consistently be considered, even in non-severe cases of COVID-19 without any risk of thrombosis.

Resolution of refractory chylothorax with a combination of talc pleurodesis and CPAP
Boon Hau Ng, Nik Nuratiqah Nik Abeed, Mohamed Faisal Abdul Hamid, Chun Ian Soo, Hsueh Jing Low, Andrea Yu-Lin Ban
DOI: 10.1002/rcr2.624

We describe a 69-year-old woman with underlying diffuse large B-cell lymphoma of the colon 16 years ago in remission, who presented with a new problem of refractory chylothorax. It was successfully treated with continuous positive airway pressure (CPAP) ventilation in tandem with talc pleurodesis.

Advanced G-CSF-producing non-small cell lung cancer-not otherwise specified, with favourable response to pembrolizumab monotherapy
Yohei Matsui, Tadaaki Yamada, Naoko Masuzawa, Shinshichi Hamada, Koichi Takayama, Osamu Hiranuma
DOI: 10.1002/rcr2.625

Here, we report a patient with non-small cell lung cancer-not otherwise specified (NSCLC-NOS) with high PD-L1 expression and aberrant granulocyte colony-stimulating factor (G-CSF) production, in whom monotherapy with the anti-PD-1 antibody pembrolizumab was effective as an initial treatment.

Bronchial mucoepidermoid carcinoma, recurrent asthmatic symptoms, and pneumonia presenting in pregnancy
Ritsuya Shiiba, Daisuke Himeji, Kiichiro Beppu, Kousuke Marutsuka, Masahiro Mitsuoka, Kazuki Nabeshimaa
DOI: 10.1002/rcr2.626

Here, we report the case of a 37-year-old pregnant Japanese woman with bronchial mucoepidermoid carcinoma, recurrent asthmatic symptoms, and pneumonia that we treated successfully via interventional bronchoscopy and surgery. At one-year follow-up, the patient was disease-free and her baby was growing well.

Incomplete metalloptysis linger pneumonia after a wedge resection of the lung for organizing pneumonia
Sen-Ei Shai, Yi-Ling Lai, Hsiao-Wen Tang, Shih-Chieh Hung
DOI: 10.1002/rcr2.627

We report the first case of incomplete metalloptysis linger pneumonia after the wedge resection of organizing pneumonia, with complete recovery by removal of residual clips, where clips from the staple cartridges had been applied on the periphery of the lung migrated and been incompletely expectorated.

Thrombocytopaenia during nintedanib treatment in a patient with idiopathic pulmonary fibrosis
Yusuke Ochi, Motoyasu Kato, Masahiro Fujioka, Mika Hayashi, Haruhi Takagi, Kazuhisa Takahashi
DOI: 10.1002/rcr2.628

We present a rare case of symptomatic thrombocytopaenia associated with nintedanib treatment in a patient with idiopathic pulmonary fibrosis (IPF).

De novo thymic carcinoma or malignant transformation: a myasthenic patient presented with multiple mediastinal tumours
Chu-Pin Pai, Chih-Ming Lin, Yi-Chen Yeh, Chien-Sheng Huang, Biing-Shiun Huanga
DOI: 10.1002/rcr2.629

Synchronous triple thymic carcinomas and thymoma have not been reported. The finding of this case report supports the hypothesis of malignant transformation of thymoma to thymic carcinoma.

Haemorrhagic bronchial casts causing complete ventilatory failure in a COVID-19 patient on ECMO
Samantha Herath, Natalie Kruit, Adam Eslick, Nicole Giroya
DOI: 10.1002/rcr2.631

We describe the surprise finding of haemorrhagic endobronchial casts causing complete ventilation failure in the first patient placed on extracorporeal membrane oxygenation (ECMO) for coronavirus disease 2019 (COVID-19) in Australia. Removal of casts with international bronchoscopy procedures leads to the restoration of ventilation.

Large cell carcinoma of the lung presenting as diffuse pulmonary infiltrates with haemoptysis
Gil Myeong Seong, Chang Lim Hyun, Jonggeun Lee, Changhwan Kima
DOI: 10.1002/rcr2.632

We report a case of large cell carcinoma identified during differential diagnosis of diffuse alveolar haemorrhage in a patient with haemoptysis.

ABCA3 deficiency from birth to adulthood presenting as paediatric interstitial lung disease
Jin-Gun Cho, Devesh Thakkar, Peter Buchanan, Nicole Graf, John Wheatleya
DOI: 10.1002/rcr2.633

We describe the clinical progress of siblings who initially presented with an undifferentiated paediatric interstitial lung disease at birth which was eventually diagnosed in adulthood as pulmonary surfactant dysfunction due to ATP-binding cassette subfamily A member 3 (ABCA3 ) mutations. Clinical deterioration was due to progressive pulmonary hypertension and a moderate decline in forced expiratory volume in 1 sec (FEV1), rather than progression of the interstitial lung disease.

Solitary fibrous tumour of the pleura arising in a pulmonary cavity
Hiroyuki Miura, Jun Miura, Keisei Tachibana, Shinichi Gotoa
DOI: 10.1002/rcr2.635

Solitary fibrous tumour of the pleura (SFTP) is a rare neoplasm. Moreover, cavity formation associated with SFTP is extremely rare. To our knowledge, only one such case has been previously reported.

Severe gastritis due to pembrolizumab treatment in a lung cancer patient
Noriko Hayama, Hiroaki Ihara, Yuichirou Honma, Yukinari Itoigawa, Kyoichi Kaira, Mitsuhiro Fujii
DOI: 10.1002/rcr2.636

The incidence of immune checkpoint inhibitor (ICI)-induced gastritis is relatively rare, compared with colitis, but a massive immunoreaction caused by ICIs can induce severe gastritis. Thus, gastritis should be considered when patients taking ICIs complain of any gastrointestinal symptoms.

Eosinophilic airway inflammation and eosinophilic chronic rhinosinusitis during nivolumab and ipilimumab
Hirofumi Watanabe, Kazuhiro Asada, Toshihiro Shirai, Hiroko Torii, Koji Yoshimura, Kimihide Kusafukaa
DOI: 10.1002/rcr2.638

There are many immune-related adverse events (irAEs) induced by immune checkpoint inhibitors; however, irAEs associated with type 2 inflammation are less known. We report a case of eosinophilic airway inflammation and eosinophilic chronic rhinosinusitis simultaneously during combination therapy with nivolumab and ipilimumab for renal cell carcinoma.

Re-establishing indwelling pleural catheter patency with alteplase after failure of streptokinase
Mohamed Faisal, Siti Nurhanis, Nik Nuratiqah, Nik Abeed, Boon Hau Ng, Andrea Yu-Lin Bana
DOI: 10.1002/rcr2.639

We describe the successful use of a single low-dose intrapleural (IP) alteplase in both indwelling pleural catheter blockage and symptomatic loculation drainage, following a failed therapy with six doses of IP streptokinase.

IgG4-related lung disease progressing to respiratory failure
Yusuke Kunimatsu, Nozomi Tani, Izumi Sato, Yuri Ogura, Kazuki Hirose, Takayuki Takedaa
DOI: 10.1002/rcr2.641

Chest computed tomography (CT) showed non-segmental reticular shadow and ground-glass opacity predominantly spreading over the lymphatic tract, including the centrilobular and perilymphatic areas. 18F-fluorodeoxyglucose (FDG) positron emission tomography/CT showed significant FDG accumulation in the lung fields, indicating the proliferative and reversible status of immunoglobulin G4-related lung disease (IgG4-RLD).

Radiographic change over 11 years in a patient with asbestos-related pleural disease
Reina Hara, Yukihiro Yano, Fukuko Okabe, Tomoki Kuge, Masahide Mori, Koji Urasaki
DOI: 10.1002/rcr2.642

We report the case of a 72-year-old man with asbestos-related disease, firstly benign asbestos pleural effusion and subsequently diffuse pleural thickening, which progressed over 11 years and finally presented chronic respiratory failure. After his death, moderate asbestos body concentration was proven in his autopsy-derived lung tissue.

Endobronchial metastases from a primary embryonal carcinoma
Chi-Kang Teng, Wen-Chien Cheng, Chieh-Lung Chen, Ting-Han Chen, Yun-Shan Lin, Chih-Yen Tu
DOI: 10.1002/rcr2.644

In this report, we present a case of endobronchial metastases from a primary embryonal carcinoma.

Clinical Image
Multiple patchy pulmonary consolidation in granulomatosis with polyangiitis
Masahiro Yamasaki, Masaya Taniwaki, Shota Nakano, Naoko Matsumoto, Shinji Nabeshima, Noboru Hattori
DOI: 10.1002/rcr2.623

Multiple patchy pulmonary consolidations that are unresponsive to antibiotics and/or exist at peri-bronchial sites and bloody bronchoalveolar lavage may effectively help clinicians diagnose granulomatosis with polyangiitis.

Penetrating pulmonary injury caused by a steel rod
Dario Amore, Emanuele Muto, Dino Casazza, Marcellino Cicalese, Marco Rispoli, Carlo Curcio
DOI: 10.1002/rcr2.640

Penetrating thoracic injuries by metallic rod are relatively rare. Here, we present the case of a stable patient with penetrating thoracic trauma where a careful radiological assessment helped us to perform a correct surgical management.

Endobronchial hamartoma coexisting with lung cancer
Seigo Miyoshi, Eiji Sugimoto, Mayu Kawakami, Yoshihiro Taguchi, Naohiko Hamaguchi, Osamu Yamaguchi
DOI: 10.1002/rcr2.643

We present the case of a 70-year-old man diagnosed with endobronchial hamartoma (EH) with concurrent malignant disease. Hamartomas are rarely identified as endobronchial lesions and only a few cases of EH with concurrent malignant disease are reported. Radiographic imaging and symptoms cannot reliably differentiate between EH and malignant bronchial nodules, thus careful examination is warranted.

Pseudoaneurysm after total arch replacement mimicking malignant lymphadenopathy
Yosuke Chiba, Kei Yamasaki, Hiroaki Ikegami, Kazuhiro Yatera
DOI: 10.1002/rcr2.645

Pseudoaneurysm should be considered in the differential diagnosis when the computed tomography (CT) findings show a mediastinal mass in patients with a history of cardiovascular surgery even if such surgery occurred over two decades previously.

Regional society news

The spotlight this month is on

Republic of Korea

Each month we share details of activities of a particular country, region or society.

If you would like the spotlight to be on your country, region or society next month, contact the Bulletin Coordinator or APSR Secretariat.

Korean Academy of Tuberculosis and Respiratory Diseases (KATRD) International Conference

The KATRD International Conference 2020 will be held virtually on 12-13 November 2020.

As the global impact of the coronavirus pandemic grows daily, the priority is always the health and safety of our community and participants.

The KATRD has developed into an international academic conference thanks to your efforts and support. Last year, the conference attracted 1,067 participants from 20 countries. The KATRD will build a dynamic, interactive, and inclusive virtual conference.

Internationally renowned speakers will be in attendance to discuss the latest trends with plenary sessions and symposiums which will cover all areas of our rapidly changing medical environment. Throughout these programmes, the Conference will offer exciting opportunities to gain insights and new ideas as you are connected to globally well-known speakers and enthusiastic fellow scholars. This Conference hopes to build an international network and promote collaboration.

The registration fee has been substantially reduced to encourage students and trainees from non-presenting attendees from all over the world to attend the conference on a new digital meeting platform.

Registration fee
Early
(until 16 October)
Late
(after 16 October)
Medical Doctor, ProfessorDomesticKR₩ 20,000KR₩ 50,000
OverseasUS$ 20US$ 50
Fellow, Resident, Nurse,
Military Doctor, Researcher, etc.
DomesticKR₩ 10,000KR₩ 30,000
OverseasUS$ 10US$ 30

Registration will provide each participant with an access code to participate in sessions.

Other regional news:

China

The date has changed for the World Congress of Bronchology & Interventional Pulmonology (WCBIP), biennial flagship international congress of the WABIP (World Association of Bronchology & Interventional Pulmonology).

This had been scheduled to be held in Shanghai, China, on 16-19 April 2020 and has been postponed to 19-22 November 2020 due to the coronavirus pandemic.

Please check the WABIP webpage www.wabip.com/congress for the latest details.

Japan

The date has changed for the 60th Annual Meeting of the Japanese Respiratory Society

This had been scheduled to be held in Nagoya on 24-26 April 2020 and has been postponed to 20-22 September 2020 due to the coronavirus pandemic. The venue has also been changed and the Annual Meeting will now be held at the Kobe Convention Center, Japan.

Please check the JRS webpage www.jrs.or.jp/jrs60/en/index.html for the latest details.

Singapore

Also due to the pandemic, the date of the World Conference on Lung Cancer has changed.

This had been scheduled to be held on 9-12 August 2020 and has been postponed to 26-29 January 2021.

Please check the IASLC website wclc2020.iaslc.org for the latest details.

Thailand

The Global Health Challenges for the New Decade

This virtual conference was hosted by Rajavithi Hospital, Rajavithi Hospital Foundation, Thailand on 15-17 July 2020.

The 'COVID-19 Global Health Challenges for the New Decade Virtual Conference' was held to assemble the experts in the expanding fields related to the COVID-19, from very fundamental issue to "new normal" practical approach and vaccine development. We are all acutely aware of the growing crisis associated with the Coronavirus. Thus it is timely that this meeting was held to enable all front liners in this battle to meet and discuss critical issues in this escalating problem. This 3-day virtual conference had gathered 27 invited speakers from around the world including the UK, Vietnam, Philippines, Indonesia, USA, China and Thailand.

These experts covered the fields of laboratory, diagnosis, critical care, infection control and treatment, paediatric issues, crisis and hospital management and vaccine. It attracted almost 1,000 participants from around the world. The Opening Ceremony was presided over by Dr Somsak Akkasilp, Director General, Department of Medical Services.

International sessions were held on the first day, followed by two days of Thai sessions. See the full programme here

Session 3 of the first day's programme was led by Dr Jennifer Ann Wi, Head-Elect of the APSR Tuberculosis Assembly, who spoke on the situation and experiences in Philippines.

A 30-minute video recording of her presentation is streamed here.

Session 4 of the first day's programme was led by Dr Erlina Burhan, Head of the APSR Tuberculosis Assembly, who spoke on the situation and experiences in Indonesia.

A 20-minute video recording of her presentation is streamed here.

Podcasts of both sessions are available at anchor.fm/apsr

Health news

Coronavirus: Letter from New Zealand

See Respirology's article: Letter from New Zealand doi/10.1111/resp.13931 published last week, which complements the following BBC News extract.

Coronavirus: New Zealand locks down Auckland after cases end 102-day run

New Zealand has put its largest city back into lockdown after recording four new Covid-19 cases, ending a 102-day streak without a local infection. >A three-day lockdown was swiftly imposed in Auckland after the cases were confirmed. The four new cases are all members of a single family. None had travelled recently.

The restrictions will come into effect on Wednesday [12 August], as authorities scramble to trace contacts of the family. Auckland residents will be asked to stay at home, large gatherings will be banned, non-essential businesses will be shut, and some social-distancing restrictions will be reintroduced in the rest of the country.

The country's Prime Minister Jacinda Ardern also on Wednesday deferred the dissolution of parliament, following the latest Covid-19 cases. The dissolution of parliament, which is required to make way for a general election, has now been deferred until Monday.

Ms Ardern said no decision had yet been made on postponing the election - originally scheduled for 19 September. "We have some time to work through that," she said, according to a TVNZ report.

New Zealand has fared better than other countries, recording 1,220 confirmed cases and 22 deaths since the virus arrived in late February. Before Tuesday, New Zealand had gone 102 days without recording a locally transmitted case of Covid-19, one of the few countries to reach such a milestone. All 22 active cases of the virus before Tuesday's announcement were among returning travellers quarantined in isolation facilities.

Praised internationally for its handling of the pandemic, the country's government had lifted almost all of its lockdown restrictions, first imposed in March. An early lockdown, tough border restrictions, effective health messaging and an aggressive test-and-trace programme have all been credited with virtually eliminating the virus in the country. But as infections continue to rise across the world, surpassing 20 million globally on Tuesday, New Zealand officials have warned against complacency.

Announcing the lockdown, Ms Ardern said it was necessary to go hard and go early to stamp out the virus. Auckland - a city of around 1.6 million people - would move to level three restrictions from 12:00 local time on Wednesday as a "precautionary approach", she said.

The prime minister said the rest of the country would move to level two of New Zealand's 4-tier alert system of measures against Covid-19. "This is something we have prepared for," Ms Ardern said at a news conference.

"We have had 102 days and it was easy to feel New Zealand was out of the woods. No country has gone as far as we did without having a resurgence. And because we were the only ones, we had to plan. And we have planned," she said.

Director-General of Health, Dr Ashley Bloomfield, said at least three days of lockdown were needed in Auckland to trace the source of the new cases. "We're expecting to see other cases," Dr Bloomfield said. "We want to find those other cases as soon as possible and identify or isolate any contacts."

Michael Baker, professor of Public Health at the University of Otago, told BBC's Newsnight programme that even with the most successful strategies in dealing with the coronavirus outbreak "one thing you have to plan for is setbacks".

"I think New Zealand will succeed and get rid of the virus," he added.

In anticipation of a pre-lockdown rush to supermarkets, Ms Ardern and the mayor of Auckland, Phil Goff, called for calm, saying there was no need to panic-buy.

Despite their pleas, large crowds of shoppers were seen queuing at supermarkets on Tuesday night, as they attempted to stock up before lockdown. One video posted to social media shows customers streaming through the door of a supermarket as a security guard tries to prevent them from entering.

The World Health Organization (WHO) had hailed New Zealand as an example to others for having "successfully eliminated community transmission". But other countries have had early success in suppressing the virus, only to see infections rise again after lifting lockdown restrictions that damaged the economy.

Vietnam went 99 days with no community transmission until July, when a 57-year-old man in Da Nang tested positive for the virus. By the end of July, Da Nang was the epicentre of a new coronavirus outbreak, leading to the country's first coronavirus death since the pandemic began.

Australia, too, has seen a resurgence of Covid-19 in some states, including New South Wales and Victoria, where a strict lockdown has been imposed.

Extracted from BBC News 12 August 2020
bbc.com/news/world-asia-53741091

Coronavirus Vietnam: The mysterious resurgence of Covid-19

By Preeti Jha
BBC News

In mid-July, Vietnam still shone as a Covid-19 outlier. No reported deaths, and months without a locally transmitted case. Fans packed into football stadiums, schools had reopened, and customers returned to their favourite cafes. "We were already back to normal life," said Mai Xuan Tu, a 27-year-old from Da Nang in central Vietnam.

Like many in the coastal city wildly popular with domestic visitors, she works in the tourism industry and was slowly resuming bookings for the tour company she founded. But by the end of July, Da Nang was the epicentre of a new coronavirus outbreak, the source of which has stumped scientists. Cases suddenly surged after 99 straight days with no local transmissions. Last week the city saw the country's first Covid-19 death, a toll that has since risen to 10.

Successful response

Just weeks earlier, Vietnam was praised globally as a rare pandemic success story. The communist country acted fast and decisively where other nations faltered, closing its borders to almost all travellers except returning citizens as early as March. It quarantined and tested anyone who entered the country in government facilities, and conducted widespread contact-tracing and testing nationwide.

So what went wrong?

"I'm not sure anything went wrong," says Prof Michael Toole, an epidemiologist and principal research fellow at the Burnet Institute in Melbourne.

Most countries that thought they had the pandemic under control have seen resurgences, he says, pointing to a long list including Spain, Australia and Hong Kong. "Like in the first wave, Vietnam has responded quickly and forcefully."

Around 80,000 visitors in Danang - many of whom had relaxed into thinking the disease was contained - were flown home promptly after the new cases emerged, as the historic port city sealed itself off from visitors and retreated into full lockdown. Vietnam's spike shows that "once there's a little crack and the virus gets in it can just spread so quickly," Prof Toole says.

Scientists and researchers across the country are racing to find out exactly how it did. In Hanoi Prof Rogier van Doorn, director of the Oxford University Clinical Research Unit, says the source of this latest outbreak remains a "big mystery". His team works with the government on its infectious diseases programmes and some of them focus on what he calls "genetic detective work" - the sequencing of viruses that can help illuminate "the chains of transmission. Who or where the virus came from". But so far no-one knows how the first new case in Da Nang - a 57-year-old man known as patient 416 - came into contact with the coronavirus.

The knowledge gap has allowed some speculation to set in. Local media have carried reports suggesting the latest outbreak may have been caused by a more virulent strain of the virus. Others have pointed to recent people-smuggling cases along the Vietnam-China border. But there is no evidence to suggest a more deadly strain or that migrants have brought the virus into the country.

National pride

A more likely possibility, say researchers, is that the virus went undetected during the months where there were no reported cases, potentially being asymptomatically transmitted in the community. Or there could have been an error somewhere along the quarantine process with someone released prematurely.

"There's evidence [the virus] was circulating in Da Nang for several weeks before that first case was diagnosed," says Dr Justin Beardsley, a senior lecturer in infectious diseases at the University of Sydney whose research has focused on Vietnam.

There could be some element of people dropping their guard, he adds, while noting that Vietnam showed exceptionally strong community engagement when it came to curbing spread of the virus. "There was big national pride about controlling the pandemic. And I think that's been missing in some Western countries.

Since hovering around the 400 mark in late July, the number of confirmed coronavirus cases in Vietnam has surged above 780. The deputy health minister has said they expect numbers to rise and forecast on Wednesday that the epidemic will reach a peak in 10 days.

With the recent tourists to Da Nang now back at home, cases have been detected in a total of 14 cities and provinces including the capital and Ho Chi Minh City. But it has been reassuring, says Prof Van Doorn, that all new cases in other parts of the country so far have had a direct link to the Da Nang outbreak. Crucially, there has been no reported community transmission outside of the city and bordering province. This is something authorities will be monitoring closely. "What was successful before is being done again. I'm again impressed," he adds.

'The year we look after our health'

Speckled among the praise showered on Vietnam for its handling of Covid-19 were some questions about the accuracy of the authoritarian state's data, which medical and diplomatic communities had widely agreed was reliable.

"The new deaths reported shows that there is transparency in reporting Covid-19 in Vietnam and that previous 'no deaths' should have not been questioned in the first place," Dr Huong Le Thu, a senior analyst at the Australian Strategic Policy Institute, tells the BBC. All the fatalities so far have been older patients with co-morbidities.

In Da Nang residents are readjusting. The beaches and streets are virtually empty once again as people only leave home to buy food. All eateries have been closed, including for takeout and deliveries. Flights are grounded. Each resident is set to be tested for the virus, and a field hospital has been erected as every resource is thrown at slowing the spread of the disease.

Freedoms mostly remain intact in other parts of the country, though Hanoi has closed down bars and karaoke parlours as an extra precaution, and several cities including the capital and Ho Chi Minh City have made face masks compulsory again in public places.

Like many worldwide, Xuan Tu is rolling with the uncertainty triggered by the pandemic. "This year is now the year we look after our health. Focus on family. The things that are most important," she says.

Extracted from BBC News 8 August 2020
bbc.com/news/world-asia-53690711

World Lung Day
25 September

Respirology and Respirology Case Reports have published article collections in support of World Lung Day and can be found here:

The Forum of International Respiratory Societies (FIRS) have prepared a series of fliers in different languages.

Click any image to enlarge and copy.

Education

En Bloc Society - APSR Joint Symposium

Teaching Library

The Teaching Library is open for your self-study. Challenging yourself to choose the correct procedure for any of the 122 cases in the Library at apsresp.org/education/teaching-library/index.php.

Many more cases are needed for this Library and any member is welcome to submit a case through the same link as above.

APSR Membership

Donations received

The following members have kindly sent their donation towards the Society's goals, as outlined at apsresp.org/members/donors.php.

  • Dr Laxmi Devi FAPSR
  • Dr Philip Eng FAPSR
  • Dr Sharad Joshi FAPSR
  • Dr Chin Kook Rhee

The APSR is profoundly grateful for their generosity.

New Fellows of the APSR

Congratulations to the following members who have recently become Fellows of the APSR:

  • Dr Laxmi Devi FAPSR
  • Dr Govindasamy Chinnasamy FAPSR
  • Dr Venkateswara Babu Ranganathan FAPSR
  • Dr Anil Kumar Gandham FAPSR

New and updated assembly memberships

A warm welcome to the following members who have recently joined or re-joined APSR assemblies.

Dr Govindasamy Chinnasamy Bronchoscopy and Interventional Techniques
COPD
Lung Cancer
Dr Sajal De Clinical Respiratory Medicine
Dr Anil Kumar Gandham Bronchoscopy and Interventional Techniques
Respiratory Infections (non-tuberculous)
Critical Care Medicine
Dr Vanitha Gnanasoundran Sundarasamy Tuberculosis
Clinical Respiratory Medicine
Bronchoscopy and Interventional Techniques
Dr Sharad Joshi Bronchoscopy and Interventional Techniques
Interstitial Lung Disease
Respiratory Infections (non-tuberculous)
Dr Muralidhara Reddy Kona Clinical Respiratory Medicine
Asthma
Tuberculosis
Dr Petru Emil Muntean Clinical Respiratory Medicine
Respiratory Infections (non-tuberculous)
Tuberculosis
Dr Peter Wark Asthma
COPD
Respiratory Infections (non-tuberculous)
Dr Sally Wootton COPD
Interstitial Lung Disease
Lung Cancer

Future Pulmonology Events

Here are the main respiratory events in Asia-Pacific region for the next few months. You can see our full listing on the APSR Calendar.

  • 60th Annual Meeting of the Japanese Respiratory Society
    20-22 September 2020, online
    (Details)
  • The 16th National Congress Indonesian Society of Respirology in conjunction with 1st Indonesia Chronic Lung Disease International Meeting (ICLIME)
    23-26 September 2020, Makassar, Indonesia
    (Details)
  • Scientific conference with updates from The Congress of European Respiratory Society (ERS) 2020 (VNRS)
    25-26 September 2020, Hanoi, Vietnam
    (Details)
  • Congress of International Lung Health and World COPD Day 2020 (VNRS)
    5-7 November 2020, Hanoi, Vietnam
    (Details)
  • 130th Conference of the Korean Academy of Tuberculosis and Respiratory Diseases (KATRD)
    12–13 November 2020, Online
    (Details)
  • Annual Congress of Vietnam Respiratory Society 2020 (combination of VNRS Congress and Association Franco-Vietnamienne De Pneumologie) and Pre-congress Workshop on Bronchoscopy
    13-15 November 2020, Da Nang city, Vietnam
    (Details)
  • Asthma & COPD Outpatient Care Unit (ACOCU) Network Day
    15 November 2020, Ho Chi Minh City, Vietnam
    (Details)
  • World Congress of Bronchology & Interventional Pulmonology (WCBIP)
    19-22 November 2020, Shanghai, China
    (Details)
  • Malaysian Thoracic Society (MTS) 2020 Annual Congress
    10-13 December 2020, Nusajaya, Johor, Malaysia
    (Details)
  • World Conference on Lung Cancer
    26-29 January 2021, Singapore
    (Details)

For more pulmonology events, see apsresp.org/calendar.html
(These events are for information only and APSR endorsement should not be assumed.)

Contact

If you have news of interest to APSR members, please send details to one of the Bulletin Coordinators: Prof. A Azuma (a-azuma@nms.ac.jp) or Prof. C K Rhee (chinkook77@gmail.com).


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