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The COVID-19 outbreak was declared a public health emergency of international concern by the World Health Organization on January 30, 2020. Since then, the virus has spread to affect more countries worldwide. During this period, our nuclear medicine department at Singapore General Hospital segregated our staff and patients by time, by space, or both, to minimize contact and prevent spread of the virus. Necessary changes to our clinical practices and stricter infection control measures were also enforced. We share our personal experience in managing a nuclear medicine department during this epidemic.

The new coronavirus pneumonia (coronavirus disease 2019 [COVID-19]) was first reported in Wuhan, China, in December 2019; the virus was extracted from lower-respiratory-tract samples from humans ([1][1]). The World Health Organization officially announced COVID-19 to be a pandemic on March 11, 2020

> If you can look into the seeds of time, and say which grain will grow and which will not, speak then to me… > —William Shakespeare’s Macbeth In late 2019, a new virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China, causing an infectious disease ([1

The true impact and long-term damage to organs such as the lungs after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remain to be determined. Noninvasive molecularly targeted imaging may play a critical role in aiding visualization and understanding of the systemic damage. We have identified αvβ6 as a molecular target; an epithelium-specific cell surface receptor that is low or undetectable in healthy adult epithelium but upregulated in select injured tissues, including fibrotic lung. Herein we report the first human PET/CT images using the integrin αvβ6-binding peptide (18F-αvβ6-BP) in a patient 2 mo after the acute phase of infection. Minimal uptake of 18F-αvβ6-BP was noted in normal lung parenchyma, with uptake being elevated in areas corresponding to opacities on CT. This case suggests that 18F-αvβ6-BP PET/CT is a promising noninvasive approach to identify the presence and potentially monitor the persistence and progression of lung damage.

The coronavirus disease 2019 (COVID-19) pandemic has redefined the way nuclear medicine is practiced. The threat from COVID-19 to health and to the nuclear medicine community is rapidly changing. During the acute phase of COVID-19, there were significant direct and indirect impacts on nuclear

TO THE EDITOR: A recently published editorial by Zuckier et al. ([1][1]), titled “Diagnostic Evaluation of Pulmonary Embolism During the COVID-19 Pandemic,” suggested reverting to a nonventilation approach for the evaluation of pulmonary embolism (PE) to minimize potential exposure to

CR3022 is a human antibody that binds to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we explore the use of CR3022 as a molecularly targeted radiotherapeutic. Methods: CR3022 was labeled with 131I and purified, yielding 131I-CR3022. Using a magnetic bead assay and a recombinant SARS-CoV-2 spike protein fragment, we tested binding of 131I-CR3022 in the presence and absence of CR3022. Results: We conjugated the antibody CR3022 with a purity of more than 98% and a specific activity of more than 292 MBq/mg. Using a bead-based assay, we confirmed that binding of 131I-CR3022 is selective and is significantly reduced in the presence of unlabeled antibody (3.14% ± 0.14% specific uptake and 0.10% ± 0.01% specific uptake, respectively; P < 0.0001). Conclusion: Our results confirm the potential of CR3022 as a molecularly targeted probe for SARS-CoV-2. A labeled version of CR3022 could potentially be used for Auger radiotherapy or noninvasive imaging.

We report the case of a 72-y-old man with concomitant autoimmune encephalitis and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The patient presented with subacute cerebellar syndrome and myoclonus several days after general infectious symptoms began. Methods: Clinical examination, CT, PET, MRI, and autoantibody testing were performed. Results: The oropharyngeal swab test was positive for SARS-CoV-2. The brain MRI results were normal. Cerebrospinal fluid testing showed normal cell counts, a negative result on reverse-transcription polymerase chain reaction testing, and no oligoclonal banding. Brain 18F-FDG PET showed diffuse cortical hypometabolism associated with putaminal and cerebellum hypermetabolism, compatible with encephalitis and especially cerebellitis. The immunologic study revealed high titers of IgG autoantibodies in serum and cerebrospinal fluid directed against the nuclei of Purkinje cells, striatal neurons, and hippocampal neurons. Whole-body 18F-FDG PET and CT scans did not show neoplasia. Treatment with steroids allowed a rapid improvement in symptoms. Conclusion: This clinical case argues for a possible relationship between SARS-CoV-2 infection and autoimmune encephalitis and for the use of 18F-FDG PET in such a context.

The COVID-19 crisis has forced Nuclear Medicine and Molecular Imaging Departments to cancel appointments, change procedures and protocols, and adapt to significant changes rapidly. Nuclear Medicine Technologists are often on the frontlines, working and communicating directly with their patients. To

[Figure][1] Johannes Czernin These are difficult times for all of us. None of us has ever experienced anything like the current pandemic. Nuclear medicine clinics are usually very safe, low-risk, low-stress environments. This has changed now as each patient can be infected, and staff

The coronavirus disease 2019 (COVID-19) pandemic has placed significant challenges on health-care systems worldwide, whether in the preparation, response, or recovery phase of the pandemic. This has been primarily managed by dramatically reducing in- and outpatient services for other diseases and implementing infection prevention and control measures. The impact of the pandemic on nuclear medicine departments and their services has not yet been established. The aim of this online survey was to evaluate the impact of COVID-19 on nuclear medicine departments. Methods: A web-based questionnaire, made available from April 16 to May 3, 2020, was designed to determine the impact of the pandemic on in- and outpatient nuclear medicine departments, including the number of procedures, employee health, availability of radiotracers and other essential supplies, and availability of personal protective equipment. The survey also inquired about operational aspects and types of facilities as well as other challenges. Results: A total of 434 responses from 72 countries were registered and analyzed. Respondents reported an average decline of 54% in diagnostic procedures. PET/CT scans decreased by an average of 36%, whereas sentinel lymph-node procedures decreased by 45%, lung scans by 56%, bone scans by 60%, myocardial studies by 66%, and thyroid studies by 67%. Of all participating centers, 81% performed radionuclide therapies, and they reported a reduction of 45% on average in the last 4 wk, ranging from over 76% in Latin America and South East Asia to 16% in South Korea and Singapore. Survey results showed that 52% of participating sites limited their 99mTc/99Mo generator purchases, and 12% of them temporarily cancelled orders. Insufficient supplies of essential materials (radioisotopes, generators, and kits) were reported, especially for 99mTc/99Mo generators and 131I, particularly in Africa, Asia, and Latin America. Conclusion: Both diagnostic and therapeutic nuclear medicine procedures declined precipitously, with countries worldwide being affected by the pandemic to a similar degree. Countries that were in the postpeak phase of the pandemic when they responded to the survey, such as South Korea and Singapore, reported a less pronounced impact on nuclear medicine services; however, the overall results of the survey showed that nuclear medicine services worldwide had been significantly impacted. In relation to staff health, 15% of respondents experienced COVID-19 infections within their own departments.

The novel coronavirus disease 2019 (COVID-19) is now considered a pandemic imposing a tremendous challenge on many nuclear medicine departments. Whereas preliminary precautions have been addressed regarding the risk of infection ([1][1]), the potential impact of COVID-19 on the risk–benefit ratio

TO THE EDITOR: As every medical department worldwide is bracing for the impact the coronavirus disease 2019 (COVID-19) pandemic will pose on daily routines, the scientific community starts to excel in exploring the different facets this novel disease bears for prevention, diagnosis, and treatment.

TO THE EDITOR: Telemedicine is broadly defined as the use of audiovisual technology in the provision of medical care remotely ([1][1]). Recent developments in the COVID-19 outbreak necessitated the change of many conventional practices, to avoid cross-infection between health-care institutions and