Frequency of exposure to Toxoplasma gondii in COVID-19 patients. a systematic review and meta-analysis (preprint)

Background Toxoplasmosis is a chronic protozoan parasitic infection that affects nearly one-third of the global population. During the COVID-19 pandemic, cases were observed in patients with COVID-19 and toxoplasmosis. Therefore, this systematic review and meta-analysis aimed to determine the frequency of Toxoplasma gondii exposure in patients with COVID-19. Methods A literature search was conducted in six databases (PubMed, Scopus, Embase, Web of Science, ScienceDirect, and Google Scholar) until March 3, 2024. Study selection, quality assessment, and data extraction were performed independently by three investigators. Statistical analysis was performed using R version 4.3, applying a random-effects model. The quality of the included observational studies was assessed using the "JBI-MAStARI". Results A total of 5,936 studies were retrieved, 13 of which were included in the final meta-analysis. The sample included a total of 2,947 patients with COVID-19 from four countries, of whom approximately 43.26% were men and 49.41% were women. Among the patients, 1,323 showed evidence of exposure to T. gondii through IgG detection, while 1,302 COVID-19 patients were specifically examined for the presence of T. gondii by IgM detection, and 36 positive cases were identified. The frequency of exposure to T. gondii, determined by the presence of IgG in patients with COVID-19, reached 49% (95% CI: 34-63%; 2,947 participants; 13 studies; I2 = 98%, p < 0.01). In addition, the frequency of exposure to T. gondii, evaluated by IgM presence in patients with COVID-19, was 2% (95% CI: 0-6%; 1,302 participants; 6 studies; I2 = 94%, p < 0.01). Conclusion It was shown that almost half of COVID-19 patients had previous exposure to T. gondii through the presence of IgG, and a small percentage, 2%, showed active infection through IgM detection.

Prevalence of Computer Vision Syndrome During the COVID-19 Pandemic: Systematic Review and Meta-Analysis (preprint)

Background Computer vision syndrome (CVS) has become a significant public health problem, especially in developing countries. Therefore, this study aims to identify the prevalence of CVS during the COVID-19 pandemic. Methods A systematic review and meta-analysis of the literature was conducted using the databases PubMed, Scopus, Web of Science, and Embase up to February 22, 2023, using the search terms "Computer Vision Syndrome" and "COVID-19". Three authors independently performed study selection, quality assessment, and data extraction, and the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used to evaluate study quality. Heterogeneity was assessed using the statistical test I2, and the R version 4.2.3 program was used for statistical analysis. Results A total of 192 studies were retrieved, of which 18 were included in the final meta-analysis. The total sample included 10337 participants from 12 countries. The combined prevalence of CVS was 74% (95% CI: 66, 81). Subgroup analysis based on country revealed a higher prevalence of CVS in Pakistan (99%, 95% CI: 97, 100) and a lower prevalence in Turkey (48%, 95% CI: 44, 52). In addition, subgroup analysis based on study subjects showed a prevalence of 82% (95% CI: 74, 89) for CVS in non-students and 70% (95% CI: 60, 80) among students. Conclusion According to the study, 74% of the participants experienced CVS during the COVID-19 pandemic. Given this finding, it is essential to implement preventive and therapeutic measures to reduce the risk of developing CVS and improve the quality of life of those affected. Trial registration The protocol for this systematic review and meta-analysis was registered in the international registry of systematic reviews, PROSPERO, with registration number CRD42022345965.

Prevalence of Malaria and COVID-19 Coinfection: A Systematic Review and Meta-Analysis (preprint)

Background COVID-19, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has significantly impacted public health worldwide. However, the outcomes can be unfavourable for those living in areas where malaria is endemic and are affected by SARS-CoV-2. Therefore, this systematic review and meta-analysis aimed to determine the prevalence of coinfection between malaria and COVID-19.  Methods A systematic review and meta-analysis of the literature were conducted, utilizing the most important databases in the field, such as PubMed, Scopus, Web of Science, Embase, and Google Scholar, up to April 9, 2023, using the search terms "Malaria" and "COVID-19". Three authors independently carried out the selection of studies, evaluation of their quality, and data extraction. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used to assess the quality of the studies. In addition, heterogeneity was evaluated using the statistical test I2, and the statistical analysis was performed using the R version 4.2.3 program. Results A total of 10227 studies were retrieved, of which 13 were included in the final meta-analysis. The pooled prevalence of coinfection between Malaria and COVID-19 was 45% (95% CI: 16, 76). Subgroup analysis was performed based on country, and the prevalence of coinfection between Malaria and COVID-19 was highest in China (100%, 95% CI: 88, 100) and lowest in the Democratic Republic of Congo (1%, 95% CI: 0, 2). Regarding the subgroup analysis to evaluate the prevalence of different types of Plasmodium spp. in COVID-19 patients, it was found that the combined prevalence of Plasmodium spp. was 53% (95% CI: 15%-88%; 478/1011 cases).  Conclusion The current research revealed a 45% prevalence of coinfection between Malaria and COVID-19. However, additional future studies are necessary to evaluate the impact of COVID-19 in Malaria-endemic areas fully.  Trial registration  The protocol for this systematic review and meta-analysis was registered with PROSPERO under the registration number CRD42023410177.

Monkeypox Post COVID19: Knowledge, Worrying, and Vaccine Adoption of the Arabic General Population (preprint)

Abstract: Background: The outbreak of monkeypox was designated a global public health emergency by the World Health Organization on July 23, 2022. There have been more reported 60000 cases worldwide, most of which are in places where monkeypox has never been seen due to the travel of people who have the virus. This research aims to evaluate the Arabic general population on monkeypox disease, fears, and vaccine adoption after the WHO proclaimed a monkeypox epidemic and to compare these attitudes to those of the COVID-19 pandemic. Methods: This cross-sectional study was performed in some Arabic countries (Syria, Egypt, Qatar, Yemen, Jordan, Sudan, Algeria, and Iraq) between August 18 and September 7, 2022 to examine the Arabic people perspectives on monkeypox disease, fears, and vaccine adoption and to compare these attitudes to those of the COVID-19 pandemic. The inclusion criteria were the general public residing in Arabic nations and older than 18. This questionnaire has 32 questions separated into three sections: sociodemographic variables, prior COVID-19 exposure, and COVID-19 vaccination history. The second portion assesses knowledge and anxieties about monkeypox, while the third section includes the generalized anxiety disorder (GAD7) scale. Logistic regression analysis were performed to compute the adjusted odds ratios (aOR), and their confidence intervals (95%CI) using STATA (version 17.0) Results: A total of 3665 respondents from 17 Arabic countries were involved in this study. Almost two third (n= 2427, 66.2%) of participants expressed more worried about COVID -19 than monkeypox diseases. Regarding the major cause for concern about monkeypox, 39.5% of participants attributed their anxiety they or a member of their family may contract the illness, while 38.4% were concerned about another worldwide pandemic of monkeypox. According to the GAD 7 score, 71.7% of respondents showed very low anxiety toward monkeypox. 43.8% of the participants scored poor levels of knowledge about monkeypox disease. Participants with previous COVID-19 infection showed greater acceptance to receive the monkeypox vaccine 1.206 times than those with no previous infection. A higher concern for the monkeypox than COVID-19 was shown by the participants who perceived monkeypox as dangerous and virulent 3.097 times than those who didn’t. Participants who have a chronic disease (aOR: 1.32; 95%CI: 1.09-1.60); participants worried about monkeypox (aOR: 1.21; 95%CI: 1.04-1.40); and perceived monkeypox as a dangerous and virulent disease (aOR: 2.25; 95%CI: 1.92-2.65); and excellent knowledge level (aOR: 2.28; 95%CI: 1.79-2.90) have emerged as significant predictors. Conclusion: Our study reported that three fourth of the participants were more concerned about COVID-19 than monkeypox disease. As well, most of the participants have inadequate levels of knowledge regarding monkeypox disease. Hence immediate action should be taken to address this problem. Consequently, it is crucial to learn about monkeypox and spread information about its prevention.

Knowledge and attitude regarding monkeypox virus among physicians in Saudi Arabia, a cross-sectional study (preprint)

Objectives The aim of this study was to assess the knowledge and attitudes towards monkeypox infection among physicians, a frontline healthcare worker group, in Saudi Arabia.Methods A cross-sectional, online survey assessing knowledge and attitudes towards monkeypox infection on multiple-item scales was sent to physicians in Saudi Arabia. The associations between independent factors and either knowledge or attitude were assessed.Results The final analysis included 398 participants. Approximately 57% of the participants were under 30 years old, and 56.8% were male. Only 18.6% of the surveyed participants had ever received information about monkeypox in their medical education. A substantial proportion of assessed physicians lack knowledge regarding the endemicity of monkeypox, its transmission, clinical differences with smallpox, chickenpox, and influenza, as well as the clinical evolution and the main associated findings. In addition, there is a significant knowledge gap between the therapeutic management of monkeypox and its vaccination. Such poor knowledge is influenced by various factors.Conclusions Physicians' knowledge and attitudes regarding monkeypox infection are inadequate. Training and knowledge assessment is important, as demonstrated by previous epidemics and pandemics such as Zika and COVID-19, especially when studies show significant improvement in related and specific knowledge.

Importance of bats in wildlife: not just carriers of pandemic SARS-CoV-2 and other viruses. (Special Issue: Coronaviruses and COVID-19- Past, Present, and Future.)

Bats are the only flying mammals that carry multiple pathogens, such as the SARS-CoV-2. As a consequent of fear of the zoonotic origin of SARS-CoV-2, there is an adverse reaction in multiple countries against these animals. Bats contribute with arthropod control and pollination, among other positive roles of these animals.

Reinfection after SARS-CoV2 infection: a looming concern. (Special Issue: SARS-CoV-2.)

Many unanswered questions remain about COVID-19 infection caused by SARS-CoV-2 coronavirus. One such looming concern is the possibility of reinfection of recovered cases. We conducted a literature review on various aspects of this possibility, including the case presentations of relapsed/re-infected patients, the immune response of production of neutralizing antibodies, immunity in response to coronavirus during SARS-CoV2 and MERS, possibility of false-positive results of real-time polymerase chain reaction. We concluded that further studies are required to establish whether relapse or reinfection is possible firmly. However, these possibilities point towards the needs of change in the protocol of isolation, quarantine, and discharge. It also undermines the role of the upcoming vaccine in disease prevention and treatment.

MERS-CoV and SARS-CoV Infections in Animals: A Systematic Review and Meta-Analysis of Prevalence Studies (preprint)

Introduction: Coronaviruses are zoonotic viruses that include human epidemic pathogens such as the Middle East Respiratory Syndrome virus (MERS-CoV), and the Severe Acute Respiratory Syndrome virus (SARS-CoV), among others (e.g., COVID-19, the recently emerging coronavirus disease). The role of animals as potential reservoirs for such pathogens remains an unanswered question. No systematic reviews have been published on this topic to date. Methods: We performed a systematic literature review with meta-analysis, using three databases to assess MERS-CoV and SARS-CoV infection in animals and its diagnosis by serological and molecular tests. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). Results: 6,493articles were retrieved (1960-2019). After screening by abstract/title, 50 articles were selected for full-text assessment. Of them, 42 were finally included for qualitative and quantitative analyses. From a total of 34 studies (n=20,896 animals), the pool prevalence by RT-PCR for MERS-CoV was 7.2% (95%CI 5.6-8.7%), with 97.3% occurring in camels, in which pool prevalence was 10.3% (95%CI 8.3-12.3). Qatar was the country with the highest MERS-CoV RT-PCR pool prevalence, 32.6% (95%CI 4.8-60.4%). From 5 studies and 2,618 animals, for SARS-CoV, the RT-PCR pool prevalence was 2.3% (95%CI 1.3-3.3). Of those, 38.35% were reported on bats, in which the pool prevalence was 14.1% (95%CI0.0-44.6%). Discussion: A considerable proportion of infected animals tested positive, particularly by nucleic acid amplification tests (NAAT). This essential condition highlights the relevance of individual animals as reservoirs of MERS-CoV and SARS-CoV. In this meta-analysis, camels and bats were found to be positive by RT-PCR in over 10% of the cases for both; thus, suggesting their relevance in the maintenance of wild zoonotic transmission.

Modelling the Paucity of COVID-19 Pandemic Spread Incidence across the India Nation (preprint)

Background: The highly contagious Co rona vi rus d isease (COVID-19) pandemic affected nearly all nations across the world. It was emerged as most swiftly affected disease across the world and more than 2934 lakhs population suffered in four months of the time period as on date April 26, 2020. Its first epicenter was at Wuhan city of China during the month of December 2019. Currently, the most affected people and new epicenter of Coronavirus is at the United States of America (USA). Various nation’s administration including the India government called for the regional and local lockdown. We predicted the confirmed COVID-19 cases for next May-2020 month, map the magnitude of COVID-19 disease for Indian states and model the paucity of COVID-19 disease with statistical confirmatory data analysis model for declining rate for the cases represented for the Indian proportion of population. Method: The ARIMA model used to predict for next short-term cases, based moving average of past confirmed cases. The restriction of COVID-19 pandemic disease analyzed with predicted cases for month May 2020 data at 95 percent confidence is more than 2.5 lakh cases. Results: The confirmatory data analysis model for the time estimation for the paucity of cases it takes in between six to eighteen months of time frame. The Confirmatory model which considers recovery rate, social, economic and government policy. To complete recovery from the COVID-19 cases it takes on an average more than next ten months. Conclusion: The disease impacts also depend upon administrative and local people support for self-quarantine and other measures. The India nation Gross Domestic Product (GDP) based on more than 17% of its agriculture production, due to longer affect of the disease and extended lockdown period it will be severely affected. However, all the economic activities with full of its intensity takes-up after complete paucity of COVID-19 disease spread. Keywords: SARS-CoV-2; Lockdown; GDP; Nobel-Corona; Confirmatory data model

Pandemic Coronavirus Disease (COVID-19): Challenges and A Global Perspective (preprint)

The technology-driven world of the 21st century is currently confronted with a major threat to humankind in the form of the coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). As of April 22, 2020, COVID-19 has claimed 169, 006 human lives and had spread to over 200 countries with more than 2,471,136 confirmed cases. The perpetually increasing figures associated with COVID-19 are disrupting the social and economic systems globally. The losses are unmatched and significantly higher compared to those from previously encountered pathogenic infections. Previously, two CoVs (SARS-CoV and Middle East respiratory syndrome-CoV) affected the human population in 2002 and 2012 in China and Saudi Arabia, respectively. Based on genomic similarities, animal-origin CoVs, primarily those infecting bats, civet cats, and pangolins, were presumed to be the source of emerging human CoVs, including the SARS-CoV-2. The cohesive approach amongst virologists, bioinformaticians, big data analysts, epidemiologists, and public health researchers across the globe has delivered high-end viral diagnostics. Similarly, vaccines and therapeutics against COVID-19 are currently in the pipeline for clinical trials. The rapidly evolving and popular technology of artificial intelligence played a major role in confirming and countering the COVID-19 pandemic using digital technologies and mathematical algorithms. In this review, we discuss the noteworthy advancements in the mitigation of the COVID-19 pandemic, focusing on the etiological viral agent, comparative genomic analysis, population susceptibility, disease epidemiology, animal reservoirs, laboratory animal models, disease transmission, diagnosis using artificial intelligence interventions, therapeutics and vaccines, and disease mitigation measures to combat disease dissemination.

SARS-CoV-2/COVID-19 and Advances in Developing Potential Therapeutics and Vaccines to Counter this Emerging Pandemic Virus – A Review (preprint)

A novel coronavirus (SARS-CoV-2), causing an emerging coronavirus disease (COVID-19), first detected in Wuhan City, Hubei Province, China has resulted in an outbreak in China which has taken a catastrophic turn with high toll rates in China and subsequently spreading across the globe. The rapid spread of this virus to more than 175 countries while affecting nearly 500,000 persons and causing more than 22,000 human deaths, it has resulted in a pandemic situation in the world. The SARS-CoV-2 virus belongs to the genus Betacoronavirus, like MERS-CoV and SARS-CoV, all of which originated in bats. It is highly contagious, causing symptoms like fever, dyspnea, asthenia and pneumonia, thrombocytopenia and the severely infected patients succumb to the disease. Coronaviruses (CoVs) among all known RNA viruses have the largest genomes ranging from 26 to 32 kb in length. Extensive research has been conducted to understand the molecular basis of the SARS-CoV-2 infection and evolution, develop effective therapeutics, antiviral drugs and vaccines, and to design rapid and confirmatory viral diagnostics as well as adopt appropriate prevention and control strategies. Till date, no clinically proclaimed, proven therapeutic antibodies or specific drugs and therapeutics, and vaccines have turned up. Several molecular diagnostic tests such as Real Time-PCR, isothermal loop-mediated amplification of coronavirus (i-LACO), full genome analysis by next-generation sequencing (NGS), multiplex nucleic acid amplification, and microarray-based assays are in use currently for the laboratory confirmation of this CoV infection. In this review article, we describe the basic molecular organization and phylogenetic analysis of the coronaviruses, including the SARS-CoV-2, and recent advances in diagnosis and vaccine development in brief and focusing mainly on developing potential therapeutic options that can be explored to manage this pandemic virus infection, which would help in valid countering of COVID-19.

SARS-CoV-2: Jumping the Species Barrier, Lessons from SARS and MERS, Its Zoonotic Spillover, Transmission to Humans, Preventive and Control Measures and Recent Developments to Counter This Pandemic Virus (preprint)

Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome - Coronavirus-2) of the family Coronaviridae, appeared in Wuhan, Hubei province, China being its epicenter in December 2019. This disease was declared as posing Public Health International Emergency by World Health Organization on January 30, 2020, attained the status of a very high-risk category on February 29, and now having a pandemic status (March 11, 2020). COVID-19 has presently spread to more than 195 countries/territories while killing nearly 19,600 humans out of cumulative confirmed cases accounting to more than 430,000 within a short period of just a few weeks. The majority of deaths have been reported in Italy and China. Researchers worldwide are pacing with high efforts to counter the spread of this virus and to design effective vaccines and therapeutics/drugs. Few of the studies have shown the potential of animal-human interface and zoonotic links in the origin of SARS-CoV-2. Exploring the possible zoonosis and revealing the factors responsible for its initial transmission from animals to humans will pave ways to design and implement effective preventive and control strategies to counter COVID-19. The present review presents an overview of COVID-19 and the causative virus SARS-CoV-2, with particular emphasis on the role of animals and their jumping the cross-species barriers, experiences learned from SARS- and MERS-CoVs, zoonotic links, and spillover events, transmission to humans and rapid spread., highlighting in very brief the preventive and control measures along with a few of the recent research developments to counter this pandemic virus/disease.

Emerging Coronavirus Disease (COVID-19), a Pandemic Public Health Emergency with Animal Linkages: Current Status Update (preprint)

After the appearance of first cases of ‘pneumonia of unknown origin’ in the Wuhan city, China, during late 2019, the disease progressed fast. Its cause was identified as a novel coronavirus, named provisionally 2019-nCoV. Subsequently, an official name was given as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) by the International Committee on Taxonomy of Viruses (ICTV) study group. The World Health Organization (WHO) named the Coronavirus disease-2019 as COVID-19. The epidemics of COVID-2019 have been recorded over 113 countries/territories/areas apart from China and filched more than 4292 humans, affecting severely around 1,18,326 cases in a short span. The status of COVID-2019 emergency revised by the WHO within 42 days from Public Health International Emergency (January 30, 2020) to a pandemic (March 11, 2020). Nonetheless, the case fatality rate (CFR) of the current epidemic is on the rise (between 2-4%), relatively is lower than the previous SARS-CoV (2002/2003) and MERS-CoV (2012) outbreaks. Even though investigations are on its way, the researchers across the globe have assumptions of animal-origin of current SARS-CoV-2. A recent case report provides evidence of mild COVID-2019 infection in a pet dog that acquired COVID-2019 infection from his owner in Hong Kong. The news on travellers associated spread across the globe have also put many countries on alert with the cancellation of tourist visa to all affected countries and postponement of events where international visits were required. A few diagnostic approaches, including quantitative and differential real-time polymerase chain reaction assays, have been recommended for the screening of the individuals at risk. In the absence of any selective vaccine against SARS-CoV-2, re-purposed drugs are advocated in many studies. This article discourse the current worldwide situation of COVID-2019 with information on virus, epidemiology, host, the role of animals, effective diagnosis, therapeutics, preventive and control approaches making people aware on the disease outcomes.

An Update on SARS-COV-2/COVID-19 with Particular Reference on Its Clinical Pathology, Pathogenesis, Immunopathology and Mitigation Strategies – A Review (preprint)

Coronavirus Disease 2019 (COVID-19), caused by a novel coronavirus named Severe Acute Respiratory Syndrome - Coronavirus-2 (SARS-CoV-2), emerged in early December 2019 in China and attained a pandemic situation worldwide by its rapid spread to nearly 167 countries with 287.239 confirmed cases and 11.921 human deaths with a case fatality rate (CFR) of around 4 per cent. Bats were considered as the reservoir host, and the search of a probable intermediate host is still going on. Animals have anticipated culprit of SARS-CoV-2 as of now. The disease is mainly manifested by pneumonia and related respiratory signs and symptoms, but the involvement of the gastrointestinal system and nervous system is also suggested. The severe form of the disease associated with death is mainly reported in older and immune-compromised patients with pre-existing disease history. Death in severe cases is attributed to respiratory failure associated with hyperinflammation. Cytokine storm syndrome associated with rampant inflammation in response to SARS-CoV-2 infection is considered as the leading killer of COVID-19 patients. COVID-19 patients were reported with higher levels of many pro-inflammatory cytokines and chemokines like IFN-g, IL-1b, IP-10, and MCP-1. Furthermore, severe cases of COVID-19 revealed higher levels of TNF-α, G-CSF, and MIP-1A. Blood profile of the COVID-19 patients exhibits lymphopenia, leucopenia, thrombocytopenia and RNAaemia along with increased levels of aspartate aminotransferase. SARS-CoV-2 infection in pregnant women does not lead to fetus mortalities unlike other zoonotic coronaviruses like SARS-CoV and MERS-CoV, with no evidence of intrauterine transmission to neonates. Rapid and confirmatory diagnostics have been developed, and high efforts are being made to develop effective vaccines and therapeutics. In the absence of any virus-specific therapeutic, internationally health care authorities are recommending adoption of effective prevention and control measures to counter and contain this pandemic virus. This paper is an overview of this virus and the disease with a particular focus on SARS-COV-2 / COVID-19 clinical pathology, pathogenesis and immunopathology along with a few recent research developments.

Clinical, Laboratory and Imaging Features of COVID-19: A Systematic Review and Meta-analysis (preprint)

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing a Public Health Emergency of International Concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. Methods: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID-19 confirmed cases. Observational studies, and also case reports, were included and analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). Results: 660 articles were retrieved (1/1/2020-2/23/2020). After screening by abstract/title, 27 articles were selected for full-text assessment. Of them, 19 were finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), with 32.8% presenting acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) of hospitalized patients with fatal outcomes (case fatality rate, CFR).Conclusion: COVID-19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID-19 infected patients and this group was associated with a CFR of over 13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure, and facilities to treat severe COVID-19.