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2.
Popul Health Manag ; 2021 Dec 17.
Article in English | MEDLINE | ID: covidwho-1577496

ABSTRACT

A healthy diet is an important protective factor to prevent cardiometabolic disease. Traditional face-to-face dietary interventions are often episodic, expensive, and may have limited effectiveness, particularly among older adults and people living in rural areas. Telehealth-delivered dietary interventions have proven to be a low-cost and effective alternative approach to improve dietary behaviors among adults with chronic health conditions. In this study, we developed a validated agent-based model of cardiometabolic health conditions to project the impact of expanding telehealth-delivered dietary interventions among older adults in the state of Georgia, a state with a large rural population. We projected the incidence of major cardiometabolic health conditions (type 2 diabetes, hypertension, and high cholesterol) with the implementation of telehealth-delivered dietary interventions versus no intervention among all older adults and 3 subpopulations (older adults with diabetes, hypertension, and high cholesterol, separately). The results showed that expanding telehealth-delivered dietary interventions could avert 22,774 (95% confidence interval [CI]: 22,091-23,457) cases of type 2 diabetes, 19,732 (19,145-20,329) cases of hypertension, and 18,219 (17,672-18,766) cases of high cholesterol for 5 years among older adults in Georgia. The intervention would have a similar effect in preventing cardiometabolic health conditions among the 3 selected subpopulations. Therefore, expanding telehealth-delivered dietary interventions could substantially reduce the burden of cardiometabolic health conditions in the long term among older adults and those with chronic health conditions.

4.
J Occup Environ Med ; 63(11): 931-937, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1504374

ABSTRACT

OBJECTIVE: We examined associations of negative employment changes during the COVID-19 pandemic with mental health in a national sample of U.S. workers, and whether the associations differed by race. METHODS: Data were from the Health, Ethnicity, and Pandemic Study, a cross-sectional survey. The effects of negative employment changes on psychological distress in 1510 workers were examined via linear regression, and stratified analyses were conducted across racial subgroups. RESULTS: After adjustment for covariates, compared to workers with no change in employment, those who experienced permanent job loss had the highest psychological distress (ß and 95% CI = 3.27 [1.89, 4.65]). Permanent job loss had the greatest effect on psychological distress in Blacks and Asians. CONCLUSION: Negative employment changes related to the pandemic may have deleterious impacts on workers' mental health, with disproportionate effects on racial minorities.


Subject(s)
COVID-19 , Psychological Distress , Cross-Sectional Studies , Employment , Humans , Pandemics , SARS-CoV-2
5.
Medicine (Baltimore) ; 100(41): e27516, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1501204

ABSTRACT

BACKGROUND: Hainan province is a very popular leisure tourist arriving city in China. Coronavirus disease 2019 (COVID-19) emerged in China and rapidly in early 2020, and due to its rapid worldwide spread, the World Health Organization declared COVID-19 as a global emergency. During the COVID-19 pandemic in Hainan province, many businesses and economies were influenced in this unexpected event, especially in tourism. METHODS: This study used 2 classical forecasting methods to predict the number of tourists on Hainan Leisure Island from September to December in the second half of 2020 and to summarize the COVID-19 fighting experience during the pandemic. In addition, the Hainan government implemented epidemic control measures to resume production and work, and promote new tourism measures to acquire superior COVID-19 protection. RESULTS: Winter's method provides a statistical model for predicting the number of visitors to Hainan under normal conditions. The trend analysis method considers the impact of the black swan event, an irregular event, and only uses the data under the influence of the event to predict according to the trend. CONCLUSION: If the impact of the black swan event (COVID-19) continues, the prediction can be made using this method. In addition, the Hainan government has undertaken timely and effective measures against COVID-19 to promote leisure tourism development.


Subject(s)
COVID-19/epidemiology , Tourism , COVID-19/prevention & control , China/epidemiology , Forecasting , Humans , Models, Statistical , Pandemics/prevention & control , SARS-CoV-2
6.
Technol Forecast Soc Change ; : 121316, 2021 Oct 29.
Article in English | MEDLINE | ID: covidwho-1487299
7.
J Telemed Telecare ; : 1357633X211051677, 2021 Oct 11.
Article in English | MEDLINE | ID: covidwho-1463096

ABSTRACT

Telehealth is an important source of health care during the COVID-19 pandemic. Evidence is scarce regarding disparities in telehealth utilization in the United States. We aimed to investigate the prevalence and factors associated with telehealth utilization among US adults. Our data came from the Health, Ethnicity, and Pandemic Study, a nationally representative survey conducted in October 2020, with 2554 adults ≥ 18 and an oversample of racial/ethnic minorities. Telehealth utilization was measured as self-reported teleconsultation with providers via email, text message, phone, video, and remote patient monitoring during the pandemic. Logistic regressions were performed to examine the association between telehealth use and factors at the individual, household, and community levels. Overall, 43% of the sample reported having used telehealth, representing 114.5 million adults in the nation. East and Southeast Asians used telehealth less than non-Hispanic Whites (OR = 0.5, 95% CI: 0.3-0.8). Being uninsured (compared with private insurance: OR = 0.4, 95% CI: 0.2-0.8), and those with limited broadband coverage in the community (OR = 0.5, 95% CI: 0.3-0.8) were less likely to use telehealth. There is a need to develop and implement more equitable policies and interventions at both the individual and community levels to improve access to telehealth services and reduce related disparities.

8.
Nutrients ; 13(10)2021 Sep 25.
Article in English | MEDLINE | ID: covidwho-1438685

ABSTRACT

OBJECTIVE: To investigate the impact of the COVID-19 pandemic on multiple lifestyle changes among adults in the United States (USA). METHODS: We conducted a survey, the Health, Ethnicity, and Pandemic (HEAP) Study, in October 2020 among USA adults. Participants were selected from the United States using 48 sampling strata, including age, race, ethnicity, education, and gender, and were asked to report five lifestyle behaviors (i.e., exercise time, screen time, fast-food meal consumption, alcohol drinking, and cigarette smoking) before and during the COVID-19 pandemic. The associations of sociodemographic factors with each lifestyle change were estimated using weighted multivariable logistic regression models. RESULTS: All 2709 HEAP participants were included in this study. Compared to pre-pandemic, the time spent on exercise decreased (32.06 vs. 38.65 min/day; p < 0.001) and screen time increased (6.79 vs. 5.06 h/day; p < 0.001) during the pandemic. The percentage of individuals who reported consuming fast-food meals ≥3 times/week decreased from 37.7% before the pandemic to 33.3% during the pandemic. The percentage of heavy drinkers (≥5 times/week) increased from 20.9% before the pandemic to 25.7% during the pandemic. Among smokers, heavy smoking (≥11 cigarettes/day) increased from 5.8% before the pandemic to 7.9% during the pandemic. We also identified subgroups who were more vulnerable to adverse influences from the pandemic, including racial/ethnic minority groups and young adults. CONCLUSIONS: The COVID-19 pandemic had negative impacts on multiple lifestyle behaviors among Americans. Mitigating such negative impacts of COVID-19 requires effective interventions, particularly for some vulnerable subgroups.


Subject(s)
Alcohol Drinking/epidemiology , COVID-19/psychology , Cigarette Smoking/epidemiology , Exercise/psychology , Fast Foods/statistics & numerical data , Screen Time , Adolescent , Adult , Age Factors , Alcohol Drinking/psychology , Cigarette Smoking/psychology , Cross-Sectional Studies , /statistics & numerical data , Female , Health Behavior , Humans , Male , Middle Aged , Pandemics , /statistics & numerical data , SARS-CoV-2 , Socioeconomic Factors , United States/epidemiology , Young Adult
9.
Water Res ; 204: 117606, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1373297

ABSTRACT

The epidemic of COVID-19 has aroused people's particular attention to biosafety. A growing number of disinfection products have been consumed during this period. However, the flaw of disinfection has not received enough attention, especially in water treatment processes. While cutting down the quantity of microorganisms, disinfection processes exert a considerable selection effect on bacteria and thus reshape the microbial community structure to a great extent, causing the problem of disinfection-residual-bacteria (DRB). These systematic and profound changes could lead to the shift in regrowth potential, bio fouling potential, as well as antibiotic resistance level and might cause a series of potential risks. In this review, we collected and summarized the data from the literature in recent 10 years about the microbial community structure shifting of natural water or wastewater in full-scale treatment plants caused by disinfection. Based on these data, typical DRB with the most reporting frequency after disinfection by chlorine-containing disinfectants, ozone disinfection, and ultraviolet disinfection were identified and summarized, which were the bacteria with a relative abundance of over 5% in the residual bacteria community and the bacteria with an increasing rate of relative abundance over 100% after disinfection. Furthermore, the phylogenic relationship and potential risks of these typical DRB were also analyzed. Twelve out of fifteen typical DRB genera contain pathogenic strains, and many were reported of great secretion ability. Pseudomonas and Acinetobacter possess multiple disinfection resistance and could be considered as model bacteria in future studies of disinfection. We also discussed the growth, secretion, and antibiotic resistance characteristics of DRB, as well as possible control strategies. The DRB phenomenon is not limited to water treatment but also exists in the air and solid disinfection processes, which need more attention and more profound research, especially in the period of COVID-19.


Subject(s)
COVID-19 , Microbiota , Bacteria , Disinfection , Humans , SARS-CoV-2
10.
Front Public Health ; 9: 613980, 2021.
Article in English | MEDLINE | ID: covidwho-1367761

ABSTRACT

As global public health is under threat by the 2019-nCoV and a potential new wave of large-scale epidemic outbreak and spread is looming, an imminent question to ask is what the optimal strategy of epidemic prevention and control (P&C) measures would be, especially in terms of the timing of enforcing aggressive policy response so as to maximize health efficacy and to contain pandemic spread. Based on the current global pandemic statistic data, here we developed a logistic probability function configured SEIR model to analyse the COVID-19 outbreak and estimate its transmission pattern under different "anticipate- or delay-to-activate" policy response scenarios in containing the pandemic. We found that the potential positive effects of stringent pandemic P&C measures would be almost canceled out in case of significantly delayed action, whereas a partially procrastinatory wait-and-see control policy may still be able to contribute to containing the degree of epidemic spread although its effectiveness may be significantly compromised compared to a scenario of early intervention coupled with stringent P&C measures. A laissez-faire policy adopted by the government and health authority to tackling the uncertainly of COVID19-type pandemic development during the early stage of the outbreak turns out to be a high risk strategy from optimal control perspective, as significant damages would be produced as a consequence.


Subject(s)
COVID-19 , Pandemics , Disease Outbreaks/prevention & control , Humans , Pandemics/prevention & control , Retrospective Studies , SARS-CoV-2
11.
Int J Infect Dis ; 111: 154-163, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1364097

ABSTRACT

PURPOSE: To detect the risk factors for pulmonary embolism (PE) in patients with COVID-19. METHODS: Studies were searched for in PubMed, Cochrane Library, Web of Science, and EMBASE. Two authors independently screened articles and extracted data. The data were pooled by meta-analysis and three subgroup analyses were performed. RESULTS: Of the 2210 articles identified, 27 studies were included. Pooled analysis suggested that males (odds ratio (OR) 1.49, 95% confidence interval (CI) 1.26-1.75, P = 0.000), obesity (OR 1.37, 95% CI 1.03-1.82, P = 0.033), mechanical ventilation (OR 3.34, 95% CI 1.90-5.86, P = 0.000), severe parenchymal abnormalities (OR 1.92, 95% CI 1.43-2.58, P = 0.000), ICU admission (OR 2.44, 95% CI 1.48-4.03, P = 0.000), and elevated D-dimer and white blood cell values (at two time points: hospital admission or closest to computed tomography pulmonary angiography) (P = 0.000) correlated with a risk for PE occurrence in COVID-19 patients. However, age and common comorbidities had no association with PE occurrence. Computed tomography pulmonary angiography, unclear-ratio/low-ratio, and hospitalization subgroups had consistent risk factors with all studies; however, other subgroups had fewer risk factors for PE. CONCLUSIONS: Risk factors for PE in COVID-19 were different from the classic risk factors for PE and are likely to differ in diverse study populations.


Subject(s)
COVID-19 , Pulmonary Embolism , Computed Tomography Angiography , Humans , Male , Pulmonary Embolism/epidemiology , Pulmonary Embolism/etiology , Risk Factors , SARS-CoV-2
12.
Front Public Health ; 9: 705777, 2021.
Article in English | MEDLINE | ID: covidwho-1325590

ABSTRACT

Social distancing due to the COVID-19 pandemic has driven some consumers to online shopping, and concerns about pandemic risks and personal hygiene have increased the demand for e-commerce. Providing personalized recommendations seems quite profitable for e-commerce platforms, and consumers also benefit from personalized content with the advancement of AI technologies. However, this possible win-win situation is marred by the increase in consumers' privacy concerns. Technical solutions have been widely studied to protect consumer privacy, while few analyses have been conducted from the perspective of psychological and behavioral implications. In this paper, an evolutionary game model of privacy protection between e-commerce platforms and consumers is established to determine the mechanisms by which various factors exert influence, and evolutionary stable strategies are obtained from equilibrium points. Then, the strategy selections are simulated with MATLAB 2020 software. Based on the results, the following conclusions are drawn: (1) the application of AI technologies in e-commerce will fundamentally benefit consumers, which makes them actively share personal information with e-commerce platforms with incentives for generous rewards; (2) it is profitable for e-commerce platforms to conduct data mining by improving the ability to use AI technologies and making efforts to reduce technical costs; and (3) regulators should improve the level of supervision instead of imposing a large penalty to enhance consumer trust, which could effectively increase the profits of e-commerce platforms and protect consumers' privacy.


Subject(s)
COVID-19 , Privacy , Artificial Intelligence , Consumer Behavior , Humans , Pandemics , SARS-CoV-2
13.
J Occup Environ Med ; 63(11): 931-937, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1315712

ABSTRACT

OBJECTIVE: We examined associations of negative employment changes during the COVID-19 pandemic with mental health in a national sample of U.S. workers, and whether the associations differed by race. METHODS: Data were from the Health, Ethnicity, and Pandemic Study, a cross-sectional survey. The effects of negative employment changes on psychological distress in 1510 workers were examined via linear regression, and stratified analyses were conducted across racial subgroups. RESULTS: After adjustment for covariates, compared to workers with no change in employment, those who experienced permanent job loss had the highest psychological distress (ß and 95% CI = 3.27 [1.89, 4.65]). Permanent job loss had the greatest effect on psychological distress in Blacks and Asians. CONCLUSION: Negative employment changes related to the pandemic may have deleterious impacts on workers' mental health, with disproportionate effects on racial minorities.


Subject(s)
COVID-19 , Psychological Distress , Cross-Sectional Studies , Employment , Humans , Pandemics , SARS-CoV-2
14.
Lancet ; 397(10291): 2304-2308, 2021 06 12.
Article in English | MEDLINE | ID: covidwho-1265895

ABSTRACT

Strong US-China collaboration on health and medicine is a crucial element of the global effort against COVID-19. We review the history of health collaboration and exchanges between the public and private sectors in the USA and China, including the long-lasting collaboration between governmental public health agencies of the two countries. Academic and scientific exchanges should be reinvigorated and the increasing valuable role of non-profit foundations acknowledged. The shared interests of the two countries and the magnitude of the pandemic necessitate both countries to collaborate and cooperate. We provide recommendations to the two governments and the global health community to control the ongoing COVID-19 pandemic and prepare for future threats. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.


Subject(s)
Health , International Cooperation/history , Medicine , China , Global Health , Government Agencies , History, 20th Century , History, 21st Century , Humans , Private Sector , Public Health , Public Sector , Science , United States , Universities
16.
Environ Pollut ; 285: 117257, 2021 Sep 15.
Article in English | MEDLINE | ID: covidwho-1217544

ABSTRACT

Reusing treated wastewater can effectively alleviate water shortages and water contamination problems but depends on ensuring the safety of the reclaimed water that is produced. The operating and management conditions for water reclamation plants in China have been changed since the outbreak of the COVID-19 epidemic in China at the end of 2019 to prevent emerging viruses being spread through wastewater treatment processes and the reclaimed water that is produced. Removal of pathogens and trace organic compounds (e.g., pharmaceuticals and personal care products and endocrine disrupting chemicals) in a real water reclamation plant after the start of COVID-19 epidemic was studied. Disinfection byproduct formation caused by chlorine being added to meet disinfection requirements was also assessed. The pathogenic microorganism concentrations in effluent were <2 (most probable number)/L, and the removal rates for most trace organic compounds were >80% when advanced treatments were performed using ozone, ultraviolet light, and chlorine doses of 2 mg/L, 20.5 mJ/cm2, and 2-3 mg/L, respectively. The main disinfection byproduct produced at a chlorine dose of 2 mg/L and a residence time of 1 h was chloroform (at concentrations <15 µg/L). The results indicated that the water reclamation processes with modified conditions gave high pathogen and trace organic compound removal rates and reasonably well-controlled disinfection byproduct concentrations.


Subject(s)
COVID-19 , Water Pollutants, Chemical , Water Purification , Chlorine , Disinfection , Humans , SARS-CoV-2 , Waste Water , Water , Water Pollutants, Chemical/analysis
17.
Int Health ; 2021 May 04.
Article in English | MEDLINE | ID: covidwho-1214596

ABSTRACT

BACKGROUND: We aimed to investigate the association between institution trust and public responses to the coronavirus disease 2019 (COVID-19) outbreak. METHODS: An Internet-based, cross-sectional survey was administered on 29 January 2020. A total of 4393 adults ≥18 y of age and residing or working in the province of Hubei, central China were included in the study. RESULTS: The majority of the participants expressed a great degree of trust in the information and preventive instructions provided by the central government compared with the local government. Being under quarantine (adjusted odds ratio [OR] 2.35 [95% confidence interval {CI} 1.80 to 3.08]) and having a high institutional trust score (OR 2.23 [95% CI 1.96 to 2.53]) were both strong and significant determinants of higher preventive practices scores. The majority of study participants (n=3640 [85.7%]) reported that they would seek hospital treatment if they suspected themselves to have been infected with COVID-19. Few of the participants from Wuhan (n=475 [16.6%]) and those participants who were under quarantine (n=550 [13.8%]) expressed an unwillingness to seek hospital treatment. CONCLUSIONS: Institutional trust is an important factor influencing adequate preventive behaviour and seeking formal medical care during an outbreak.

18.
Int J Equity Health ; 20(1): 106, 2021 04 26.
Article in English | MEDLINE | ID: covidwho-1204078

ABSTRACT

BACKGROUND: Partial- or full-lockdowns, among other interventions during the COVID-19 pandemic, may disproportionally affect people (their behaviors and health outcomes) with lower socioeconomic status (SES). This study examines income-related health inequalities and their main contributors in China during the pandemic. METHODS: The 2020 China COVID-19 Survey is an anonymous 74-item survey administered via social media in China. A national sample of 10,545 adults in all 31 provinces, municipalities, and autonomous regions in mainland China provided comprehensive data on sociodemographic characteristics, awareness and attitudes towards COVID-19, lifestyle factors, and health outcomes during the lockdown. Of them, 8448 subjects provided data for this analysis. Concentration Index (CI) and Corrected CI (CCI) were used to measure income-related inequalities in mental health and self-reported health (SRH), respectively. Wagstaff-type decomposition analysis was used to identify contributors to health inequalities. RESULTS: Most participants reported their health status as "very good" (39.0%) or "excellent" (42.3%). CCI of SRH and mental health were - 0.09 (p < 0.01) and 0.04 (p < 0.01), respectively, indicating pro-poor inequality in ill SRH and pro-rich inequality in ill mental health. Income was the leading contributor to inequalities in SRH and mental health, accounting for 62.7% (p < 0.01) and 39.0% (p < 0.05) of income-related inequalities, respectively. The COVID-19 related variables, including self-reported family-member COVID-19 infection, job loss, experiences of food and medication shortage, engagement in physical activity, and five different-level pandemic regions of residence, explained substantial inequalities in ill SRH and ill mental health, accounting for 29.7% (p < 0.01) and 20.6% (p < 0.01), respectively. Self-reported family member COVID-19 infection, experiencing food and medication shortage, and engagement in physical activity explain 9.4% (p < 0.01), 2.6% (the summed contributions of experiencing food shortage (0.9%) and medication shortage (1.7%), p < 0.01), and 17.6% (p < 0.01) inequality in SRH, respectively (8.9% (p < 0.01), 24.1% (p < 0.01), and 15.1% (p < 0.01) for mental health). CONCLUSIONS: Per capita household income last year, experiences of food and medication shortage, self-reported family member COVID-19 infection, and physical activity are important contributors to health inequalities, especially mental health in China during the COVID-19 pandemic. Intervention programs should be implemented to support vulnerable groups.


Subject(s)
COVID-19 , Health Status Disparities , Income/statistics & numerical data , Adult , China/epidemiology , Female , Humans , Male , Socioeconomic Factors , Surveys and Questionnaires
19.
Vaccine ; 39(20): 2746-2754, 2021 05 12.
Article in English | MEDLINE | ID: covidwho-1174522

ABSTRACT

BACKGROUND: This study examined the safety and immunogenicity of an inactivated SARS-CoV-2 vaccine. METHOD: In a phase I randomized, double-blinded, placebo-controlled trial involving 192 healthy adults 18-59 years old, two injections of three doses (50 EU, 100 EU, 150 EU) of an inactivated SARS-CoV-2 vaccine or placebo were administered intramuscularly at a 2- or 4-week interval. The safety and immunogenicity of the vaccine were evaluated. RESULTS: Vaccination was completed in 191 subjects. Forty-four adverse reactions occurred within 28 days, most commonly mild pain and redness at the injection site or slight fatigue. At days 14 and 28, the seroconversion rates were 87.5% and 79.2% (50 EU), 100% and 95.8% (100 EU), and 95.8% and 87.5% (150 EU), respectively, with geometric mean titers (GMTs) of 18.1 and 10.6, 54.5 and 15.4, and 37.1 and 18.5, respectively, for the schedules with 2-week and 4-week intervals. Seroconversion was associated with synchronous upregulation of antibodies against the S protein, N protein and virion and a cytotoxic T lymphocyte (CTL) response. No cytokines and immune cells related to immunopathology were observed. Transcriptome analysis revealed the genetic diversity of immune responses induced by the vaccine. INTERPRETATION: In a population aged 18-59 years in this trial, this inactivated SARS-CoV-2 vaccine was safe and immunogenic. TRIAL REGISTRATION: CTR20200943 and NCT04412538.


Subject(s)
COVID-19 Vaccines , COVID-19 , Vaccines , Adolescent , Adult , Antibodies, Viral , China , Double-Blind Method , Humans , Immunogenicity, Vaccine , Middle Aged , SARS-CoV-2 , Young Adult
20.
Infect Drug Resist ; 14: 671-687, 2021.
Article in English | MEDLINE | ID: covidwho-1171729

ABSTRACT

Purpose: Nowadays, the number of patients with COVID-19 pneumonia worldwide is still increasing. The clinical diagnosis of COVID-19 pneumonia faces challenges, such as the difficulty to perform RT-PCR tests in real time, the lack of experienced radiologists, clinical low-quality images, and the similarity of imaging features of community-acquired pneumonia and COVID-19. Therefore, we proposed an artificial intelligence model GARCD that uses chest CT images to assist in the diagnosis of COVID-19 in real time. It can show better diagnostic performance even facing low-quality CT images. Methods: We used 14,129 CT images from 104 patients. A total of 12,929 samples were used to build artificial intelligence models, and 1200 samples were used to test its performance. The image quality improvement module is based on the generative adversarial structure. It improves the quality of the input image under the joint drive of feature loss and content loss. The enhanced image is sent to the disease diagnosis model based on residual convolutional network. It automatically extracts the semantic features of the image and then infers the probability that the sample belongs to COVID-19. The ROC curve is used to evaluate the performance of the model. Results: This model can effectively enhance the low-quality image and make the image that is difficult to be recognized become recognizable. The model proposed in this paper reached 97.8% AUC, 96.97% sensitivity and 91.16% specificity in an independent test set. ResNet, GADCD, CNN, and DenseNet achieved 80.9%, 97.3%, 70.7% and 85.7% AUC in the same test set, respectively. By comparing the performance with related works, it is proved that the model proposed has stronger clinical usability. Conclusion: The method proposed can effectively assist doctors in real-time detection of suspected cases of COVID-19 pneumonia even faces unclear image. It can quickly isolate patients in a targeted manner, which is of positive significance for preventing the further spread of COVID-19 pneumonia.

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