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1.
One Health Bulletin ; 1(1):17-23, 2021.
Article in English | ProQuest Central | ID: covidwho-2144087

ABSTRACT

To prevent and control COVID-19, COVID-19 vaccines are being developed, tested, and approved at an unprecedented rate. As of September 24, 2021, 22 types of COVID-19 vaccines have been approved for conditional marketing or emergency use by at least one country worldwide. Vaccine efficacy/effectiveness is a crucial concern for vaccination. This article provides an overview of efficacy of phase III clinical trials, vaccination, effectiveness of real-world studies as well as challenges of COVID-19 vaccine.

2.
BMC Microbiol ; 22(1): 274, 2022 Nov 14.
Article in English | MEDLINE | ID: covidwho-2115637

ABSTRACT

BACKGROUND: Dozens of studies have demonstrated gut dysbiosis in COVID-19 patients during the acute and recovery phases. However, a consensus on the specific COVID-19 associated bacteria is missing. In this study, we performed a meta-analysis to explore whether robust and reproducible alterations in the gut microbiota of COVID-19 patients exist across different populations. METHODS: A systematic review was conducted for studies published prior to May 2022 in electronic databases. After review, we included 16 studies that comparing the gut microbiota in COVID-19 patients to those of controls. The 16S rRNA sequence data of these studies were then re-analyzed using a standardized workflow and synthesized by meta-analysis. RESULTS: We found that gut bacterial diversity of COVID-19 patients in both the acute and recovery phases was consistently lower than non-COVID-19 individuals. Microbial differential abundance analysis showed depletion of anti-inflammatory butyrate-producing bacteria and enrichment of taxa with pro-inflammatory properties in COVID-19 patients during the acute phase compared to non-COVID-19 individuals. Analysis of microbial communities showed that the gut microbiota of COVID-19 recovered patients were still in unhealthy ecostates. CONCLUSIONS: Our results provided a comprehensive synthesis to better understand gut microbial perturbations associated with COVID-19 and identified underlying biomarkers for microbiome-based diagnostics and therapeutics.


Subject(s)
COVID-19 , Gastrointestinal Microbiome , Humans , RNA, Ribosomal, 16S/genetics , Gastrointestinal Microbiome/genetics , Dysbiosis/microbiology , Bacteria/genetics , Feces/microbiology
3.
Journal of Tropical Medicine ; 20(8):1093-1097, 2020.
Article in Chinese | CAB Abstracts | ID: covidwho-2034142

ABSTRACT

Objective: The characteristics of imported coronavirus disease 2019(COVID-19) cases from outside China were analyzed to provide evidence for prevention and control backflow of the epidemic.

4.
Front Cell Infect Microbiol ; 12: 892508, 2022.
Article in English | MEDLINE | ID: covidwho-1952261

ABSTRACT

Non-pharmacological interventions (NPIs) implemented during the coronavirus disease 2019 (COVID-19) pandemic have demonstrated significant positive effects on other communicable diseases. Nevertheless, the response for dengue fever has been mixed. To illustrate the real implications of NPIs on dengue transmission and to determine the effective measures for preventing and controlling dengue, we performed a systematic review and meta-analysis of the available global data to summarize the effects comprehensively. We searched Embase, PubMed, and Web of Science in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines from December 31, 2019, to March 30, 2022, for studies of NPI efficacy on dengue infection. We obtained the annual reported dengue cases from highly dengue-endemic countries in 2015-2021 from the European Centre for Disease Prevention and Control to determine the actual change in dengue cases in 2020 and 2021, respectively. A random-effects estimate of the pooled odds was generated with the Mantel-Haenszel method. Between-study heterogeneity was assessed using the inconsistency index (I2 ) and subgroup analysis according to country (dengue-endemic or non-endemic) was conducted. This review was registered with PROSPERO (CRD42021291487). A total of 17 articles covering 32 countries or regions were included in the review. Meta-analysis estimated a pooled relative risk of 0.39 (95% CI: 0.28-0.55), and subgroup revealed 0.06 (95% CI: 0.02-0.25) and 0.55 (95% CI: 0.44-0.68) in dengue non-endemic areas and dengue-endemic countries, respectively, in 2020. The majority of highly dengue-endemic countries in Asia and Americas reported 0-100% reductions in dengue cases in 2020 compared to previous years, while some countries (4/20) reported a dramatic increase, resulting in an overall increase of 11%. In contrast, there was an obvious reduction in dengue cases in 2021 in almost all countries (18/20) studied, with an overall 40% reduction rate. The overall effectiveness of NPIs on dengue varied with region and time due to multiple factors, but most countries reported significant reductions. Travel-related interventions demonstrated great effectiveness for reducing imported cases of dengue fever. Internal movement restrictions of constantly varying intensity and range are more likely to mitigate the entire level of dengue transmission by reducing the spread of dengue fever between regions within a country, which is useful for developing a more comprehensive and sustainable strategy for preventing and controlling dengue fever in the future.


Subject(s)
COVID-19 , Dengue , COVID-19/epidemiology , COVID-19/therapy , Dengue/epidemiology , Dengue/prevention & control , Humans , Pandemics/prevention & control , Travel , Travel-Related Illness
6.
Front Immunol ; 12: 772511, 2021.
Article in English | MEDLINE | ID: covidwho-1556241

ABSTRACT

Recent exposure to seasonal coronaviruses (sCoVs) may stimulate cross-reactive antibody responses against severe acute respiratory syndrome CoV 2 (SARS-CoV-2). However, previous studies have produced divergent results regarding protective or damaging immunity induced by prior sCoV exposure. It remains unknown whether pre-existing humoral immunity plays a role in vaccine-induced neutralization and antibody responses. In this study, we collected 36 paired sera samples from 36 healthy volunteers before and after immunization with inactivated whole-virion SARS-CoV-2 vaccines for COVID-19, and analyzed the distribution and intensity of pre-existing antibody responses at the epitope level pre-vaccination as well as the relationship between pre-existing sCoV immunity and vaccine-induced neutralization. We observed large amounts of pre-existing cross-reactive antibodies in the conserved regions among sCoVs, especially the S2 subunit. Excep t for a few peptides, the IgG and IgM fluorescence intensities against S, M and N peptides did not differ significantly between pre-vaccination and post-vaccination sera of vaccinees who developed a neutralization inhibition rate (%inhibition) <40 and %inhibition ≥40 after two doses of the COVID-19 vaccine. Participants with strong and weak pre-existing cross-reactive antibodies (strong pre-CRA; weak pre-CRA) had similar %inhibition pre-vaccination (10.9% ± 2.9% vs. 12.0% ± 2.2%, P=0.990) and post-vaccination (43.8% ± 25.1% vs. 44.6% ± 21.5%, P=0.997). Overall, the strong pre-CRA group did not show a significantly greater increase in antibody responses to the S protein linear peptides post-vaccination compared with the weak pre-CRA group. Therefore, we found no evidence for a significant impact of pre-existing antibody responses on inactivated vaccine-induced neutralization and antibody responses. Our research provides an important basis for inactivated SARS-CoV-2 vaccine use in the context of high sCoV seroprevalence.


Subject(s)
Antibodies, Viral/immunology , COVID-19 Vaccines/immunology , COVID-19/immunology , Cross Reactions/immunology , SARS-CoV-2/immunology , Adult , COVID-19/prevention & control , Coronavirus/immunology , Coronavirus Infections/immunology , Female , Humans , Immunoglobulin G/immunology , Immunoglobulin M/immunology , Male , Middle Aged , Neutralization Tests , Seasons , Vaccines, Inactivated/immunology
7.
J Biosaf Biosecur ; 4(1): 5-11, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1487854

ABSTRACT

Coronavirus disease 2019 (COVID-19) is as an emerging infectious disease (EID) that has caused the worst public health catastrophe of the 21st century thus far. In terms of impact, the COVID-19 pandemic is second only to the Spanish Flu pandemic of 1918 in modern world history. As of 7 September 2021, there have been 220 million confirmed cases of COVID-19 and more than 4.5 million deaths. EIDs pose serious public health and socio-economic risks, and 70% of EIDs originate from wildlife. Preventing development of EIDs such as COVID-19 is a pressing concern. Here, taking the COVID-19 pandemic as an example, we illustrate the disastrous effects of EIDs and assess their emergence and evolution from a One Health perspective. We propose a One Health strategy, centered on 'moving the gates forward', for EID prevention and control at the human-animal-environment interface. This strategy may be instructive and provide early warnings of EIDs in the future.

8.
Mediators Inflamm ; 2021: 9924542, 2021.
Article in English | MEDLINE | ID: covidwho-1450632

ABSTRACT

Compared with other deadly diseases, the coronavirus disease 2019 (COVID-19) is highly infectious with a relatively low mortality rate. Although critical cases account for only 5% of cases, the mortality rate for the same is nearly 50%. Therefore, the key to the COVID-19 treatment is to effectively treat severe patients and reduce the transition from severe to critical cases. A retrospective study was carried out to evaluate outcomes of treatment in patients with severe and critical COVID-19 admitted to a COVID-19 special hospital in Wuhan, China. A total of 75 severe and critical COVID-19 patients were admitted and treated with immunomodulation as the main strategy combined with anti-inflammatory therapy and appropriate anticoagulation. Leukocyte levels in patients with 7-14 days of onset to diagnosis were significantly lower than in those with >14 days. Higher levels of globulin and D-dimer and lower lymphocyte levels were found in the older age group (>65 years) than in the middle-aged group (50-64 years). Patients with comorbidity had higher levels of inflammatory indicators. After treatment, 65 (86.67%) patients were cured, 7 (9.33%) had improved, and 3 (4.00%) had died. Median hospitalization duration was 23 days. Fatal cases showed continuously increased levels of globulin, dehydrogenase (LDH), hypersensitive C-reactive protein (hs-CRP), D-dimer, and cytokines during treatment. Time from onset to diagnosis, age, and comorbidity are important influencing factors on treatment effects. The occurrence of immunosuppression, "cytokine storm," and thrombosis may be an important cause of death in severely infected cases. In conclusion, high cure rate and low mortality suggested that immunomodulation combined with anti-inflammatory therapy and appropriate anticoagulant therapy is a good strategy for treatment of patients with severe and critical COVID-19.


Subject(s)
COVID-19/drug therapy , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , Anti-Inflammatory Agents/therapeutic use , COVID-19/blood , COVID-19/diagnostic imaging , COVID-19/immunology , Female , Humans , Immunomodulation , Male , Middle Aged , Retrospective Studies , Severity of Illness Index
9.
Epidemiol Infect ; 149: e212, 2021 09 17.
Article in English | MEDLINE | ID: covidwho-1447272

ABSTRACT

Hebei Province was affected by two coronavirus disease 2019 (COVID-19) outbreak waves during the period 22 January 2020 through 27 February 2020 (wave 1) and 2 January 2021 through 14 February 2021 (wave 2). To evaluate and compare the epidemiological characteristics, containment delay, cluster events and social activity, as well as non-pharmaceutical interventions of the two COVID-19 outbreak waves, we examined real-time update information on all COVID-19-confirmed cases from a publicly available database. Wave 1 was closely linked with the COVID-19 pandemic in Wuhan, whereas wave 2 was triggered, to a certain extent, by the increasing social activities such as weddings, multi-household gatherings and church events during the slack agricultural period. In wave 2, the epidemic spread undetected in the rural areas, and people living in the rural areas had a higher incidence rate than those living in the urban areas (5.3 vs. 22.0 per 1 000 000). Furthermore, Rt was greater than 1 in the early stage of the two outbreak waves, and decreased substantially after massive non-pharmaceutical interventions were implemented. In China's 'new-normal' situation, development of targeted and effective intervention remains key for COVID-19 control in consideration of the potential threat of new coronavirus strains.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , SARS-CoV-2/pathogenicity , Social Behavior , Adolescent , Adult , Age Factors , Aged , COVID-19/etiology , COVID-19/virology , Chi-Square Distribution , Child , Child, Preschool , China/epidemiology , Demography , Disease Outbreaks , Humans , Incidence , Infant , Middle Aged , Physical Distancing , Rural Population , SARS-CoV-2/classification , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Travel , Urban Population , Young Adult
11.
Commun Biol ; 4(1): 225, 2021 02 12.
Article in English | MEDLINE | ID: covidwho-1387490

ABSTRACT

Serodiagnosis of SARS-CoV-2 infection is impeded by immunological cross-reactivity among the human coronaviruses (HCoVs): SARS-CoV-2, SARS-CoV-1, MERS-CoV, OC43, 229E, HKU1, and NL63. Here we report the identification of humoral immune responses to SARS-CoV-2 peptides that may enable discrimination between exposure to SARS-CoV-2 and other HCoVs. We used a high-density peptide microarray and plasma samples collected at two time points from 50 subjects with SARS-CoV-2 infection confirmed by qPCR, samples collected in 2004-2005 from 11 subjects with IgG antibodies to SARS-CoV-1, 11 subjects with IgG antibodies to other seasonal human coronaviruses (HCoV), and 10 healthy human subjects. Through statistical modeling with linear regression and multidimensional scaling we identified specific peptides that were reassembled to identify 29 linear SARS-CoV-2 epitopes that were immunoreactive with plasma from individuals who had asymptomatic, mild or severe SARS-CoV-2 infections. Larger studies will be required to determine whether these peptides may be useful in serodiagnostics.


Subject(s)
COVID-19/immunology , COVID-19/virology , Peptide Mapping , Peptides/immunology , SARS-CoV-2/physiology , Amino Acid Sequence , Animals , COVID-19/blood , Chiroptera , Epitopes/immunology , Humans , Immunoglobulin G/metabolism , Peptides/chemistry , Proteome/metabolism
12.
Front Public Health ; 9: 696664, 2021.
Article in English | MEDLINE | ID: covidwho-1365587

ABSTRACT

Since severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) began to spread in late 2019, laboratories around the world have widely used whole genome sequencing (WGS) to continuously monitor the changes in the viral genes and discovered multiple subtypes or branches evolved from SARS-CoV-2. Recently, several novel SARS-CoV-2 variants have been found to be more transmissible. They may affect the immune response caused by vaccines and natural infections and reduce the sensitivity to neutralizing antibodies. We analyze the distribution characteristics of prevalent SARS-CoV-2 variants and the frequency of mutant sites based on the data available from GISAID and PANGO by R 4.0.2 and ArcGIS 10.2. Our analysis suggests that B.1.1.7, B.1.351, and P.1 are more easily spreading than other variants, and the key mutations of S protein, including N501Y, E484K, and K417N/T, have high mutant frequencies, which may have become the main genotypes for the spread of SARS-CoV-2.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , Humans , Spike Glycoprotein, Coronavirus
13.
NPJ Biofilms Microbiomes ; 7(1): 61, 2021 07 22.
Article in English | MEDLINE | ID: covidwho-1322476

ABSTRACT

The human oral and gut commensal microbes play vital roles in the development and maintenance of immune homeostasis, while its association with susceptibility and severity of SARS-CoV-2 infection is barely understood. In this study, we investigated the dynamics of the oral and intestinal flora before and after the clearance of SARS-CoV-2 in 53 COVID-19 patients, and then examined their microbiome alterations in comparison to 76 healthy individuals. A total of 140 throat swab samples and 81 fecal samples from these COVID-19 patients during hospitalization, and 44 throat swab samples and 32 fecal samples from sex and age-matched healthy individuals were collected and then subjected to 16S rRNA sequencing and viral load inspection. We found that SARS-CoV-2 infection was associated with alterations of the microbiome community in patients as indicated by both alpha and beta diversity indexes. Several bacterial taxa were identified related to SARS-CoV-2 infection, wherein elevated Granulicatella and Rothia mucilaginosa were found in both oral and gut microbiome. The SARS-CoV-2 viral load in those samples was also calculated to identify potential dynamics between COVID-19 and the microbiome. These findings provide a meaningful baseline for microbes in the digestive tract of COVID-19 patients and will shed light on new dimensions for disease pathophysiology, potential microbial biomarkers, and treatment strategies for COVID-19.


Subject(s)
COVID-19/microbiology , Gastrointestinal Microbiome/physiology , SARS-CoV-2/isolation & purification , Viral Load , Bacteria/classification , Bacteria/genetics , COVID-19/diagnosis , COVID-19/virology , Feces/microbiology , Female , Hospitalization , Humans , Male , Mouth/microbiology , RNA, Ribosomal, 16S , SARS-CoV-2/genetics
14.
Clin Infect Dis ; 72(12): e1146-e1153, 2021 06 15.
Article in English | MEDLINE | ID: covidwho-1269565

ABSTRACT

The role of children in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains highly controversial. To address this issue, we performed a meta-analysis of the published literature on household SARS-CoV-2 transmission clusters (n = 213 from 12 countries). Only 8 (3.8%) transmission clusters were identified as having a pediatric index case. Asymptomatic index cases were associated with a lower secondary attack in contacts than symptomatic index cases (estimate risk ratio [RR], 0.17; 95% confidence interval [CI], 0.09-0.29). To determine the susceptibility of children to household infections the secondary attack rate in pediatric household contacts was assessed. The secondary attack rate in pediatric household contacts was lower than in adult household contacts (RR, 0.62; 95% CI, 0.42-0.91). These data have important implications for the ongoing management of the COVID-19 pandemic, including potential vaccine prioritization strategies.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Child , Family Characteristics , Humans , Incidence , Pandemics
15.
Scandinavian Journal of Immunology ; n/a(n/a):e13088, 2021.
Article in English | Wiley | ID: covidwho-1263865

ABSTRACT

Abstract The coronavirus disease 2019 (COVID-19) pandemic has triggered a global health emergency and brought disaster to humans. Tremendous efforts have been made to control the pandemic, among which neutralizing antibodies (NAbs) are of specific interest to researchers. Neutralizing antibodies are generated within weeks after infection or immunization, and can protect cells from virus intrusion and confer protective immunity to cells. Thus, production of NAbs is considered as a main goal for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines and NAbs may be used for patient treatment in the form of monoclonal antibodies. Neutralization assays are capable of quantitatively detecting NAbs against SARS-CoV-2, allowing to explore the relationship between the level of NAbs and the severity of the disease, and may predict the possibility of re-infection in COVID-19 patients. They can also be used to test the effects of monoclonal antibodies, convalescent plasma and vaccines. At present, wild-type virus neutralization assay remains the gold standard for measuring NAbs;while pseudovirus neutralization assays, Surrogate virus neutralization test (sVNT), and high-throughput versions of neutralization assays are popular alternatives with their own advantages and disadvantages. In this review article, we summarize the characteristics and recent progress of SARS-CoV-2 neutralization assays. Special attention is given to the current limitations of various neutralization assays so as to promote new possible strategies with NAbs by which rapid SARS-CoV-2 serological diagnosis and antiviral screening in the future will be achieved.

16.
Global Health ; 16(1): 79, 2020 09 07.
Article in English | MEDLINE | ID: covidwho-750233

ABSTRACT

The Second International Symposium on One Health Research (ISOHR) was held in Guangzhou city, China on 23-24 November 2019. A transdisciplinary collaborative approach, One Health (OH), was the central theme of the symposium which brought together more than 260 experts, scholars and emerging researchers from human health, veterinary health, food safety, environmental health and related disciplines and sectors. More than 50 organizations including World Health Organization, Centers for Disease Control (USA), and Queensland Government (Australia) participated in the symposium. Scholars, experts and emerging researchers, policy-makers and practitioners in their respective fields delivered over 50 presentations at the symposium, highlighting the collective vulnerability to some of the emerging health challenges the region was combating. These included emerging infectious diseases, antimicrobial resistance, climate change, food safety and the growing burden of non-communicable diseases. The Pearl River Declaration, emanated from the symposium, called for establishing a One Health Cooperation Network in the Southeast Asia-Pacific region with a vision to strengthen regional health security through sharing each other's knowledge and experience, and making investments in workforce development, scientific innovations such as vaccine research and development, sharing epidemic intelligence, risk identification, risk communication and appropriate response measures against emerging health threats.


Subject(s)
Global Health , One Health , World Health Organization , China , Communicable Diseases, Emerging , Epidemics , Government , Humans , International Cooperation , Organizations
17.
Journal of Tropical Medicine ; 20(3):289-291, 2020.
Article in Chinese | GIM | ID: covidwho-1139085

ABSTRACT

The article listed some epidemiology key concepts involved in the outbreak of corona virus disease 2019 I COVID-19 11 as well as some examples of epidemiological terminology understanding deviation in reports, news conferences and interviews from the authorities and social media in the period from 21' January 2020 to 14" February. The errors were corrected in the examples and the concept of terminologies were illustrated. The basic epidemiological concepts and the importance of public health should be introduced to the public by the health authorities.

18.
J Proteome Res ; 20(5): 2224-2239, 2021 05 07.
Article in English | MEDLINE | ID: covidwho-1118785

ABSTRACT

The outbreak of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has posed a serious threat to global public health. The mechanism of pathogenesis and the host immune response to SARS-CoV-2 infection are largely unknown. In the present study, we applied a quantitative proteomic technology to identify and quantify the ubiquitination changes that occur in both the virus and the Vero E6 cells during SARS-CoV-2 infection. By applying label-free, quantitative liquid chromatography with tandem mass spectrometry proteomics, 8943 lysine ubiquitination sites on 3086 proteins were identified, of which 138 sites on 104 proteins were quantified as significantly upregulated, while 828 sites on 447 proteins were downregulated at 72 h post-infection. Bioinformatics analysis suggested that SARS-CoV-2 infection might modulate host immune responses through the ubiquitination of important proteins, including USP5, IQGAP1, TRIM28, and Hsp90. Ubiquitination modification was also observed on 11 SAR-CoV-2 proteins, including proteins involved in virus replication and inhibition of the host innate immune response. Our study provides new insights into the interaction between SARS-CoV-2 and the host as well as potential targets for the prevention and treatment of COVID-19.


Subject(s)
COVID-19 , Proteome , Humans , Proteome/genetics , Proteomics , SARS-CoV-2 , Ubiquitin
19.
Journal of Tropical Medicine ; 20(4):427-430, 2020.
Article in Chinese | GIM | ID: covidwho-1115749

ABSTRACT

Objective: The epidemic of Corona Virus disease 20l9 (COVID-l9) in Guangdong province during January 19, and February 7, 2020 was evaluated to provide evidence for the prevention and control of the COVID- l9 outbreak.

20.
J Infect Dev Ctries ; 14(8): 853-860, 2020 08 31.
Article in English | MEDLINE | ID: covidwho-750610

ABSTRACT

INTRODUCTION: An unprecedented outbreak of the novel coronavirus disease (COVID-19) has swept across the globe since the end of 2019. Shenzhen confirmed its first imported case from Wuhan on 19 January 2020. However, little is known regarding the epidemiological characteristics of COVID-19 in these imported cities. METHODOLOGY: Data of all 417 confirmed cases diagnosed in Shenzhen before 29 February were collected. The epidemiological characteristics of imported and local cases were compared. The resilience to COVID-19 was evaluated by discharge density. RESULTS: All ten districts reported COVID-19 cases by 29 February, including 331 imported and 86 local cases. The Pearson linear correlation model showed the number of confirmed cases (r = 0.990, p < 0.001) as well as incidence of COVID-19 (r = 0.766, p = 0.010) was positively correlated with the gross domestic product of district. Family clusters were more commonly found in local cases. Imported patients had earlier onset (p < 0.001) and diagnosis (p < 0.001), but longer interval from onset to admission (p = 0.030), diagnosis (p = 0.003) and discharge (p = 0.016). Older and severe cases had lower discharge density (0.024 and 0.018, respectively); while cases with subclinical symptoms exhibited higher discharge density (0.052). CONCLUSIONS: COVID-19 patients were predominantly imported cases in Shenzhen and the spatial distribution was closely related to district GDP. Imported and local cases differed in the intervals from onset to admission, diagnosis and discharge. Moreover, family-based transmission should not be ignored, especially in local cases.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adult , Aged , COVID-19 , China/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
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