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1.
Epidemiology ; 26:26, 2023.
Article in English | MEDLINE | ID: covidwho-2212952

ABSTRACT

Results from randomized controlled trials (RCTs) help determine vaccination strategies and related public health policies. However, defining and identifying estimands that can guide policies in infectious disease settings is difficult, even in an RCT. The effects of vaccination critically depend on characteristics of the population of interest, such as the prevalence of infection, the number of vaccinated, and social behaviors. To mitigate the dependence on such characteristics, estimands, and study designs, that require conditioning or intervening on exposure to the infectious agent have been advocated. But a fundamental problem for both RCTs and observational studies is that exposure status is often unavailable or difficult to measure, which has made it impossible to apply existing methodology to study vaccine effects that account for exposure status. In this study, we present new results on this type of vaccine effects. Under plausible conditions, we show that point identification of certain relative effects is possible even when the exposure status is unknown. Furthermore, we derive sharp bounds on the corresponding absolute effects. We apply these results to estimate the effects of the ChAdOx1 nCoV-19 vaccine on SARS-CoV-2 disease (COVID-19) conditional on postvaccine exposure to the virus, using data from a large RCT.

2.
SSM. Qualitative Research in Health ; 3:100207, 2023.
Article in English | MEDLINE | ID: covidwho-2211501

ABSTRACT

This analysis of people's accounts of establishing their need and experiences of healthcare for long Covid (LC) symptoms draws on interview data from five countries (UK, US, Netherlands, Canada, Australia) during the first ~18 months of the Covid-19 pandemic when LC was an emerging, sometimes contested, condition with scant scientific or lay knowledge to guide patients and professionals in their sense-making of often bewildering constellations of symptoms. We extend the construct of candidacy to explore positive and (more often) negative experiences that patients reported in their quest to understand their symptoms and seek appropriate care. Candidacy usually considers how individuals negotiate healthcare access. We argue a crucial step preceding individual claims to candidacy is recognition of their condition through generation of collective candidacy. "Vanguard patients" collectively identified, named and fought for recognition of long Covid in the context of limited scientific knowledge and no established treatment pathways. This process was technologically accelerated via social media use. Patients commonly experienced "rejected" candidacy (feeling disbelieved, discounted/uncounted and abandoned, and that their suffering was invisible to the medical gaze and society). Patients who felt their candidacy was "validated" had more positive experiences;they appreciated being believed and recognition of their changed lives/bodies and uncertain futures. More positive healthcare encounters were described as a process of "co-experting" through which patient and healthcare professional collaborated in a joint quest towards a pathway to recovery. The findings underpin the importance of believing and learning from patient experience, particularly vanguard patients with new and emerging illnesses.

3.
European Review for Medical & Pharmacological Sciences ; 27(1):404-410, 2023.
Article in English | MEDLINE | ID: covidwho-2205453

ABSTRACT

OBJECTIVE: To perform a systematic review of case reports or case series regarding thrombosis with thrombocytopenia syndrome (TTS) and cerebral venous thrombosis (CVT) related to ChAdOx1 nCoV-19 vaccination to address the clinical features, laboratory findings, treatment modalities, and prognosis related with CVT.

4.
PLoS ONE [Electronic Resource] ; 17(12):e0279355, 2022.
Article in English | MEDLINE | ID: covidwho-2197089

ABSTRACT

In 2020, schools in England closed for six months due to COVID-19, resulting in children being home-schooled. There is limited understanding about the impacts of this on children's mental and physical health and their education. Therefore, we explored how families coped with managing these issues during the school closures. We conducted 30 qualitative interviews with parents of children aged 18 years and under (who would usually be in school) between 16 and 21 April 2020. We identified three themes and eight sub-themes that impacted how families coped whilst schools were closed. We found that family dynamics, circumstances, and resources (Theme 1), changes in entertainment activities and physical movement (Theme 2) and worries about the COVID-19 pandemic (Theme 3) impacted how well families were able to cope. A key barrier to coping was struggles with home-schooling (e.g., lack of resources and support from the school). However, parents being more involved in their children's personal development and education were considered a benefit to home-schooling. Managing the lack of entertainment activities and in-person interactions, and additional health worries about loved ones catching COVID-19 were challenges for families. Parents reported adverse behaviour changes in their children, although overall, they reported they were coping well. However, pre-existing social and educational inequalities are at risk of exacerbation. Families with more resources (e.g., parental supervision, access to green space, technology to facilitate home-schooling and no special educational needs) were better able to cope when schools were closed. On balance, however, families appeared to be able to adapt to the schools being closed. We suggest that policy should focus on supporting families to mitigate the widening health and educational gap between families with more and less resources.

5.
PLoS ONE [Electronic Resource] ; 17(12):e0279285, 2022.
Article in English | MEDLINE | ID: covidwho-2197084

ABSTRACT

AIM: To investigate UK parents' vaccination intention at a time when COVID-19 vaccination was available to some children.

6.
Archives of Disease in Childhood ; 04:04, 2023.
Article in English | MEDLINE | ID: covidwho-2193640

ABSTRACT

OBJECTIVES: To describe the physical and mental health of children and young people (CYP) 6 months after infection with SARS-CoV-2 and explore whether this varies by COVID-19 vaccination.

7.
Open Forum Infectious Diseases ; 9(Supplement 2):S259-S260, 2022.
Article in English | EMBASE | ID: covidwho-2189649

ABSTRACT

Background. Infectious disease exposure investigations in the hospital are labor-intensive for the infection prevention and control (IPC) team and vulnerable to healthcare personnel (HCP) recall bias. We developed an electronic health record (EHR) algorithm to identify and rank patient-HCP interactions based on the likelihood and intensity of exposure. Methods. We compared conventional and EHR-based findings from seven exposure investigations conducted between November 1, 2020 and February 1, 2022 at The Johns Hopkins Hospital (JHH), a 1095 bed academic tertiary center in Baltimore, MD. Conventional exposure investigations were conducted for hospitalized patients who tested positive for SARS-CoV-2 while not in COVID-19 isolation precautions. IPC contacted department managers to identify and report potentially exposed HCPs to occupational health. The EHR-based method identified HCP-patient interactions based on clinical data such as documentation in the flowsheet, medication administration, etc. A score was calculated for each HCP based on the estimated duration and intensity of the contact. Genomic sequencing of available samples was performed to investigate transmission events. Results. Overall, the EHR-based system identified 75% (59/79) of the HCPs identified by conventional exposure investigations and 100% of those who document in the EHR. In contrast, it was unable to identify any potentially exposed individuals who do not document in the EHR (Table 1). All patient-HCP COVID-19 transmissions identified by conventional investigation and confirmed through genomic sequencing were identified by the EHR-based system, and all had high-intensity scores (i.e., top quartile of the list of exposed individuals). Conclusion. We found clinical EHR data was highly sensitive and specific in identifying potentially exposed HCPs compared with conventional exposure investigations. The inability to detect interactions with support staff or others who do not document in the EHR was a limitation and suggests that EHR data can augment but not replace conventional exposure investigations. The system's speed, ease, and lower resource requirements make it a promising tool to more efficiently complete exposure investigations in healthcare settings.

8.
Preventive Medicine Reports ; 31:102096, 2023.
Article in English | MEDLINE | ID: covidwho-2182366

ABSTRACT

Little is known about how COVID-19 has impacted the diagnosis of neck and low back pain in outpatient practices in Germany. Thus, this study aimed to compare the number of new diagnoses of neck and low back pain in German general and orthopedic practices between 2020 and 2021 and 2019. This retrospective study included patients aged >= 18 years with at least one visit to one of 915 general and 145 orthopedic practices in Germany in March - December 2019 (N = 2,842,145), March - December 2020 (N = 2,810,179), or March - December 2021 (N = 3,214,419). The number of patients newly diagnosed with neck and low back pain per general and orthopedic practice was compared between March - December 2020 and March - December 2019, and between March - December 2021 and March - December 2019 using Wilcoxon signed-rank tests. Analyses were conducted in general and orthopedic practices separately and were also stratified by sex and age. There was a decrease in new diagnoses of neck and low back pain in general and orthopedic practices between 2020 and 2019, and between 2021 and 2019. This decrease reached statistical significance for neck pain in general practices in 2020 (-12.4 %) and 2021 (-6.1 %), and for low back pain in general practices in 2020 (-9.3 %). Similar findings were obtained in sex- and age-stratified analyses. The COVID-19 pandemic had a negative impact on the diagnosis of neck and low back pain in general and orthopedic practices in Germany. More data from other settings and countries are warranted to confirm or refute these results.

9.
European Geriatric Medicine ; 13(Supplement 1):S143-S144, 2022.
Article in English | EMBASE | ID: covidwho-2175549

ABSTRACT

Introduction: The COVID-19 pandemic may have a disproportionate impact on people with dementia/mild cognitive impairment (MCI) due to isolation and loss of services. The aim of this systematic review was to investigate the effects of the COVID-19 lockdown on neuropsychiatric symptoms (NPS) in people living with dementia/ MCI. Method(s): Two authors searched major electronic databases from inception to June 2021 for observational studies investigating COVID-19 and NPS in people with dementia/MCI. Summary estimates of mean differences in NPS scores pre- versus post-COVID-19 were calculated using a random-effects model, weighting cases using inverse variance. Study quality and risk of bias were assessed by the Newcastle-Ottawa Scale. Result(s): From 2730 citations, 21 studies including 7139 patients (60.0% female, mean age 75.6 +/- 7.9 years, 4.0% MCI) with dementia were evaluated in the review. Five studies found no changes in NPS, but in all other studies, an increase in at least one NPS or the pre-pandemic Neuropsychiatric Inventory (NPI) score was found. The most common aggravated NPS were depression, anxiety, agitation, irritability, and apathy during lockdown, but 66.7% of the studies had a high bias. Seven studies including 420 patients (22.1% MCI) yielded enough data to be included in the meta-analysis. The mean follow-up time was 5.9 +/- 1.5 weeks. The pooled increase in NPI score before compared to during COVID-19 was 3.85 (95% CI: 0.43-7.27;P = 0.03;I2 = 82.4%). All studies had high risk of bias. These results were characterized by high heterogeneity, but there was no presence of publication bias. Key conclusions: There is an increase in the worsening of NPS in people living with dementia/MCI during lockdown in the COVID pandemic. Future comparative studies are needed to elucidate whether a similar deterioration might occur in people without dementia/MCI.

10.
World J Pediatr ; : 1-12, 2023.
Article in English | PubMed Central | ID: covidwho-2175145

ABSTRACT

Background: Although smoking is classified as a risk factor for severe COVID-19 outcomes, there is a scarcity of studies on prevalence of smoking during the COVID-19 pandemic. Thus, this study aims to analyze the trends of prevalence of smoking in adolescents over the COVID-19 pandemic period. Methods: The present study used data from middle to high school adolescents between 2005 and 2021 who participated in the Korea Youth Risk Behavior Web-based Survey (KYRBS). We evaluated the smoking prevalence (ever or daily) by year groups and estimated the slope in smoking prevalence before and during the pandemic. Results: A total of 1,137,823 adolescents participated in the study [mean age, 15.04 years [95% confidence interval (CI) 15.03–15.06];and male, 52.4% (95% CI 51.7–53.1)]. The prevalence of ever smokers was 27.7% (95% CI 27.3–28.1) between 2005 and 2008 but decreased to 9.8% (95% CI 9.3–10.3) in 2021. A consistent trend was found in daily smokers, as the estimates decreased from 5.4% (95% CI 5.2–5.6) between 2005 and 2008 to 2.3% (95% CI 2.1–2.5) in 2021. However, the downward slope in the overall prevalence of ever smokers and daily smokers became less pronounced in the COVID-19 pandemic period than in the pre-pandemic period. In the subgroup with substance use, the decreasing slope in daily smokers was significantly more pronounced during the pandemic than during the pre-pandemic period. Conclusions: The proportion of ever smokers and daily smokers showed a less pronounced decreasing trend during the pandemic. The findings of our study provide an overall understanding of the pandemic's impact on smoking prevalence in adolescents.Supplementary file2 (MP4 64897 KB) Supplementary Information: The online version contains supplementary material available at 10.1007/s12519-022-00673-8.

11.
Journal of Medical Virology ; 05:05, 2023.
Article in English | MEDLINE | ID: covidwho-2173225

ABSTRACT

INTRODUCTION: With the ongoing COVID-19 pandemic, several previous studies from different countries showed that physical activity (PA) decreased during the COVID-19 outbreak. However, few studies have examined the recent tendency of PA in the adolescent population. Thus, we aimed to investigate the long-term trend of PA in Korean youth and the prevalence changes between before and during the COVID-19 pandemic.

12.
Reviews in Medical Virology ; : e2414, 2022.
Article in English | MEDLINE | ID: covidwho-2157907

ABSTRACT

The susceptibility, risk factors, and prognosis of COVID-19 in patients with inflammatory bowel disease (IBD) remain unknown. Thus, our study aims to assess the prevalence and clinical outcomes of COVID-19 in IBD. We searched PubMed, EMBASE, and medRxiv from 2019 to 1 June 2022 for cohort and case-control studies comparing the prevalence and clinical outcomes of COVID-19 in patients with IBD and in the general population. We also compared the outcomes of patients receiving and not receiving 5-aminosalicylates (ASA), tumour necrosis factor antagonists, biologics, systemic corticosteroids, or immunomodulators for IBD. Thirty five studies were eligible for our analysis. Pooled odds ratio of COVID-19-related hospitalisation, intensive care unit (ICU) admission, or death in IBD compared to in non-IBD were 0.58 (95% confidence interval (CI) = 0.28-1.18), 1.09 (95% CI = 0.27-4.47), and 0.67 (95% CI = 0.32-1.42), respectively. Inflammatory bowel disease was not associated with increased hospitalisation, ICU admission, or death. Susceptibility to COVID-19 did not increase with any drugs for IBD. Hospitalisation, ICU admission, and death were more likely with 5-ASA and corticosteroid use. COVID-19-related hospitalisation (Odds Ratio (OR): 0.53;95% CI = 0.38-0.74) and death (OR: 0.13;95% CI = 0.13-0.70) were less likely with Crohn's disease than ulcerative colitis (UC). In conclusion, IBD does not increase the mortality and morbidity of COVID-19. However, physicians should be aware that additional monitoring is needed in UC patients or in patients taking 5-ASA or systemic corticosteroids.

13.
J Alzheimers Dis ; 2022.
Article in English | PubMed | ID: covidwho-2154619

ABSTRACT

BACKGROUND: Dementia has been identified as a major predictor of mortality associated with COVID-19. OBJECTIVE: The objective of this study was to investigate the association between dementia and mortality in COVID-19 inpatients in Germany across a longer interval during the pandemic. METHODS: This retrospective study was based on anonymized data from 50 hospitals in Germany and included patients with a confirmed COVID-19 diagnosis hospitalized between March 11, 2020 and July, 20, 2022. The main outcome of the study was the association of mortality during inpatient stays with dementia diagnosis, which was studied using multivariable logistic regression adjusted for age, sex, and comorbidities as well as univariate logistic regression for matched pairs. RESULTS: Of 28,311 patients diagnosed with COVID-19, 11.3% had a diagnosis of dementia. Prior to matching, 26.5% of dementia patients and 11.5% of non-dementia patients died;the difference decreased to 26.5% of dementia versus 21.7% of non-dementia patients within the matched pairs (n = 3,317). This corresponded to an increase in the risk of death associated with dementia (OR = 1.33;95% CI: 1.16-1.46) in the univariate regression conducted for matched pairs. CONCLUSION: Although dementia was associated with COVID-19 mortality, the association was weaker than in previously published studies. Further studies are needed to better understand whether and how pre-existing neuropsychiatric conditions such as dementia may impact the course and outcome of COVID-19.

14.
Sci Rep ; 12(1):20662, 2022.
Article in English | PubMed | ID: covidwho-2133650

ABSTRACT

Alaska has the lowest population density in the United States (US) with a mix of urban centers and isolated rural communities. Alaska's distinct population dynamics compared to the contiguous US may have contributed to unique patterns of SARS-CoV-2 variants observed in early 2021. Here we examined 2323 SARS-CoV-2 genomes from Alaska and 278,635 from the contiguous US collected from December 2020 through June 2021 because of the notable emergence and spread of lineage B.1.1.519 in Alaska. We found that B.1.1.519 was consistently detected from late January through June of 2021 in Alaska with a peak prevalence in April of 77.9% unlike the rest of the US at 4.6%. The earlier emergence of B.1.1.519 coincided with a later peak of Alpha (B.1.1.7) compared to the contiguous US. We also observed differences in variant composition over time between the two most populated regions of Alaska and a modest increase in COVID-19 cases during the peak incidence of B.1.1.519. However, it is difficult to disentangle how social dynamics conflated changes in COVID-19 during this time. We suggest that the viral characteristics, such as amino acid substitutions in the spike protein, likely contributed to the unique spread of B.1.1.519 in Alaska.

15.
COVID-19 and the Voluntary and Community Sector in the UK: Responses, Impacts and Adaptation ; : 211-224, 2022.
Article in English | Scopus | ID: covidwho-2093030
16.
Central European Journal of Sport Sciences and Medicine ; 38(2):5-12, 2022.
Article in English | Scopus | ID: covidwho-2091154

ABSTRACT

Mobile health applications provide individuals with a mobile tool that can be tailored to meet various health needs and physical activity goals, which is particularly important during the COVID-19 pandemic and the associated social distancing protocols. The consequence that the pandemic has on the mental health of university students has prompted and increased the demand of physical activity interventions. The aim of this study was to determine the self-perceived effects of mobile health applications on physical activity participation among university students. Participants included students registered in one of the faculties at a university in Johannesburg. Data collection took place by means of an electronic questionnaire using Google Forms as a platform, completed by a sample of 192 students. The findings in the study reflected that majority of university students use health applications to increase physical activity levels or to track current activity levels. Participants also indicated that specific health applications were used to set goals, monitor progress and receive feedback. Aerobic activities proved to be the more popular type of physical activity in comparison to anaerobic activity. This study concluded that health applications can be used as a tool to facilitate and promote physical activity participation in the university student population. © 2022 The authors.

17.
American Journal of Transplantation ; 22(Supplement 3):1087-1088, 2022.
Article in English | EMBASE | ID: covidwho-2063515

ABSTRACT

Purpose: The demand for kidney transplant continues to rise, and limited supply has encouraged acceptance of marginal donor organs, such as those at risk for acute kidney injury (AKI). We evaluated the utilization of such organs (defined as donation after cardiac death, pediatric donors, kidneys with a cold ischemic time >24 hrs, terminal serum creatinine (SCr) >2mg/dL or rising SCr with decreasing urine output at donation) at our center who were discharged on belatacept based maintenance immunosuppression with mycophenolate and steroids (BBMS). Method(s): This retrospective, descriptive study examined kidney transplant recipients (KTR) who received AKI organs and were discharged on BBMS between 1/2019-4/2021. Primary outcome assessed graft function and rejection at 6 & 12 months (mos) post-transplant (txp). Secondary outcomes evaluated graft failure, mortality, infection, DSA & changes to BBMS. All outcomes were evaluated at 1yr if records were available. Result(s): 68 KTR w/1 yr results & 52 w/6 mo results on BBMS were included. Baseline characteristics (Table 1) show most KTR received a DCD or en bloc organ and lymphocyte depleting induction. Mean eGFR improved from 1 to 6 mo post-txp and was stable through 1yr. Episodes of biopsy proven rejection were more common during the first 6mos post-txp. There were 2 deaths during the study period, due to COVID, and no graft failures. Twelve KTR developed DSA. There were 21 KTR with CMV viremia, mostly in moderate risk group, & 12 with BK viremia. Table 4 shows changes to BBMS occurred in 32 KTR. Most KTR required multiple BBMS changes with most common dose adjustments to mycophenolate due to leukopenia or neutropenia. Conclusion(s): Utilization of AKI organs with BBMS in KTR at our center resulted in no graft failures & sustained eGFR despite more rejection episodes during the first 6mos post-txp. Although 32 KTR had changes to BBMS, only 5 KTR had rejection following a change. Incidence of CMV was common but did not impact KTR outcomes. Overall, BBMS could be a promising option in AKI organs to avoid nephrotoxicity associated with CNI based regimens. These findings suggest the need to further evaluate the impact of long-term outcomes associated with changes made to BBMS in AKI donor organs.

18.
American Journal of Transplantation ; 22(Supplement 3):782, 2022.
Article in English | EMBASE | ID: covidwho-2063443

ABSTRACT

Purpose: Mortality secondary to COVID-19 infection is significantly higher in solid organ transplant recipients compared to the general population. Limited data exists evaluating the impact COVID has had on mortality compared to other causes, with even less data specific to the Mountain West region of the United States. This quality improvement project seeks to evaluate trends in patient mortality at a center in the Mountain West region before and after the COVID pandemic in kidney transplant recipients (KTR). Method(s): This is a retrospective single-center analysis of all adult KTRs who underwent transplant between January 1999 and July 2021 and subsequently died between January 2015 and July 2021, assessing the change in mortality trends with the advent of the COVID-19 pandemic. Additional endpoints include time from transplant to death, graft status at time of death, and COVID vaccination status. Data collection included UNOS data reports as well as manual electronic medical record review. Result(s): One-hundred and seventy-two KTRs were included with baseline characteristics described in Table 1. Prior to the COVID-19 pandemic, the most common etiology of mortality was cardiovascular cause with a median of 18% mortality (see Table 1). Of those who died in 2020, 33% were secondary to COVID-19 leading to a 174% increase in cumulative patient deaths compared to the year prior (23 vs 40 patient deaths in 2019 vs 2020;see Table 1 and Figure 1). Of those who died secondary to COVID, none had received the COVID-19 vaccine. Conclusion(s): COVID-19 pneumonia and its associated complications have led to an increase in and earlier mortality prior to vaccination implementation, changing the mortality landscape in KTRs. Further investigation is needed to elucidate non- COVID related changes in mortality and patient outcomes in the ongoing COVID pandemic.

19.
Chest ; 162(4):A559, 2022.
Article in English | EMBASE | ID: covidwho-2060630

ABSTRACT

SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare hematologic disorder that can lead to thrombosis, hemolytic anemia and leukemia. Though there are documented relationships between autoimmune hemolytic anemia (AIHA) and COVID-19 infection, this is the first to highlight aa potential association between PNH exacerbations and COVID vaccinations. CASE PRESENTATION: A 38 year-old female with a history of chronic paroxysmal nocturnal hemoglobinuria (PNH) currently on maintenance ravculizumab therapy presented with 3 days of generalized fatigue, chills, and worsening scleral icterus. She reports being unable to move out of the bed with concomitant somnolence. Of note, she received her second dose of the Moderna COVID-19 vaccine 2 days prior to symptom onset and not had any similar symptoms prior to this episode. Patient was hemodynamically stable on admission and afebrile. Physical exam revealed generalized lethargy/weakness and jaundice. Chest x-ray did not demonstrate any evidence of infection or pleural effusions. Initial complete blood count showed a hemoglobin of 5.9 g/dL, compared to her baseline of 9 without any evidence of bleeding. Absolute reticulocyte and bilirubin levels were elevated to 295.2 x 109 and 4.7 mg/dL respectively with a haptoglobin of <20 mg/dL. She received a total of 3 units of packed red-blood cells with subsequent stable hemoglobin levels and did not require emergent use of glucocorticoids or plasma exchange. Her lethargy improved slowly, and within a week, she returned back to her baseline functional status. She was ultimately stable and discharged for follow up with her hematologist without any complications. DISCUSSION: Though the sequelae of COVID-19 infections and associated hematologic diseases have been extensively established, the pathogenesis of COVID-19 vaccinations associated exacerbations remain unclear. Given the timing of the onset of our patient's symptoms, it is highly suggestive that her second COVID-19 vaccination was the inciting factor for her acute hemolytic anemia. It is crucial to be cognizant of the potential hematologic side effects in individuals with rare auto-immune disorders such as PNH and take into consideration the timing of vaccination or booster administrations. CONCLUSIONS: While COVID-19 vaccination benefit most likely outweighs the risks for this specific patient population, our case raises the question about the need for extra precautions in patients with known PNH associated AIHA including the timing of PNH treatment before receiving the vaccination. Reference #1: Algassim AA, Elghazaly AA, Alnahdi AS, Mohammed-Rahim OM, Alanazi AG, Aldhuwayhi NA, Alanazi MM, Almutairi MF, Aldeailej IM, Kamli NA, Aljurf MD. Prognostic significance of hemoglobin level and autoimmune hemolytic anemia in SARS-CoV-2 infection. Annals of Hematology. 2021 Jan;100(1):37-43. DISCLOSURES: No relevant relationships by Suhwoo Bae No relevant relationships by Edward Bae No relevant relationships by Joseph You

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