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1.
Risk Manag Healthc Policy ; 16: 711-723, 2023.
Article in English | MEDLINE | ID: covidwho-2302128

ABSTRACT

Background: This study aimed to explore the levels of anxiety and depression in a sample of home-quarantined college students to identify the risk factors for psychological distress during the COVID-19 lockdown. Methods: A total of 1156 college students studying in Jiangsu, China, participated from August 5 to August 14. A structured questionnaire was used to collect data anonymously, including demographic characteristics, the generalized anxiety disorder-7 (GAD-7) questionnaire, the patient health questionnaire-9 (PHQ-9), a physical activity scale, and items related to COVID-19. The chi-square test and Fisher's exact test were employed to establish the differences in levels of anxiety and depression across sociodemographic characteristics. Binary logistic regression was applied to measure the predictors of levels of anxiety and depression, and associations were considered significant at p <0.05. Results: The estimates of anxiety and depression were 48.1% and 57.6%, respectively. The univariate analysis indicated a significant difference in anxiety levels across student grades, whether the student was an only child, the distance from the worst-hit areas, and physical activity/exercise intensity. Physical activity intensity and living in communities with infected people were statistically correlated with the level of depression. Binary logistic regression results indicated that the predictive factors for anxiety were living within a short distance from the worst-hit areas (10~20 km), engaging in higher education (graduate students), and low-intensity daily exercise. Factors statistically predicting depression symptoms were having siblings, a COVID-19 diagnosis in the community and low-intensity daily exercise. Conclusion: During outbreaks, students in an extremely stressful state are more likely to develop anxiety and depression, particularly postgraduates. Psychological interventions to reduce fears and encourage exercise should be available to home-quarantined college students. Students who live in the worst-hit areas and are not the only child in the family should be prioritized.

2.
Front Immunol ; 14: 1107639, 2023.
Article in English | MEDLINE | ID: covidwho-2261428

ABSTRACT

Neutralizing antibody (NtAb) levels are key indicators in the development and evaluation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccines. Establishing a unified and reliable WHO International Standard (IS) for NtAb is crucial for the calibration and harmonization of NtAb detection assays. National and other WHO secondary standards are key links in the transfer of IS to working standards but are often overlooked. The Chinese National Standard (NS) and WHO IS were developed by China and WHO in September and December 2020, respectively, the application of which prompted and coordinated sero-detection of vaccine and therapy globally. Currently, a second-generation Chinese NS is urgently required owing to the depletion of stocks and need for calibration to the WHO IS. The Chinese National Institutes for Food and Drug Control (NIFDC) developed two candidate NSs (samples 33 and 66-99) traced to the IS according to the WHO manual for the establishment of national secondary standards through a collaborative study of nine experienced labs. Either NS candidate can reduce the systematic error among different laboratories and the difference between the live virus neutralization (Neut) and pseudovirus neutralization (PsN) methods, ensuring the accuracy and comparability of NtAb test results among multiple labs and methods, especially for samples 66-99. At present, samples 66-99 have been approved as the second-generation NS, which is the first NS calibrated tracing to the IS with 580 (460-740) International Units (IU)/mL and 580 (520-640) IU/mL by Neut and PsN, respectively. The use of standards improves the reliability and comparability of NtAb detection, ensuring the continuity of the use of the IS unitage, which effectively promotes the development and application of SARS-CoV-2 vaccines in China.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , Calibration , Reproducibility of Results , SARS-CoV-2 , Antibodies, Viral , Antibodies, Neutralizing , China , World Health Organization
3.
Viruses ; 15(3)2023 03 02.
Article in English | MEDLINE | ID: covidwho-2254712

ABSTRACT

Compared to other vaccines, the inherent properties of messenger RNA (mRNA) vaccines and their interaction with lipid nanoparticles make them considerably unstable throughout their life cycles, impacting their effectiveness and global accessibility. It is imperative to improve mRNA vaccine stability and investigate the factors influencing stability. Since mRNA structure, excipients, lipid nanoparticle (LNP) delivery systems, and manufacturing processes are the primary factors affecting mRNA vaccine stability, optimizing mRNA structure and screening excipients can effectively improve mRNA vaccine stability. Moreover, improving manufacturing processes could also prepare thermally stable mRNA vaccines with safety and efficacy. Here, we review the regulatory guidance associated with mRNA vaccine stability, summarize key factors affecting mRNA vaccine stability, and propose a possible research path to improve mRNA vaccine stability.


Subject(s)
Commerce , Excipients , Liposomes , RNA, Messenger/genetics , mRNA Vaccines , Vaccines, Synthetic/genetics
4.
Biol Direct ; 17(1): 36, 2022 Nov 29.
Article in English | MEDLINE | ID: covidwho-2139383

ABSTRACT

BACKGROUND: The major histocompatibility complex (MHC) and the killer cell immunoglobulin-like receptors (KIR) are key regulators of immune responses. The cynomolgus macaque, an Old World monkey species, can be applied as an important preclinical model for studying human diseases, including coronavirus disease 2019 (COVID-19). Several MHC-KIR combinations have been associated with either a poor or good prognosis. Therefore, macaques with a well-characterized immunogenetic profile may improve drug evaluation and speed up vaccine development. At present, a complete overview of the MHC and KIR haplotype organizations in cynomolgus macaques is lacking, and characterization by conventional techniques is hampered by the extensive expansion of the macaque MHC-B region that complicates the discrimination between genes and alleles. METHODS: We assembled complete MHC and KIR genomic regions of cynomolgus macaque using third-generation long-read sequencing approach. We identified functional Mafa-B loci at the transcriptome level using locus-specific amplification in a cohort of 33 Vietnamese cynomolgus macaques. RESULTS: This is the first physical mapping of complete MHC and KIR gene regions in a Vietnamese cynomolgus macaque. Furthermore, we identified four functional Mafa-B loci (B2, B3, B5, and B6) and showed that alleles of the Mafa-I*01, -B*056, -B*034, and -B*001 functional lineages, respectively, are highly frequent in the Vietnamese cynomolgus macaque population. CONCLUSION: The insights into the MHC and KIR haplotype organizations and the level of diversity may refine the selection of animals with specific genetic markers for future medical research.


Subject(s)
COVID-19 , Humans , Animals , Major Histocompatibility Complex/genetics , Receptors, KIR/genetics , Macaca , Genomics
5.
MedComm (2020) ; 3(3): e157, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1976753

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dysregulates antiviral signaling, immune response, and cell metabolism in human body. Viral genome and proteins hijack host metabolic network to support viral biogenesis and propagation. However, the regulatory mechanism of SARS-CoV-2-induced metabolic dysfunction has not been elucidated until recently. Multiomic studies of coronavirus disease 2019 (COVID-19) revealed an intensive interaction between host metabolic regulators and viral proteins. SARS-CoV-2 deregulated cellular metabolism in blood, intestine, liver, pancreas, fat, and immune cells. Host metabolism supported almost every stage of viral lifecycle. Strikingly, viral proteins were found to interact with metabolic enzymes in different cellular compartments. Biochemical and genetic assays also identified key regulatory nodes and metabolic dependencies of viral replication. Of note, cholesterol metabolism, lipid metabolism, and glucose metabolism are broadly involved in viral lifecycle. Here, we summarized the current understanding of the hallmarks of COVID-19 metabolism. SARS-CoV-2 infection remodels host cell metabolism, which in turn modulates viral biogenesis and replication. Remodeling of host metabolism creates metabolic vulnerability of SARS-CoV-2 replication, which could be explored to uncover new therapeutic targets. The efficacy of metabolic inhibitors against COVID-19 is under investigation in several clinical trials. Ultimately, the knowledge of SARS-CoV-2-induced metabolic reprogramming would accelerate drug repurposing or screening to combat the COVID-19 pandemic.

6.
Dis Markers ; 2022: 6362344, 2022.
Article in English | MEDLINE | ID: covidwho-1909902

ABSTRACT

Sepsis is a common critical clinical disease with high mortality that can cause approximately 10 million deaths worldwide each year. Acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) is a common clinical complication of sepsis, which occurs primarily as diffuse alveolar injury, hypoxemia, and respiratory distress. The mortality rate of ALI/ARDS is as high as 30%-40%, which greatly endangers human health. Due to the unclear pathogenesis of ALI/ARDS, its treatment is still a worldwide problem. At present, clinical treatment mainly relies on lung-protective ventilation, prone position ventilation, and fluid management. However, there is a lack of effective and specific treatment measures. In recent years, domestic and foreign scholars have committed to basic research on ALI/ARDS, trying to further clarify its pathogenesis and find new targets and methods for the treatment of ALI/ARDS. In this review, we summarize the signaling pathways related to alveolar injury and repair in sepsis-induced ALI/ARDS and their latest research progress. They include the NF-κB, JAK2/STAT3, mitogen-activated protein kinase (MAPK), mTOR, and Notch signaling pathways. Understanding the molecular mechanisms of these signaling pathways in sepsis-induced ALI/ARDS may provide new targets and ideas for the clinical treatment of this disease.


Subject(s)
Acute Lung Injury , Respiratory Distress Syndrome , Sepsis , Acute Lung Injury/etiology , Acute Lung Injury/pathology , Humans , Respiration, Artificial , Respiratory Distress Syndrome/etiology , Sepsis/complications , Signal Transduction
7.
Applied Sciences ; 12(12):5909, 2022.
Article in English | MDPI | ID: covidwho-1883983

ABSTRACT

COVID-19 can be easily transmitted to passengers by inhaling exhaled droplets from the infected person in a bus. Therefore, studying droplet dispersion would provide further insight into the mechanism of virus transmission and predict the risk of infection among passengers on a bus. In this research, a bus equipped with air-conditioning was employed as the research object. To determine the dispersion path, concentration distribution, and escape time of the droplets, computational fluid dynamic (CFD) was applied to simulate the flow field and the droplets' dispersion. The effect of the air supply rate, the location of vents, and the location of infected persons on the dispersion were discussed. Based on the distribution of droplets in the cabin calculated by CFD, a superposition method was used to determine the number of virus particles inhaled by every individual passenger over a four-hour journey. Then, infection risk was assessed by the Wells-Riley equation for all the passengers in the cabin after the whole journey. The results show that the distribution of droplets in the cabin is greatly influenced by the location of the infected person, and the airflow pattern is highly associated with the air supply rate and the location of vents. The infection risk of passengers located at the droplet dispersion path and the distance from the infected persons less than 2.2 m is over 10%. The increase in the air supply rate could speed up the spread of the droplets but at the same time, it could reduce the infection risk.

8.
Vaccine ; 40(14): 2233-2239, 2022 03 25.
Article in English | MEDLINE | ID: covidwho-1757910

ABSTRACT

A reference standard is needed for quality control of protein subunit SARS-CoV-2 vaccines to meet urgent domestic needs. The Chinese National Institutes for Food and Drug Control (NIFDC) launched a project to establish the first reference material for the protein subunit SARS-CoV-2 vaccine to be used for calibration of antigen testing. The potency and stability of the national candidate standard (CS) were determined by collaborative calibration, and accelerated and freeze-thaw degradation studies. Moreover, a suitability study of the CS was performed. Eight laboratories in mainland China were asked to detect antigen content of CS using a common validated enzyme-linked immunosorbent assay (ELISA) kit established by NIFDC and in-house kits in the collaborative study. Six laboratories returned valid results, which established that the antigen content of the CS was 876,938 YU/mL, with good agreement across laboratories. In the suitability study, the CS exhibited excellent parallelism and a linear relationship with four samples produced by different expression systems and target proteins. In addition, good stability in the accelerated and freeze-thaw degradation study was observed. In conclusion, the CS was approved by the Biological Product Reference Standards Sub-Committee of the National Drug Reference Standards Committee as the first Chinese national standard for determining antigen content of protein subunit SARS-CoV-2 vaccines, with an assigned antigen content of 877,000 U/mL (Lot. 300050-202101). This standard will contribute to a standardized assessment of protein subunit SARS-CoV-2 vaccine in China and may provide experience for developing reference materials for antigen content detection of SARS-CoV-2 vaccine in other countries.


Subject(s)
COVID-19 Vaccines , COVID-19 , COVID-19/prevention & control , Humans , Protein Subunits , Reference Standards , SARS-CoV-2
9.
Physics of fluids (Woodbury, N.Y. : 1994) ; 34(1), 2022.
Article in English | EuropePMC | ID: covidwho-1755411

ABSTRACT

During an airborne infectious disease outbreak, bus passengers can be easily infected by the dispersion of exhaled droplets from an infected passenger. Therefore, measures to control the transport of droplets are necessary, such as a mask or purifier. The current research examined aerosol transport in a bus with air-conditioning. To determine the dispersion path, deposition distribution, and droplet escape time, the computational fluid dynamics were used to predict the flow field and the dispersion of droplets considering the effects of droplet size, location of the infected person, and purifier type. In addition, based on the viability and the number of virus particles in a droplet, the total number of virus particles inhaled by passengers over a 4-h journey was obtained by the superposition method. The Wells–Riley equation was then used to assess the infection risk of the passengers in the bus cabin. The results showed that droplets with a size of 1–20 μm have essentially the same deposition characteristics, and the location of the infected passenger affects the distribution of droplets' transport and the effectiveness of a purifier in removing droplets. A purifier can effectively remove droplets from passengers' coughs and reduce the infection risk of passengers. The performance of the smaller purifiers is not as stable as that of the larger purifiers, and the performance is influenced by the airflow structure where the infected passenger is located.

10.
Int J Gen Med ; 15: 2957-2962, 2022.
Article in English | MEDLINE | ID: covidwho-1753258

ABSTRACT

Background: The aim of this study was to analyse changes in influenza detection rates of the influenza seasons 2017/2018, 2018/2019, 2019/2020, and 2020/2021 and the changes in personal awareness of protection during the COVID-19 pandemic. Methods: This retrospective study included patients tested for influenza virus A and B from November 2017 to March 2021 at the Affiliated People's Hospital of Ningbo University (Ningbo, China). Influenza virus A and B tested by direct RT-PCR. A small group of 100 regular participants in influenza virus detection were surveyed on the use of protective measures in four different influenza seasons. Results: There were 14,902, 14,762, 25,070, and 1107 tests of influenza virus A and B in the four influenza periods, for total positive rates of 32.45%, 35.77%, 29.40%, and 0.54%, respectively. In the two periods of four influenza seasons, from November to January, the total number of influenza samples was 8530, 4980, 22,925, 868; from February to March, the number of tests was 6372, 9782, 2145, 239. Total number of tests and positive rate decreased significantly from February/March onwards of the 2019/2020 season, coinciding with the beginning of COVID-19. The proportion of people taking protective measures also increased during the 2019/20 and 2020/21 flu seasons. Conclusion: The influenza virus has a high incidence in this area. The diagnosis rate of influenza decreased after the start of the COVID-19 pandemic. The COVID-19 pandemic had an important impact on the detection rates for influenza virus.

12.
World J Clin Cases ; 9(19): 5266-5269, 2021 Jul 06.
Article in English | MEDLINE | ID: covidwho-1314996

ABSTRACT

BACKGROUND: Since the initial recognition of coronavirus disease 2019 (COVID-19) in Wuhan, this infectious disease has spread to most areas of the world. The pathogenesis of COVID-19 is yet unclear. Hepatitis B virus (HBV) reactivation occurring in COVID-19 patients has not yet been reported. CASE SUMMARY: A 45-year-old hepatitis B man with long-term use of adefovir dipivoxil and entecavir for antiviral therapy had HBV reactivation after being treated with methylprednisolone for COVID-19 for 6 d. CONCLUSION: COVID-19 or treatment associated immunosuppression may trigger HBV reactivation.

13.
Signal Transduct Target Ther ; 6(1): 199, 2021 05 18.
Article in English | MEDLINE | ID: covidwho-1233705

ABSTRACT

The outbreak of COVID-19 has posed a huge threat to global health and economy. Countermeasures have revolutionized norms for working, socializing, learning, and travel. Importantly, vaccines have been considered as most effective tools to combat with COVID-19. As of the beginning of 2021, >200 COVID-19 vaccine candidates, covering nearly all existing technologies and platforms, are being research and development (R&D) by multiple manufacturers worldwide. This has posed a huge obstacle to the quality control and evaluation of those candidate vaccines, especially in China, where five vaccine platforms are deployed in parallel. To accelerate the R&D progress of COVID-19 vaccines, the guidances on R&D of COVID-19 vaccine have been issued by National Regulatory Authorities or organizations worldwide. The Center for Drug Evaluation and national quality control laboratory in China have played a leading role in launching the research on quality control and evaluation in collaboration with relevant laboratories involved in the vaccine R&D, which greatly supported the progression of vaccines R&D, and accelerated the approval for emergency use and conditional marketing of currently vaccine candidates. In this paper, the progress and experience gained in quality control and evaluation of COVID-19 vaccines developed in China are summarized, which might provide references for the R&D of current and next generation of COVID-19 vaccines worldwide.


Subject(s)
COVID-19 Vaccines , COVID-19 , SARS-CoV-2/immunology , COVID-19/immunology , COVID-19/prevention & control , COVID-19 Vaccines/chemistry , COVID-19 Vaccines/immunology , COVID-19 Vaccines/therapeutic use , Global Health , Humans , Quality Control
14.
Nature ; 595(7865): 107-113, 2021 07.
Article in English | MEDLINE | ID: covidwho-1207148

ABSTRACT

COVID-19, which is caused by SARS-CoV-2, can result in acute respiratory distress syndrome and multiple organ failure1-4, but little is known about its pathophysiology. Here we generated single-cell atlases of 24 lung, 16 kidney, 16 liver and 19 heart autopsy tissue samples and spatial atlases of 14 lung samples from donors who died of COVID-19. Integrated computational analysis uncovered substantial remodelling in the lung epithelial, immune and stromal compartments, with evidence of multiple paths of failed tissue regeneration, including defective alveolar type 2 differentiation and expansion of fibroblasts and putative TP63+ intrapulmonary basal-like progenitor cells. Viral RNAs were enriched in mononuclear phagocytic and endothelial lung cells, which induced specific host programs. Spatial analysis in lung distinguished inflammatory host responses in lung regions with and without viral RNA. Analysis of the other tissue atlases showed transcriptional alterations in multiple cell types in heart tissue from donors with COVID-19, and mapped cell types and genes implicated with disease severity based on COVID-19 genome-wide association studies. Our foundational dataset elucidates the biological effect of severe SARS-CoV-2 infection across the body, a key step towards new treatments.


Subject(s)
COVID-19/pathology , COVID-19/virology , Kidney/pathology , Liver/pathology , Lung/pathology , Myocardium/pathology , SARS-CoV-2/pathogenicity , Adult , Aged , Aged, 80 and over , Atlases as Topic , Autopsy , Biological Specimen Banks , COVID-19/genetics , COVID-19/immunology , Endothelial Cells , Epithelial Cells/pathology , Epithelial Cells/virology , Female , Fibroblasts , Genome-Wide Association Study , Heart/virology , Humans , Inflammation/pathology , Inflammation/virology , Kidney/virology , Liver/virology , Lung/virology , Male , Middle Aged , Organ Specificity , Phagocytes , Pulmonary Alveoli/pathology , Pulmonary Alveoli/virology , RNA, Viral/analysis , Regeneration , SARS-CoV-2/immunology , Single-Cell Analysis , Viral Load
15.
Nature ; 595(7865): 114-119, 2021 07.
Article in English | MEDLINE | ID: covidwho-1207147

ABSTRACT

Respiratory failure is the leading cause of death in patients with severe SARS-CoV-2 infection1,2, but the host response at the lung tissue level is poorly understood. Here we performed single-nucleus RNA sequencing of about 116,000 nuclei from the lungs of nineteen individuals who died of COVID-19 and underwent rapid autopsy and seven control individuals. Integrated analyses identified substantial alterations in cellular composition, transcriptional cell states, and cell-to-cell interactions, thereby providing insight into the biology of lethal COVID-19. The lungs from individuals with COVID-19 were highly inflamed, with dense infiltration of aberrantly activated monocyte-derived macrophages and alveolar macrophages, but had impaired T cell responses. Monocyte/macrophage-derived interleukin-1ß and epithelial cell-derived interleukin-6 were unique features of SARS-CoV-2 infection compared to other viral and bacterial causes of pneumonia. Alveolar type 2 cells adopted an inflammation-associated transient progenitor cell state and failed to undergo full transition into alveolar type 1 cells, resulting in impaired lung regeneration. Furthermore, we identified expansion of recently described CTHRC1+ pathological fibroblasts3 contributing to rapidly ensuing pulmonary fibrosis in COVID-19. Inference of protein activity and ligand-receptor interactions identified putative drug targets to disrupt deleterious circuits. This atlas enables the dissection of lethal COVID-19, may inform our understanding of long-term complications of COVID-19 survivors, and provides an important resource for therapeutic development.


Subject(s)
COVID-19/pathology , COVID-19/virology , Lung/pathology , SARS-CoV-2/pathogenicity , Single-Cell Analysis , Aged , Aged, 80 and over , Alveolar Epithelial Cells/pathology , Alveolar Epithelial Cells/virology , Atlases as Topic , Autopsy , COVID-19/immunology , Case-Control Studies , Female , Fibroblasts/pathology , Fibrosis/pathology , Fibrosis/virology , Humans , Inflammation/pathology , Inflammation/virology , Macrophages/pathology , Macrophages/virology , Macrophages, Alveolar/pathology , Macrophages, Alveolar/virology , Male , Middle Aged , Plasma Cells/immunology , T-Lymphocytes/immunology
16.
Int Immunopharmacol ; 89(Pt B): 107089, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-844966

ABSTRACT

AIM: To evaluate the nucleic acid and antibody test results of patients with Coronavirus Disease 2019 (COVID-19) in China. METHODS: All patients with laboratory-confirmed SARS-CoV-2 infection from Jan to Apr 2020were retrospectively analyzed. Clinical characteristics and laboratory test results were obtained from electronic medical records. Patients were divided into three groups based on antibody production, and compared for laboratory test results. RESULTS: Of 73 patients aged11-82 years, 12 (16.4%), 28 (38.4%), 25 (34.2%) and 8 (11.0%)were ≤ 30, 31-50, 51-70,and ≥ 71 years old, respectively. Thirty-four (46.6%) patients were male. Most individuals had mild symptoms, and no patient died during treatment. All patients were tested positive for SARS-CoV-2 in sputum and nasopharyngeal samples, and 40 (54.8%) were also tested positive in stool. Nine(12.3%) patients were re-positivefor SARS-CoV-2, as assessed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR) after discharge. Sixty-five (89.0%) patients had IgM or IgG antibodies against SARS-CoV-2.Among the four age groups, there was no difference in IgG antibody production (P = 0.664).CD3, CD4, CD8 and CD19 cell counts between the antibody producing and non-producing groups showed no significant differences (all P > 0.05).The antibodies disappeared within two months in four patients. Lymphocyte count, C-reactive protein, IL-6, lactate dehydrogenase, alanine aminotransferase, creatinine and D-Dimer levels were similar in the three groups (all P > 0.05). CONCLUSIONS: Patients after recovery from COVID-19 can be tested positive for SARS-CoV-2.Some patients may produce antibodies only for a short time, or even no antibodies at all.


Subject(s)
Antibodies, Viral/analysis , COVID-19 Nucleic Acid Testing , COVID-19 Serological Testing , COVID-19/diagnosis , SARS-CoV-2 , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Retrospective Studies , Young Adult
17.
Genes Dis ; 7(4): 558-566, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-666065

ABSTRACT

Superspreaders are critical infectious resources in multiple infectious diseases. They can be asymptomatic or present mild symptoms but can transmit pathogens to susceptible populations, leading to severe symptoms, and even death. Early identification of this population is extremely important to inhibit the spread of infectious diseases. Right now, the whole global world is suffering from a devastating infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this article, a superspreader cluster event in coronavirus disease 2019 (COVID-19) was identified by tracking contacting histories of infected patients. This cluster was found to be originated from an asymptomatic SARS-CoV-2 carrier, which resulted in 13 secondary cases getting infected. All the secondary patients presented with non-typical symptoms of COVID-19, such as fever, dry cough, and myalgia, one of which died of respiratory failure at the end. From this cluster, we learn that people with older ages, low immunity, multiple underlying diseases, especially pulmonary diseases, can contribute to a poor prognosis. Thus, asymptomatic superspreaders of COVID-19 can be extremely dangerous and must be handled time-efficiently.

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