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1.
Einstein (Sao Paulo) ; 20: eAO6497, 2022.
Article in English | MEDLINE | ID: covidwho-1789931

ABSTRACT

OBJECTIVE: To evaluate the positioning of the distal tip of central venous catheters and the factors that contributed to inadequate positioning in patients admitted to intensive care. METHODS: This is a cross-sectional study, with a sample of 246 medical records of patients admitted to intensive care units. A catheter position analysis form was used as an instrument for data collection. RESULTS: It was seen that 86.2% of catheters used in intensive care were centrally inserted in the internal jugular veins, 74.4% were double-lumen catheter, and ultrasound was employed for puncture technique in 84.6% of cases. Of the distal ends of the catheters, 53.7% were at the cavoatrial junction (correct position). According to statistical tests, there was a positive correlation between the inadequate positioning of the distal extremity with the central insertion catheter (p=0.012). Patients with presumptive diagnosis associated with COVID-19 showed a positive correlation with inappropriate positioning of the catheter distal tip (p=0.017). CONCLUSION: There are extrinsic factors related to improper positioning of the distal tip of catheters, such as the type of catheter used, the patients' diagnosis and the puncture with insertion in the left jugular vein.


Subject(s)
COVID-19 , Catheterization, Central Venous , Central Venous Catheters , Catheters, Indwelling , Cross-Sectional Studies , Humans , Intensive Care Units , Jugular Veins/diagnostic imaging
2.
Kidney360 ; 1(10): 1165-1177, 2020 10 29.
Article in English | MEDLINE | ID: covidwho-1776843

ABSTRACT

In-center hemodialysis (HD) remains the predominant dialysis therapy in patients with ESKD. Many patients with ESKD present in late stage, requiring urgent dialysis initiation, and the majority start HD with central venous catheters (CVCs), which are associated with poor outcomes and high cost of care. Peritoneal dialysis (PD) catheters can be safely placed in such patients with late-presenting ESKD, obviating the need for CVCs. PD can begin almost immediately in the recumbent position, using low fill volumes. Such PD initiations, commencing within 2 weeks of the catheter placement, are termed urgent-start PD (USPD). Most patients with an intact peritoneal cavity and stable home situation are eligible for USPD. Although there is a small risk of PD catheter-related mechanical complications, most can be managed conservatively. Moreover, overall outcomes of USPD are comparable to those with planned PD initiations, in contrast to the high rate of catheter-related infections and bacteremia associated with urgent-start HD. The ongoing coronavirus disease 2019 pandemic has further exposed the vulnerability of patients with ESKD getting in-center HD. PD can mitigate the risk of infection by reducing environmental exposure to the virus. Thus, USPD is a safe and cost-effective option for unplanned dialysis initiation in patients with late-presenting ESKD. To develop a successful USPD program, a strong infrastructure with clear pathways is essential. Coordination of care between nephrologists, surgeons or interventionalists, and hospital and PD center staff is imperative so that patient education, home visits, PD catheter placements, and urgent PD initiations are accomplished expeditiously. Implementation of urgent-start PD will help to increase PD use, reduce cost, and improve patient outcomes, and will be a step forward in fostering the goal set by the Advancing American Kidney Health initiative.


Subject(s)
COVID-19 , Central Venous Catheters , Kidney Failure, Chronic , Peritoneal Dialysis , COVID-19/epidemiology , Humans , Kidney Failure, Chronic/therapy , Renal Dialysis
3.
Clin J Am Soc Nephrol ; 17(3): 429-433, 2022 03.
Article in English | MEDLINE | ID: covidwho-1674203

ABSTRACT

Measures implemented to prevent transmission of severe acute respiratory syndrome coronavirus 2 in outpatient dialysis facilities may also help to prevent catheter-associated bloodstream infections in patients receiving hemodialysis. We used United States Renal Data System data to examine rates of antibiotic administration within dialysis facilities and rates of hospital admission for catheter-associated bloodstream infection from March 2018 through November 2020, and rates of hospitalization for sepsis, to address overall changes in hospitalization during the coronavirus disease 2019 (COVID-19) pandemic. Using logistic regression, we estimated year-over-year adjusted odds ratios of these events in 3-month intervals. During the first 6 months of the pandemic, rates of antibiotic administration were between 20% and 21% lower, and rates of hospitalization for catheter-associated bloodstream infection were between 17% and 24% lower than during corresponding periods in 2019, without significant changes in rates of hospitalization for sepsis. However, rates of catheter-associated events also decreased between 2018 and 2019, driven by reductions in facilities operated by a large dialysis provider. These data suggest that significant reductions in catheter-associated infections occurred during the pandemic, superimposed on nonpandemic-related reductions in some facilities before the pandemic. Even after the pandemic, it may be prudent to continue some COVID-19 mitigation measures to prevent catheter-associated bloodstream infections.


Subject(s)
COVID-19/prevention & control , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Central Venous Catheters/adverse effects , Infection Control , Renal Dialysis/adverse effects , Aged , Anti-Bacterial Agents/therapeutic use , COVID-19/transmission , COVID-19/virology , Catheter-Related Infections/microbiology , Catheter-Related Infections/transmission , Catheterization, Central Venous/instrumentation , Female , Hospitalization , Humans , Male , Middle Aged , Protective Factors , Renal Dialysis/instrumentation , Risk Assessment , Risk Factors , Time Factors , United States
4.
Breast Dis ; 41(1): 1-3, 2022.
Article in English | MEDLINE | ID: covidwho-1604128

ABSTRACT

During the first hit of SARS-COVID pandemic, an important reorganization of Healthcare Services has been done, and new protocols and pathways to protect frail patients like oncological patients were designed. The second hit of pandemic had stressed these new pathways and suggests to health-workers some improvements for safer management of patents.We reported our experience in organizing the clinical pathway of neoadjuvant therapy candidate patients based on the execution of sentinel lympho-node biopsy and the placement of implantable venous access port in the same access to operating room before neoadjuvant chemotherapy suggesting a possible organizational model. In the period October-December 2020 we have included in this new type of path twelve patients and we have not registered any cases of COVID among the patients included. We think this new path, adopted amid the second hit, will be useful for all Breast Units that are facing the challenge of guaranteeing the highest standards of care in a historical moment where the health emergency occupies the efforts of health workers and the economic resources of health systems.


Subject(s)
Antineoplastic Agents/administration & dosage , Breast Neoplasms/drug therapy , COVID-19/prevention & control , Catheterization, Central Venous/methods , Infection Control/methods , Patient Safety , Sentinel Lymph Node Biopsy/methods , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/therapeutic use , Breast Neoplasms/pathology , Breast Neoplasms/surgery , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/standards , Central Venous Catheters , Chemotherapy, Adjuvant , Critical Pathways , Female , Humans , Infection Control/standards , Mastectomy , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Sentinel Lymph Node Biopsy/standards
6.
Int Urol Nephrol ; 54(1): 193-199, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1270535

ABSTRACT

PURPOSE: Hemodialysis patients with COVID-19 are at increased risk of death. We aimed to describe the characteristics of a cohort of Brazilian hemodialysis patients with COVID-19 and assess their mortality rate and risk factors for death. METHODS: Retrospective cohort study of 741 Brazilian hemodialysis patients with confirmed COVID-19 from Feb-Dec/2020, of 52 dialysis centers of the country. We analyzed comorbid conditions, sociodemographic factors, and dialysis-related parameters. To detect risk factors for mortality in hemodialysis patients, we performed multivariable Cox proportional hazard regression analysis. Survival was analyzed by Kaplan-Meier. RESULTS: From 9877 hemodialysis patients, 741 were diagnosed with COVID-19. Mean age was 57 ± 16 years, 61% were male, and 51% white. The most frequent symptoms were fever (54.1%), cough (50.9%), and dyspnea (37.2%); 14.2% were asymptomatic. There were 139 deaths (18.8%), with 66% within the disease's first 15 days. 333 patients (44.9%) required hospitalization, and 211 (28.5%) were admitted to an intensive care unit. The cumulative probability of survival at 90 days of diagnosis was 79% (95% CI 76-82%). In the fully adjusted multivariate model, the risk factors significantly associated with death were diabetes mellitus (HR 1.52, 95% CI 1.05-2.19, P = 0.026), use of a central venous catheter (CVC) (HR 1.79, 95% CI 1.22-2.64, P = 0.003), age (HR 1.03, 95% CI 1.01-1.04, P < 0.001), and origin from the North vs. Southeast region (HR 2.60, 95% CI 1.01-6.68, P = 0.047). CONCLUSIONS: Hemodialysis patients using a CVC as the vascular access, aside from diabetic and elderly ones, should be closely monitored due to their high risk of death in the course of the COVID-19.


Subject(s)
COVID-19/epidemiology , Catheter-Related Infections/etiology , Central Venous Catheters/adverse effects , Kidney Failure, Chronic/therapy , Renal Dialysis/adverse effects , Brazil/epidemiology , Catheter-Related Infections/epidemiology , Comorbidity , Female , Follow-Up Studies , Humans , Incidence , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Retrospective Studies , SARS-CoV-2 , Survival Rate/trends , Time Factors
7.
BMJ Open ; 11(4): e042475, 2021 04 14.
Article in English | MEDLINE | ID: covidwho-1186290

ABSTRACT

INTRODUCTION: Peripherally inserted central catheters (PICCs) are vital for the delivery of medical therapies, but up to 30% of PICCs are associated with complications such as deep vein thrombosis or infection. The integration of antimicrobial and hydrophobic catheter materials, and pressure-activated valves, into polyurethane PICCs are innovations designed to prevent infective and/or thrombotic complications. METHODS AND ANALYSIS: A multicentre, parallel group, superiority randomised controlled trial with two experimental arms ((1) hydrophobic PICC (with pressure-activated valve); (2) chlorhexidine gluconate-impregnated PICC (with external clamp)) and one control group ((3) conventional polyurethane PICC (with external clamp)). Recruitment of 1098 adult and paediatric patients will take place over 2 years at three tertiary-referral hospitals in Queensland, Australia. Patients are eligible for inclusion if their PICC is to be inserted for medical treatment, with a vascular size sufficient to support a 4-Fr PICC or larger, and with informed consent. The primary outcome is PICC failure, a composite of thrombotic (venous thrombosis, breakage and occlusion) and infective complications (PICC-associated bloodstream infection and local infection). Secondary outcomes include: all-cause PICC complication; thrombotic complications; infective complications; adverse events (local or systemic reaction); PICC dwell time; patient/parent satisfaction; and healthcare costs. Differences between both intervention groups and the control group will be compared using Cox proportional hazards regression. Effect estimates will be presented as HRs with corresponding 95% CI. ETHICS AND DISSEMINATION: Ethical approval from Queensland Health (HREC/QCHQ/48682) and Griffith University (Ref. No. 2019/094). Results will be published. TRIAL REGISTRATION NUMBER: ACTRN12619000022167.


Subject(s)
Catheter-Related Infections , Catheterization, Central Venous , Catheterization, Peripheral , Central Venous Catheters , Adult , Australia , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Catheterization, Peripheral/adverse effects , Central Venous Catheters/adverse effects , Child , Humans , Multicenter Studies as Topic , Queensland , Randomized Controlled Trials as Topic , Risk Factors
8.
ESMO Open ; 6(2): 100100, 2021 04.
Article in English | MEDLINE | ID: covidwho-1141761

ABSTRACT

High mortality rates in elderly patients or in those with underlying chronic illnesses and/or a compromised immune system is a peculiar feature of COVID-19 infection. The possible coexistence of a cancer and COVID-19 infection in the same individual prompted concerns regarding their synergistic effect on prognosis. In order to balance patients' needs with the risks related to the infection, the question oncologists have asked from the beginning of the first wave of the pandemic has been: 'how can we deal with COVID-19 infection in cancer patients?' In pursuing its mission, the Associazione Italiana Oncologia Medica (AIOM) has made every possible effort to support cancer patients, health care professionals and institutions in the decision-making processes the pandemic has engendered within this scenario. The relevant documents as well as the educational and institutional initiatives the AIOM has taken are reported in this article.


Subject(s)
COVID-19 Vaccines , COVID-19 , Neoplasms , Societies, Medical , COVID-19/prevention & control , Central Venous Catheters , Clinical Trials as Topic , Humans , Influenza Vaccines , Neoplasms/therapy , Oncologists , Practice Guidelines as Topic
9.
J Vasc Surg ; 73(6): 1881-1888.e3, 2021 06.
Article in English | MEDLINE | ID: covidwho-1096146

ABSTRACT

OBJECTIVE: The hypercoagulability seen in patients with novel coronavirus disease 2019 (COVID-19) likely contributes to the high temporary hemodialysis catheter (THDC) malfunction rate. We aim to evaluate prophylactic measures and their association with THDC patency. METHODS: A retrospective chart review of our institutions COVID-19 positive patients who required placement of a THDC between February 1 to April 30, 2020, was performed. The association between heparin locking, increased dosing of venous thromboembolism (VTE) prophylaxis and systemic anticoagulation on THDC patency was assessed. Proportional hazards modeling was used to perform a survival analysis to estimate the likelihood and timing of THDC malfunction with the three different prophylactic measures. We also determined the mortality, rate of THDC malfunction and its association with d-dimer levels. RESULTS: A total of 48 patients with a mortality rate of 71% were identified. THDC malfunction occurred in 31.3% of patients. Thirty-seven patients (77.1%) received heparin locking, 22 (45.8%) received systemic anticoagulation, and 38 (79.1%) received VTE prophylaxis. Overall, the rate of THDC malfunction was lower at a trend level of significance, with heparin vs saline locking (24.3% vs 54.6%; P = .058). The likelihood of THDC malfunction in the heparin locked group is lower than all other groups (hazard ratio [HR], 0.07; 95% confidence interval [CI], 0.01-0.45]; P = .005). The rate of malfunction in patients with subcutaneous heparin (SQH) 7500 U three times daily is significantly lower than of the rate for patients receiving none (HR, 0.03; 95% CI, 0.001-0.74; P = .032). A trend level significant association was found for SQH 5000 U vs none (P = .417) and SQH 7500 vs 5000 U (P = .059). Systemic anticoagulation did not affect the THDC malfunction rate (P = .240). Higher d-dimer levels were related to greater mortality (HR, 3.28; 95% CI, 1.16-9.28; P = .025), but were not significantly associated with THDC malfunction (HR, 1.79; 95% CI, 0.42, 7.71; P = .434). CONCLUSIONS: Locking THDCs with heparin is associated with a lower malfunction rate. Prospective randomized studies will be needed to confirm these findings to recommend locking THDC with heparin in patients with COVID-19. Increased VTE prophylaxis suggested a possible association with improved THDC patency, although the comparison lacked sufficient statistical power.


Subject(s)
Anticoagulants/therapeutic use , COVID-19/complications , Central Venous Catheters , Equipment Failure , Heparin/therapeutic use , Renal Dialysis/instrumentation , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Aged , Cohort Studies , Female , Humans , Male , Retrospective Studies , Time Factors
10.
J Thromb Thrombolysis ; 52(2): 482-492, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1086634

ABSTRACT

Previous studies have suggested that COVID-19 pneumonia is associated with an increased risk of venous thromboembolism (VTE). This study aimed to investigate the incidence of VTE among mechanically ventilated adults with COVID-19 pneumonia, compared to patients with respiratory failure related to other causes. Prospective study that enrolled critically ill adults with suspected COVID-19 pneumonia between June 2, 2020 and August 11, 2020. Critically ill adults with suspected COVID-19 pneumonia who required mechanical ventilation within 24 h after hospital admission were followed until death or hospital discharge. Sequential ultrasonography screening of the lower extremities and catheter insertion sites, as well as testing for plasma biochemical markers, were performed at the intensive care unit admission, day 3, day 7, and day 14. The primary outcome was a composite of deep venous thrombosis, pulmonary embolism, and thrombosis at the central catheter insertion sites. We enrolled 70 patients, including 57 patients with COVID-19 and 13 patients without COVID-19, and all patients completed follow-up. The incidence of the primary outcome was higher among patients with COVID-19 than among patients with respiratory failure related to other etiologies (36.8% vs. 0%, p = 0.023). Multivariate regression analysis revealed that VTE was independently associated with a COVID-19 diagnosis (odds ratio: 6.28, 95% confidence interval: 1.19-68.07) and D-dimer concentration (1-ng/mL increase, odds ratio: 1.15, 95% confidence interval: 1.05-1.30). The incidence of VTE was higher among critically ill mechanically ventilated patients, relative to among patients with respiratory failure related to other causes.


Subject(s)
COVID-19 , Critical Illness , Pneumonia, Viral , Pulmonary Embolism , Respiratory Insufficiency , Risk Assessment , Venous Thromboembolism , Brazil/epidemiology , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , COVID-19 Testing/methods , Central Venous Catheters/adverse effects , Critical Illness/epidemiology , Critical Illness/therapy , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Incidence , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Prospective Studies , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , Respiration, Artificial/methods , Respiration, Artificial/statistics & numerical data , Respiratory Insufficiency/epidemiology , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Venous Thromboembolism/blood , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology , Venous Thromboembolism/therapy
12.
Infect Control Hosp Epidemiol ; 42(1): 84-88, 2021 01.
Article in English | MEDLINE | ID: covidwho-1003194

ABSTRACT

We observed bacterial or fungal coinfections in COVID-19 patients admitted between March 1 and April 18, 2020 (152 of 4,267, 3.6%). Among these patients, mortality was 57%; 74% were intubated; 51% with bacteremia had central venous catheters. Time to culture positivity was 6-7 days, and 79% had received prior antibiotics. Metallo-ß-lactamase-producing E. cloacae coinfections occurred in 5 patients.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia , COVID-19 , Coinfection , Mycoses , SARS-CoV-2/isolation & purification , Bacteremia/diagnosis , Bacteremia/epidemiology , Bacteremia/therapy , COVID-19/epidemiology , COVID-19/microbiology , COVID-19/therapy , Central Venous Catheters/microbiology , Central Venous Catheters/statistics & numerical data , Coinfection/epidemiology , Coinfection/microbiology , Coinfection/virology , Drug Resistance, Bacterial , Female , Humans , Male , Microbiological Techniques/methods , Microbiological Techniques/statistics & numerical data , Middle Aged , Mycoses/diagnosis , Mycoses/epidemiology , Mycoses/therapy , New York/epidemiology , Outcome and Process Assessment, Health Care , Respiration, Artificial/statistics & numerical data , Severity of Illness Index
13.
J Nephrol ; 34(2): 345-353, 2021 04.
Article in English | MEDLINE | ID: covidwho-996505

ABSTRACT

BACKGROUND: In hemodialysis (HD) patients, central venous catheter (CVC) related bloodstream infections are a major cause of morbidity and mortality. Hygienic precautions are a key aspect of dialysis care for infection prevention, but they are not sufficient to completely avoid the occurrence of CVC related infections. During the COVID-19 pandemic, hygienic precautions for preventing viral transmission have been markedly reinforced. We evaluated their effects on CVC-related infection rates. METHODS: An observational retrospective study was conducted in two hemodialysis units of the same institution treating 215 chronic hemodialysis patients, 71 of whom are currently (33%) using a CVC. In the CVC cohort, we compared data on catheter-related infection rates during the maximum spread of the COVID-19 pandemic in Italy (February to May 2020) with data from the same period of the previous year and with the whole of 2019. RESULTS: In 2019, we recorded a catheter-related bloodstream infection (CRBSI) rate of 1.19 (95% CI 0.81-1.68)/1000 days [2.07 (95% CI 1.12-3.52)/1000 days in the Feb-May 2019 period] and a tunnel and exit-site infection rate of 0.82 (95% CI 0.51-1.24)/1000 days [1.04 (95% CI 0.41-2.15)/1000 days in the Feb-May 2019 period]. Infection rates drastically decreased during the COVID-19 pandemic, with just one catheter-related bloodstream infection being recorded. Catheter-related bloodstream infection rates showed a significant reduction to 0.20 (95% CI 0.01-0.9)/1000 days (p < 0.05 and p < 0.005 compared to 2019 and to Feb-May 2019, respectively) and a non-significant reduction in tunnel and exit-site infections to 0.6 (95% CI 0.15-1.6)/1000 days. CONCLUSIONS: The observed 91% reduction in catheter-related bloodstream infections compared to the same period in 2019 [IRR 0.09 (95% CI 0.002-0.64)] and the 83% reduction compared to the whole of 2019 [IRR 0.17 (95% CI 0.004-1.009)] suggest that a stricter implementation of hygienic precautions in the dialysis setting can markedly improve the problem of CVC-related infections.


Subject(s)
COVID-19/prevention & control , Catheter-Related Infections/prevention & control , Central Venous Catheters/adverse effects , Pandemics , Renal Dialysis/adverse effects , Aged , COVID-19/epidemiology , Catheter-Related Infections/epidemiology , Comorbidity , Female , Humans , Incidence , Italy/epidemiology , Kidney Failure, Chronic/epidemiology , Kidney Failure, Chronic/therapy , Male , Retrospective Studies , SARS-CoV-2
14.
Adv Chronic Kidney Dis ; 27(5): 377-382, 2020 09.
Article in English | MEDLINE | ID: covidwho-796111

ABSTRACT

Acute kidney injury is a common complication in hospitalized patients with coronavirus disease 2019. Similar to acute kidney injury associated with other conditions such as sepsis and cardiac surgery, morbidity and mortality are much higher in patients with coronavirus disease 2019 who develop acute kidney injury, especially in the intensive care unit. Management of coronavirus disease 2019-associated acute kidney injury with kidney replacement therapy should follow existing recommendations regarding modality, dose, and timing of initiation. However, patients with coronavirus disease 2019 are very hypercoagulable, and close vigilance to anticoagulation strategies is necessary to prevent circuit clotting. During situations of acute surge, where demand for kidney replacement therapy outweighs supplies, conservative measures have to be implemented to safely delay kidney replacement therapy. A collaborative effort and careful planning is needed to conserve dialysis supplies, to ensure that treatment can be safely delivered to every patient who will benefit for kidney replacement therapy.


Subject(s)
Acute Kidney Injury/therapy , Anticoagulants/therapeutic use , COVID-19/therapy , Renal Replacement Therapy/methods , Thrombophilia/drug therapy , COVID-19/blood , Catheterization, Central Venous , Central Venous Catheters , Citric Acid/therapeutic use , Continuous Renal Replacement Therapy/methods , Hemodialysis Solutions/supply & distribution , Hemoperfusion/methods , Heparin/therapeutic use , Humans , Hybrid Renal Replacement Therapy/methods , Intermittent Renal Replacement Therapy/methods , Kidneys, Artificial/supply & distribution , Partial Thromboplastin Time , Renal Replacement Therapy/instrumentation , SARS-CoV-2 , Surge Capacity , Thrombophilia/blood
16.
J Vasc Access ; 22(4): 654-657, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-723976

ABSTRACT

This report aims to illustrate how to perform a venous access to a COVID-19 patient at the bedside. The decision on the type of venous access, the selection of the material necessary to perform the procedure, and the preparation of the operators are described. The described approach can reduce costs, speed up execution times, and make the operator's work safer. Furthermore, these precautions may help control the spread of COVID-19 within the healthcare facility.


Subject(s)
COVID-19/diagnosis , Catheterization, Central Venous/methods , Central Venous Catheters , Pandemics , Point-of-Care Testing , COVID-19/epidemiology , Humans , Radiography, Interventional/methods , SARS-CoV-2
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