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2.
J Hematol Oncol ; 15(1): 54, 2022 05 07.
Article in English | MEDLINE | ID: covidwho-1951282

ABSTRACT

BACKGROUND: The clinical efficacy of SARS-CoV-2 vaccines according to antibody response in immunosuppressed patients such as hematological patients has not yet been established. PATIENTS AND METHODS: A prospective multicenter registry-based cohort study conducted from December 2020 to December 2021 by the Spanish transplant and cell therapy group was used to analyze the relationship of antibody response at 3-6 weeks after full vaccination (2 doses) with breakthrough SARS-CoV-2 infection in 1394 patients with hematological disorders. RESULTS: At a median follow-up of 165 days after complete immunization, 37 out of 1394 (2.6%) developed breakthrough SARS-CoV-2 infection at median of 77 days (range 7-195) after full vaccination. The incidence rate was 6.39 per 100 persons-year. Most patients were asymptomatic (19/37, 51.4%), whereas only 19% developed pneumonia. The mortality rate was 8%. Lack of detectable antibodies at 3-6 weeks after full vaccination was the only variable associated with breakthrough infection in multivariate logistic regression analysis (Odds Ratio 2.35, 95% confidence interval 1.2-4.6, p = 0.012). Median antibody titers were lower in cases than in non-cases [1.83 binding antibody units (BAU)/mL (range 0-4854.93) vs 730.81 BAU/mL (range 0-56,800), respectively (p = 0.007)]. We identified 250 BAU/mL as a cutoff above which incidence and severity of the infection were significantly lower. CONCLUSIONS: Our study highlights the benefit of developing an antibody response in these highly immunosuppressed patients. Level of antibody titers at 3 to 6 weeks after 2-dose vaccination links with protection against both breakthrough infection and severe disease for non-Omicron SARS-CoV-2 variants.


Subject(s)
COVID-19 , Hematologic Diseases , Antibodies, Viral , BNT162 Vaccine , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Cohort Studies , Hematologic Diseases/complications , Hematologic Diseases/therapy , Humans , Prospective Studies , SARS-CoV-2
3.
Am J Hematol ; 97(1): 119-128, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1479374

ABSTRACT

Coronavirus disease 19 (COVID-19) is considered a multisystemic disease. Several studies have reported persistent symptoms or late-onset complications after acute COVID-19, including post-COVID-19 hematological disorders. COVID-19-induced coagulopathy, an immunothrombotic state, has been linked to thromboembolic and hemorrhagic events. Late-onset thrombocytopenia related to immune system dysregulation has also been reported as a rare manifestation post COVID-19. Close monitoring of laboratory dynamics is considered essential to identify timely abnormal values that need further investigation, providing supportive care whenever indicated. The role of hematologists is essential in terms of the multidisciplinary approach of long COVID-19. This review summarizes all the available evidence on post-acute COVID-19 hematological complications.


Subject(s)
COVID-19/complications , Hematologic Diseases/etiology , Animals , COVID-19/etiology , COVID-19/therapy , Disease Management , Hematologic Diseases/therapy , Hemorrhagic Disorders/etiology , Hemorrhagic Disorders/therapy , Humans , SARS-CoV-2/isolation & purification , Thrombocytopenia/etiology , Thrombocytopenia/therapy , Thromboembolism/etiology , Thromboembolism/therapy , Thrombosis/etiology , Thrombosis/therapy
4.
Int J Hematol ; 114(6): 709-718, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1474138

ABSTRACT

Polymerase chain reaction (PCR) tests cannot always detect the SARS-CoV-2 virus, possibly due to differences in sensitivity between sample types. Under these circumstances, immunochromatography may serve as an alternative method to detect anti-SARS-CoV-2 IgG antibodies that indicate a history of infection. In our analysis of patients with severe COVID-19 infection, we found that 14 of 19 serum samples were positive for IgG antibodies, whereas 6 of 10 samples from patients with asymptomatic or mild cases were negative. Two patients with immune thrombocytopenia who were treated with prednisolone experienced aggressive COVID-19-related respiratory failure and eventually died. Patients not in remission and those who received steroid-based chemotherapy had a higher risk of death, and patients with lymphoid malignancies including lymphoma and myeloma died in larger numbers than those with myeloid malignancies. A stricter cohorting strategy based on repeat PCR tests or isolation to a private room should be adopted in routine care in hematology departments to prevent viral spread to the environment.


Subject(s)
COVID-19 , Cross Infection/prevention & control , Hematologic Diseases/therapy , Antibodies, Viral/blood , Biomarkers/blood , COVID-19/complications , COVID-19/diagnosis , COVID-19/mortality , COVID-19/prevention & control , Female , Hematologic Diseases/complications , Hematologic Diseases/mortality , Humans , Immunoassay/methods , Immunoglobulin G/blood , Infection Control/methods , Japan , Male , Patient Isolation , Polymerase Chain Reaction , Risk , SARS-CoV-2/immunology , Severity of Illness Index , Survival Rate
6.
Clin Lymphoma Myeloma Leuk ; 21(9): 606-612, 2021 09.
Article in English | MEDLINE | ID: covidwho-1252599

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) represents an important infectious complication associated with high mortality rates in patients with hematologic diseases. There have not been published any epidemiologic studies from Czech Republic so far. PATIENTS AND METHODS: This study is the first analysis of patients with hematologic malignancies and bone marrow failure syndromes treated at single hematology center in the Czech Republic between March 1 and December 31, 2020, in whom COVID-19 infection was confirmed. RESULTS: The sample comprised 96 patients aged 26 to 84 years (median, 66.0 years). At the time of their COVID-19 diagnosis, 75 patients (78.1%) were treated for hematologic diseases. Twenty-seven patients (28.1%) in the sample had complete remission (CR) of their hematologic disease. They were nonsignificantly more likely to have asymptomatic to moderate COVID-19 infection than those who failed to achieve CR (74.1% vs. 56.5%; P = .06). A more severe course of the infection was significantly correlated with older age (P = .047). Lung involvement was also statistically significantly associated with older age (P = .045). Over the study period, a total of 15 patients died. Age greater than 60 years was significantly associated with deaths from COVID-19 (P = .036), with failure to achieve CR having a statistically nonsignificant impact on mortality (P = .22). CONCLUSION: These results confirm the prognostic significance of age for achieving treatment response of hematologic disease as well as the severity and mortality of COVID-19 in hematology patients.


Subject(s)
COVID-19 , Hematologic Diseases , Adult , Aged , Aged, 80 and over , Bone Marrow Failure Disorders/complications , Bone Marrow Failure Disorders/diagnosis , Bone Marrow Failure Disorders/epidemiology , Bone Marrow Failure Disorders/therapy , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , COVID-19 Testing/methods , COVID-19 Testing/statistics & numerical data , Czech Republic/epidemiology , Disease Progression , Female , Hematologic Diseases/complications , Hematologic Diseases/diagnosis , Hematologic Diseases/epidemiology , Hematologic Diseases/therapy , Hematologic Neoplasms/complications , Hematologic Neoplasms/diagnosis , Hematologic Neoplasms/epidemiology , Hematologic Neoplasms/therapy , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Mortality , Prevalence , SARS-CoV-2/physiology
7.
J Thromb Thrombolysis ; 52(1): 354-362, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1201643

ABSTRACT

American Society of Hematology conducts an annual meeting, where investigators from around the globe presented ground-breaking research in the fields of malignant and non-malignant hematology. We provide a summary of non-malignant hematology abstracts from the 2020 meeting. Topics included range from those related to thrombosis, including thrombotic complications of COVID-19, bleeding and novel therapies such as gene therapies. Readers are encouraged to access meeting materials for a more detailed coverage of the event.


Subject(s)
Biomedical Research , Hematology , Animals , Anticoagulants/therapeutic use , Antifibrinolytic Agents/therapeutic use , COVID-19/blood , COVID-19/complications , COVID-19/drug therapy , Congresses as Topic , Genetic Therapy , Hematologic Diseases/blood , Hematologic Diseases/genetics , Hematologic Diseases/therapy , Hemorrhage/etiology , Hemorrhage/prevention & control , Humans , Thrombosis/blood , Thrombosis/etiology , Thrombosis/prevention & control
8.
J Pediatr Hematol Oncol ; 44(1): e185-e187, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1197060

ABSTRACT

Medical care during the Coronavirus 2019 global pandemic required significant shifts in health care delivery systems. Telehealth was widely deployed but was of limited utility for patient populations who rely heavily on laboratory monitoring. This includes pediatric hematology and oncology patients. We report on the feasibility and successful implementation of a home phlebotomy program that has minimized disruption in care for this high-risk patient population. During the initial months of the COVID-19 outbreak, we completed 189 home phlebotomy visits for pediatric hematology and oncology patients. Patient and staff satisfaction with the program were high, and potential exposures to COVID were avoided.


Subject(s)
Hematologic Diseases/therapy , Hematologic Neoplasms/therapy , Home Care Services , Phlebotomy , Adolescent , COVID-19/epidemiology , COVID-19/prevention & control , Child , Child, Preschool , Feasibility Studies , Female , Hematologic Diseases/diagnosis , Hematologic Neoplasms/diagnosis , Humans , Infant , Male , Pandemics , Phlebotomy/methods , Pilot Projects , Telemedicine
9.
Int J Med Sci ; 18(10): 2146-2154, 2021.
Article in English | MEDLINE | ID: covidwho-1190600

ABSTRACT

Objectives: To report a COVID-19 outbreak among workers and inpatients at a medical ward for especially vulnerable patients. Methods: Descriptive study of a nosocomial COVID-19 outbreak registered in March-April 2020 at medical ward of onco-hematological patients in an Spanish hospital. Confirmed cases were hospitalized patients, healthcare and non-healthcare workers who tested positive by PCR on a nasopharyngeal swab. Results: Twenty-two COVID-19 cases (12 workers and 10 inpatients) were laboratory-confirmed. Initial cases were a healthcare provider and a visitor who tested positive. The median patients age was 73 years (range 62-88). The main reason of admission was haematological in 8 patients and oncologic in 2. All patients followed an immunosuppressive treatment, 5/10 with high-flow oxygen nebulizations. Five patients presented a moderate/serious evolution, and 5 patients died. The mean workers age was 42.1±10.9. One healthworker required Intensive Care Unit admission, and all of them recovered completely. Conclusions: In the hospital setting, close patients surveillance for SARS-CoV-2 is essential, especially in immunosuppressed patients. Replacing nebulizations or high-flow oxygen therapies, when other equivalent options were available, to reduce dispersion, and controlling ventilation ducts, together with hygiene measures and an active follow-up on inpatients, visitors and workers appear to be important in preventing nosocomial outbreaks.


Subject(s)
COVID-19/epidemiology , Cross Infection/epidemiology , Infection Control/methods , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Disease Outbreaks , Female , Health Personnel , Hematologic Diseases/therapy , Hospital Units , Humans , Immunocompromised Host , Inpatients , Intensive Care Units , Male , Middle Aged , Nebulizers and Vaporizers , Spain
10.
Rinsho Ketsueki ; 62(2): 125-129, 2021.
Article in Japanese | MEDLINE | ID: covidwho-1121492

ABSTRACT

Preventing COVID-19 infection in pediatric patients with hematological disease and cancer is important. Thus, patients and those around them should avoid crowds, wear masks, and perform hand hygiene. It is necessary to try to prevent nosocomial infections during hospitalization. Moreover, determining COVID-19 complications and the condition of patients with hematological disease and cancer, and determining a personalized treatment strategy that prioritizes the treatment of high-risk conditions is necessary when suffering from COVID-19. However, another problem is when the patient refrains from visiting a medical institution due to the fear of contracting COVID-19 infection and becomes seriously ill. Furthermore, the lack of medical resources has affected the treatment of pediatric patients with hematological disease and cancer (e.g., delays and changes in treatment). Thus, appropriate information needs to be provided to children and their parents so that preventive measures can be taken.


Subject(s)
COVID-19 , Hematologic Diseases , Neoplasms , Child , Hematologic Diseases/epidemiology , Hematologic Diseases/therapy , Humans , Pandemics , SARS-CoV-2
11.
Rinsho Ketsueki ; 62(2): 101-105, 2021.
Article in Japanese | MEDLINE | ID: covidwho-1120266

ABSTRACT

The novel coronavirus (COVID-19) pandemic has affected all aspects of human life worldwide. Under this situation, the American Society of Hematology and European Hematology Association have provided resources and recommendations for the management of hematologic diseases during the COVID-19 pandemic. This review aims to summarize these recommendations and provide helpful, accurate, and up-to-date information for Japanese hematologists.


Subject(s)
COVID-19 , Hematologic Diseases , Hematology , Hematologic Diseases/diagnosis , Hematologic Diseases/epidemiology , Hematologic Diseases/therapy , Humans , Pandemics , SARS-CoV-2 , United States
12.
Am J Trop Med Hyg ; 104(4): 1188-1201, 2021 02 19.
Article in English | MEDLINE | ID: covidwho-1090244

ABSTRACT

COVID-19 is caused by SARS-CoV-2. Although pulmonary manifestations have been identified as the major symptoms, several hematological abnormalities have also been identified. This review summarizes the reported hematological abnormalities (changes in platelet, white blood cell, and hemoglobin, and coagulation/fibrinolytic alterations), explores their patho-mechanisms, and discusses its management. Common hematological abnormalities in COVID-19 are lymphopenia, thrombocytopenia, and elevated D-dimer levels. These alterations are significantly more common/prominent in patients with severe COVID-19 disease, and thus may serve as a possible biomarker for those needing hospitalization and intensive care unit care. Close attention needs to be paid to coagulation abnormalities, and steps should be taken to prevent these occurring or to mitigate their harmful effects. The effect of COVID-19 in patients with hematological abnormalities and recognized hematological drug toxicities of therapies for COVID-19 are also outlined.


Subject(s)
Blood Coagulation , Blood Platelets/pathology , COVID-19/blood , COVID-19/complications , Hematologic Diseases/complications , Lymphopenia/blood , Thrombocytopenia/blood , Biomarkers/blood , COVID-19/therapy , Erythrocytes/pathology , Hematologic Diseases/therapy , Humans , Leukocytes/pathology , Lymphopenia/etiology , SARS-CoV-2 , Thrombocytopenia/etiology
14.
Br J Haematol ; 191(2): 194-206, 2020 10.
Article in English | MEDLINE | ID: covidwho-966626

ABSTRACT

Haematology patients receiving chemo- or immunotherapy are considered to be at greater risk of COVID-19-related morbidity and mortality. We aimed to identify risk factors for COVID-19 severity and assess outcomes in patients where COVID-19 complicated the treatment of their haematological disorder. A retrospective cohort study was conducted in 55 patients with haematological disorders and COVID-19, including 52 with malignancy, two with bone marrow failure and one immune-mediated thrombotic thrombocytopenic purpura (TTP). COVID-19 diagnosis coincided with a new diagnosis of a haematological malignancy in four patients. Among patients, 82% were on systemic anti-cancer therapy (SACT) at the time of COVID-19 diagnosis. Of hospitalised patients, 37% (19/51) died while all four outpatients recovered. Risk factors for severe disease or mortality were similar to those in other published cohorts. Raised C-reactive protein at diagnosis predicted an aggressive clinical course. The majority of patients recovered from COVID-19, despite receiving recent SACT. This suggests that SACT, where urgent, should be administered despite intercurrent COVID-19 infection, which should be managed according to standard pathways. Delay or modification of therapy should be considered on an individual basis. Long-term follow-up studies in larger patient cohorts are required to assess the efficacy of treatment strategies employed during the pandemic.


Subject(s)
Antineoplastic Agents/therapeutic use , COVID-19/complications , Hematologic Diseases/complications , Immunotherapy , Adult , Age Factors , Aged , Aged, 80 and over , Antineoplastic Agents/administration & dosage , Blacks , COVID-19/mortality , COVID-19/therapy , Comorbidity , Cross Infection/complications , Female , Hematologic Diseases/drug therapy , Hematologic Diseases/mortality , Hematologic Diseases/therapy , Hematopoietic Stem Cell Transplantation , Humans , Leukemia/complications , Leukemia/drug therapy , Leukemia/mortality , London/epidemiology , Lymphoma/complications , Lymphoma/drug therapy , Lymphoma/mortality , Male , Middle Aged , Respiration, Artificial , Retrospective Studies , Risk Factors , SARS-CoV-2 , Thrombophilia/drug therapy , Thrombophilia/etiology , Treatment Outcome , Young Adult
17.
Blood Rev ; 47: 100777, 2021 05.
Article in English | MEDLINE | ID: covidwho-912075

ABSTRACT

The ongoing COVID-19 pandemic is the most trending and talked topic across the World. From its point of origin in Wuhan, China to clinical laboratory at NIH, a mere six-month-old SARS-CoV-2 virus is keeping the clinicians, and scientists busy at various fronts. However, COVID-19 is an emerging and evolving disease and each day brings in more data, new figures, and findings from the field of clinical practice. The role of hematologists has been increasingly recognized during the current pandemic because of several reasons. Most important of them are the characteristic hematological findings of COVID-19 patients that also have prognostic implications and that were not seen in other viral infections. The treatment of hematological complications in COVID-19 patients is very challenging given the critical care setting. There are interim and limited guidelines thus far due to the novelty of the disease. As this remains to be a quite fluid situation, all the appropriate medical societies including the major hematology bodies are proposing initial and interim guidelines (e.g. ASH guideline). This puts a hematologist on consult service in a dubious position where, he/she must tailor the recommendations on case to case basis. The purpose of this review is to provide the background context about the impact of COVID-19 on the blood system and to summarize the current interim guidelines to manage the associated hematological issues in COVID-19 infection.


Subject(s)
COVID-19/complications , Hematologic Diseases/etiology , COVID-19/blood , COVID-19/epidemiology , COVID-19/therapy , Disease Management , Hematologic Diseases/blood , Hematologic Diseases/therapy , Hematology , Humans , Pandemics , Practice Guidelines as Topic , SARS-CoV-2/isolation & purification
18.
Acta Haematol ; 143(6): 574-582, 2020.
Article in English | MEDLINE | ID: covidwho-768107

ABSTRACT

INTRODUCTION: Patients with cancer may be more susceptible to and have higher morbidity and mortality rates from COVID-19 than the general population, while epidemiologic data specifically addressed to hematologic patients are limited. To investigate whether patients with hematologic diseases undergoing therapy are at increased risk for acquiring SARS CoV-2 infection compared to the general population, a retrospective study was carried out at a referral hematologic center in Rome, Italy, during the period of the greatest epidemic spread (March 8 to May 14, 2020). METHODS: All adult and pediatric patients with a diagnosis of a neoplastic or a nonneoplastic hematologic disease who underwent treatment (chemotherapy or immunosuppressive or supportive therapy) during the study period or in the previous 6 months were considered. The prevalence of COVID-19 in the overall outpatient and inpatient population undergoing hematologic treatment compared to that of the general population was analyzed. The measures taken to manage patients during the epidemic period are described. RESULTS: Overall, 2,513 patients with hematological diseases were considered. Out of 243 (9.7%) patients who were screened for SARS CoV-2, three of 119 (2.5%) outpatients with fever or respiratory symptoms and none of 124 asymptomatic patients were diagnosed with COVID-19. Three further patients were diagnosed with COVID-19 and managed in other hospitals in Rome. As of May 14, 2020, the prevalence of COVID-19 in our hematologic population accounted for 0.24% (95% CI 0.23-0.25; 6 of 2,513 patients: 1 case in every 419 patients) as compared to 0.12% (7,280 of 5,879,082 residents; 1 case in every 807 residents) in the general population (p = 0.14). Three of 6 patients diagnosed with COVID-19 required critical care and 2 died while still positive for SARS CoV-2. Out of 225 healthcare providers on duty at our Institution during the study period, 2 (0.9%) symptomatic cases were diagnosed with COVID-19. CONCLUSION: In our experience, the prevalence of COVID-19 in hematologic patients, mainly affected by malignancies, was not significantly higher compared to that of the general population. Definition of adapted strategies for healthcare services, while continuing to administer the standard hematologic treatments, represents the crucial challenge for the management of hematologic diseases in the COVID-19 era.


Subject(s)
COVID-19/diagnosis , Hematologic Diseases/complications , Adolescent , Adult , Aged , COVID-19/complications , COVID-19/epidemiology , COVID-19/virology , Child , Female , Hematologic Diseases/drug therapy , Hematologic Diseases/therapy , Humans , Immunosuppressive Agents/therapeutic use , Italy/epidemiology , Male , Middle Aged , Prevalence , Retrospective Studies , SARS-CoV-2/isolation & purification , Tertiary Care Centers , Young Adult
19.
Expert Rev Hematol ; 13(10): 1081-1092, 2020 10.
Article in English | MEDLINE | ID: covidwho-759836

ABSTRACT

INTRODUCTION: Many patients with inherited or acquired benign hematological disorders are at increased risk of developing severe complications from COVID-19. These patients, therefore, require specific advice regarding isolation and changes to their usual treatment schedules. Their disease can also be associated with significant burden, and they necessitate life-long and regular access to therapy, and regular follow-up consultations and hospital visits. The current COVID-19 pandemic is therefore presenting many challenges for these patients, their families, and health-care professionals. AREAS COVERED: This review provides an overview of the reported COVID-19 cases in the literature in patients with certain benign hematological disorders including thalassemia, sickle cell disease, hemophilia, immune thrombocytopenia, venous thromboembolism, and aplastic anemia. The review also outlines some recommendations on how to manage these patients if they are infected with SARS-CoV-2. To review the literature on benign hematological disorders and COVID-19, a bibliographic search was performed using PubMed for articles published between January 2020 and June 2020. EXPERT OPINION: International efforts must be made to continue reporting and better understanding the effects of SARS-CoV-2 infection in these patients and accordingly develop a set of recommendations to optimize the treatment of future infected patients.


Subject(s)
Coronavirus Infections/complications , Hematologic Diseases/complications , Pneumonia, Viral/complications , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Disease Management , Health Personnel , Hematologic Diseases/therapy , Humans , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , SARS-CoV-2
20.
Dtsch Med Wochenschr ; 145(15): 1044-1050, 2020 Jul.
Article in German | MEDLINE | ID: covidwho-691147

ABSTRACT

Infection with SARS-COV-2 leads to a number of pathologies in the hematopoetic system that have significant impact on clinical symptoms and mortality. There are 3 stages of infection: (1) early upper respiratory tract infection with fever and lymphopenia (2) pulmonary phase and (3) hyperinflammatory phase with the clinical signs of organ failure such as ARDS/shock. Hyperinflammation, which is triggered by activation of T cells and monocytes/macrophages, is essential for organ pathologies. Interferon IFN-É£, tumor necrosis factor (TNF)-α, IL-10 and interleukin-6 (IL-6) play important roles as mediators of inflammation. In analogy to the cytokine release syndrome (CRS) after CAR-T cell therapy, the therapeutic activity of the IL-6 receptor antibody tocilizumab is investigated in clinical studies.The coagulation system is activated during the inflammatory phase of COVID infection, most likely on the pathophysiological basis of immune thrombosis. Clinically, there is a significantly increased incidence of venous (especially pulmonary artery embolism), but also arterial thromboembolism (TE). In laboratory chemistry, the D-dimer, fibrinogen but also vWF and FVIII are significantly increased. Guidelines for the prophylaxis and therapy of COVID-associated coagulopathy have been developed. Analogous to other viral infections, there are approaches to passive immunization using convalescent plasma. Its administration has shown promising activity in first uncontrolled case series and is currently being examined in clinical studies worldwide for its therapeutic activity.


Subject(s)
Coronavirus Infections , Hematologic Diseases , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/therapy , Embolism/prevention & control , Embolism/therapy , Embolism/virology , Hematologic Diseases/prevention & control , Hematologic Diseases/therapy , Hematologic Diseases/virology , Humans , Inflammation/prevention & control , Inflammation/therapy , Inflammation/virology , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , SARS-CoV-2
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