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1.
PLoS Med ; 19(3): e1003930, 2022 03.
Article in English | MEDLINE | ID: covidwho-1793652

ABSTRACT

BACKGROUND: Low syphilis testing uptake is a major public health issue among men who have sex with men (MSM) in many low- and middle-income countries. Syphilis self-testing (SST) may complement and extend facility-based testing. We aimed to evaluate the effectiveness and costs of providing SST on increasing syphilis testing uptake among MSM in China. METHODS AND FINDINGS: An open-label, parallel 3-arm randomized controlled trial (RCT) was conducted between January 7, 2020 and July 17, 2020. Men who were at least 18 years of age, had condomless anal sex with men in the past year, reported not testing for syphilis in the last 6 months, and had a stable residence with mailing addresses were recruited from 124 cities in 26 Chinese provinces. Using block randomization with blocks of size 12, enrolled participants were randomly assigned (1:1:1) into 3 arms: standard of care arm, standard SST arm, and lottery incentivized SST arm (1 in 10 chance to win US$15 if they had a syphilis test). The primary outcome was the proportion of participants who tested for syphilis during the trial period and confirmed with photo verification and between arm comparisons were estimated with risk differences (RDs). Analyses were performed on a modified intention-to-treat basis: Participants were included in the complete case analysis if they had initiated at least 1 follow-up survey. The Syphilis/HIV Duo rapid test kit was used. A total of 451 men were enrolled. In total, 136 (90·7%, 136/150) in the standard of care arm, 142 (94·0%, 142/151) in the standard of SST arm, and 137 (91·3%, 137/150) in the lottery incentivized SST arm were included in the final analysis. The proportion of men who had at least 1 syphilis test during the trial period was 63.4% (95% confidence interval [CI]: 55.5% to 71.3%, p = 0.001) in the standard SST arm, 65.7% (95% CI: 57.7% to 73.6%, p = 0.0002) in the lottery incentivized SST arm, and 14.7% (95% CI: 8.8% to 20.7%, p < 0.001) in the standard of care arm. The estimated RD between the standard SST and standard of care arm was 48.7% (95% CI: 37.8% to 58.4%, p < 0.001). The majority (78.5%, 95% CI: 72.7% to 84.4%, p < 0.001) of syphilis self-testers reported never testing for syphilis. The cost per person tested was US$26.55 for standard SST, US$28.09 for the lottery incentivized SST, and US$66.19 for the standard of care. No study-related adverse events were reported during the study duration. Limitation was that the impact of the Coronavirus Disease 2019 (COVID-19) restrictions may have accentuated demand for decentralized testing. CONCLUSIONS: Compared to standard of care, providing SST significantly increased the proportion of MSM testing for syphilis in China and was cheaper (per person tested). TRIAL REGISTRATION: Chinese Clinical Trial Registry: ChiCTR1900022409.


Subject(s)
HIV Infections/diagnosis , Homosexuality, Male , Patient Participation/methods , Self-Testing , Syphilis/diagnosis , Adolescent , Adult , COVID-19/epidemiology , China/epidemiology , Follow-Up Studies , HIV Infections/prevention & control , Health Services Accessibility/organization & administration , Homosexuality, Male/statistics & numerical data , Humans , Immunoassay/methods , Male , Mass Screening/economics , Mass Screening/methods , Mass Screening/organization & administration , Middle Aged , Motivation , Pandemics , Reagent Kits, Diagnostic/economics , Reagent Kits, Diagnostic/supply & distribution , SARS-CoV-2 , Sexual and Gender Minorities/statistics & numerical data , Syphilis/epidemiology , Syphilis/prevention & control , Young Adult
2.
Inflamm Bowel Dis ; 27(10): 1703-1705, 2021 Oct 18.
Article in English | MEDLINE | ID: covidwho-1740876

ABSTRACT

The recent emergency use authorization of a third COVID-19 vaccine means that most patients with inflammatory bowel disease (IBD) will soon be eligible to be vaccinated. Gastroenterology clinicians should be prepared to address patients' concerns regarding safety and efficacy of vaccines. They should also strongly recommend that all their patients be vaccinated with a COVID-19 vaccine. Additionally, they should be prepared to educate patients about logistics that will result in successful vaccination completion. All these measures will be crucial to ensure high uptake among their patients with IBD.


Subject(s)
COVID-19 Vaccines/pharmacology , COVID-19 , Gastroenterologists , Inflammatory Bowel Diseases , Vaccination , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/immunology , Inflammatory Bowel Diseases/psychology , Patient Participation/methods , Patient Participation/psychology , Physician's Role , Preventive Health Services , Risk Assessment , SARS-CoV-2 , Vaccination/methods , Vaccination/psychology , Vaccination Coverage/methods
3.
Int Urol Nephrol ; 54(3): 493-498, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1653676

ABSTRACT

The COVID-19 pandemic and subsequent lockdown had a substantial impact on normal research operations. Researchers needed to adapt their methods to engage at-home participants. One method is crowdsourcing, in which researchers use social media to recruit participants, gather data, and collect samples. We utilized this method to develop a diagnostic test for Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS). Participants were recruited via posts on popular social-media platforms, and enrolled via a website. Participants received and returned a mail kit containing bladder symptom surveys and a urine sample cup containing room-temperature preservative. Using this method, we collected 1254 IC/BPS and control samples in 3 months from all 50 United States. Our data demonstrate that crowdsourcing is a viable alternative to traditional research, with the ability to reach a broad patient population rapidly. Crowdsourcing is a powerful tool for at-home participation in research, particularly during the lockdown caused by the COVID-19 pandemic.


Subject(s)
Biomedical Research , COVID-19 , Crowdsourcing/methods , Cystitis, Interstitial , Patient Participation , Urinalysis , Biomedical Research/organization & administration , Biomedical Research/trends , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control , Cystitis, Interstitial/diagnosis , Cystitis, Interstitial/epidemiology , Diagnostic Techniques and Procedures/trends , Female , Humans , Male , Middle Aged , Patient Participation/methods , Patient Participation/statistics & numerical data , Patient Selection , Reagent Kits, Diagnostic/supply & distribution , Research Design , SARS-CoV-2 , Social Media , Specimen Handling/methods , United States/epidemiology , Urinalysis/instrumentation , Urinalysis/methods
4.
J Cyst Fibros ; 20 Suppl 3: 41-46, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587338

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, CF centers shifted to a telehealth delivery model. Our study aimed to determine how people with CF (PwCF) and their families experienced telehealth and assessed its quality and acceptability for future CF care. METHODS: The CF Patient and Family State of Care Survey (PFSoC) was fielded from August 31-October 30, 2020. The PFSoC explored themes of overall telehealth quality, ease of use, desirability, and preference for a future mix of in-person and telehealth care. Demographic covariates considered included: gender, age, CFTR modulator status, and region of residence. RESULTS: 424 PwCF and parents of PwCF responded (47% parents). Most (81%) reported a telehealth visit which included a MD/APP and nurse team members. 91% found telehealth easy to use, and 66% reported similar/higher quality than in-person care. One-third (34%) reported the highest desire for future telehealth care, with 45% (n =212) desiring 50% or more of visits conducted via telehealth. Adults were more likely than parents to report highest desire for future telehealth (64% vs. 36%). Respondents who perceived telehealth as similar/higher quality were more likely to desire future telehealth compared to those who perceived telehealth as lower quality (96% vs. 50%). Mixed methods analysis revealed themes affecting perceptions of telehealth. CONCLUSIONS: PwCF desire for future telehealth was influenced by perception of quality and age. Several themes emerged that need to be explored as telehealth is adapted into the CF chronic care model, especially when thinking about integration into pediatric care.


Subject(s)
COVID-19 , Communication Barriers , Consumer Behavior/statistics & numerical data , Cystic Fibrosis , Disease Transmission, Infectious/prevention & control , Telemedicine , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Child , Cystic Fibrosis/epidemiology , Cystic Fibrosis/psychology , Cystic Fibrosis/therapy , Family Health , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Humans , Models, Organizational , Patient Participation/methods , Patient Participation/psychology , Pediatrics/methods , Pediatrics/trends , Quality Improvement , Quality of Health Care/trends , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/standards , United States/epidemiology
5.
J Cyst Fibros ; 20 Suppl 3: 9-13, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587343

ABSTRACT

BACKGROUND: Cystic fibrosis (CF) care programs in the United States rapidly adopted telehealth during the COVID-19 pandemic. Understanding factors that promote or impede telehealth will inform planning for future telehealth-enabled care models. METHODS: Adult, pediatric, and affiliate CF care programs in the United States (n = 287) were surveyed twice eight months apart in 2020-2021 about telehealth use. Programs were asked to describe barriers to and promoters of telehealth. RESULTS: Ninety-seven percent of programs provided telehealth services. In the first CF Care Program State of Care Survey (SoC1), programs estimated that 57% of patients exclusively received in-person care, 36% of patients received telehealth by phone/computer with video, and 8% of patients received telephone-only care. In the second CF Care Program State of Care Survey (SoC2), programs estimated that 80% of visits were in-person and 15% were via audio and video telehealth. Pediatric programs (21%) were less likely than adult (37%) or affiliate (41%) programs to recommend telehealth (p = 0.007). All programs ranked lack of internet access as the highest barrier to patient engagement with telehealth. Promoters of telehealth were increased accessibility and avoidance of infection transmission. Top ranked changes to improve telehealth were expanded provision of remote monitoring devices and technology access. Similar proportions of program types anticipated institutional telehealth expansion. CONCLUSION: During the COVID-19 pandemic, CF programs in the United States identified factors to improve future care delivery via telehealth. Targeting specific barriers and promoters will improve the use and quality of telehealth throughout the care center network.


Subject(s)
COVID-19 , Communication Barriers , Cystic Fibrosis , Disease Transmission, Infectious/prevention & control , Health Services Accessibility , Patient Participation , Telemedicine , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Child , Cystic Fibrosis/epidemiology , Cystic Fibrosis/psychology , Cystic Fibrosis/therapy , Female , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Humans , Internet Access , Male , Needs Assessment , Patient Participation/methods , Patient Participation/psychology , Patient Satisfaction/statistics & numerical data , Quality Improvement , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administration , Telemedicine/standards , United States/epidemiology
6.
J Cyst Fibros ; 20 Suppl 3: 23-28, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587339

ABSTRACT

BACKGROUND: The COVID-19 pandemic forced cystic fibrosis (CF) care programs to rapidly shift from in-person care delivery to telehealth. Our objective was to provide a qualitative exploration of facilitators and barriers to: 1) implementing high-quality telehealth and 2) navigating reimbursement for telehealth services. METHODS: We used data from the 2020 State of Care CF Program Survey (n=286 U.S. care programs) administered in August-September to identify two cohorts of programs, with variation in telehealth quality (n=12 programs) and reimbursement (n=8 programs). We conducted focus groups and semi-structured interviews with CF program directors and coordinators in December 2020, approximately 9 months from onset of the pandemic. We used the Consolidated Framework for Implementation Research to identify facilitators and barriers of implementation, and inductive thematic analysis to identify facilitators and barriers of reimbursement. RESULTS: Factors differentiating programs with greater and lower perceived telehealth quality included telehealth characteristics (perceived advantage over in-person care, cost, platform quality); external influences (needs and resources of those served by the CF program), characteristics of the CF program (compatibility with workflows, relative priority, available resources); characteristics of team members (individual stage of change), and processes for implementation (engaging patients and teams). Reimbursement barriers included documentation to optimize billing; reimbursement of multi-disciplinary team members, remote monitoring, and telephone-only telehealth; and lower volume of patients. CONCLUSIONS: A number of factors are associated with successful implementation and reimbursement of telehealth. Future efforts should provide guidance and incentives that support telehealth delivery and infrastructure, share best practices across CF programs, and remove barriers.


Subject(s)
COVID-19 , Communication Barriers , Cystic Fibrosis , Disease Transmission, Infectious/prevention & control , Health Services Accessibility , Patient Participation , Telemedicine , Adult , Attitude of Health Personnel , COVID-19/epidemiology , COVID-19/prevention & control , Child , Cystic Fibrosis/epidemiology , Cystic Fibrosis/psychology , Cystic Fibrosis/therapy , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Humans , Needs Assessment , Patient Participation/methods , Patient Participation/psychology , Qualitative Research , Quality Improvement , Reimbursement Mechanisms , SARS-CoV-2 , Telemedicine/economics , Telemedicine/methods , Telemedicine/standards , United States/epidemiology
7.
Ann Allergy Asthma Immunol ; 128(2): 132-138, 2022 02.
Article in English | MEDLINE | ID: covidwho-1520681

ABSTRACT

OBJECTIVE: To identify current patient and provider engagement methods that use technology in allergy and immunology clinics, in hospitals, and at home. DATA SOURCES: Apple App Store and Google searches for allergy and immunology technology applications and PubMed search of literature involving keywords of website, technology, electronic health record, medical devices, disparity in technology, coding for remote patient monitoring, and artificial intelligence. STUDY SELECTIONS: Studies that addressed the keywords were included and narrowed down based on their applicability in the allergy and immunology clinic. RESULTS: There has been rapid innovation in the digital health care space with expansion of electronic medical record services and the patient portal, creation of allergy and immunology-specific medical devices and applications with remote patient monitoring capabilities, and website and artificial intelligence development to interact with patients. CONCLUSION: These technological advances provide distinct advantages to the provider and patient but also have a burden of time for evaluation of the data for the provider and disparate access to certain technologies for patients. The development of these technologies has been fast-tracked since the start of the coronavirus disease 2019 pandemic. With the explosion in telehealth and medical device development, advancement of medical technology is not revealing any signs of slowing down. It is paving a new way to interact with patients in the future.


Subject(s)
Hypersensitivity , Mobile Applications , Patient Participation/methods , Telemedicine , Artificial Intelligence , Humans
8.
Health Expect ; 25(2): 477-481, 2022 04.
Article in English | MEDLINE | ID: covidwho-1511311

ABSTRACT

BACKGROUND: Processes of the patient and public involvement (PPI) in health research shifted quickly during 2020. Faced with large-scale issues, such as the COVID-19 pandemic, the need to adapt processes of PPI to uphold commitments to nurturing the practice of 'nothing about us without us' in research has been urgent and profound. We describe how processes of PPI in research on patient-oriented methods of knowledge translation and implementation science were adapted by four teams in a Canadian setting. METHODS: As part of an ongoing quality improvement self-study to enhance PPI within these teams, team members shared their experiences of PPI in the context of this pivotal year during interviews and facilitated discussions. Drawing on these experiences, we outline challenges and reflections for adapting processes of PPI in health research on methods in times of urgency, conflict and fast-moving change. DISCUSSION: Our reflections offer insight into common issues encountered across teams that may be amplified during times of rapid change, including handling change and uncertainty, sustaining relationship-building and hearing differing perspectives in processes of PPI. CONCLUSION: These learnings present an opportunity to help others active in or planning patient-oriented methods research to reflect on the changing nature of PPI and how to adapt PPI processes in response to turbulent situations in the future.


Subject(s)
COVID-19 , Canada , Humans , Pandemics , Patient Participation/methods , Research Design
13.
Can Assoc Radiol J ; 73(1): 121-124, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1295348

ABSTRACT

The Covid pandemic has taught many lessons, including the importance of mental health. The value of the radiologist in holistic patient care may be underestimated and underresearched. Barriers to the acceptance of imaging as an important component in reassurance may be rooted in old ideas minimizing the importance of mental health.


Subject(s)
Anxiety/psychology , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/psychology , Mammography/psychology , Paternalism , Patient Participation/methods , Patient Participation/psychology , Clinical Decision-Making/methods , Female , Humans , Mammography/methods
15.
Inflamm Bowel Dis ; 27(10): 1703-1705, 2021 Oct 18.
Article in English | MEDLINE | ID: covidwho-1236236

ABSTRACT

The recent emergency use authorization of a third COVID-19 vaccine means that most patients with inflammatory bowel disease (IBD) will soon be eligible to be vaccinated. Gastroenterology clinicians should be prepared to address patients' concerns regarding safety and efficacy of vaccines. They should also strongly recommend that all their patients be vaccinated with a COVID-19 vaccine. Additionally, they should be prepared to educate patients about logistics that will result in successful vaccination completion. All these measures will be crucial to ensure high uptake among their patients with IBD.


Subject(s)
COVID-19 Vaccines/pharmacology , COVID-19 , Gastroenterologists , Inflammatory Bowel Diseases , Vaccination , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/immunology , Inflammatory Bowel Diseases/psychology , Patient Participation/methods , Patient Participation/psychology , Physician's Role , Preventive Health Services , Risk Assessment , SARS-CoV-2 , Vaccination/methods , Vaccination/psychology , Vaccination Coverage/methods
17.
Curr Opin Support Palliat Care ; 15(2): 147-153, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1177359

ABSTRACT

PURPOSE OF REVIEW: COVID-19 has permeated the very essence of human existence and society and disrupted healthcare systems. The attrition stemming from this highly contagious disease particularly affects those rendered vulnerable by age and infirmity, including those with underlying cardiovascular disease. This article critically reviews how best to integrate supportive care into the management of those affected. RECENT FINDINGS: Numerous studies have described the pathophysiology of COVID-19, including that specifically arising in those with cardiovascular disease. Potential treatment strategies have emerged but there is limited guidance on the provision of palliative care. A framework for implementation of this service needs to be developed, perhaps involving the training of non-specialists to deliver primary palliative care in the community, bolstered by the use of telemedicine. The appropriate use of limited clinical resources has engendered many challenging discussions and complex ethical decisions. Prospective implementation of future policies requires the incorporation of measures to assuage moral distress, burnout and compassion fatigue in healthcare staff who are psychologically and physically exhausted. SUMMARY: Further research based on patient-centred decision making and advance care planning is required to ensure the supportive needs of COVID-19 patients with cardiovascular disease are adequately met. This research should focus on interventions applicable to daily healthcare practice and include strategies to safeguard staff well-being.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Communication , Palliative Care/organization & administration , Advance Care Planning/organization & administration , Burnout, Professional/prevention & control , Burnout, Professional/psychology , Compassion Fatigue/prevention & control , Compassion Fatigue/psychology , Cultural Competency , Decision Making , Humans , Pandemics , Patient Participation/methods , Patient Participation/psychology , SARS-CoV-2 , Telemedicine/organization & administration
18.
Contemp Clin Trials ; 104: 106356, 2021 05.
Article in English | MEDLINE | ID: covidwho-1126762

ABSTRACT

BACKGROUND: Up to 75% of hip fracture patients never recover to their pre-fracture functional status. Supervised exercise that includes strength training can improve functional recovery after hip fracture. The role of testosterone replacement for augmenting the effects of exercise in older women after hip fracture is unknown. METHODS: The Starting Testosterone and Exercise after Hip Injury (STEP-HI) Study is a 6-month Phase 3 multicenter randomized placebo-controlled trial designed to compare supervised exercise (EX) plus 1% testosterone topical gel, with EX plus placebo gel, and with enhanced usual care (EUC). Female hip fracture patients age ≥ 65 years are being recruited from clinical centers across the United States. Participants are community dwelling and enrolled within 24 weeks after surgical repair of the fracture. The EX intervention is a center-based program of progressive resistance training. The EUC group receives a home exercise program and health education. Participants receive dietary counseling, calcium and vitamin D. The primary outcome is the Six Minute Walk Distance. Secondary outcomes include physical performance measures, self-reported function and quality of life, and dual energy x-ray absorptiometry measures of body composition and bone mineral density. RESULTS: Enrollment, interventions, and follow-up are ongoing. We describe the impact of the coronavirus disease 2019 pandemic on the trial, including modifications made to allow continuation of the interventions and outcome data collection using remote video and audio technology. CONCLUSIONS: Results from the STEP-HI study are expected to have important clinical and public health implications for management of the growing population of hip fracture patients.


Subject(s)
COVID-19 , Functional Status , Hip Fractures/rehabilitation , Resistance Training/methods , Testosterone , Walk Test/methods , Absorptiometry, Photon/methods , Administration, Topical , Aged , Androgens/administration & dosage , Androgens/adverse effects , Bone Density , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Female , Hip Fractures/diagnosis , Hip Fractures/metabolism , Hip Fractures/psychology , Humans , Outcome Assessment, Health Care/methods , Patient Participation/methods , Recovery of Function , SARS-CoV-2 , Telemedicine/methods , Testosterone/administration & dosage , Testosterone/adverse effects
19.
Plast Surg Nurs ; 41(1): 27-33, 2021.
Article in English | MEDLINE | ID: covidwho-1099659

ABSTRACT

The readability of letters sent to patients plays a pivotal role in facilitating joint decision making and positive health outcomes. Guidance suggests that all correspondence should be directed to patients. Covid-19 led to an increase in direct-to-patient communication. This study aims to determine the quantity and quality of plastic surgery clinic letters sent to patients before and during the Covid-19 pandemic. A total of 127 pre-Covid clinic letters from November to December 2019 and 103 peri-Covid clinic letters from April to May 2020 were identified and assessed for readability. Text was analyzed using a standardized set of commonly used readability formulae, including SMOG, Flesch Reading Ease, and the Coleman-Liao Index. A total of 100 pre-Covid and 58 peri-Covid letters were suitable for inclusion. Median results for formulae that output a U.S. grade score ranged between 9 and 12.9 for letters written prior to Covid-19 and 9 and 13.2 for those written during Covid-19. Eight percent of letters were sent to patients pre-Covid, increasing to 28% during the pandemic. Letters sent to patients had a median grade score of between 8 and 12 prior to Covid-19 and 8 and 10.6 during Covid-19. Letters sent to clinicians ranged between 9 and 13 and 9 and 13.3, respectively. Outpatient plastic surgery letters are written at a readability level too high to facilitate understanding among the general population. The increase in direct-to-patient contact during the Covid-19 outbreak has not led to a significant improvement in the readability of clinic letters. The authors suggest an increase in letter standardization and raising awareness of readability when writing clinic letters.


Subject(s)
Comprehension , Correspondence as Topic , Health Literacy , Patient Participation/methods , Professional-Patient Relations , Surgery, Plastic/standards , Writing/standards , Ambulatory Care/methods , Ambulatory Care/standards , Humans , United Kingdom
20.
IEEE Pulse ; 11(5): 28-31, 2020.
Article in English | MEDLINE | ID: covidwho-873194

ABSTRACT

An at-home test for coronavirus disease 2019 (COVID-19) could be released commercially as early as August, according to Scanwell Health of Los Angeles. A combination of a finger-prick blood sample and a smart-phone app, the test is designed to detect the presence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. The company hopes to receive Emergency Use Authorization from the U.S. Food and Drug Administration (FDA) by the end of summer, and make its first commercially available tests soon after.


Subject(s)
Antibodies, Viral/blood , Betacoronavirus/immunology , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/instrumentation , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Humans , Mobile Applications , Pandemics , Patient Participation/methods , Pneumonia, Viral/epidemiology , Pneumonia, Viral/immunology , SARS-CoV-2 , United States/epidemiology
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