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1.
BMJ Open ; 12(1): e047748, 2022 01 11.
Article in English | MEDLINE | ID: covidwho-1622050

ABSTRACT

OBJECTIVES: To explore clinically important increases in depression/anxiety from before to during the first UK COVID-19 lockdown and factors related to this change, with a particular focus on ethnic differences. DESIGN: Pre-COVID-19 and lockdown surveys nested within two longitudinal Born in Bradford cohort studies. PARTICIPANTS: 1860 mothers with a child aged 0-5 or 9-13, 48% Pakistani heritage. MAIN OUTCOME MEASURES: ORs for a clinically important increase (5 points or more) in depression (eight item Patient Health Questionnaire (PHQ-8)) and anxiety (Generalised Anxiety Disorder Assessment (GAD-7)) in unadjusted regression analyses, repeated with exposures of interest separated by ethnicity to look for differences in magnitude of associations, and lived experience of mothers captured in open text questions. RESULTS: The number of women reporting clinically important depression/anxiety increased from 11% to 20% (95% CI 10%-13%; 18%-22%) and from 10% to 16% (95% CI 8%-11%; 15%-18%), respectively. Increases in depression/anxiety were associated with loneliness (OR=8.37, 95% CI 5.70 to 12.27; 8.50, 95% CI 5.71 to 12.65, respectively); financial (6.23, 95% CI 3.96 to 9.80; 6.03, 95% CI 3.82 to 9.51), food (3.33, 95% CI 2.09 to 5.28; 3.46, 95% CI 2.15 to 5.58) and housing insecurity (3.29, 95% CI 2.36 to 4.58; 3.0, 95% CI 2.11 to 4.25); a lack of physical activity (3.13, 95% CI 2.15 to 4.56; 2.55, 95% CI 1.72 to 3.78); and a poor partner relationship (3.6, 95% CI 2.44 to 5.43; 5.1, 95% CI 3.37 to 7.62). The magnitude of associations between key exposures and worsening mental health varied between ethnic groups.Responses to open text questions illustrated a complex interplay of challenges contributing to mental ill health including: acute health anxieties; the mental load of managing multiple responsibilities; loss of social support and coping strategies; pressures of financial and employment insecurity; and being unable to switch off from the pandemic. CONCLUSIONS: Mental ill health has worsened for many during the COVID-19 lockdown, particularly in those who are lonely and economically insecure. The magnitude of associations between key exposures and worsening mental health varied between ethnic groups. Mental health problems may have longer term consequences for public health and interventions that address the potential causes are needed.


Subject(s)
COVID-19 , Mental Health , Anxiety/epidemiology , Child , Communicable Disease Control , Depression/epidemiology , Female , Humans , Longitudinal Studies , Mothers , SARS-CoV-2 , United Kingdom
2.
J Occup Health ; 64(1): e12311, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1620088

ABSTRACT

OBJECTIVES: This study aims to develop a comprehensive list of stressors relevant to junior doctors and will also report findings exploring the associations between burnout and stressors, which include work and non-work-related stressors as well as pandemic-related stressors. METHODS: An anonymous online questionnaire was sent to 1000 randomly selected junior doctors in the North-West of England. The questionnaire included 37 questions on general and pandemic-specific stressors, and the Maslach Burnout Inventory Health Services Survey. The main outcomes of interest were junior doctor ratings of stressors and scores for burnout (emotional exhaustion [EE], depersonalisation [DP], and personal accomplishment [PA]). Stepwise regression analysis was undertaken to assess associations between stressors and burnout. RESULTS: In total, 326 responses were collected (response rate = 33%). Of the top 10 stressors rated by junior doctors, 60% were related to the pandemic. Multiple stressors were found to be associated with the burnout dimensions. Fatigue (ß = .43), pandemic-related workload increase (ß = .33), and feeling isolated (ß = .24) had the strongest associations with EE, whereas fatigue (ß = .21), uncertainty around COVID-19 information (ß = .22) and doing unproductive tasks (ß = .17) had the strongest associations with DP. Working beyond normal scope due to COVID-19 (ß = -.26), not confident in own ability (ß = -.24) and not feeling valued (ß = -.20) were found to have the strongest associations with PA. CONCLUSIONS: Junior doctors experience a combination of general stressors and additional stressors emerging from the pandemic which significantly impact burnout. Monitoring these stressors and targeting them as part of interventions could help mitigating burnout in junior doctors.


Subject(s)
Burnout, Professional , COVID-19 , Burnout, Professional/epidemiology , Cross-Sectional Studies , Humans , Pandemics , SARS-CoV-2 , Surveys and Questionnaires , United Kingdom/epidemiology
3.
Int J Environ Res Public Health ; 19(1)2022 01 04.
Article in English | MEDLINE | ID: covidwho-1613765

ABSTRACT

COVID-19 has caused a global pandemic with considerable impact. Studies have examined the influence of socioeconomic status and air pollution on COVID-19 risk but in low detail. This study seeks to further elucidate the nuances of socioeconomic status, as defined by the Index of Multiple Deprivation (IMD), air pollution, and their relationship. We examined the effect of IMD and air pollution on the likelihood of testing positive for SARS-CoV-2 among 66,732 UKB participants tested for SARS-CoV-2 from 16 March 2020 through 16 March 2021. Logistic regression was performed controlling for age, sex, ancestry and IMD or air pollution in the respective models. IMD and its sub-scores were significantly associated with increased risk of testing positive for SARS-CoV-2. All particulate matter less than 2.5 µm (PM2.5), nitrogen oxide (NOx), and nitrogen dioxide (NO2) levels were associated with increased likelihood of testing positive for SARS-CoV-2. Measures of green space and natural environment around participants' homes were associated with reduced likelihood of SARS-CoV-2. Socioeconomic status and air pollution have independent effects on the risk of testing positive for SARS-CoV-2. Green space and natural environment space in the proximity of people's homes may mediate the effect of air pollution on the risk of testing positive for SARS-CoV-2.


Subject(s)
Air Pollutants , Air Pollution , COVID-19 , Air Pollutants/analysis , Air Pollutants/toxicity , Air Pollution/adverse effects , Air Pollution/analysis , Biological Specimen Banks , Humans , Particulate Matter/analysis , Particulate Matter/toxicity , SARS-CoV-2 , United Kingdom/epidemiology
4.
Euro Surveill ; 27(1)2022 01.
Article in English | MEDLINE | ID: covidwho-1613512

ABSTRACT

Serum samples were collected pre- and post-booster vaccination with Comirnaty in 626 participants (aged ≥ 50 years) who had received two Comirnaty doses < 30 days apart, two Comirnaty doses ≥ 30 days apart or two Vaxzevria doses ≥ 30 days apart. Irrespective of primary vaccine type or schedule, spike antibody GMTs peaked 2-4 weeks after second dose, fell significantly ≤ 38 weeks later and rose above primary immunisation GMTs 2-4 weeks post-booster. Higher post-booster responses were observed with a longer interval between primary immunisation and boosting.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , London , SARS-CoV-2 , United Kingdom
5.
BMC Public Health ; 22(1): 34, 2022 01 06.
Article in English | MEDLINE | ID: covidwho-1613231

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, the UK government implemented a series of guidelines, rules, and restrictions to change citizens' behaviour to tackle the spread of the virus, such as the promotion of face masks and the imposition of lockdown stay-at-home orders. The success of such measures requires active co-operation on the part of citizens, but compliance was not complete. Detailed research is required on the factors that aided or hindered compliance with these measures. METHODS: To understand the facilitators and barriers to compliance with COVID-19 guidelines, we used structural topic modelling, a text mining technique, to extract themes from over 26,000 free-text survey responses from 17,500 UK adults, collected between 17 November and 23 December 2020. RESULTS: The main factors facilitating compliance were desires to reduce risk to oneself and one's family and friends and to, a lesser extent, the general public. Also of importance were a desire to return to normality, the availability of activities and technological means to contact family and friends, and the ability to work from home. Identified barriers were difficulties maintaining social distancing in public (due to the actions of other people or environmental constraints), the need to provide or receive support from family and friends, social isolation, missing loved ones, and mental health impacts, perceiving the risks as low, social pressure to not comply, and difficulties understanding and keep abreast of changing rules. Several of the barriers and facilitators raised were related to participant characteristics. Notably, women were more likely to discuss needing to provide or receive mental health support from friends and family. CONCLUSION: The results demonstrated an array of factors contributed to compliance with guidelines. Of particular policy importance, the results suggest that government communication that emphasizes the potential risks of the virus and provides simple, consistent guidance on how to reduce the spread of the virus would improve compliance with preventive behaviours as COVID-19 continues and for future pandemics.


Subject(s)
COVID-19 , Adult , Communicable Disease Control , Female , Humans , Pandemics , SARS-CoV-2 , United Kingdom
6.
Vet Rec ; 190(1): 18-22, 2022 01.
Article in English | MEDLINE | ID: covidwho-1611361

ABSTRACT

With Covid-19 and Brexit continuing to change the ways in which veterinary teams work, 2021 was another year of uncertainty. Here, Kathryn Clark sums up the year that was.


Subject(s)
COVID-19 , Animals , COVID-19/veterinary , European Union , SARS-CoV-2 , United Kingdom
7.
Schweiz Arch Tierheilkd ; 164(10): 661-671, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1603045

ABSTRACT

INTRODUCTION: Three outbreaks of fatal diarrhoea occurred in bush dog (Speothos venaticus) groups at two zoological collections in the United Kingdom between 2009 and 2017. In all cases, the predominant clinical signs were diarrhoea, anorexia and severe loss of condition. Despite supportive treatment, a number of fatalities occurred during each outbreak. Common gross post mortem findings were emaciation, with erythema, mucosal haemorrhage, and ulceration of the gastrointestinal tract. Histopathological features included villus blunting and fusion, crypt epithelial loss and lymphoid depletion, supporting a viral aetiology and canine coronavirus was suspected. Diagnosis was confirmed on the basis of serology (rising antibody titres) and the detection of viral nucleic acid using polymerase chain reaction. The canine coronavirus was subtyped as type 2a, which is known to cause systemic fatal disease in immature domestic dogs. To the authors' knowledge, these are the first reported cases of fatal diarrhoea associated with canine coronavirus type 2a in bush dogs. These outbreaks suggest that adult bush dogs are highly susceptible to canine coronavirus infection and may succumb to viral enteritis.


Subject(s)
Canidae , Coronavirus, Canine , Dog Diseases , Animals , Diarrhea/epidemiology , Diarrhea/veterinary , Disease Outbreaks/veterinary , Dog Diseases/epidemiology , Dogs , United Kingdom
8.
10.
PLoS Med ; 19(1): e1003870, 2022 01.
Article in English | MEDLINE | ID: covidwho-1608093

ABSTRACT

BACKGROUND: Excess mortality captures the total effect of the Coronavirus Disease 2019 (COVID-19) pandemic on mortality and is not affected by misspecification of cause of death. We aimed to describe how health and demographic factors were associated with excess mortality during, compared to before, the pandemic. METHODS AND FINDINGS: We analysed a time series dataset including 9,635,613 adults (≥40 years old) registered at United Kingdom general practices contributing to the Clinical Practice Research Datalink. We extracted weekly numbers of deaths and numbers at risk between March 2015 and July 2020, stratified by individual-level factors. Excess mortality during Wave 1 of the UK pandemic (5 March to 27 May 2020) compared to the prepandemic period was estimated using seasonally adjusted negative binomial regression models. Relative rates (RRs) of death for a range of factors were estimated before and during Wave 1 by including interaction terms. We found that all-cause mortality increased by 43% (95% CI 40% to 47%) during Wave 1 compared with prepandemic. Changes to the RR of death associated with most sociodemographic and clinical characteristics were small during Wave 1 compared with prepandemic. However, the mortality RR associated with dementia markedly increased (RR for dementia versus no dementia prepandemic: 3.5, 95% CI 3.4 to 3.5; RR during Wave 1: 5.1, 4.9 to 5.3); a similar pattern was seen for learning disabilities (RR prepandemic: 3.6, 3.4 to 3.5; during Wave 1: 4.8, 4.4 to 5.3), for black or South Asian ethnicity compared to white, and for London compared to other regions. Relative risks for morbidities were stable in multiple sensitivity analyses. However, a limitation of the study is that we cannot assume that the risks observed during Wave 1 would apply to other waves due to changes in population behaviour, virus transmission, and risk perception. CONCLUSIONS: The first wave of the UK COVID-19 pandemic appeared to amplify baseline mortality risk to approximately the same relative degree for most population subgroups. However, disproportionate increases in mortality were seen for those with dementia, learning disabilities, non-white ethnicity, or living in London.


Subject(s)
COVID-19/epidemiology , COVID-19/mortality , Mortality/trends , Adult , Aged , Female , Humans , Male , Middle Aged , Models, Statistical , Pandemics , Risk Factors , SARS-CoV-2/pathogenicity , Time Factors , United Kingdom/epidemiology
11.
J Prim Care Community Health ; 13: 21501319211066667, 2022.
Article in English | MEDLINE | ID: covidwho-1606935

ABSTRACT

OBJECTIVE: This study aims to evaluate the safety, utilization, ability to reduce length of hospitalization and overall outcomes of a COVID-19 virtual ward providing ongoing treatment at home. METHOD: A retrospective single-center study of patients discharged to the COVID-19 virtual "step down" ward between January 27th 2021 and March 2nd 2021. The referral process, length of hospitalization, length of stay on the virtual ward, readmissions, and ongoing treatment requirements including supplemental oxygen, antibiotics, and/or steroids were all noted. RESULTS: A total of 50 patients were referred to the virtual ward. 43 referrals were accepted, 39 of which were from the respiratory ward. Four patients were readmitted, all due to hypoxia. All readmissions occurred within 5 days of discharge. 72% (n = 31) were discharged home with an ongoing oxygen requirement. 14.3% of patients were discharged with antibiotics only, 9.5% with steroids only and 23.8% with both antibiotics and steroids. The mean length of hospital stay for patients discharged to the virtual ward was 10.3 ± 9.7 days and 11.9 ± 11.6 days for all covid positive patients during this time. On average, patients spent 13.7 ± 7.3 days on the virtual ward. The average number of days spent on oxygen on the virtual ward was 11.6 ± 6.0 days. CONCLUSION: The virtual ward model exemplifies the potential benefits of collaborative working between primary and secondary care services, relieving pressure on hospitals whilst providing ongoing treatments at home such as supplemental oxygen. It also facilitates an early supported discharge of clinically stable patients with an improving clinical trajectory by managing them in the community.


Subject(s)
COVID-19 , Hospitals, General , Humans , Length of Stay , Patient Discharge , Retrospective Studies , SARS-CoV-2 , United Kingdom
12.
BMJ Open ; 12(1): e053094, 2022 01 03.
Article in English | MEDLINE | ID: covidwho-1604769

ABSTRACT

OBJECTIVES: COVID-19 is having a disproportionate impact on Black, Asian and minority ethnic (BAME) groups and women. Concern over direct and indirect effects may also impact on sleep. We explore the levels and social determinants of self-reported sleep loss among the UK population during the pandemic, focusing on ethnic and gender disparities. SETTING: This prospective longitudinal study analysed data from seven waves of the Understanding Society: COVID-19 Study collected from April 2020 to January 2021 linked to prepandemic data from the 2019 mainstage interviews, providing baseline information about the respondents prior to the pandemic. PARTICIPANTS: The analytical sample included 8163 respondents aged 16 and above who took part in all seven waves with full information on sleep loss, defined as experiencing 'rather more' or 'much more' than usual sleep loss due to worry, providing 57 141 observations. PRIMARY OUTCOME MEASURES: Self-reported sleep loss. Mixed-effects regression models were fitted to consider within-individual and between-individual differences. RESULTS: Women were more likely to report sleep loss than men (OR 2.1, 95% CI 1.9 to 2.4) over the 10-month period. Being female, having young children, perceived financial difficulties and COVID-19 symptoms were all predictive of sleep loss. Once these covariates were controlled for, the bivariate relationship between ethnicity and sleep loss (1.4, 95% CI 1.6 to 2.4) was reversed (0.7, 95% CI 0.5 to 0.8). Moreover, the strength of the association between gender and ethnicity and the risk of sleep loss varied over time, being weaker among women in July (0.6, 95% CI 0.5 to 0.7), September (0.7, 95% CI 0.6 to 0.8), November (0.8, 95% CI 0.7 to 1.0) and January 2021 (0.8, 95% CI 0.7 to 0.9) compared with April 2020, but positively stronger among BAME individuals in May (1.4, 95% CI 1.0 to 2.1), weaker only in September (0.7, 95% CI 0.5 to 1.0). CONCLUSIONS: The pandemic has widened sleep deprivation disparities, with women with young children, COVID-19 infection and BAME individuals experiencing sleep loss, which may adversely affect their mental and physical health.


Subject(s)
COVID-19 , Pandemics , Child , Child, Preschool , Communicable Disease Control , Female , Humans , Longitudinal Studies , Male , Prospective Studies , SARS-CoV-2 , Sleep , United Kingdom/epidemiology
14.
BMJ ; 375: e065834, 2021 12 29.
Article in English | MEDLINE | ID: covidwho-1599220

ABSTRACT

OBJECTIVES: To describe the rates for consulting a general practitioner (GP) for sequelae after acute covid-19 in patients admitted to hospital with covid-19 and those managed in the community, and to determine how the rates change over time for patients in the community and after vaccination for covid-19. DESIGN: Population based study. SETTING: 1392 general practices in England contributing to the Clinical Practice Research Datalink Aurum database. PARTICIPANTS: 456 002 patients with a diagnosis of covid-19 between 1 August 2020 and 14 February 2021 (44.7% men; median age 61 years), admitted to hospital within two weeks of diagnosis or managed in the community, and followed-up for a maximum of 9.2 months. A negative control group included individuals without covid-19 (n=38 511) and patients with influenza before the pandemic (n=21 803). MAIN OUTCOME MEASURES: Comparison of rates for consulting a GP for new symptoms, diseases, prescriptions, and healthcare use in individuals admitted to hospital and those managed in the community, separately, before and after covid-19 infection, using Cox regression and negative binomial regression for healthcare use. The analysis was repeated for the negative control and influenza cohorts. In individuals in the community, outcomes were also described over time after a diagnosis of covid-19, and compared before and after vaccination for individuals who were symptomatic after covid-19 infection, using negative binomial regression. RESULTS: Relative to the negative control and influenza cohorts, patients in the community (n=437 943) had significantly higher GP consultation rates for multiple sequelae, and the most common were loss of smell or taste, or both (adjusted hazard ratio 5.28, 95% confidence interval 3.89 to 7.17, P<0.001); venous thromboembolism (3.35, 2.87 to 3.91, P<0.001); lung fibrosis (2.41, 1.37 to 4.25, P=0.002), and muscle pain (1.89, 1.63 to 2.20, P<0.001); and also for healthcare use after a diagnosis of covid-19 compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients in the community were joint pain (2.5%), anxiety (1.2%), and prescriptions for non-steroidal anti-inflammatory drugs (1.2%). Patients admitted to hospital (n=18 059) also had significantly higher GP consultation rates for multiple sequelae, most commonly for venous thromboembolism (16.21, 11.28 to 23.31, P<0.001), nausea (4.64, 2.24 to 9.21, P<0.001), prescriptions for paracetamol (3.68, 2.86 to 4.74, P<0.001), renal failure (3.42, 2.67 to 4.38, P<0.001), and healthcare use after a covid-19 diagnosis compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients admitted to hospital were venous thromboembolism (3.5%), joint pain (2.7%), and breathlessness (2.8%). In patients in the community, anxiety and depression, abdominal pain, diarrhoea, general pain, nausea, chest tightness, and tinnitus persisted throughout follow-up. GP consultation rates were reduced for all symptoms, prescriptions, and healthcare use, except for neuropathic pain, cognitive impairment, strong opiates, and paracetamol use in patients in the community after the first vaccination dose for covid-19 relative to before vaccination. GP consultation rates were also reduced for ischaemic heart disease, asthma, and gastro-oesophageal disease. CONCLUSIONS: GP consultation rates for sequelae after acute covid-19 infection differed between patients with covid-19 who were admitted to hospital and those managed in the community. For individuals in the community, rates of some sequelae decreased over time but those for others, such as anxiety and depression, persisted. Rates of some outcomes decreased after vaccination in this group.


Subject(s)
COVID-19/complications , Community Health Services , General Practitioners , Hospitalization , Office Visits/statistics & numerical data , SARS-CoV-2 , Venous Thromboembolism/diagnosis , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Proportional Hazards Models , State Medicine , United Kingdom/epidemiology , Venous Thromboembolism/etiology
17.
Nat Microbiol ; 7(1): 97-107, 2022 01.
Article in English | MEDLINE | ID: covidwho-1596437

ABSTRACT

Global and national surveillance of SARS-CoV-2 epidemiology is mostly based on targeted schemes focused on testing individuals with symptoms. These tested groups are often unrepresentative of the wider population and exhibit test positivity rates that are biased upwards compared with the true population prevalence. Such data are routinely used to infer infection prevalence and the effective reproduction number, Rt, which affects public health policy. Here, we describe a causal framework that provides debiased fine-scale spatiotemporal estimates by combining targeted test counts with data from a randomized surveillance study in the United Kingdom called REACT. Our probabilistic model includes a bias parameter that captures the increased probability of an infected individual being tested, relative to a non-infected individual, and transforms observed test counts to debiased estimates of the true underlying local prevalence and Rt. We validated our approach on held-out REACT data over a 7-month period. Furthermore, our local estimates of Rt are indicative of 1-week- and 2-week-ahead changes in SARS-CoV-2-positive case numbers. We also observed increases in estimated local prevalence and Rt that reflect the spread of the Alpha and Delta variants. Our results illustrate how randomized surveys can augment targeted testing to improve statistical accuracy in monitoring the spread of emerging and ongoing infectious disease.


Subject(s)
COVID-19/epidemiology , Models, Statistical , SARS-CoV-2/isolation & purification , Basic Reproduction Number , Bias , COVID-19/diagnosis , COVID-19/transmission , COVID-19 Testing/statistics & numerical data , Forecasting , Humans , Prevalence , Reproducibility of Results , SARS-CoV-2/genetics , Spatio-Temporal Analysis , United Kingdom/epidemiology
19.
BMJ Open ; 11(12): e055823, 2021 12 27.
Article in English | MEDLINE | ID: covidwho-1595269

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has resulted in a shift to remote consultations, but telehealth consultation guidelines are lacking or inconsistent. Therefore, a scoping review was performed to chart the information in the articles exploring telehealth for the UK allied health professionals (AHPs) and compare them with the UK AHP professional bodies' guidelines. DESIGN: Scoping review following Aksey and O' Malley methodological framework. DATA SOURCES: CINHAL and MEDLINE were searched from inception to March 2021 using terms related to 'telehealth', 'guidelines' and 'AHPs'. Additionally, the UK AHP professional bodies were contacted requesting their guidelines. STUDY SELECTION: Articles exploring telehealth for patient consultations, written in English and published in peer-reviewed journal or guidelines available from UK AHP professional bodies/their websites were considered eligible for review. DATA EXTRACTION: One reviewer extracted data concerning three overarching domains: implementation, financial and technological considerations. RESULTS: 2632 articles were identified through database searches with 21 articles eligible for review. Eight guidelines were obtained from the UK AHP professional bodies with a total of 29 included articles/guidelines. Most articles were published in the last two years; there was variety in telehealth terminology, and most were developed for occupational therapists, physiotherapists and speech and language therapists. Information was lacking about the assessment of telehealth use and effectiveness, barriers and limitations, the logistical management, the family's and caregiver's roles and the costs. There was lack of clarity on the AHPs' registration requirements, costs and coverage, and legal aspects. CONCLUSION: This study identified gaps in current guidelines, which showed similarities as well as discrepancies with the guidance for non-AHP healthcare professionals and revealed that the existing guidelines do not adequately support AHPs delivering telehealth consultations. Future research and collaborative work across AHP groups and the world's leading health institutions are suggested to establish common guidelines that will improve AHP telehealth services.


Subject(s)
COVID-19 , Remote Consultation , Telemedicine , Allied Health Personnel , Humans , Pandemics , SARS-CoV-2 , United Kingdom
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