Lachapelle, F. COVID-19 preprints and their publishing rate: an improved method. Learn the mission, vision, goals, organization, and other information about this office. Risk factors for primary Middle East respiratory syndrome coronavirus illness in humans, Saudi Arabia, 2014. 2020;395(10229):1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3 30. and transmitted securely. PMC Much of the, Robust evidence suggests that several mechanisms might increase the risk of respiratory tract infections in smokers. Use the Previous and Next buttons to navigate the slides or the slide controller buttons at the end to navigate through each slide. Article provided critical review of the manuscript. Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. The increased associations for only the coronavirus 229E did not reach statistical significance. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. Smoking increases the risk of illness and viral infection, including type of coronavirus. COVID-19 attacks the lungs, and people who smoke or vape are at higher risk of developing lung infections. Epub 2020 Apr 8. https://doi.org/10.1093/cid/ciaa270 (2020). French researchers are trying to find out. Talk to your doctor or health care . Crit. These findings are consistent with known harms caused by smoking to immune and respiratory defenses and some observational evidence of increased COVID-19 infection and disease progression in current smokers. 164, 22062216 (2004). Chen Q, Zheng Z, Zhang Sheltzer, J. Association Between Clinical Manifestations and Prognosis in Patients with COVID-19. Dis. Third, since exposure to health misinformation on social media is more common among youth and young adults6, primary HCPs may choose to actively bring up the subject of smoking and COVID-19 in consultations with youth and young adults and advise non-smokers to never start smoking. At the time of this review, the available evidence suggests that smoking is associated with increased severity of disease and death in hospitalized COVID-19 patients. International journal of infectious diseases: IJID: official publication of the COVID-19, there has never been a better time to quit. 18(March):20. https://doi.org/10.18332/tid/119324 41. Med. 2020. https://doi.org/10.32388/FXGQSB 8. 2020. Dis. See this image and copyright information in PMC. What we do know for sure is that smoking and vaping causes harm to the lungs, leaving lung tissue inflamed, fragile and susceptible to infection. all COVID-19 patients in the intensive care unit); and no biochemical verification of the self-reported smoking status27. The finding that smoking is not associated with SARS-CoV-2 infection contradicts earlier studies which found that smokers are more vulnerable to infections in general and to respiratory infections in particular. A HCPs advice for smoking cessation has always been very important, but in these COVID-19 times it is more urgent than ever before. Y, Zhang Z, Tian J, Xiong S. Risk factors associated with disease progression in a cohort of patients infected with the 2019 novel coronavirus. 75, 107108 (2020). Since researchers noticed associations between tobacco smoking and COVID-19 incidence, significant efforts have been made to determine the role tobacco smoking might play in SARS-CoV-2 infection. Well-designed population-based studies are needed to address questions about the risk of infection by SARS-CoV-2 and the risk of hospitalization with COVID-19. "Smoking increases the risk of illness and viral infection, including type of coronavirus." 2020. The data showed that current smokers had an increased risk of respiratory viral infection and illness, with no significant difference across the types of viruses. Google Scholar. Reed G ; Hendlin Y . Eur. 2020. Eighteen of the 26 observational studies containing data on smoking status by severity of COVID-19 outcomes. The CDC map, which is based on the number of new coronavirus cases and Covid-19 patients in Kentucky hospitals, shows 90 counties have a low level of infection . Scientists are still learning about the disease, but we know that: Being a current smoker increases your risk for severe illness from COVID-19. Zhang X, Cai H, Hu J, Lian J, Gu J, Zhang S, et al. The origins of the myth, https://doi.org/10.1038/s41533-021-00223-1. 2023 Jan 25;21:11. doi: 10.18332/tid/156855. Tobacco causes 8 million deaths every year from cardiovascular diseases, lung disorders, cancers, diabetes, and hypertension.1 Smoking tobacco is also a known risk factor for severe disease and death from many respiratory infections.2-4 In the COVID-19 pandemic, questions have been asked about clinical outcomes for smokers, and whether they are . The tobacco industry in the time of COVID-19: time to shut it down? Copyright 2023 Elsevier Inc. except certain content provided by third parties. in the six meta-analyses of smoking and severity (five to seven studies in each analysis), resulting in 1,604 sets of patient data being reported more than once. MeSH Access the latest 2019 novel coronavirus disease (COVID-19) content from across The Lancet journals as it is published. Lancet. Melanie S Dove, Bruce N Leistikow, Nossin Khan, Elisa K Tong. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Eur. A review was conducted on 12 May 2020 on smoking and COVID-19, using MEDLINE, EMBASE, Cochrane Library, and WHO Global Database. 2020. 2020;18:37. https://doi:10.18332/tid/121915 40. Get the most important science stories of the day, free in your inbox. https://doi:10.3346/jkms.2020.35.e142 19. 92, 19151921 (2020). European Journal of Internal Medicine. Background: Identification of prognostic factors in COVID-19 remains a global challenge. The remaining six studies were small case series (ranging from 11 to 145 people) that reported no statistically significant associations between smoking Individual studies not included in meta-analyses: Nine studies were not included in any of the meta-analyses identified. Both findings emphasise the great caution needed in interpreting (social) media claims of preprint results. determining risk factor and disease at the same time). And smoking has . We encourage HCPs to use the information provided by recognised international organisations, such as the World Health Organisation. of hospitalization with COVID-19 or of infection by SARS-CoV-2 was found in the peer-reviewed literature. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. For more information and all your COVID-19 coverage, go to theMayo Clinic News Networkandmayoclinic.org. BMJ. 2020 May;29(3):245-246. doi: 10.1136/tobaccocontrol-2020-055807. 2020. Global tobacco control is urgently important too, as many countries have even higher smoking prevalence rates.". These studies, in which smoking status was not a primary exposure of interest, were subsequently brought together in several systematic reviews and meta-analyses19,20,21,22,23,24,25. Cancer patients Mar 13.https://doi:10.1002/jmv.25763 33. Second, primary HCPs can inform patients about the harmful relationship between smoking, COVID-19 and other serious illnesses, for example, by addressing the issue on their website or on posters/television screens in the waiting room. Clinical features and treatment Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. 2020;94:81-7. https://doi.org/10.1016/j.ijid.2020.03.040 29. Arch. Underner M, Peiffer G, Perriot J, Jaafari N. Rev Mal Respir. Kalak G, Jarjou'i A, Bohadana A, Wild P, Rokach A, Amiad N, Abdelrahman N, Arish N, Chen-Shuali C, Izbicki G. J Clin Med. and JavaScript. Sebastin Pea, Katja Ilmarinen, Sakari Karvonen, Pierre Hausfater, David Boutolleau, Florence Tubach, Erika Molteni, Christina M. Astley, Marc Modat, Gareth J. Griffith, Tim T. Morris, Gibran Hemani, Claire E. Hastie, David J. Lowe, Jill P. Pell, Viyaasan Mahalingasivam, Guobin Su, Dorothea Nitsch, Sofa Jijn, Ahmad Al Shafie, Mohamed El-Kassas, Helen Ward, Christina Atchison, Paul Elliott, npj Primary Care Respiratory Medicine There's no way to predict how sick you'll get from COVID-19. It is not intended to provide medical or other professional advice. government site. The World Health Organization (WHO) maintains that smoking any kind of tobacco reduces lung capacity and may increase the risk and severity of respiratory infections like COVID-19. association. use of ventilators and death. An official American Thoracic Society public policy statement: novel risk factors and the global burden of chronic obstructive pulmonary disease. Hospital based studies that report patient characteristics can suffer from several limitations, including poor data quality. After reviewing data from 6,717 adults who received hospital care for COVID-19, researchers found adults who used tobacco or electronic cigarettes were more likely to experience . Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. https://doi.org/10.1093/cid/ciaa270 24. One of these studies reported observational data for 7162 people in hospital and outpatient settings in the United States of America but did not include any statistical analysis of Get the latest science news in your RSS reader with ScienceDaily's hourly updated newsfeeds, covering hundreds of topics: Keep up to date with the latest news from ScienceDaily via social networks: Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. of COVID-19 patients in northeast Chongqing. After all, we know smoking is bad for our health. Risk Factors Associated with Clinical Outcomes in 323 COVID-19 Hospitalized Patients in Wuhan, China. 2020. Although it is well established that cigarette smoking is associated with morbidity and mortality in several respiratory infections, data from recent studies suggest that active smokers are underrepresented among patients with COVID-19. Several reports have claimed a smoker's paradox in coronavirus disease 2019 (COVID-19), in line with previous suggestions that smoking is associated with better survival after acute myocardial infarction and appears protective in preeclampsia. For requests to be unblocked, you must include all of the information in the box above in your message. doi: 10.1056/NEJMc2021362. 2020. 2022 Nov 22;10:985494. doi: 10.3389/fpubh.2022.985494. Tobacco induced diseases. CAS HHS Vulnerability Disclosure, Help Morbidity and Mortality Weekly Report. Farsalinos et al. 2020. Disclaimer. C. R. Biol. Qeios. on COVID-19. The best way to stop smoking is to talk to your health care provider,make a planand stick to it, using many of the resources available, such as behavioral therapy and medications. We now know that <20% of COVID-19 preprints actually received comments4. To obtain "Smoking increases the risk of illness and viral infection, including type of coronavirus." . May 9;1-8. https://doi:10.1007/s11739-020-02355-7 35. If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. 2020;9(2):428-36. https://doi:10.21037/apm.2020.03.26 31. 55: 2000547 https://doi.org/10.1183/13993003.00547-2020 13. Smoking injures the local defenses in the lungs by increasing mucus production and inflammation. Archives of Academic Emergency Medicine. Text the word "QUIT" (7848) to IQUIT (47848) for free help. This paper quantifies the association between smoking and COVID-19 disease progression. CAS Journal of Medical Virology. For help quitting smoking or vaping: Visit the free and confidential New York State Smokers' Quitline online, call 1-866-NY-QUITS (1-866-697-8487), or text (716) 309-4688. Could it be possible that SARS-CoV-2 is the big exception to the rule? 5-7 At the time of writing, one clinical trial to test the effects of nicotine has been announced, but no trial registration record was found as of 12 May 2020. Anyone shown without a mask was recorded prior to COVID-19 or recorded in an area not designated for patient care, where social distancing and other safety protocols were followed. Cluster of COVID-19 in northern France: A retrospective closed cohort study. 2020 Elsevier Ltd. All rights reserved. The Lancet Oncology. 41 found a statistically significant We use cookies to help provide and enhance our service and tailor content and ads. of 487 cases outside Wuhan. "Besides examining associations by type of virus, a key reason we re-analyzed the original British Cold Study is to report a risk ratio instead of an odds ratio," Dove explained. It's a leading risk factor for heart disease, lung disease and many cancers. The association of smoking status with SARSCoV2 infection, hospitalization and mortality from COVID19: a living rapid evidence review with Bayesian metaanalyses (version 7). It is unclear on what grounds these patients were selected for inclusion in the study. Although it is clear that smoking is a risk factor for the severity of Covid-19, early studies reported an underrepresentation of smokers among patients hospitalized for Covid-19 [25]. None examined tobacco use and the risk of infection or the risk of hospitalization. Methods Univariable and . doi: 10.1111/jdv.16738. for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Other UC Davis researchers who participated in the study included Bruce Leistikow and Nossin Khan from the Department of Public Health Sciences. DOI: https://doi.org/10.1016/S2213-2600(20)30239-3. May 5. https://doi.org/10.1002/jmv.25967 37. Acad. relationship between smoking and severity of COVID-19. Google Scholar. During the COVID-19 lockdown in Spain, the tobacco consumption decreased and the prevalence of daily tobacco smoking decreased, and secondhand smoke exposition reduces in Spain during this period. Smoking may enhance the risk of COVID-19 by its biological effects and behaviors of smokers. Smoking cessation improves health status and enhances quality of life.17 Smoking cessation medications approved by the FDA and behavioral counseling can double the chances of quitting smoking.18 When people quit smoking, the number of ACE2 receptors in a person's lungs decreases.19 & Niaura, R. Smoking, vaping and hospitalization for COVID-19. Factors associated with anxiety in males and females in the Lebanese population during the COVID-19 lockdown. Farsalinos, K., Barbouni, A. Accessibility So, what research was this claim based on in the first place? The Covid-19 pandemic has highlighted the importance of maintaining a healthy lifestyle and reducing risk factors that can worsen disease. Wkly. Federal government websites often end in .gov or .mil. Epidemiological, clinical characteristics and outcome of medical staff infected with COVID-19 in Wuhan, China: a retrospective case series analysis. 2020. Here, we suggest a few steps to help reduce tobacco use during this pandemic and hopefully long after. Surg. The new analysis in Nature Medicine examined a comprehensive, prespecified set of cardiovascular outcomes among patients in the US Veterans Health Administration (VHA) system who survived the first 30 days of COVID-19. Chest CT Findings in Patients with Coronavirus Disease 2019 and Its Relationship with Clinical Features. However, the battle against tobacco use should continue, by assisting smokers to successfully and permanently quit. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. The association between smoking and COVID-19 has generated a lot of interest in the research community. with Coronavirus Disease 2019 (COVID-19) Outside Wuhan. Liu, J. et al. Simons, D., Shahab, L., Brown, J. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Much of the global focus on tobacco prevention and cessation focuses around non-infective respiratory, cardiovascular, and cancer related deaths, and much of the e-cigarette promotional rhetoric revolves around potentially saving billions of lives that . the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Arcavi, L. & Benowitz, N. L. Cigarette smoking and infection. Such studies are also prone to significant sampling bias. and transmitted securely. 22, 16531656 (2020). Vardavas et al.40 analysed data from 5 studies totalling 1549 patients and calculated a relative risk that indicated a non-significant Patanavanich, R. & Glantz, S. A. National and . Materials provided by University of California - Davis Health. When we look more closely at specific patient groups in the data, we see that, of the 24 included chronic obstructive pulmonary disorder (COPD) patients, only 3 had ever smoked (12.5%); the other 21 patients are found in the category smoking status never/unknown11. University of California - Davis Health. Zheng Y, Xiong C, Liu Y, Qian X, Tang Y, Liu L, et al. disappeared when the largest study by Guan et al.13 was removed from the analysis (a sensitivity test to see the impact of a single study on the findings of the meta-analysis). also found an unusually low number of smokers among patients with a cardiovascular or cerebrovascular disease11. 55, 2000547 (2020). Intern. In South Africa, before the pandemic, the. Dong X, Cao YY, Lu XX, Zhang JJ, Du H, Yan YQ, et al. Currently, no evidence suggests that e-cigarette use increases the risk of being infected by SARS-CoV-2. Prevalence of underlying diseases in hospitalized patients with COVID-19: a systematic review and meta-analysis. 2020.69:1002-1009. http://dx.doi.org/10.1136/gutjnl-2020-320926 18. Vardavas, C. & Nikitara, K. COVID-19 and smoking: a systematic review of the evidence. Original written by Stephanie Winn. But what was left out of the (media) attention was that 32% of patients reported being former smokers, defined as anyone having smoked in the past, occasionally or daily, and had abstained from smoking prior to COVID-19 onset27. & Coronini-Cronberg, S. Smoking, SARS-CoV-2 and COVID-19: a review of reviews considering implications for public health policy and practice. Annals of Palliative Medicine. And, when it comes to the COVID-19 pandemic, the side effects of smoking and the behaviors of people who smoke or vape could create a one-two punch. If you smoke or vape and get the COVID-19 virus, you increase your risk of developing more severe COVID-19 symptoms. 2. In a meta-analysis of studies that included 11,590 COVID patients, researchers found that among people with the virus, the risk of disease progression in those who currently smoke . Guo FR. This has led to claims that a 'smoker's paradox' may exist in COVID-19, wherein smokers are protected from infection and severe complications of COVID-19 . [A gastrointestinal overview of COVID-19]. The Journal of Infection. Clinical Therapeutics. A new study led by UC Davis Comprehensive Cancer Center researchers shows that current smokers have a 12% increased risk of a laboratory-confirmed viral infection and a 48% increased risk of being diagnosed with respiratory illnesses. 8, 247255 (2020). Nicotine Tob. 34 analysed data for 5960 hospitalized patients and found a pooled prevalence of 6.5% (1.4% - 12.6%). https://www.biorxiv.org/content/10.1101/2020.11.23.394577v3 (2020). Lancet. Virol. Correspondence to However, it remains controversial with respect to the relationship of smoking with COVID-19. Tobacco smoking is a known risk factor for many respiratory infections and increases the severity of respiratory diseases. MMWR Morb. Effect of smoking on coronavirus disease susceptibility: A case-control study. Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Guo FR. Global center for good governance in tobacco control. Baradaran, A., Ebrahimzadeh, M. H., Baradaran, A. 2020 Jul 2;383(1):e4. ciaa270. The purpose of this study was to explore the role of smoking in COVID-19.MethodsA total of 622 patients with COVID-19 in China were enrolled in the study. Due to the preliminary nature of the many non-peer-reviewed reports issued during the COVID-19 pandemic, preprint repositories were deliberately excluded from this review. Dis. Ando W, Horii T, Jimbo M, Uematsu T, Atsuda K, Hanaki H, Otori K. Front Public Health. It seems the tobacco industry benefited from the (social) media hype, since exposure to claims about a protective effect of smoking was associated with an increase in tobacco consumption among Chinese citizens during the pandemic6. ", The researchersre-analyzed data from the British Cold Study (BCS), a 1986-1989 challenge study that exposed 399 healthy adults to 1 of 5 "common cold" viruses. This was the first association between tobacco smoking and chronic respiratory disease. This included a type of common coronavirus (coronavirus 229E) that existed prior to the novel coronavirus (SARS-CoV-2 virus), which causes COVID-19 disease. in SARS-CoV-2 infection: a nationwide analysis in China. SARS-CoV, Mers-CoV and COVID-19: what differences from a dermatological viewpoint? Gut. Provided by the Springer Nature SharedIt content-sharing initiative, npj Primary Care Respiratory Medicine (npj Prim. Coronavirus symptoms: 10 key indicators and . We also point out the methodological flaws of various studies on which hasty conclusions were based. Please share this information with . What are some practical steps primary HCPs can take? The highest achievable outcome in cross-sectional research is to find a correlation, not causation. A Paris hospital network study suggests that regular smokers may be safer from COVID-19 infection than the general public, according to reports by Radio France Internationale and the Guardian . Lancet Respir. Alterations in the smoking behavior of patients were investigated in the study. Lancet 395, 10541062 (2020). This review therefore assesses the available peer-reviewed literature Global Burden of Disease: GBD Compare Tool, 2020 (Available from: https://vizhub.healthdata.org/gbd-compare/) Accessed: April 27 2020. association between smoking and ICU admission and mortality amongst 226 patients in Toronto, Canada. In combination with past findings, the current findings published today in the Nicotine and Tobacco Research journal support urgent recommendations to increase tobacco control efforts for countering COVID-19. Miyara M, Tubach F, Pourcher V, Morelot-Panzini C, Pernet J, Lebbah S, et al. Review of: Smoking, vaping and hospitalization for COVID-19. Lancet 395, 497506 (2020). Independent Oversight and Advisory Committee. Cardiovascular Implications of Fatal Outcomes of Patients with Coronavirus Disease 2019 (COVID-19). Smokers are 60%-80% more likely to be admitted to hospital with Covid-19 and also more likely to die from the disease, data suggests. Med.) Kozak R, Although scientific discussions could be continued afterwards on the preprint servers, the media and many scientists did not follow these discussions. A university hospital in Paris appears to have collected their data more systematically: they asked 482 COVID-19 patients whether they smoked or had done so in the past, resulting in only 9 missing answers27. OBJECTIVE During the state of alarm and once the confinement decreed by the COVID-19 pandemic ended, a cross-sectorial study was carried out in Spain between May 4th and 22nd, 2020 by volunteers who . In other words, the findings may not be generalizable to other coronaviruses. Further, most studies did not make statistical adjustments to account for age and other confounding factors. Zhao et al.35 analysed data from 7 studies (1726 patients) and found a statistically significant association between smoking and severity of COVID-19 outcomes amongst patients (Odds Ratio (OR) 2.0 (95% CI 1.3 3.1). Care Respir. Two common quit lines for coaching and support are 1-800-784-8669 and SmokefreeTXT. 2020. Mar16. Clinical Course and Outcomes of Patients with Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Preliminary Report of the First 28 Patients from the Korean Cohort Study 2020. Med. To date, there is no strong evidence (i.e., evidence based on causal research) that smokers are protected against SARS-CoV-2 infection. volume31, Articlenumber:10 (2021) To summarize, smoking is known to increase TB infection and also adversely affect treatment outcomes in TB making it a deadly duo. Smoking also reduces our immunity, and makes us more susceptible to . Although likely related to severity, there is no evidence to quantify the risk to smokers Heterogeneity in the clinical presentation of SARS-CoV-2 infection and COVID-19 progression underscores the urgent need to identify individual-level susceptibility factors that . 2022 Dec 14;11(24):7413. doi: 10.3390/jcm11247413. Introduction: Preliminary reports indicated that smokers could be less susceptible to coronavirus SARS-CoV-2, which causes Covid-19. Low incidence of daily active tobacco smoking in patients with symptomatic COVID-19. Collecting smoking history is challenging in emergency contexts and severity of disease is often not clearly defined and is inconsistent The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the cause of the coronavirus disease 2019 (COVID-19) pandemic, is a continuing global threat to human health and economies that despite increasing vaccinations has, to date, infected almost 700 million people, while its death toll is approaching seven million [].Tobacco smoking is the cause of another unending and . Current snus use was associated with a 68% higher risk of a confirmed COVID-19 case (RR 1.68 . The relative risks from this study can provide an estimate of the strength of associations that can be used to guide tobacco control decisions.". Induc. For additional information, or to request that your IP address be unblocked, please send an email to PMC. Six meta-analyses were identified that examined the association between smoking and severity of COVID-19. J. government site. meta-analyses that were not otherwise identified in the search were sought. Table 2 Relative risk of confirmed COVID-19 cases by tobacco use in participants of FinSote surveys. Apr 27. https://doi.org/10.1016/j.clinthera.2020.04.009. Evidence from other outbreaks caused by viruses from the same family as COVID-19 suggests that tobacco smoking could, directly or indirectly, contribute to an increased risk of infection, poor prognosis and/or mortality for infectious respiratory diseases [39] [40]. BackgroundCigarette smoking has been proven to be a risk factor in the development of many diseases. CDC COVID-19 Response Team. ScienceDaily. Yang, X. et al. Bottom line: Your lungs and immune system work better . Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. To determine the effect smoking might have on infection, it is essential that every person tested for COVID-19, and for other respiratory infectious diseases, should be asked about their smoking history. Tob. The double-edged relationship between COVID-19 stress and smoking: Implications for smoking cessation. In this article, we shed light on the process that resulted in the misinterpretation of observational research by scientists and the media. Dis. Han L, Ran J, Mak YW, Suen LK, Lee PH, Peiris JSM, et al. The connection between smoking, COVID-19. Epidemiology. official website and that any information you provide is encrypted Emami, A., Javanmardi, F., Pirbonyeh, N. & Akbari, A. During the coronavirus disease (COVID-19) pandemic, the issue of tobacco smoking and risk for acute respiratory infection is again topical. Before Apr 23;S0163-4453(20)30234-6. https://doi:10.1016/j.jinf.2020.04.021 38. 2020 Oct;34(10):e581-e582. B, Zhao J, Liu H, Peng J, et al.
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