Corpus overview


MeSH Disease

Human Phenotype


    displaying 1 - 10 records in total 28
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    A Pandemic since When?

    Authors: Gal Almogy

    id:10.20944/preprints202009.0436.v1 Date: 2020-09-18 Source:

    late in December 2019 2019-nCoV was identified as the pathogen responsible for an outbreak of severe respiratory distress HP in Wuhan, China. The virus was detected in multiple countries during January, but it is believed widespread community transmission TRANS began late in February or early March. Since March the virus has caused over 100k confirmed deaths in the US, with some states more severely impacted, notably NY and NJ. Here I examine excess mortality at the national and state level from January through July 2020. I find that the increase in excess mortality began in late February, suggesting the pathogen was circulating undetected earlier than assumed. The timing and intensity of the increase in excess mortality varied across states, with two patterns emerging: an early, sharp increase reaching a peak during April-May, best exemplified by NY and NJ, and a shallower, sustained increase, reaching a peak in late July, observed mostly in the southern regions of the US.

    Detection of SARS-CoV-2 in peritoneal fluid from patients with kidney disease MESHD and COVID-19: report of two cases

    Authors: Margarita Ibarra-Hernandez; María de la Luz Alcantar-Vallín; Rodolfo I. Cabrera-Silva; Karina Sánchez-Reyes; Monserrat Alvarez-Zavala; Judith C. De Arcos-Jiménez; Luz A. González-Hernández; Vida V. Ruiz-Herrera; Sara A. Aguirre-Díaz; Roxana García-Salcido; Guillermo García-García; Jaime F. Andrade-Villanueva

    doi:10.21203/ Date: 2020-09-16 Source: ResearchSquare

    Background: Coronavirus disease-2019 (COVID-19) has a broad clinical presentation, involving multiple organs besides the respiratory system. Currently, there is little evidence available on the presence of severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) in peritoneal fluid (PF). In this study, we describe the detection of SARS-CoV-2 in the PF of two patients with COVID 19 and kidney disease MESHD.Case presentation: Case 1: A 71-year-old woman with a history of end-stage kidney disease MESHD who presented with a 15-day evolution of progressive dyspnea HP dyspnea MESHD, accompanied by dry cough MESHD cough HP and fever HP fever MESHD; IgM antibodies SERO to SARS-CoV-2 were detected on admission. Real-time SARS-CoV-2 polymerase chain reaction (qRT-PCR) in the PF was positive. Three days after admission the patient's respiratory distress HP improved and she was discharged after 8 days of hospitalization.Case 2: A 78-year-old woman, with type 2 diabetes MESHD, hypertension HP hypertension MESHD, a 15-day history of polypnea, and a 5-day onset of fever HP fever MESHD and dyspnea HP dyspnea MESHD. IgM and IgG antibodies SERO to SARS-CoV-2 were detected on admission, as well as a positive nasopharyngeal qRT-PCR test for SARS-CoV-2. During hospitalization she developed acute kidney injury HP acute kidney injury MESHD, requiring peritoneal dialysis, SARS-CoV-2 was confirmed in PF by qRT-PCRConclusions: These two cases highlights the importance of increasing the level of awareness for the presence and possible SARS-CoV-2 transmission TRANS through non-respiratory routes, like peritoneal fluid.Emphasis should be given to appropriate preventive strategies for minimizing the risk of transmission TRANS of COVID-19 from patients on peritoneal dialysis in both inpatient and outpatient settings.

    SARS-CoV-2 spike D614G variant exhibits highly efficient replication and transmission TRANS in hamsters

    Authors: Bobo Wing Yee Mok; Conor J Cremin; Siu-Ying Lau; Shaofen Deng; Pin Chen; Anna Jinxia Zhang; Andrew Chak-Yiu Lee; Honglian Liu; Siwen Liu; Timothy Ting-Leung Ng; Hiu-Yin Lao; Eddie Lam-Kwong Lee; Kenneth Siu-Sing Leung; Pui Wang; Kelvin Kai-Wang To; Jasper Fuk-Woo Chan; Kwok-Hung Chan; Kwok-Yung Yuen; Gilman Kit-Hang Siu; Honglin Chen; David Peterhoff; Ralf Wagner; Roman Jerala; Georgios A Pavlopoulos; Sylvie Van Der Werf; Isabelle Fournier; Frederick P Roth; Michel Salzet; Caroline Demeret; Yves Jacob; Etienne Coyaud; Joseph Newman; Amin S Asfor; Alison Burman; Sylvia Crossley; John Hammond; Elma Tchilian; Bryan Charleston; Dalan Bailey; Tobias J Tuthill; Simon Graham; Tomas Malinauskas; Jiandong Huo; Julia Tree; Karen Buttigieg; Ray Owens; Miles Carroll; Rod Daniels; John McCauley; Kuan-Ying A Huang; Mark Howarth; Alain Townsend

    doi:10.1101/2020.08.28.271635 Date: 2020-08-28 Source: bioRxiv

    SARS-CoV-2 causes disease varying in severity from asymptomatic TRANS infections to severe HP respiratory distress HP and death in humans. The viral factors which determine transmissibility TRANS and pathogenicity are not yet clearly characterized. We used the hamster infection model to compare the replication ability and pathogenicity of five SARS-CoV-2 strains isolated from early cases originating in Wuhan, China, in February, and infected individuals returning from Europe and elsewhere in March 2020. The HK-13 and HK-95 isolates showed distinct pathogenicity in hamsters, with higher virus titers and more severe pathological changes in the lungs observed compared to other isolates. HK-95 contains a D614G substitution in the spike protein and demonstrated higher viral gene expression and transmission TRANS efficiency in hamsters. Intra-host diversity analysis revealed that further quasi species were generated during hamster infections, indicating that strain-specific adaptive mutants with advantages in replication and transmission TRANS will continue to arise and dominate subsequent waves of SARS-CoV-2 dissemination.

    Diagnosis Challenges, Management, and Outcome of Infants Born to Mothers With COVID 19

    Authors: Gabriela Zaharie; Monica Hasmasanu; Daniel Muresan; Tunde Kovacs; Melinda Matyas

    doi:10.21203/ Date: 2020-08-25 Source: ResearchSquare

    Background: Severe acute respiratory distress HP respiratory distress MESHD syndrome with Coronavirus 2 (SARS-CoV-2) infection MESHD affected the pregnant women during the pandemics. Immunological particularity of this population and the increased need for medical assistance put this population in a high-risk category for SARS-Cov-2 infection MESHD.Because of high contamination risk and limited studies about vertical transmission TRANS, the labor and delivery of positive women require special conditions. Cesarean section is probably the best option for delivery of infants to reduce the risk of infection TRANS risk of infection TRANS infection MESHD during birth.Aim: Our study aims to present the management and outcome of infants born to mothers confirmed with coronavirus disease MESHD 2019 (COVID19) before delivery.Material and methods: This is longitudinal, retrospective study, analyzing demographics, laboratory data and management of neonates born of mothers with diagnosis of SARS-Cov -2 infection MESHD.Results: 5 neonates were born of SARS-Cov-2 positive mothers , all by C- section and had negative real time –PCR ( RT-PCR) test. None of them was breastfed during hospital stay. The negative RT-PCR test allowed us to reduce the hospital stay of infants and care them in non –isolated area.Conclusion: In our study, vertical or perinatal transmission TRANS of the infection was not present. The testing of the pregnant women, their isolation and delivery in safe conditions for the medical staff were possible, using adequate protection equipment to limit their infection and the risk TRANS infection and the risk TRANS infection and the risk MESHD for the newborns.

    A Large-Scale Clinical Validation Study Using nCapp Cloud Plus Terminal by Frontline Doctors for the Rapid Diagnosis of COVID-19 and COVID-19 pneumonia HP pneumonia MESHD in China

    Authors: Dawei Yang; Tao Xu; Xun Wang; Deng Chen; Ziqiang Zhang; Lichuan Zhang; Jie Liu; Kui Xiao; Li Bai; Yong Zhang; Lin Zhao; Lin Tong; Chaomin Wu; Yaoli Wang; Chunling Dong; Maosong Ye; Yu Xu; Zhenju Song; Hong Chen; Jing Li; Jiwei Wang; Fei Tan; Hai Yu; Jian Zhou; Jinming Yu; Chunhua Du; Hongqing Zhao; Yu Shang; Linian Huang; Jianping Zhao; Yang Jin; Charles A. Powell; Yuanlin Song; Chunxue Bai

    doi:10.1101/2020.08.07.20163402 Date: 2020-08-11 Source: medRxiv

    Background The outbreak of coronavirus disease MESHD 2019 (COVID-19) has become a global pandemic acute infectious disease MESHD, especially with the features of possible asymptomatic TRANS carriers TRANS and high contagiousness. It causes acute respiratory distress HP respiratory distress MESHD syndrome and results in a high mortality rate if pneumonia HP is involved. Currently, it is difficult to quickly identify asymptomatic TRANS cases or COVID-19 patients with pneumonia HP pneumonia MESHD due to limited access to reverse transcription-polymerase chain reaction (RT-PCR) nucleic acid tests and CT scans, which facilitates the spread of the disease TRANS at the community level, and contributes to the overwhelming of medical resources in intensive care units. Goal This study aimed to develop a scientific and rigorous clinical diagnostic tool for the rapid prediction of COVID-19 cases based on a COVID-19 clinical case database in China, and to assist global frontline doctors to efficiently and precisely diagnose asymptomatic TRANS COVID-19 patients and cases who had a false-negative RT-PCR test result. Methods With online consent, and the approval of the ethics committee of Zhongshan Hospital Fudan Unversity (approval number B2020-032R) to ensure that patient privacy is protected, clinical information has been uploaded in real-time through the New Coronavirus Intelligent Auto-diagnostic Assistant Application of cloud plus terminal (nCapp) by doctors from different cities (Wuhan, Shanghai, Harbin, Dalian, Wuxi, Qingdao, Rizhao, and Bengbu) during the COVID-19 outbreak in China. By quality control and data anonymization on the platform, a total of 3,249 cases from COVID-19 high-risk groups were collected. These patients had SARS-CoV-2 RT-PCR test results and chest CT scans, both of which were used as the gold standard for the diagnosis of COVID-19 and COVID-19 pneumonia HP pneumonia MESHD. In particular, the dataset included 137 indeterminate cases who initially did not have RT-PCR tests and subsequently had positive RT-PCR results, 62 suspected cases who initially had false-negative RT-PCR test results and subsequently had positive RT-PCR results, and 122 asymptomatic TRANS cases who had positive RT-PCR test results, amongst whom 31 cases were diagnosed. We also integrated the function of a survey in nCapp to collect user feedback from frontline doctors. Findings We applied the statistical method of a multi-factor regression model to the training dataset (1,624 cases) and developed a prediction model for COVID-19 with 9 clinical indicators that are fast and accessible: 'Residing or visiting history in epidemic regions', 'Exposure history to COVID-19 patient', 'Dry cough HP', ' Fatigue HP', 'Breathlessness', 'No body temperature decrease after antibiotic treatment', 'Fingertip blood SERO oxygen saturation<=93%', ' Lymphopenia HP Lymphopenia MESHD', and 'C-reactive protein (CRP) increased'. The area under the receiver operating characteristic (ROC) curve (AUC) for the model was 0.88 (95% CI: 0.86, 0.89) in the training dataset and 0.84 (95% CI: 0.82, 0.86) in the validation dataset (1,625 cases). To ensure the sensitivity SERO of the model, we used a cutoff value of 0.09. The sensitivity SERO and specificity of the model were 98.0% (95% CI: 96.9%, 99.1%) and 17.3% (95% CI: 15.0%, 19.6%), respectively, in the training dataset, and 96.5% (95% CI: 95.1%, 98.0%) and 18.8% (95% CI: 16.4%, 21.2%), respectively, in the validation dataset. In the subset of the 137 indeterminate cases who initially did not have RT-PCR tests and subsequently had positive RT-PCR results, the model predicted 132 cases, accounting for 96.4% (95% CI: 91.7%, 98.8%) of the cases. In the subset of the 62 suspected cases who initially had false-negative RT-PCR test results and subsequently had positive RT-PCR results, the model predicted 59 cases, accounting for 95.2% (95% CI: 86.5%, 99.0%) of the cases. Considering the specificity of the model, we used a cutoff value of 0.32. The sensitivity SERO and specificity of the model were 83.5% (95% CI: 80.5%, 86.4%) and 83.2% (95% CI: 80.9%, 85.5%), respectively, in the training dataset, and 79.6% (95% CI: 76.4%, 82.8%) and 81.3% (95% CI: 78.9%, 83.7%), respectively, in the validation dataset, which is very close to the published AI model. The results of the online survey 'Questionnaire Star' showed that 90.9% of nCapp users in WeChat mini programs were 'satisfied' or 'very satisfied' with the tool. The WeChat mini program received a significantly higher satisfaction rate than other platforms, especially for 'availability and sharing convenience of the App' and 'fast speed of log-in and data entry'. Discussion With the assistance of nCapp, a mobile-based diagnostic tool developed from a large database that we collected from COVID-19 high-risk groups in China, frontline doctors can rapidly identify asymptomatic TRANS patients and avoid misdiagnoses of cases with false-negative RT-PCR results. These patients require timely isolation or close medical supervision. By applying the model, medical resources can be allocated more reasonably, and missed diagnoses can be reduced. In addition, further education and interaction among medical professionals can improve the diagnostic efficiency for COVID-19, thus avoiding the transmission TRANS of the disease from asymptomatic TRANS patients at the community level.

    COVID19: An Opinion on Animal Infections and Role of Veterinarians in One Health Perspective


    id:10.20944/preprints202008.0069.v1 Date: 2020-08-03 Source:

    Coronavirus disease is the current cause of global concern. The massive outbreak of COVID-19 has led the World Health Organization (WHO) to declare this as a pandemic situation. The Severe Acute Respiratory Syndrome Coronavirus-2 MESHD ( SARSCoV-2 MESHD) is responsible for COVID-19 leading to acute respiratory distress HP respiratory distress MESHD and substantial mortality in humans. However, the first laboratory confirmation of SARS-CoV-2 in a pet dog in Hong Kong has shown the possibility of human-to-animal transmission TRANS (zooanthroponotic) of the virus. Thereafter, many animals including cat, tiger, lion and mink have also been reported to acquire the virus in several countries. In this situation the role of veterinarian assumes important in treating the animals, helping in food security, disease diagnosis, surveillance and boosting the economy of livestock stakeholders at the grassroot level. In the absence of any selective vaccine or drug against SARS-CoV-2, the world is anticipated to triumph over this pandemic with collaborative, multisectoral, and transdisciplinary approach linking human, animal and environmental health. This article gives an insight into the confirmed SARS-CoV-2 outbreaks in animals, including the factors behind the shuffling of the virus among variety of species and also emphasizes on the role of veterinarian in managing and safeguarding public health so as to pave the way for adopting one health approach in order to conserve biodiversity.

    Dissemination and co-circulation of SARS-CoV2 subclades exhibiting enhanced transmission TRANS associated with increased mortality in Western Europe and the United States

    Authors: Yuan Hu; Lee W Riley

    doi:10.1101/2020.07.13.20152959 Date: 2020-07-15 Source: medRxiv

    Mechanisms underlying the acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD)-like clinical manifestations leading to deaths in patients who develop COVID-19 remain uncharacterized. While multiple factors could influence these clinical outcomes, we explored if differences in transmissibility TRANS and pathogenicity of SARS-CoV2 variants could contribute to these terminal clinical consequences of COVID-19. We analyzed 34,412 SARS-CoV2 sequences deposited in the Global Initiative for Sharing All Influenza Data (GISAID) SARS-CoV2 sequence database to determine if regional differences in circulating strain variants correlated with increased mortality in Europe, the United States, and California. We found two subclades descending from the Wuhan HU-1 strain that rapidly became dominant in Western Europe and the United States. These variants contained nonsynonymous nucleotide mutations in the Orf1ab segment encoding RNA-dependent RNA polymerase (C14408T), the spike protein gene (A23403G), and Orf1a (G25563T), which resulted in non-conservative amino acid substitutions P323L, D614G, and Q57H, respectively. In Western Europe, the A23403G-C14408T subclade dominated, while in the US, the A23403G-C14408T-G25563T mutant became the dominant strain in New York and parts of California. The high cumulative frequencies of both subclades showed inconsistent but significant association with high cumulative CFRs in some of the regions. When the frequencies of the subclades were analyzed by their 7-day moving averages across each epidemic, we found co-circulation of both subclades to temporally correlate with peak mortality periods. We postulate that in areas with high numbers of these co-circulating subclades, a person may get serially infected. The second infection may trigger a hyperinflammatory response similar to the antibody SERO-dependent enhancement (ADE) response, which could explain the ARDS MESHD-like manifestations observed in people with co-morbidity, who may not mount sufficient levels of neutralizing antibodies SERO against the first infection. Further studies are necessary but the implication of such a mechanism will need to be considered for all current COVID-19 vaccine designs.

    Placental SARS-CoV-2 in a patient with mild COVID-19 disease

    Authors: Albert L. Hsu; Minhui Guan; Eric Johannesen; Amanda J. Stephens; Nabila Khaleel; Nikki Kagan; Breanna C. Tuhlei; Xiu-Feng Wan

    doi:10.1101/2020.07.11.20149344 Date: 2020-07-14 Source: medRxiv

    Background: The full impact of COVID-19 on pregnancy remains uncharacterized. Current literature suggests minimal maternal, fetal, and neonatal morbidity and mortality,1 and COVID-19 manifestations appear similar between pregnant and non-pregnant women.2 We present a case of placental SARS-CoV-2 virus in a woman with an uncomplicated pregnancy and mild COVID-19 disease. Methods: A pregnant woman was evaluated at University of Missouri Women and Childrens Hospital. Institutional review board approval was obtained; information was obtained from medical records. Reverse transcriptase-polymerase chain reaction (RT-PCR) was performed to detect SARS-CoV-2. A gynecological pathologist examined the placenta and performed histolopathology. Sections were formalin-fixed and paraffin-embedded; slides were cut and subjected to hematoxylin-and-eosin or immunohistochemistry (IHC) staining. IHC was performed with specific monoclonal antibodies SERO to detect SARS-CoV-2 antigen or to identify trophoblasts. Findings: A 29 year-old multigravida presented at 40-4/7 weeks for labor induction. With myalgias HP myalgias MESHD two days prior, she tested positive for SARS-CoV-2. Her parents TRANS were in self-isolation for COVID-19 positivity; husband was asymptomatic TRANS and tested negative for COVID-19, but exposed to a workplace (meatpacking facility) outbreak. Prenatal course was uncomplicated, with no gestational hypertension HP hypertension MESHD. She was afebrile and asymptomatic TRANS with normal vital signs throughout hospitalization. Her myalgias HP myalgias MESHD improved prior to admission. A liveborn male TRANS infant was delivered vaginally. Newborn course was uneventful; he was appropriate for gestational age TRANS, physical was unremarkable, and he was discharged home at 36 hours. COVID-19 RT-PCR test was negative at 24 hours. At one-week follow-up, newborn was breastfeeding well, with no fevers HP or respiratory distress HP. Overall placental histology is consistent with acute uterine hypoxia MESHD (subchorionic laminar necrosis MESHD) superimposed on chronic uterine hypoxia MESHD (extra-villous trophoblasts and focal chronic villitis MESHD). IHC using SARS-CoV-2 nucleocapsid-specific monoclonal antibody SERO demonstrated SARS-CoV-2 antigens throughout the placenta in chorionic villi endothelial cells, and rarely in CK7-expressing trophoblasts. Negative control placenta (November 2019 delivery) and ferret nasal turbinate tissues (not shown) were negative for SARS-CoV-2. Interpretation: In this report, SARS-CoV-2 was found in the placenta, but newborn was COVID-19 negative. Our case shows maternal vascular malperfusion, with no features of fetal vascular malperfusion. To our knowledge, this is the first report of placental COVID-19 despite mild COVID-19 disease in pregnancy (with no symptoms of COVID-19 aside from myalgias HP myalgias MESHD); specifically, this patient had no fever HP fever MESHD, cough HP cough MESHD, or shortness of breath MESHD, but only myalgias HP myalgias MESHD and sick contacts. Despite her having mild COVID-19 disease in pregnancy, we demonstrate placental vasculopathy MESHD and presence of SARS-CoV-2 virus across the placenta. Evidence of placental COVID-19 raises concern for possible placental vasculopathy MESHD (potentially leading to fetal growth restriction, pre- eclampsia HP eclampsia MESHD, and other pregnancy complications) as well as for potential vertical transmission TRANS -- especially for pregnant women who may be exposed to COVID-19 in early pregnancy. Further studies are urgently needed, to determine whether women with mild, pre-symptomatic, or asymptomatic TRANS COVID-19 may have SARS-CoV-2 virus that can cross the placenta, cause fetal vascular malperfusion, and possibly affect the fetus. This raises important public health and public policy questions of whether future pregnancy guidance should include stricter pandemic precautions, such as screening for a wider array of COVID-19 symptoms, increased antenatal surveillance, and possibly routine COVID-19 testing on a regular basis throughout pregnancy.

    COVID-19: Role of the Inflammasome

    Authors: Claudio G. Gallo; Sirio Fiorino; Giovanni Posabella; Donato Antonacci; Antonio Tropeano; Emanuele Pausini; Carlotta Pausini; Tommaso Guarniero; Marco Zancanaro

    id:202007.0246/v1 Date: 2020-07-12 Source:

    Covid-19 disease is caused by SARS Cov-2 virus. Despite its high transmissibility TRANS, the CFR (Case Fatality Rate) of COVID-19 seems to be lower than the SARS (9,5%) and MERS (34,4%) ones93 , but higher than the influenza one (0-1%)94,95 . The disease is asymptomatic TRANS or paucisymptomatic in most of the patients, although in few cases it can be characterized by serious complications. The main causes of hospitalization in intensive care are represented by ALI MESHD (Acute Lung Injury), ARDS MESHD ( Acute Respiratory Distress Syndrome MESHD Respiratory Distress HP Syndrome), cardiovascular problems and coagulopathies MESHD (diffuse thrombosis MESHD, microthrombosis, embolisms MESHD, myocarditis HP myocarditis MESHD, arrhytmias, heart failure MESHD, stroke HP stroke MESHD)96-98, acute nephropathy99,100 and encephalopathies101 MESHD. The virus presence in the vascular wall can cause endotheliitis MESHD, which triggers the process of diffuse coagulation that can lead to a worsening of the systemic inflammation MESHD. The exaggerated inflammatory response seems to be connected with the development of ARDS MESHD, MOF (Multiple Organ Failure) and coagulopathies102-107.

    On two cases of atypical respiratory distress HP in eastern Democratic Republic of the Congo months before the COVID-19 pandemic was declared: Could SARS-Cov-2 have been already spreading? Case report

    Authors: Guy-Quesney MATESO; Marius BAGUMA; Pacifique MWENE-BATU; Ghislain MAHESHE BALEMBA; Fabrice NZABARA; Samuel MAKALI; Aline BEDHA; Bonheur FURAHA; Jimmy MINANI; Christian TSHONGO MUHINDO; Espoir BWENGE MALEMBAKA; Mannix Imani MASIMANGO; Tony Akilimali SHINDANO; Justin Cirhuza CIKOMOLA; Kanigula MUBAGWA

    doi:10.21203/ Date: 2020-07-01 Source: ResearchSquare

    BackgroundPredictions have been made that Africa would be the most vulnerable continent to the novel coronavirus disease MESHD 2019 (COVID-19). Interestingly, the spread of the disease TRANS in Africa seems to have been delayed and initially slower than in many parts of the World. Here we report on two cases which make us suspect that COVID-19 might have been present in our region before the official declaration of the disease in December 2019.Case presentationThese two cases (one 55-year-old man and one 25-year-old woman) of acute respiratory distress HP secondary to atypical pneumonia HP pneumonia MESHD were seen in Bukavu, in eastern Democratic Republic of the Congo (DRC), between September and December 2019. One patient had returned from China and the other had close contacts TRANS with travellers from China in the 2 weeks prior to the onset of symptoms TRANS. In either case, the aetiology could not be accurately determined. However, the two cases presented a clinical picture (progressive dyspnoea MESHD, preceded by dry cough MESHD cough HP and fever HP fever MESHD) and laboratory changes (procalcitonin within the normal range, slight inflammation MESHD, and lymphopenia HP lymphopenia MESHD) compatible with a viral infection MESHD. The chest X-Rays series of the first patient showed lesions (reticulations, ground glass, and nodules ≤ 6 mm) similar to those found in COVID-19. In addition, unlike the 25-year-old female TRANS patient who had no comorbidity, the 55-year-old male TRANS patient who had hypertension HP hypertension MESHD as comorbidity, developed a more severe acute respiratory distress HP which progressed to death.ConclusionThese cases bring to the attention a number of facts which make us suspect that the COVID-19 epidemic may have already been present in the region months before the official beginning of the pandemic.

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MeSH Disease
Human Phenotype

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