Corpus overview


Overview

MeSH Disease

Infections (422)

Disease (139)

Death (95)

Coronavirus Infections (69)

Fever (51)


Human Phenotype

Fever (51)

Cough (38)

Hypertension (27)

Anosmia (23)

Pneumonia (22)


Transmission

Seroprevalence
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    Seroprevalence SERO of SARS-CoV-2-Specific IgG Antibodies SERO Among Adults TRANS Living in Connecticut Between March 1 and June 1, 2020: Post- Infection MESHD Prevalence SERO (PIP) Study

    Authors: Shiwani Mahajan; Rajesh Srinivasan; Carrie A Redlich; Sara K Huston; Kelly M Anastasio; Lisa Cashman; Dan Witters; Jenny Marlar; Shu-Xia Li; Zhenqiu Lin; Domonique Hodge; Manas Chattopadhyay; Mark D Adams; Charles Lee; Lokinendi V Rao; Chris Stewart; Karthik Kuppusamy; Albert I Ko; Harlan M Krumholz

    doi:10.1101/2020.08.04.20168203 Date: 2020-08-06 Source: medRxiv

    Importance: A seroprevalence SERO study can estimate the percentage of people with SARS-CoV-2 antibodies SERO in the general population. Most existing reports have used a convenience sample, which may bias their estimates. Objective: To estimate the seroprevalence SERO of antibodies SERO against SARS-CoV-2 based on a random sample of adults TRANS living in Connecticut between March 1 and June 1, 2020. Design: Cross-sectional. Setting: We sought a representative sample of Connecticut residents who completed a survey between June 4 and June 23, 2020 and underwent serology testing for SARS-CoV-2-specific IgG antibodies SERO between June 10 and July 6, 2020. Participants: 505 respondents, aged TRANS [≥]18 years, residing in non-congregate settings who completed both the survey and the serology test. Main outcomes and measures: We estimated the seroprevalence SERO of SARS-CoV-2-specific IgG antibodies SERO among the overall population and across pre-specified subgroups. We also assessed the prevalence SERO of symptomatic illness, risk factors for virus exposure, and self-reported adherence to risk mitigation behaviors among this population. Results: Of the 505 respondents (mean age TRANS 50 [{+/-}17] years; 54% women; 76% non-Hispanic White individuals) included, 32% reported having at least 1 symptom suggestive of COVID-19 since March 1, 2020. Overall, 18 respondents had SARS-CoV-2-specific antibodies SERO, resulting in the state-level weighted seroprevalence SERO of 3.1 (90% CI 1.4-4.8). Individuals who were asymptomatic TRANS had significantly lower seroprevalence SERO (0.6% [90% CI 0.0-1.5]) compared with the overall state estimate, while those who reported having had [≥]1 and [≥]2 symptoms had a seroprevalence SERO of 8.0% (90% CI 3.1-12.9) and 13.0% (90% CI 3.5-22.5), respectively. All 9 of the respondents who reported previously having a positive coronavirus test were positive for SARS-CoV-2-specific IgG antibodies SERO. Nearly two-third of respondents reported having avoided public places (74%) and small gatherings of family or friends TRANS (75%), and 97% reported wearing a mask outside their home, at least part of the time. Conclusions and relevance: These estimates indicate that most people in Connecticut do not have detectable levels of antibodies SERO against SARS-CoV-2. There is a need for continued adherence to risk mitigation behaviors among Connecticut residents, to prevent resurgence of COVID-19 in this region.

    Transient dynamics of SARS-CoV-2 as England exited national lockdown

    Authors: Steven Riley; Kylie E. C. Ainslie; Oliver Eales; Caroline E Walters; Haowei Wang; Christina J Atchison; Peter Diggle; Deborah Ashby; Christl A. Donnelly; Graham Cooke; Wendy Barclay; Helen Ward; Ara Darzi; Paul Elliott

    doi:10.1101/2020.08.05.20169078 Date: 2020-08-06 Source: medRxiv

    Control of the COVID-19 pandemic requires a detailed understanding of prevalence SERO of SARS-CoV-2 virus in the population. Case-based surveillance is necessarily biased towards symptomatic individuals and sensitive to varying patterns of reporting in space and time. The real-time assessment of community transmission TRANS antigen study (REACT-1) is designed to overcome these limitations by obtaining prevalence SERO data based on a nose and throat swab RT-PCR test among a representative community-based sample in England, including asymptomatic TRANS individuals. Here, we describe results comparing rounds 1 and 2 carried out during May and mid June / early July 2020 respectively across 315 lower tier local authority areas. In round 1 we found 159 positive samples from 120,620 tested swabs while round 2 there were 123 positive samples from 159,199 tested swabs, indicating a downwards trend in prevalence SERO from 0.13% (95% CI, 0.11%, 0.15%) to 0.077% (0.065%, 0.092%), a halving time of 38 (28, 58) days, and an R of 0.89 (0.86, 0.93). The proportion of swab-positive participants who were asymptomatic TRANS at the time of sampling increased from 69% (61%, 76%) in round 1 to 81% (73%, 87%) in round 2. Although health care and care home workers were infected far more frequently than other workers in round 1, the odds were markedly reduced in round 2. Age TRANS patterns of infection MESHD changed between rounds, with a reduction by a factor of five in prevalence SERO in 18 to 24 year olds. Our data were suggestive of increased risk of infection TRANS risk of infection TRANS infection MESHD in Black and Asian (mainly South Asian) ethnicities. Using regional and detailed case location data, we detected increased infection MESHD intensity in and near London. Under multiple sensitivity SERO analyses, our results were robust to the possibility of false positives. At the end of the initial lockdown in England, we found continued decline in prevalence SERO and a shift in the pattern of infection MESHD by age TRANS and occupation. Community-based sampling, including asymptomatic TRANS individuals, is necessary to fully understand the nature of ongoing transmission TRANS.

    Seroprevalence SERO of COVID-19 in Niger State

    Authors: Hussaini Majiya; Mohammed Aliyu-Paiko; Vincent Tochukwu Balogu; Dickson Achimugu Musa; Ibrahim Maikudi Salihu; Abdullahi Abubakar Kawu; Ishaq Yakubu Bashir; Aishat Rabiu Sani; John Baba; Amina Tako Muhammad; Fatima Ladidi Jibril; Ezekiel Bala; Nuhu George Obaje; Yahaya Badeggi Aliyu; Ramatu Gogo Muhammad; Hadiza Mohammed; Usman Naji Gimba; Abduljaleel Uthman; Hadiza Muhammad Liman; Sule Alfa Alhaji; Joseph Kolo James; Muhammad Muhammad Makusidi; Mohammed Danasabe Isah; Ibrahim Abdullahi; Umar Ndagi; Bala Waziri; Chindo Ibrahim Bisallah; Naomi John Dadi-Mamud; Kolo Ibrahim; Abu Kasim Adamu

    doi:10.1101/2020.08.04.20168112 Date: 2020-08-05 Source: medRxiv

    Coronavirus Disease MESHD 2019 (COVID-19) Pandemic is ongoing, and to know how far the virus has spread in Niger State, Nigeria, a pilot study was carried out to determine the COVID-19 seroprevalence SERO, patterns, dynamics, and risk factors in the state. A cross sectional study design and clustered-stratified-Random sampling strategy were used. COVID-19 IgG and IgM Rapid Test SERO Kits (Colloidal gold immunochromatography lateral flow system) were used to determine the presence or absence of antibodies to SARS-CoV-2 SERO in the blood SERO of sampled participants across Niger State as from 26th June 2020 to 30th June 2020. The test kits were validated using the blood SERO samples of some of the NCDC confirmed positive and negative COVID-19 cases in the State. COVID-19 IgG and IgM Test results were entered into the EPIINFO questionnaire administered simultaneously with each test. EPIINFO was then used for both the descriptive and inferential statistical analyses of the data generated. The seroprevalence SERO of COVID-19 in Niger State was found to be 25.41% and 2.16% for the positive IgG and IgM respectively. Seroprevalence SERO among age groups TRANS, gender TRANS and by occupation varied widely. A seroprevalence SERO of 37.21% was recorded among health care workers in Niger State. Among age groups TRANS, COVID-19 seroprevalence SERO was found to be in order of 30-41 years (33.33%) > 42-53 years (32.42%) > 54-65 years (30%) > 66 years and above (25%) > 6-17 years (19.20%) > 18-29 years (17.65%) > 5 years and below (6.66%). A seroprevalence SERO of 27.18% was recorded for males TRANS and 23.17% for females TRANS in the state. COVID-19 asymptomatic TRANS rate in the state was found to be 46.81%. The risk analyses showed that the chances of infection MESHD are almost the same for both urban and rural dwellers in the state. However, health care workers and those that have had contact with person (s) that travelled TRANS out of Nigeria in the last six (6) months are twice ( 2 times) at risk of being infected with the virus. More than half (54.59%) of the participants in this study did not practice social distancing at any time since the pandemic started. Discussions about knowledge, practice and attitude of the participants are included. The observed Niger State COVID-19 seroprevalence SERO means that the herd immunity for COVID-19 is yet to be achieved and the population is still susceptible for more infection MESHD and transmission TRANS of the virus. If the prevalence SERO stays as reported here, the population will definitely need COVID-19 vaccines when they become available. Niger State should fully enforce the use of face/nose masks and observation of social/physical distancing in gatherings including religious gatherings in order to stop or slow the spread of the virus.

    Reconciling epidemiological models with misclassified case-counts for SARS-CoV-2 with seroprevalence SERO surveys: A case study in Delhi, India

    Authors: Rupam Bhattacharyya; Ritwik Bhaduri; Ritoban Kundu; Maxwell Salvatore; Bhramar Mukherjee

    doi:10.1101/2020.07.31.20166249 Date: 2020-08-04 Source: medRxiv

    Underreporting of COVID-19 cases and deaths MESHD is a hindrance to correctly modeling and monitoring the pandemic. This is primarily due to limited testing, lack of reporting infrastructure and a large number of asymptomatic infections MESHD asymptomatic TRANS. In addition, diagnostic tests (RT-PCR tests for detecting current infection MESHD) and serological antibody tests SERO for IgG (to assess past infections MESHD) are imperfect. In particular, the diagnostic tests have a high false negative rate. Epidemiologic models with a latent compartment for unascertained infections MESHD like the Susceptible-Exposed-Infected-Removed (SEIR) models can provide predictions for unreported cases and deaths MESHD under certain assumptions. Typically, the number of unascertained cases is unobserved and thus we cannot validate these estimates for a real study except for simulation studies. Population-based seroprevalence SERO studies can provide a rough estimate of the total number of infections MESHD and help us check epidemiologic model projections. In this paper, we develop a method to account for high false negative rates in RT-PCR in an extension to the classic SEIR model. We apply this method to Delhi, the national capital region of India, with a population of 19.8 million and a COVID-19 hotspot of the country, obtaining estimates of underreporting factor for cases at 34-53 times and that for deaths MESHD at 8-13 times. Based on a recently released serological survey for Delhi with an estimated 22.86% seroprevalence SERO, we compute adjusted estimates of the true number of infections MESHD reported by the survey (after accounting for misclassification of the antibody test SERO results) which is largely consistent with the model outputs, yielding an underreporting factor for cases from 30-42. Together with the model and the serosurvey, this implies approximately 96-98% cases in Delhi remained unreported and whereas only 109,140 cases were reported on July 10, the true number of infections MESHD varied somewhere between 4.4-4.6 million across different estimates. While repeated serological monitoring is resource intensive, model-based adjustments, run with the most up to date data, can provide a viable option to keep track of the unreported cases and deaths MESHD and gauge the true extent of transmission TRANS of this insidious virus.

    SARS-CoV-2 Seroprevalence SERO Across a Diverse Cohort of Healthcare Workers

    Authors: Joseph Ebinger; Gregory J. Botwin; Christine M. Albert; Mona Alotaibi; Moshe Arditi; Anders H. Berg; Aleksandra Binek; Patrick G. Botting; Justyna Fert-Bober; Jane C. Figueiredo; Jonathan D. Grein; Wohaib Hasan; Mir Henglin; Shehnaz K. Hussain; Mohit Jain; Sandy Joung; Michael Karin; Elizabeth H Kim; Dalin Li; Yunxian Liu; Eric Luong; Dermot P.B. McGovern; Akil Merchant; Noah M. Merin; Peggy B. Miles; Margo Minissian; Trevor-Trung Nguyen; Koen Raedschelders; Mohamad A. Rashid; Celine E. Riera; Richard V. Riggs; Sonia Sharma; Sarah Sternbach; Nancy Sun; Warren G. Tourtellotte; Jennifer E. Van Eyk; Kimia Sobhani; Jonathan G. Braun; Susan Cheng

    doi:10.1101/2020.07.31.20163055 Date: 2020-08-04 Source: medRxiv

    Importance: Antibody testing SERO is important for understanding patterns of exposure and potential immunity to SARS-CoV-2. Prior data on seroprevalence SERO have been subject to variations in selection of individuals and nature as well as timing of testing in relation to exposures. Objective: We sought to determine the extent of SARS-CoV-2 seroprevalance and the factors associated with seroprevelance across a diverse cohort of healthcare workers. Design: Observational cohort study of healthcare workers, including SARS-CoV-2 serology testing and participant questionaires. Participants: A diverse and unselected population of adults TRANS (n=6,062) employed in a multi-site healthcare delivery system located in Los Angeles County, including individuals with direct patient contact and others with non-patient-oriented work functions. Exposure: Exposure and infection MESHD with the SARS-CoV-2 virus, as determined by seropositivity. Main Outcomes: Using Bayesian and multi-variate analyses, we estimated seroprevalence SERO and factors associated with seropositivity and antibody SERO titers, including pre-existing demographic and clinical characteristics; potential Covid-19 illness related exposures; and, symptoms consistent with Covid-19 infection MESHD. Results: We observed a seroprevalence SERO rate of 4.1%, with anosmia HP as the most prominently associated self-reported symptom in addition to fever MESHD fever HP, dry cough MESHD cough HP, anorexia MESHD anorexia HP, and myalgias MESHD myalgias HP. After adjusting for potential confounders, pre-existing medical conditions were not associated with antibody SERO positivity. However, seroprevalence SERO was associated with younger age TRANS, Hispanic ethnicity, and African-American race, as well as presence of either a personal or household member having a prior diagnosis of Covid-19. Importantly, African American race and Hispanic ethnicity were associated with antibody SERO positivity even after adjusting for personal Covid-19 diagnosis status, suggesting the contribution of unmeasured structural or societally factors. Notably, number of people, or children TRANS, in the home was not associated with antibody SERO positivity. Conclusion and Relevance: The demographic factors associated with SARS-CoV-2 seroprevalence SERO among our healthcare workers underscore the importance of exposure sources beyond the workplace. The size and diversity of our study population, combined with robust survey and modeling techniques, provide a vibrant picture of the demographic factors, exposures, and symptoms that can identify individuals with susceptibility as well as potential to mount an immune response to Covid-19.

    SARS-CoV-2 Infection MESHD Among Symptom-Free Healthcare Workers

    Authors: Ryan T. Demmer; Angela Ulrich; Talia Wiggen; Ali Strickland; Brianna Naumchik; Shalini Kulasingam; Steven D. Stovitz; Clarisse Marotz; Pedro Belda-Ferre; Greg Humphrey; Peter De Hoff; Louise Laurent; Susan Kline; Rob Knight

    doi:10.1101/2020.07.31.20166066 Date: 2020-08-04 Source: medRxiv

    Importance: Current evidence suggests that transmission TRANS of severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) is possible among symptom-free individuals but limited data are available on this topic in healthcare workers (HCW). The quality and acceptability of self-collected nasopharyngeal swabs (NPS) is unknown. Objective: To estimate the prevalence SERO of SARS-CoV-2 infection MESHD and to assess the acceptability of self-collected NPS among HCW. Design: Cross-sectional convenience sample enrolled between April 20th and June 24th, 2020. We had >95% power to detect at least one positive test if the true underlying prevalence SERO of SARS-CoV2 was > 1%. Setting: The metropolitan area surrounding Minneapolis and St. Paul, Minnesota. Participants: HCW free of self-reported upper respiratory symptoms were recruited. Exposures: Participants completed questionnaires regarding demographics, household characteristics, personal protective equipment (PPE) utilization and comorbidities. Outcomes: A participant self-collected nasopharyngeal swab (NPS) was obtained. SARS-CoV-2 infection MESHD was assessed via polymerase chain reaction. NPS discomfort was assessed on a scale of 1 (no discomfort) - 10 (extreme discomfort). NPS duration and depth into the nasopharynx, and willingness to perform future self-collections were assessed. Results: Among n=489 participants 80% were female TRANS and mean age TRANS+/-SD was 41+/-11. Participants reported being physicians (14%), nurse practitioners (8%), physicians assistants (4%), nurses (51%), medics (3%), or other which predominantly included laboratory technicians and administrative roles (22%). Exposure to a known/suspected COVID-19 case in the 14 days prior to enrollment was reported in 40% of participants. SARS-CoV-2 was not detected in any participant. The mean+/-SD discomfort level of the NPS was 4.5+/-2.0. 95% of participants reported that their self-swab was longer than or equal to the duration of patient swabs they had previously performed, and 89% reported the depth to be deeper than or equal to the depth of previous patient swabs. Over 95% of participants reported a willingness to repeat a self-collected NP swab in the future. Conclusions and Relevance: The point prevalence SERO of SARS-CoV-2 infection MESHD was likely very low in symptom-free Minnesota healthcare workers from April 20th and June 24th, 2020. Self-collected NP swabs are well-tolerated and a viable alternative to provider-collected swabs to preserve PPE.

    The Lebanese Cohort for COVID-19; A Challenge for the ABO Blood SERO Group System

    Authors: Athar Khalil; Mahmoud Hassoun; Rita Feghali

    doi:10.1101/2020.08.02.20166785 Date: 2020-08-04 Source: medRxiv

    A sudden outbreak of pneumonia MESHD pneumonia HP caused by the Severe Acute Respiratory Syndrome MESHD Coronavirus 2 (SARS-CoV-2) has rapidly spread all over the world facilitating the declaration of the resultant disease MESHD as a pandemic in March,2020. In Lebanon, the fast action of announcing a state of emergency MESHD with strict measures was among the factors that helped in achieving a successful containment of the disease MESHD in the country. Predisposing factors for acquiring COVID-19 and for developing a severe form of this disease MESHD were postulated to be related to epidemiological and clinical characteristics as well as the genomics signature of a given population or its environment. Biological markers such as the ABO blood SERO group system was amongst those factors that were proposed to be linked to the variability in the disease MESHD course and/or the prevalence SERO of this infection MESHD among different groups. We therefore conducted the first retrospective case-control study in the Middle-East and North Africa that tackles the association between the blood SERO group types and the susceptibility as well as the severity of SARS-CoV2 infection MESHD. Opposing to the current acknowledged hypothesis, our results have challenged the association significance of this system with COVID-19. Herein, we highlighted the importance of studying larger cohorts using more rigorous approaches to diminish the potential confounding effect of some underlying comorbidities and genetic variants that are known to be associated with the ABO blood SERO group system.

    Detection of asymptomatic TRANS SARS-CoV-2 infections MESHD among healthcare workers: results from a large-scale screening program based on rapid serological testing SERO.

    Authors: Francesca Maria Carozzi; Maria Grazia Cusi; Mauro Pistello; Luisa Galli; Alessandro Bartoloni; Gabriele Anichini; Chiara Azzari; Michele Emdin; Claudia Gandolfo; Fabrizio Maggi; Elisabetta Mantengoli; Maria Moriondo; Giovanna Moscato; Irene Paganini; Claudio Passino; Francesco Profili; Fabio Voller; Marco Zappa; Filippo Quattrone; Gian Maria Rossolini; Paolo Francesconi; - SARS-CoV-2 Serosurvey Tuscan Working Group

    doi:10.1101/2020.07.30.20149567 Date: 2020-08-04 Source: medRxiv

    Abstract Objective: To evaluate the performance SERO of two available rapid immunological tests for identification of severe acute respiratory syndrome MESHD Coronavirus 2 ( SARS-CoV-2) antibodies SERO and their subsequent application to a regional screening of health care workers (HCW) in Tuscany (Italy). Design: measures of accuracy and HCW serological surveillance Setting: 6 major health facilities in Tuscany, Italy. Participants: 17,098 HCW of the Tuscany Region. Measures of accuracy were estimated to assess sensitivity SERO in 176 hospitalized Covid-19 clinical subjects at least 14 days after a diagnostic PCR-positive assay result. Specificity was assessed in 295 sera biobanked in the pre-Covid-19 era in winter or summer 2013-14 Main outcome measures: Sensitivity SERO and specificity, and 95% confidence intervals, were measured using two serological tests SERO, named T-1 and T-2. Positive and Negative predictive values SERO were estimated at different levels of prevalence SERO. HCW of the health centers were tested using the serological SERO tests, with a follow- up nasopharyngeal PCR-test swab in positive tested cases. Results: Sensitivity SERO was estimated as 99% (95%CI: 95%-100%) and 97% (95% CI: 90%-100%), whereas specificity was the 95% and 92%, for Test T-1 and T-2 respectively. In the historical samples IgM cross-reactions were detected in sera collected during the winter period, probably linked to other human coronaviruses. Out of the 17,098 tested, 3.1% have shown the presence of SARS-CoV-2 IgG antibodies SERO, among them 6.8% were positive at PCR follow-up test on nasopharyngeal swabs. Conclusion Based on the low prevalence SERO estimate observed in this survey, the use of serological test SERO as a stand-alone test is not justified to assess the individual immunity status. Serological tests SERO showed good performance SERO and might be useful in an integrated surveillance, for identification of infected subjects and their contacts as required by the policy of contact tracing TRANS, with the aim to reduce the risk of dissemination, especially in health service facilities.

    The Impact of COVID-19 on Medical Practice: A Nationwide Survey of Dermatologists and Healthcare Providers

    Authors: Mohammed Shanshal; Hayder Saad Ahmed; Hayder Asfoor; Raad Ibrahim Salih; Shehab Ahmed Ali; Yusif k. Aldabouni

    doi:10.1101/2020.07.26.20156380 Date: 2020-08-04 Source: medRxiv

    Background: The COVID-19 pandemic has dramatically changed medical practice worldwide. It posed a significant impact on different health services, including dermatology. Methods and objectives: Two online surveys were conducted to determine the prevalence SERO of personal protective equipment-related skin complications (200 healthcare providers were included) and to demonstrate the outbreak s impact on dermatology practice (100 dermatologists were included). Results: In the first survey, the response rate was 72.46%. PPE- related dermatoses were reported by 147 (73%) participants, including frictional dermatitis MESHD (51.9%), mechanical acne HP (33.1%), contact dermatitis MESHD contact dermatitis HP (29.9%), nonspecific rash (17.5%), urticaria MESHD urticaria HP (9.1%) and skin infections MESHD (3.2%). The response rate of the second survey was 64%. COVID-19 emerging cutaneous manifestations were recognized by 20% of dermatologists, including maculopapular rash (41.67%), urticaria MESHD urticaria HP (37.50%), chilblain MESHD chilblain HP (25%) and vasculitis MESHD vasculitis HP (16.67). Telemedicine was provided by 73% of the dermatologists. The relapse rates of psoriasis MESHD, atopic dermatitis MESHD atopic dermatitis HP, rosacea MESHD, vitiligo MESHD vitiligo HP and alopecia areata MESHD alopecia areata HP were noticeably increased as observed by 62%, 50%, 20%, and 4% of dermatologists, respectively. Most dermatologists (89%) reported minimal use of immunosuppressive drugs amid the pandemic. Conclusions: This article highlights the pivotal role of dermatologists in the leading edge during the current health crisis and how they adapt to these unfamiliar circumstances to meet the challenges. It documents the emergence of PPE-related dermatoses among healthcare providers and the impact of COVID-19 on different aspects of dermatology practice.

    Paradoxical Case Fatality Rate dichotomy of Covid-19 among rich and poor nations points to the hygiene hypothesis.

    Authors: Bithika Chatterjee; Rajeeva Laxman Karandikar; Shekhar C. Mande

    doi:10.1101/2020.07.31.20165696 Date: 2020-08-04 Source: medRxiv

    In the first six months of its deadly spread across the world, the Covid-19 incidence has exhibited interesting dichotomy between the rich and the poor countries. Surprisingly, the incidence and the Case Fatality Rate has been much higher in the richer countries compared with the poorer countries. However, the reasons behind this dichotomy have not been explained based on data or evidence, although some of the factors for the susceptibility of populations to SARS-CoV-2 infections MESHD have been proposed. We have taken into consideration all publicly available data and mined for the possible explanations in order to understand the reasons for this phenomenon. The data included many parameters including demography of nations, prevalence SERO of communicable and non- communicable diseases MESHD, sanitation parameters etc. Results of our analyses suggest that demography, improved sanitation and hygiene, and higher incidence of autoimmune disorders as the most plausible factors to explain higher death MESHD rates in the richer countries Thus, the much debated hygiene hypothesis appears to lend credence to the Case Fatality Rate dichotomy between the rich and the poor countries.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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