Corpus overview


MeSH Disease

Human Phenotype


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    Understanding the patterns of repeated testing for COVID-19: Association with patient characteristics and outcomes

    Authors: Stephen Salerno; Zhangchen Zhao; Swaraaj Prabhu Sankar; Maxwell Salvatore; Tian Gu; Lars G. Fritsche; Seunggeun Lee; Lynda D Lisabeth; Thomas S Valley; Bhramar Mukherjee

    doi:10.1101/2020.07.26.20162453 Date: 2020-07-29 Source: medRxiv

    Importance The diagnostic tests for COVID-19 have a high false negative rate, but not everyone with an initial negative result is re-tested. Michigan Medicine, being one of the primary regional centers accepting COVID-19 cases, provided an ideal setting for studying COVID-19 repeated testing patterns during the first wave of the pandemic. Objective To identify the characteristics of patients who underwent repeated testing for COVID-19 and determine if repeated testing was associated with patient characteristics and with downstream outcomes among positive cases. Design This cross-sectional study described the pattern of testing for COVID-19 at Michigan Medicine. The main hypothesis under consideration is whether patient characteristics differed between those tested once and those who underwent multiple tests. We then restrict our attention to those that had at least one positive test and study repeated testing patterns in patients with severe COVID-19 related outcomes (testing positive, hospitalization and ICU care). Setting Demographic and clinical characteristics, test results, and health outcomes for 15,920 patients presenting to Michigan Medicine between March 10 and June 4, 2020 for a diagnostic test for COVID-19 were collected from their electronic medical records on June 24, 2020. Data on the number and types of tests administered to a given patient, as well as the sequences of patient-specific test results were derived from records of patient laboratory results. Participants Anyone tested between March 10 and June 4, 2020 at Michigan Medicine with a diagnostic test for COVID-19 in their Electronic Health Records were included in our analysis. Exposures Comparison of repeated testing across patient demographics, clinical characteristics, and patient outcomes Main Outcomes and Measures Whether patients underwent repeated diagnostic testing for SARS CoV-2 in Michigan Medicine Results Between March 10th and June 4th, 19,540 tests were ordered for 15,920 patients, with most patients only tested once (13596, 85.4%) and never testing positive (14753, 92.7%). There were 5 patients who got tested 10 or more times and there were substantial variations in test results within a patient. After fully adjusting for patient and neighborhood socioeconomic status MESHD ( NSES MESHD) and demographic characteristics, patients with circulatory diseases MESHD (OR: 1.42; 95% CI: (1.18, 1.72)), any cancer MESHD (OR: 1.14; 95% CI: (1.01, 1.29)), Type 2 diabetes MESHD (OR: 1.22; 95% CI: (1.06, 1.39)), kidney diseases MESHD (OR: 1.95; 95% CI: (1.71, 2.23)), and liver diseases MESHD (OR: 1.30; 95% CI: (1.11, 1.50)) were found to have higher odds of undergoing repeated testing when compared to those without. Additionally, as compared to non-Hispanic whites, non-Hispanic blacks were found to have higher odds (OR: 1.21; 95% CI: (1.03, 1.43)) of receiving additional testing. Females TRANS were found to have lower odds (OR: 0.86; 95% CI: (0.76, 0.96)) of receiving additional testing than males TRANS. Neighborhood poverty level also affected whether to receive additional testing. For 1% increase in proportion of population with annual income below the federal poverty level, the odds ratio of receiving repeated testing is 1.01 (OR: 1.01; 95% CI: (1.00, 1.01)). Focusing on only those 1167 patients with at least one positive result in their full testing history, patient age TRANS in years (OR: 1.01; 95% CI: (1.00, 1.03)), prior history of kidney diseases MESHD (OR: 2.15; 95% CI: (1.36, 3.41)) remained significantly different between patients who underwent repeated testing and those who did not. After adjusting for both patient demographic factors and NSES MESHD, hospitalization (OR: 7.44; 95% CI: (4.92, 11.41)) and ICU-level care (OR: 6.97; 95% CI: (4.48, 10.98)) were significantly associated with repeated testing. Of these 1167 patients, 306 got repeated testing and 1118 tests were done on these 306 patients, of which 810 (72.5%) were done during inpatient stays, substantiating that most repeated tests for test positive patients were done during hospitalization or ICU care. Additionally, using repeated testing data we estimate the "real world" false negative rate of the RT-PCR diagnostic test was 23.8% (95% CI: (19.5%, 28.5%)). Conclusions and Relevance This study sought to quantify the pattern of repeated testing for COVID-19 at Michigan Medicine. While most patients were tested once and received a negative result, a meaningful subset of patients (2324, 14.6% of the population who got tested) underwent multiple rounds of testing (5,944 tests were done in total on these 2324 patients, with an average of 2.6 tests per person), with 10 or more tests for five patients. Both hospitalizations and ICU care differed significantly between patients who underwent repeated testing versus those only tested once as expected. These results shed light on testing patterns and have important implications for understanding the variation of repeated testing results within and between patients.

    COVID-19 and Epilepsy MESHD

    Authors: Amira Sidig; Radi Tofaha Alhusseini; Khabab Abbasher; Mohamed Elsayed; Hussien Abbasher; Mohammed Abbasher; Sufian Khalid M. N; Khalid Hajnoor; Mohammed Malekaldar; Abbasher Hussien; Omer Eladil A. Hamid; Mutaz F. Digna

    doi:10.21203/ Date: 2020-07-26 Source: ResearchSquare

    Introduction: COVID-19 caused by SARS-CoV-2 acquired via respiratory droplets. It can present with many systemic disorders MESHD, includingA 45-year-old Sudanese male TRANS known to have well-controlled generalized tonic-clonic epilepsy MESHD, He presented to the Accident and Emergency (A&E) department complaining of refractory status epilepticus HP status epilepticus MESHD. Despite immediate initial stabilization, the seizure HP seizure MESHD attacks were still refractory to intravenous loading doses of antiepileptic drugs AEDs. Hence the patient was intubated and mechanically ventilated. Brain MRI and EEG were normal. The chest X-ray was normal. The screening of COVID-19 was positive. Epilepsy MESHD is one of the most common neurological disorders MESHD. Since the beginning of the Coronavirus outbreak in December 2019, no available research data is suggesting that the patients with epilepsy MESHD are at more risk than others. As no available data relating epilepsy MESHD to severe COVID-19 infection (6). Moreover, no data studied COVID-19 and the sudden unexpected death MESHD among epileptic MESHD patients (SUDEP).Conclusion: This case might report the effect of SARS-CoV-2 on provoking the refractory seizures HP seizures MESHD in a previously well-controlled patient with epilepsy MESHD. More researches are needed to explain the relation between COVID and seizure HP seizure MESHD threshold.

    Privacy-Preserving Multi-Operator Contact Tracing TRANS for Early Detection of Covid19 Contagions

    Authors: Davide Andreoletti; Omran Ayoub; Silvia Giordano; Massimo Tornatore; Giacomo Verticale

    id:2007.10168v1 Date: 2020-07-20 Source: arXiv

    The outbreak of coronavirus disease MESHD 2019 (covid-19) is imposing a severe worldwide lock-down. Contact tracing TRANS based on smartphones' applications (apps) has emerged as a possible solution to trace TRANS contagions and enforce a more sustainable selective quarantine. However, a massive adoption of these apps is required to reach the critical mass needed for effective contact tracing TRANS. As an alternative, geo-location technologies in next generation networks (e.g., 5G) can enable Mobile Operators (MOs) to perform passive tracing TRANS of users' mobility and contacts with a promised accuracy of down to one meter. To effectively detect contagions, the identities of positive individuals, which are known only by a Governmental Authority (GA), are also required. Note that, besides being extremely sensitive, these data might also be critical from a business perspective. Hence, MOs and the GA need to exchange and process users' geo-locations and infection status data in a privacy-preserving manner. In this work, we propose a privacy-preserving protocol that enables multiple MOs and the GA to share and process users' data to make only the final users discover the number of their contacts with positive individuals. The protocol is based on existing privacy-enhancing strategies that guarantee that users' mobility and infection status MESHD are only known to their MOs and to the GA, respectively. From extensive simulations, we observe that the cost to guarantee total privacy (evaluated in terms of data overhead introduced by the protocol) is acceptable, and can also be significantly reduced if we accept a negligible compromise in users' privacy.

    Clinical Electroencephalography Findings and Considerations in Hospitalized Patients with Coronavirus SARS-CoV-2 MESHD

    Authors: Neishay Ayub; Joseph Cohen; Jin Jing; Aayushee Jain; Ryan Tesh; Shibani S. Mukerji; Sahar F. Zafar; M. Brandon Westover; Eyal Y Kimchi

    doi:10.1101/2020.07.13.20152207 Date: 2020-07-15 Source: medRxiv

    Background and Purpose Reports have suggested that severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) causes neurologic manifestations including encephalopathy HP encephalopathy MESHD and seizures HP seizures MESHD. However, there has been relatively limited electrophysiology data to contextualize these specific concerns and to understand their associated clinical factors. Our objective was to identify EEG abnormalities HP present in patients with SARS-CoV-2, and to determine whether they reflect new or preexisting brain pathology. Methods We studied a consecutive series of hospitalized patients with SARS-CoV-2 who received an EEG, obtained using tailored safety protocols. Data from EEG reports and clinical records were analyzed to identify EEG abnormalities HP and possible clinical associations, including neurologic symptoms, new or preexisting brain pathology, and sedation practices. Results We identified 37 patients with SARS-CoV-2 who underwent EEG, of whom 14 had epileptiform MESHD findings (38%). Patients with epileptiform MESHD findings were more likely to have preexisting brain pathology (6/14, 43%) than patients without epileptiform MESHD findings (2/23, 9%; p=0.042). There were no clear differences in rates of acute brain pathology. One case of nonconvulsive status epilepticus HP nonconvulsive status epilepticus MESHD was captured, but was not clearly a direct consequence of SARS-CoV-2. Abnormalities of background rhythms were common, and patients recently sedated were more likely to lack a posterior dominant rhythm (p=0.022). Conclusions Epileptiform abnormalities MESHD were common in patients with SARS-CoV-2 referred for EEG, but particularly in the context of preexisting brain pathology and sedation. These findings suggest that neurologic manifestations during SARS-CoV-2 infection MESHD may not solely relate to the infection itself, but rather may also reflect patients' broader, preexisting neurologic vulnerabilities.

    Socioeconomic disparities in subway use and COVID-19 outcomes in New York City

    Authors: Karla Therese L. Sy; Micaela E. Martinez; Benjamin Rader; Laura F. White

    doi:10.1101/2020.05.28.20115949 Date: 2020-05-30 Source: medRxiv

    Background: The United States CDC has reported that racial and ethnic disparities in the COVID-19 pandemic may in part be due to socioeconomic disadvantages that require individuals to continue to work outside their home and a lack of paid sick leave. However, data-driven analyses of the socioeconomic determinants of COVID-19 burden are still needed. Using data from New York City (NYC), we aimed to determine how socioeconomic factors impact human mobility and COVID-19 burden. Methods/Summary: New York City has a large amount of heterogeneity in socioeconomic status (SES) and demographics among neighborhoods. We used this heterogeneity to conduct a cross-sectional spatial analysis of the associations between human mobility (i.e., subway ridership), sociodemographic factors, and COVID-19 incidence as of April 26, 2020. We also conducted a secondary analysis of NYC boroughs (which are equivalent to counties in the city) to assess the relationship between the decline in subway use and the time it took for each borough to end the exponential growth period of COVID-19 cases. Findings: Areas with the lower median income, a greater percentage of individuals who identify as non-white and/or Hispanic/Latino, a greater percentage of essential workers, and a greater percentage of healthcare workers had more subway use during the pandemic. The positive associations between subway use and median income, and between subway use and percent non-white and/or Hispanic/Latino do not remain when adjusted for the percent of essential workers. This suggests essential work is what drives subway use in lower SES zip codes and communities of color. Increased subway use was associated with a higher rate of COVID-19 cases per 100,000 population when adjusted for testing effort (aRR=1.11; 95% CI: 1.03 - 1.19), but this association was weaker once we adjusted for median income (aRR=1.06; 95% CI: 1.00 - 1.12). All sociodemographic variables were significantly associated with the rate of positive cases per 100,000 population when adjusting for testing effort (except percent uninsured) and adjusting for both income and testing effort. The risk factor with the strongest association with COVID-19 was the percent of individuals in essential work (aRR = 1.59, 95% CI: 1.36 - 1.86). We found that subway use declined prior to any executive order, and there was an estimated 28-day lag between the onset of reduced subway use and the end of the exponential growth period of SARS-CoV-2 within New York City boroughs. Interpretation: Our results suggest that the ability to stay home during the pandemic has been constrained by SES and work circumstances. Poorer neighborhoods are not afforded the same reductions in mobility as their richer counterparts. Furthermore, lower SES neighborhoods MESHD have higher disease burdens, which may be due to inequities in ability to shelter-in-place, and/or due to the plethora HP of other existing health disparities that increase vulnerability to COVID-19. Furthermore, the extended lag time between the dramatic fall HP in subway ridership and the end of the exponential growth phase for COVID-19 cases is important for future policy, because it demonstrates that if there is a resurgence, and stay-at-home orders are re-issued, then cities can expect to wait a month before reported cases will plateau.

    Central Nervous System Disorders MESHD in Severe SARS-CoV-2 Infection MESHD: detailed clinical work-up of eight cases

    Authors: Emanuela Keller; Giovanna Brandi; Sebastian Winklhofer; Lukas Imbach; Daniel Kirschenbaum; Karl Joachim Frontzek; Peter Steiger; Sabeth Aurelia Dietler; Marcellina Isabelle Haeberlin; Jan Folkard Willms; Francesca Porta; Adrian Waeckerlin; Irene Alma Abela; Andreas Lutterotti; Christoph Stippich; Ilijas Jelcic

    doi:10.21203/ Date: 2020-05-29 Source: ResearchSquare

    Objective Case series with different clinical presentations indicating central nervous system (CNS) involvement in coronavirus disease MESHD 2019 (COVID-19) have been published. Comprehensive work-ups including clinical characteristics, laboratory, electroencephalography (EEG), neuroimaging and cerebrospinal fluid (CSF) findings are needed to understand the mechanisms.DesignWe evaluated 32 consecutive patients with severe SARS-CoV-2 infection MESHD treated at a tertiary care centre from March 09 to April 03, 2020 for concomitant severe central nervous system (CNS) symptoms occurring during their critical disease state. Those with CNS disorders MESHD were examined in detail regarding clinical characteristics and undergoing additional examinations, e.g. computed tomography (CT), magnetic resonance imaging (MRI), (EEG), (CSF) analysis and autopsy if they had died.ResultsOf 32 critically ill patients with COVID-19 eight (18%) had severe CNS involvement (mean [SD] age TRANS, 67.6 [6.8] years; seven men; two patients died). All eight patients had cardiovascular risk factors, most frequently arterial hypertension HP hypertension MESHD. Two patients presented with lacunar ischemic stroke HP ischemic stroke MESHD and one with status epilepticus HP status epilepticus MESHD in the early phase. As most common presentation, six patients presented with prolonged impaired consciousness MESHD after termination of analgosedation. In all but one with delayed wake-up, neuroimaging or autopsy showed multiple cerebral microbleeds, in three of them with additional subarachnoid haemorrhage MESHD and in another two with additional small ischemic lesions MESHD. In three patients intracranial vessel wall sequence MRI was performed, for the first time to our knowledge. All cases showed contrast-enhancement of vessel walls in large and middle-sized cerebral arteries, suggesting vascular wall pathologies with an inflammatory component. CSF analysis showed normal cells counts and chemistry. RT-PCRs for SARS-CoV-2 in CSF were all negative, and no intrathecal SARS-CoV-2 specific IgG synthesis was detectable. ConclusionsCNS disorders MESHD are common in patients with severe COVID-19. Different mechanisms might be involved. Besides unspecific encephalopathy HP encephalopathy MESHD and encephalitic syndromes MESHD, large vessel strokes HP strokes MESHD might occur early after disease onset. In a later phase, microbleeds and microinfarctions indicate potential CNS small vessel disease. MRI vessel wall contrast enhancement suggests cerebral vascular wall pathologies with an inflammatory component. CNS disorders MESHD associated with COVID-19 may lead to long-term disabilities aggravating socio-economic damage. The mechanisms have to be investigated urgently in order to develop preventive and therapeutic neuroprotective strategies.

    A Modified Epidemiological Model to Understand the Uneven Impact of COVID-19 on Vulnerable Individuals and the Approaches Required to Help them Emerge from Lockdown

    Authors: Dario Ortega Anderez; Eiman Kanjo; Ganna Pogrebna; Shane Johnson; John Alan Hunt

    id:2006.10495v2 Date: 2020-05-25 Source: arXiv

    COVID-19 has shown a relatively low mortality rate in young healthy individuals, with the majority of this group being asymptomatic TRANS or having mild symptoms, while the severity of the disease among individuals with underlying health conditions has caused signiffcant mortality rates worldwide. Understanding these differences in mortality amongst different sectors of society and modelling this will enable the different levels of risk and vulnerabilities to be determined to enable strategies exit the lockdown. However, epidemiological models do not account for the variability encountered in the severity of the SARS-CoV-2 disease MESHD across different population groups. To overcome this limitation, it is proposed that a modiffed SEIR model, namely SEIR-v, through which the population is separated into two groups regarding their vulnerability to SARS-CoV-2 is applied. This enables the analysis of the spread of the epidemic when different contention measures are applied to different groups in society regarding their vulnerability to the disease. A Monte Carlo simulation indicates a large number of deaths could be avoided by slightly decreasing the exposure of vulnerable groups to the disease. From this modelling a number of mechanisms can be proposed to limit the exposure of vulnerable individuals to the disease in order to reduce the mortality rate among this group. One option could be the provision of a wristband to vulnerable people and those without a contact-tracing TRANS app. By combining very dense contact tracing TRANS data from smartphone apps and wristband signals with information about infection status MESHD and symptoms, vulnerable people can be protected and kept safer. Widespread utilisation would extend the protection further beyond these high risk groups.

    Neurological Involvement of Coronavirus Disease MESHD 2019: A Systematic Review

    Authors: Malik Ghannam; Qasem Alshaer; Mustafa Al-Chalabi; Lara Zakarna; Jetter Robertson; Georgios Manousakis

    doi:10.21203/ Date: 2020-05-23 Source: ResearchSquare

    Background: In December 2019, unexplained cases of pneumonia HP pneumonia MESHD emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease MESHD 2019 (COVID-2019) outbreak, a pandemic. Although the most common presentations of COVID-19 are fever HP fever MESHD, cough HP cough MESHD and shortness of breath MESHD, several clinical observations indicate that COVID-19 does affect the central and peripheral nervous system.  Methods: We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 that were evident for neurological involvement.  Results: We were able to identify 82 cases of COVID-19 with neurological complications. The mean age TRANS was 62.28 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n=40) had cerebrovascular insults, 28% (n=23) had neuromuscular disorders MESHD, 18.3% of the patients (n=15) had encephalitis HP encephalitis MESHD or encephalopathy HP encephalopathy MESHD, and 2.4% (n=2) presented with status epilepticus HP status epilepticus MESHD. Conclusions: Neurological manifestations of COVID-19 infection MESHD are not rare, especially large vessel stroke HP stroke MESHD, Guillain barre syndrome MESHD and meningoencephalitis MESHD. Moving forward, further studies are needed to clarify the prevalence SERO of the neurological complications of COVID-19, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic.

    Self-limited focal epilepsy MESHD in a young child TRANS with SARS-CoV-2: serendipity or causal association?

    Authors: Davide Silvagni; Pietro Soloni; Francesca Darra; Paolo Biban

    doi:10.21203/ Date: 2020-05-21 Source: ResearchSquare

    Neurological manifestations have been reported in adults TRANS with COVID-19. In children TRANS with COVID-19, data on neurological symptoms are scarce. A 4-year-old girl was assisted at home for prolonged afebrile seizures HP. She was unresponsive, with a conjugate eye right deviation lasting > 20 minutes. Intravenous midazolam was administered. Before arrival in our Emergency Department, EMS providers excluded risk factors for COVID-19, such as fever HP fever MESHD, respiratory symptoms, other signs of viral infections MESHD, or recent contacts with suspected COVID-19 cases. Upon her arrival, seizures HP seizures MESHD had resolved, GCS was 12. Temperature was 36,6°C. Chest was clear (SatO2 100%). Blood SERO tests did not show signs of infection MESHD. We collected a nasopharyngeal swab, which tested positive for SARS-CoV-2. The patient rapidly recovered her neurological function. A pediatric neurological examination and video-EEG recording produced a possible diagnosis of self-limited focal epilepsy MESHD, with temporo-occipital spikes. Family history revealed her father had occasional seizures HP seizures MESHD during fever HP fever MESHD episodes, at 14 and 21 years. The child TRANS was discharged home, scheduling further neurological investigations once the swab was negative. Our case emphasizes that keeping a high suspicion for SARS-CoV-2 infection MESHD is pivotal in hot spots, regardless of the absence of typical COVID-19 symptoms. As for the seizures HP seizures MESHD episode, we know infections MESHD and fever HP fever MESHD are leading seizure HP seizure MESHD precipitating factors in children TRANS. To our knowledge, this is the first case of focal status epilepticus HP status epilepticus MESHD in new onset focal self-limited epilepsy MESHD in an afebrile child TRANS with SARS-CoV-2. We speculate that SARS-CoV-2 infection MESHD may have triggered the onset of self-limited focal epilepsy MESHD in our patient.

    Facemasks prevent influenza-like illness: implications for COVID-19

    Authors: Jie Wei; Michael Doherty; Monica S.M. Persson; Subhashisa Swain; Changfu Kuo; CHAO ZENG; guanghua Lei; Weiya Zhang

    doi:10.1101/2020.05.07.20094912 Date: 2020-05-12 Source: medRxiv

    The coronavirus disease MESHD 2019 (COVID-19) pandemic is causing a huge toll on individuals, families, communities and societies across the world. Currently, whether wearing facemasks in public should be a measure to prevent transmission TRANS of severe acute respiratory syndrome coronavirus-2 MESHD (SARS-CoV-2) remains contraversial.1 This is largely because there have been no randomized controlled trials (RCTs) for coronavirus to directly support this. However, lessons may be taken from published RCTs examining influenza-like illness (ILI).2,3 Recent studies suggested that SARS-CoV-2 shares similar transmission TRANS route with influenza virus,4 and the incidence of community transmission TRANS of SARS-CoV-2 in individuals with ILI is high.5 Therefore, we undertook this meta-analysis of RCTs examining the efficacy of wearing facemasks to prevent ILI in community settings, irrespective of confirmatory testing for the causative virus. We undertook a systematic literature search for RCTs related to facemasks and ILI between 1966 and April 2020 using PUBMED, EMBASE, and Cochrane library. RCTs undertaken in community (not hospital) settings comparing wearing and not wearing facemasks for ILI were included. Incidence of ILI (e.g., fever HP fever MESHD, cough HP cough MESHD, headache HP headache MESHD, sore throat, aches MESHD or pains HP pains MESHD in muscles or joints MESHD) was estimated per group. Relative risk (RR) and 95% confidence interval (CI) were calculated. We screened 899 related abstracts and eventually included 8 RCTs (Figure S1). Basic characteristics and quality of included RCTs are listed in Supplement. Participants wearing facemasks had a significantly lower risk of developing ILI than those not wearing facemasks (pooled RR=0.81, 95% CI: 0.70-0.95) and there was no heterogeneity (Figure 1). The decreased risk of ILI was more pronounced if everyone wore facemask irrespective of whether they were infected MESHD or not (RR=0.77, 95% CI: 0.65-0.91), compared to those wearing facemasks when infected (RR=0.95, 95% CI: 0.58-1.56) or uninfected (RR=1.26, 95% CI: 0.69-2.31). This study shows that wearing facemasks, irrespective of infection status MESHD, is effective in preventing ILI spread in the community. This situation mirrors what is happening now in public settings where we do not know who has been infected MESHD and who has not. Although there are no RCTs of facemasks for SARS-CoV-2, as with other simple measures such as social distancing and handwashing, these data support the recommendation to wear facemasks in public to further reduce transmission TRANS of SARS-CoV-2 and flatten the curve of this pandemic, especially when social distancing is impractical, such as shopping, or travelling TRANS with public transport for work that cannot be done from home.

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MeSH Disease
Human Phenotype

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