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2.
Infez Med ; 28(suppl 1): 64-70, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32532941

RESUMO

Preparing for emerging respiratory pathogens is a fundamental requirement for enhancements of the safeguard in healthcare settings. We are facing an increasing pressure to be prepared more than before. Healthcare organizations should be ready to deal with such emerging infectious disease. Here, we share some points that are essential to be considered while we prepare our institutions to prevent the transmission of emerging respiratory pathogens such as MERS-CoV and the recently emerging pandemic of SARS-CoV-2, the causative agent of COVID-19.


Assuntos
Betacoronavirus , Defesa Civil/métodos , Doenças Transmissíveis Emergentes/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Coronavírus da Síndrome Respiratória do Oriente Médio , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Vírus da SARS , Síndrome Respiratória Aguda Grave/prevenção & controle , Técnicas de Laboratório Clínico , Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Fidelidade a Diretrizes , Administração Hospitalar , Humanos , Comunicação Interdisciplinar , Isolamento de Pacientes , Recursos Humanos em Hospital/educação , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Equipamentos de Proteção , Arábia Saudita , Síndrome Respiratória Aguda Grave/epidemiologia , Avaliação de Sintomas , Triagem
3.
Euro Surveill ; 25(21)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32489176

RESUMO

The coronavirus disease (COVID-19) pandemic has caused tremendous pressure on hospital infrastructures such as emergency rooms (ER) and outpatient departments. To avoid malfunctioning of critical services because of large numbers of potentially infected patients seeking consultation, we established a COVID-19 rapid response infrastructure (CRRI), which instantly restored ER functionality. The CRRI was also used for testing of hospital personnel, provided epidemiological data and was a highly effective response to increasing numbers of suspected COVID-19 cases.


Assuntos
Defesa Civil/organização & administração , Infecções por Coronavirus/epidemiologia , Coronavirus , Surtos de Doenças , Administração dos Cuidados ao Paciente , Pneumonia Viral/epidemiologia , Adulto , Betacoronavirus , Alemanha/epidemiologia , Humanos , Pessoa de Meia-Idade , Pandemias , Medição de Risco , Centros de Atenção Terciária , Triagem
4.
JNMA J Nepal Med Assoc ; 58(225): 355-359, 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32538935

RESUMO

The COVID-19 pandemic is unfolding at an unprecedented pace. The unprecedented threat provides an opportunity to emerge with robust health systems. Nepal has implemented several containment measures such as Rapid Response Team formulation; testing; isolation; quarantine; contact tracing;surveillance, establishment of COVID-19 Crisis Management Centre and designation of dedicated hospitals to gear up for the pandemic. The national public health emergency management mechanisms need further strengthening with the proactive engagement of relevant ministries; we need a strong, real-time national surveillance system and capacity building of a critical mass of health care workers; there is a need to further assess infection prevention and control capacity; expand the network of virus diagnostic laboratories in the private sector with adequate surge capacity;implement participatory community engagement interventions and plan for a phased lockdown exit strategy enabling sustainable suppression of transmission at low-level and enabling in resuming some parts of economic and social life.


Assuntos
Defesa Civil , Controle de Doenças Transmissíveis , Infecções por Coronavirus , Serviços Médicos de Emergência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral , Betacoronavirus/isolamento & purificação , Defesa Civil/legislação & jurisprudência , Defesa Civil/métodos , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Regulamentação Governamental , Humanos , Nepal/epidemiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Saúde Pública/métodos
6.
Emerg Microbes Infect ; 9(1): 1372-1378, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32538295

RESUMO

Background: According to the World Health Organization (WHO), the outbreak of coronavirus disease in 2019 (COVID-19) has been declared as pandemic and public health emergency that infected more than 5 million people worldwide at the time of writing this protocol. Strong evidence for the burden, admission, and outcome of COVID-19 has not been published in Africa. Therefore, this protocol will be served as a guideline to conduct a systematic review and meta-analysis of the burden, admission, and outcome of COVID-19 in Africa. Methods: Published and unpublished studies on the burden, admission, and outcome of COVID-19 in Africa and written in any language will be included. Databases (PubMed / MEDLINE, Google Scholar, Google, EMBASE, Web of Science, Microsoft Academic, WHO COVID-19 database, Cochran Library, Africa Wide Knowledge, and Africa Index Medicus) from December 2019 to May 2020 will be searched. Two independent reviewers will select, screen, extract data, and assess the risk of bias. The proportion will be measured using a random-effects model. Subgroup analysis will be conducted to manage hetrogeinity. The presence of publication bias will be assessed using Egger's test and visual inspection of the funnel plots. This systematic and meta-analysis review protocol will be reported per the PRISMA-P guidelines. Conclusion: This systematic review and meta-analysis protocol will be expected to quantify the burden, admission, and outcome of COVID-19 in Africa. Systematic review registration: This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) in March 2020 and accepted with the registration number: CRD42020179321(https://www.crd.york.ac.uk/PROSPERO).


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Metanálise como Assunto , Pandemias , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Revisões Sistemáticas como Assunto , África/epidemiologia , Betacoronavirus/isolamento & purificação , Defesa Civil/economia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/economia , Infecções por Coronavirus/transmissão , Países em Desenvolvimento/economia , Humanos , Incidência , Pandemias/economia , Pneumonia Viral/diagnóstico , Pneumonia Viral/economia , Pneumonia Viral/transmissão , Organização Mundial da Saúde
7.
Ann Glob Health ; 86(1): 51, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32477887

RESUMO

The developed countries of the world were ill-prepared for the pandemic that they have suffered. When we compare developed to developing countries, the sophisticated parameters we use do not necessarily address the weaknesses in the healthcare systems of developed countries that make them susceptible to crises like the present pandemic. We strongly suggest that better preparation for such events is necessary for a country to be considered developed.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde , Países Desenvolvidos/classificação , Regulamento Sanitário Internacional , Pandemias , Pneumonia Viral/epidemiologia , Saúde Pública , Betacoronavirus/isolamento & purificação , Defesa Civil/organização & administração , Defesa Civil/normas , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Humanos , Regulamento Sanitário Internacional/organização & administração , Regulamento Sanitário Internacional/normas , Saúde Pública/normas
8.
Emerg Microbes Infect ; 9(1): 1300-1308, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32458760

RESUMO

The recently emerged novel coronavirus, "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)", caused a highly contagious disease called coronavirus disease 2019 (COVID-19). The virus was first reported from Wuhan city in China in December, 2019, which in less than three months spread throughout the globe and was declared a global pandemic by the World Health Organization (WHO) on 11th of March, 2020. So far, the ongoing pandemic severely damaged the world's most developed countries and is becoming a major threat for low- and middle-income countries. The poorest continent, Africa with the most vulnerable populations to infectious diseases, is predicted to be significantly affected by the ongoing COVID-19 outbreak. Therefore, in this review we collected and summarized the currently available literature on the epidemiology, etiology, vulnerability, preparedness and economic impact of COVID-19 in Africa, which could be useful and provide necessary information on ongoing COVID-19 pandemics in the continent. We also briefly summarized the concomitance of the COVID-19 pandemic and global warming.


Assuntos
Betacoronavirus/patogenicidade , Defesa Civil/economia , Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento/economia , Pandemias , Pneumonia Viral/epidemiologia , África/epidemiologia , Animais , China/epidemiologia , Quirópteros/virologia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/economia , Infecções por Coronavirus/transmissão , Europa (Continente)/epidemiologia , Humanos , Incidência , Pandemias/economia , Pneumonia Viral/diagnóstico , Pneumonia Viral/economia , Pneumonia Viral/transmissão , Viagem , Estados Unidos/epidemiologia , Organização Mundial da Saúde
9.
J Health Psychol ; 25(7): 883-887, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32370621

RESUMO

The COVID-19 pandemic is producing a huge health care burden with millions of cases and thousands of deaths. The coronavirus' high virulence and contagiousness and the frequent sudden onset of illness is overwhelming critical care and frontline healthcare staff. Frontline professionals are exposed to unprecedented levels of intensive existential threat requiring systematic, specialized psychological intervention and support. New psychological services need to be urgently implemented to manage the mental healthcare needs of frontline medical staff working with patients with COVID-19. The COVID-19 pandemic is a watershed moment: health care systems universally require a step-change to improve our preparedness for future pandemics.


Assuntos
Infecções por Coronavirus , Corpo Clínico/psicologia , Serviços de Saúde Mental , Pandemias , Pneumonia Viral , Betacoronavirus , Defesa Civil , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Humanos , Saúde Mental , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia
10.
J Emerg Manag ; 18(3): 213-220, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32441038

RESUMO

OBJECTIVE: This study aimed to provide foundational data supporting the need for nursing education focused on emergency preparedness and response for nursing staff. DESIGN: This study is a cross-sectional, quantitative, descriptive, correlational quality improvement study. SETTING: The study location is a Midwest healthcare system comprised of 14 acute care facilities including pediat-ric and adult level I trauma centers, a burn center, and a fully dedicated pediatric hospital; five long-term care facili-ties; 230 ambulatory sites; 4,200 employed providers; and a health plan. PARTICIPANTS: A convenience sample of 5,172 currently employed nurses. MAIN OUTCOME MEASURE: The main outcome of this study is the documentation of overall familiarity with emer-gency preparedness and response knowledge among nursing staff. Logistic ordinal regression statistical analysis was completed to determine the significance of individual domains impacting the overall familiarity score. RESULTS: Findings based on the results of the "overall familiarity with response activities related to a large-scale emergency incident" question documented most staff (78.45 percent) have little or no familiarity with their role in dis-aster response. Six domains or focused education areas were identified as having a statistically significant impact (p < 0.0001 - p = 0.0195) on the results of the overall familiarity question. CONCLUSIONS: These study results support the need for more education (academic and/or institutional) related to nursing emergency preparedness and response.


Assuntos
Atitude do Pessoal de Saúde , Defesa Civil , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros/psicologia , Estudos Transversais , Emergências , Serviço Hospitalar de Emergência , Humanos , Inquéritos e Questionários
11.
J Emerg Manag ; 18(3): 221-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32441039

RESUMO

Scholarly efforts to understand the use of social media during disasters have grown over the past decade, thanks to widely available data and powerful analytical tools. These efforts occurred in several academic fields, including disaster management, public administration, computer science, communications, and medicine. While such efforts have created a rich tapestry of perspectives, the ever-growing body of literature has become difficult to navigate. This article tackles this issue by painting a broad picture of the past, present, and future of the literature by analyzing metadata of 1,414 articles published on this subject. The results identify five important points. First, the literature on the use of social media during disasters has grown very rapidly in the past decade, but it is approaching a maturation point. Second, the literature is interdisciplinary in nature, and with the exception of medical journals, journals from different disciplines frequently cite each other. Third, the interdisciplinary nature of the literature comes from its intel-lectual roots. Fourth, the topography of the literature consists of a small number of core journals that publish a signifi-cant number of articles and a large number of journals in the periphery that occasionally publish relevant articles. Fi-nally, the article discusses the challenges facing the future of the literature and makes suggestions.


Assuntos
Defesa Civil , Comunicação , Desastres , Mídias Sociais , Humanos
12.
JNMA J Nepal Med Assoc ; 58(224): 248-251, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32417862

RESUMO

INTRODUCTION: Coronavirus disease pandemic has affected large number of people globally and has continued to spread. Preparedness of individual nations and the hospitals is important to effectively deal with the surge of cases. We aimed to obtain nation wide data from Nepal, about hospital preparedness for COVID-19. METHODS: Online questionnaire was prepared in accordance with the Center for Disease Control recommendations to assess preparedness of hospitals for COVID-19. The questionnaire was circulated to the over 800 doctors across the nation, who are the life members of six medical societies. RESULTS: We obtained 131 completed responses from all seven provinces. Majority of respondents had anaesthesiology as the primary specialty. Only 52 (39.7%) participants mentioned that their hospital had policy to receive suspected or proven cases with COVID-19. Presence of isolation ward was mentioned by 83 (63.4%) respondents, with only 9 (6.9%)mentioning the presence of airborne isolation. Supply of personal protective equipment (PPE) was inadequate as per 124 (94.7%) respondents. Critical care services for COVID-19 patients were possible only in hospitals of 42 (32.1%)respondents. RT-polymerase chain reaction could be performed only in the hospital of 6 (4.6%) respondents. CONCLUSIONS: It is apparent that most of the hospitals are not well prepared for management of patients with COVID-19. Resource allocation and policy making should be aimed to enhance national preparedness for the pandemic.


Assuntos
Defesa Civil , Infecções por Coronavirus , Coronavirus , Serviço Hospitalar de Emergência/organização & administração , Pandemias , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Emergências , Humanos , Nepal/epidemiologia , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Inquéritos e Questionários
13.
Am J Gastroenterol ; 115(6): 801-804, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32427684
14.
Tidsskr Nor Laegeforen ; 140(8)2020 05 26.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-32463204

RESUMO

BACKGROUND: The Emergency Department in Trondheim has prepared for a large influx of patients infected with the SARS-CoV-2 virus. We conducted a study comparing patients in the Emergency Department in the first weeks of the pandemic in Norway (weeks 11 and 12) with the average number of patient visits. MATERIAL AND METHOD: Data from patients at the Emergency Department of St Olav's Hospital in the period 6 January 2020-22 March 2020 were retrieved from the Emergency Department's database. Logistical patient data concerning patient numbers, chief complaints, length of stay in the Emergency Department, acuity level, isolation status, and treatment level were analysed. RESULTS: In week 12, 331 patients were referred to the Emergency Department, a reduction of 39 % compared with the average of 541 patients in weeks 2-10. There was a general reduction in all patient groups, but particularly those discharged from the Emergency Department. In week 12 there were 56 more patients isolated with suspected/potentially infectious disease (187 %) compared with the average for weeks 2-10, and these patients spent almost two hours longer in the Emergency Department than other patients. INTERPRETATION: There was a reduction in patient visits to the Emergency Department in the first weeks of the pandemic. The percentage of patients isolated for infection control increased, and the time spent in the Emergency Department for these patients was greater than for other patients. The reduction in the inflow of patients is expected to be temporary, and the Emergency Department at St Olav's Hospital expects a large influx of patients with suspected COVID-19 disease.


Assuntos
Infecções por Coronavirus , Serviço Hospitalar de Emergência , Pandemias , Pneumonia Viral , Betacoronavirus , Defesa Civil , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Noruega/epidemiologia , Pneumonia Viral/epidemiologia
16.
Eur Heart J Acute Cardiovasc Care ; 9(3): 222-228, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32375487

RESUMO

Hospitals play a critical role in providing communities with essential medical care during all types of disaster. Depending on their scope and nature, disasters can lead to a rapidly increasing service demand that can overwhelm the functional capacity and safety of hospitals and the healthcare system at large. Planning during the community outbreak of coronavirus disease 2019 (Covid-19) is critical for maintaining healthcare services during our response. This paper describes, besides general measures in times of a pandemic, also the necessary changes in the invasive diagnosis and treatment of patients presenting with different entities of acute coronary syndromes including structural adaptations (networks, spokes and hub centres) and therapeutic adjustments.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Serviço Hospitalar de Emergência/organização & administração , Pneumonia Viral/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Defesa Civil/organização & administração , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Desastres , Surtos de Doenças/estatística & dados numéricos , Emergências/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Utilização de Instalações e Serviços/tendências , Hospitais , Humanos , Pandemias , Segurança , Capacidade de Resposta ante Emergências/estatística & dados numéricos
17.
Eur Heart J Acute Cardiovasc Care ; 9(3): 229-238, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32375488

RESUMO

The severe acute respiratory syndrome coronavirus 2 pandemic is to date affecting more than a million of patients and is challenging healthcare professionals around the world. Coronavirus disease 2019 may present with a wide range of clinical spectrum and severity, including severe interstitial pneumonia with high prevalence of hypoxic respiratory failure requiring intensive care admission. There has been increasing sharing experience regarding the patient's clinical features over the last weeks which has underlined the need for general guidance on treatment strategies. We summarise the evidence existing in the literature of oxygen and positive pressure treatments in patients at different stages of respiratory failure and over the course of the disease, including environment and ethical issues related to the ongoing coronavirus disease 2019 infection.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Hipóxia/terapia , Equipamento de Proteção Individual/normas , Pneumonia Viral/complicações , Insuficiência Respiratória/terapia , Defesa Civil , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Cuidados Críticos/métodos , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Gerenciamento Clínico , Oxigenação por Membrana Extracorpórea/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Feminino , Humanos , Hipóxia/etiologia , Peso Corporal Ideal/fisiologia , Intubação Intratraqueal/ética , Intubação Intratraqueal/métodos , Masculino , Oxigênio/administração & dosagem , Oxigênio/uso terapêutico , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Respiração com Pressão Positiva/métodos , Respiração Artificial/métodos , Insuficiência Respiratória/etiologia
18.
Indian J Med Ethics ; V(2): 167-168, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32393442

RESUMO

J Krishnamurti, a renowned philosopher, describes fear as the transition from the convictions of the Known to the flux of the Unknown1. The weakening of the interspecies transmission barrier between the animal and human interface has strengthened this fear. Consequently, our impulsive selves have taken precedence over our reflective voices.


Assuntos
Controle de Doenças Transmissíveis , Infecções por Coronavirus , Medo , Pandemias , Pneumonia Viral , Saúde Pública , Incerteza , Betacoronavirus , Defesa Civil , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Assistência à Saúde , Saúde Global , Humanos , Índia , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia
19.
Indian J Med Ethics ; V(2): 1-4, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32393458

RESUMO

China reported cases of a severe form of pneumonia in December 2019 from Wuhan city, Hubei province. The virus causing this illness was identified as the novel Coronavirus 2019, which has now been christened Covid-19. The illness is characterised by fever, cough, body pain and in a few cases, progression to acute respiratory distress syndrome (ARDS) which marks very serious damage to the lungs (1-4). Apart from Wuhan, China, the virus has spread to 26 other countries as on February 18, 2020. Of these 26 countries, the cases of Covid-19 have been exported directly from China in 23 of them. As on February 23, 2020, a total of 78,811 confirmed cases, 2445 deaths have been reported globally. The World Health Organization declared this as a Public Health Emergency of International Concern (PHEIC) on January 30, 2020 (5).


Assuntos
Governança Clínica , Infecções por Coronavirus , Assistência à Saúde , Recursos em Saúde , Pandemias , Pneumonia Viral , Betacoronavirus , Defesa Civil , Humanos , Índia/epidemiologia
20.
AAPS PharmSciTech ; 21(5): 153, 2020 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-32449007

RESUMO

The supply of affordable, high-quality pharmaceuticals to US patients has been on a critical path for decades. In and beyond the COVID-19 pandemic, this critical path has become tortuous. To regain reliability, reshoring of the pharmaceutical supply chain to the USA is now a vital national security need. Reshoring the pharmaceutical supply with old know-how and outdated technologies that cause inherent unpredictability and adverse environmental impact will neither provide the security we seek nor will it be competitive and affordable. The challenge at hand is complex akin to redesigning systems, including corporate and public research and development, manufacturing, regulatory, and education ones. The US academic community must be engaged in progressing solutions needed to counter emergencies in the COVID-19 pandemic and in building new methods to reshore the pharmaceutical supply chain beyond the pandemic.


Assuntos
Antivirais/provisão & distribução , Betacoronavirus/efeitos dos fármacos , Defesa Civil/organização & administração , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde/organização & administração , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Pandemias , Pneumonia Viral/terapia , Vacinas Virais/provisão & distribução , Antivirais/economia , Betacoronavirus/patogenicidade , Defesa Civil/economia , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/virologia , Custos de Medicamentos , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Determinação de Necessidades de Cuidados de Saúde/economia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estados Unidos , Vacinas Virais/economia
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