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1.
Cir. Esp. (Ed. impr.) ; 98(5): 0-0, mayo 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-188232

RESUMEN

INTRODUCCIÓN: La expansión de la infección por SARS-CoV-2 (COVID-19) ha requerido la adaptación de los hospitales afectados por la pandemia, causando una reducción de la actividad quirúrgica electiva. MÉTODOS: Estudio retrospectivo de pacientes operados durante el mes previo y el pico de la pandemia. Se analizó la tasa de contagio por COVID-19, la gravedad de la infección respiratoria según la Brescia Respiratory COVID-19 Severity Scale, las medidas terapéuticas adoptadas y las complicaciones postoperatorias globales. RESULTADOS: Desde el 17 de febrero hasta el 31 de marzo de 2020 se produjo una reducción progresiva de la actividad quirúrgica, interviniéndose únicamente 213 pacientes: 59 (27,8%) de forma programada por patología tumoral, 97 (45,5%) por patología benigna y 57 (26,7%) de forma urgente. Se produjo un aumento progresivo de la tasa de contagio por COVID-19 con un total de 15 (7%) casos. De los pacientes oncológicos, 10 (16,9%) resultaron afectos; en el grupo de cirugía electiva, un paciente (1%); y en el grupo de cirugía urgente, 4 (7%) (p < 0,001). Cinco pacientes presentaron una infección respiratoria grave de los cuales 4 estaban afectos por enfermedad oncológica. Hubo 3 (1,4%) fallecimientos, todos debidos a progresión de la infección respiratoria. CONCLUSIONES: Los pacientes sometidos a cirugía presentaron una elevada tasa de infección por COVID-19 y de complicaciones postoperatorias, sobre todo en los pacientes oncológicos. La puesta en marcha de la de la actividad quirúrgica debe basarse en una priorización de los casos a operar, respetando unas premisas de seguridad y optimización de los recursos disponibles


INTRODUCTION: The spread of the SARS-CoV-2 infection (COVID-19) has required adaptation by hospitals affected by the pandemic, which has caused a reduction in elective surgical activity. METHODS: Retrospective study of patients operated on in the previous month and during the peak of the pandemic. We analysed the COVID-19 infection rate, the severity of respiratory infection according to the Brescia respiratory COVID-19 severity scale, the adopted therapeutic measures and the overall postoperative complications. RESULTS: From 17th February to 31st March 2020, there was a progressive decrease in surgical activity, with only 213 patients operated on. This comprised 59 (27.8%) elective operations for oncological diseases, 97 (45.5%) elective operations for benign diseases and 57 (26.7%) as urgent procedures. There was a progressive increase in the rate of infection by COVID-19, with a total of 15 cases (7%). This included 10 patients (16.9%) in the elective group for oncological disease, 1 (1%) in the elective surgery group for benign disease and 4 (7%) in the urgent surgery group (P < .001). Five patients presented with a severe respiratory infection, of which 4 were affected by oncological disease. There were 3 deaths (1.4%), which were all due to the worsening of a respiratory infection. CONCLUSIONS: The patients undergoing the surgical procedures showed high rates of COVID-19 infection and postoperative complications, especially the patients with oncological diseases. Local resumption of surgical activity must be based on the prioritisation of the cases to be operated on, respecting certain premises of security and optimisation of the available resources


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Infecciones por Coronavirus/transmisión , Neumonía Viral/transmisión , Pandemias , Estudios Retrospectivos , Seguridad del Paciente , Morbilidad
3.
BMJ Case Rep ; 13(5)2020 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-32371416

RESUMEN

The coronavirus disease (COVID-19) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China, in late 2019 and has affected more than 1 270 000 people worldwide. The numbers of reported cases continue to rise and threaten global health. Transmissions among family members are frequently observed, although the route of transmission is partially known. Here we report three cases of SARS-CoV-2 infection within one family. Sequencing of the S gene of the viral genome showed 100% identity among samples, suggesting that the same strain caused the infection. Following treatment with oseltamivir and short-term methylprednisolone combined with symptomatic management, all three patients recovered within 3 weeks, as evidenced by the disappearance of their symptoms, clearance of pulmonary infiltrates and consecutive negative molecular diagnostic test findings. Our observations suggest the importance of preventing family transmission and the efficacy of current integrated treatment for mild/moderate pneumonia in COVID-19 cases.


Asunto(s)
Infecciones por Coronavirus , Pandemias , Neumonía Viral , Glicoproteína de la Espiga del Coronavirus , Adulto , Antivirales/uso terapéutico , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/transmisión , Salud de la Familia , Femenino , Genoma Viral , Humanos , Masculino , Metilprednisolona/uso terapéutico , Persona de Mediana Edad , Oseltamivir/uso terapéutico , Neumonía Viral/diagnóstico , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/transmisión , Reacción en Cadena en Tiempo Real de la Polimerasa , Glicoproteína de la Espiga del Coronavirus/genética , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
4.
Global Health ; 16(1): 45, 2020 05 12.
Artículo en Inglés | MEDLINE | ID: mdl-32398137

RESUMEN

The recent pandemic caused by the 2019 outbreak of novel coronavirus (2019-nCoV or COVID-19) has affected more than 3.0 million people resulting ~ 212,000 deaths across 215 countries/territories as on 28th April 2020. The importation of the cases owing to enormous international travels from the affected countries is the foremost reason for local cycle of transmission. For a country like India, the second most populous country in the world with ~ 1.35 billion population, the management and control of 2019-nCoV domestic spread heavily relied on effective screening and strict quarantine of passengers arriving at various international airports in India from affected countries. Here, by extracting the data from FLIRT, an online airline database for more than 800 airlines, and scanning more than 180,000 flights and 39.9 million corresponding passenger seats during 4th - 25th March, we show that India experienced the highest risk index of importing the passengers from middle eastern airports. Contrary to perception, travelers from China imposed lowest risk of importing the infected cases in India. This is clearly evident form the fact that while the number of infected cases were on the peak in China India was one of the least affected countries. The number of cases in India started exhibiting a sharp increase in the infected cases only after the European countries and USA recorded large number of infected cases. We further argue that while the number of cases in middle eastern countries may still be very low, the airports in middle eastern countries, particularly Dubai, being one of the largest transit hubs for international passengers, including arriving in India, might have posed a higher risk of getting infected with 2019-nCoV. We suggest that any future travel related disease infection screening at the airports should critically assess the passengers from major transit hubs in addition to affected country of origin.


Asunto(s)
Enfermedades Transmisibles Importadas , Infecciones por Coronavirus/transmisión , Brotes de Enfermedades/prevención & control , Pandemias , Neumonía Viral/transmisión , Medición de Riesgo/métodos , Viaje , Aeronaves , Aeropuertos , China/epidemiología , Infecciones por Coronavirus/epidemiología , Humanos , India/epidemiología , Tamizaje Masivo/métodos , Neumonía Viral/epidemiología , Cuarentena , Enfermedad Relacionada con los Viajes
5.
Hum Genomics ; 14(1): 17, 2020 05 12.
Artículo en Inglés | MEDLINE | ID: mdl-32398162

RESUMEN

The recent coronavirus disease (COVID-19), caused by SARS-CoV-2, is inarguably the most challenging coronavirus outbreak relative to the previous outbreaks involving SARS-CoV and MERS-CoV. With the number of COVID-19 cases now exceeding 2 million worldwide, it is apparent that (i) transmission of SARS-CoV-2 is very high and (ii) there are large variations in disease severity, one component of which may be genetic variability in the response to the virus. Controlling current rates of infection and combating future waves require a better understanding of the routes of exposure to SARS-CoV-2 and the underlying genomic susceptibility to this disease. In this mini-review, we highlight possible genetic determinants of COVID-19 and the contribution of aerosol exposure as a potentially important transmission route of SARS-CoV-2.


Asunto(s)
Microbiología del Aire , Betacoronavirus/fisiología , Infecciones por Coronavirus/genética , Infecciones por Coronavirus/transmisión , Predisposición Genética a la Enfermedad , Neumonía Viral/genética , Neumonía Viral/transmisión , Infecciones por Coronavirus/inmunología , Infecciones por Coronavirus/prevención & control , Transmisión de Enfermedad Infecciosa , Humanos , Pandemias/prevención & control , Equipo de Protección Personal , Neumonía Viral/inmunología , Neumonía Viral/prevención & control
7.
Euro Surveill ; 25(18)2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32400358

RESUMEN

An exponential growth model was fitted to critical care admissions from two surveillance databases to determine likely coronavirus disease (COVID-19) case numbers, critical care admissions and epidemic growth in the United Kingdom before the national lockdown. We estimate, on 23 March, a median of 114,000 (95% credible interval (CrI): 78,000-173,000) new cases and 258 (95% CrI: 220-319) new critical care reports, with 527,000 (95% CrI: 362,000-797,000) cumulative cases since 16 February.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/transmisión , Coronavirus/aislamiento & purificación , Cuidados Críticos/estadística & datos numéricos , Notificación de Enfermedades/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Neumonía Viral/diagnóstico , Neumonía Viral/transmisión , Síndrome Respiratorio Agudo Grave/transmisión , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Brotes de Enfermedades , Monitoreo Epidemiológico , Femenino , Humanos , Incidencia , Masculino , Modelos Teóricos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , Vigilancia de la Población , Síndrome Respiratorio Agudo Grave/diagnóstico , Síndrome Respiratorio Agudo Grave/epidemiología , Síndrome Respiratorio Agudo Grave/virología , Reino Unido/epidemiología
8.
Euro Surveill ; 25(18)2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32400361

RESUMEN

For 45 African countries/territories already reporting COVID-19 cases before 23 March 2020, we estimate the dates of reporting 1,000 and 10,000 cases. Assuming early epidemic trends without interventions, all 45 were likely to exceed 1,000 confirmed cases by the end of April 2020, with most exceeding 10,000 a few weeks later.


Asunto(s)
Infecciones por Coronavirus , Coronavirus , Brotes de Enfermedades , Pandemias , Neumonía Viral , África/epidemiología , Betacoronavirus , China/epidemiología , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Predicción , Humanos , Modelos Estadísticos , Mortalidad , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Factores de Tiempo
9.
Vet Microbiol ; 244: 108693, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32402329

RESUMEN

The recent pandemic caused by the novel human coronavirus, referrred to as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), not only is having a great impact on the health care systems and economies in all continents but it is also causing radical changes of common habits and life styles. The novel coronavirus (CoV) recognises, with high probability, a zoonotic origin but the role of animals in the SARS-CoV-2 epidemiology is still largely unknown. However, CoVs have been known in animals since several decades, so that veterinary coronavirologists have a great expertise on how to face CoV infections in animals, which could represent a model for SARS-CoV-2 infection in humans. In the present paper, we provide an up-to-date review of the literature currently available on animal CoVs, focusing on the molecular mechanisms that are responsible for the emergence of novel CoV strains with different antigenic, biologic and/or pathogenetic features. A full comprehension of the mechanisms driving the evolution of animal CoVs will help better understand the emergence, spreading, and evolution of SARS-CoV-2.


Asunto(s)
Coronaviridae/clasificación , Infecciones por Coronavirus/veterinaria , Neumonía Viral/epidemiología , Neumonía Viral/virología , Animales , Betacoronavirus/clasificación , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Coronaviridae/genética , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Modelos Animales de Enfermedad , Evolución Molecular , Humanos , Pandemias , Neumonía Viral/transmisión , Zoonosis/epidemiología , Zoonosis/transmisión , Zoonosis/virología
10.
MMWR Morb Mortal Wkly Rep ; 69(19): 606-610, 2020 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-32407303

RESUMEN

On March 17, 2020, a member of a Skagit County, Washington, choir informed Skagit County Public Health (SCPH) that several members of the 122-member choir had become ill. Three persons, two from Skagit County and one from another area, had test results positive for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Another 25 persons had compatible symptoms. SCPH obtained the choir's member list and began an investigation on March 18. Among 61 persons who attended a March 10 choir practice at which one person was known to be symptomatic, 53 cases were identified, including 33 confirmed and 20 probable cases (secondary attack rates of 53.3% among confirmed cases and 86.7% among all cases). Three of the 53 persons who became ill were hospitalized (5.7%), and two died (3.7%). The 2.5-hour singing practice provided several opportunities for droplet and fomite transmission, including members sitting close to one another, sharing snacks, and stacking chairs at the end of the practice. The act of singing, itself, might have contributed to transmission through emission of aerosols, which is affected by loudness of vocalization (1). Certain persons, known as superemitters, who release more aerosol particles during speech than do their peers, might have contributed to this and previously reported COVID-19 superspreading events (2-5). These data demonstrate the high transmissibility of SARS-CoV-2 and the possibility of superemitters contributing to broad transmission in certain unique activities and circumstances. It is recommended that persons avoid face-to-face contact with others, not gather in groups, avoid crowded places, maintain physical distancing of at least 6 feet to reduce transmission, and wear cloth face coverings in public settings where other social distancing measures are difficult to maintain.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Brotes de Enfermedades , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Canto , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/mortalidad , Neumonía Viral/terapia , Factores de Riesgo , Washingtón/epidemiología
12.
Can J Surg ; 63(3): E231-E232, 2020 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-32386473

RESUMEN

Summary: Postoperative fever is common following orthopedic trauma surgery. As the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases in the community, migration into the acute care hospital setting intensifies, creating confusion when fever develops postoperatively. The transmission dynamics of SARS-CoV-2 make it difficult to adequately gauge and pinpoint risk groups with questionnaires at the time of hospital admission. This is particularly problematic when asymptomatic or presymptomatic patients infected with SARS-CoV-2 require urgent surgery and cannot be screened effectively. One approach is to treat every patient as though they were SARS-CoV-2-positive in preparation for surgery, but doing so could exacerbate shortages of personal protective equipment and staffing limitations. Uncertainty regarding the etiology of postoperative fever could be significantly reduced by universal SARS-CoV-2 testing of all surgical patients at the time of hospital admission in addition to routine screening, but testing capacity and a rapid turnaround time would be required.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Transmisión de Enfermedad Infecciosa/prevención & control , Fiebre/etiología , Tamizaje Masivo/métodos , Procedimientos Ortopédicos , Neumonía Viral/diagnóstico , Heridas y Traumatismos/cirugía , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/transmisión , Fiebre/virología , Humanos , Tamizaje Masivo/normas , Procedimientos Ortopédicos/efectos adversos , Pandemias , Equipo de Protección Personal/provisión & distribución , Neumonía Viral/complicaciones , Neumonía Viral/transmisión , Precauciones Universales/métodos , Heridas y Traumatismos/complicaciones
13.
Artículo en Inglés | MEDLINE | ID: mdl-32392880

RESUMEN

COVID-19 is an infectious disease caused by a novel coronavirus, which first appeared in China in late 2019, and reached pandemic distribution in early 2020. The first major outbreak in Europe occurred in Northern Italy where it spread to neighboring countries, notably to Austria, where skiing resorts served as a main transmission hub. Soon, the Austrian government introduced strict measures to curb the spread of the virus. Using publicly available data, we assessed the efficiency of the governmental measures. We assumed an average incubation period of one week and an average duration of infectivity of 10 days. One week after the introduction of strict measures, the increase in daily new cases was reversed, and the reproduction number dropped. The crude estimates tended to overestimate the reproduction rate in the early phase. Publicly available data provide a first estimate about the effectiveness of public health measures. However, more data are needed for an unbiased assessment.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus , Brotes de Enfermedades/prevención & control , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Salud Pública , Austria/epidemiología , Betacoronavirus , Coronavirus/aislamiento & purificación , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Humanos , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Factores de Tiempo
15.
Artículo en Inglés | MEDLINE | ID: mdl-32397515

RESUMEN

In the early stages of the 2019 novel coronavirus disease (COVID-19) pandemic, containment of disease importation from epidemic areas was essential for outbreak control. This study is based on publicly accessible data on confirmed COVID-19 cases in Taiwan extracted from the Taiwan Centers for Disease Control website. We analysed the characteristics, infection source, symptom presentation, and route of identification of the 321 imported cases that were identified from 21 January to 6 April 2020. They were mostly returned Taiwanese citizens who had travelled to one or more of 37 countries for tourism, business, work, or study. Half of these cases developed symptoms before arrival, most of the remainder developed symptoms 1-13 days (mean 4.0 days) after arrival, and 3.4% never developed symptoms. Three-quarters of the cases had respiratory symptoms, 44.9% had fever, 13.1% lost smell or taste, and 7.2% had diarrhoea. Body temperature and symptom screening at airports identified 32.7% of the cases. Of the remainder, 27.7% were identified during home quarantining, 16.2% were identified via contact tracing, and 23.4% were reported by hospitals. Under the strict enforcement of these measures, the incidence of locally acquired COVID-19 cases in Taiwan remains sporadic. In conclusion, proactive border control measures are effective for preventing community transmission of this disease.


Asunto(s)
Trazado de Contacto , Infecciones por Coronavirus , Coronavirus/aislamiento & purificación , Transmisión de Enfermedad Infecciosa/prevención & control , Fiebre de Origen Desconocido/diagnóstico , Tamizaje Masivo/métodos , Neumonía Viral , Viaje , Aeropuertos , Infecciones Asintomáticas , Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Brotes de Enfermedades/prevención & control , Humanos , Incidencia , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Vigilancia de la Población , Cuarentena , Vigilancia de Guardia , Aislamiento Social , Taiwán/epidemiología , Medicina del Viajero
18.
MMW Fortschr Med ; 162(9): 64-67, 2020 May.
Artículo en Alemán | MEDLINE | ID: mdl-32405834

RESUMEN

On Mar 11th, 2020, the World Health Organization (WHO) stated in its Situation Report - 51 Coronavirus disease 2019 (COVID-19) as a pandemic. In early April 2020, a teaching hospital underwent shutdown and quarantine due to an outbreak of infection in accordance with Section 6 of the Infection Protection Act (index patient and 5 infected nursing staff). The complete staff (physicians, nurses and nonmedical personnel [NMP]) underwent COVID-19 testing within two phases: (1) between Apr 3rd and 5th, 2020 [n=1170], followed by (2) between Apr 8th and 9th, 2020 [n=953] with COVID-19 silent carrier positivity rates in accordance to testing phases of (1) n=19 (1.6%) and (2) n=25 (2.6%). The cumulative infection rate for NMP (1.6%), doctors (3.8%) and nurses (9.7%) was connected to type and extent of COVID-19 patient contact. Despite COVID-19 positivity of 34.8% (46 of 132 beds), a risk-free management of hospital operation is possible to a certain extent if hygiene regulations and strict patient selection are followed. However, a COVID-19-free clinic cannot be expected due to silent carriers.


Asunto(s)
Infecciones por Coronavirus , Coronavirus , Hospitales de Enseñanza , Control de Infecciones , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Pandemias , Neumonía Viral , Enfermedades Asintomáticas , Betacoronavirus , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Humanos , Pandemias/prevención & control , Personal de Hospital , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión
19.
Euro Surveill ; 25(17)2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32372755

RESUMEN

BackgroundEstimating key infectious disease parameters from the coronavirus disease (COVID-19) outbreak is essential for modelling studies and guiding intervention strategies.AimWe estimate the generation interval, serial interval, proportion of pre-symptomatic transmission and effective reproduction number of COVID-19. We illustrate that reproduction numbers calculated based on serial interval estimates can be biased.MethodsWe used outbreak data from clusters in Singapore and Tianjin, China to estimate the generation interval from symptom onset data while acknowledging uncertainty about the incubation period distribution and the underlying transmission network. From those estimates, we obtained the serial interval, proportions of pre-symptomatic transmission and reproduction numbers.ResultsThe mean generation interval was 5.20 days (95% credible interval (CrI): 3.78-6.78) for Singapore and 3.95 days (95% CrI: 3.01-4.91) for Tianjin. The proportion of pre-symptomatic transmission was 48% (95% CrI: 32-67) for Singapore and 62% (95% CrI: 50-76) for Tianjin. Reproduction number estimates based on the generation interval distribution were slightly higher than those based on the serial interval distribution. Sensitivity analyses showed that estimating these quantities from outbreak data requires detailed contact tracing information.ConclusionHigh estimates of the proportion of pre-symptomatic transmission imply that case finding and contact tracing need to be supplemented by physical distancing measures in order to control the COVID-19 outbreak. Notably, quarantine and other containment measures were already in place at the time of data collection, which may inflate the proportion of infections from pre-symptomatic individuals.


Asunto(s)
Infecciones Asintomáticas/epidemiología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Brotes de Enfermedades/prevención & control , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Betacoronavirus , China/epidemiología , Coronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Humanos , Modelos Teóricos , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Cuarentena , Singapur/epidemiología , Factores de Tiempo
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