Written by Steven Hansen
The U.S. new cases 7-day rolling average is 21.5 % HIGHER than the 7-day rolling average one week ago. U.S. deaths due to coronavirus are now 9.7 % HIGHER than the rolling average one week ago. U.S. hospitalizations due to COVID-19 are up 12.7 % from the levels one week ago. At the end of this post is a set of interactive graphs and tables for the world and individual States – as well as today’s headlines which include;
- The U.S. 7 day rolling average of new cases is at record levels – 72,335
- The post-Covid ‘zombification’ of advanced economies is here to stay
- Seniors are better at pandemic safety than young adults
- Counties without mask mandates have much higher hospitalizations
- Homeless Camps Less Risky Than Shelters for COVID-19
- No news on Pfizer’s Covid-19 vaccine is good news – and bad news
- Why some people are superspreaders and how the body emits coronavirus
- Eli Lilly lines up a blockbuster deal for Covid-19 antibody, right after it failed an NIAID trial
- Tocilizumab Stumbles as COVID-19 Treatment, Narrow Role Possible
- WHO Reports Record 3 Million New COVID-19 Cases in a Week
The recent worsening of the trendlines for new cases should be attributed to going back to college/university, cooler weather causing more indoor activities, fatigue from wearing masks / social distancing, holiday activities, and continued loosening of regulations designed to slow the coronavirus spread.
My continuing advice is to continue to wash your hands, wear masks, avoid crowds, and maintain social distancing. No handwashing, mask, or social distancing will guarantee you do not get infected – but it sure as hell lowers the risk in all situations – as the evidence to-date shows a lower severity of COVID-19. In addition, certain activities are believed to carry higher risk – like being inside in air conditioning and removing your mask (such as restaurants, around your children/grandchildren, bars, and gyms). It is all about viral load – and outdoor activities are generally safe.
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Hospitalizations (grey line) and Mortality (green line) For Week ending 17OCT2020
source: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
Coronavirus News You May Have Missed
France set for second national lockdown – BBC
French President Emmanuel Macron has announced a second national lockdown for at least the whole of November.
Mr Macron said under the new measures, starting on Friday, people would only be allowed to leave home for essential work or medical reasons.
Non-essential businesses, such as restaurants and bars, will close, but schools and factories will remain open.
Covid daily deaths in France are at the highest level since April. On Tuesday, 33,000 new cases were confirmed.
Mr Macron said the country risked being “overwhelmed by a second wave that no doubt will be harder than the first”.
The president said that people would need to fill in a form to justify leaving their homes, as was required in the initial lockdown in March.
Counties without mask mandates have much higher hospitalizations – The Hill
A new study finds that coronavirus hospitalizations increased significantly more in areas without mask requirements, bolstering guidance from public health officials on the importance of wearing facial coverings to slow the spread of COVID-19.
The study by Vanderbilt University compared Tennessee counties with mask requirements to those without any.
Hospitals where less than 25 percent of the patients came from counties with mask requirements had the largest increase in coronavirus hospitalizations, up more than 200 percent since July 1, the study found. In hospitals where more than 75 percent of the patients came from counties with a mask requirement, hospitalizations were about flat compared to July 1.
“It’s very clear that areas where masking requirements have remained in place have seen much lower growth in COVID-19 hospitalizations,” said John Graves, one of the authors of the study and an associate professor of health policy at Vanderbilt.
The study notes that masks alone likely do not explain the entire difference in hospitalizations between counties, given that places with mask requirements have also seen people being less mobile and taking other precautions.
Virus pushes twin cities El Paso and Juarez to the brink – AP
A record surge in coronavirus cases is pushing hospitals to the brink in the border cities of El Paso and Ciudad Juarez, confronting health officials in Texas and Mexico with twin disasters in the tightly knit metropolitan area of 3 million people.
Health officials are blaming the spike on family gatherings, multiple generations living in the same household and younger people going out to shop or conduct business.
The crisis — part of a deadly comeback by the virus across nearly the entire U.S. — has created one of the most desperate hot spots in North America and underscored how intricately connected the two cities are economically, geographically and culturally, with lots of people routinely going back and forth across the border to shop or visit with family.
Hospitals Are Reeling Under a 46 Percent Spike in Covid-19 Patients – New York Times
Approaching the eve of the election, President Trump has downplayed the steep rise in cases, attributing much of it to increased testing. But the number of people hospitalized for the virus tells a different story, climbing an estimated 46 percent from a month ago and raising fears about the capacity of regional health care systems to respond to overwhelming demand.
The exploding case numbers point to a volatile new phase in the pandemic, coming after earlier waves hit large cities such as New York, then Sun Belt states like Florida and Arizona. While some of those places have begun to bring the virus under control, the surge of hospitalizations is crippling some cities with fewer resources.
In El Paso, where the number of people hospitalized with Covid-19 has more than tripled over the past three weeks, doctors at University Medical Center have started airlifting some patients to hospitals as far away as San Antonio while treating others in a field hospital in a nearby parking lot. Across the border in Mexico, the mayor of Ciudad Juárez, himself hospitalized after testing positive for the virus for the second time, is urging a temporary ban on U.S. citizens crossing into his city.
[editor’s note: Above, we are now publishing daily levels of hospitalization due to coronavirus. This post was written in the New York Times in a way to sensationalize the problem. The truth is that the peak hospitalizations were 59,940 in the U.S. with today’s rising load at 44,212. Not trying to downplay hospitalizations, just trying to convey the proper context of this problem.]
Eli Lilly lines up a blockbuster deal for Covid-19 antibody, right after it failed a NIAID trial – Endpoint
Two days after Eli Lilly conceded that its antibody bamlanivimab was a flop in hospitalized Covid-19 patients, the US government is preparing to make it a blockbuster.
The pharma giant reported early Wednesday that it struck a deal to supply the feds with 300,000 vials of the drug at a cost of $375 million — once it gets an EUA stamp from the FDA. And once that 2-month supply deal is done, the government has an option on another 650,000 doses on the same terms — which could potentially add another $812 million.
The government is lining up delivery of the 700 mg dose of the drug, even though the one study Eli Lilly points to for proof of efficacy underscores the drug — obtained from AbCellera — did not work at that dose for recently diagnosed patients. Only the 2800 mg dose was effective for the primary endpoint, change from baseline in viral load at day 11, with the low and high doses falling short of significance — though even that is a questionable assumption.
A number of analysts remarked that Lilly’s data were middling at best, with no dose dependent response to help make Lilly’s case. But Lilly said the data were close enough, and used that lower dose, which they can make more of, for their EUA application.
Lilly added that it has the manufacturing in place to make a million doses of the drug by the end of 2021, with supplies ramping up for global delivery in Q1. The first 100,000 vials should be good to go almost immediately after the FDA acts, says the company, though the pharma giant has also been cited by regulators for quality problems with the manufacturing facility that makes the antibody.
No news on Pfizer’s Covid-19 vaccine is good news — and bad news – STAT
Pfizer revealed Tuesday that researchers have not yet conducted an analysis of the efficacy of the vaccine it is developing against Covid-19.
The announcement is both good news and bad news.
Umer Raffat, a senior managing director at the investment bank Evercore ISI, wrote in an analyst note that the fact that Pfizer hasn’t conducted an interim analysis was “a good thing” because it means that, based on the details of the trial protocol, the vaccine had not failed to prevent more than 77% of Covid cases, the benchmark for success at this early juncture.
But it also suggests that cases of Covid are being reported less frequently among participants in the Pfizer study than in the U.S. as a whole. That means that the study is progressing more slowly than Pfizer and its partner, BioNTech, originally expected. In August, Pfizer had thought that the first interim analysis could occur as early as September.
Pfizer and BioNTech are under a white-hot spotlight because their Covid-19 vaccine, by design, is likely to be the first to have any efficacy data. But that first analysis will come when there have been a total of only 32 cases of Covid-19 across the company’s entire 42,000-volunteer study. It would be considered to be positive, Pfizer has said, if six or fewer of those 32 cases occurred in the group that received the vaccine, with the rest occurring in the group that received the placebo. The trial is expected to continue until 150 of the volunteers in the study have had Covid-19.
Homeless Camps Less Risky Than Shelters for COVID-19 – MedPage
Homeless people who gather in outdoor encampments were less likely to test positive for SARS-CoV-2 compared to those housed in shelters, researchers reported.
The rate of SARS-CoV-2 positive tests among 650 people living in shelters in the Denver area was 9%, compared with a 3% positivity rate for 281 people living in tent encampments in the area (P<0.01), reported Sarah Rowan, MD, of the University of Colorado and Bernard F. Gipson Sr. Eastside Family Health Center in Denver, in a presentation at the 2020 virtual meeting of IDWeek.
When testing for SARS-CoV-2 antibodies — a measure of previous infection — the researchers found that 24% of shelter users were positive compared with 8% of those in encampments (P<0.01). Although Rowan said there was no difference in antibody positivity by race, ethnicity, or sex, the people who tested positive were about 54 years old, while the average age of those who tested negative was 43 years (P<0.01).
“Transmission of SARS-CoV-2 at outdoor encampments may be less common than in shelters,” Rowan said. “Continued assessment of mitigation strategies in shelters should be a priority, particularly as shelters densify in cold winter months.” The study was performed in July and August, and Rowan suggested the numbers of homeless people might be on the upswing with about 10% of people in Colorado being out of work.
Previous studies and infection-control guidelines indicate that the degree of fresh air flow correlates inversely with risk of contracting COVID-19 — i.e., the risk is very low outdoors but higher when people are confined in small, poorly ventilated indoor spaces.
Germany to impose one-month partial shutdown amid COVID-19 surge – The Hill
Germany is imposing a one-month partial shutdown that will close bars, restaurants and gyms as it seeks to prevent a wider spread of the coronavirus.
Case counts are on the rise in the United States and in Europe, and Germany is just one of several countries reimposing at least some restrictions. The closures will mark the most severe restrictions since Germany went into a national lockdown in the spring.
The deal to impose COVID-19 measures was agreed upon by leaders of the country’s 16 states and German Chancellor Angela Merkel, Bloomberg reported. An official announcement is slated to be made later Wednesday, a person familiar with the matter who requested anonymity told the press.
The German order won’t close everything. While museums will close and sporting teams will have to play with no spectators, German soccer teams will continue to play and stores and markets will remain open.
The new restrictions, which will take effect on Monday, are aimed at providing a compromise between public health and allowing the economy to function. They are also intended to help hospitals and prevent crowding. The New York Times reported that some hospitals have seen the number of patients double in the last 10 days.
Tocilizumab Stumbles as COVID-19 Treatment, Narrow Role Possible – Medscape
Tocilizumab (Actemra/RoActemra) was not found to have any clear role as a treatment for COVID-19 in four new studies.
Three randomized controlled trials showed that the drug either had no benefit or only a modest one, contradicting a large retrospective study that had hinted at a more robust effect.
“This is not a blockbuster,” said David Cennimo, MD, an infectious disease expert at Rutgers New Jersey Medical School, Newark, New Jersey. “This is not something that’s going to revolutionize our treatment of COVID-19.”
But some researchers still regard these studies as showing evidence that the drug benefits certain patients with severe inflammation.
The immune response to SARS-CoV-2 includes elevated levels of the cytokine interleukin-6 (IL-6). In some patients, this response becomes a nonspecific inflammation, a “cytokine storm,” involving edema and inflammatory cell infiltration in the lungs. These cases are among the most severe.
Dr. Fauci Says It May Be Years Before America Feels Normal Again – Newsweek
Dr. Anthony Fauci, the nation’s top infectious disease expert, told a Melbourne, Australia audience on Wednesday that it could be years before Americans are able to resume their lives normally amid the novel coronavirus pandemic.
“I think it will be easily by the end of 2021 and perhaps into the next year before we start having some semblance of normality,” Fauci said during the University of Melbourne webinar.
“If normal means you can get people in a theatre without worrying about what we call congregate-setting super infections, if we can get restaurants to open almost at full capacity,” he added.
Fauci went on to explain that opening up the economy and maintaining public health safety is a “fine line” to walk.
“I firmly believe that you can continue to open to business [and] open up the country from an economic standpoint. But if you do that prudently with public health measures, that prevents surges of infection. We’ve seen it done before in countries and in sections of our own country,” he said.
Why some people are superspreaders and how the body emits coronavirus – National Geographic
… the rapid spread of the novel SARS-CoV-2 virus has reignited interest in research into how our lungs launch infectious material into the air, namely the tiniest respiratory droplets called aerosols. Understanding how aerosols form in the body is crucial to figuring out why this virus spreads so readily and what’s fueling so-called superspreading events, where a small number of disease carriers end up infecting many individuals. Such incidents are a hallmark of COVID-19.
… However, figuring out who are the most prodigious producers of aerosols has proven difficult—with many biological and physical factors affecting aerosol generation that are tough to parse out or even measure.
“The smallest aerosols are generated in the deeper part of the respiratory tract,” Morawska says. These are especially important for disease transmission because they can stay aloft longer and travel farther compared to the big gobs that fall quickly.
These smallest aerosols are created within the bronchioles, the thin, branching airways deep within our lungs. By carefully measuring the aerosols produced by people when they breathe in different ways, Morawska and colleague Graham Richard Johnson proposed in a seminal 2009 paper that the respiratory fluid lining these tubes creates films that burst like soap bubbles when the bronchioles contract and expand. This is now considered to be the main mechanism that creates aerosols deep in the lungs.
Something similar happens higher up in the respiratory tract, in the sound-producing larynx.
“The vocal folds are opening and shutting too fast really for the naked eye to see,” says William Ristenpart, a chemical engineer at the University of California, Davis, who studies disease transmission. Much like the bronchioles, these folds pull apart respiratory fluid when they are slamming together during speech and singing, creating tiny droplets. Imagine vigorously washing your hands, and the soapy film rupturing as you pull them apart.
… But this field of science is having a moment in the spotlight now due to COVID-19. Aerosols have helped reveal why the SARS-CoV-2 coronavirus is even more transmissible through the air than the original SARS of 2003. Many experts now agree that better ventilation of indoor environments and masking can help curb this aerosol-borne disease.
[editor’s note: this article is hard to summarize and deserves a full read]
The post-Covid ‘zombification’ of advanced economies is here to stay, EIU warns – CNBC
The coronavirus pandemic is likely to cause a long-lasting “zombification” of the global economy, a prominent research firm warns.
Agathe Demarais, global forecasting director of the Economist Intelligence Unit, suggested that those “zombie” features previously associated with the “Japanese economy — slow growth, low inflation and high debt — will become common across advanced economies” following the pandemic.
In the EIU’s fourth quarter economic forecast report, published Wednesday, Demarais said that before the outbreak of the coronavirus Japan was considered an “economic oddity.”
Japan’s economic crash, after its stock market and real estate bubble burst in 1989, was followed by a “‘lost decade’ of feeble growth between 1991 and 2001,” said Demarais, who wrote the EIU report.
The Japanese government’s attempt at boosting economic activity through fiscal stimulus failed, she said. Its debt-to-gross domestic product ratio climbed to 240% and inflation remained “stubbornly low.”
As a result of the coronavirus, those characteristics of slow growth, low inflation and high levels of debt would now become common among advanced economies in decades to come, Demarais said.
“The pandemic may not last once a vaccine is found,” she stated in the report. “However, the post-coronavirus zombification of advanced economies appears to be here to stay.”
Seniors are better at pandemic safety than young adults, CDC finds – CNN
Older Americans are better than younger adults at following the recommendations from the US Centers for Disease Control and Prevention to mitigate the spread of the coronavirus, according to a new survey.
This discrepancy could explain why Covid-19 infections started to rise in younger people starting in June, according to the team at the Data Foundation, a nonprofit think tank that conducted the survey.
Most Americans say they’re doing what they should, the researchers reported in the CDC’s Morbidity and Mortality Weekly Report.
Face coverings: Use of masks went up from an average of 78% in April to 83% in May, and reached 89% in June, the survey of 6,500 US adults aged 18 and above showed.
The percentage of older adults who reported wearing a mask was up to 14 percentage points higher, depending on the month, than those in the youngest age group.
WHO Reports Record 3 Million New COVID-19 Cases in a Week – VOA
The World Health Organization says a record 2.8 million new COVID-19 cases have been reported globally over the past seven days ending Tuesday, including 40,000 new deaths.
The U.N. health agency says Europe accounts for the greatest proportion of reported new cases for the second consecutive week with more than 1.3 million, an increase of 33% compared to the previous week. The region accounted for nearly half of the new COVID-19 cases during the seven-day period.
The figures also show that cases are also increasing in the Americas, Eastern Mediterranean and African regions, while declines continue to be reported in Southeast Asia. The Western Pacific region also showed a slight decline in new cases and deaths over the seven-day period.
WHO said the countries reporting the highest number of cases over the past week are India, the United States, France, Brazil and Britain — the same countries as the previous three weeks.
The virus has even affected operations at the U.N.’s main headquarters in New York. General Assembly President Volkan Bozkir canceled all in-person meetings Tuesday after five staffers with Niger’s mission to the world body tested positive for COVID-19.
The following are foreign headlines with hyperlinks to the posts
Pope Francis’ decision to forgo wearing a mask has been noticed, with some concern, by the commission of Vatican experts he appointed to help chart the Catholic Church’s path through the coronavirus pandemic and the aftermath.
New protests loom as Europeans tire of virus restrictions
Doctors and health workers in hospitals in Belgium have been asked to keep working even if they test positive for COVID-19 as long as they’re not showing symptoms.
In Australia, the lockdown that felt like it might last forever has finally ended.
Machu Picchu to reopen after 7-month closure
China reports 183 cases in Xinjiang after testing nearly 5 million people
London Heathrow loses its crown to Paris as passenger numbers plummet
India capital has its worst 1-day virus caseload
Japanese tourists who test negative for COVID-19 will be able to bypass Hawaii quarantine
The following are additional national and state headlines with hyperlinks to the posts
“We’re on a battlefield, and we’re losing,” a Tulsa doctor said as Oklahoma set a state record for the most coronavirus deaths reported in a day.
Ballad Health will begin deferring elective procedures at three of its Tennessee hospitals due to a surge in COVID-19 hospitalizations.
Novavax delayed the start of its phase III vaccine trial to late November. Phase II data are expected Friday.
A doctor with all the symptoms of a COVID long-hauler found it difficult to identify as one.
Stocks Sink As Rising Coronavirus Cases Deepen Fears About Economy
Kushner told Woodward in April Trump was ‘getting the country back from the doctors’
University of Wisconsin pauses football activities due to COVID-19
Boeing plans thousands of additional job cuts in next year amid pandemic losses
Wisconsin reports record number of COVID-19 deaths, hospitalizations and cases
Dodgers player Justin Turner celebrates World Series win with teammates after positive COVID-19 test
Florida Moms Removed From School Board Meeting for Refusing to Wear Masks
Woman Shot With Stun Gun on Plane After Fight Breaks Out Over Face Masks
Kim Kardashian Criticized for Maskless Birthday Trip Amid Covid-19 Pandemic
Maine Pastor Apologizes for COVID Outbreak That Infected At Least 60 People
In Australia, the lockdown that felt like it might last forever has finally ended.
Thieves in Florida steal 6 million medical gloves headed for hospitals fighting the pandemic.
Even while unemployment rates remain high and coronavirus cases continue to surge across the U.S., student loan borrowers could find their monthly bills due again in two months.
Two years’ worth of e-commerce growth is about to be packed into one holiday season, according to a new forecast, as Americans turn in droves to online shopping to avoid crowded stores and malls during the coronavirus pandemic.
Today’s Posts On Econintersect Showing Impact Of The Pandemic With Hyperlinks
In Rural America, Resentment Over COVID-19 Shutdowns Is Colliding With Rising Case Numbers
Warning to Readers
The amount of politically biased articles on the internet continues to increase. And studies and opinions of the experts continue to contradict other studies and expert opinions. Honestly, it is difficult to believe anything anymore. A study usually cannot establish cause and effect – but only correlation. Be very careful what you believe about this pandemic.
I assemble this coronavirus update daily – sifting through the posts on the internet. I try to avoid politically slanted posts (mostly from CNN, New York Times, and the Washington Post) and can usually find unslanted posts on that subject from other sources on the internet. I wait to publish posts on subjects that I cannot validate across several sources. But after all this extra work, I do not know if I have conveyed the REAL facts. It is my job to provide information so that you have the facts necessary – and then it is up to readers to draw conclusions.
Analyst Opinion of Coronavirus Data
There are several takeaways that need to be understood when viewing coronavirus statistical data:
- The global counts are suspect for a variety of reasons including political. Even the U.S. count has issues as it is possible that as much as half the population has had coronavirus and was asymptomatic. It would be a far better metric using a random sampling of the population weekly. In short, we do not understand the size of the error in the tracking numbers.
- Just because some of the methodology used in aggregating the data in the U.S. is flawed – as long as the flaw is uniformly applied – you establish a baseline. This is why it is dangerous to compare two countries as they likely use different methodologies to determine who has (and who died) from coronavirus.
- COVID-19 and the flu are different but can have similar symptoms. For sure, COVID-19 so far is much more deadly than the flu. [click here to compare symptoms]
- From an industrial engineering point of view, one can argue that it is best to flatten the curve only to the point that the health care system is barely able to cope. This solution only works if-and-only-if one can catch this coronavirus once and develops immunity. In the case of COVID-19, herd immunity may need to be in the 80% to 85% range. WHO warns that few have developed antibodies to COVID-19. At this point, herd immunity does not look like an option although there is now a discussion of whether T-Cells play a part in immunity [which means one might have immunity without antibodies]
- Older population countries will have a higher death rate.
- There are at least 8 strains of the coronavirus. New York may have a deadlier strain imported from Europe, compared to less deadly viruses elsewhere in the United States.
- Each publication uses different cutoff times for its coronavirus statistics. Our data uses 11:00 am London time. Also, there is an unexplained variation in the total numbers both globally and in the U.S.
- The real question remains if the U.S. is over-reacting to this virus. The following graphic from the CDC puts the annual flu burden in perspective [click on image to enlarge]. Note that using this data is dangerous as the actual flu cases are estimated and not counted – nobody knows how accurate these guesses are.
What we do not know about the coronavirus [actually there is little scientifically proven information]. Most of our knowledge is anecdotal, from studies with limited subjects, or from studies without peer review.
- How many people have been infected as many do not show symptoms?
- Masks do work.
- Do we develop lasting immunity to the coronavirus? Another coronavirus – the simple cold – does not develop long term immunity.
- To what degree do people who never develop symptoms contribute to transmission?
- The US has scaled up coronavirus testing – and the accuracy of the tests has been improving. However, if one loses immunity – the coronavirus testing value is reduced.
- Can children widely spread coronavirus? [current thinking is that they are becoming a major source of the pandemic spread]
- Why have some places avoided big coronavirus outbreaks – and others hit hard?
- What effect will the weather have? At this point, it does not seem hot weather slows this coronavirus down – and it seems air conditioning contributes to its spread.
- Outdoor activities seem to be a lower risk than indoor activities.
- Can the world really push out an effective vaccine in 12 to 18 months?
- Will other medical treatments for Covid-19 ease symptoms and reduce deaths? So far only one drug (remdesivir) is approved for treatment.
- A current scientific understanding of the way the coronavirus works can be found [here].
Heavy breakouts of coronavirus have hit farm workers. Farmworkers are essential to the food supply. They cannot shelter at home. Consider:
- they have high rates of the respiratory disease [occupational hazard]
- they travel on crowded buses chartered by their employers
- few have health insurance
- they cannot social distance and live two to four to a room – and they eat together
- some reports say half are undocumented
- they are low paid and cannot afford not to work – so they will go to work sick
- they do not have access to sanitation when working
- a coronavirus outbreak among farmworkers can potentially shutter entire farm
The bottom line is that COVID-19 so far has been shown to be much more deadly than the data on the flu. Using CDC data, the flu has a mortality rate between 0.06 % and 0.11 % Vs. the coronavirus which to date has a mortality rate of 4 % [the 4% is the average of overall statistics – however in the last few months it has been hovering around 1.0%] – which makes it between 10 and 80 times more deadly. The reason for ranges:
Because influenza surveillance does not capture all cases of flu that occur in the U.S., CDC provides these estimated ranges to better reflect the larger burden of influenza.
There will be a commission set up after this pandemic ends to find fault [it is easy to find fault when a once-in-a-lifetime event occurs] and to produce recommendations for the next time a pandemic happens. Those that hate President Trump will conclude the virus is his fault.
Resources:
- Get the latest public health information from CDC: https://www.coronavirus.gov .
- Get the latest research from NIH: https://www.nih.gov/coronavirus.
- Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/.
- List of studies: https://icite.od.nih.gov/covid19/search/#search:searchId=5ee124ed70bb967c49672dad
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