Common #human #coronaviruses seem at least as severe as #influenza in patients hospitalized with acute respiratory infection: results from 8-year hospital-based #surveillance in #Quebec, #Canada (J Infect Dis., abstract)

[Source: Journal of Infectious Diseases, full page: (LINK). Abstract, edited.]

Common human coronaviruses seem at least as severe as influenza in patients hospitalized with acute respiratory infection: results from 8-year hospital-based surveillance in Quebec, Canada

Rodica Gilca, Sara Carazo, Rachid Amini, Hugues Charest, Gaston De Serres

The Journal of Infectious Diseases, jiaa477, https://doi.org/10.1093/infdis/jiaa477

Published: 06 August 2020

 

Abstract

Background

Few data exist about the role of common human coronaviruses (HCoV) in patients hospitalized for acute respiratory illness (ARI) and the severity of these infections compared to influenza.

Methods

Prospective data on virus etiology of ARI hospitalizations during the peaks of 8 influenza seasons (2011-12 to 2018-19) in Quebec, Canada, was used to compare patients with HCoV to those with influenza infections; generalized estimation equations models were used for multivariate analyses.

Results

We identified 340 HCoV infections which affected 11.6%(n=136) of children and 5.2%(n=204) of adults hospitalized with ARI. The majority of children (75%) with HCoV infections were also coinfected with other respiratory viruses compared to 24% of the adults (p<0.0001). No deaths were recorded in children; 5.8% of adults with HCoV monoinfection compared to 4.2% of those with influenza monoinfection died (p=0.226). The risk of pneumonia was non-significantly lower in children with HCoV than with influenza but similarly high in adults. Markers of severity (length-of-stay, intensive-care admissions and case-fatality ratio) were comparable between these infections in multivariate analyses, both in children and adults.

Conclusions

In children and adults hospitalized with ARI, HCoV infections were less frequent than influenza infections, but HCoV monoinfections were as severe as influenza monoinfections.

common coronaviruses, influenza, respiratory  hospitalization, children, adults, severity, case-fatality ratio, coinfections

Topic:  influenza – coronavirus – adult – canada – child – inpatients – respiratory tract  infections – infections – surveillance, medical – case fatality rate – quebec

Issue Section:  Major Article

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Coronavirus; Canada; Epidemiology.

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#Risk #Factors Associated With #Mortality Among #Residents With #Coronavirus Disease 2019 (#COVID19) in Long-term #Care #Facilities in #Ontario, #Canada (JAMA Netw Open, abstract)

[Source: JAMA Network Open, full page: (LINK). Abstract, edited.]

Risk Factors Associated With Mortality Among Residents With Coronavirus Disease 2019 (COVID-19) in Long-term Care Facilities in Ontario, Canada

David N. Fisman, MD, MPH1; Isaac Bogoch, MD, MS2,3,4; Lauren Lapointe-Shaw, MD, PhD2,3; et alJanine McCready, MD5; Ashleigh R. Tuite, PhD, MPH1

Author Affiliations: 1 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; 2 Department of Medicine, University of Toronto, Toronto, Ontario, Canada; 3 Division of General Internal Medicine and Geriatrics, University Health Network, Toronto, Ontario, Canada; 4 Division of Infectious Diseases, University Health Network, Toronto, Ontario, Canada; 5 Department of Medicine and Division of Infectious Diseases, Michael Garron Hospital, Toronto, Ontario, Canada

JAMA Netw Open. 2020;3(7):e2015957. doi:10.1001/jamanetworkopen.2020.15957

 

Key Points

  • Question  – How does the risk of death from coronavirus disease 2019 (COVID-19) among residents of long-term care (LTC) homes compare with that among the general population?
  • Findings  – In this cohort study of 627 LTC facilities, the incidence rate ratio for COVID-19–related death among LTC residents was 13 times higher than that among community-living adults older than 69 years.
  • Meaning  – In this study, the risk of COVID-19–related death was elevated among LTC residents, highlighting the need for improved infection control, widespread testing, access to personal protective equipment, and other supports to protect this vulnerable population.

 

Abstract

Importance  

The coronavirus disease 2019 (COVID-19) pandemic has been particularly severe among individuals residing in long-term care (LTC) facilities. As of April 10, 2020, half of Canada’s COVID-19 deaths had occurred in LTC facilities.

Objective  

To better understand trends and risk factors associated with COVID-19 death in LTC facilities in Ontario, Canada.

Design, Setting, and Participants  

This cohort study of 627 LTC facilities included 269 total individuals who died of COVID-19 in Ontario to April 11, 2020, and 83 individuals who died of COVID-19 in Ontario LTC facilities to April 7, 2020. Because population denominators were not available for LTC residents, they were approximated as the total number of LTC facility beds in Ontario (79 498), assuming complete occupancy.

Exposures  

Confirmed or suspected COVID-19 outbreaks; confirmed COVID-19 infection among residents and staff, diagnosed by real-time polymerase chain reaction testing.

Main Outcomes and Measures  

COVID-19–specific mortality incidence rate ratios (IRRs) for LTC residents were calculated with community-living Ontarians older than 69 years as the comparator group. Count-based regression methods were used to model temporal trends and to identify associations of infection risk among staff and residents with subsequent LTC resident death. Model-derived IRRs for COVID-19–specific mortality were generated through bootstrap resampling (1000 replicates) to generate median and 95% credible intervals for IRR over time.

Results  

Of 627 LTC facilities, 272 (43.4%) reported COVID-19 infection in residents or staff. Of 1 731 315 total individuals older than 69 years living in Ontario during the study period, 229 (<0.1%) died; of 79 498 potential residents in LTC facilities, 83 (0.1%) died. The IRR for COVID-19–related death in LTC residents was 13.1 (95% CI, 9.9-17.3) compared with community-living adults older than 69 years. The IRR increased sharply over time and was 87.3 (95% credible interval, 6.4-769.8) by April 11, 2020. Infection among LTC staff was associated with death among residents with a 6-day lag (eg, adjusted IRR for death per infected staff member, 1.17; 95% CI, 1.11-1.26).

Conclusions and Relevance  

In this cohort study of COVID-19–related deaths during the pandemic in Ontario, Canada, mortality risk was concentrated in LTC residents and increased during a short period. Early identification of risk requires a focus on testing, providing personal protective equipment to staff, and restructuring the LTC workforce to prevent the movement of COVID-19 between facilities.

Keywords: SARS-CoV-2; COVID-19; Institutional Outbreaks; Canada.

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Temporal #estimates of #CFR for #COVID19 #outbreaks in #Canada and the #USA (CMAJ, abstract)

[Source: CMAJ, full page: (LINK). Abstract, edited.]

Temporal estimates of case-fatality rate for COVID-19 outbreaks in Canada and the United States

Elaheh Abdollahi, David Champredon, Joanne M. Langley, Alison P. Galvani and Seyed M. Moghadas

CMAJ June 22, 2020 192 (25) E666-E670; DOI: https://doi.org/10.1503/cmaj.200711

 

Abstract

BACKGROUND:

Estimates of the case-fatality rate (CFR) associated with coronavirus disease 2019 (COVID-19) vary widely in different population settings. We sought to estimate and compare the COVID-19 CFR in Canada and the United States while adjusting for 2 potential biases in crude CFR.

METHODS:

We used the daily incidence of confirmed COVID-19 cases and deaths in Canada and the US from Jan. 31 to Apr. 22, 2020. We applied a statistical method to minimize bias in the crude CFR by accounting for the survival interval as the lag time between disease onset and death, while considering reporting rates of COVID-19 cases less than 50% (95% confidence interval 10%–50%).

RESULTS:

Using data for confirmed cases in Canada, we estimated the crude CFR to be 4.9% on Apr. 22, 2020, and the adjusted CFR to be 5.5% (credible interval [CrI] 4.9%–6.4%). After we accounted for various reporting rates less than 50%, the adjusted CFR was estimated at 1.6% (CrI 0.7%–3.1%). The US crude CFR was estimated to be 5.4% on Apr. 20, 2020, with an adjusted CFR of 6.1% (CrI 5.4%–6.9%). With reporting rates of less than 50%, the adjusted CFR for the US was 1.78 (CrI 0.8%–3.6%).

INTERPRETATION:

Our estimates suggest that, if the reporting rate is less than 50%, the adjusted CFR of COVID-19 in Canada is likely to be less than 2%. The CFR estimates for the US were higher than those for Canada, but the adjusted CFR still remained below 2%. Quantification of case reporting can provide a more accurate measure of the virulence and disease burden of severe acute respiratory syndrome coronavirus 2.

Keywords: SARS-CoV-2; COVID-19; Canada; USA.

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#Isolation, #Sequence, #Infectivity, and #Replication #Kinetics of #SARS-CoV-2 (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 26, Number 9—September 2020 | Research

Isolation, Sequence, Infectivity, and Replication Kinetics of Severe Acute Respiratory Syndrome Coronavirus 2

Arinjay Banerjee, Jalees A. Nasir1, Patrick Budylowski1, Lily Yip, Patryk Aftanas, Natasha Christie, Ayoob Ghalami, Kaushal Baid, Amogelang R. Raphenya, Jeremy A. Hirota, Matthew S. Miller, Allison J. McGeer, Mario Ostrowski, Robert A. Kozak1, Andrew G. McArthur, Karen Mossman  , and Samira Mubareka

Author affiliations: McMaster University, Hamilton, Ontario, Canada (A. Banerjee, J.A. Nasir, K. Baid, A.R. Raphenya, J.A. Hirota, M.S. Miller, A.G. McArthur, K. Mossman); University of Toronto, Toronto, Ontario, Canada (P. Budylowski, N. Christie, A. Ghalami, A.J. McGeer, M. Ostrowski, R.A. Kozak, S. Mubareka); Sunnybrook Research Institute, Toronto (L. Yip, P. Aftanas, R.A. Kozak, S. Mubareka); Mount Sinai Hospital, Toronto (A.J. McGeer)

 

Abstract

Since its emergence in Wuhan, China, in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected ≈6 million persons worldwide. As SARS-CoV-2 spreads across the planet, we explored the range of human cells that can be infected by this virus. We isolated SARS-CoV-2 from 2 infected patients in Toronto, Canada; determined the genomic sequences; and identified single-nucleotide changes in representative populations of our virus stocks. We also tested a wide range of human immune cells for productive infection with SARS-CoV-2. We confirm that human primary peripheral blood mononuclear cells are not permissive for SARS-CoV-2. As SARS-CoV-2 continues to spread globally, it is essential to monitor single-nucleotide polymorphisms in the virus and to continue to isolate circulating viruses to determine viral genotype and phenotype by using in vitro and in vivo infection models.

Keywords: SARS-CoV-2; COVID-19; Canada.

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#Pandemic #Planning in #Homeless #Shelters: A pilot study of a #COVID19 #testing and #support program to mitigate the risk of COVID-19 outbreaks in congregate settings (Clin Infect Dis., abstract)

[Source: Clinical Infectious Diseases, full page: (LINK). Abstract, edited.]

Pandemic Planning in Homeless Shelters: A pilot study of a COVID-19 testing and support program to mitigate the risk of COVID-19 outbreaks in congregate settings

Claire Bodkin, BA, MD, Vaibhav Mokashi, BSc, MD, Kerry Beal, RT, ART, BSc, MD, Jill Wiwcharuk, MD, Robin Lennox, MD, Dale Guenter, MD, MPH, Marek Smieja, MD, Timothy O’Shea, MD, MPH

Clinical Infectious Diseases, ciaa743, https://doi.org/10.1093/cid/ciaa743

Published: 08 June 2020

 

Abstract

We tested 104 residents and 141 staff for COVID-19 who failed daily symptom screening in homeless shelters in Hamilton, Canada. We detected one resident (1%), seven staff (5%) and one case of secondary spread. Shelter restructuring to allow physical distancing, testing and isolation can decrease outbreaks in shelters.

coronavirus, homeless, shelter, surveillance, outbreak

Issue Section: Brief Report

This content is only available as a PDF.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: SARS-CoV-2; COVID-19; Institutional Outbreaks; Canada.

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#Risk for #COVID19 #Resurgence Related to Duration and Effectiveness of #Physical #Distancing in #Ontario, #Canada (Ann Intern Med., summary)

[Source: Annals of Internal Medicine, full page: (LINK). Summary, edited.]

Risk for COVID-19 Resurgence Related to Duration and Effectiveness of Physical Distancing in Ontario, Canada

Ashleigh R. Tuite, PhD, MPH, Amy L. Greer, MSc, PhD, Steven De Keninck, BICT, David N. Fisman, MD, MPH

DOI: https://doi.org/10.7326/M20-2945

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Background: Insights from epidemiologic models have helped to guide and improve understanding of mitigation policies for coronavirus disease 2019 (COVID-19) across the globe. As the pandemic progresses, models can be used to quantify what may unfold when such measures are relaxed.

(…)

Keywords: SARS-CoV-2; COVID-19; Canada; Quarantine.

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Characteristics and #Outcomes of #Children With #Coronavirus Disease 2019 (#COVID19) Infection Admitted to #US and #Canadian #Pediatric #ICU (JAMA Pediatr., abstract)

[Source: JAMA Pediatrics, full page: (LINK). Abstract, edited.]

Characteristics and Outcomes of Children With Coronavirus Disease 2019 (COVID-19) Infection Admitted to US and Canadian Pediatric Intensive Care Units

Lara S. Shekerdemian, MD, MHA1; Nabihah R. Mahmood, MD2; Katie K. Wolfe, MD3; et al. Becky J. Riggs, MD4; Catherine E. Ross, MD5; Christine A. McKiernan, MD6; Sabrina M. Heidemann, MD7; Lawrence C. Kleinman, MD, MPH8; Anita I. Sen, MD9; Mark W. Hall, MD10; Margaret A. Priestley, MD11; John K. McGuire, MD12; Konstantinos Boukas, MD13; Matthew P. Sharron, MD14; Jeffrey P. Burns, MD, MPH15; for the International COVID-19 PICU Collaborative

Author Affiliations: 1 Texas Children’s Hospital, Baylor College of Medicine, Houston; 2 Children’s Healthcare of Atlanta, Atlanta, Georgia; 3 Ann and Robert H. Lurie Children’s  Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; 4 Johns  Hopkins Children’s Center, Johns Hopkins School of Medicine, Baltimore, Maryland; 5 Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts; 6 Baystate  Children’s Hospital, UMass Medical School Baystate Campus, Springfield, Massachusetts; 7 Children’s Hospital of Michigan, Wayne State University, Detroit; 8 Bristol-Myers  Squibb Hospital, Robert Wood Johnson Medical School, Rutgers University, New  Brunswick, New Jersey; 9 NewYork-Presbyterian Morgan Stanley Children’s Hospital,  Columbia University Medical Center, New York; 10 Nationwide Children’s Hospital, The  Ohio State University College of Medicine, Columbus; 11 Children’s Hospital of  Philadelphia, University of Pennsylvania, Philadelphia; 12 Seattle Children’s Hospital,  University of Washington, Seattle; 13 Children’s Memorial Hermann Hospital, University  of Texas, Houston; 14 Children’s National Medical Center, George Washington School of  Medicine, Washington, DC; 15 Boston Children’s Hospital, Harvard Medical School,  Boston, Massachusetts

JAMA Pediatr. Published online May 11, 2020. doi:10.1001/jamapediatrics.2020.1948

 

Key Points

  • Question  – What has been the early experience of coronavirus disease 2019 (COVID-19) in pediatric intensive care units (PICUs)?
  • Findings  – In this cross-sectional study of 46 North American PICUs, between March 14 and April 3, 2020, 48 children were admitted to 14 PICUs in the US and none in Canada. A total of 40 children (83%) had preexisting underlying medical conditions, 35 (73%) presented with respiratory symptoms, and 18 (38%) required invasive ventilation, and the hospital mortality rate was 4.2%.
  • Meaning  – This early study shows that COVID-19 can result in a significant disease burden in children but confirms that severe illness is less frequent, and early hospital outcomes in children are better than in adults.

 

Abstract

Importance  

The recent and ongoing coronavirus disease 2019 (COVID-19) pandemic has taken an unprecedented toll on adults critically ill with COVID-19 infection. While there is evidence that the burden of COVID-19 infection in hospitalized children is lesser than in their adult counterparts, to date, there are only limited reports describing COVID-19 in pediatric intensive care units (PICUs).

Objective  

To provide an early description and characterization of COVID-19 infection in North American PICUs, focusing on mode of presentation, presence of comorbidities, severity of disease, therapeutic interventions, clinical trajectory, and early outcomes.

Design, Setting, and Participants  

This cross-sectional study included children positive for COVID-19 admitted to 46 North American PICUs between March 14 and April 3, 2020. with follow-up to April 10, 2020.

Main Outcomes and Measures  

Prehospital characteristics, clinical trajectory, and hospital outcomes of children admitted to PICUs with confirmed COVID-19 infection.

Results  

Of the 48 children with COVID-19 admitted to participating PICUs, 25 (52%) were male, and the median (range) age was 13 (4.2-16.6) years. Forty patients (83%) had significant preexisting comorbidities; 35 (73%) presented with respiratory symptoms and 18 (38%) required invasive ventilation. Eleven patients (23%) had failure of 2 or more organ systems. Extracorporeal membrane oxygenation was required for 1 patient (2%). Targeted therapies were used in 28 patients (61%), with hydroxychloroquine being the most commonly used agent either alone (11 patients) or in combination (10 patients). At the completion of the follow-up period, 2 patients (4%) had died and 15 (31%) were still hospitalized, with 3 still requiring ventilatory support and 1 receiving extracorporeal membrane oxygenation. The median (range) PICU and hospital lengths of stay for those who had been discharged were 5 (3-9) days and 7 (4-13) days, respectively.

Conclusions and Relevance  

This early report describes the burden of COVID-19 infection in North American PICUs and confirms that severe illness in children is significant but far less frequent than in adults. Prehospital comorbidities appear to be an important factor in children. These preliminary observations provide an important platform for larger and more extensive studies of children with COVID-19 infection.

Keywords: SARS-CoV-2; COVID-19; Intensive Care; USA; Canada; Pediatrics.

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#Covid19 in Critically Ill Patients in the #Seattle Region — Case Series (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Covid-19 in Critically Ill Patients in the Seattle Region — Case Series

Pavan K. Bhatraju, M.D., Bijan J. Ghassemieh, M.D., Michelle Nichols, M.D., Richard Kim, M.D., Keith R. Jerome, M.D., Arun K. Nalla, Ph.D., Alexander L. Greninger, M.D., Sudhakar Pipavath, M.D., Mark M. Wurfel, M.D., Ph.D., Laura Evans, M.D., Patricia M. Kritek, M.D., T. Eoin West, M.D., M.P.H., et al.

 

Abstract

BACKGROUND

Community transmission of coronavirus 2019 (Covid-19) was detected in the state of Washington in February 2020.

METHODS

We identified patients from nine Seattle-area hospitals who were admitted to the intensive care unit (ICU) with confirmed infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Clinical data were obtained through review of medical records. The data reported here are those available through March 23, 2020. Each patient had at least 14 days of follow-up.

RESULTS

We identified 24 patients with confirmed Covid-19. The mean (±SD) age of the patients was 64±18 years, 63% were men, and symptoms began 7±4 days before admission. The most common symptoms were cough and shortness of breath; 50% of patients had fever on admission, and 58% had diabetes mellitus. All the patients were admitted for hypoxemic respiratory failure; 75% (18 patients) needed mechanical ventilation. Most of the patients (17) also had hypotension and needed vasopressors. No patient tested positive for influenza A, influenza B, or other respiratory viruses. Half the patients (12) died between ICU day 1 and day 18, including 4 patients who had a do-not-resuscitate order on admission. Of the 12 surviving patients, 5 were discharged home, 4 were discharged from the ICU but remained in the hospital, and 3 continued to receive mechanical ventilation in the ICU.

CONCLUSIONS

During the first 3 weeks of the Covid-19 outbreak in the Seattle area, the most common reasons for admission to the ICU were hypoxemic respiratory failure leading to mechanical ventilation, hypotension requiring vasopressor treatment, or both. Mortality among these critically ill patients was high. (Funded by the National Institutes of Health.)

Keywords: SARS-CoV-2; COVID-19; ARSD; Canada; Intensive Care.

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#Severity of #Coronavirus Respiratory Tract #Infections in Adults Admitted to Acute Care in #Toronto, #Ontario (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Journal of Clinical Virology | Available online 29 March 2020, 104338 | In Press, Journal Pre-proof

Severity of Coronavirus Respiratory Tract Infections in Adults Admitted to Acute Care in Toronto, Ontario

Robert Kozak a, Karren Prost b, Lily Yip b, Victoria Williams c, Jerome A.Leis c,d, Samira Mubareka a,b,d

{a} Department of Laboratory Medicine and Molecular Diagnostics, Division of Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; {b} Biological Sciences, Sunnybrook Research Institute, Toronto, ON, Canada; {c} Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; {d} Division of Infectious Diseases, Sunnybrook Health Sciences Centre and Department of Medicine, University of Toronto, Toronto, ON, Canada

Received 10 October 2019, Revised 19 March 2020, Accepted 25 March 2020, Available online 29 March 2020.

DOI: https://doi.org/10.1016/j.jcv.2020.104338

 

Highlights

  • Coronaviruses represent a significant burden in acute care settings.
  • Female gender and smoking were associated with poor prognosis.
  • All cause mortality in our cohort was similar to what is observed for influenza virus.

Keywords: SARS-CoV-2; COVID-19; Canada.

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#Canada and #COVID19: learning from #SARS (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Canada and COVID-19: learning from SARS

Paul Webster

Published: March 21, 2020 | DOI: https://doi.org/10.1016/S0140-6736(20)30670-X

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The 2003 SARS epidemic killed 44 people in Canada, and led to many proposals for reforms. Paul Webster looks at how the SARS outbreak has affected Canada’s COVID-19 response. In an exclusive interview with The Lancet, David Naylor, one of Canada’s leading experts on pandemic control, says Canada’s response to coronavirus disease 2019 (COVID-19) is vastly benefiting from the country’s experience with a 2003 epidemic of severe acute respiratory syndrome (SARS) that killed 44 Canadians.

(…)

___

Keywords: SARS-CoV-2; COVID-19; Canada.

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