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| ===== What is Coronavirus? ===== | ===== What is Coronavirus? ===== | ||
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| + | <box 30% round right | > | ||
| + | {{ :coronavirus_pic.jpg?300|}} | ||
| + | </box| Figure 1: Magnified image of coronavirus under electron microscope (BBC & Getty Images, 2020).> | ||
| The name “Coronavirus” was found in the mid-1960s and it was derived from the “corona” or the crown-like shape observed for these viruses. | The name “Coronavirus” was found in the mid-1960s and it was derived from the “corona” or the crown-like shape observed for these viruses. | ||
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| A total of 8098 cases were confirmed worldwide, 774 of which resulted in death. The case fatality rate was thus calculated at 9.6% (WHO, 2004). | A total of 8098 cases were confirmed worldwide, 774 of which resulted in death. The case fatality rate was thus calculated at 9.6% (WHO, 2004). | ||
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| + | <box 40% round right | > | ||
| + | {{ :covid19_symptoms.png?400|}} | ||
| + | </box| Figure 2: Common pneumonia-related symptoms of patients infected with SARS or Covid-19 (BBC & WHO, 2020).> | ||
| + | |||
| ==== Symptoms ==== | ==== Symptoms ==== | ||
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| <box 30% round right | > | <box 30% round right | > | ||
| - | {{ :hk_superspreader.jpg?300|}} | + | {{ :hk_superspreader_2.jpg?300|}} |
| - | </box| Figure 1: Chains of infection overseas initiated by the superspreader in Hong Kong. Image reflects number of confirmed cases as of March 28, 2003 (NCBI, 2004).> | + | </box| Figure 3: Chains of infection overseas initiated by the superspreader in Hong Kong. Image reflects number of confirmed cases as of March 28, 2003 (NCBI, 2004).> |
| The SARS coronavirus was primarily transmitted through respiratory droplets during short-distance human contact. The droplets are produced from coughing or sneezing, and can travel up to a radius of 3 feet/0.9m (CDC, 2005). | The SARS coronavirus was primarily transmitted through respiratory droplets during short-distance human contact. The droplets are produced from coughing or sneezing, and can travel up to a radius of 3 feet/0.9m (CDC, 2005). | ||
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| At the beginning of the 2003 SARS outbreak, an infected Chinese doctor unwittingly passed on the virus to 12 other people while staying at a hotel in Hong Kong. The 12 people then traveled abroad and spread the infection to Southeast Asia, Western Europe, and North America. The resulting chain reaction accounts for most of the more than 8000 cases worldwide (NCBI, 2004). From Hong Kong, the infection spread to 5 countries within 24 hours, and to more than 30 countries on 6 continents within the following 6 months (WHO, 2003). The rapid spread was made possible by the ease of globalized travel from Hong Kong, a major airline hub, despite the virus having a lower transmission rate (R0) than many other infectious diseases. | At the beginning of the 2003 SARS outbreak, an infected Chinese doctor unwittingly passed on the virus to 12 other people while staying at a hotel in Hong Kong. The 12 people then traveled abroad and spread the infection to Southeast Asia, Western Europe, and North America. The resulting chain reaction accounts for most of the more than 8000 cases worldwide (NCBI, 2004). From Hong Kong, the infection spread to 5 countries within 24 hours, and to more than 30 countries on 6 continents within the following 6 months (WHO, 2003). The rapid spread was made possible by the ease of globalized travel from Hong Kong, a major airline hub, despite the virus having a lower transmission rate (R0) than many other infectious diseases. | ||
| + | <box 60%| > | ||
| + | {{ :sars_hk_epidemic_curve.png?600 |}} | ||
| + | </box| Figure 4: Epidemic curve by infection cluster for the 2003 SARS outbreak in Hong Kong (Leung et al., 2004).> | ||
| ===== Middle East Respiratory Syndrome (MERS) ===== | ===== Middle East Respiratory Syndrome (MERS) ===== | ||
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| <box 80%| > | <box 80%| > | ||
| {{ :mers-epicurve-july-2019.png?650 |}} | {{ :mers-epicurve-july-2019.png?650 |}} | ||
| - | </box| Figure 2: Epidemic Curve of MERS-CoV cases as of June 30, 2018. Graph representation of all reported cases of MERS-CoV since 2012 (WHO, 2018).> | + | </box| Figure 5: Epidemic Curve of MERS-CoV cases as of June 30, 2018. Graph representation of all reported cases of MERS-CoV since 2012 (WHO, 2018).> |
| ==== Symptoms ==== | ==== Symptoms ==== | ||
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| Like SARS, MERS-CoV most likely spreads from an infected patients’ respiratory secretions like coughing and large droplets of bodily fluids (Zumla et al.,2015). Unlike SARS-CoV and Covid-19, MERS-CoV has a different receptor, DDP4, which further leads to transcription in the body (Zumla et al.,2015). All MERS-CoV cases have been linked to countries near the Arabian Peninsula (CDC, 2019). Most patients either lived in the Arabian Peninsula or traveled to Arabian Peninsula. 27 countries have been reported to have cases or MERS-CoV in their countries. However, the reproductive rate (R0) of MERS-CoV was relatively low, R0=0.7. This is substantially lower than the epidemic potential (R0=1)(World Health Organization, 2019). Therefore, the only country that was heavily affected by MERS was South Korea in 2015 with 186 confirmed cases and 38 deaths (largest outbreak outside of Arabian Peninsula)(Kim et al.,2017). | Like SARS, MERS-CoV most likely spreads from an infected patients’ respiratory secretions like coughing and large droplets of bodily fluids (Zumla et al.,2015). Unlike SARS-CoV and Covid-19, MERS-CoV has a different receptor, DDP4, which further leads to transcription in the body (Zumla et al.,2015). All MERS-CoV cases have been linked to countries near the Arabian Peninsula (CDC, 2019). Most patients either lived in the Arabian Peninsula or traveled to Arabian Peninsula. 27 countries have been reported to have cases or MERS-CoV in their countries. However, the reproductive rate (R0) of MERS-CoV was relatively low, R0=0.7. This is substantially lower than the epidemic potential (R0=1)(World Health Organization, 2019). Therefore, the only country that was heavily affected by MERS was South Korea in 2015 with 186 confirmed cases and 38 deaths (largest outbreak outside of Arabian Peninsula)(Kim et al.,2017). | ||
| - | <box 30% round right| > | + | <box 45% round right| > |
| - | {{ ::screen_shot_2020-02-24_at_1.53.01_am.png?300 |}} | + | {{ ::screen_shot_2020-02-24_at_1.53.01_am.png?450 |}} |
| - | </box| Figure 3: Distribution of MERS cases around the world, Orange label represents camel to camel transmission, blue label represents human to human transmission and red label represents camel to human transmission (WHO,2018).> | + | </box| Figure 6: Distribution of MERS cases around the world, Orange label represents camel to camel transmission, blue label represents human to human transmission and red label represents camel to human transmission (WHO,2018).> |
| === Four different transmission patterns in MERS === | === Four different transmission patterns in MERS === | ||
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| ===== Covid-19 ===== | ===== Covid-19 ===== | ||
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| + | <box 25% round right | > | ||
| + | {{ :r0_comparison_1.png?250|}} | ||
| + | </box| Figure 7: Chart comparison of the R0 values of several types of infectious diseases to visualize how contagious they respectively are (Belluz, 2020).> | ||
| The disease caused by the 2019-2020 coronavirus outbreak has officially been named Covid-19, while the strain of coronavirus is now known as SARS-Cov-2. | The disease caused by the 2019-2020 coronavirus outbreak has officially been named Covid-19, while the strain of coronavirus is now known as SARS-Cov-2. | ||
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| * Fever, cough, shortness of breath (CDC, 2020) | * Fever, cough, shortness of breath (CDC, 2020) | ||
| * Dyspnoea/breathing difficulty in 55% of patients, one week after onset of symptoms (Huang et al., 2020) | * Dyspnoea/breathing difficulty in 55% of patients, one week after onset of symptoms (Huang et al., 2020) | ||
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| - | <box 30% round right | > | ||
| - | {{ :covid_spread_edited.png?300|}} | ||
| - | </box| Figure 4: Spread of Covid-19 from Wuhan, the provincial capital of Hubei Province, to the rest of China as of Jan. 30, 2020 (China National Health Commission & BBC, 2020).> | ||
| ==== Epidemiology ==== | ==== Epidemiology ==== | ||
| Significant epidemiological features of Covid-19 are summarized as follows: | Significant epidemiological features of Covid-19 are summarized as follows: | ||
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| + | <box 35% round right | > | ||
| + | {{ :covid_spread_edited.png?350|}} | ||
| + | </box| Figure 8: Spread of Covid-19 from Wuhan, the provincial capital of Hubei Province, to the rest of China as of Jan. 30, 2020 (China National Health Commission & BBC, 2020).> | ||
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| * Covid-19 has a median incubation period of 3 days, though individual cases range from 1 to 24 days, as reported by top Chinese epidemiologist Dr. Nanshan Zhong, who is widely credited for discovering the SARS virus. | * Covid-19 has a median incubation period of 3 days, though individual cases range from 1 to 24 days, as reported by top Chinese epidemiologist Dr. Nanshan Zhong, who is widely credited for discovering the SARS virus. | ||
| * However, a new case confirmed on February 22 involves a 70-year-old man who started experiencing symptoms 27 days after getting infected, raising concerns that the mean incubation period could be longer than 14 days (Reuters, 2020). | * However, a new case confirmed on February 22 involves a 70-year-old man who started experiencing symptoms 27 days after getting infected, raising concerns that the mean incubation period could be longer than 14 days (Reuters, 2020). | ||
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| ===== Covid-19 vs. SARS ===== | ===== Covid-19 vs. SARS ===== | ||
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| + | <box 20% round right | > | ||
| + | {{ :animal_source.jpg?200|}} | ||
| + | </box| Figure 9: Animal sources of different coronaviruses prior to human infection (Sheahan, 2020).> | ||
| <box 30% round right | > | <box 30% round right | > | ||
| {{ :compare_number_of_cases.png?300|}} | {{ :compare_number_of_cases.png?300|}} | ||
| - | </box| Figure 5: Compare number of confirmed cases and deaths resulting from Covid-19, SARS, and MERS as of Feb. 23, 2020 (WHO & BBC, 2020).> | + | </box| Figure 10: Compare number of confirmed cases and deaths resulting from Covid-19, SARS, and MERS as of Feb. 23, 2020 (WHO & BBC, 2020).> |
| ==== Similarities ==== | ==== Similarities ==== | ||
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| === Transmission === | === Transmission === | ||
| Both infections are transmitted primarily through airborne respiratory droplets, produced when patients cough or sneeze. The droplets usually infect the mucous membranes of the mouth and nose upon contact. However, the respiratory tract is not the only transmission route. Both strains of coronavirus are also able to infect the ocular membrane, specifically the conjunctiva, of people not wearing protective eyewear (Lu et al., 2020). | Both infections are transmitted primarily through airborne respiratory droplets, produced when patients cough or sneeze. The droplets usually infect the mucous membranes of the mouth and nose upon contact. However, the respiratory tract is not the only transmission route. Both strains of coronavirus are also able to infect the ocular membrane, specifically the conjunctiva, of people not wearing protective eyewear (Lu et al., 2020). | ||
| - | |||
| - | <box 30% round right | > | ||
| - | {{ :cases_outside_china.png?300|}} | ||
| - | </box| Figure 6: Number of confirmed cases of Covid-19 worldwide as of Feb. 1, 2020 (WHO & BBC, 2020).> | ||
| === Clinical Manifestation === | === Clinical Manifestation === | ||
| SARS and SARS-Cov-2 belong to the same family of virus, coronavirus, which invades the respiratory tract and causes atypical pneumonia. Patients develop breathing difficulties due to inflamed alveoli of the lungs. Atypical pneumonia, also known as walking pneumonia, differs from typical pneumonia as it is caused by viral agents or atypical bacteria that lack normal cell structure. Patients with atypical pneumonia experience milder symptoms and resistance to normal antibacterial medications (Cleveland Clinic, 2019). | SARS and SARS-Cov-2 belong to the same family of virus, coronavirus, which invades the respiratory tract and causes atypical pneumonia. Patients develop breathing difficulties due to inflamed alveoli of the lungs. Atypical pneumonia, also known as walking pneumonia, differs from typical pneumonia as it is caused by viral agents or atypical bacteria that lack normal cell structure. Patients with atypical pneumonia experience milder symptoms and resistance to normal antibacterial medications (Cleveland Clinic, 2019). | ||
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| + | <box 40% round right | > | ||
| + | {{ :cases_outside_china.png?400|}} | ||
| + | </box| Figure 11: Number of confirmed cases of Covid-19 worldwide as of Feb. 21, 2020 (WHO & BBC, 2020).> | ||
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| ==== Differences ==== | ==== Differences ==== | ||
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| <box 45% round left| > | <box 45% round left| > | ||
| {{ ::screen_shot_2020-02-27_at_3.16.47_pm.png?400 |}} | {{ ::screen_shot_2020-02-27_at_3.16.47_pm.png?400 |}} | ||
| - | </box| Figure 7: The size distribution of coughing droplet (without mask) (Yang, Lee, Chen, Wu, & Yu, 2007).> | + | </box| Figure 12: The size distribution of coughing droplet (without mask) (Yang, Lee, Chen, Wu, & Yu, 2007).> |
| <box 45% round right| > | <box 45% round right| > | ||
| {{ ::screen_shot_2020-02-27_at_3.17.06_pm.png?400 |}} | {{ ::screen_shot_2020-02-27_at_3.17.06_pm.png?400 |}} | ||
| - | </box| Figure 8: The concentration of coughing droplet for different gender and age group (Yang, Lee, Chen, Wu, & Yu, 2007).> | + | </box| Figure 13: The concentration of coughing droplet for different gender and age group (Yang, Lee, Chen, Wu, & Yu, 2007).> |
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| <box 25% round right| > | <box 25% round right| > | ||
| {{ ::screen_shot_2020-02-21_at_10.36.12_pm.png?200|}} | {{ ::screen_shot_2020-02-21_at_10.36.12_pm.png?200|}} | ||
| - | </box| Figure 9: The filtration mechanisms of masks (Brosseau & Brosseau 2009).> | + | </box| Figure 14: The filtration mechanisms of masks (Brosseau & Brosseau 2009).> |
| To prevent contact with these droplets that contain viruses, wearing a mask is certainly a good idea. The multilayer structure of the mask can effectively block large particles, the smaller particles can be attracted to an oppositely charged fiber in the mask (fig. 9). | To prevent contact with these droplets that contain viruses, wearing a mask is certainly a good idea. The multilayer structure of the mask can effectively block large particles, the smaller particles can be attracted to an oppositely charged fiber in the mask (fig. 9). | ||
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| If we plot the particle diameter on x-axis, and the filtration efficiency on the y-axis, the filtration effects of masks exhibit as U-shaped curves (fig. 10). The hardest particles to filter are the ones around 0.3 micrometers. Which is why most masks use 0.3 micrometers as a performance indicator(Brosseau & Brosseau 2009). | If we plot the particle diameter on x-axis, and the filtration efficiency on the y-axis, the filtration effects of masks exhibit as U-shaped curves (fig. 10). The hardest particles to filter are the ones around 0.3 micrometers. Which is why most masks use 0.3 micrometers as a performance indicator(Brosseau & Brosseau 2009). | ||
| - | <box 65%| > | + | <box 50%| > |
| - | {{ ::screen_shot_2020-02-21_at_9.14.02_pm.png?600 |}} | + | {{ ::screen_shot_2020-02-21_at_9.14.02_pm.png?500 |}} |
| - | </box| Figure 10: The filtration efficiency of masks(Brosseau & Brosseau 2009).> | + | </box| Figure 15: The filtration efficiency of masks(Brosseau & Brosseau 2009).> |
| To protect against most coughed droplets, a regular medical mask is enough. In a randomized clinical trial with more than 2800 influenza health care providers, the flu infection rates of those who wore N95 masks and regular medical masks actually showed no significant differences, if compare the total outcomes of both masks in fig. 11. (Radonovich, et al., 2019). | To protect against most coughed droplets, a regular medical mask is enough. In a randomized clinical trial with more than 2800 influenza health care providers, the flu infection rates of those who wore N95 masks and regular medical masks actually showed no significant differences, if compare the total outcomes of both masks in fig. 11. (Radonovich, et al., 2019). | ||
| - | <box 65%| > | + | <box 60%| > |
| {{ ::screen_shot_2020-02-21_at_9.31.20_pm.png?600 |}} | {{ ::screen_shot_2020-02-21_at_9.31.20_pm.png?600 |}} | ||
| - | </box| Figure 11: The effect of N95 masks vs medical masks in clinical settings (Radonovich, et al., 2019).> | + | </box| Figure 16: The effect of N95 masks vs medical masks in clinical settings (Radonovich, et al., 2019).> |
| === Personal Hygiene === | === Personal Hygiene === | ||
| - | What’s more important than whether you wear a N95 or not, is did you wash your hands? Washing hands are critical because your hands can carry live coronavirus from the contaminated surfaces. When you rub your eyes and pick your nose with your hands, the viruses can complete the infection. So, please take your time to wash your hands and avoid touching eyes, nose and mouth (World Health Organization, 2020). | ||
| - | <box 45%| > | + | <box 33% round right| > |
| - | {{ :screen_shot_2020-02-21_at_9.50.24_pm.png?400 |}} | + | {{ :protection_measures.png?330|}} |
| - | </box| Figure 12: How to wash your hands? (World Health Organization, 2020).> | + | </box| Figure 17: Protective measures that reduce risk of coronavirus infection (WHO & BBC, 2020).> |
| + | What’s more important than whether you wear a N95 or not, is did you wash your hands? Washing hands are critical because your hands can carry live coronavirus from the contaminated surfaces. When you rub your eyes and pick your nose with your hands, the viruses can complete the infection. So, please take your time to wash your hands and avoid touching eyes, nose and mouth (World Health Organization, 2020). | ||
| + | <box 30% round left| > | ||
| + | {{ :screen_shot_2020-02-21_at_9.50.24_pm.png?300 |}} | ||
| + | </box| Figure 18: How to wash your hands? (World Health Organization, 2020).> | ||
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| During the SARS epidemic in 2003, hospitalized patients received the same treatment as recommended for severe atypical pneumonia (CDC, 2005). Antiviral medications are sometimes given to reduce the swelling of the lungs but there are no studies that prove this is effective for every individual affected by SARS. No effective pharmacological interventions against the virus exists at this time. However, antiviral medications were later developed to combat the MERS outbreak in 2012. | During the SARS epidemic in 2003, hospitalized patients received the same treatment as recommended for severe atypical pneumonia (CDC, 2005). Antiviral medications are sometimes given to reduce the swelling of the lungs but there are no studies that prove this is effective for every individual affected by SARS. No effective pharmacological interventions against the virus exists at this time. However, antiviral medications were later developed to combat the MERS outbreak in 2012. | ||
| + | |||
| + | <box 30% round right| > | ||
| + | {{::unnamed.png?300|}} | ||
| + | </box| Figure 19: Possible receptors on the coronavirus that can be targeted by antiviral drugs (“Coronavirus – Simple Precautions to Take care for loved ones,” 2020).> | ||
| ==== Remdesivir ==== | ==== Remdesivir ==== | ||
| - | |||
| - | <box 25% round right| > | ||
| - | {{::unnamed.png?250|}} | ||
| - | </box| Figure 12: Possible receptors on the coronavirus that can be targeted by antiviral drugs (“Coronavirus – Simple Precautions to Take care for loved ones,” 2020).> | ||
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| Remdesivir is known to be an effective drug against the coronavirus, specifically the one related to the Middle Eastern Respiratory Syndrome (MERS-CoV). Studies in the past have shown that Remdesivir prevented MERS in monkeys when it was administered before exposing the monkeys to the virus. Furthermore, when the drug was administered after the infection, it reduced the severity of the disease, virus replication and the amount of damage to the lungs (Wit et al., 2020). | Remdesivir is known to be an effective drug against the coronavirus, specifically the one related to the Middle Eastern Respiratory Syndrome (MERS-CoV). Studies in the past have shown that Remdesivir prevented MERS in monkeys when it was administered before exposing the monkeys to the virus. Furthermore, when the drug was administered after the infection, it reduced the severity of the disease, virus replication and the amount of damage to the lungs (Wit et al., 2020). | ||
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| Remdesivir functions by inhibiting the replication of MERS-CoV in respiratory tissues and preventing the formation of lung lesions. In vitro studies involving mice infected with the hepatitis virus suggests that Remdesivir works against the coronavirus by interfering with the viral polymerase responsible for replication to occur (Wit et al., 2020). | Remdesivir functions by inhibiting the replication of MERS-CoV in respiratory tissues and preventing the formation of lung lesions. In vitro studies involving mice infected with the hepatitis virus suggests that Remdesivir works against the coronavirus by interfering with the viral polymerase responsible for replication to occur (Wit et al., 2020). | ||
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| ===== Conclusion ===== | ===== Conclusion ===== | ||
| - | In conclusion, coronavirus is an ongoing concern. Although treatments are being research, it will be a long way until a solution is reached. Therefore, preventative methods should be taken seriously. With the current outbreak slowly becoming a concern, it is crucial to wash hands thoroughly and maintain overall personal hygiene. The best way to receive immediate medical care is to get treated early for symptoms. | + | In conclusion, coronavirus is an ongoing concern. Although treatments are being developed through research, it will be a long process until an effective solution is reached. Therefore, preventative methods should be taken seriously. With the current outbreak slowly becoming a concern on a global scale, it is crucial to wash hands thoroughly and maintain overall personal hygiene. The best way to receive appropriate medical care is to seek treatment as early as possible for any display of symptoms. |
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| + | ===== Presentation Slides ===== | ||
| + | {{:coronavirus.pdf|}} | ||
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| and public health implications. Journal of Hospital Infection, 95(2), 207–213. doi: | and public health implications. Journal of Hospital Infection, 95(2), 207–213. doi: | ||
| 10.1016/j.jhin.2016.10.008 | 10.1016/j.jhin.2016.10.008 | ||
| + | |||
| + | Leung, G. M., Hedley, A. J., Ho, L.-M., & Chau, P. (2004). The Epidemiology of Severe Acute | ||
| + | Respiratory Syndrome in the 2003 Hong Kong Epidemic: An Analysis of All 1755 | ||
| + | Patients. Annals of Internal Medicine, 141, 662–673. doi: | ||
| + | 10.7326/0003-4819-141-9-200411020-00006 | ||
| Lu, C.-W., Liu, X.-F., & Jia, Z.-F. (2020). 2019-nCoV transmission through the ocular surface | Lu, C.-W., Liu, X.-F., & Jia, Z.-F. (2020). 2019-nCoV transmission through the ocular surface | ||
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| - | ===== Presentation ===== | ||
| - | {{:coronavirus.pdf|}} | ||
