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18 "SARS-CoV-2"
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Original Article
Seroprevalence of immunoglobulin G antibodies against SARS-CoV-2 in children and adolescents in Delhi, India, from January to October 2021: a repeated cross-sectional analysis
Pragya Sharma, Saurav Basu, Suruchi Mishra, Mongjam Meghachandra Singh
Osong Public Health Res Perspect. 2022;13(3):184-190.   Published online June 10, 2022
DOI: https://doi.org/10.24171/j.phrp.2022.0014
  • 1,928 View
  • 55 Download
Graphical AbstractGraphical Abstract AbstractAbstract PDF
Objectives
The aim of this study was to assess changes in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) seroprevalence among children and adolescents in Delhi, India from January 2021 to October 2021. Methods: This was a repeated cross-sectional analysis of participants aged 5 to 17 years from 2 SARS-CoV-2 seroprevalence surveys conducted in Delhi, India during January 2021 and September to October 2021. Anti-SARS-CoV-2 IgG antibodies were detected by using the VITROS assay (90% sensitivity, 100% specificity). Results: The seroprevalence among 5- to 17-year-old school-age children and adolescents increased from 52.8% (95% confidence interval [CI], 51.3%−54.3%) in January 2021 to 81.8% (95% CI, 80.9%−82.6%) in September to October 2021. The assay-adjusted seroprevalence was 90.8% (95% CI, 89.8%−91.7%). Seropositivity positively correlated with participants’ age (p<0.001), but not sex (p=0.388). A signal to cut-off ratio ≥4.00, correlating with the presence of neutralization antibodies, was observed in 4,814 (57.9%) participants. Conclusion: The high percentage of seroconversion among children and adolescents indicates the presence of natural infection-induced immunity from past exposure to the SARS-CoV-2 virus. However, the lack of hybrid immunity and the concomitant likelihood of lower levels of neutralization antibodies than in adults due to the absence of vaccination warrants careful monitoring and surveillance of infection risk and disease severity from newer and emergent variants.
Review Article
Immune-related therapeutics: an update on antiviral drugs and vaccines to tackle the COVID-19 pandemic
Iqra Mir, Sania Aamir, Syed Rizwan Hussain Shah, Muhammad Shahid, Iram Amin, Samia Afzal, Amjad Nawaz, Muhammad Umer Khan, Muhammad Idrees
Osong Public Health Res Perspect. 2022;13(2):84-100.   Published online April 27, 2022
DOI: https://doi.org/10.24171/j.phrp.2022.0024
  • 1,961 View
  • 77 Download
Graphical AbstractGraphical Abstract AbstractAbstract PDF
The coronavirus disease 2019 (COVID-19) pandemic rapidly spread globally. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, is a positive-sense single-stranded RNA virus with a reported fatality rate ranging from 1% to 7%, and people with immune-compromised conditions, children, and older adults are particularly vulnerable. Respiratory failure and cytokine storm-induced multiple organ failure are the major causes of death. This article highlights the innate and adaptive immune mechanisms of host cells activated in response to SARS-CoV-2 infection and possible therapeutic approaches against COVID-19. Some potential drugs proven to be effective for other viral diseases are under clinical trials now for use against COVID-19. Examples include inhibitors of RNA-dependent RNA polymerase (remdesivir, favipiravir, ribavirin), viral protein synthesis (ivermectin, lopinavir/ ritonavir), and fusion of the viral membrane with host cells (chloroquine, hydroxychloroquine, nitazoxanide, and umifenovir). This article also presents the intellectual groundwork for the ongoing development of vaccines in preclinical and clinical trials, explaining potential candidates (live attenuated-whole virus vaccines, inactivated vaccines, subunit vaccines, DNAbased vaccines, protein-based vaccines, nanoparticle-based vaccines, virus-like particles and mRNA-based vaccines). Designing and developing an effective vaccine (both prophylactic and therapeutic) would be a long-term solution and the most effective way to eliminate the COVID-19 pandemic.
Original Articles
COVID-19 outbreak response at a nursing hospital in South Korea in the post-vaccination era, including an estimation of the effectiveness of the first shot of the Oxford-AstraZeneca COVID-19 vaccine (ChAdOx1-S)
Chanhee Kim, Geon Kang, Sun Gu Kang, Heeyoung Lee
Osong Public Health Res Perspect. 2022;13(2):114-122.   Published online April 26, 2022
DOI: https://doi.org/10.24171/j.phrp.2021.0262
  • 1,627 View
  • 63 Download
AbstractAbstract PDF
Objectives
We descriptively reviewed a coronavirus disease 2019 (COVID-19) outbreak at a nursing hospital in Gyeonggi Province (South Korea) and assessed the effectiveness of the first dose of the Oxford-AstraZeneca vaccine in a real-world population. Methods: The general process of the epidemiological investigation included a public health intervention. The relative risk (RR) of vaccinated and unvaccinated groups was calculated and compared to confirm the risk of severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) infection, and vaccine effectiveness was evaluated based on the calculated RR. Results: The population at risk was confined to ward E among 8 wards of Hospital X, where the outbreak occurred. This population comprised 55 people, including 39 patients, 12 nurses, and 4 caregivers, and 19 cases were identified. The RR between the vaccinated and unvaccinated groups was 0.04, resulting in a vaccine effectiveness of 95.3%. The vaccination rate of the nonpatients in ward E was the lowest in the entire hospital, whereas the overall vaccination rate of the combined patient and non-patient groups in ward E was the third lowest. Conclusion: The first dose of the Oxford-AstraZeneca vaccine (ChAdOx1-S) was effective in preventing SARS-CoV-2 infection. To prevent COVID-19 outbreaks in medical facilities, it is important to prioritize the vaccination of healthcare providers.
Phylogenetic and genome-wide mutational analysis of SARS-CoV-2 strains circulating in Nigeria: no implications for attenuated COVID-19 outcomes
Daniel B. Kolawole, Malachy I. Okeke
Osong Public Health Res Perspect. 2022;13(2):101-113.   Published online April 22, 2022
DOI: https://doi.org/10.24171/j.phrp.2021.0329
  • 1,296 View
  • 45 Download
Graphical AbstractGraphical Abstract AbstractAbstract PDF
Objectives
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). The COVID-19 incidence and mortality rates are low in Nigeria compared to global trends. This research mapped the evolution of SARS-CoV-2 circulating in Nigeria and globally to determine whether the Nigerian isolates are genetically distinct from strains circulating in regions of the world with a high disease burden. Methods: Bayesian phylogenetics using BEAST 2.0, genetic similarity analyses, and genomewide mutational analyses were used to characterize the strains of SARS-CoV-2 isolated in Nigeria. Results: SARS-CoV-2 strains isolated in Nigeria showed multiple lineages and possible introductions from Europe and Asia. Phylogenetic clustering and sequence similarity analyses demonstrated that Nigerian isolates were not genetically distinct from strains isolated in other parts of the globe. Mutational analysis demonstrated that the D614G mutation in the spike protein, the P323L mutation in open reading frame 1b (and more specifically in NSP12), and the R203K/ G204R mutation pair in the nucleocapsid protein were most prevalent in the Nigerian isolates. Conclusion: The SARS-CoV-2 strains in Nigeria were neither phylogenetically nor genetically distinct from virus strains circulating in other countries of the world. Thus, differences in SARS-CoV-2 genomes are not a plausible explanation for the attenuated COVID-19 outcomes in Nigeria.
Factors influencing acceptance of the COVID-19 vaccine in Malaysia: a web-based survey
June Fei Wen Lau, Yuan Liang Woon, Chin Tho Leong, Hoon Shien Teh
Osong Public Health Res Perspect. 2021;12(6):361-373.   Published online November 25, 2021
DOI: https://doi.org/10.24171/j.phrp.2021.0085
  • 7,114 View
  • 407 Download
  • 5 Citations
AbstractAbstract PDFSupplementary Material
Objectives
The coronavirus disease 2019 (COVID-19) pandemic has set a precedent for the fastest-produced vaccine as a result of global collaboration and outreach. This study explored Malaysians’ acceptance of the COVID-19 vaccine and its associated factors.
Methods
A cross-sectional anonymous web-based survey was disseminated to Malaysian adults aged ≥18 years old via social media platforms between July 10, 2020 and August 31, 2020.
Results
In the analysis of 4,164 complete responses, 93.2% of participants indicated that they would accept the COVID-19 vaccine if it was offered for free by the Malaysian government. The median out-of-pocket cost that participants were willing to pay for a COVID-19 vaccine was Malaysian ringgit (MYR) 100 (interquartile range [IQR], 100) if it was readily available and MYR 150 (IQR, 200) if the supply was limited. Respondents with a low likelihood of vaccine hesitancy had 13 times higher odds of accepting the COVID-19 vaccine (95% confidence interval [CI], 8.69 to 19.13). High perceived risk and severity were also associated with willingness to be vaccinated, with adjusted odds ratios of 2.22 (95% CI, 1.44 to 3.41) and 2.76 (95% CI, 1.87 to 4.09), respectively. Age and ethnicity were the only independent demographic characteristics that predicted vaccine uptake.
Conclusion
Public health strategies targeting perceived risk, perceived susceptibility and vaccine hesitancy could be effective in enhancing vaccine uptake.
Review Articles
The role of lipids in the pathophysiology of coronavirus infections
Milad Zandi, Parastoo Hosseini, Saber Soltani, Azadeh Rasooli, Mona Moghadami, Sepideh Nasimzadeh, Farzane Behnezhad
Osong Public Health Res Perspect. 2021;12(5):278-285.   Published online October 15, 2021
DOI: https://doi.org/10.24171/j.phrp.2021.0153
  • 2,798 View
  • 139 Download
Graphical AbstractGraphical Abstract AbstractAbstract PDF
Coronaviruses, which have been known to cause diseases in animals since the 1930s, utilize cellular components during their replication cycle. Lipids play important roles in viral infection, as coronaviruses target cellular lipids and lipid metabolism to modify their host cells to become an optimal environment for viral replication. Therefore, lipids can be considered as potential targets for the development of antiviral agents. This review provides an overview of the roles of cellular lipids in different stages of the life cycle of coronaviruses.
Severe acute respiratory syndrome coronavirus 2 and respiratory syncytial virus coinfection in children
Milad Zandi, Saber Soltani, Mona Fani, Samaneh Abbasi, Saeedeh Ebrahimi, Ali Ramezani
Osong Public Health Res Perspect. 2021;12(5):286-292.   Published online October 1, 2021
DOI: https://doi.org/10.24171/j.phrp.2021.0140
  • 3,352 View
  • 130 Download
  • 2 Citations
AbstractAbstract PDF
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has infected many people around the world. Children are considered an important target group for SARS-CoV-2, as well as other viral infections such as respiratory syncytial virus infection. Both SARS-CoV-2 and respiratory syncytial virus can affect the respiratory tract. Coinfection of SARS-CoV-2 and respiratory syncytial virus can pose significant challenges in terms of diagnosis and treatment in children. This review compares the symptoms, diagnostic methods, and treatment of COVID-19 and respiratory syncytial virus infection in children.
Review of the early reports of the epidemiological characteristics of the B.1.1.7 variant of SARS-CoV-2 and its spread worldwide
Yeonju Kim, Eun-Jin Kim, Sang-Won Lee, Donghyok Kwon
Osong Public Health Res Perspect. 2021;12(3):139-148.   Published online June 24, 2021
DOI: https://doi.org/10.24171/j.phrp.2021.0037
  • 3,752 View
  • 134 Download
  • 5 Citations
AbstractAbstract PDF
The variant B.1.1.7 of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the RNA virus causing the pandemic more than a year worldwide, was reported from United Kingdom (UK) in late December 2020. It was reported that mortality increases by 65% and transmissibility increases by 70%, which may result in an increase of reproduction number to 1.13−1.55 from 0.75−0.85. To analyze the global increasing trend of the variant B.1.1.7, we extracted results of B.1.1.7 from GISAID on May 11 and May 12, 2021, and conducted a doseresponse regression. It took 47 days to reach 20% and 121 days to reach 50% among the sequence submitted from UK. In Korea, cases of B.1.1.7 have increased since the first report of three cases on December 28, 2020. Positive rate of B.1.1.7 in Korea was 21.6% in the week from May 9 to May 15, 2021. Detection rate of the variants is expected to increase further and new variants of SARS-CoV-2 are emerging, so a close monitoring and control would be maintained for months.
Brief Reports
Genomic Surveillance of SARS-CoV-2: Distribution of Clades in the Republic of Korea in 2020
Ae Kyung Park, Il-Hwan Kim, Junyoung Kim, Jeong-Min Kim, Heui Man Kim, Chae young Lee, Myung-Guk Han, Gi-Eun Rhie, Donghyok Kwon, Jeong-Gu Nam, Young-Joon Park, Jin Gwack, Nam-Joo Lee, SangHee Woo, Jin Sun No, Jaehee Lee, Jeemin Ha, JeeEun Rhee, Cheon-Kwon Yoo, Eun-Jin Kim
Osong Public Health Res Perspect. 2021;12(1):37-43.   Published online February 23, 2021
DOI: https://doi.org/10.24171/j.phrp.2021.12.1.06
  • 4,357 View
  • 180 Download
  • 13 Citations
AbstractAbstract PDF

Since a novel beta-coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in December 2019, there has been a rapid global spread of the virus. Genomic surveillance was conducted on samples isolated from infected individuals to monitor the spread of genetic variants of SARS-CoV-2 in Korea. The Korea Disease Control and Prevention Agency performed whole genome sequencing of SARS-CoV-2 in Korea for 1 year (January 2020 to January 2021). A total of 2,488 SARS-CoV-2 cases were sequenced (including 648 cases from abroad). Initially, the prevalent clades of SARS-CoV-2 were the S and V clades, however, by March 2020, GH clade was the most dominant. Only international travelers were identified as having G or GR clades, and since the first variant 501Y.V1 was identified (from a traveler from the United Kingdom on December 22nd, 2020), a total of 27 variants of 501Y.V1, 501Y.V2, and 484K.V2 have been classified (as of January 25th, 2021). The results in this study indicated that quarantining of travelers entering Korea successfully prevented dissemination of the SARS-CoV-2 variants in Korea.

Air Evacuation of Passengers with Potential SARS-CoV-2 Infection Under the Guidelines for Appropriate Infection Control and Prevention
Jeong-Gil Kim, Seung Hak Lee, Hansuk Kim, Hong Sang Oh, Jacob Lee
Osong Public Health Res Perspect. 2020;11(5):334-338.   Published online October 22, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.5.10
  • 3,640 View
  • 71 Download
  • 1 Citations
AbstractAbstract PDF

This report describes the air evacuation of 80 Koreans from Iran to Korea on March 19th, 2020, with a direct transfer of passengers between airplanes in Dubai. The passengers were potentially infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) so, strict precautions were taken for the duration of the flight, and the passengers were screened before embarking from Dubai and disembarking at Incheon International Airport in Korea. Passengers with fever or symptoms of SARS-CoV-2 were assessed by a quarantine doctor, and if they were suspected of being infected with SARS-CoV-2, they were categorized as a “patient under investigation (PUI)”. There was 1 passenger designated as a PUI before the departure from Dubai and another designated as a PUI upon arrival into Korea. The first PUI tested negative, but the second PUI tested positive for SARS-CoV-2. All those aboard the flight (passengers, aircrew, and medical staff) were screened for SARS-CoV-2 upon arrival into Korea and completed a mandatory 14-day medical quarantine. There were no additional cases of infection.

Original Article
COVID-19 in Nursing Facilities: Experience in Republic of Korea
Rok Song, Hee-Sook Kim, Seok-Ju Yoo, Kwan Lee, Ji-Hyuk Park, Joon Ho Jang, Gyoung-Sook Ahn, Jun-Nyun Kim
Osong Public Health Res Perspect. 2020;11(4):164-169.   Published online August 31, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.4.04
  • 4,710 View
  • 131 Download
  • 5 Citations
AbstractAbstract PDF
Objectives

Coronavirus disease 2019 (COVID-19) outbreaks in nursing facilities can easily lead to a high rate of infection and fatality. A surge in newly infected cases in the first quarter of 2020 in Gyeongsan-si, in the Republic of Korea, was followed by several outbreaks in nursing facilities in the same area. The aim of this study is to report on the epidemiological investigation and the management to reduce the infection rate in nursing facilities for older adults.

Methods

The municipal government and the Korea Centers for Disease Control and Prevention performed an epidemiological investigation into 5 nursing facilities that reported a high number of COVID-19 infection cases from February to May 2020. COVID-19 infected cases in the facilities were investigated to identify the infection routes, and the fatality rate of the 5 facilities.

Results

The 5 facilities had a combined fatality rate of 12.2% (9 deceased among the 74 infected cases). The median age of the deceased was 87 years old (range: 82–91). The infection was first identified on February 27th, 2020, peaked on March 6th, and was last detected on March 24th, 2020.

Conclusion

Difficulties specific to such facilities included the delay in the recognition of symptoms and limitation in distancing. Tailored strategies such as daily monitoring of symptoms and proactive COVID-19 screening of quarantined residents, contributed to a decline in the infections in the facilities.

Review Article
COVID-19 Outbreak in Malaysia
Asita Elengoe
Osong Public Health Res Perspect. 2020;11(3):93-100.   Published online June 1, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.3.08
  • 65,535 View
  • 3,772 Download
  • 62 Citations
AbstractAbstract PDF

In 2020 a significant threat to public health emerged. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic outbreak emerged in December 2019 from Wuhan City, Hubei Province, China and spread to the rest of the world. This disease was named COVID-19 by World Health Organization. To date (17th April 2020) a total of 2,230,439 cases of COVID-19; 150,810 cases of deaths and 564,210 recovered cases have been reported worldwide. In this review the SARS-CoV-2 morphology, pathogenic mechanism, similarities and differences between SARS-CoV and Middle East Respiratory Syndrome and severe acute respiratory syndrome, transmission mode, diagnosis, treatment, and preventive measures were investigated. The outbreak of COVID-19 from a Malaysian perspective was explored and mental health care during the COVID-19 outbreak was explored. To date, there is no vaccine or no specific treatment for COVID-19. Therefore, preventive measures are very important to prevent and control the rapid spread of the SARS-CoV-2 virus. Preparedness should be a priority for future pandemic outbreaks.

Original Articles
Genome-Wide Identification and Characterization of Point Mutations in the SARS-CoV-2 Genome
Jun-Sub Kim, Jun-Hyeong Jang, Jeong-Min Kim, Yoon-Seok Chung, Cheon-Kwon Yoo, Myung-Guk Han
Osong Public Health Res Perspect. 2020;11(3):101-111.   Published online May 14, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.3.05
  • 11,513 View
  • 497 Download
  • 49 Citations
AbstractAbstract PDF
Objectives

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019 and has been rapidly spreading worldwide. Although the causal relationship among mutations and the features of SARS-CoV-2 such as rapid transmission, pathogenicity, and tropism, remains unclear, our results of genomic mutations in SARS-CoV-2 may help to interpret the interaction between genomic characterization in SARS-CoV-2 and infectivity with the host.

Methods

A total of 4,254 genomic sequences of SARS-CoV-2 were collected from the Global Initiative on Sharing all Influenza Data (GISAID). Multiple sequence alignment for phylogenetic analysis and comparative genomic approach for mutation analysis were conducted using Molecular Evolutionary Genetics Analysis (MEGA), and an in-house program based on Perl language, respectively.

Results

Phylogenetic analysis of SARS-CoV-2 strains indicated that there were 3 major clades including S, V, and G, and 2 subclades (G.1 and G.2). There were 767 types of synonymous and 1,352 types of non-synonymous mutation. ORF1a, ORF1b, S, and N genes were detected at high frequency, whereas ORF7b and E genes exhibited low frequency. In the receptor-binding domain (RBD) of the S gene, 11 non-synonymous mutations were observed in the region adjacent to the angiotensin converting enzyme 2 (ACE2) binding site.

Conclusion

It has been reported that the rapid infectivity and transmission of SARS-CoV-2 associated with host receptor affinity are derived from several mutations in its genes. Without these genetic mutations to enhance evolutionary adaptation, species recognition, host receptor affinity, and pathogenicity, it would not survive. It is expected that our results could provide an important clue in understanding the genomic characteristics of SARS-CoV-2.

Detection and Isolation of SARS-CoV-2 in Serum, Urine, and Stool Specimens of COVID-19 Patients from the Republic of Korea
Jeong-Min Kim, Heui Man Kim, Eun Jung Lee, Hye Jun Jo, Youngsil Yoon, Nam-Joo Lee, Junseock Son, Ye-Ji Lee, Mi Seon Kim, Yong-Pyo Lee, Su-Jin Chae, Kye Ryeong Park, Seung-Rye Cho, Sehee Park, Su Jin Kim, Eunbyeol Wang, SangHee Woo, Aram Lim, Su-Jin Park, JunHyeong Jang, Yoon-Seok Chung, Bum Sik Chin, Jin-Soo Lee, Duko Lim, Myung-Guk Han, Cheon Kwon Yoo
Osong Public Health Res Perspect. 2020;11(3):112-117.   Published online May 8, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.3.02
  • 10,582 View
  • 514 Download
  • 79 Citations
AbstractAbstract PDF
Objectives

Coronavirus Disease-19 (COVID-19) is a respiratory infection characterized by the main symptoms of pneumonia and fever. It is caused by the novel coronavirus severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), which is known to spread via respiratory droplets. We aimed to determine the rate and likelihood of SARS-CoV-2 transmission from COVID-19 patients through non-respiratory routes.

Methods

Serum, urine, and stool samples were collected from 74 hospitalized patients diagnosed with COVID-19 based on the detection of SARS-CoV-2 in respiratory samples. The SARS-CoV-2 RNA genome was extracted from each specimen and real-time reverse transcription polymerase chain reaction performed. CaCo-2 cells were inoculated with the specimens containing the SARS-COV-2 genome, and subcultured for virus isolation. After culturing, viral replication in the cell supernatant was assessed.

Results

Of the samples collected from 74 COVID-19 patients, SARS-CoV-2 was detected in 15 serum, urine, or stool samples. The virus detection rate in the serum, urine, and stool samples were 2.8% (9/323), 0.8% (2/247), and 10.1% (13/129), and the mean viral load was 1,210 ± 1,861, 79 ± 30, and 3,176 ± 7,208 copy/µL, respectively. However, the SARS-CoV-2 was not isolated by the culture method from the samples that tested positive for the SARS-CoV-2 gene.

Conclusion

While the virus remained detectable in the respiratory samples of COVID-19 patients for several days after hospitalization, its detection in the serum, urine, and stool samples was intermittent. Since the virus could not be isolated from the SARS-COV-2-positive samples, the risk of viral transmission via stool and urine is expected to be low.

Short Communication
Coronavirus Disease-19: The First 7,755 Cases in the Republic of Korea
Osong Public Health Res Perspect. 2020;11(2):85-90.   Published online April 30, 2020
DOI: https://doi.org/10.24171/j.phrp.2020.11.2.05
Correction in: Osong Public Health Res Perspect 2020;11(3):146
  • 17,960 View
  • 675 Download
  • 76 Citations
AbstractAbstract PDF

We report the first 7,755 patients with confirmed COVID-19 in Korea as of March 12th, 2020. A total of 66 deaths have been recorded, giving a case fatality proportion of 0.9%. Older people, and those with comorbidities were at a higher risk of a fatal outcome. The highest number of cases of COVID-19 were in Daegu, followed by Gyeongbuk. This summary may help to understand the disease dynamics in the early phase of the COVID-19 outbreaks, and may therefore, guide future public health measures.


PHRP : Osong Public Health and Research Perspectives