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        "titulo" => "Elevada detecci&#243;n de SARS-CoV-2 y prolongada excreci&#243;n viral en deposiciones&#58; Estudio de cohorte y revisi&#243;n sistem&#225;tica"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Forest plots of prevalence of viral detection in stools from SARS-CoV-2 infected patients&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The current pandemic of a novel Severe Acute Respiratory Syndrome coronavirus&#44; named SARS-CoV-2&#44; has constituted a new threat worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">1</span></a> More than 13&#44;165&#44;000 cumulative cases have been confirmed in 188 countries across five continents&#44; reaching a mortality rate of 4&#46;9&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The novel coronavirus was first described in patients with pneumonia&#44; and the most common symptoms included fever&#44; dry cough&#44; and dyspnea&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">3</span></a> Gastrointestinal symptoms are less common and include diarrhea&#44; nausea&#44; vomiting&#44; and abdominal discomfort&#46; The prevalence of these symptoms varies significantly among different studied populations&#44; which can be mild at the early onset&#44; but is frequently followed by typical respiratory manifestations&#46;<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">4</span></a> A recent systematic review showed that 17&#46;6&#37; of individuals infected with SARS-CoV-2 presented with gastrointestinal symptoms&#59; the most frequent being anorexia 26&#46;8&#37;&#44; diarrhea 12&#46;5&#37;&#44; nausea and vomiting 10&#46;2&#37;&#44; and abdominal pain 9&#46;2&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">5</span></a> The presence of gastrointestinal symptoms is frequent in hospitalized patients&#44; and these became more pronounced as the severity of the disease increased&#46;<a class="elsevierStyleCrossRefs" href="#bib0375"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Several reports have shown the detection of SARS-CoV-2 RNA in stools for prolonged periods&#44; suggesting that the virus could be transmitted through the digestive tract&#46;<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">8</span></a> The viral detection in stools is variable among several studies&#44; with frequencies ranging between 15&#46;3&#37; and 70&#46;3&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">5&#44;8&#8211;10</span></a> Interestingly&#44; recent publications have described enterocyte viral invasion and detection of viable virus in stools&#44; suggesting that the fecal-oral route could provide a source of transmission&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">4&#44;10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">To date&#44; the relevance of viral presence in stools and length of shedding has not been established adequately&#46; In this study&#44; we aimed to assess the viral presence and clearance of SARS-CoV-2 in stools of infected Chilean patients&#46; We also performed a systematic review to establish the frequency of SARS-CoV-2 detection in stools&#44; and median clearance time in nasopharyngeal secretions and stools&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Cohort study&#58; baseline characteristics and sample collection</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patient clinical&#8211;epidemiological data and clinical samples were collected after informed written consent was obtained&#46; This study was reviewed and approved by the Scientific Ethics Committee of <span class="elsevierStyleItalic">Pontificia Universidad Cat&#243;lica de Chile</span> &#40;PUC&#41; &#40;ID 16-066&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">All patients diagnosed with COVID19 were eligible to participate upon consent&#44; including hospitalized individuals and outpatients&#44; of any age and severity&#46; The study protocol did not have any exclusion criteria&#46; Between March 5 and May 28&#44; 2020&#44; patients diagnosed as positive for SARS-CoV-2 were recruited at two centers&#44; which are part of the Healthcare Network of the Faculty of Medicine&#44; <span class="elsevierStyleItalic">Pontificia Universidad Cat&#243;lica de Chile</span>&#58; The <span class="elsevierStyleItalic">Red de Salud UC-Christus Hospital</span> &#40;Santiago&#44; Chile&#41; and the <span class="elsevierStyleItalic">Cl&#237;nica UC San Carlos de Apoquindo</span> &#40;Santiago&#44; Chile&#41;&#46; The diagnosis of SARS-CoV-2 form a nasopharyngeal swab &#40;NPS&#41; specimen was confirmed by a qRT-PCR Light Mix Modular Wuhan CoV-2 RdRP-gene &#40;TibMolBiol&#44; ROCHE&#41;&#44; performed at the Institutional Infectious Diseases and Molecular Virology Laboratory &#40;Santiago&#44; Chile&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">For clinical information&#44; we performed an interview and a survey to characterize the presence and timing of symptoms&#46; We recorded the physical examination and primary laboratory data obtained during medical evaluation&#46; All the patients were characterized by sociodemographic data and comorbidities&#46; We collected NPS and stool or rectal swabs between days 2 to 35 after the onset of symptoms and tested for the presence of SARS-CoV-2 by qRT-PCR&#46; All the information was registered in an anonymous database where sensitive information was excluded&#46; The stages of this process&#44; collecting&#44; transporting and processing samples are illustrated in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Additional data of RNA extraction and viral genome detection are described in Supplementary Methods&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Data analysis of the cohort study</span><p id="par0040" class="elsevierStylePara elsevierViewall">We assessed the normality assumption by means of the Shapiro&#8211;Wilk test&#46; Descriptive statistics were obtained using the mean and standard deviation &#40;SD&#41; for continuous variables with normal distribution and non-normal distributions were described with the median and interquartile range&#46; In the case of categorical variables&#44; the proportions and percentage were estimated&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Systematic review of the Viral RNA presence in stools</span><p id="par0045" class="elsevierStylePara elsevierViewall">We performed a systematic review to establish the prevalence of viral detection in stools and median clearance time among previous published data and our cohort&#46; This systematic review with meta-analysis was registered on PROSPERO &#40;CRD42020192490&#41; and followed a prespecified analysis plan&#46; This study is reported in accordance with the Preferred Reporting Items for a Review and Meta-analysis &#40;PRISMA&#41; guidelines&#46;<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">11</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Eligibility criteria</span><p id="par0050" class="elsevierStylePara elsevierViewall">Eligible studies had to include patients diagnosed with COVID-19&#44; regardless of age and gender&#46; The diagnosis of COVID-19 had to be based on a compatible clinical history and molecular evidence with a qRT-PCR for SARS-CoV-2&#46; We included studies reporting the frequency of positive viral RNA testing in stool&#46; We considered stool samples at any time of the course of the disease&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We included studies that reported the main outcome&#44; regardless of the design &#40;case-reports&#44; case-series&#44; descriptive cases&#44; case-control studies&#44; cross-sectional studies&#44; cohort studies and randomized controlled trials&#41;&#46; We excluded studies performed in vitro&#44; animal models&#44; or lacking evidence of SARS-CoV-2 infection from this systematic review&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Search strategy and selection process</span><p id="par0060" class="elsevierStylePara elsevierViewall">We conducted an electronic search from December 1&#44; 2019&#44; to June 3&#44; 2020 in MEDLINE &#40;via PubMed&#41; database&#46; We used included terms related to SARS-CoV-2 and stools in the search strategy&#46; References of studies searched were also included&#46; We hand searched &#40;up to June 3&#44; 2020&#41; preprint servers &#40;bioRxiv&#44; medRxiv&#44; and SSRN&#41; and coronavirus resource centers of The Lancet&#44; JAMA&#44; and New England Journal of Medicine&#46; We did not limit our search by language&#46; Two investigators &#40;LAD and DR&#41; independently screened the titles and abstracts to ascertain whether each study met the eligibility criteria&#46; The full texts of the identified eligible articles were then evaluated to determine whether they should be included in the analysis&#46; Disagreements between the two reviewers were resolved by consensus&#46; In case of persistent disagreement&#44; arbitration by a third reviewer &#40;JO&#41; settled the discrepancy&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Data collection and risk of bias assessment</span><p id="par0065" class="elsevierStylePara elsevierViewall">Two authors &#40;LAD and DR&#41; independently extracted data from the studies included using forms specially designed for this purpose&#46; The following data describing the design of the study were extracted&#58; number of participants&#44; age&#44; gender&#44; ethnicity&#44; hospitalization&#44; presence of viral RNA in stools&#44; clearance time and presence of gastrointestinal symptoms&#46; Discrepancies were resolved by a third reviewer &#40;JO&#41;&#46; Two investigators &#40;LAD and DR&#41; independently assessed the risk of bias of each included study with the Appraisal tool for Cross-Sectional Studies &#40;AXIS&#41; checklist for cross-sectional studies&#44; the Institute of Health Economics &#40;IHE&#41; checklist tool for Case Series&#44; and the Newcastle-Ottawa Scale &#40;NOS&#41; for case-control studies and cohort studies&#44; and the Cochrane Risk of Bias Tool for randomized trials and quasi-experimental studies&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Outcomes</span><p id="par0070" class="elsevierStylePara elsevierViewall">The main outcome was the prevalence of detection of viral RNA in stools of COVID-19 patients&#46; This data was registered as an absolute number and percentage of the total cases&#46; The secondary outcome was the clearance time &#40;defined as the days between onset of symptoms and a negative test result for viral RNA in stools&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Systematic review analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">We estimated prevalence or event rates in the form of a proportion &#40;with confidence interval 95&#37;&#41;&#46; Proportions were pooled using random-effects models&#46; Only those studies with a sample size of at least 10 patients were included in the meta-analysis to decrease bias caused by sampling error&#46;<a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">12</span></a> We used <span class="elsevierStyleItalic">Q</span> statistic and <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span> to quantify heterogeneity&#46; We planned a subgroup analysis according to age&#44; gender&#44; ethnicity&#44; presence of gastrointestinal symptoms and hospitalization&#46; We stratified age in three subgroups&#58; pediatrics &#40;patients with less than 18 years old&#41;&#44; adults &#40;patients over 18 years old&#41;&#44; and general &#40;patients of all ages&#41;&#46; Ethnicity was defined per region of origin &#40;Asian versus not-Asian studies&#41;&#46; We stratified gender by predominant gender &#40;the gender with a prevalence higher than 50&#37;&#41;&#46; Presence of gastrointestinal symptoms was arbitrarily grouped in high &#40;50&#37; or more&#41; and low &#40;lesser than 50&#37;&#41; prevalence of gastrointestinal symptoms&#46; In the case of studies with very low or very high proportion&#44; we used a double arcsine transformation&#46;<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">13</span></a> Small study effect was evaluated with a funnel plot&#46; Random effects meta-regression was used to examine whether baseline characteristics covariates explained heterogeneity of proportions between studies&#46;<a class="elsevierStyleCrossRef" href="#bib0415"><span class="elsevierStyleSup">14</span></a> As such&#44; subgroup analysis should be considered as exploratory&#46; Clearance of viral RNA in stools was defined as the time between onset of symptoms and the last detection of SARS-CoV-2 in stools&#46; We registered the disaggregated data from studies that reported clearance in NPS and stools for each participant&#46; Based on this data&#44; we performed Kaplan&#8211;Meier survival curves to estimate viral clearance in NPS and stools&#46; We compared clearance in NPS and stools curves with log-rank test&#46; The analyses were done with the use of STATA &#40;version 16&#44; StataCorp&#44; College Station&#44; Texas&#41; and R software for statistical computing version 3&#46;6&#46;1&#46;<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">15</span></a> We included the STATA <span class="elsevierStyleItalic">metaprop</span> command to perform meta-analyses&#46;<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Grading of evidence</span><p id="par0080" class="elsevierStylePara elsevierViewall">The quality of evidence for the outcomes was graded with the GRADE framework&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Role of the funding source</span><p id="par0085" class="elsevierStylePara elsevierViewall">The funding source only provided support for the analysis of the nasopharyngeal and stool samples&#46; The researchers did not receive a fee or other incentives for the systematic review process&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Gastrointestinal symptoms and stool detection in our cohort study</span><p id="par0090" class="elsevierStylePara elsevierViewall">We included 32 patients recruited between the 3rd March 2020 and 28th May 2020&#46; Median age was 43&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;7 years and 14 &#40;43&#46;8&#37;&#41; were females&#46; Nineteen &#40;59&#46;4&#37;&#41; patients were hospitalized and 6 &#40;31&#46;6&#37;&#41; required invasive mechanical ventilation&#46; One of our patients died at the end of this study &#40;mortality rate of 3&#46;1&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In our cohort&#44; the most common extraintestinal manifestations were fever &#40;90&#46;6&#37;&#41;&#44; cough &#40;81&#46;3&#37;&#41;&#44; myalgia &#40;50&#37;&#41;&#44; headache &#40;50&#37;&#41;&#44; dyspnea &#40;40&#46;6&#37;&#41;&#44; anosmia &#40;37&#46;5&#37;&#41;&#44; chills &#40;34&#46;4&#37;&#41;&#44; ageusia &#40;28&#46;1&#37;&#41;&#44; asthenia &#40;25&#37;&#41; and odynophagia &#40;18&#46;8&#37;&#41;&#46; In addition&#44; thirteen patients &#40;40&#46;6&#37;&#41; referred to gastrointestinal symptoms&#44; including&#58; diarrhea &#40;37&#46;5&#37;&#41;&#44; nausea &#40;12&#46;5&#37;&#41;&#44; abdominal pain &#40;6&#46;3&#37;&#41;&#44; vomiting &#40;3&#46;1&#37;&#41;&#44; and constipation &#40;3&#46;1&#37;&#41;&#46; The median NPS and stool samples obtained were 3 &#91;2&#8211;4&#93; and 2 &#91;1&#8211;3&#93;&#44; respectively&#46; After diagnosis&#44; Viral RNA was detected in respiratory secretions of 28 patients &#40;87&#46;5&#37;&#41;&#44; and in stools of 8 &#40;25&#37;&#41; patients&#46; Three patients &#40;37&#46;5&#37;&#41; with viral detection in stools presented with gastrointestinal symptoms&#58; three of them declared to have diarrhea&#46; Six out of 19 individuals that were hospitalized had at least one gastrointestinal symptom during infection&#46; Participant characteristics and gastrointestinal symptoms are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Positive stool samples were detected at different time points &#40;days 4&#8211;18&#41;&#40;Supplementary material&#41;&#46; The median clearance time in stools was 11 &#91;10&#8211;15&#93; days&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Systematic review of SARS-CoV-2 detection in stools</span><p id="par0100" class="elsevierStylePara elsevierViewall">We identified 1683 records and 671 were duplicated&#46; After a screening process against title and abstract&#44; we obtained 59 full-text articles that were assessed for eligibility&#46; We finally selected 30 studies for our systematic review from 6 countries &#40;China&#44; France&#44; Germany&#44; Hong Kong&#44; Singapore&#44; and the United States&#41;&#46; We included 23 articles in the meta-analysis of prevalence of SARS-CoV-2 detection in stools and 18 articles were used to estimate clearance in stools&#46; We also included data of the current study in both analyses&#46; The selection process is described in <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#46; All studies were observational in design&#59; no randomized trials were identified&#46; Among the 30 studies&#44; 14 were case series and 16 cohort studies&#46; The study with the largest number of stool samples included a total of 273 cases&#46;<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">17</span></a> The risk of bias assessment results is presented in supplementary material&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The pooled studies included a total of 1392 patients that were tested by SARS-CoV-2 qRT-PCR in stools&#46; Fifty-five percent were male and 6 studies were performed exclusively in children&#46; Twenty-two out of 30 &#40;73&#46;3&#37;&#41; studies included only hospitalized patients&#46; The grade of evidence was considered very low and low&#44; since all the information emerged from case series and cohort studies&#44; respectively&#46; We performed subgroup analyses per age&#44; gender&#44; ethnicity&#44; presence of gastrointestinal symptoms&#44; and hospitalization&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> summarizes the main baseline characteristics summary of each study&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Detection of viral RNA in stools</span><p id="par0110" class="elsevierStylePara elsevierViewall">We identified 1393 patients from 23 studies and our current study&#44; which tested the presence of viral RNA in stools &#40;including our cohort&#41;&#46; The pooled prevalence of viral detection in stools was 34&#46;6&#37; &#40;twenty-four studies&#44; 1393 patients&#59; 95&#37;CI&#58; 25&#46;4&#8211;45&#46;1&#41;&#59; the heterogeneity among studies was high &#40;<span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span>&#58; 91&#46;2&#37;&#44; Q&#58; 208&#46;6&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The funnel plot of this analysis is provided in supplementary material &#40;<a class="elsevierStyleCrossRef" href="#sec0115">Fig&#46; 1S</a>&#41;&#46; Subgroup analysis by gender showed a prevalence of 30&#37; in female-predominant studies &#40;six studies&#44; 509 patients&#59; 95&#37;CI&#58; 15&#46;0&#8211;51&#46;0&#41; and 42&#37; in male-predominant studies &#40;seven studies&#44; 208 patients&#59; 95&#37;CI&#58; 29&#46;0&#8211;57&#46;0&#41;&#46; However&#44; there was no significant differences between subgroups &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;30&#41;&#44; and heterogeneity was high &#91;&#40;<span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span>&#58; 92&#46;8&#37;&#44; <span class="elsevierStyleItalic">Q</span>&#58; 66&#46;9&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and &#40;<span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span>&#58; 73&#46;7&#37;&#44; <span class="elsevierStyleItalic">Q</span>&#58; 19&#46;2&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#44; respectively&#93;&#46; Subgroup analysis by age&#44; ethnicity&#44; presence of gastrointestinal symptoms and hospitalization did not identify relevant differences to global pooled prevalence &#40;Supplementary material&#41;&#46; The heterogeneity was high in those four subgroups analysis&#46; We performed a meta-regression of 8 studies including age&#44; gender&#44; and presence of gastrointestinal symptoms&#46; The <span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span> was 60&#46;6&#37; and the <span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span> was 63&#46;1&#37;&#44; with a <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;038 of the model&#46; For each increase of 1&#37; of female in the sample&#44; proportion of SARS-CoV-2 detection in stools decreased a 0&#46;5&#37; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;&#46; The age and presence of gastrointestinal symptoms were not associated to increase in the proportion of SARS-CoV-2 detection in stools &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;816 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;103&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Clearance time of viral RNA in stools</span><p id="par0115" class="elsevierStylePara elsevierViewall">We included patients with viral detection in stool samples from 18 studies and our current study to assess viral clearance in stools&#46; From a total of 442 patients&#44; 423 were tested in stools and only 140 had an adequate prospectively follow-up&#46; We also included 197 patients with nasopharyngeal samples follow-up&#46; The percentage of viral absence in stools at the end of follow up was 72&#46;6&#37; &#40;95&#37;CI&#58; 64&#46;39&#8211;79&#46;51&#41;&#46; The median clearance time of viral RNA detection in NPS and stools was 13 days &#40;95&#37;CI&#58; 12&#8211;14&#41; and 22 days &#40;95&#37;CI&#58; 19&#8211;25&#41;&#44; respectively &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; At day 10&#44; only 10&#46;8&#37; &#40;95&#37;CI&#58; 6&#46;7&#8211;17&#46;3&#41; of patients presented virus clearance in stools&#46; Interestingly&#44; after 34 days&#44; the 19&#46;9&#37; &#40;95&#37;CI&#58; 11&#46;3&#8211;29&#46;7&#41; of patients still had a persistent detection of viral RNA in stools&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">In this study&#44; we analyzed general clinical data from 32 SARS-CoV-2 infected patients&#46; In the first stage&#44; we found that 40&#46;6&#37; of the studied population presented with gastrointestinal symptoms&#58; 37&#46;5&#37; reported diarrhea&#44; 12&#46;5&#37; nausea&#44; 6&#46;3&#37; abdominal pain&#44; 3&#46;1&#37; vomiting&#44; and 3&#46;1&#37; constipation&#46; A significant percentage of our cohort required hospitalization 59&#46;4&#37;&#44; reaching a mortality of 3&#46;1&#37;&#46; We determined that 25&#37; of patients had detectable stool viral RNA during illnesses&#46; Posteriorly&#44; we conducted a systematic review from 30 studies and the data obtained from our cohort phase&#46; The systematic review of the evidence found that the proportion of viral RNA detection in stools is 34&#46;6&#37;&#44; with a median clearance time in stools of 22 days &#40;95&#37;CI 19&#8211;25&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">In our cohort&#44; diarrhea and nausea were the most prevalent symptoms&#44; highlighting and confirming the diverse clinical manifestation induced by this novel coronavirus&#46;<a class="elsevierStyleCrossRefs" href="#bib0370"><span class="elsevierStyleSup">5&#44;18&#8211;21</span></a> The pooled prevalence of SARS-CoV-2 detection in stools was 34&#46;6&#37;&#44; which reflects gastrointestinal shedding in a considerable number of patients&#46; On the other hand&#44; there is an important number of patients without SARS-CoV-2 detection in stools&#46; The differences among detection in stools could potentially be explained by time since onset of symptoms and collection of stool samples&#44; inadequate transport&#47;storage conditions&#44; differences in sample processing&#44; or characteristics inherent to the virus or patients&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The SARS and SARS-CoV-2 strains share approximately 78&#37; identity at the amino acid level&#46;<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">22</span></a> It has been proposed that SARS could enter into cells using the Angiotensin-converting Enzyme 2 &#40;ACE2&#41; as a receptor&#44; which is widely distributed on the respiratory and gastrointestinal tract&#44; could potentially allow the entry of the virus in the intestinal tract&#46;<a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">23</span></a> Hence&#44; given their similarity in tropism&#44; SARS-CoV-2 could also enter cells by similar mechanism&#46;<a class="elsevierStyleCrossRefs" href="#bib0465"><span class="elsevierStyleSup">24&#44;25</span></a> Moreover&#44; since ACE2 modulates intestinal inflammation&#44; it is plausible that SARS-CoV-2 infection could disrupt the ACE2 function&#44; promoting fecal-oral transmission&#46;<a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">26</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Remarkably&#44; the Kaplan&#8211;Meier clearance curves showed a median clearance time in NPS of 13 days &#40;95&#37;CI&#58; 12&#8211;14&#41;&#44; which was significantly lower than clearance in stools &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; In fact&#44; viral RNA detection in stools could occur for at least another nine &#40;for 22 days or more&#41; in the half proportion of individuals tested &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; These findings suggest a longer shedding period in the gastrointestinal tract&#44; which is in agreement with reports from cohort studies in Hong Kong&#44; Macau&#44; Beijing and Germany&#44;<a class="elsevierStyleCrossRefs" href="#bib0480"><span class="elsevierStyleSup">27&#8211;30</span></a> and a case study in Italy&#46;<a class="elsevierStyleCrossRef" href="#bib0500"><span class="elsevierStyleSup">31</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The identification of prolonged SARS-CoV-2 RNA shedding in rectal swabs was reported as early as mid-February 2020 by Zhang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">32</span></a> Therefore&#44; the potential of viral transmission through the oral-fecal route has been cautioned since then&#44; and recent additional evidence supports this idea&#46; First&#44; it was reported that viral RNA can be detected in fecal samples of infected individuals for up to 11&#46;2 days after respiratory samples became negative and up to 47 days after symptom onset<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">33</span></a>&#59; secondly&#44; virus RNA was found at high concentrations in stool&#44; and occasionally viral sub genomic messenger RNA &#40;only present in replicating cells&#41; can also be detected in these specimens&#59; third&#44; endoscopic studies of SARS-CoV-2 infected individuals revealed esophageal bleeding&#44; erosions and ulcers in one patient and viral RNA was detected in different gastrointestinal tissues of 3 individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">34</span></a> Fourth&#44; several studies demonstrated the presence of viral RNA in untreated wastewater from the Netherlands&#44; Italy&#44; Australia&#44; and Chile&#46;<a class="elsevierStyleCrossRefs" href="#bib0520"><span class="elsevierStyleSup">35&#8211;38</span></a> Interestingly&#44; two studies demonstrated that viral isolation from feces was possible&#46;<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">10&#44;39</span></a> Additionally&#44; two recent studies reported the infection and replication of SARS-CoV-2 on intestinal organoids&#46;<a class="elsevierStyleCrossRefs" href="#bib0545"><span class="elsevierStyleSup">40&#44;41</span></a> Altogether&#44; our current study and previous reports provide evidence strongly suggesting that SARS-CoV-2 can infect and possibly replicate in the gastrointestinal tract&#44; supporting the oral-fecal route of SARS-CoV-2 as a potential source for transmission&#46; This highlights the need to exercise increased caution when handling and disposing of stool samples&#44; and when conducting endoscopic procedures in SARS-CoV-2 infected individuals&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">SARS-CoV-2 detection could also be helpful in monitoring and tracking SARS-CoV-2 circulation&#44; especially during massive outbreaks with limited testing capacity&#46; Interestingly&#44; a recent study from Spain demonstrated that SARS-CoV-2 detection in wastewater could anticipate COVID-19 occurrence in a low prevalence area&#46;<a class="elsevierStyleCrossRef" href="#bib0555"><span class="elsevierStyleSup">42</span></a> On the other hand&#44; in a study carried out in Santiago&#44; Chile &#40;a high populated city&#41;&#44; the SARS-CoV-2 detection on wastewater also demonstrated a prediction of outbreak in some neighborhoods&#46;<a class="elsevierStyleCrossRef" href="#bib0535"><span class="elsevierStyleSup">38</span></a> Therefore&#44; the epidemiological information from SARS-CoV-2 testing in untreated wastewater could significantly impact the surveillance of the viral circulation of SARS-CoV-2 and its variants in the future&#46;<a class="elsevierStyleCrossRef" href="#bib0560"><span class="elsevierStyleSup">43</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The limitations of the cohort study were the limited number of patients followed-up and the difficult in obtaining daily stool samples&#46; In addition&#44; there is not a gold standard of SARS-CoV-2 infection and SARS-CoV-2 qRT-PCR has sensitivity near to 70&#37; in NPS&#46;<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">44</span></a> This sensitivity could be even lower according to a recent study&#44; reaching 47&#46;3&#37; in real life and underestimating detection of SARS-CoV-2 in organs&#44; fluids&#44; and stools&#46;<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">45</span></a> Also&#44; we identified a high heterogeneity among the studies to estimate proportion of SARS-CoV-2 RNA detection in stools&#46; We performed several analyses to elucidate the cause of this heterogeneity including a meta-regression&#46; We identified that gender can importantly contribute to this high heterogeneity&#46; This interesting observation could be explained by the higher expression of ACE2 and a less robust T cell-mediated immunity in male patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0575"><span class="elsevierStyleSup">46&#44;47</span></a> However&#44; this heterogeneity could also be explained by important differences and quality among prior published studies&#46; Future research questions include the establishment of additional data to support the fecal-oral transmission and the assessment of the long-term impact of SARS-CoV-2 infection in the gastrointestinal tract&#46; Finally&#44; although anal swabs to detect SARS-CoV-2 have been performed as a screening tool in countries such as Indonesia&#44; the sensitivity of this technique is low &#40;36&#46;7&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0585"><span class="elsevierStyleSup">48</span></a> Therefore&#44; we require more sensitive anal-swabs-based tests to recommend SARS-CoV-2 detection in anal swabs as a screening tool&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In conclusion&#44; this cohort study and systematic review demonstrated that detection of SARS-CoV-2 in stools is a frequent finding&#46; The clearance of SARS-CoV-2 in stools is significantly prolonged as compared to clearance in nasopharyngeal secretions&#46; The heterogeneity in the systematic reviews were high and could be partially explained by gender and methodological deficiencies of several included studies&#46; Further data is required to support the plausibility of fecal-oral infective route&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Authors&#8217; contributors</span><p id="par0160" class="elsevierStylePara elsevierViewall">AR and RAM are responsible for the overall content of the project and the manuscript submitted as guarantors of the project&#46; AR&#44; RAM&#44; LAD&#44; TGS&#44; DR&#44; and JO had full access to all the data in the study&#46; LAD and TGS take responsibility for the integrity of the data and the accuracy of the data analysis&#46; AR&#44; RAM&#44; LAD&#44; and TGS take the final decision to submit for publication&#46; Study concept and design&#58; AR&#44; RAM&#44; MF&#44; MA&#44; CC&#44; LAD&#44; RC&#44; GR&#44; LO&#46; Acquisition of data&#58; LAD&#44; TGS&#44; EFL&#44; GHV&#44; EiS&#44; ErS&#44; AT&#44; SV&#44; MO&#44; JC&#44; DR&#44; JO&#44; SB&#44; VG&#44; AG&#44; MFS&#46; Experiments and qRT-PCR analysis&#58; RAM&#44; MF&#44; TGS&#44; JL&#44; LIA&#44; EiS&#46; Analysis or interpretation of data&#58; RAM&#44; AR&#44; LAD&#44; TGS&#44; EFL&#44; JC&#44; LIA&#44; EiS&#44; RC&#44; CP&#44; HM&#44; AE&#44; DR&#44; JO&#44; GR&#46; Drafting of the manuscript&#58; LAD&#44; TGS&#44; EFL&#44; RAM&#44; AR&#44; JC&#44; MP&#46; Critical revision of the manuscript for relevant intellectual content&#58; LAD&#44; TGS&#44; DR&#44; JO&#44; EFL&#44; JC&#44; JL&#44; LIA&#44; EiS&#44; SB&#44; VG&#44; AG&#44; MFS&#44; MF&#44; CC&#44; MA&#44; CP&#44; AE&#44; RC&#44; HM&#44; GR&#44; LO&#44; SV&#44; ErS&#44; AT&#44; MO&#44; PG&#44; MP&#44; RAM&#44; AR&#46; Statistical analysis&#58; EFL&#44; RC&#44; LAD&#44; TGS&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Financial support</span><p id="par0165" class="elsevierStylePara elsevierViewall">Protocols and the study set-up used for this study were based on influenza virus studies established in part with the support of the <span class="elsevierStyleGrantSponsor" id="gs1">FONDECYT</span><span class="elsevierStyleGrantNumber" refid="gs1">1161971</span> grant from the <span class="elsevierStyleGrantSponsor" id="gs2">Agencia Nacional de Investigaci&#243;n y Desarrollo &#40;ANID&#41;</span> from Chile&#44; the FLUOMICS Consortium &#40;NIAID grant <span class="elsevierStyleGrantNumber" refid="gs2">U19AI135972</span>&#41; funded by NIH and with funding from CRIP &#40;Center for Research on Influenza Pathogenesis&#41;&#44; an NIH funded <span class="elsevierStyleGrantSponsor" id="gs3">Center of Excellence for Influenza Research and Surveillance</span> &#40;CEIRS&#44; contract number HHSN272201400008C&#41; to RAM&#46;</p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conflict of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors reported no potential conflict of interest&#46;</p></span></span>"
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              "titulo" => "Gastrointestinal symptoms and stool detection in our cohort study"
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              "titulo" => "Systematic review of SARS-CoV-2 detection in stools"
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              "titulo" => "Detection of viral RNA in stools"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To&#58; 1&#46; Describe the frequency of viral RNA detection in stools in a cohort of patients infected with SARS-CoV-2&#44; and 2&#46; Perform a systematic review to assess the clearance time in stools of SARS-CoV-2&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We conducted a prospective cohort study in two centers between March and May 2020&#46; We included SARS-CoV-2 infected patients of any age and severity&#46; We collected seriated nasopharyngeal swabs and stool samples to detect SARS-CoV-2&#46; After&#44; we performed a systematic review of the prevalence and clearance of SARS-CoV-2 in stools &#40;PROSPERO-ID&#58; CRD42020192490&#41;&#46; We estimated prevalence using a random-effects model&#46; We assessed clearance time by using Kaplan&#8211;Meier curves&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We included 32 patients&#59; mean age was 43&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;7 years&#44; 43&#46;8&#37; were female&#44; and 40&#46;6&#37; reported gastrointestinal symptoms&#46; Twenty-five percent &#40;8&#47;32&#41; of patients had detectable viral RNA in stools&#46; The median clearance time in stools of the cohort was 11&#91;10&#8211;15&#93; days&#46; Systematic review included 30 studies &#40;1392 patients&#41; with stool samples&#46; Six studies were performed in children and 55&#37; were male&#46; The pooled prevalence of viral detection in stools was 34&#46;6&#37; &#40;twenty-four studies&#44; 1393 patients&#59; 95&#37;CI&#58;25&#46;4&#8211;45&#46;1&#41;&#59; heterogeneity was high &#40;<span class="elsevierStyleItalic">I</span><span class="elsevierStyleSup">2</span>&#58;91&#46;2&#37;&#44; Q&#58;208&#46;6&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; A meta-regression demonstrates an association between female-gender and lower presence in stools &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;004&#41;&#46; The median clearance time in stools was 22 days &#40;nineteen studies&#44; 140 patients&#59; 95&#37;CI&#58;19&#8211;25&#41;&#46; After 34 days&#44; 19&#46;9&#37; &#40;95&#37;CI&#58;11&#46;3&#8211;29&#46;7&#41; of patients have a persistent detection in stools&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Detection of SARS-CoV-2 in stools is a frequent finding&#46; The clearance of SARS-CoV-2 in stools is prolonged and it takes longer than nasopharyngeal secretions&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">1&#46; Evaluar la detecci&#243;n de ARN viral en deposiciones y su tiempo de excreci&#243;n en una cohorte de pacientes con SARS-CoV-2&#59; 2&#46; Realizar una revisi&#243;n sistem&#225;tica para evaluar el tiempo de excreci&#243;n en deposiciones del SARS-CoV-2&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohorte prospectiva en dos centros entre marzo-mayo del 2020&#46; Incluimos pacientes infectados con SARS-CoV-2 de cualquier edad y gravedad&#46; Recolectamos secreciones nasofar&#237;ngeas y deposiciones en forma seriada para detectar SARS-CoV-2&#46; Tambi&#233;n realizamos una revisi&#243;n sistem&#225;tica de la prevalencia y excreci&#243;n del SARS-CoV-2 en deposiciones &#40;PROSPERO-ID&#58; CRD42020192490&#41;&#46; Estimamos la prevalencia usando un modelo de efectos aleatorios&#46; Evaluamos el tiempo de excreci&#243;n usando curvas Kaplan-Meier&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Incluimos 32 pacientes&#59; edad media 43 &#177; 17&#44;7 a&#241;os&#44; 43&#44;8&#37; eran mujeres y 40&#44;6&#37; reportaron s&#237;ntomas gastrointestinales&#46; Veinticinco por ciento &#40;8&#47;32&#41; ten&#237;an ARN viral detectable en deposiciones&#46; La mediana de excreci&#243;n en deposiciones fue 11 &#91;10-15&#93; d&#237;as&#46; La revisi&#243;n sistem&#225;tica incluy&#243; 30 estudios &#40;1&#46;392 pacientes&#41; con muestras en deposiciones&#46; Seis estudios fueron realizados en ni&#241;os y 55&#37; eran hombres&#46; La prevalencia estimada de detecci&#243;n viral en deposiciones fue de 34&#44;6&#37; &#40;24 estudios&#44; 1&#46;393 pacientes&#59; IC 95&#37;&#58; 25&#44;4-45&#44;1&#41;&#59; la heterogeneidad fue elevada &#40;I<span class="elsevierStyleSup">2</span>&#58; 91&#44;2&#37;&#59; Q&#58; 208&#44;6&#59; p &#8804; 0&#44;001&#41;&#46; Una metarregresi&#243;n demostr&#243; una asociaci&#243;n entre el g&#233;nero femenino y menor prevalencia en deposiciones &#40;p &#61; 0&#44;004&#41;&#46; La mediana de tiempo de excreci&#243;n fueron 22 d&#237;as &#40;19 estudios&#44; 140 pacientes&#59; IC 95&#37;&#58; 19-25&#41;&#46; Tras 34 d&#237;as&#44; 19&#44;9&#37; &#40;IC 95&#37;&#58; 11&#44;3-29&#44;7&#41; de los pacientes ten&#237;an detecci&#243;n persistente en deposiciones&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La detecci&#243;n de SARS-CoV-2 en deposiciones es un hallazgo frecuente&#46; La excreci&#243;n del SARS-CoV-2 en deposiciones es prolongada y es m&#225;s tard&#237;a que en secreciones nasofar&#237;ngeas&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">D&#237;az&#44; Garc&#237;a-Salum&#44; and Fuentes-L&#243;pez contributed equally to this study&#46;</p>"
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      1 => array:3 [
        "etiqueta" => "2"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Medina and Riquelme are co-corresponding authors&#46;</p>"
        "identificador" => "fn0010"
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      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0185" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0115"
          ]
        ]
      ]
    ]
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Stages of collection&#44; transporting&#44; and processing of samples from SARS-CoV-2 infected patients&#46; NSP&#58; nasopharyngeal swabs and aspirates&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2522
            "Ancho" => 2167
            "Tamanyo" => 287948
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Study selection for the systematic review&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2594
            "Ancho" => 2500
            "Tamanyo" => 356315
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Forest plots of prevalence of viral detection in stools from SARS-CoV-2 infected patients&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figure 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1657
            "Ancho" => 2167
            "Tamanyo" => 195352
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Survival curves to estimate clearance of SARS-CoV-2 in Nasopharyngeal swabs &#40;NPS&#41; and stools&#46; We disaggregated information for each patient to obtain individualized data&#46; Clearance was estimated considering the time between onset of symptoms and the last viral detection in NPS or stools&#46; Survival estimates were performed using Kaplan&#8211;Meier curves and we compared both curves with log-rank test&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0005"
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        "tipo" => "MULTIMEDIATABLA"
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                  \t\t\t\t">43&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#46;7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#46;4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;131&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;56&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;68&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;093&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">14 &#40;43&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;61&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;31&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Gastrointestinal symptoms</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diarrhea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">12 &#40;37&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;46&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6 &#40;31&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;403&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Constipation&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;401&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Nausea&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4 &#40;12&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;15&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2 &#40;10&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;683&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vomiting&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;7&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#46;219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Abdominal pain&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">2 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;10&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;227&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">SARS-CoV-2 detection in stools</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">8 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;30&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;21&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mechanical ventilation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;31&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Deaths</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;3&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;401&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of our cohort according to outpatient or hospitalized care&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">First author&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Date&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gender &#40;female&#41; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Exclusively hospitalized patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of patients with stool samples&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Follow-up of clearance in stools&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chen C<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">29</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">March 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">General&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;36&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chen Y<a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">27</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">April 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;64&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Chen W<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">49</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cheung KS<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">5</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hong Kong&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">April 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;54&#46;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dreher M<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">50</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Germany&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">April 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Han C<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">51</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">April 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">115 &#40;55&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Huang JT<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">17</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">June 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">157 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">273&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jiang X<a class="elsevierStyleCrossRef" href="#bib0605"><span class="elsevierStyleSup">52</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">April 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">General&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Jiehao C<a class="elsevierStyleCrossRef" href="#bib0610"><span class="elsevierStyleSup">53</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pediatrics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;60&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kujawski S<a class="elsevierStyleCrossRef" href="#bib0615"><span class="elsevierStyleSup">54</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">USA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">March 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Li H<a class="elsevierStyleCrossRef" href="#bib0620"><span class="elsevierStyleSup">55</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;62&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lescure FX<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">56</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">France&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">March 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pan Y<a class="elsevierStyleCrossRef" href="#bib0630"><span class="elsevierStyleSup">57</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wang W<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">General&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66 &#40;32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">153&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wei XS<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">58</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">March 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;66&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wolf GK<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">59</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Germany&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pediatrics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;66&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Wu Y<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">33</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">March 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;47&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Xiao F 1<a class="elsevierStyleCrossRef" href="#bib0540"><span class="elsevierStyleSup">39</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">January 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Xiao F 2<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">60</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">General&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;43&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Xing YH<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">61</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">March 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pediatrics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Xiong XL<a class="elsevierStyleCrossRef" href="#bib0655"><span class="elsevierStyleSup">62</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">May 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pediatrics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;38&#46;52&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Xu Y<a class="elsevierStyleCrossRef" href="#bib0660"><span class="elsevierStyleSup">63</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">April 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pediatrics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yang Z<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">64</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;33&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Young BE<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">65</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Singapore&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">March 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zautner AE<a class="elsevierStyleCrossRef" href="#bib0675"><span class="elsevierStyleSup">66</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Germany&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">April 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;35&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zhang J<a class="elsevierStyleCrossRef" href="#bib0680"><span class="elsevierStyleSup">67</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zeng L<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">68</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">March 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pediatrics &#40;Newborns&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;42&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zhang W 1<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zhang W 2<a class="elsevierStyleCrossRef" href="#bib0505"><span class="elsevierStyleSup">32</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Not reported&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Zheng S<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">69</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">China&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">February 2020&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adult&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;39&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                            4 => "R&#46; Wang"
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                      "titulo" => "Symptom profiles and risk factors for hospitalization in patients with SARS-CoV-2 and COVID-19&#58; a large cohort from South America"
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                            3 => "M&#46; Ferr&#233;s"
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