Evidence to support safe return to clinical practice by oral health professionals in Canada during the COVID-19 pandemic: A report prepared for the Office of the Chief Dental Officer of Canada

March 2021 update

This evidence synthesis was prepared for the Office of the Chief Dental Officer, based on a comprehensive review under contract by the following:

Raphael Freitas de Souza, Faculty of Dentistry, McGill University
Paul Allison, Faculty of Dentistry, McGill University
Lilian Aboud, Faculty of Dentistry, McGill University
Martin Morris, Library, McGill University

Contents

Foreword to the second update

By Dr James Taylor, Chief Dental Officer of Canada

March 31, 2021

Following the successful completion of the original document on 31 July 2020, the Office of the Chief Dental Officer of Canada (OCDOC) commissioned McGill University to produce three updates during the year following the first report. This is the second of those update reports, covering relevant literature published between November 20, 2020, and February 28, 2021. It is intended as an addendum to the original document and its first update, and should thus be used in conjunction with the original document. The results of the first update are also found in this document and are identified as such. This document will reside alongside the original document in the public domain, to be accessible to decision makers as they carry out their respective responsibilities.

As with the original document and its first update, McGill University drafted a comprehensive knowledge update concerning key issues that inform the provision of oral health care by relevant providers in Canada during the COVID-19 pandemic. The OCDOC then reconvened the representative multidisciplinary knowledge-based group from the national oral health professional and federal government health domains. The group's role was to work collaboratively to contribute to the generation of a single high-level national evidence update document by the team from McGill.

The organizations participating in this collaboration included:

Federal Health Portfolio

National oral health regulatory federations

National oral health professional associations

National oral health academic association

OCDOC Mandate: to advance population-level oral health through health promotion, disease prevention and professional/technical guidance with an emphasis on vulnerable populations.

Introduction

During May and June 2020, a research team completed a rapid review of the literature to support the safe practice of Canadian dental professionals during the COVID-19 pandemic. Following input from stakeholders on the draft report in mid-July, the report was finalized and submitted July 31 and then published on the Canada.ca website in both official languages in September 2020. The review covered literature published from January 1, 2000, to June 30, 2020. With the rapid pace of new publications linked to the COVID-19 pandemic, the Chief Dental Officer of Canada determined that updates to the report are needed three times during the year following the first report. These updates are to cover scientific literature published between July 1, 2020, and October 31, 2020, between November 1, 2020, and February 28, 2021, and finally between March 1, 2021, and June 30, 2021. This is the second of those update reports adding relevant literature published during the period covering July 1, 2020, to October 31, 2020, and February 28, 2021. The results of the first update are found in this document and are identified as such.

This updated document will use the same structure as the original report, addressing the same nine questions. In response to each question, we include: the rationale for the question (the same as the previous report); the summary response provided in the previous report; and then a summary of the new literature. The references are only those identified for the relevant update periods (July 1, 2020, to October 31, 2020, and November 1, 2020, to February 28, 2021, respectively) and appended tables contain only material from newly identified references. Readers should return to the original report for relevant lists of references and other material.

Project goal

To create a knowledge product around which the Office of the Chief Dental Officer of Canada can convene a representative knowledge-based group of the national oral health professional domain, in order to generate a single high-level national expert document which Canada's oral health regulatory authorities may then choose to consult in developing consistent guidance for their respective registrants at the Provincial/Territorial level. Further, educators, program officials and policy makers may also choose to consult this document as they carry out their respective responsibilities.

When reading this report it is important to recognize three essential points:

This document focuses on evidence that is categorized as high quality using internationally recognized hierarchies of evidenceFootnote 1Footnote 2Footnote 3. These are in descending order:

  1. Systematic reviews and meta-analyses
  2. Randomised controlled trials with definitive results (confidence intervals that do not overlap the threshold clinically significant effect)
  3. Randomised controlled trials with non-definitive results (a point estimate that suggests a clinically significant effect but with confidence intervals overlapping the threshold for this effect)
  4. Cohort studies
  5. Case-control studies
  6. Cross sectional surveys
  7. Case reports
  8. Expert opinion

Specific objectives

  1. To update the previously published comprehensive review of the literature concerning key issues that inform the provision of oral health care by relevant providers in Canada during the COVID-19 pandemic. Those key areas are:
    1. Which patients are at greater risk of the consequences of COVID-19 and so consideration should be given to delaying elective in-person oral health care?
    2. What are the signs and symptoms of COVID-19 that oral heal professionals should screen for prior to providing in-person health care?
    3. What evidence exists to support patient scheduling, waiting and other non-treatment management measures for in-person oral health care?
    4. What evidence exists to support the use of various forms of personal protective equipment (PPE) while providing in-person oral health care?
    5. What evidence exists to support the decontamination and re-use of PPE?
    6. What evidence exists concerning the provision of aerosol-generating procedures (AGP) as part of in-person oral health care?
    7. What evidence exists to support transmission mitigation strategies during the provision of in-person oral health care?
    8. What evidence exists to support space ventilation strategies that reduce the risk of transmission?
    9. What evidence exists to support the disinfection of surfaces in spaces in which oral health care is provided?
  2. To prepare a written report documenting the updated findings of the aforementioned literature searches. The report is prepared in a manner that provides clear and concise information to decision-makers (individuals providers or organizational) highlighting where strong to no levels of scientific evidence exist to support different approaches.

Methods used to identify and include relevant literature

The same methodological approach was used for this update as was used in the original report and first update. In summary, search words and phrases were identified for each of the above topic areas a) to i), and searches were performed for English language articles, in standard scientific literature databases for the period July 1 to October 31, 2020, (first update) and the period of November 1, 2020, and February 28, 2021 (second update). Two steps were then used to include publications in this report/process: i) step 1 was a review of abstracts to decide on the relevance of publication content for the topic areas; and ii) step 2 was to include only those publications reporting the results of prospective cohort studies, randomized controlled trials, systematic reviews and/or meta-analyses. Steps 1 and 2 were done by one author and a random number of publications were reviewed in the same way by a second author so as to ensure reliability of the findings. An additional, separate search was performed of the bibliography supporting relevant national, provincial and state guidelines concerning oral health care provision during the COVID-19 pandemic in Canada and the USA. Any publications identified in this bibliography that were not in our aforementioned search, but which fulfilled the quality criteria in step 2 and were published during the relevant period were also included in this update report.

With respect to step 1, concerning relevant subject areas, as well as searching for COVID-19 and SARS-CoV-2, we also searched for similar respiratory tract viruses such as SARS, MERS, H1N1 and influenza. In reporting the results of our work, we have made clear whether the evidence concerns COVID-19, SARS-CoV-2, SARS, MERS, H1N1, influenza and sometimes other pathogens. In reality, much of the work reported is in the form of systematic reviews that cover a range of relevant pathogens and diseases. In the second update, for questions with a robust body of evidence about COVID-19, we did not update evidence about other respiratory diseases or viruses (indicated for a topic when applicable).

With respect to step 2, concerning the inclusion of only that evidence fulfilling certain levels of quality, this was taken to enable this review to focus only on strong evidence in support of various approaches and concepts. This means that any evidence we highlight is of high quality. However, where we state that there is no evidence using our quality criteria, it does not mean there is no evidence at all, rather it means that evidence that exists is not of high enough quality to be included in our review. This is particularly important to note in the context of the current pandemic wherein there are a very high number of publications emerging from rapidly performed research, which for good reasons, may not be of the quality ideally desired. There are also many documents containing the opinions of experts, which are valuable in the circumstances, but which are recognized to be low in the hierarchy of quality of evidence.

Report structure

This report will address each of topics a) to i) in turn. For each topic, we provide the rationale for the question (the same as the previous report); the summary response provided in the previous report; and then a summary of the new literature, stating how strong the evidence is. The main body of the report contains only these summaries; however, each topic has an appendix containing a tabular summary of included papers, with summary data where appropriate. Readers of this report who are interested in more detailed information will need to access the relevant papers themselves. We also make clear where evidence is related to COVID-19/SARS-CoV-2 or related to similar respiratory tract viruses such as SARS, MERS, H1N1 and influenza. Finally, where pertinent, we refer readers to relevant Health Canada websites.

Summary of update reports

First update

This section provides an overview of the findings reported in the different sections. For more detailed information and for the references, see the relevant sections.

We identified a large number of new systematic reviews and meta-analyses concerning the symptoms of people diagnosed with COVID-19 and the risk factors for serious consequences such as hospitalization, ventilation and death among those patients. Many of these reviews and analyses confirmed data presented in the previous report. The evidence is strong that the most common signs and symptoms experienced by people diagnosed with COVID-19 are fever, cough, fatigue and muscle aches, shortness of breath, sputum, headache, sore throat and gastrointestinal symptoms, including diarrhea. New strong evidence has emerged reporting loss of sense of smell and altered sense of taste as common symptoms. With respect to risk factors for serious consequences of COVID-19, the evidence is strong for increased risk among people with cardiovascular diseases, hypertension, diabetes, chronic respiratory diseases, liver and kidney diseases, obesity and smokers. Newly added risk factors are people with cancer and cerebrovascular conditions. In terms of sociodemographic factors, the evidence is strong that increased age augments the risk of serious consequences, with this increased risk beginning to emerge particularly for those 60 years and older. There is now good evidence in the international literature indicating men being at increased risk for COVID-19 and its consequences, although it is not clear why - is it biological or because of their work, socializing habits and/or smoking and alcohol consumption? However, it is important to note that in Canada, the incidence of COVID-19 is higher in women. There is also some evidence to indicate that when studies control for socioeconomic factors, there are no racial differences in serious consequences for COVID-19.

While the evidence concerning the disease itself is increasingly strong, the evidence supporting different interventions pertinent to oral health care remains minimal and weak and relatively little work has been published in the period since the first report. In terms of clarifying guidance for oral health professionals, one systematic review highlights the categories of actions in pre-treatment, during treatment and post-treatment phases of care that organizations around the world have concentrated on, although this does not mean the relevant actions are based on evidence, rather that these are common areas to consider. Another review of guidelines for dental care during the pandemic noticed an increasing focus on preventive and non-Aerosol Generating Procedures (AGPs) and another highlighted the need to develop an evidence-based classification of AGPs and non-AGPs in dentistry rather than the theoretical approaches used thus far.

In terms of PPE, the picture remains unclear in terms of evidence directly related to oral health care, although the evidence does suggest using combined forms of facial covering (e.g., face visor and N95 mask) is better than just one, as no single interventions are fully effective in preventing transmission. There is emerging evidence that N95 masks can be microwaved and re-used at least once without loss of function but there remains no evidence supporting various mitigating approaches such as use of pre-treatment mouthwash, rubber dam and high-volume evacuation. There is evidence that chlorhexidine mouthwash reduces bacterial colony-forming units but none on this or other mouthwashes concerning viruses or disease transmission.

There is emerging evidence concerning the risk factors for Health Care Workers (HCWs) contracting COVID-19, plus the impacts of the disease on them, which are both relevant in terms of considering how to mitigate risks and impacts. Suggestions have been made for HCWs concerning reducing hours and increasing mental support services.

Second update

This section provides an overview of the findings reported in the different sections. For more detailed information and for the references, see the relevant sections.

Our second update identified another large collection of systematic reviews and meta-analyses documenting comorbidities that increase the risk of severe complications in case of infection by SARS-Cov-2. Most results are similar and/or complementary to previous versions of this report (e.g., higher risk for severe COVID-19 in individuals with hypertension, cardiac lesions and diabetes mellitus), but we have also highlighted reports that clarify risk related to pregnant women (the authors recognize that use of the term pregnant women is not gender inclusive. However, the systematic reviews on pregnant women referenced in this evidence synthesis did not include gender diverse people who are pregnant, limiting findings referenced to pregnant women only), who are at higher risk of the same complications for other individuals, including severe COVID-19 and ICU admission. Neonates can be affected negatively if born to mothers who are COVID-19-positive, including lower weight at birth and more frequent admission to a neonatal unit. Many reviews reinforce well-established evidence concerning COVID-19 signs and symptoms, but some reviews introduce a new concept of major relevance in our field: oral mucosal lesions associated to COVID-19.

Newer systematic reviews highlight the effective use of telehealth approaches to reduce in-person dental appointments, provide patient information and train professionals. They also reinforce the need for specific COVID-19 questionnaires before dental care, ventilated waiting rooms/common spaces, social distancing and regular disinfection of non-treatment and operatory areas, but evidence does not support the use of laboratory screening tests for SARS-Cov-2 in dental care settings.

Other reviews compared different masks and respirators and suggested that FFP3 and FFP2 may be comparable to N95 to protect professionals from COVID-19. Again, face shields with lateral protection seem essential for dental care providers, combined with at least type 3 medical masks or respirators. However, there is little evidence to support different methods to reuse PPEs, with recommended use only in cases of shortage.

A hierarchy of risk for contamination was suggested by evidence identified in this update, with higher risk associated with the use of ultrasonic scalers, high-speed handpieces, air-water syringe, air polishers, as well as handpieces and lasers for oral surgery (including extractions and osteotomy). Reviews have recommended the use of alternative techniques to minimise aerosols (e.g., atraumatic restorative treatment with hand instruments and silver diamine fluoride instead of conventional restorative treatment), and pre-appointment use of several types of mouthwashes to minimize risks of transmission.

Little evidence was gathered to support the use of air cleaning systems as a means to mitigate the transmission of COVID-19 in dental operatory rooms, although their use is reasonable. More studies are still needed to determine disinfection methods for surfaces and objects in an oral healthcare facility, although a novel finding, however, is the efficacy of sodium hypochlorite as a disinfecting medium for impressions and dental prostheses.

Report results

a. Which patients are at greater risk of the consequences of COVID-19 so consideration should be given to delaying elective in-person oral health care?

a.1. Findings from the first update

We identified multiple systematic reviews, meta-analyses and a few cohort studies adding to the knowledge and understanding of which patient groups are at greater risk of severe consequences of having COVID-19. The large majority of these studies confirmed findings we described in the previous report. Nevertheless, there have been some important additional findings with strong evidence supporting them. Recently published reviews and meta-analyses confirmed the increased risk for serious consequences of COVID-19 including hospitalization, ventilation and death for people with cardiovascular diseasesFootnote 4Footnote 5Footnote 6Footnote 7Footnote 8Footnote 9Footnote 10Footnote 11Footnote 12Footnote 13Footnote 14Footnote 15Footnote 16Footnote 17, hypertensionFootnote 4Footnote 5Footnote 6Footnote 7Footnote 8Footnote 9Footnote 10Footnote 11Footnote 12Footnote 17Footnote 18Footnote 19Footnote 20, respiratory diseasesFootnote 5Footnote 7Footnote 10Footnote 11Footnote 12Footnote 18Footnote 21Footnote 22Footnote 23, diabetesFootnote 4Footnote 5Footnote 7Footnote 8Footnote 10Footnote 11Footnote 19Footnote 20Footnote 24Footnote 25Footnote 26Footnote 21Footnote 27Footnote 28, liverFootnote 12Footnote 29Footnote 30Footnote 31 and kidney diseasesFootnote 5Footnote 8Footnote 11Footnote 12Footnote 14Footnote 22Footnote 32Footnote 33Footnote 34Footnote 35Footnote 36Footnote 37Footnote 38Footnote 39 plus for smokersFootnote 18. New information adds to the list of at-risk people who are obeseFootnote 20Footnote 40Footnote 41Footnote 42Footnote 43, have cancerFootnote 11Footnote 44Footnote 45Footnote 46Footnote 47 and cerebrovascular conditionsFootnote 10Footnote 11Footnote 12Footnote 13Footnote 17Footnote 48Footnote 49Footnote 50Footnote 51.

Concerning age and sex, again there has been additional high-quality evidence published. It is clear that increased age increases the risk of serious consequencesFootnote 20Footnote 49Footnote 52Footnote 53 with one review clarifying that the peak increase in risk is for serious consequences starts to occur for those 50-59 years of age but the largest risk increase is for the 60-69 year olds compared to those in their 50s, although the risk keeps increasing with older ageFootnote 52. With respect to sex, it is now clear from the international literature that the incidence of COVID-19 is greater in men than womenFootnote 10Footnote 19Footnote 54Footnote 55. However, it is important to note, as shown on the webpage COVID-19 epidemiological and economic research data, that in Canada, the incidence of COVID-19 is higher in females compared to males, although this varies by age group. In terms of disease outcomes, again the international literature shows men are at increased risk for serious consequences of COVID-19 including deathFootnote 20Footnote 54Footnote 56Footnote 57Footnote 58. However, these studies also pointed out that it is not clear why men are at greater risk for worse outcomes. They could be at increased risk because of the nature of their work, their socializing habits, their smoking, alcohol consumption and/or levels of comorbiditiesFootnote 20Footnote 58. In Canada, there have been more hospitalizations and deaths among women but more men admitted to intensive care units (again see COVID-19 epidemiological and economic research data). It is also important to recognize that certain groups in the population face greater risk due to social, economic and occupational vulnerabilities (see Vulnerable populations and COVID-19). Further research needs to be performed to better understand the different levels of risk experienced by various groups in the population.

Canada COVID-19 weekly epidemiology report. Further research needs to be performed to better understand this phenomenon.

With respect to COVID-19 in pregnancy, the evidence remains relatively limited because the numbers are considerably smaller than in the broader population studies. Nevertheless, there is limited, emerging evidence that pregnant women with COVID-19 are at increased risk for complications with their pregnancyFootnote 59Footnote 60Footnote 61Footnote 62. There is also emerging limited evidence concerning the problems suffered by neonates who are COVID-19 positiveFootnote 59Footnote 60Footnote 63Footnote 64Footnote 65. With respect to the possibility of vertical transmission from mother to foetus, one systematic review reported zero such casesFootnote 64 while two others reported rates of 2-3.2% of neonates testing positive for SARS-Cov-2 among babies born to mothers who were also SARS-Cov-2 positiveFootnote 61Footnote 66.

a.2. Findings from the second update

This second update returned several systematic reviews (SRs) within this topic. As for the November 2021 update, most of those SRs confirm previous strong evidence regarding the risk for complications of COVID-19 associated with now well-known comorbidities. Probably the most studied comorbidity linked to higher risk of severe COVID-19, ICU admission and death is hypertension, which was identified by 49 new SRsFootnote 67Footnote 68Footnote 69Footnote 70Footnote 71Footnote 72Footnote 73Footnote 74Footnote 75Footnote 76Footnote 77Footnote 78Footnote 79Footnote 80Footnote 81Footnote 82Footnote 83Footnote 84Footnote 85Footnote 86Footnote 87Footnote 88Footnote 89Footnote 90Footnote 91Footnote 92Footnote 93Footnote 94Footnote 95Footnote 96Footnote 97Footnote 98Footnote 99Footnote 100Footnote 101Footnote 102Footnote 103Footnote 104Footnote 105Footnote 106Footnote 107Footnote 108Footnote 109Footnote 110Footnote 111Footnote 112Footnote 113Footnote 114Footnote 115. Twenty-six SRs further confirm the higher rates of severe COVID-19 among CVD patients, with a higher risk for ICU admission and deathFootnote 67Footnote 68Footnote 69Footnote 70Footnote 71Footnote 72Footnote 74Footnote 76Footnote 77Footnote 78Footnote 81Footnote 82Footnote 84Footnote 86Footnote 87Footnote 88Footnote 91Footnote 92Footnote 98Footnote 99Footnote 101Footnote 107Footnote 113Footnote 114Footnote 115Footnote 116Footnote 117. Specific CVD and conditions tackled by recent SRs include congestive heart failureFootnote 10Footnote 75Footnote 107Footnote 118Footnote 119Footnote 120Footnote 121, cardiac arrythmiaFootnote 75Footnote 119Footnote 120Footnote 122, myocardial injuryFootnote 119Footnote 123, history of heart transplantFootnote 124, generalFootnote 89Footnote 125Footnote 126 and acute cardiac injuryFootnote 67Footnote 75Footnote 97Footnote 110Footnote 120Footnote 123Footnote 127Footnote 128Footnote 129Footnote 130, and coronary heart diseaseFootnote 93Footnote 103Footnote 105Footnote 115Footnote 131. In all cases, the risk of severe COVID-19 and subsequent death raises considerably.

As found in previous versions of this report, a history of respiratory diseases raises the risk for severe COVID-19 and death (six SRs)Footnote 69Footnote 105Footnote 114Footnote 132Footnote 133Footnote 134. Specific conditions associated with increased risk for poor outcomes of COVID-19 were asthma (11 SRs)Footnote 72Footnote 85Footnote 88Footnote 91Footnote 94Footnote 100Footnote 133Footnote 135Footnote 136Footnote 137Footnote 138Footnote 139, COPD (15 SRs)Footnote 67Footnote 77Footnote 84Footnote 86Footnote 90Footnote 98Footnote 113Footnote 114Footnote 116Footnote 140Footnote 141Footnote 142Footnote 143Footnote 144Footnote 145 and ARDS (12 SRs)Footnote 67Footnote 71Footnote 72Footnote 108Footnote 110Footnote 120Footnote 130Footnote 146Footnote 147Footnote 148Footnote 149Footnote 150. Three SRs suggest higher risk for severe COVID-19 in patients with a history of pneumoniaFootnote 73Footnote 112Footnote 133. This update also reinforces findings for diverse types of cancerFootnote 67Footnote 69Footnote 72Footnote 84Footnote 86Footnote 88Footnote 94Footnote 100Footnote 101Footnote 103Footnote 107Footnote 113Footnote 114Footnote 116Footnote 151Footnote 152Footnote 153Footnote 154Footnote 155Footnote 156Footnote 157Footnote 158Footnote 159Footnote 160Footnote 161Footnote 162Footnote 163, cerebrovascular diseasesFootnote 67Footnote 69Footnote 72Footnote 84Footnote 86Footnote 88Footnote 113Footnote 114Footnote 115Footnote 164Footnote 165Footnote 166Footnote 167, acuteFootnote 67Footnote 86Footnote 120Footnote 123Footnote 130Footnote 168Footnote 169Footnote 170Footnote 171Footnote 172Footnote 173Footnote 174Footnote 175Footnote 176Footnote 177Footnote 178Footnote 179 and chronic kidney diseases (including patients who received transplants and hemodialysis)Footnote 67Footnote 69Footnote 82Footnote 86Footnote 88Footnote 94Footnote 100Footnote 103Footnote 105Footnote 107Footnote 113Footnote 116Footnote 140Footnote 142Footnote 169Footnote 174Footnote 175Footnote 178Footnote 179Footnote 180Footnote 181Footnote 182Footnote 183, being linked to severe COVID-19 and higher odds for death. A history of diabetes mellitus has been associated with a higher risk of severe COVID-19 and consequences like cerebrovascular accidents, ICU admission, invasive ventilation and mortalityFootnote 67Footnote 68Footnote 69Footnote 70Footnote 71Footnote 72Footnote 73Footnote 74Footnote 76Footnote 77Footnote 78Footnote 80Footnote 81Footnote 82Footnote 84Footnote 86Footnote 87Footnote 88Footnote 90Footnote 91Footnote 92Footnote 93Footnote 94Footnote 95Footnote 96Footnote 97Footnote 98Footnote 99Footnote 100Footnote 101Footnote 102Footnote 103Footnote 104Footnote 105Footnote 106Footnote 107Footnote 108Footnote 110Footnote 112Footnote 113Footnote 114Footnote 115Footnote 116Footnote 132Footnote 142Footnote 184Footnote 185Footnote 186Footnote 187Footnote 188Footnote 189Footnote 190.

More specific findings of this update include a higher severity of and mortality through COVID-19 among individuals affected by dementiaFootnote 191Footnote 192Footnote 193Footnote 194 and other nervous system diseasesFootnote 164Footnote 195, liver disease (mostly chronic)Footnote 67Footnote 69Footnote 113Footnote 114Footnote 196Footnote 197Footnote 198Footnote 199Footnote 200Footnote 201Footnote 202Footnote 203; and thromboembolism, both arterialFootnote 204Footnote 205Footnote 206Footnote 207Footnote 208Footnote 209 and venousFootnote 210Footnote 211Footnote 212Footnote 213Footnote 214Footnote 215Footnote 216Footnote 217Footnote 218Footnote 219Footnote 220Footnote 221. Evidence seems less consensual regarding autoimmune disease, with conflicting resultsFootnote 88Footnote 100Footnote 222.

Important factors linked to severe COVID-19 outcomes include advanced ageFootnote 69Footnote 71Footnote 72Footnote 78Footnote 79Footnote 90Footnote 101Footnote 105Footnote 106Footnote 109Footnote 134Footnote 141Footnote 180Footnote 206Footnote 223Footnote 224Footnote 225Footnote 226Footnote 227, obesityFootnote 94Footnote 96Footnote 100Footnote 101Footnote 114Footnote 142Footnote 190Footnote 228Footnote 229Footnote 230Footnote 231Footnote 232Footnote 233Footnote 234Footnote 235Footnote 236 and smoking (current or previous)Footnote 67Footnote 77Footnote 78Footnote 81Footnote 86Footnote 94Footnote 103Footnote 104Footnote 145Footnote 237Footnote 238Footnote 239Footnote 240Footnote 241Footnote 242Footnote 243Footnote 244Footnote 245Footnote 246, all of which were mentioned in our previous reports. Interestingly, a history of bariatric surgery seems protective against COVID-19-related death and hospital admissionFootnote 247. In this update, we found no evidence for the role of a specific sex/gender as a risk factor for complications of COVID-19Footnote 67Footnote 69Footnote 71Footnote 72Footnote 73Footnote 77Footnote 78Footnote 79Footnote 87Footnote 90Footnote 92Footnote 101Footnote 103Footnote 104Footnote 105Footnote 130Footnote 141Footnote 223Footnote 226Footnote 248Footnote 249Footnote 250Footnote 251Footnote 252. Regarding the role of race in COVID-19 outcomes, some SRs suggest modest differences in the risk for severe disease and mortality with higher risk among Asians compared to other groupsFootnote 71Footnote 253Footnote 254Footnote 255. Interestingly, newer SRs suggest different risks to acquire COVID-19 in people with different blood types, the highest risk being for those with blood type A and Rh-positive; however, the odds for severe COVID-19 and death are the highest among blood type AB individualsFootnote 256Footnote 257Footnote 258.

Stronger evidence is now emerging concerning pregnant women, neonates and children. Pregnant women are at higher risk for hospital admission (including ICU and invasive ventilation) if affected by COVID-19, compared to non-pregnant womenFootnote 259Footnote 260Footnote 261Footnote 262. The risk is further increased if some of the abovementioned conditions are present, e.g., women who are obese, increased maternal age, pre-existing hypertension and diabetesFootnote 259Footnote 263. Neonates are at higher risk for complications if their mothers are COVID-19-positive, including admission to a neonatal unit, low birth weight and fetal distress, besides the possibility of acquiring the disease from their mothers (vertical transmission)Footnote 259Footnote 260Footnote 261Footnote 263Footnote 264Footnote 265Footnote 266Footnote 267Footnote 268. Regarding children, although they are less prone to complications from COVID-19Footnote 148Footnote 269Footnote 270Footnote 271Footnote 272Footnote 273Footnote 274, a history of cancerFootnote 275 or obesityFootnote 276 increases the risk for severe disease in this age group. We found no evidence fulfilling our inclusion criteria concerning the association between congenital and genetic syndromes (e.g., Down syndrome, intellectual disabilities) with the outcomes of COVID-19. This as a major knowledge gap that should be explored in future prospective studies.

We found moderate evidence suggesting more complications with COVID-19 among individuals who have tuberculosis, influenza, chronic hepatitis, HIV, rheumatic diseases, intestinal diseases, dyslipidemia, secondary infections and vitamin D insufficiency. Also, individuals who underwent surgical procedures while affected by COVID-19 seem to face higher mortality ratesFootnote 277.

A good document summarizing the key risk factors for severe COVID-19 disease can be found at: People who are at high risk for severe illness from COVID-19.

b. What are the signs and symptoms of COVID-19 that oral health care professionals should screen for prior to providing in-person health care?

b.1. Findings from the first update

We identified multiple systematic reviews and meta-analyses plus prospective cohort studies adding to the now strong literature on the signs and symptoms of COVID-19. The additional literature we identified largely confirmed the summary and list of symptoms provided in the earlier report (fever, cough, shortness of breath, fatigue and muscle weakness and aches, headache and digestive symptoms such as diarrheaFootnote 5Footnote 9Footnote 10Footnote 19Footnote 278Footnote 279Footnote 280Footnote 281Footnote 282Footnote 283), although notable new information has been added. This includes new signs and symptoms now recognized as among those often shown by people with COVID-19, including anosmia (lost sense of smell; 39-88%)Footnote 280Footnote 281Footnote 282Footnote 285 and dysgesia (altered sense of taste; 81%)Footnote 285. There were also important additions to the previous list of signs and symptoms, including loss of appetite (34%)Footnote 5, myocardial injury (16%)Footnote 286, dizziness (6%)Footnote 19 and confusion/agitation (5%)Footnote 281. On top of this, there has been additional literature concerning symptoms experienced by children with COVID-19, including fever (53%), cough (39%) and sore throat (14%)Footnote 287. The evidence concerning the symptoms experienced by pregnant women with COVID-19 remains relatively limited compared to the general population but new information now available includes estimates of the proportion of pregnant women with viral pneumonia (71-89%)Footnote 60, fever (44-63%)Footnote 60Footnote 65Footnote 288, cough (36-71%)Footnote 60Footnote 65Footnote 288, dyspnea (13-34%)Footnote 65Footnote 288 and myalgia or fatigue (11%)Footnote 60.

b.2. Findings from the second update

This second update found a large body of evidence confirming previously described signs and symptoms of COVID-19, including fever, cough, dyspnea, sore throat, muscle pain, headache, abdominal pain, diarrhea, agitation/confusion, dizziness, loss of appetite, as well as olfactory and gustatory impairment. Ischemic strokes also seem more frequent among COVID-19 patientsFootnote 115Footnote 164Footnote 289Footnote 290Footnote 291Footnote 292Footnote 293.

Newly described findings include expectoration with blood (hemoptysis), chest pain and tightnessFootnote 67Footnote 69Footnote 130Footnote 294, and ocular manifestations (conjunctival symptoms)Footnote 295. Specific laboratory and imaging findings can be seen in COVID-19 patients (please refer to Appendix B for more information).

Of special interest for oral healthcare providers, a single SR describes oral mucosal lesions associated with COVID-19Footnote 296. Patients may present irregular ulcers, small blisters and petechiae affecting palate, tongue, lips, gingiva or buccal mucosa. Desquamative gingivitis was also observed. Whereas mild cases seem to develop oral mucosal lesions before or at the onset of respiratory symptoms, patients who required medication and hospital admission may have those lesions between 7 and 24 days after symptoms started.

A good evidence-supported document concerning signs and symptoms of COVID-19 can be found at the following link: COVID-19 signs, symptoms and severity of disease: A clinician guide.

c. What evidence exists to support patient scheduling, waiting and other non-treatment management measures for in-person oral health care?

c.1. Findings from the first update

Again, several relevant systematic reviews were identified. One relevant publication reviewed COVID-19 transmission risk and protection protocols published by organizations in countries throughout the world and in academic journalsFootnote 297. They categorized the approaches they found common to all protocols in these publications into pre-, during and post-dental treatment measures as per Table 1 below. It is important to note that this summary of factors common to all reviewed dental COVID-19 protocols does not necessarily reflect any evidence to support their inclusion, or exactly what the advice for each factor is, rather it is a list of factors in dental COVID-19 dental protocols that were common to all review publications.

Table 1. Measures recommended in dental protocols identified in systematic review by Banakar et al.Footnote 297
Stage of care Measures recommended

Pre-dental treatment

Before entering a dental office

At the dental office

Patient triage, identification potential COVID-19 cases, delay of non-urgent dental care, management of dental appointments, active and culturally safe screening of dental staff.

Active and culturally safe screening of patients, physical distancing in the dental office, cleaning and disinfection measures for patients, use of facemasks by everyone entering the dental office, patient education, use of personal protective equipment (PPE) by the dental team and management of the dental operatory room.

During dental treatment Maintaining hand hygiene, offering preoperative anti-microbial mouth rinse to patients, using rubber dams, high-volume saliva ejectors, and extraoral dental radiographs, using 4-handed dentistry, avoiding aerosol-generating procedures, one-visit treatment and environmental cleaning and disinfection procedures.
Post-dental treatment Cleaning and disinfecting reusable facial protective equipment, as well as management of laundry and medical waste.

This list of factors to consider and the categorization of the stages of pre-, during and post-dental treatment was very similar to those documented in two other systematic reviews on the subjectFootnote 298Footnote 299. A review of guidelines for pediatric dentistry during the COVID-19 pandemic published throughout the world made similar observations but in addition, focused on the need for preventive and non-AGPsFootnote 300. The authors mentioned focusing on using approaches including telehealth, using fluoride varnish and resin or sealing non-cavitated caries, using atraumatic restorative technique (ART), interim therapeutic restorations, indirect pulp capping, the Hall technique and silver diamine fluorideFootnote 300.

c.2. Findings from the second update

Some included studies bring new information about telehealth, reaching moderate levels of evidence. The possibility of reducing physical contact and providing continuous care makes telehealth appropriate, with potential to reduce COVID-19-related morbidity and mortalityFootnote 301. Oral health-specific approaches were highlighted as useful for the present pandemic by two reviewsFootnote 302Footnote 303. Examples of contributions by teledentistry include fewer in-person appointments and remote triage of the elderly, with good cost-effectiveness and acceptability by patients, caregivers, families and care facilitiesFootnote 304. The use of remote appointments was also highlighted as favorable for evaluating cleft lip and palate patients, including their post-treatment follow-upFootnote 305. Generic telehealth methods have been pointed as a way to guarantee better access to care during a lockdownFootnote 306 and to evaluate patients in chronic pain in certain circumstancesFootnote 307. One review suggested that the use of mobile apps in health care can increase the effectiveness of tasks such as training personnel and managing patients at risk or with symptoms of COVID-19Footnote 308.

Recommended practices for patient management before entering the dental office include triage of possibly infected patientsFootnote 309Footnote 310 and restricting dental treatment to urgent care during high levels of infectious disease in the local communityFootnote 303. In-office approaches should include active screening with temperature measurement, minimum number of patients in waiting rooms, physical distancing, good ventilation and no shared objects among waiting patients and staffFootnote 309Footnote 310Footnote 311Footnote 312. Emergency treatment of COVID-19 patients should follow high levels of personal protection and be conducted within specifically equipped facilitiesFootnote 310. A recent review questions the use of laboratory tests (e.g., ELISA and rapid serological assays) for SARS-Cov-2 in an oral healthcare setting, and recommend simpler approaches instead, including an interview, checking temperature to rule out possible active COVID-19 cases and strict infection controlFootnote 313.

In terms of disinfection of dental operative settings, disinfecton/cleaning of dental chairs after each patient is recommended, while disinfecton/cleaning of all other surfaces (e.g., operatory light, counters and delivery units) twice a day is also recommendedFootnote 310. Personal belongings and jewelry should not be worn by dental professionals during patient management. Another review suggests cleaning and disinfection of waiting and treatment areas between patients, including doorknobs, chairs, floor, desks, restrooms and elevatorsFootnote 309.

d. What evidence exists to support the use of various forms of personal protective equipment (PPE) while providing in-person oral health care?

d.1. Findings from the first update

We identified several systematic reviews with relevant information. One investigated the use of powered air-purifying respirators (PAPR) compared to N95 masks and other devices in the prevention of viral infection of health care workers, focusing on SARS-Cov-2, SARS-Cov-1, MERS and Ebola viruses. This review reported no difference in HCW infection rates using PAPR versus other respirator devices. They did note however, increased heat tolerance for HCWs using PARP but more difficulty communicating and with mobilityFootnote 314. Another review investigated the benefits for oral and maxillofacial surgeons of using N95 versus surgical masks when performing AGPsFootnote 315. They concluded that most studies comparing the two showed no difference in infection rates of HCWs but there was some evidence suggesting that N95 masks may be better when performing an AGP with a patient known to be COVID-19 positive or whose status is unknownFootnote 315. Another review of N95 and surgical masks and eyewear use in dental care reported that combined use of two or more measures (for example, mask and facial visor) is effective as a barrier to aerolized microbes, although this can be affected by multiple factors such as airflow dynamics, aerolized particle size, prolonged wearing and wetness of masks and poor fit. Importantly, they noted that no intervention on its own has been demonstrated effective at preventing infectionFootnote 316. We identified no research evidence that referred specifically to KN95 masks.

Another review investigated the physical and mental health impacts of COVID-19 on HCWs during the pandemicFootnote 317 and reported that working in a high-risk setting, having a COVID-19-diagnosed family member, inadequate hand hygiene, improper PPE use, close contact with patients ≥ 12 times daily, extended contact hours (≥15 daily) and unprotected exposure are associated with increased risk of COVID-19-related impacts for HCWsFootnote 317. They also noted that prolonged PPE usage led to cutaneous manifestations and skin damage, that HCWs experienced high levels of depression, anxiety, insomnia and distress, and that female HCWs and nurses are disproportionately affectedFootnote 317. All this suggests the need for vigilance with infection control procedures, shorter work hours and mental health support for HCWsFootnote 317.

d.2. Findings from the second update

Again, this update identified several relevant new SRs. This update found moderate evidence regarding protection of health care workers against COVID-19. In general, reviews stress the critical role of proper donning and doffing of PPEFootnote 318Footnote 319. Again, reviews highlight the adversities of prolonged use of PPE, with skin damage on the nasal bridge being the most common problemFootnote 320.

Several reviews approached specific PPE items, including:

Despite the evidence that complex PPEs and procedures (e.g., PAPR, doffing after sanitation) may be more protective in ideal settings, we lack data about their performance in diverse “real life” scenarios. Future studies should clarify whether more complexity may lead to higher risk of inadequate use of PPEs and thus higher risk of contamination in oral healthcare settings.

Several reviews compared N95 to medical masksFootnote 309Footnote 310Footnote 319Footnote 321Footnote 323. General findings show that N95 masks may be superior in moderate- to high-risk clinical settings, with further reduction in the risk of COVID-19 infection and other respiratory viruses. Some reviews recommend that dental professionals, including oral and maxillofacial surgeons, should wear N95 masks when small-sized aerosolized particles are expectedFootnote 319. Although face masks (medical or not) may reduce primary respiratory infection riskFootnote 325, COVID-19-specific studies are still needed.

The Health Canada website also has information concerning PPE.

e. What evidence exists to support the decontamination and re-use of PPE?

e.1. Findings from the first update

We identified one additional systematic review on this subjectFootnote 326. The review investigated the use of microwave and heat-based decontamination of N95 masks and found that microwave irradiation may provide safe and effective viral decontamination for N95 masks while conserving function but that autoclaving did not do the latter so is not supported. The authors did however note that more research needs to be performed in "real world settings" to confirm their conclusionsFootnote 327.

e.2. Findings from the second update

Few included sources of evidence approached possible ways to re-use PPE. One scoping review did not recommend routine decontamination of facemasks, but rather in situations of shortage onlyFootnote 319. Some specific decontamination methods before re-use of masks include:

f. What evidence exists concerning the provision of aerosol-generating procedures (AGP) as part of in-person oral health care?

f.1. Findings from the first update

We identified two systematic reviews with relevant subject matter published during the period July to October inclusive. One systematic review confirmed that SARS-Cov-2 is present in saliva and as well as sputum and the nasopharynx and concluded that saliva could be used to test for COVID-19Footnote 328. Another rapid systematic review was performed with the aim of classifying aerosol generating procedures (AGPs)Footnote 329. They identified a list of procedures with strong agreement in the literature that they were AGPs. This list did not include dental procedures and the authors hypothesized that this non-inclusion of dental procedures is because they comprise a wide range of acts some of which are AGPs and others are notFootnote 329. This raises the important point that the dental professions need to identify AGPs versus non-AGPs within dental procedures and this needs to be based on sound principles and science. This is important because it has implications for the use of PPE and other interventions while performing dental procedures.

f.2. Findings from the second update

We identified limited evidence regarding this topic. Three reviews indicate that wastewater can be a source of infection by SARS‐Cov‐2Footnote 330Footnote 331Footnote 332, although we identified no study fulfilling our inclusion criteria with recommendations for oral healthcare settings. Even with the paucity of direct evidence, it seems reasonable to highlight the importance of the careful management of water processors and sedimentation tanks in dental offices and laboratories, whose interior should be seen as a potential reservoir of the virus.

Regarding transmission by droplets, particles smaller than 5 μm can move beyond 8 meters and stay suspended for more than 2 hoursFootnote 311. Environmental conditions may affect the viability of SARS-Cov-2, with longest lifespan at low temperatures and high humidity.

SRs recommend a hierarchy of contamination risk for dental procedures, as followsFootnote 333:

High-risk procedures also include laser surgery and osteotomies, commonly used in oral and maxillofacial surgeryFootnote 315Footnote 334Footnote 335.

g. What evidence exists to support transmission mitigation strategies during the provision of in-person oral health care?

g.1. Findings from the first update

As previously mentioned, we identified a systematic review confirming that SARS-Cov-2 is present in saliva and as well as in sputum and the nasopharynxFootnote 328. This is important to consider in the context of this topic concerning mitigating strategies. We also identified several systematic reviews published in the relevant period investigating a number of mitigating strategies during the provision of dental care and other health care procedures. A Cochrane review looked at a range of mitigating strategies including high volume evacuation, dental isolation combination systems, rubber dam and disinfectants, including disinfectant coolantsFootnote 336. The authors observed that all the studies included in their review investigated interventions' effects on colony forming units of bacteria, not viruses or respiratory disease transmission. They nevertheless concluded that there was probably benefit in using all the tested interventions but that the evidence to support them was weakFootnote 336. Another Cochrane review investigated the potential protective effect against COVID-19 transmission of health care workers using antimicrobial mouthwashes and/or nasal sprays and identified no studies, although they did note a few relevant on-going randomized trialsFootnote 337. Another systematic review investigated the specific question "Does hydrogen peroxide mouthwash (at any concentration) have a virucidal effect?" and identified no research fulfilling their quality criteria addressing this question, thereby concluding that there is no evidence to support the use of hydrogen peroxide mouthwash to control viral loadFootnote 338. A rapid systematic review noted the possible beneficial effect of hypertonic saline nasal washes and mouth washes to mechanically reduce viral load and so potentially reduce risk of transmission from patients with COVID-19 to othersFootnote 339. Finally, another systematic review investigated the potential benefits of anti-microbial mouthwashes in managing COVID and found no clinical studies, only in vitro evaluations of chlorhexidine, povidone-iodine and C31G. The review noted that all these mouthwashes demonstrated reduced viral load in in vitro studies but recognized the lack of clinical evidenceFootnote 340.

In summary, there remains no evidence concerning interventions to mitigate viral or COVID-19 transmission during dental treatments but there is good evidence supporting Chlorhexidine mouthwash reducing bacterial load (this was identified in the previous version of this report). Evidence for other interventions is weak and equivocal.

g.2. Findings from the second update

Newer systematic and scoping reviews indicate different methods to mitigate contamination during dental treatment, although evidence could be classified as limited. Two SRs recommend the use of chemomechanical caries removal, extraoral radiographs and hand scalers whenever possibleFootnote 309.

High-volume evacuators (HVE) have also been recommended as a valid approach to reduce contamination during AGP, although included reviews gathered data from studies about bacterial contaminationFootnote 309Footnote 312Footnote 319Footnote 341. The same has been stated for the use of a rubber dam, which is another effective method to reduce airborne particles and thus microbial contaminationFootnote 310Footnote 312Footnote 319Footnote 341.

Some of the reviews and clinical studies included in this update approach the use of different antimicrobial mouthrinses to reduce contamination in the mouth and pharynx. In general, the pre-procedural use of those mouthrinses is considered a valid method to reduce contamination by aerosols during dental treatmentFootnote 309Footnote 319Footnote 341Footnote 342, although the real benefit in COVID-19 patients remains unclearFootnote 343. Povidone- iodine (PVP-I) and essential oils (EO) showed efficacy against SARS-CoV-2 in a small RCT (5 participants/mouthwash), when used as a prophylaxis for viral spread. In that trial, participants recruited from a COVID-19 reference center used either substances for 4-6 days (gargling for 30 sec, 3x/day), reaching negative viral load in most cases at 4 daysFootnote 344. There is evidence that reinforces the virucidal effect of PVP-I against other respiratory virusesFootnote 345, whereas EO, chlorhexidine (CHX) and cetylpyridinium chloride (CPC) mouthrinses are able to reduce airborne bacteria during AGPFootnote 341.

A recent RCT displays promising results for CPC-, dipotassium glycyrrhizinate- and tranexamic acid-based mouthrinses used 3x daily for 7 to 10 days before dental implant placement, as methods to reduce airborne bacterial contaminationFootnote 346. Finally, a systematic review states that there is no evidence to support whether mouthwashes containing chlorine compounds, including chlorine dioxide and sodium chlorite, can prevent or manage COVID-19Footnote 347.

h. What evidence exists to support space ventilation strategies that reduce the risk of transmission?

h.1. Findings from the first update

We identified one systematic review published in the relevant period and with pertinent informationFootnote 336. This Cochrane systematic review of multiple interventions to reduce aerosols during dental procedures reported one study with only two participants suggesting a stand-alone ventilation system may reduce aerosols during cavity preparation and ultrasonic scaler useFootnote 336. It also reported another study with 50 participants suggesting laminar flow with a HEPA filter may reduce aerosols at 76cm from the floor and 20-30cm from a patient's mouth. However, they stated that no studies reported on viral contamination or disease transmission, rather they concerned bacterial contamination and the evidence was of low certaintyFootnote 336.

h.2. Findings from the second update

In the period, there were just three SRs and a scoping review about ventilation as a way to reduce COVID-19 transmission. Air purifiers with HEPA filters and room ventilation (30 min) between patients have been recommended as a protocol to reduce the risk of infection, as well as irradiation with UVCFootnote 309Footnote 310. Recommendations for HEPA filters included at least 99.995% retention for particles of 0.01 µm or moreFootnote 348. In case of emergency dental treatment of COVID-19-positive patients, the operatory room should be under negative pressure or continuous air exchangeFootnote 312. Although the role of air exchange is recommended for any patientFootnote 331, the exact degree of protection provided by those approaches is still unclear. Recommended air exchange rates depend on whether the patient is diagnosed with COVID-19, with at least 1.5 and 6.0 air change/hr for negative and positive patients, respectivelyFootnote 348.

i. What evidence exists to support the disinfection of surfaces in spaces in which oral health care is provided?

i.1. Findings from the first update

We identified one additional systematic review covering surface disinfection published during this periodFootnote 349. This review investigated the use of surface decontamination against SARS-Cov-2 and against airborne pathogens and directly transmitted viral pathogens in dental settings. They found no evidence that fulfilled their quality criteria concerning SARS-Cov-2. However, they reported finding good quality evidence that 70% ethanol and 0.5% sodium hypochlorite used as surface disinfectants reduce the possibility of surface transmission of respiratory viruses. They recommended applying these disinfectants on surfaces for 1 minute to reduce the risk of contamination with SARS-Cov-2Footnote 349.

i.2. Findings from the second update

This second update gathered more SRs about this topic than the previous update. Moderate evidence suggests the disinfection of impressions, trays and dental prostheses with 1% NaOCl for 1 minute as a way to reduce SARS-CoV infectivityFootnote 350. A scoping review reinforces the need for routine disinfection of any dental prosthetic material with intermediate level disinfectants as well as methods to mitigate patients’ gag reflex (e.g., proper suction and anaesthesia)Footnote 312.

Some reviews gathered limited evidence that certain disinfectants may reduce contamination by bacteria and other respiratory viruses on diverse surfaces, including door handles, chairs, desks and other surfaces that may be touched regularly. The most frequent disinfectants studied were 0.1% sodium hypochlorite, 62-70% isopropyl alcohol, 0.5% hydrogen peroxideFootnote 309Footnote 310Footnote 351. Single SRs indicated successful viral inactivation with glutaraldehyde and iodine-containing detergentsFootnote 351, whereas 0.05-0.2% benzalkonium chloride and 0.02% chlorhexidine digluconate were less able to inactivate various coronavirusesFootnote 331. Finally, irradiation by ultraviolet-C (UV-C) has been stated as an effective method to inactivate pathogenic bacteriaFootnote 352 and virusesFootnote 351. Most of those agents may be useful against SARS-Cov-2, although this second update could not gather any direct evidence.

It is important to note that Health Canada has lists of surface disinfectants and hand sanitizers that it states are supported by evidence and likely to be effective against SARS-CoV-2. However, since disinfecting agents may damage dental materials and equipment and other surfaces, it is important to review their compatibility before use.

Glossary of abbreviations

Abbreviation
Explanation
AGP
Aerosol-generating procedures
CDC
Centers for Disease Control and Prevention
CFU
Colony-Forming Unit (count of viable bacteria)
CHX
Chlorhexidine
COVID-19
Coronavirus disease 2019
DHCP
Dental Health Care Professionals
HCP
Health Care Professionals
HCW
Health Care Worker
HVE
High-Volume Evacuation
H1N1
Influenza A
ICU
Intensive Care Unit
IgM
Immunoglobulin M
MD
Mean Deviation (statistical analysis)
MERS
Middle East Respiratory Syndrome
PPE
Personal Protective Equipment
PCS
Prospective Cohort Study
RCT
Randomized Controlled Trials
RR
Risk Ratio (statistical analysis)
SARS
Severe Acute Respiratory Syndrome
SARS-CoV-2
Severe Acute Respiratory Syndrome Coronavirus-2
SR
Systematic Review
TMD
Temporomandibular disorders
UVGI
Ultra-violet Germicidal Irradiation

Appendix A: Key findings for topic a) patients at greater risk of the consequences of COVID-19

The following diseases, conditions and groups have strong evidence for risk.

Heart diseases and conditions

Cardiovascular disease (CVD)

Main finding Source

Higher risk for COVID-19:

  1. severity: odds 1.70 to 4.81x greater, RR=2.25 to 4.97
  2. ICU admission: odds 1.50 to 3.11x greater
  3. mortality: 10.9% to 37%, odds 2.71 to 10.8x greater, RR 2.1

Prevalence: 9.7% to 28.30%

SR and meta-analysis: Sabatino et al.Footnote 68; SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Biswas et al.Footnote 72; SR and meta-analysis: Cordero et al.Footnote 74; SR and meta-analysis: Corona et al.Footnote 116; SR and meta-analysis: de Almeida-Pititto et al.Footnote 76; SR and meta-analysis: Del Sole et al.Footnote 77; SR and meta-analysis: Dorjee et al.Footnote 78; SR and meta-analysis: Emami et al.Footnote 81; SR and meta-analysis: Fathi et al.Footnote 82; SR and meta-analysis: Honardoost et al.Footnote 84; SR and meta-analysis: Katzenschlager et al.Footnote 86; SR and meta-analysis: Khamis et al.Footnote 87; SR and meta-analysis: Khan et al.Footnote 88; SR and meta-analysis: Mahumud et al.Footnote 91; SR and meta-analysis: Matsushita et al.Footnote 92; SR and meta-analysis: Mudatsir et al.Footnote 98; Meta-analysis: Naeini et al.Footnote 99; SR and meta-analysis: Nannoni et al.Footnote 115; Meta-analysis: Noor et al.Footnote 101; Meta-analysis: Shoar et al.Footnote 117; SR and meta-analysis: Ssentongo et al.Footnote 107; SR and meta-analysis: Yin et al.Footnote 113; SR and meta-analysis: Zhou Y et al.Footnote 114

Congestive heart failure

Main finding Source

Higher risk for COVID-19:

  1. poor outcomes: odds 2.86x greater
  2. hospitalization: odds 2.37x greater
  3. severity: odds 4.76x greater, RR=2.03
  4. mortality: odds 3.46x to 6.02x greater, RR 2.35

Prevalence in patients with COVID-19: 11.50% to 22.34%

SR and meta-analysis: Chidambaram et al.Footnote 73; SR and meta-analysis: Dalia et al.Footnote 75; SR and meta-analysis: Li X et al.Footnote 118; SR and meta-analysis: Sahranavard et al.Footnote 119; SR and meta-analysis: Ssentongo et al.Footnote 107; Meta-analysis : Vakili et al.Footnote 120; SR and meta-analysis: Yonas et al.Footnote 121

Cardiac arrythmias

Main finding Source

Higher risk for COVID-19:

  1. severity: odds 3.61x greater
  2. ICU admission: 13.09x greater
  3. associated with pneumonia: severity odds 17.97x greater

Prevalence in patients with COVID-19: 10.11% to 16.64%

SR and meta-analysis: Dalia et al.Footnote 75; SR and meta-analysis: Sahranavard et al.Footnote 119; Meta-analysis : Vakili et al.Footnote 120; Meta-analysis : Wen et al.Footnote 122

Myocardial injury

Main finding Source

Higher risk for COVID-19:

  1. severity: 44%
  2. mortality: 74%

Prevalence in patients with COVID-19: 17.85%

SR and meta-analysis: Sahranavard et al.Footnote 119; SR and meta-analysis: 2 Vakhshoori et al.Footnote 123

Heart transplant recipients

Main finding Source

Higher risk for COVID-19:

  1. mechanical ventilation: 33.3%
  2. mortality: 25.6%
  3. with diabetes: odds 3.60x greater
  4. with Chronic kidney disease: odds 3.79x greater
SR and meta-analysis: Granger et al.Footnote 124

Cardiac injury

Main finding Source

Higher risk for:

  1. severe COVID-19: developing coagulopathy (RR: 3.86)
  2. ICU admission: 30% (RR: 4.06)
  3. mechanical ventilation (RR: 5.53)
  4. mortality (RR:7.79)

Lower chance to increased risk when associated to:

  1. acute respiratory distress syndrome (RR:3.22)
  2. acute kidney injury (RR: 11.52)
Meta-analysis: Bansal et al.Footnote 125; SR and meta-analysis: Koeppen et al.Footnote 89; SR and meta-analysis: Zeng et al.Footnote 124

Acute cardiac injury

Main finding Source

Higher risk for COVID-19:

  1. severity: 36%, odds -8.52 to 16.79x greater
  2. mortality: 48%, odds 16.79x greater

Prevalence in patients with COVID-19:

  • 15.68% to 37.1%
  • age <60 years: 15%
  • age >60 years: 30%
  • males: 54.3%
SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Dalia et al.Footnote 75; SR and meta-analysis: Fu et al.Footnote 127; SR and meta-analysis: Huang et al.Footnote 128; SR and meta-analysis: Momtazmanesh et al.Footnote 97; SR and meta-analysis: Prasitlumkum et al.Footnote 129; SR and meta-analysis: Vakhshoori et al.Footnote 123; Meta-analysis : Vakili et al.Footnote 120; SR and meta-analysis : Wang Z et al.Footnote 110; Meta-analysis: Zhong et al.Footnote 130

Coronary heart disease

Main finding Source

Higher risk for COVID-19:

  1. severity: odds 3.23 to 4.10x greater
  2. ICU admission: odds 2.25x greater
  3. mortality: odds 4.37x greater

Higher risk to developing acute cerebrovascular diseases, compared to those who did not: odds 3.12x greater.

Higher risk to developing hypertension: 30%, odds 3.78x greater.

SR and meta-analysis: Nannoni et al.Footnote 115; Meta-analysis: Liang et al.Footnote 131; SR and meta-analysis: Meng et al.Footnote 93; SR and meta-analysis: Radwan et al.Footnote 103; SR and meta-analysis Sepandi et al.Footnote 105

Hypertension

Main finding Source

Higher risk for COVID-19:

  1. severity: 32% to 37%; odds 0.71 to 3.17x greater, RR= 1.79 to 2.87
  2. ICU admission: 49.5%, odds 1.62 to 2.95x greater, RR=2.11
  3. mortality: 46% to 66%, odds 1.97 to 4.17x greater; RR 1.52 to 1.8

Prevalence: 11.7% to 55%

Patients with COVID-19 developing acute cerebrovascular diseases, compared to those who did not: odds 7.35 x greater

SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Sabatino et al.Footnote 68; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Barrera et al.Footnote 70; SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Biswas et al.Footnote 72; SR and meta-analysis: Chidambaram et al.Footnote 73; SR and meta-analysis: Cordero et al.Footnote 74; SR and meta-analysis: Dalia et al.Footnote 75; SR and meta-analysis: de Almeida-Pititto et al.Footnote 76; SR and meta-analysis: Del Sole et al.Footnote 77; SR and meta-analysis: Dorjee et al.Footnote 78; SR and meta-analysis: Du et al.Footnote 79; SR and meta-analysis: Ebrahimi et al.Footnote 80; SR and meta-analysis: Emami et al.Footnote 81; SR and meta-analysis: Fathi et al.Footnote 82; SR and meta-analysis: GuoX et al.Footnote 83; SR and meta-analysis: Honardoost et al.Footnote 84; SR and meta-analysis: Javanmardi et al.Footnote 85; SR and meta-analysis: Katzenschlager et al.Footnote 86; SR and meta-analysis: Khamis et al.Footnote 87; SR and meta-analysis: Khan et al.Footnote 88; SR and meta-analysis: Koeppen et al.Footnote 89; SR and meta-analysis: Lu et al.Footnote 90; SR and meta-analysis: Mahumud et al.Footnote 91; SR and meta-analysis: Matsushita et al.Footnote 92; SR and meta-analysis: Meng et al.Footnote 93; SR and meta-analysis: Mesas et al.Footnote 94; SR and meta-analysis: Miller et al.Footnote 95; SR and meta-analysis: Moazzami et al.Footnote 96; SR and meta-analysis: Momtazmanesh et al.Footnote 97; SR and meta-analysis: Mudatsir et al.Footnote 98; Meta-analysis: Naeini et al.Footnote 99; SR and meta-analysis: Ng et al.Footnote 100; Meta-analysis: Noor et al.Footnote 101; SR and meta-analysis: Parveen et al.Footnote 102; SR and meta-analysis: Radwan et al.Footnote 103; Meta-analysis : Rahman et al.Footnote 104; SR and meta-analysis : Sepandi et al.Footnote 105; SR and meta-analysis: Silverio et al.Footnote 106; SR and meta-analysis: Ssentongo et al.Footnote 107; SR and meta-analysis: Tan et al.Footnote 108; SR and meta-analysis: Taylor et al.Footnote 109; SR and meta-analysis : Wang Z et al.Footnote 110; SR and meta-analysis: Wong et al.Footnote 111; SR and meta-analysis: Xie et al.Footnote 112; SR and meta-analysis: Yin et al.Footnote 113; SR and meta-analysis: Zhou Y et al.Footnote 114; SR and meta-analysis: Nannoni et al.Footnote 115

Respiratory diseases and conditions

Respiratory disease (general)

Main finding Source

Higher risk for COVID-19:

  1. severity: odds 3.33x greater
  2. mortality: odds 2.55x greater

Prevalence in patients with COVID-19: 8% to 10.8%

Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Gold et al.Footnote 132; SR and meta-analysis: Hashizume et al.Footnote 133; SR and meta-analysis : Sepandi et al.Footnote 105; SR and meta-analysis: Xiang et al.Footnote 134; SR and meta-analysis: Zhou Y et al.Footnote 114

Respiratory disease (asthma)

Main finding Source

Higher risk for COVID-19:

  1. severity: 14.55%, RR=1.21
  2. ICU admission: odds 1.39x greater, RR=0.87 to 1.19
  3. endotracheal intubation: RR=1.27
  4. mechanical ventilation: 14%, odds 0.96x greater, RR=0.87 to 1.03
  5. mortality: 9%, odds 1.94x greater, RR=0.80 to1.09
  6. prevalence in patients with COVID-19: 1.1% to 16.9%
Meta-analysis: Biswas et al.Footnote 135; SR and meta-analysis: Hashizume et al.Footnote 133; Meta-analysis: Hussein et al.Footnote 136; SR and meta-analysis: Javanmardi et al.Footnote 85; SR and meta-analysis: Khan et al.Footnote 88; SR and meta-analysis: Liu S et al.Footnote 137; SR and meta-analysis: Mahumud et al.Footnote 91; SR and meta-analysis: Mesas et al.Footnote 94; SR and meta-analysis: Ng et al. [100]; SR and meta-analysis: Shi et al.Footnote 138; SR and meta-analysis: Sunjaya et al.Footnote 139

Respiratory disease (pneumonia/bilateral lung involvement)

Main finding Source

Higher risk for COVID-19 severity: 8.51%, odds 4.86x greater

Prevalence in patients with COVID-19: 82.2%

SR and meta-analysis: Chidambaram et al.Footnote 73; SR and meta-analysis: Hashizume et al.Footnote 133; SR and meta-analysis: Xie et al.Footnote 112

Chronic obstructive pulmonary disease (COPD)

Main finding Source

Higher risk for:

  1. poor outcomes: odds 5.01x greater
  2. severe COVID-19 (risk difference: 0.05; odds 2.48 to 4.67x greater, RR=3.63)
  3. severity associated with smokers: odds 1.65x greater
  4. ICU admission (risk difference: 0.10, odds 1.39 to 8.33x greater)
  5. COVID-19 mortality: 6.8% (risk difference: 0.12, odds 3.43 to 4.36x greater, RR=3.18)
  6. mortality associated with males: RR=1.20
SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Awortwe et al.Footnote 140; SR and meta-analysis: Corona et al.Footnote 116; SR and meta-analysis: Del Sole et al.Footnote 77; SR and meta-analysis: Honardoost et al.Footnote 84; SR and meta-analysis: Jain et al.Footnote 141; SR and meta-analysis: Katzenschlager et al.Footnote 86; SR and meta-analysis: Lu et al.Footnote 90; SR and meta-analysis: Mudatsir et al.Footnote 98; SR and meta-analysis: Poly et al.Footnote 142; SR and meta-analysis: Pranata et al.Footnote 143; SR and meta-analysis: Rabbani et al.Footnote 144; SR and meta-analysis: Yin et al.Footnote 113; SR and meta-analysis: Zhao et al.Footnote 145; SR and meta-analysis: Zhou Y et al.Footnote 114

Acute respiratory distress syndrome (ARDS)

Main finding Source

Higher risk for COVID-19:

  1. severity: 33.15% to 39%; odds: 26.12 to 34.45x greater
  2. worse clinical outcomes for patients infected with SARS-CoV-2 with elevated D-dimers
  3. ICU admission: 76.1%
  4. mortality: odds 2.74x greater

Prevalence in patients with COVID-19: 14.6% to 60.8%

SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Bansal et al.Footnote 146; SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Biswas et al.Footnote 72; SR and meta-analysis: Hasan et al.Footnote 147; SR and meta-analysis: Cui et al.Footnote 148; SR and meta-analysis: Tan et al.Footnote 108; Meta-analysis : Vakili et al.Footnote 120; SR and meta-analysis : Wang Z et al.Footnote 110; SR and meta-analysis: Xie Y et al.Footnote 149; SR and meta-analysis: Zhang JJY et al.Footnote 150; Meta-analysis: Zhong et al.Footnote 130

Diabetes mellitus

Main finding Source

Higher risk to developing acute cerebrovascular diseases, compared to those who did not: 17% vs 6%; odds 5.56x greater.

Higher risk for COVID-19:

  1. severity: 10.6% to18%, odds 1.48 to 2.78x greater, RR=1.51 to 3.20
  2. ICU admission: 26.6%, odds 1.58x greater, RR=1.16 to 1.88
  3. mechanical ventilation: odds 1.35x greater
  4. mortality: 13.3% to 39%, odds 1.02 to 3.73x greater, RR=1.61 to 3.16
  5. mortality with hyperglycemia rates: odds 3.45x greater

Prevalence in patients with COVID-19: -7.87% to 33%

SR and meta-analysis: Nannoni et al.Footnote 115; SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Sabatino et al.Footnote 68; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Barrera et al.Footnote 70; SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Biswas et al.Footnote 72; SR and meta-analysis: Chidambaram et al.Footnote 73; SR and meta-analysis: Cordero et al.Footnote 74; SR and meta-analysis: Corona et al.Footnote 116; SR and meta-analysis: de Almeida-Pititto et al.Footnote 76; SR and meta-analysis: Del Sole et al.Footnote 77; SR and meta-analysis: Dorjee et al.Footnote 78; SR and meta-analysis: Du et al.Footnote 184; SR and meta-analysis: Ebrahimi et alFootnote 80; SR and meta-analysis: Emami et al.Footnote 81; SR and meta-analysis: Faghir-Gangi et al.Footnote 85; SR and meta-analysis: Fathi et al.Footnote 82; SR and meta-analysis: Gold et al.Footnote 132; SR and meta-analysis: Honardoost et al.Footnote 84; Meta-analysis: Hussain et al.Footnote 186; SR and meta-analysis: Katzenschlager et al.Footnote 86; SR and meta-analysis: Khamis et al.Footnote 87; SR and meta-analysis: Khan et al.Footnote 88; SR and meta-analysis: Lu et al.Footnote 90; SR and meta-analysis: Mahumud et al.Footnote 91; SR and meta-analysis: Matsushita et al.Footnote 92; SR and meta-analysis: Meng et al.Footnote 93; SR and meta-analysis: Mesas et al.Footnote 94; SR and meta-analysis: Miller et al.Footnote 95; SR and meta-analysis: Moazzami et al.Footnote 96; SR and meta-analysis: Momtazmanesh et al.Footnote 97; SR and meta-analysis: Mudatsir et al.Footnote 98; SR and meta-analysis: Ng et al.Footnote 100; Meta-analysis: Noor et al.Footnote 101; SR and meta-analysis: Palaiodimos et al.Footnote 187; SR and meta-analysis: Parveen et al.Footnote 102; SR and meta-analysis: Poly et al.Footnote 142; SR and meta-analysis: Radwan et al.Footnote 103; Meta-analysis : Rahman et al.Footnote 104; SR and meta-analysis : Sepandi et al.Footnote 105; SR and meta-analysis : Shang et al.Footnote 188; SR and meta-analysis: Silverio et al.Footnote 106; SR and meta-analysis: Ssentongo et al.Footnote 107; SR and meta-analysis: Tan et al.Footnote 108; SR and meta-analysis : Wang Z et al.Footnote 110; SR and meta-analysis: Wu ZH et al.Footnote 189; SR and meta-analysis: Xie et al.Footnote 112; Meta-analysis: Yang J et al.Footnote 190; SR and meta-analysis: Yin et al.Footnote 113; SR and meta-analysis: Zhou Y et al.Footnote 114

Cancer

Main finding Source

Higher risk infection in patients with COVID-19 with different types of cancer:

  1. prostate cancer: a worse prognosis, 2.6% (n=118/4532)
  2. colorectal cancer: not a significant risk in the global population (odds 0.261x greater), but significant correlation in Chinese patients (odds 0.221x greater)
  3. hematological cancer: RR=2.68
  4. solid tumor: RR=1.16

Higher risk for COVID-19:

  1. severity: 45.4%, odds 2.28 to 3.91x greater, RR=1.47
  2. ICU admission: 14.5%, odds 3.10x greater, RR=1.56
  3. mechanical ventilation: 11.7%, odds 2.5 to 4.86x greater
  4. mortality: 8.2% to 30%, odds 1.63 to 3.7x greater, RR =1.66 to 1.8
  5. mortality of patients > 65 years with cancer and COVID-19: RR=1.06 to 1.82
  6. mortality of male patients with cancer and COVID-19: RR=1.16
  7. mortality of patients with comorbidities, cancer and COVID-19: RR=1.12
  8. mortality lung cancer: RR=1.8
  9. mortality in patients with active chemotherapy: odds 1.42 to 1.85x greater
  10. lung cancer: mortality odds 1.62x greater
  11. hematologic cancer: mortality in adults: 34%, in children:4%, > 60 years RR=1.82
SR and meta-analysis: Mou et al.Footnote 151Footnote 88; SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Antikchi et al.Footnote 152; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Biswas et al.Footnote 72; SR and meta-analysis: Corona et al.Footnote 116; SR and meta-analysis: Desai et al.Footnote 153; SR and meta-analysis: ElgoharyFootnote 154; Meta-analysis: Giannakoulis et al.Footnote 155; SR and meta-analysis: Honardoost et al.Footnote 84; SR and meta-analysis: Katzenschlager et al.Footnote 86; SR and meta-analysis: Khan et al.Footnote 88; SR and meta-analysis: Liu H et al.Footnote 156; SR and meta-analysis: Liu Y et al.Footnote 353 SR and meta-analysis: Mesas et al.Footnote 94; SR and meta-analysis: Ng et al.Footnote 100; Meta-analysis: Noor et al.Footnote 101; SR and meta-analysis: Park et al.Footnote 157; SR and meta-analysis: Peravali et al.Footnote 158; SR and meta-analysis: Radwan et al.Footnote 103; SR and meta-analysis: Ssentongo et al.Footnote 107; SR and meta-analysis: Vijenthira et al.Footnote 159; SR and meta-analysis: Yang L et al.Footnote 160; SR and meta-analysis: Yekeduz et al.Footnote 161; SR and meta-analysis: Yin et al.Footnote 113; SR and meta-analysis: Zarifkar et al.Footnote 162; SR and meta-analysis: Zhang et al.Footnote 163; SR and meta-analysis: Zhou Y et al.Footnote 114

Cerebrovascular diseases and conditions

Cerebrovascular diseases (general)

Main finding Source

Patients with COVID-19 developing acute cerebrovascular diseases, compared to those who did not:

  1. older (pooled median difference = 4.8 years)

Higher risk for COVID-19:

  1. severity: odds 2.42 to 5.10x greater
  2. ICU admission: odds 5.88x greater
  3. mortality: odds 5.21x greater

Prevalence in patients with COVID-19: 6% to 15.58%

SR and meta-analysis: Nannoni et al.Footnote 115; SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Nannoni et al.Footnote 115; SR and meta-analysis: Biswas et al.Footnote 72; SR and meta-analysis: Del Sole et al.Footnote 77; SR and meta-analysis: Gao et al.Footnote 164; SR and meta-analysis: Honardoost et al.Footnote 84; SR and meta-analysis: Katzenschlager et al.Footnote 86; SR and meta-analysis: Khan et al.Footnote 88; Meta-analysis: Xu J et al.Footnote 165; SR and meta-analysis: Yin et al.Footnote 113; Meta-analysis: Zhang J et al.Footnote 166; SR and meta-analysis: Zhou Y et al.Footnote 114

Cerebral venous thrombosis

Main finding Source
  • 4.2% of cerebrovascular diseases in individuals with COVID-19 (n=406 patients)
  • Predisposing factors (31%)
  • Mortality (40%)
  • 0.08% frequency among patients hospitalized for SARS-CoV-2 (n=34,331 patients)
SR and meta-analysis: Baldini et al.Footnote 167

Nervous system diseases and conditions

Nervous system diseases (general)

Main finding Source

Higher risk for COVID-19:

  1. severity: odds 3.19x greater
  2. mortality: odds 3.75x greater

Prevalence in patients with COVID-19: 6% to 15.58%

SR and meta-analysis: Gao et al.Footnote 164

Ischemic cerebrovascular accidents

Main finding Source

Prevalence in patients with COVID-19: 1.7%

Higher risk for COVID-19:

  1. mortality: 29.2%
SR and meta-analysis: Parsay et al.Footnote 195

Dementia

Main finding Source

Higher risk for COVID-19:

  1. severity: odds 2.63x greater
  2. mortality: odds 2.62 to 5.17x greater
  3. poor outcomes: odds 2.67x greater
Meta-analysis: Hariyanto et al.Footnote 191Footnote 128; SR and meta-analysis: July et al.Footnote 192; SR and meta-analysis: Liu N et al.Footnote 193; SR and meta-analysis: Zuin et al.Footnote 194

Chronic kidney diseases (CKD)

CKD (general)

Main finding Source

Higher risk for COVID-19:

  1. severity: risk difference: 0.05; odds 1.26 to 4.06x greater, RR=2.89 to 3.25
  2. admission to ICU: risk difference: 0.10, odds 1.48x greater
  3. mechanical ventilation: odds 2.4x greater
  4. mortality: 27%, risk difference: 0.12, odds 2.36 to 5.81x greater, RR=3.47
  5. poor outcomes: RR=2.63

Prevalence in patients with COVID-19: 3.52% to 5.19%

SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Awortwe et al.Footnote 140; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Cai et al.Footnote 180; SR and meta-analysis: Fathi et al.Footnote 82; SR and meta-analysis: Katzenschlager et al.Footnote 86; SR and meta-analysis: Khan et al.Footnote 88; SR and meta-analysis: Liu YF et al.Footnote 174; SR and meta-analysis: Mesas et al.Footnote 94; SR and meta-analysis: Ng et al.Footnote 100; SR and meta-analysis: Poly et al.Footnote 142; SR and meta-analysis: Pranata et al.Footnote 181; SR and meta-analysis: Radwan et al.Footnote 103; SR and meta-analysis : Sepandi et al.Footnote 105; SR and meta-analysis: Ssentongo et al.Footnote 107; Meta-analysis: Wang et al.Footnote 175; SR and meta-analysis: Yin et al.Footnote 113; SR and meta-analysis: Zhou et al.Footnote 178; SR and meta-analysis: Zhou Y et al.Footnote 179

Kidney transplant

Main finding Source
Comorbidities + kidney transplant patients + COVID-19 = any impact on the severity or outcome (odds 0.95x) SR and meta-analysis: Bansal et al.Footnote 183; SR and meta-analysis: Chan et al.Footnote 169

Hemodialysis patients

Main finding Source

Higher risk for COVID-19:

  1. mortality: 12% to 26.2%
SR and meta-analysis: Chen et al.Footnote 182; SR and meta-analysis: Corona et al.Footnote 116; SR and meta-analysis: Zhou et al.Footnote 178

Acute kidney disease (AKI)

Main finding Source

Higher risk for COVID-19:

  1. severity: 20% vs non severe patients (2%, odds 6.97 to 17.2x greater)
  2. mortality: 31% to 67% vs survivors (7%), odds 3.43 to 45.79x greater
  3. mortality AKI + comorbidities: odds 8.78x greater

Prevalence in patients with COVID-19: 9.87% to 28.6%

  • (overall COVID-19 patients: 8.3%
  • critically COVID-19 patients: 19.9%)

Higher risk for COVID-19 + AKI+

  • male: odds 3.43x greater
  • diabetes: odds 2.63x greater
  • COPD: odds 2.98x greater
  • CKD: odds 3.26x greater
  • CVD: odds 2.26x greater
  • cerebrovascular disease: odds 2.95x greater
SR: Zhang et al.Footnote 67; Meta-analysis : Brienza et al.Footnote 105; SR and meta-analysis: Chan et al.Footnote 169; SR and meta-analysis: Fabrizi et al.Footnote 107; SR and meta-analysis: Fu et al.Footnote 108; Meta-analysis: Hansrivijit et al.Footnote 109; SR and meta-analysis: Katzenschlager et al.Footnote 86; Meta-analysis: Lin L et al.Footnote 110; SR and meta-analysis: Liu YF et al.Footnote 174; SR and meta-analysis: Vakhshoori et al.Footnote 123; Meta-analysis : Vakili et al.Footnote 120; Meta-analysis: Wang et al.Footnote 175; Meta-analysis: Yang Q et al.Footnote 113; SR and meta-analysis: Zhang Z et al.Footnote 114; Meta-analysis: Zhong et al.Footnote 130; SR and meta-analysis: Zhou et al.Footnote 178 SR and meta-analysis: Zhou Y et al.Footnote 114

Smoking

Main finding Source

Higher risk to severe COVID-19:

  • current smokers: 21.2%, odds 1.34 to 2.06x greater, RR=1.80
  • never-smokers: 10.7%, odds1.98x greater
  • previous smoking history (ex-smoking): odds 1.55 to 4.60x greater, RR 1.31 to 1.71
  • compared to never-smokers, patients with a smoking history: increased risk of severe COVID-19 (RR 1.26 to 1.79)

Higher risk to ICU admission:

  • odds 1.73x greater

Higher risk to COVID-19 mortality:

  • current smokers: 29.4% to 44%, odds1.19 to 2.8x greater, RR= 2.07
  • previous smoking history (ex-smoking): odds 2.58x greater
  • compared to former smokers, current smokers’ patients: increased mortality COVID-19 (RR= 1.03)

Prevalence: 7.63% to 23%

SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Reddy Charles et al.Footnote 237; SR and meta-analysis: Del Sole et al.Footnote 77; SR and meta-analysis: Dorjee et al.Footnote 78; SR and meta-analysis: Emami et al.Footnote 81; SR and meta-analysis: Gülsen et al.Footnote 238; SR and meta-analysis: Jimenez-Ruiz et al.Footnote 239; SR and meta-analysis: Karanasos et al.Footnote 240; SR and meta-analysis: Katzenschlager et al. [86]; SR and meta-analysis: Lansiaux et al.Footnote 241; SR and meta-analysis: Mesas et al.Footnote 94; SR and meta-analysis: Patanavanich et al.Footnote 242; SR and meta-analysis: Patanavanich et al.Footnote 243; SR and meta-analysis: Radwan et al.Footnote 103; Meta-analysis : Rahman et al.Footnote 104; Meta-analysis: Salah et al.Footnote 244; SR and meta-analysis: Umnuaypornlert et al.Footnote 245; SR and meta-analysis: 2 Zhang et al.Footnote 246; SR and meta-analysis: Zhao et al.Footnote 145

Obesity

Main finding Source

Higher risk for COVID-19:

  1. poor outcome: odds 1.29 to 2.09x greater
  2. severity: odds 1.72 to 4.17x greater
  3. ICU admission: odds 1.189 to 2.32x greater
  4. invasive mechanical ventilation: odds 1.59 to 2.63x greater
  5. disease progression: odds 1.16 to 1.41x greater
  6. in younger patients: odds 3.30x greater
  7. associated to ARDS: odds 1.39x greater

Chance of mortality COVID-19:

  1. 58%, odds: 0.89 to 2.08 x greater

Prevalence in patients with COVID-19: 27.6% to 42%

Previous bariatric surgery (associated with a lower rate of mortality and hospital admission):

  1. risk of mortality: odds 0.22x greater
  2. hospitalization: odds 0.28x greater

SR and meta-analysis: Aghili et al.Footnote 228; SR and meta-analysis: Hoong et al.Footnote 229; SR and meta-analysis: Chu et al.Footnote 230; Meta-analysis : Deng et al.Footnote 231; SR and meta-analysis: Ho et al.Footnote 232; SR and meta-analysis: Huang et al.Footnote 233; SR and meta-analysis: Malik et al.Footnote 234; SR and meta-analysis: Ng et al.Footnote 100; SR and meta-analysis: Soreoto et al.Footnote 235; SR and meta-analysis: Yang et al.Footnote 190; SR and meta-analysis: Zhao X et al.Footnote 236; SR and meta-analysis: Zhou Y et al.Footnote 114

SR and meta-analysis: Aghili et al.Footnote 228; SR and meta-analysis: Chu et al.Footnote 230; Meta-analysis : Deng et al.Footnote 231; SR and meta-analysis: Hoong et al.Footnote 229; SR and meta-analysis: Huang et al.Footnote 233; SR and meta-analysis: Ho et al.Footnote 232; SR and meta-analysis: Mesas et al.Footnote 94; SR and meta-analysis: Moazzami et al.Footnote 96; SR and meta-analysis: Ng et al.Footnote 100; Meta-analysis: Noor et al.Footnote 101; SR and meta-analysis: Poly et al.Footnote 142; Meta-analysis: Yang J et al.Footnote 190; SR and meta-analysis: Zhao X et al.Footnote 236

SR and meta-analysis: Aghili et al.Footnote 228; SR and meta-analysis: Chu et al.Footnote 230; Meta-analysis : Deng et al.Footnote 231; SR and meta-analysis: Hoong et al.Footnote 229; SR and meta-analysis: Huang et al.Footnote 233; SR and meta-analysis: Ho et al.Footnote 232; SR and meta-analysis: Mesas et al.Footnote 94; SR and meta-analysis: Moazzami et al.Footnote 96; SR and meta-analysis: Ng et al.Footnote 100; Meta-analysis: Noor et al.Footnote 101; SR and meta-analysis: Poly et al.Footnote 142; Meta-analysis: Yang J et al.Footnote 190; SR and meta-analysis: Zhao X et al.Footnote 236

SR and meta-analysis: Aminian et al.Footnote 247

Liver diseases and conditions

Liver diseases (general)

Main finding Source

Higher chance for COVID-19:

  1. severity: odds 0.81x to 4.48x greater
  2. severity in males: odds 1.52x greater than in females
  3. mortality: odds 1.98x to 2.35x greater
SR and meta-analysis: S. Afra et al.Footnote 196; SR and meta-analysis: Ampuero et al.Footnote 197; Meta-analysis: Barek et al.Footnote 69; Meta-analysis: Wu ZH et al.Footnote 198; SR and meta-analysis: Zhou Y et al.Footnote 114

Liver transplanted patients

Main finding Source

Higher risk for COVID-19:

  1. mild to moderate: 87%
  2. severity: 13%
  3. ICU admission: 41%
  4. mortality: 17.8% to 20%
  5. elderly patients: odds 4.26x greater
  6. males: odds 1.58x greater
SR and meta-analysis: Jayant et al.Footnote 199; Meta-analysis: Waleed et al.Footnote 200

Chronic liver diseases

Main finding Source

Higher chance for COVID-19:

  1. severity: odds 0.97 to 0.99x greater
  2. ICU admission: odds 0.97x greater

Prevalence in patients with COVID-19: 2.64% to 2.67%, RR=1.69

SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Kumar et al.Footnote 201; SR and meta-analysis: Vancsa et al.Footnote 202; SR and meta-analysis: Yin et al.Footnote 113

Acute liver diseases

Main finding Source

Prevalence in patients with COVID-19: 19%

SR and meta-analysis: Merola et al.Footnote 203

Effect of age

Main finding Source

High risk for severe COVID-19:

  1. age of >=50 years (odds: 0.740x greater, RR = 3.36 in comparison with age below 50 years)
  2. age>=65 years are not associated to severity (RR: 0.79 to 3.59 compared to severe patients age below 65 years)
  3. associated to:
    • diabetes: odds 4.02x greater
    • hypertension: odds 4.60x greater
    • cardiovascular diseases: odds 8.24x greater
    • chronic Kidney disease: odds 1.94x greater
    • liver diseases: odds 1.25x greater

High risk for severe COVID-19 (ICU admissions):

  1. age <40-50 years: 5.4%
  2. age 40-69 years: 52.6%
  3. age ≥60-70 years: 41.8%, odds 2.70x greater

High risk for COVID-19 mortality:

  1. age <40 years: 0.1%
  2. age 40 to 69 years:13%
  3. age >=50 years: odds 1.378 to 1.86x greater, compared to patients with age <50 years (odds 15.44x)
  4. age ≥60 years: 66.6% to 85%, odds 3.12 to 11.99x greater, RR3.6
  5. age ≥70 years: 86.6%, odds 3.61x greater
  6. age >= 70 and < 70 years with Chronic Kidney Diseases and COVID-19 (odds 8.69x greater) than in the >= 70 years (odds 2.44x)
  7. age >= 80 years: 84.4%

Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Li X et al.Footnote 206; Meta-analysis: Noor et al.Footnote 101; Meta-analysis: Pijls et al.Footnote 223; SR and meta-analysis: Yifan et al.Footnote 224

SR and meta-analysis: Cohen et al.Footnote 225; SR and meta-analysis: Jain et al.Footnote 141; Meta-analysis: Pijls et al.Footnote 223

SR and meta-analysis: Biswas et al.Footnote 72; SR and meta-analysis: Cai et al.Footnote 180; SR and meta-analysis: Cohen et al.Footnote 225; SR and meta-analysis: Borges do Nascimento et al.Footnote 226; SR and meta-analysis: Dorjee et al.Footnote 78; SR and meta-analysis: Du et al.Footnote 79; SR and meta-analysis: Lim et al.Footnote 227; SR and meta-analysis: Lu et al.Footnote 90; Meta-analysis: Pijls et al.Footnote 223; SR and meta-analysis : Sepandi et al.Footnote 105; SR and meta-analysis: Silverio et al.Footnote 106; SR and meta-analysis: Taylor et al.Footnote 109; SR and meta-analysis: Xiang et al.Footnote 134

Effect of sex difference

Main finding Source

High risk for severe COVID-19:

  1. male (odds 0.75 to 3.04x greater than female patients (male Vs. female 54% to 59.67% vs. 40.33%)
  2. male: RR=1.29
  3. male with advanced age: odds 1.45x greater, RR=1.73
  4. asymptomatic: 38% male vs 62% female
  5. male ICU admission: odds 0.45 to 2.84x greater
  6. male mechanical ventilation: odds 1.05x greater

High risk for COVID-19 mortality:

  1. male: 66% (odds 1.15 to 1.86x greater, RR 1.3)
  2. female: 0.51x greater
  3. undergoing surgeries: males (63.05%) vs females (43%)

SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Chidambaram et al.Footnote 73; SR and meta-analysis: Del Sole et al.Footnote 77; SR and meta-analysis: Borges do Nascimento et al.Footnote 226; SR and meta-analysis: Du et al.Footnote 79; SR and meta-analysis: Jain et al.Footnote 141; SR and meta-analysis: Khamis et al.Footnote 87; SR and meta-analysis: Lakbar et al.Footnote 248; SR and meta-analysis: Matsushita et al.Footnote 92; SR and meta-analysis: Patel et al.Footnote 249; SR and meta-analysis: Peckham et al.Footnote 250; Meta-analysis: Pijls et al.Footnote 223; SR and meta-analysis: Radwan et al.Footnote 103; Meta-analysis : Rahman et al.Footnote 104; Meta-analysis: Zhong et al.Footnote 130

SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Biswas et al.Footnote 72; SR and meta-analysis: Dorjee et al.Footnote 78; SR and meta-analysis: Lakbar et al.Footnote 248; SR and meta-analysis: Lu et al.Footnote 90; Meta-analysis: Noor et al.Footnote 101; SR and meta-analysis: Patel et al.Footnote 249; SR and meta-analysis: Peckham et al.Footnote 250; SR and meta-analysis: Perez-Lopez et al.Footnote 354; Meta-analysis: Pijls et al.Footnote 223; SR and meta-analysis: Pranata et al.Footnote 105; SR and meta-analysis : Sepandi et al.Footnote 105; SR and meta-analysis : Wang K et al.Footnote 252

Effect of race

Main finding Source

Higher risk for cases and mortality:

  • White Non- Hispanic (39%)
  • Hispanic/ Latino (31.6%)
  • Black Non- Hispanic (20%, RR=2.02)
  • Caucasian (odds 0.46x greater)
  • Asian (RR=1.50)
  • White vs Black (RR=0.96)
  • White vs Asian (RR=0.99)
  • White vs Hispanic (RR=0.69)

Asian:

Higher risk for COVID-19:

  1. ICU admission: RR=1.97
  2. mortality: RR=1.22

SR and meta-analysis: Bhattacharyya et al.Footnote 71; Meta-analysis: Pabalan et al.Footnote 253; SR and meta-analysis: Raharja et al.Footnote 254; SR and meta-analysis: Sze et al.Footnote 255

SR and meta-analysis: Sze et al.Footnote 255

Effect of blood group

Main finding Source

Higher risk for COVID-19:

  • Group A: 36.22%, odds 1.249x to 1.33x greater
  • Group B: 24.99%, odds 1.06x greater
  • Group AB: 9.29%, odds 1.07x greater
  • Group O: 29.67%, odds 0.699x greater
  • Rh-positive: odds 1.22x greater

Higher risk for COVID-19 severity:

  • Group AB: odds 2.424x greater
  • Group O: odds 0.748x greater

Higher risk for COVID-19 mortality:

  • Group A: 40%, 1.25x greater
  • Group B: 23%
  • Group AB: 8%, odds 1.348x greater
  • Group O: 29%
SR and meta-analysis: Liu N et al.Footnote 256; Meta-analysis: Pourali et al.Footnote 257; SR and meta-analysis: Wu et al.Footnote 258

Arterial thrombosis/coagulopathies

Main finding Source

Higher risk for COVID-19:

  1. severe: odds 3.623x greater
  2. ICU admission: odds 2.63x greater
  3. mechanical ventilation: odds 3.14x greater
  4. mortality: odds 1.93x greater, RR=0.56 to 10.86
  5. coagulopathies + ARDS: RR=16.52

Prevalence in patients with COVID-19: 33%

SR and meta-analysis: Kamel et al.Footnote 204; SR and meta-analysis: Kefale et al.Footnote 205; SR and meta-analysis: Li X et al.Footnote 206; SR and meta-analysis: Wang C et al.Footnote 207; SR and meta-analysis: Xiang G et al.Footnote 208; Meta-analysis: Zhu et al.Footnote 209; SR and meta-analysis:Zhu et al.Footnote 355

Venous thromboembolism (VTE), vein thrombosis (DVT) and/or pulmonary embolism (PE)

Main finding Source

Prevalence in patients with COVID-19:

  • VTE: 21% to 31.3%
  • DVT: 14% to 27%
  • PE: 12% to 18.9%

Higher prevalence in aged patients with COVID-19:

  • VTE: Z-score: 3.1
  • DVT: Z-score: 2.33
  • PE: Z-score: 3.03

Higher prevalence in patients with COVID-19 with obesity:

  • PE: Z-score = 2.01

Higher prevalence in patients with COVID-19:

  • female: odds 1.59x greater
  • males, PE: odds 1.98x greater

Higher risk for patients with severe COVID-19:

  • VTE: 31% to 38%, odds 2.66x greater
  • DVT:22.1% to 28%
  • PE: 21.7%
  • VTE+ embolism: 17%

Higher risk for COVID-19, ICU admission:

  • VTE: 22.7% to 31%
  • DVT: 19% to 40%
  • PE: 7% to 37%

Higher risk for COVID-19 mortality:

  • VTE: 17.2%, odds 1.74 to 2.02x greater, RR=0.86
  • DVT: 22%
Meta- analysis: Di Minno et al.Footnote 210; SR and meta-analysis: Liu Y et al.Footnote 211; Meta-analysis: Loomba et al.Footnote 212; Meta-analysis: Lu YF et al.Footnote 213; SR and meta-analysis: Malas et al.Footnote 214; SR and meta-analysis: Mir et al.Footnote 215; Meta-analysis: Nopp et al.Footnote 216; SR and meta-analysis: Porfidia et al.Footnote 217; SR and meta-analysis: Roncon et al.Footnote 218; SR and meta-analysis: Sridharan et al.Footnote 219; SR and meta-analysis: Wu T et al.Footnote 220; SR and meta-analysis: Zhang R et al.Footnote 221; SR and meta-analysis: Liu Yet al.Footnote 211

Autoimmune diseases

Main finding Source

Higher risk for:

  1. severe COVID-19: odds 2.19x greater
  2. hospitalization: odds 0.35x greater
  3. ICU admission: odds 3.55x greater
  4. mortality: odds 0.066 to 2.46x greater
SR and meta-analysis: Akiyama et al.Footnote 222; SR and meta-analysis: Khan et al.Footnote 88; SR and meta-analysis: Ng et al.Footnote 100

Pregnant women

Main finding Source

Pregnant and recently pregnant women with covid-19 compared with non-pregnant women of reproductive age, higher risk for:

  1. admission to ICU: less than 20%, odds 1.62x greater
  2. invasive ventilation: odds1.88x greater

Higher risk for severe COVID-19:

  1. increased maternal age: odds 1.78x greater
  2. high body mass index: 38.2%, odds 2.38x greater
  3. chronic hypertension: odds 2.0x greater
  4. pre-existing diabetes: 18%, odds 2.51x greater

Higher risk for COVID-19 pregnant mortality:

  1. 1% to 11.3%, odds 1.6x greater
  2. arterial/venous thrombosis: odds 0.66x
  3. coagulopathy: odds 0.28x

Pre-existing maternal comorbidity, higher risk for:

  1. admission to ICU: 7%, odds 4.21x greater
  2. invasive ventilation: 3.4%, odds 4.48x greater

Delivery in in pregnant women with covid-19:

  1. spontaneous preterm birth: 6% to 29.7%, odds 1.45 to 2.5x
  2. compared with those without the disease: odds 3.01x greater (n=339)
  3. maternal complications: 45.0 %
  4. caesarean section: 48% to 88%, odds 1.54 to 3.0x
  5. fetal death: 4% to 4.8%
  6. abortion: 2.9%
  7. post-partum hemorrhage: 54.5%
  8. intrauterine fetal distress: 14%

SR and meta-analysis: Allotey et al.Footnote 259; SR and meta-analysis: Capobianco et al.Footnote 260; SR and meta-analysis: Di Toro et al.Footnote 261; SR and meta-analysis: Kadir et al.Footnote 262

SR and meta-analysis: Allotey et al.Footnote 259; SR and meta-analysis: Jafari et al.Footnote 263

SR and meta-analysis: Borges do Nascimento et al.Footnote 226; SR and meta-analysis: Jafari et al.Footnote 263; SR and meta-analysis: Allotey et al.Footnote 259; SR and meta-analysis: Servante et al.Footnote 356

SR and meta-analysis: Allotey et al.Footnote 259; SR and meta-analysis: Bellos et al.Footnote 267; SR and meta-analysis: Capobianco et al.Footnote 260; SR and meta-analysis: Di Toro et al.Footnote 261; SR and meta-analysis: Dube et al.Footnote 265; SR and meta-analysis: Della-Gatta et al.Footnote 357; SR and meta-analysis: Abou Ghayda et al.Footnote 266; SR and meta-analysis: Hassanipour et al.Footnote 358; SR and meta-analysis: Jafari et al.Footnote 263; SR and meta-analysis : Servante et alFootnote 356; SR and meta-analysis: Soheili et al.Footnote 268

Neonates

Main finding Source

Higher risk for neonates born to mothers with covid-19:

  1. admitted to the neonatal unit (2% to 30%)
  2. compared with those to mothers without covid-19: odds 3.13x greater (n=1121)
  3. vertical transmission: 1.4% to 8%, odds 1.94x
  4. low birth weight: 21% to 25%, odds 9.0x
  5. fetal distress: 30%
SR and meta-analysis: Allotey et al.Footnote 259; SR and meta-analysis: Bhuiyan et al.Footnote 264; SR and meta-analysis: Capobianco et al.Footnote 260; SR and meta-analysis: Di Toro et al.Footnote 261; SR and meta-analysis: Dube et al.Footnote 265; SR and meta-analysis: Abou Ghayda et al.Footnote 266; SR and meta-analysis: Jafari et al.Footnote 263; SR and meta-analysis: Bellos et al.Footnote 267; SR and meta-analysis: Soheili et al.Footnote 268

Children

Main finding Source

Higher risk for COVID-19:

  1. patient cases were non-severe or mild: 29 % to 33%
  2. patient cases were moderate:51% to 66%
  3. severity: 5 %
  4. ICU admission: 9.9% to 61%
  5. mechanical ventilation: 25%
  6. mortality: 0.28% to 1%, RR=2.14
  7. higher prevalence in adults than children and adolescents: odds 0.56x, RR=1.71

Pediatric patients with cancer and COVI-19:

  • survival rate: 99.4%
  • risk of hospitalization: no statistically significant differences in the between hematological malignancies and solid tumors (odds 2.94x)
  • risk of being admitted to the ICU: not different between hematological malignancies and other tumors (odds 1.42x)
  • need of ventilatory support: (odds 0.68x)

Pediatric patients with comorbidities and COVID-19:

Higher risk for:

  1. severity: 5.1%
  2. severity in obese: RR=2.87
  3. mortality: RR=2.81

SR and meta-analysis: Cui et al.Footnote 148; SR and meta-analysis: Irfan et al.Footnote 269; SR and meta-analysis: Koh et al.Footnote 270; SR and meta-analysis: Li B et al.Footnote 271; SR and meta-analysis: Viner et al.Footnote 272; Meta-analysis: Wang JG et al.Footnote 273; SR and meta-analysis: Williams et al.Footnote 274

Meta-analysis: Dorantes- Acosta et al.Footnote 275

SR and meta-analysis: Tsankov et al.Footnote 276

The following diseases, conditions and groups have limited to moderate evidence for risk.

Surgical procedures

Main finding Source

Higher risk for COVID-19:

  1. mortality: odds 7.9x greater in patients who underwent a surgical procedure while COVID-19 positive
Meta-analysis: Brown et al.Footnote 277

Tuberculosis

Main finding Source

Higher risk for COVID-19:

  1. severity: odds 4.50x greater
  2. mortality: RR=2.10
SR and meta-analysis: Sarkar et al.Footnote 359; SR and meta-analysis: Tamuzi et al.Footnote 360

Influenza

Main finding Source

Higher risk for COVID-19:

  1. mortality: RR=2.04
SR and meta-analysis: Sarkar et al.Footnote 359

Chronic hepatitis

Main finding Source

Higher risk for COVID-19:

  1. mortality: RR=1.15
SR and meta-analysis: Sarkar et al.Footnote 359

Immunosuppressed patients

Main finding Source
Prevalence in patients with COVID-19: 0.637% Meta-analysis: Tassone et al.Footnote 361

HIV

Main finding Source

Difference between patients with severe and non-severe COVID-19: odds 3.28x greater.

Higher risk for COVID-19: RR=0.99

SR: Zhang et al.Footnote 67; SR and meta-analysis : Sarkar et al.Footnote 359; SR and meta-analysis: Tamuzi et al.Footnote 360

Rheumatic diseases

Main finding Source

Higher risk for COVID-19:

  1. severity: odds 0.33x greater
  2. ICU admission: odds 0.09x greater
  3. mortality: 7%, odds 0.07x greater
SR and meta-analysis: Xu et al.Footnote 362

Intestine diseases

Main finding Source

Higher risk for COVID-19:

  1. hospitalization: 27.29%
  2. ICU admission: 5.33%
  3. mortality: 4.27%

Inflammatory Bowel disease: RR=4.02

Ulcerative colitis and Crohn’s disease: RR=1.03

SR and meta-analysis: Singh et al.Footnote 363

Dyslipidemia

Main finding Source

Dyslipidemia potentially increases mortality and severity of COVID-19: odds 1.39x greater

Association between dyslipidemia and poor outcome varies by:

  • age (coefficient: -0.04)
  • male gender (coefficient: -0.03)
  • hypertension (coefficient: -0.02)
  • diabetes (coefficient: -0.24, not associated)
  • cardiovascular diseases (coefficient: -0.01, not associated)
SR and meta-analysis: Atmosudigdo et al.Footnote 364; SR and meta-analysis: Vakhshoori et al.Footnote 365

Secondary infection

Main finding Source
Difference between patients with severe and non-severe COVID-19: odds 9.21x greater SR and meta-analysis: Zhang et al.Footnote 67

Anemia\iron metabolism\ferritin level

Main finding Source
The ferritin level was significantly increased in patients with severe compared with those with non-severe COVID-19: 74.2% SR and meta-analysis: Xie et al.Footnote 112

Vitamin D insufficiency

Main finding Source

Higher risk for COVID-19:

  1. severe: 64%, odds 1.64x greater
  2. hospitalization: odds 1.81x greater
  3. mortality: odds 1.82x greater
SR and meta-analysis: Pereira et al.Footnote 366

Appendix B: Key findings for topic b) clinical signs and symptoms of COVID-19

The following signs, symptoms, groups and situations have strong evidence for risk.

Fever

Main finding Source

High risk for COVID-19:

  1. severity: odds 1.68 to 1.89x greater, RR= 1.14
  2. worst prognostic in elderly patients: odds 1.19x

Prevalence in patients with COVID-19: 57% to 89%

SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Barek et al.Footnote 69; Meta-analysis: He et al.Footnote 367; SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Corona et al.Footnote 116; SR and meta-analysis: Borges do Nascimento et al.Footnote 226; SR and meta-analysis: Ebrahimi et al.Footnote 80; SR and meta-analysis: Fathi et al.Footnote 82; SR and meta-analysis: Gómez-Ochoa et al.Footnote 368; SR and meta-analysis: Khamis et al.Footnote 87; SR and meta-analysis: Miller et al.Footnote 95; Meta-analysis : Rahman et al.Footnote 104; Meta-analysis : Vakili et al.Footnote 120; SR and meta-analysis: Wong et al.Footnote 111; SR and meta-analysis: Xie et al.Footnote 112; SR and meta-analysis: Xie Y et al.Footnote 149; SR and meta-analysis: Yifan et al.Footnote 224; Meta-analysis: Zhong et al.Footnote 130

Cough

Main finding Source

High risk for COVID-19:

  1. severity: odds 0.66 to 5.52x greater, RR=1.13

Prevalence in patients with COVID-19: 54.3% to 79%

12% of the asymptomatic patients developed cough during course of the infection.

SR and meta-analysis: Zhang et al.Footnote 69; Meta-analysis: Barek et al.Footnote 130; Meta-analysis: He et al.Footnote 367; SR and meta-analysis: Corona et al.Footnote 116; SR and meta-analysis: Borges do Nascimento et al.Footnote 226; SR and meta-analysis: Ebrahimi et al.Footnote 80; SR and meta-analysis: Fathi et al.Footnote 82; SR and meta-analysis: Gómez-Ochoa et al.Footnote 368; SR and meta-analysis: Khamis et al.Footnote 87; SR and meta-analysis: Miller et al.Footnote 95; SR and meta-analysis: Mudatsir et al.Footnote 98; Meta-analysis : Rahman et al.Footnote 104; Meta-analysis : Vakili et al.Footnote 120; SR and meta-analysis: Wong et al.Footnote 111; SR and meta-analysis: Xie et al.Footnote 112; SR and meta-analysis: Xie Y et al.Footnote 149; SR and meta-analysis: Yao et al.Footnote 369; Meta-analysis: Zhong et al.Footnote 130

Dyspnea/shortness of breath

Main finding Source

High risk for COVID-19:

  1. severity: 51%, odds 3.28 to 6.42x greater
  2. ICU admission: odds 5.35 to 17.8x greater
  3. mortality: odds 3.31 to 3.52x greater

Prevalence in patients with COVID-19: 29% to 51%

SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Borges do Nascimento et al.Footnote 226; SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Corona et al.Footnote 116; SR and meta-analysis: Fathi et al.Footnote 82; Meta-analysis: He et al.Footnote 367; SR and meta-analysis: Jain et al.Footnote 141; SR and meta-analysis: Katzenschlager et al.Footnote 86; SR and meta-analysis: Li X et al.Footnote 143; SR and meta-analysis: Mudatsir et al.Footnote 98; Meta-analysis : Vakili et al.Footnote 120; SR and meta-analysis: Xiang et al.Footnote 134; SR and meta-analysis: Xie Y et al.Footnote 149; SR and meta-analysis: Yang L et al.Footnote 220; Meta-analysis: Zhong et al.Footnote 130

Myalgia or fatigue (muscle ache)

Main finding Source

High risk for COVID-19:

  1. severity: odds1.20 to 2.1x greater, RR=1.17
  2. ICU admission: odds 1.63x greater
  3. mortality: odds 1.36x greater
  4. worst prognostic in elderly patients: odds 0.85x

Prevalence in patients with COVID-19: 19.5% to 60%

SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Collantes et al.Footnote 370; Meta-analysis: Barek et al.Footnote 69; Meta-analysis: He et al.Footnote 367; SR and meta-analysis: Katzenschlager et al.Footnote 86; SR and meta-analysis: Mudatsir et al.Footnote 98; Meta-analysis : Rahman et al.Footnote 104; SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis : Vakili et al.Footnote 120; SR and meta-analysis: Yang L et al.Footnote 220; SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Corona et al.Footnote 116; SR and meta-analysis: Ebrahimi et al.Footnote 80; SR and meta-analysis: Fathi et al.Footnote 82; SR and meta-analysis: Gómez-Ochoa et al.Footnote 368; SR and meta-analysis: Khamis et al.Footnote 87; SR and meta-analysis: Xiang et al.Footnote 134; SR and meta-analysis: Xie et al.Footnote 112; SR and meta-analysis: Xie Y et al.Footnote 149; SR and meta-analysis: Yifan et al.Footnote 224; Meta-analysis: Zhong et al.Footnote 130

Headache

Main finding Source

Difference between patients with severe and non-severe COVID-19: odds 0.12 to 3.57x greater

Associated with dizziness: odds 0.09x greater

Prevalence in patients with COVID-19: 8 to 15.49%

4% of the asymptomatic patients developed cough during course of the infection.

SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Collantes et al.Footnote 370; SR and meta-analysis: Borges do Nascimento et al.Footnote 226; SR and meta-analysis: Khamis et al.Footnote 87; SR and meta-analysis: Xie Y et al.Footnote 149; SR and meta-analysis: Yao et al.Footnote 369; Meta-analysis: Zhong et al.Footnote 130

Gastrointestinal symptoms

Main finding Source

Higher chance for COVID-19:

  1. severity: odds 1.63 to 2.1x greater
  2. ICU admission: RR= 2.56
  3. mechanical ventilation: RR=0.90
  4. mortality: 15%; odds: 0.90x greater, RR=0.72 to 2.01

Abdominal pain: Difference between patients with severe and non-severe COVID-19: odds 2.35 to 7.6x greater, 4%

Prevalence in patients with COVID-19: 15.47% to 20%

Higher risk of complications:

  • acute respiratory distress syndrome (RR = 8.16)
  • acute cardiac injury (RR = 5.36)
  • acute kidney injury (RR = 5.52)
SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Dorrell et al.Footnote 371; Meta- analysis: Elshazli et al.Footnote 372; SR and meta-analysis: Ghimire et al.Footnote 373; Meta-analysis: He et al.Footnote 367; SR and meta-analysis: Renelus et al.Footnote 374

Diarrhea

Main finding Source

High risk for COVID-19:

  1. severity: odds 1.35 to 2.6x greater, RR=0.75 to 1.14

Prevalence in patients with COVID-19: 6.11% to 17.2%

First manifestation in patients with COVID-19: 4.3%

SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Dorrell et al.Footnote 371; SR and meta-analysis: Corona et al.Footnote 116; Meta- analysis: Elshazli et al.Footnote 372; SR and meta-analysis: Fathi et al.Footnote 82; SR and meta-analysis: Ghimire et al.Footnote 373; Meta-analysis: He et al.Footnote 367; SR and meta-analysis: Maslennikov et al.Footnote 375; Meta-analysis : Rahman et al.Footnote 104; SR and meta-analysis: Renelus et al.Footnote 374; Meta-analysis : Vakili et al.Footnote 120; Meta-analysis: Zhong et al.Footnote 130

Nausea and vomiting

Main finding Source

Difference between patients with severe and non-severe COVID-19: odds 0.06 to 1.73x greater

Prevalence in patients with COVID-19: 5.9% to 11.1%

SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Collantes et al.Footnote 370; SR and meta-analysis: Corona et al.Footnote 116; SR and meta-analysis: Dorrell et al.Footnote 371; Meta- analysis: Elshazli et al.Footnote 372; SR and meta-analysis: Ghimire et al.Footnote 373; Meta-analysis: Zhong et al.Footnote 130

Hemoptysis

Main finding Source

High risk for COVID-19:

  1. severity: odds 3.76 to 4.93x greater
SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Barek et al.Footnote 69; Meta-analysis: He et al.Footnote 367; SR and meta-analysis: Yang L et al.Footnote 294

Oral mucosal lesions

Main finding Source
  • white and erythematous plaques
  • irregular ulcers
  • small blisters
  • petechiae
  • desquamative gingivitis

Tongue, palate, lips, gingiva, and buccal mucosa were affected.

In mild cases: oral mucosal lesions developed before or at the same time as the initial respiratory symptoms.

In cases requiring medication and hospitalization: the lesions developed approximately 7 to 24 days after onset symptoms.

SSR: Amorim dos SantosFootnote 296

Anosmia/hyposomnia

Main finding Source
Prevalence in patients with COVID-19: 50%, odds 11.76x, RR=4.56 Meta-analysis: Hariyanto et al.Footnote 376; SR and meta-analysis: Hoang et al.Footnote 377

Anosmia/hyposmia

Main finding Source
Prevalence in patients with COVID-19: 50%, odds 11.76x, RR=4.56 Meta-analysis: Hariyanto et al.Footnote 376; SR and meta-analysis: Hoang et al.Footnote 377

Gustatory impairment

Main finding Source

The most common oral manifestation associated with COVID-19: 45% (odds: 12.68 x greater).

Associated with mild/moderate severity for COVID-19: odds: 2.09x greater

Associated with female patients for COVID-19: odds: 1.64x greater

SR: Amorim dos SantosFootnote 296; SR and meta -analysis: Hoang et al.Footnote 377

Dysgeusia

Main finding Source
Prevalence in patients with COVID-19: 15.4% to 38% SR: Amorim dos SantosFootnote 296; Meta- analysis: Elshazli et al.Footnote 372

Hypogeusia

Main finding Source
Prevalence in patients with COVID-19: 35% SR: Amorim dos SantosFootnote 296

Ageusia

Main finding Source
Prevalence in patients with COVID-19: 15.4% to 24% SR: Amorim dos SantosFootnote 296; Meta- analysis: Elshazli et al.Footnote 372

Anorexia/loss of appetite

Main finding Source

Difference between patients with severe and non-severe COVID-19: odds 1.77x greater

High risk for COVID-19:

  1. severity: odds 1.83 to 2.8x greater

Prevalence in patients with COVID-19: 19.9% to 21%

SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Dorrell et al.Footnote 371; Meta- analysis: Elshazli et al.Footnote 372; Meta-analysis: He et al.Footnote 367; SR and meta-analysis: Mudatsir et al.Footnote 98

Impairment of consciousness (also termed "confusion" or "agitation")

Main finding Source

High risk for COVID-19:

  1. severity: odds 0.05x greater
SR and meta-analysis: Collantes et al.Footnote 370

Stroke

Main finding Source

The most common manifestation was acute ischemic stroke (87.4%)

The patients with COVID-19 and stroke were younger (pooled median difference = -6.0 years)

Higher chance for COVID-19:

  1. severity: in patients with previous comorbid conditions (46.9%, odds 1.95x greater, RR=4.18)
  2. mortality: 34.4% to 46.7%, odds 5.60x greater
  3. mortality was 31.76% to 67% lower in patients <50 years of age relative to those >70 years of age (odds 0.33x)
  4. mortality: in patients with previous comorbid conditions (58.6%, odds 3.52x)
  5. mortality: associated to diabetes odds 1.39x greater
  6. mortality associated to males: 65.5%

Prevalence in patients with COVID-19: 29% to 87.4%

SR and meta-analysis: Nannoni et al.Footnote 115; SR and meta-analysis: Fridman et al.Footnote 289; SR and meta-analysis: Gao et al.Footnote 164; Meta-analysis: Katsanos et al.Footnote 290; Meta-analysis: Siepmann et al.Footnote 291; SR and meta-analysis: Siow et al.Footnote 292; SR and meta-analysis: Yamakawa et al.Footnote 293

Dizziness

Main finding Source

Difference between patients with severe and non-severe COVID-19: odds 0.08 to 3.17x greater

Prevalence in patients with COVID-19: 6.1% to 11.5%

SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Collantes et al.Footnote 370; SR and meta-analysis: Mudatsir et al.Footnote 98; SR and meta-analysis: Yao et al.Footnote 369; Meta-analysis: Zhong et al.Footnote 130

Chest pain/chest tightness

Main finding Source

High risk for COVID-19:

  1. severity: odds 2.11 to 4.39x greater
  2. mortality: odds2.50x greater

Prevalence in patients with COVID-19: 37.4%

SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Barek et al.Footnote 69; SR and meta-analysis: Yang L et al.Footnote 220; Meta-analysis: Zhong et al.Footnote 130

Sputum

Main finding Source

Difference between patients with severe and non-severe COVID-19: odds 1.33 to 5.10x greater

Prevalence in patients with COVID-19: 17.85% to 66%

SR and meta-analysis: Zhang et al.Footnote 67; SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Khamis et al.Footnote 87; SR and meta-analysis: Xie Y et al.Footnote 149; SR and meta-analysis: Yao et al.Footnote 369

Sore throat

Main finding Source
Prevalence in patients with COVID-19: 8% to 21.7% SR and meta-analysis: Corona et al.Footnote 116; SR and meta-analysis: Borges do Nascimento et al.Footnote 226; SR and meta-analysis: Khamis et al.Footnote 87; SR and meta-analysis: Xie Y et al.Footnote 149

Expectoration

Main finding Source
Prevalence in patients with COVID-19: 31.9%, odds 1.52x greater Meta-analysis: Zhong et al.Footnote 130; SR and meta-analysis : Yang L et al.Footnote 220

Rhinorrhea

Main finding Source
Difference between patients with severe and non-severe COVID-19: odds 1.67x greater SR and meta-analysis: Zhang et al.Footnote 67

Pharyngalgia

Main finding Source

Difference between patients with severe and non-severe COVID-19: odds 1.25x greater

Prevalence in patients with COVID-19: 11%

SR and meta-analysis: Zhang et al.Footnote 67; Meta-analysis: Zhong et al.Footnote 130

Pneumonia

Main finding Source

Prevalence in patients with COVID-19:

  1. 87%
  2. bilateral pneumonia: 70.9%

62% of the asymptomatic patients developed cough during course of the infection.

SR and meta-analysis: Borges do Nascimento et al.Footnote 226; SR and meta-analysis: Khamis et al.Footnote 87

Ocular manifestations

Main finding Source

Prevalence in patients with COVID-19: 7%

The most common: Conjunctival symptoms.

SR and meta-analysis: Ling et al.Footnote 295

Laboratory abnormalities

Main finding Source
  • Hypocalcemia: 26%, odds 3.19x greater
SR and meta-analysis: Martha et al.Footnote 378

D-dimer (elevated)

Main finding Source

Higher risk for COVID-19:

  1. severity: odds 3.780 to 6.19x greater, RR=1.58
  2. mortality: odds 3.7x greater, RR= 1.82 to 4.77

Prevalence in patients with COVID-19: 29.3% to 73.3%

SR and meta-analysis: Duz et al.Footnote 379; SR and meta-analysis: Gungor et al.Footnote 380; Meta-analysis: Jin et al.Footnote 381; SR and meta-analysis: Li X et al.Footnote 143; SR and meta-analysis: Lin et al.Footnote 382; SR and meta-analysis: Mudatsir et al.Footnote 98; Meta-analysis: Nugroho et al.Footnote 383; SR and meta-analysis : Shah et al.Footnote 384; SR and meta-analysis: Simadibrata et al.Footnote 385; Meta-analysis: Zhong et al.Footnote 130

Lymphopenia/lymphadenopathy

Main finding Source

18.9%

High risk for COVID-19:

  1. severity: odds 3.19 to 8.34x greater
  2. mortality: odds 3.71x greater

Prevalence in patients with COVID-19: 70.3%

SR and meta-analysis: Bhattacharyya et al.Footnote 71; SR and meta-analysis: Chidambaram et al.Footnote 73; Meta-analysis: Henry et al.Footnote 386; SR and meta-analysis: Li X et al.Footnote 143; SR and meta-analysis: Mudatsir et al.Footnote 98; Meta-analysis: Zhong et al.Footnote 130

Neutrophilia

Main finding Source

High risk for COVID-19:

  1. severity: odds 7.99x greater
  2. mortality: odds 7.87x greater
Meta-analysis: Henry et al.Footnote 386

Thrombocytopenia

Main finding Source

High risk for COVID-19:

  1. severity: RR= 1.90
  2. poor outcomes: RR= 1.90

Prevalence in patients with COVID-19: 18% to 19%

SR and meta-analysis: Pranata et al.Footnote 387; Meta-analysis: Zhong et al.Footnote 130

Radiological features

Main finding Source
  • Ground glass: 60.7%
  • Vascular enlargement: 64.3%
SR and meta-analysis: Xie et al.Footnote 112

Asymptomatic

Main finding Source
  • Prevalence in COVID-19 patients: 20%
  • Higher prevalence the symptomatic patients than asymptomatic: RR=3.23
SR and meta-analysis: Buitrago-Garcia et al.Footnote 388; SR and meta-analysis: Koh et al.Footnote 270

Long-term symptoms

Main finding Source

Prevalence in patients post-COVID-19 infection: 80%

  • fatigue: 80%
  • headache: 44%
  • attention disorder: 27%
  • hair loss: 25%
  • dyspnea: 24%
SR and meta-analysis: Lopez-Leon et al.Footnote 389

Pregnant women

General considerations

Main finding Source
The mean duration from the first symptoms to the hospital admission and to labour were 5.5 and 9.5 days, respectively SR and meta-analysis: Capobianco et al.Footnote 260

Fever

Main finding Source

Common (40%- 76%)

Fever in postpartum period: 23%- 37.1%

The most frequent maternal symptom.

Pregnant and recently pregnant women with COVID-19: less likely to report fever (odds 0.43x greater), compared with non-pregnant women of reproductive age.

SR and meta-analysis: Allotey et al.Footnote 259; SR and meta-analysis: Della-Gatta et al.Footnote 263; SR and meta-analysis: Abou Ghayda et al.Footnote 266; SR and meta-analysis: Hassanipour et al.Footnote 264; SR and meta-analysis: Jafari et al.Footnote 263; SR and meta-analysis: Soheili et al.Footnote 268; SR and meta-analysis: Capobianco et al.Footnote 260; SR and meta-analysis: Bellos et al.Footnote 267

Cough

Main finding Source

Common (29% - 70%)

Higher risk for COVID-19 severity: odds 0.7x greater

SR and meta-analysis: Capobianco et al.Footnote 260; SR and meta-analysis: Borges do Nascimento et al.Footnote 226; SR and meta-analysis: Della-Gatta et al.Footnote 263; SR and meta-analysis: Abou Ghayda et al.Footnote 266; SR and meta-analysis: Hassanipour et al.Footnote 264; SR and meta-analysis: Jafari et al.Footnote 263; SR and meta-analysis: Soheili et al.Footnote 268

Dyspnea

Main finding Source

Common (3% - 34.4%)

Higher risk for COVID-19 severity: odds 2.55x greater

SR and meta-analysis: Chidambaram et al.Footnote 73; SR and meta-analysis: Abou Ghayda et al.Footnote 266; SR and meta-analysis: Hassanipour et al.Footnote 264; SR and meta-analysis: Soheili et al.Footnote 268

Myalgia or fatigue

Main finding Source

Common (11.4%- 26.5%)

Pregnant and recently pregnant women with COVID-19: less likely to report myalgia (odds 0.48x greater) and fatigue (odds 0.58x greater), compared with non-pregnant women of reproductive age.

SR and meta-analysis: Allotey et al.Footnote 259; SR and meta-analysis: Hassanipour et al.Footnote 264; SR and meta-analysis: Jafari et al.Footnote 263

Diarrhea

Main finding Source

Common (7.6% to 9%)

Higher risk for COVID-19 severity: odds 0.46x greater

SR and meta-analysis: Hassanipour et al.Footnote 264; SR and meta-analysis: Jafari et al.Footnote 263; SR and meta-analysis: Soheili et al.Footnote 268

Chest discomfort

Main finding Source
Common (3.9%) SR and meta-analysis: Abou Ghayda et al.Footnote 266

Headache

Main finding Source
Higher risk for COVID-19 severity: odds 0.55x greater SR and meta-analysis: Jafari et al.Footnote 263

Chill

Main finding Source
Common (25%) SR and meta-analysis: Jafari et al.Footnote 263

Sputum

Main finding Source
1% SR and meta-analysis: Abou Ghayda et al.Footnote 266

Sore throat

Main finding Source

Common (2.9%- 11.5%)

Higher risk for COVID-19 severity: odds 0.66x greater

SR and meta-analysis: Abou Ghayda et al.Footnote 266; SR and meta-analysis: Hassanipour et al.Footnote 264; SR and meta-analysis: Jafari et al.Footnote 263

Nasal obstruction

Main finding Source
1% SR and meta-analysis: Abou Ghayda et al.Footnote 266

Laboratory abnormalities

Main finding Source
  • leukocytosis: 27%
  • thrombocytopenia: 18%
  • procalcitonin: 54.0%
  • lymphopenia: 34.2%
  • elevated transaminases: 16.0%
SR and meta-analysis: Jafari et al.Footnote 263

Radiological features

Main finding Source
Ground glass image: 57% SR and meta-analysis: Jafari et al.Footnote 263

Neonates

Main finding Source
  • fever (40%)
  • shortness of breath (28 %)
  • vomiting (24 %)
  • asymptomatic (20%)
  • breathing difficulty (1.79%)

The most frequent neonatal complications were pneumonia and respiratory distress syndrome.

SR and meta-analysis: Bellos et al.Footnote 267; SR and meta-analysis: Capobianco et al.Footnote 260; SR and meta-analysis: Dube et al.Footnote 265

Children

Multisystem inflammatory syndrome (MIS-C)

Main finding Source

Common:

  • fever (82.4% to 97%)
  • gastrointestinal symptoms (78% to 87.3%)
  • skin rashes (60%)
  • shock (49% to 55%)
  • conjunctivitis (54%)
  • respiratory symptoms (39% to 55.3%)
  • neurologic problems (33%)
  • skin desquamation (30%)
  • cardiovascular symptoms (55.3% to 75.5%)
  • myocarditis (32% to 55.1%)
  • coronary vessel abnormalities (18% to 21.7%)
  • congestive cardiac failure (9%)
  • polymorphous maculopapular exanthema (63.7%)
  • oral mucosal changes (58.1%)
  • conjunctival injections (56.0%)
  • edematous extremities (40.7%)
  • cervical lymphadenopathy (28.5%)
  • neurocognitive symptoms (31.8%)
  • hypotension (77%)
  • shock (65.8% to 68.1%)

Prevalence in COVID-19 patients: 6.2%

  • more prevalent in males (53.7%) compared to females (46.3%)
  • prevalence in Hispanic patients: 34.6%
  • prevalence in Black patients: 31.5%

High risk for:

  1. ICU admission: 19% to 73.7%
  2. mechanical ventilation: 37.9%
  3. mortality: 1.9% to 4.8%
SR and meta-analysis: Baradaran et al.Footnote 390; SR and meta-analysis: Irfan et al.Footnote 269; SR and meta-analysis: Sood et al.Footnote 391; Meta-analysis: Toraih et al.Footnote 392; Meta-analysis: Wang JG et al. [273]; SR and meta-analysis: Yasuhara et al.Footnote 393

Fever

Main finding Source
Common (46% to 63.3%) SR and meta-analysis: Badal et al.Footnote 394; SR and meta-analysis: Cui et al.Footnote 148; SR and meta-analysis: Irfan et al.Footnote 269; SR and meta-analysis: Li et al.Footnote 271; SR and meta-analysis: Mansourian et al.Footnote 395; Meta-analysis: Wang JG et al.Footnote 273

Cough

Main finding Source
Common (33.7% to 50%) SR and meta-analysis: Badal et al.Footnote 394; SR and meta-analysis: Cui et al.Footnote 148; SR and meta-analysis: Irfan et al.Footnote 269; SR and meta-analysis: Li et al.Footnote 271; SR and meta-analysis: Mansourian et al.Footnote 395

Headache

Main finding Source
Common (67%) SR and meta-analysis: Badal et al.Footnote 394

Gastro-intestinal symptoms

Main finding Source
Common (14.4%) Meta-analysis: Wang JG et al.Footnote 273

Vomiting

Main finding Source
Common (33%) SR and meta-analysis: Cui et al.Footnote 148

Diarrhea

Main finding Source
Common (19%) SR and meta-analysis: Mansourian et al.Footnote 395

Nervous system symptoms

Main finding Source
Common (6.7%) Meta-analysis: Wang JG et al.Footnote 273

Pharyngalgia

Main finding Source
Common (13%) SR and meta-analysis: Mansourian et al.Footnote 395

Respiratory symptoms

Main finding Source
Common (56.8%) Meta-analysis: Wang JG et al.Footnote 273

Chest tightness

Main finding Source
Common (6.1%) Meta-analysis: Wang JG et al.Footnote 273

Laboratory abnormalities

Main finding Source

Common:

  • leukopenia (8.8% to 12%)
  • lymphopenia (12% to 26%)
  • elevated Ferritin (26 %)
  • normal white blood cell (69%)
  • elevated creatine-kinase (37%)
  • neutropenia (34%)
  • D-dimer (36%)
SR and meta-analysis: Badal et al.Footnote 394; SR and meta-analysis: Cui et al.Footnote 148; SR and meta-analysis: Li et al.Footnote 271; SR and meta-analysis: Mansourian et al.Footnote 395; Meta-analysis: Wang JG et al.Footnote 273

Radiological features

Main finding Source

Common:

  • ground-glass opacities (36 %)
  • normal finding (33 % to 41%)
SR and meta-analysis: Badal et al.Footnote 394; SR and meta-analysis: Cui et al.Footnote 148; Meta-analysis: Wang JG et al.Footnote 273

General considerations

Main finding Source
  • 13% to 23% (RR=0.17) were asymptomatic

Children younger than five years with laboratory-confirmed COVID-19 infection (n=1,214):

  1. 50% young COVID-19 cases were infants
  2. 53% were male
  3. 43% were asymptomatic
  4. 7% had severe disease (ICU admission)

SR and meta-analysis: Badal et al.Footnote 394; SR and meta-analysis: Bhuiyan et al.Footnote 264

SR and meta-analysis: Cui et al.Footnote 148; SR and meta-analysis: Koh et al.Footnote 270; Meta-analysis: Wang JG et al.Footnote 273; Meta-analysis: Zhu et al.Footnote 209

Appendix C: Key findings for topic c) non disease-specific approaches to assist with non-treatment patient management measures for in-person oral health care

The following approaches and settings have moderate evidence for risk.

Teledentistry

Main finding Source

Teledentistry is a solution as dental health services and is very useful in this COVID-19 pandemic situation.

In the provision of oral care in elderly people:

  1. Minimizing the risk of contamination, avoiding unnecessary appointments and triaging dental visits.
  2. Accurate diagnosis way as traditional face-to-face dental examinations; cost-effective; and well accepted among patients, patients’ families, and caregivers.
  3. Implementing in residential aged care facilities and in home-assistance programs: viable tool for the management of oral care in people who cannot access dental care.

SR: Achmad et al.Footnote 302; Scoping review :Bastani et al.Footnote 303

SR: Aquilanti et al.Footnote 304

Telehealth

Main finding Source

Telehealth is a beneficial way to evaluate patients with Cleft lip and Cleft palate.

The proper care and follow-up reduce complications and to improve health outcomes.

The application of Telehealth and e-health systems plays a critical role to ensure continuous access to healthcare in lockdown scenarios in the combat to COVID-19.

Management of chronic pain during COVID-19:

  • use of telemedicine, screening for painful intensity, and the use of color-signaled intervention packages according to severity (green, yellow, and red)

Telehealth is certainly appropriate in minimizing the risk of COVID-19 transmission:

  • potential to prevent any sort of direct physical contact
  • provide continuous care to the community
  • reduce morbidity and mortality in COVID-19 outbreak

SR: Bedi et al.Footnote 305

SR: Alonso et al.Footnote 306

SR: de Moraes et al.Footnote 307

SR: Monaghesh et al.Footnote 301

Mobile apps

Main finding Source

Have been implemented for:

  • training
  • information sharing
  • risk assessment
  • self-management of symptoms
  • contact tracing
  • home monitoring
  • decision making for managing the COVID-19 pandemic
SR: Kondylakis et al.Footnote 308

Dental office

Before entering a dental office

Main finding Source
  1. Patient triage (identification of possible suspects using a questionnaire).
  2. Most important Ethical concerns for oral and DHCP during the COVID-19 outbreak: the obligation for restricting dental health services to the emergency conditions at the expense of preventive procedures.

    Emergency Dental Conditions:

    1. Pulpal inflammation, resulting in pain.
    2. Inflammation of tissue surrounding an impacted third molar (pericoronitis).
    3. Postoperative osteitis or dry socket dressing changes.
    4. Localized pain associated with swelling as a result of localized abscess or localized infection.
    5. Pain or soft tissue trauma, as a result of a broken tooth.
    6. Dental traumatology related to an avulsed/luxated tooth.
    7. Loss of temporary restoration, as a result of soft tissue trauma or a broken tooth.

    Non-Emergency Dental Conditions:

    1. Initial or regular oral examinations and follow-up appointments with or without routine radiographs.
    2. Regular hygienist appointment (scaling and root planning) and other preventive therapies.
    3. Orthodontic treatments other than those to address acute issues (eg, pain, infection, trauma).
    4. Elective tooth removal procedures.
    5. Restorative treatments related to asymptomatic carious teeth or crown preparation.
    6. Aesthetic dental treatments.

    Any other dental treatments that require a face-face approach without generating aerosol should be managed as minimally invasive as possible.

  3. Management of paediatric dental emergencies applicable to the COVID-19 pandemic:
    • Children with congenital heart disease high risk for endocarditis;
    • Only one Clinical Practice Guidelines was classified as "highly recommended" to support DHCP in decision-making to adopt specific dental procedures in the current COVID-19 pandemic.
  4. Quarantine, contact tracing, screening, and isolation are effective measures of COVID-19 prevention, particularly whenever integrated together.
  5. For orthodontic treatment: careful patient screening and collection of records; minimal physical visits; utilizing technology at its best; virtual consultations; clear aligner therapy (CAT) to minimize the AGPs.

SR: Mahdi et al.Footnote 309; SR: Turkistani et al.Footnote 310

Scoping review: Bastani et al.Footnote 303

SR: Bordea et al.Footnote 396

SR: Arieta-Miranda et al.Footnote 397

SR: Girum et al.Footnote 398

Scoping Review: Kaur et al.Footnote 399

At the dental office

Main finding Source
  1. Active screening of patients (the temperature of the patient should be taken and for patients coming with a temperature >100.4 oF or 38 oC should be postponed if possible or performed in an airborne infection isolation room (AIIR) or negative-pressure room)
  2. limiting the number of patients and displaying cough etiquette in the waiting area
  3. waiting area with proper ventilation
  4. keeping the physical distancing
  5. removing the shared objects from waiting area

Management of patients:

  1. Unsuspected asymptomatic patients: treat only ER following a standard regime.
  2. Suspected asymptomatic patients: reschedule appointment and instruct to self-quarantine at home for 14 days.
  3. Suspected symptomatic or body temperature higher than 37.3oC: register patient information, refer to hospital, and clean reception area ASAP. In case of dental ER, follow the highest level of personal protection.
  4. COVID-19 confirmed patients: treat only ER and follow the highest level of personal protection.

Any suspected case that needs urgent treatment: last appointment of the day.

COVID-19 diagnostics with a particular focus on the methods which can be utilized in an outpatient and dental care setting:

  • Reverse transcription polymerase chain reaction: utilization in outpatient care is limited;
  • Serological enzyme-linked immunosorbent: not give sufficient information about the acute infection;
  • Rapid serological assays: to facilitate testing especially in dental offices. Not recommended by the World Health Organization to be used outside research settings and frequent false-negative results.
  • The best methods to ensure the occupational safety: epidemiological interview, temperature measurement to rule out patients with an active infection, and the implementation of strict infection control procedures.

SR: Mahdi et al.Footnote 309; SR: Turkistani et al.Footnote 310; SR: Delikhoon et al.Footnote 311; Scoping Review : Kathree et al.Footnote 312

SR: Turkistani et al.Footnote 310

SR: Tysiąc-Miśta et al.Footnote 313

Post dental treatment

Main finding Source
  1. Cleaning and Disinfection of the treatment room and waiting area, including doorknobs, chairs, floor, desks, restrooms, and elevators between patients;
  2. Dental chair needs to be wiped after every patient and the operatory surfaces needs to be wiped minimally twice a day.
  3. Dentists are recommended to keep their belongings aside and refrain from using jewelry while treating confirmed cases.

SR: Mahdi et al.Footnote 309

SR: Turkistani et al.Footnote 310

Specific precautions

Frequent handwashing

Main finding Source

Before and after contact with every patient.

High chances of SARS‐Cov‐2 infection via faecal‐oral transmission. (commonly present in stool samples or anal swabs in which the virus can persist long after respiratory testing has become negative and that the virus may be viable). Attention to person‐to‐person transmission and to hand and sanitation hygiene.

Use of Alcohols:

  1. Lower risk of skin irritation for n-propanol and isopropanol.
  2. The combination of n-propanol or isopropanol with detergents (such as sodium lauryl sulfate): increase the potential irritants.
  3. Repeated exposure to 60% n-propanol: significant barrier damage effects as atopic skin.

SR: Turkistani et al.Footnote 310

SR: Van Doorn et al.Footnote 330

SR: Tasar et al.Footnote 400

Masks or respirators worn by health care professionals

Main finding Source

HCP must be provided with N95, FFP2, or FFP3 masks combined with gowns and goggles.

SR: Delikhoon et al.Footnote 311

Specific settings, general precautions

Main finding Source

Nosocomial transmission (through aerosols, droplets, and direct contact) of COVID-19 patients to HCW can be controlled by social distancing, wearing masks, personal hygiene, and avoiding crowds.

Proportion of reported global SARS-CoV-2 infections (n=5):

  • occurred outdoors: <10%
  • indoor transmission was very high compared to outdoors: odds of 18.7 times

Asymptomatic patients: Studies from seven countries that tested 21,708 at-risk people, of which 663 were positive and 111 asymptomatic. Meta-analysis (fixed effects) found:

  • asymptomatic cases was 17% (95% CI 14% to 20%)
  • overall and higher in aged care (20%; 95% CI 14% to 27%)
  • in non-aged care (16%; 95% CI 13% to 20%)

The relative risk of transmission:

  • asymptomatic 42% lower than that for symptomatic transmission (combined RR 0.58)

Transmission of viruses was lower with physical distancing:

  • 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds: 0·18)
  • protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m)

SR: Rahman et al.Footnote 104

SR: Bulfone et al.Footnote 401

SR and meta-analysis: Byambasuren et al.Footnote 402

SR and meta-analysis: Chu et al.Footnote 322

Appendix D: Key findings for topic d) PPE for providing in-person healthcare

The following personal protective approaches have limited evidence for risk, though strong evidence for other diseases.

Specific settings, general precautions

Main finding Source

Recommendation to replace the mask every 2 h with non-aerosol procedures and every 4 h with aerosol generating procedures.

Strong reduction of infection risk in frontline HCWs (odds:-1.04) using gloves, gown, surgical mask, N95 respirator, face protection, and infection training.

  1. Proper donning and doffing is critical for the safety of both the DHCP and the patient.
  2. Following Guidance for doffing PPE compared to no guidance may reduce self-contamination (MD −5.44).
  3. Face-to-face training may reduce non-compliance with doffing guidance (odds ratio 0.45) compared to solely providing folders or videos.

Medical interventions:

Higher risk of droplet contamination:

  • osteotomies: indicating that these types of surgeries warrant the most advanced PPE

Lowest risk of droplet contamination:

  • transoral robotic surgeries: suggesting that less stringent PPE is sufficient for providers during these procedures

HCW masks and probability to carry virus and increase the risk of viral transmission: low chance and weak evidence to support when HCW treating patients with clinical respiratory illness.

Prolonged PPE usage led to:

  • headaches (1 of 27 studies)

SR: Turkistani et al.Footnote 310

SR and meta-analysis: Tian et al.Footnote 403

Scoping Review : Bradford et al.Footnote 319; SR and meta-analysis: HegdeFootnote 318

SR: McCarty et al.Footnote 334

SR: Jones et al.Footnote 404

SR: Gross et al.Footnote 320

Face shields and eye protection

Main finding Source
  1. Should only be used in combination with an underlying face mask (mask or respirator and, if necessary, a surgical cap) for all procedures in which copious fluid quantities are expected in close proximity to the user’s face.
  2. Larger face shields that offer lateral facial protection should be selected.
Scoping Review: Bradford et al.Footnote 319; SR: Griswold et al.Footnote 321

Goggles

Main finding Source
DHCPs should consider using goggles in supplement to a face mask: when performing procedures that are likely to produce small-sized aerosolized particles directed towards the practitioner. Scoping Review: Bradford et al.Footnote 319

Respirators

Main finding Source

A higher-level respirator such as EU FFP3 conforming to European Standard 149 (EN149): recommended when treating COVID-19 suspected patients.

High-performance filtering masks:

  • FFP1: high filtration efficiency of 80%;
  • FFP2: high filtration efficiency of 94%;
  • FFP3: high filtration efficiency of 99%;
  • Thus, the FFP3 is likely to be twice as effective as the FFP2 mask, and broadly both are equivalent or superior to an N95 mask.

SR: Turkistani et al.Footnote 310

SR: Rahman et al.Footnote 405

Face masks

Main finding Source

Wearing face masks may reduce primary respiratory infection risk, probably by 6-15% (odds: 0.85 to 0.94). COVID-19-specific studies are required.

Wearing face masks vs. no mask: not at statistically significant levels (odds: 0.90).

Mathematical models: important decrease in mortality when the population mask coverage is near-universal, regardless of mask efficacy.

Weak evidence for scientific studies that have investigated the effectiveness or ineffectiveness use of face masks to limit the spread of COVID-19 among "healthy individuals".

Contamination can be reduced amongst HCW: added tabs to facilitate doffing of masks (RR 0.33).

Scoping Review : Brainard et al.Footnote 325

SR: Coclite et al.Footnote 324

SR: MarasingheFootnote 406

SR and meta-analysis: HegdeFootnote 318

Surgical masks

Main finding Source

Especially a Type 3 mask, should be standard protocol within the dental operatory.

Medical masks provided similar protection against other viruses, including coronavirus (RR = 0.74).

Levels of mask filtration efficiency: depending on the materials used (45–97%).

Scoping Review : Bradford et al.Footnote 319

SR and meta-analysis: Barycka et al.Footnote 323

SR : Coclite et al.Footnote 324

N95 masks

Main finding Source

Should only be worn by a DHCP when there is a high likelihood of small-sized aerosolized particles directed to- wards the DHCP and there are no engineering safeguards (high- volume evacuation, etc.) in place.

The use of N95 respirators or air supplying respirators and adherence to the principles of personal hygiene, frequent hand washing and the use of disinfectants can reduce the prevalence of COVID-19 in HCP.

Scoping Review : Bradford et al.Footnote 319

SR: Fouladi et al.Footnote 407

N95 masks vs surgical masks

Main finding Source

Wearing surgical mask is the standard, vs FFP2/N95 (or higher) for aerosol-generating procedures or for all procedures. Use for both clinical and nonclinical staff (clinicians and assistants).

In clinical settings: indicate the non- superiority of N95 mask use vs surgical masks in moderate and high-risk clinical situations (5.7% vs. 7.9%; RR = 1.12)

  1. The use could result in a large reduction in risk of COVID-19 infection in moderate to high-risk environments;
  2. stronger association of protection from COVID-19, SARS, or MERS with N95 or similar respirators versus other face masks (posterior probability for RR <1, 100% and 95%, respectively).

SR: Mahdi et al.Footnote 309; SR: Turkistani et al.Footnote 310

Scoping Review: Bradford et al.Footnote 319

SR and meta-analysis: Barycka et al.Footnote 323

SR: Griswold et al.Footnote 321

Powered air-purifying respirator (PAPR)

Main finding Source
  1. PAPR with coverall may protect against the risk of contamination better than a N95 mask and gown (RR 0.27);
  2. PAPR with coverall: more difficult to donning (RR 7.5).
SR and meta-analysis: HegdeFootnote 318

Gowns

Main finding Source
  1. Compared to aprons: protect better against contamination (MD) -10.28).
  2. Contamination can be reduced:
    • using a sealed gown and glove combination so that they can be removed together and cover the wrist area (RR 0.27);
    • tight fitting gown around the neck, wrist area and hands (RR 0.08);
    • added tabs to facilitate doffing of masks (RR 0.33, 95%nCI 0.14 to 0.80) or gloves (RR 0.22, 95% CI 0.15 to 0.31).
SR and meta-analysis: HegdeFootnote 318

Gloves

Main finding Source
  1. Reducing contamination:
    • added tabs to facilitate doffing of gloves (RR 0.22);
    • one-step removal of gloves and gown compared to separate removal (RR 0.20);
    • double gloving compared to single gloving (RR 0.34);
    • sanitising gloves before doffing with quaternary ammonium or bleach (but not alcohol-based hand rub).
SR and meta-analysis: HegdeFootnote 318

Appendix E: Key findings for topic e) decontamination and re-use of PPE

The following decontamination and personal protective approaches have limited evidence for risk.

N95 respirators

Considerations

Main finding Source

Current sterilization measures are not sufficient to permit routine re-use of face masks. All face masks should be treated as single use only to prevent cross-contamination.

In an emergency shortage situation, were masks must be reused, masks should be stored in a paper bag, paying strict attention to doffing protocols, until sterilized.

Scoping Review: Bradford et al.Footnote 319

Ultraviolet C radiation (UV-C)

Main finding Source

Some efficacy of using UV-C to inactivate coronaviruses, including SARS-CoV-2 and MERS, as well as H1N1 influenza viruses.

N95 2FFR for 60–70 s at 17 mW/cm

Scoping Review: Bradford et al.Footnote 319

Hydrogen peroxide vapor (H2O2)

Main finding Source

Relatively novel sterilizing technique. May be a viable solution when respirators are in short supply.

After 50 cycles: respirator function was excellent, with no impairment of aerosol collection efficiency or airflow resistance.

Scoping Review: Bradford et al.Footnote 319

Appendix F: Key findings for topic f) the provision of aerosol-generating procedures (AGP)

The following aerosol-generating procedures have limited evidence for risk in relation to COVID-19/SARS-CoV-2.

Water contamination

Main finding Source

SARS‐CoV‐2 in wastewater from households with infection: High risk chances of SARS‐Cov‐2 infection via faecal‐oral transmission from gastrointestinal AGPs.

Clean drinking water provision, proper sanitation, food safety and hygiene could be critical in the current fight against COVID-19.

SR: Van Doorn et al.Footnote 313; Scoping Review: Rahimi et al.Footnote 331

SR: GwenziFootnote 332

Droplet transmission

Main finding Source

Occurency:

  1. From particles >5 μm, which can settle on surfaces under gravitational settling and do not move more than 1 m.
  2. Particles <5 μm: can stay suspended for an extended period of time (≥2 h) and travel longer distances (up to 8 m) through simple diffusion and convection mechanisms.
  3. The droplets <10 μm: can be transferred larger distant when the weather is cold and humid.
  4. The persistence of the SARS-CoV-2 is remarkable at a low temperature (4 oC), and, by raising the temperature to 70 oC, the virus was no longer detectable after 5 min.

A PCS was designed to investigate blood viral load of COVID-19 in 52 patients (median age, 62 years; 31 [59.6%] male): The viral loads in critical patients were significantly higher than those in their general and severe counterparts. Meanwhile, none of their close contacts had evidence of infection.

SR: Delikhoon et al.Footnote 311

Prospective Cohort Study: Chen et al.Footnote 408

Bio-aerosol transmission/contamination

Main finding Source

Higher aerosol levels for AGP contamination: oral-maxillofacial surgeries that utilize lasers, or pneumatic or electric tools, such as rotary drills and saws.

Medical interventions:

  • droplet contamination was highest and most widespread during osteotomies, while transoral robotic surgeries have the lowest risk of droplet contamination.

Creative solutions to minimize the risk of COVID-19 transmission on AGP:

  • application of topical viricidal agents
  • make-shift mask filters
  • three-dimensional (3-D) printable adapters for headlights
  • aerosol containing separation boxes

SR: Zhang et al.Footnote 315

SR: McCarty et al.Footnote 334

Consensus of AGP on oral and dental procedures

Main finding Source

Evidence of microbiological and blood contamination during oral surgery procedures using:

  • drills of variable speeds, with/without reported irrigation
  • suction (high/low/none stated)
SR: Gallagher et al.Footnote 335

The following aerosol-generating procedures have limited evidence for risk in relation to SARS, MERS, H1N1, influenza and bacteria.

Consensus of AGP on oral and dental procedures

Main finding Source

Hierarchy of procedure contamination risk:

  1. Higher: Ultrasonic scaler, highspeed air-rotor, air-water syringe, air polishing, extractions using motorized handpieces;
  2. Moderate: slow-speed handpieces, prophylaxis, extractions;
  3. Lower: air-water syringe [water only] and hand scaling.

During oral surgery procedures: the use of standard reagents for the presumptive identification of blood revealed more extensive contamination (aerosol) than indicated by visible blood (splatter), particularly where all disposable PPE were examined.

SR: Innes et al.Footnote 333

SR: Gallagher et al.Footnote 335

Appendix G: Key findings for topic g) mitigation strategies (for example, rubber dam, mouth rinses etc.) during the provision of in-person oral health care

The following interventions have limited evidence for risk in dental procedures.

Minimal invasive procedures

Main finding Source
  1. As an alternative to AGP: use of CariSolv for caries removal; extraoral radiographs; the use of a hand scaler where a rubber dam is unavailable.
SR: Mahdi et al.Footnote 309

High‐volume evacuator

Main finding Source
  1. The use reduces contamination in aerosols during dental procedures particularly in combination with four-handed dentistry during every procedure will allow for better control over evacuating systems and limit the production of aerosolized particles at the source.
  2. A review of a total of 17 clinical studies indicates that HVE is an obligatory requirement to reduce bio- aerosols in dentistry.
  3. Significantly higher reduction in the quantity of mean CFUs.
  4. Air polisher without HVE generated a significantly higher number of CFUs on the face mask plate.

HVE vs CDS (conventional dental suction):

HVE: Mean Aerobic microbes 0.9 (1.3)

Mean Anaerobic microbes 1.1 (1.2) vs CDS: Mean Aerobic microbes 1.0 (1.2)

Mean Anaerobic microbes 3.3 (2.7)

SR: Mahdi et al.Footnote 309; Scoping Review: Bradford et al.Footnote 319; Scoping Review: Kathree et al.Footnote 312

SR: Mahdi et al.Footnote 341

Rubber dam

Main finding Source
  1. During dental treatment: is essential to reduce the risk of cross-transmission through saliva and minimize droplet spatter;
  2. A review of a total of 17 clinical studies indicates that while rubber dam application must be utilized when opportune to reduce bio- aerosols in dentistry;
  3. The use reduces microorganisms in 90 to 98%;
  4. Bacterial reduction at 1m: 98.8% and increased when antiseptic mouth rinse was used together (99.4%).

SR: Turkistani et al.Footnote 310; Scoping Review: Bradford et al.Footnote 319; Scoping Review: Kathree et al.Footnote 312

SR: Samaranayake et al.Footnote 341

Mouth rinse solutions

Different types of solution

Main finding Source
  1. The use of a patient pre-procedural mouth rinse with an antimicrobial agent reduces contamination in aerosols and bacterial challenges to the mask and must be utilized when opportune to reduce bio- aerosols in dentistry.
  2. Unable to ascertain the relative benefits and harms of the use of antimicrobial mouthwashes and nasal sprays by individuals with COVID‐19.
  3. Nonsurgical periodontal therapy: by the use of laser and ozone therapy, air polishing, probiotics and chlorhexidine: reduction of microorganism load present in aerosols.

SR: Mahdi et al.Footnote 309; SR: Samaranayake et al.Footnote 341; Scoping Review : Bradford et al.Footnote 319

SR: Burton et al.Footnote 343

Scoping Review: Butera et al.Footnote 342

Povidine-iodine (PVP-I)

Main finding Source

RCT proposed to assess the ability of regular gargling to eliminate SARS-CoV-2 in the oropharynx and nasopharynx (n=5 confirmed Stage 1 COVID-19 patients).

Effect of 30 sec, 3 times/day gargling:

  • Day 4: SARS-CoV-2 was not detected (n=5)
  • Day 6: SARS-CoV-2 was not detected (n=5)
  • Day 12: SARS-CoV-2 was not detected (n=5)
  • Viral clearance was achieved in 100% for 1%PVP-I

PVP-I solution for mouthwash for virucidal action on the SARS-CoV and MERS-CoV:

  • 1%PVP-I without dilution/15 s exposure: viral reduction of ≥99.99%
  • 7%PVP-I with 1:30 dilution/15 s exposure: viral reduction of ≥ 99.99%
  • 1% and 7%PVP-I: appears to be the most effective mouthwash for reducing the viral load of COVID-19 present in human saliva

RCT: Mohamed et al.Footnote 344

SR: Cavalcante-Leão et al.Footnote 345

SR: Samaranayake et al.Footnote 341

Essential oil (EO)

Main finding Source
  1. 94.1% reduction in CFUs;
  2. Significantly reduce the level of viable bacteria in an aerosol produced via ultrasonic scaling 40 min later.

RCT proposed to to assess the ability of regular gargling to eliminate SARS-CoV-2 in the oropharynx and nasopharynx (n=5 confirmed Stage 1 COVID-19 patients).

Effect of 30 sec, 3 times/day gargling:

  • Day 4: SARS-CoV-2 was not detected (n=4)
  • Day 6: SARS-CoV-2 was not detected (n=4)
  • Day 12: SARS-CoV-2 was not detected (n=4)
  • Viral clearance was achieved in 80% for EO

SR: Samaranayake et al.Footnote 341

RCT: Mohamed et al.Footnote 344

Chlorhexidine (CHX)

Main finding Source
  1. Reduce most of the bacterial aerosols generated via the use of the air-polishing device
  2. reduces aerosol as far as 9 feet from the patients’ head
  3. reduces the dissemination of bacteria
  4. 0.12% CHX is effective in reducing the levels of spatter containing microbes generated during ultrasonic scaling
  5. 0.2% CHX mouth rinse increases in the numbers and diversity of airbone microbes
SR: Samaranayake et al.Footnote 341

Dipotassium glycyrrhizinate

Main finding Source
The use of mouthwash was used 3x/day for 7 to 10 days after Implant Placement (n=16) inhibited propagation of the bacteria, especially for total G [-] anaerobes (reduction of CFUs). RCT: Taninokuchi et al.Footnote 346

Tranexamic acid-based

Main finding Source
The use of mouthwash was used 3x/day for 7 to 10 days after Implant Placement (n=16) inhibited propagation of the bacteria, especially for total G [-] anaerobes (reduction of CFUs). RCT: Taninokuchi et al.Footnote 346

Chlorine dioxide, sodium chlorite or chlorine derivatives

Main finding Source
There is no scientific evidence to support the use of chlorine dioxide or chlorine derivatives to prevent or treat COVID-19. SR: Burela et al.Footnote 347

Cetylpyridinium chloride (CPC)

Main finding Source
  1. 0.05% CPC and 0.12% CHX and are equally effective in reducing the levels of spatter containing microbes generated during ultrasonic scaling.

The use of mouthwash was used 3x/day for 7 to 10 days after Implant Placement (n=16) inhibited propagation of the bacteria, especially for total G [-] anaerobes (reduction of CFUs).

SR: Samaranayake et al.Footnote 341

RCT: Taninokuchi et al.Footnote 346

Appendix H: Key findings for topic h) space ventilation strategies to reduce the risk of transmission

The following ventilation settings have limited evidence for risk in relation to SARS-CoV and MERS-CoV and microorganisms.

Air cleaning systems in dental office

Main finding Source

May reduce the risk of infection:

  1. Using a UVC light, a HEPA filter air purifier, or room ventilation for 30 min prior to surface disinfection after treatment or between patients.
  2. Using HEPA14 filters or higher, where the filtration efficiency is ≥99.995%, for particles ≥0.01 µm, is highly recommended while the patient is undergoing, and immediately after, an AGP.

If patient is not suspect of being infected with COVID-19:

  • the standard ventilation rate of ≥1.5 air change/h, during and after the visit, should be provided

If patient is suspect of being infected with COVID-19:

  • mechanical ventilation with a constant 6 air change/h, during and after the visit, is recommended

If patient is positive for COVID-19 and emergency treatment required:

  • highest level of PPE
  • negative pressure room should be utilized (min 12 air changes per hour or at least 160 L/s per patient)
  • mechanical ventilation used before treating next patient

Airborne SARS-CoV-2 can be transmissible in 4 m in closed spaces. Is highly recommended to use air conditioning systems with extra persuasions, especially when the air is possibly infected.

SR: Madhi et al.Footnote 309; SR: Turkistani et al.Footnote 310

SR: Tysiac-MistaFootnote 348

SR: Tysiac-MistaFootnote 348

SR: Tysiac-MistaFootnote 348

Scoping review: Kathree et al.Footnote 312

SR: Rahimi et al.Footnote 331

Air-conditioning systems disinfection

Main finding Source

Some viral aerosols remaining in the dental clinic, after a working day that is why air-conditioning systems should be periodically cleaned and disinfected. The methods for air-conditioning disinfection are:

By by fogging with hydrogen peroxide:

  • Hydrogen peroxide is a widely recommended agent for daily use in enclosed areas (bactericidal, fungicidal, virucidal and sporicidal activity)
  • safe for humans, medical materials, and the environment
  • Disadvantage: the rooms must be vacated and pre-cleaned to remove the visible dirt; the Vapors must be moved around as they are irritating to the eyes, mucous membrane and skin; they may cause lung irritation if inhaled.
  • There is no data on the use of such a disinfection method in the dentistry setting, but due to the decades of a successful use of vaporized hydrogen peroxide in other clinical settings, this method can certainly be recommended as an effective way to meet the new hygienic demands in dentistry.

By UVGI Ultraviolet (UV) radiation:

  • has been used for almost half a century to annihilate airborne microorganisms in hospitals, laboratories, and dental offices
  • the susceptibility of SARS-CoV-2 to UV has not been fully investigated yet, studies of other coronaviruses (SARS-CoV and MERS-CoV), have proven their liability to this type of radiation
  • only the UV-C light can exterminate viruses by disrupting their DNA base pairing and halting their reproductive capability
  • UV-C flow germicidal lamps: infection control protocol in the dental office should imply thorough cleaning between patients with the addition of UV-C radiation for 20–30 min

By Ozone generators:

  • has shown the inactivation of influenza viruses, herpes simplex viruses, coronaviruses, rhinoviruses and polioviruses after exposure to 100 ppm of ozone for 30 min
  • could easily penetrate into all areas of the room, furniture and other objects
  • disavantage: causes some materials (e.g., natural rubber) corrosion and for the virus to be inactivated; ≥80% air humidity is required; is toxic for humans (can only be carried out in a sealed room, without any people inside)
  • safe ozone concentration for humans as 0.1 ppm for 8 h or 0.3 ppm for 15 min
  • the optimal virucidal effect: ozone concentration to 25 ppm for 15 min, maintaining this concentration for 10 min, and then increasing the relative humidity to 95% and leaving it for additional 5 min

By Plasma:

  • the non-thermal plasma disinfection method is environmentally friendly as it does not generate waste or toxic by-products and does not use toxic chemicals. It is also easy and safe in handling

By Photocatalytic disinfection with titanium oxide:

  • relative effectiveness against SARS-CoV-1, which also gives a high probability of the virucidal effect on SARS-CoV-2
  • filters made of silver and titanium dioxide activated by the UV light are a very interesting alternative for air disinfection
  • disadvantages: high relative humidity decreases the effectiveness of the devices
  • the surface coating with a thin layer of titanium dioxide nanoparticles can also be utilized in the dental setting, where UV radiation is often used for surface disinfection. It is advised to apply ceramic wall tiles coated with a layer of titanium oxide
SR: Tysiac-MistaFootnote 348

Appendix I: Key findings for topic i) disinfection of surfaces in spaces in which oral health care is provided

The following approaches and interventions have moderate evidence for risk in relation to SARS-CoV.

Disinfectants

Main finding Source

Effects on prosthetic surfaces:

  • Prosthodontic material (e.g.impressions): disinfected by intermediate level disinfectant.
  • Salivary suction carefully done, use topical anaesthesia when choosing size/ modifying impression trays to prevent gag reflex.
Scoping Review: Kathree et al.Footnote 312

Chlorine

Main finding Source
  • 1%NaOCl solution for 1 minute: reduce SARS-CoV infectivity and to minimize the risk of cross-contamination through prosthetic materials;
  • 1%NaOCl solution: increase in surface roughness and color alteration on acrylic resin (not clinically significant);
  • 1% NaOCl solution: decrease in bonding strength on lithium disilicate.
SR: di Fiore et al.Footnote 350

Alcohols

Main finding Source
  • 96% isopropanol and 80% ethanol solutions decrease in bonding strength on lithium disilicate.
SR: di Fiore et al.Footnote 350

The following approaches and interventions have limited evidence for risk in relation to different viruses.

Disinfectants

Chlorine

Main finding Source

Strict cleaning protocol of the surfaces including door handles, chairs and room desks using a solution containing hospital-grade disinfectants, including 0.1% sodium hypochlorite, have proven to be effective against coronaviruses.

The various coronaviruses survive on surfaces for up to nine days, and they can be eliminated by disinfection with 0.1% sodium hypochlorite for at least 1 min.

In sewage, sodium hypochlorite had better action than chlorine dioxide.

SR: Mahdi et al.Footnote 309; SR: Turkistani et al.Footnote 310; SR: Shimabukuro et al.Footnote 351

SR: Delikhoon et al.Footnote 311; SR: Rahimi et al.Footnote 331

SR: Shimabukuro et al.Footnote 351

Alcohols

Main finding Source

Strict cleaning protocol of the surfaces including door handles, chairs and room desks using a solution containing hospital-grade disinfectants, including alcohol-based products such as 62 to 70% isopropyl alcohol, have proven to be effective against coronaviruses.

The various coronaviruses survive on surfaces for up to nine days, and they can be eliminated by disinfection with 62–72% ethanol for 1 min.

70% alcohol showed efficient immediate activity.

SR: Delikhoon et al.Footnote 311; SR: Rahimi et al.Footnote 331

SR: Shimabukuro et al.Footnote 351

Hydrogen peroxide

Main finding Source

Strict cleaning protocol of the surfaces including door handles, chairs and room desks using a solution containing hospital-grade disinfectants, including 0.5% hydrogen peroxide, have proven to be effective against coronaviruses.

Viral inactivation was achieved using UV-C.

The various coronaviruses survive on surfaces for up to nine days, and they can be eliminated by disinfection with 0.5% hydrogen peroxide for 1 min.

SR: Turkistani et al.Footnote 310

SR: Shimabukuro et al.Footnote 351

SR: Rahimi et al.Footnote 331

Glutaraldehyde

Main finding Source
Viral inactivation was achieved. SR: Shimabukuro et al.Footnote 351

Iodine-containing detergents

Main finding Source
Viral inactivation was achieved. SR: Shimabukuro et al.Footnote 351

Benzalkonium chloride

Main finding Source
The use of 0.05–0.2% were found to be less successful for inactivating the various coronaviruses. SR: Rahimi et al.Footnote 331

Chlorhexidine digluconate

Main finding Source
The use of 0.02% were found to be less successful for inactivating the various coronaviruses. SR: Rahimi et al.Footnote 331

Ultraviolet-C (UV-C)

Main finding Source
  1. Germicidal effect against microorganisms including viruses, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. Lower evidence for COVID-19.
  2. Advantages:
    • useful in high-traffic, high-touch places, and surfaces where bioburden is high;
    • takes up less time and less manpower; - UV-C can be utilized as an adjunct to terminal manual cleaning as disinfectants.
  3. UV-C light devices used as a disinfecting tool utilize 254 nm UV-C newer studies suggest that the 222 nm wavelength has the same bactericidal without the hazardous effects.

Viral inactivation was achieved using UV-C.

SR: Ramos et al.Footnote 352

SR: Shimabukuro et al.Footnote 351

References

Footnote 1

G. T., "Getting your bearings (deciding what the paper is about)," BMJ, vol. 315, no. 7102, pp. 243-246, 1997.

Return to footnote 1 referrer

Footnote 2

e. a. Guyatt GH, "Users' guides to the medical literature. IX. A method for grading health care recommendations. Evidence-Based Medicine Working Group," JAMA, vol. 274, no. 22, pp. 1800-1804, 1995.

Return to footnote 2 referrer

Footnote 3

Oxford Centre for Evidence-based Medicine, "Levels of evidence," 2009. [Online]. Available: https://www.cebm.ox.ac.uk/resources/levels-of-evidence/ocebm-levels-of-evidence.

Return to footnote 3 referrer

Footnote 4

S. M. Abate, S. Ahmed Ali, B. Mantfardo and B. Basu, "Rate of Intensive Care Unit admission and outcomes among patients with coronavirus: A systematic review and Meta-analysis.," PLoS ONE [Electronic Resource], vol. 15, no. 7, p. e0235653, 2020.

Return to footnote 4 referrer

Footnote 5

S. Bennett, J. Tafuro, J. Mayer, D. Darlington, C. Wai Wong, E. A. Muntean, N. Wong, C. Mallen and C. Shing Kwok, "Clinical features and outcomes of adults with coronavirus disease 2019: A systematic review and pooled analysis of the literature.," International journal of clinical practice, vol. 0, no. 0, pp. E13725, 2020, 2020.

Return to footnote 5 referrer

Footnote 6

A. Hessami, A. Shamshirian, K. Heydari, F. Pourali, R. Alizadeh-Navaei, M. Moosazadeh, S. Abrotan, L. Shojaie, S. Sedighi, D. Shamshirian and N. Rezaei, "Cardiovascular diseases burden in COVID-19: Systematic review and meta-analysis.," American Journal of Emergency Medicine, vol. 0, no. 0, 2020.

Return to footnote 6 referrer

Footnote 7

H. Liu, S. Chen, M. Liu, H. Nie and H. Lu, "Comorbid chronic diseases are strongly correlated with disease severity among COVID-19 patients: A systematic review and meta-analysis," Aging and Disease, vol. 11, no. 3, pp. 668-678, 2020.

Return to footnote 7 referrer

Footnote 8

N, K. y, A. Salunke, S. K. Pathak, P, A. ey, C. Doctor, K. Puj, M. Sharma, A. Jain and V. Warikoo, " Coronavirus disease (COVID-19): A systematic review and meta-analysis to evaluate the impact of various comorbidities on serious events," Clinical Research and Reviews, vol. 14, no. 5, pp. 1017-1025, 2020.

Return to footnote 8 referrer

Footnote 9

J. Meena, J. Yadav, L. Saini, A. Yadav and J. Kumar, "Clinical Features and Outcome of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-analysis," Indian Pediatrics, vol. 57, no. 9, pp. 820-826, 2020.

Return to footnote 9 referrer

Footnote 10

P. Qiu, Y. Zhou, F. Wang, H. Wang, M. Zhang, X. Pan, Q. Zhao and J. Liu, "Clinical characteristics, laboratory outcome characteristics, comorbidities, and complications of related COVID-19 deceased: a systematic review and meta-analysis," Aging Clinical & Experimental Research, vol. 32, no. 9, pp. 1869-1878, 2020.

Return to footnote 10 referrer

Footnote 11

A. K. Singh, C. L. Gillies, R. A. Singh, Y. Chudasama, B. Coles, S. Seidu, F. Zaccardi, M. J. Davies and K. Khunti, "Prevalence of co-morbidities and their association with mortality in patients with COVID-19: A systematic review and meta-analysis," Diabetes, Obesity and Metabolism, vol. 22, no. 10, pp. 1915-1924, 2020.

Return to footnote 11 referrer

Footnote 12

T. Wu, Z. Zuo, S. Kang, L. Jiang, X. Luo, Z. Xia, J. Liu, X. Xiao, M. Ye and M. Deng, "Multi-organ Dysfunction in Patients with COVID-19: A Systematic Review and Meta-analysis," Aging & Disease, vol. 11, no. 4, pp. 874-894, 2020.

Return to footnote 12 referrer

Footnote 13

J. N. Yu, B. B. Wu, J. Yang, X. L. Lei and W. Q. Shen, "Cardio-Cerebrovascular Disease is Associated With Severity and Mortality of COVID-19: A Systematic Review and Meta-Analysis," Biological research for nursing, vol. 0, no. 0, 2020.

Return to footnote 13 referrer

Footnote 14

S. Figliozzi, P. G. Masci, N. Ahmadi, L. Tondi, E. Koutli, A. Aimo, K. Stamatelopoulos, M. A. Dimopoulos, A. L. P. Caforio and G. Georgiopoulos, "Predictors of adverse prognosis in COVID-19: A systematic review and meta-analysis," European Journal of Clinical Investigation, vol. 50, no. 10, p. E13362, 2020.

Return to footnote 14 referrer

Footnote 15

R. Pranata, I. Huang, M. A. Lim, E. J. Wahjoepramono and J. July, "Impact of cerebrovascular and cardiovascular diseases on mortality and severity of COVID-19-systematic review, meta-analysis, and meta-regression," Journal of Stroke & Cerebrovascular Diseases, vol. 29, no. 8, 2020.

Return to footnote 15 referrer

Footnote 16

R. Pranata, I. Huang and S. B. Raharjo, "Incidence and impact of cardiac arrhythmias in coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis," Indian Pacing & Electrophysiology Journal, vol. 20, no. 5, pp. 193-198, 2020.

Return to footnote 16 referrer

Footnote 17

A. M. A. Shafi, S. A. Shaikh, M. M. Shirke, S. Iddawela and A. Harky, "Cardiac manifestations in COVID-19 patients-A systematic review," Journal of Cardiac Surgery, vol. 35, no. 8, pp. 1988-2008, 2020.

Return to footnote 17 referrer

Footnote 18

J. Li, X. He, Y. Yuan, W. Zhang, X. Li, Y. Zhang, S. Li, C. Guan, Z. Gao and G. Dong, "Meta-analysis investigating the relationship between clinical features, outcomes, and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)pneumonia," American Journal of Infection Control, vol. 0, no. 0, 2020.

Return to footnote 18 referrer

Footnote 19

D. T. Di Carlo, N. Montemurro, G. Petrella, G. Siciliano, R. Ceravolo and P. Perrini, "Exploring the clinical association between neurological symptoms and COVID-19 pandemic outbreak: a systematic review of current literature," Journal of Neurology, vol. 1, no. 0, p. 01, 2020.

Return to footnote 19 referrer

Footnote 20

M. J. Cummings, M. R. Baldwin, D. Abrams, S. D. Jacobson, B. J. Meyer, E. M. Balough, J. G. Aaron, J. Claassen, L. E. Rabbani, J. Hastie, B. R. Hochman, J. Salazar-Schicchi, N. H. Yip and Bro, "Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study," Lancet, vol. 395, no. 10239, pp. 1763-1770, 2020.

Return to footnote 20 referrer

Footnote 21

I. Huang, M. A. Lim and R. Pranata, "Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia - A systematic review, meta-analysis, and meta-regression," Diabetes & Metabolic Syndrome, vol. 14, no. 4, pp. 395-403, 2020.

Return to footnote 21 referrer

Footnote 22

S. Khateri, H. Mohammadi, R. Khateri and Y. Moradi, "The Prevalence of Underlying Diseases and Comorbidities in COVID-19 Patients; an Updated Systematic Review and Meta-analysis," Archives of Academic Emergency Medicine, vol. 8, no. 1, p. E72, 2020.

Return to footnote 22 referrer

Footnote 23

Y. Wang, J. Chen, W. Chen, L. Liu, M. Dong, J. Ji, D. Hu and N. Zhang, "Does Asthma Increase the Mortality of Patients with COVID-19?: A Systematic Review and Meta-Analysis," International Archives of Allergy and Immunology, vol. 0, no. 0, 2020.

Return to footnote 23 referrer

Footnote 24

A. Abdi, M. Jalilian, P. A. Sarbarzeh and Z. Vlaisavljevic, "Diabetes and COVID-19: A systematic review on the current evidences.," Diabetes Research and Clinical Practice, vol. 166, no. 0, 2020.

Return to footnote 24 referrer

Footnote 25

I. Pinedo-Torres, Flores-Fern, M. ez, M. Yovera-Aldana, C. Gutierrez-Ortiz, P. Zegarra-Lizana, C. Intimayta-Escalante, C. Moran-Marinos, C. Alva-Diaz and K. Pacheco-Barrios, "Prevalence of Diabetes Mellitus and Its Associated Unfavorable Outcomes in Patients With Acute Respiratory Syndromes Due to Coronaviruses Infection: A Systematic Review and Meta-Analysis," Clinical Medicine Insights: Endocrinology and Diabetes, vol. 13, no. 0, 2020.

Return to footnote 25 referrer

Footnote 26

L. Guo, Z. Shi, Y. Zhang, C. Wang, N. C. Do Vale Moreira, H. Zuo and A. Hussain, "Comorbid diabetes and the risk of disease severity or death among 8807 COVID-19 patients in China: A meta-analysis," Diabetes Research & Clinical Practice, vol. 166, no. 0, 2020.

Return to footnote 26 referrer

Footnote 27

J. Chen, C. Wu, X. Wang, J. Yu and Z. Sun, "The Impact of COVID-19 on Blood Glucose: A Systematic Review and Meta-Analysis," Frontiers in Endocrinology, vol. 11, no. 0, p. 575541, 2020.

Return to footnote 27 referrer

Footnote 28

A. Mantovani, ro, C. D. Byrne, M.-H. Zheng and G. Targher, "Diabetes as a risk factor for greater COVID-19 severity and in-hospital death: A meta-analysis of observational studies," Nutrition, Metabolism & Cardiovascular Diseases, vol. 30, no. 8, pp. 1236-1248, 2020.

Return to footnote 28 referrer

Footnote 29

A. V. Kulkarni, P. Kumar, H. V. Tevethia, M. Premkumar, J. P. Arab, C, R. ia, R. Talukdar, M. Sharma, X. Qi, P. N. Rao and D. N. Reddy, "Systematic review with meta-analysis: liver manifestations and outcomes in COVID-19," Alimentary Pharmacology & Therapeutics, vol. 52, no. 4, pp. 584-599, 2020.

Return to footnote 29 referrer

Footnote 30

A. J. Kovalic, S. K. Satapathy and P. J. Thuluvath, "Prevalence of chronic liver disease in patients with COVID-19 and their clinical outcomes: a systematic review and meta-analysis," Hepatology International, vol. 14, no. 5, pp. 612-620, 2020.

Return to footnote 30 referrer

Footnote 31

A. Sharma, P. Jaiswal, Y. Kerakhan, L. Saravanan, Z. Murtaza, A. Zergham, N. S. Honganur, A. Akbar, A. Deol, B. Francis, S. Patel, D. Mehta, R. Jaiswal, J. Singh, U. Patel and P. Malik, "Liver disease and outcomes among COVID-19 hospitalized patients- a systematic review and meta-analysis," Annals of hepatology., vol. 16, no. 0, 2020.

Return to footnote 31 referrer

Footnote 32

S. K. Kunutsor, J. A. Laukkanen and R. c. i. C.-1. a. s. r. a. meta-analysis, "Renal complications in COVID-19: a systematic review and meta-analysis," Annals of Medicine, vol. 52, no. 7, pp. 345-353, 2020.

Return to footnote 32 referrer

Footnote 33

I. Cheruiyot, V. Kipkorir, B. Ngure, M. Misiani, J. Munguti, B. Henry and G. Lippi, "Acute kidney injury is associated with worse prognosis in COVID-19 patients: A systematic review and meta-analysis," Acta Biomedica, vol. 91, no. 3, pp. 1-19, 2020.

Return to footnote 33 referrer

Footnote 34

D. Huang, X. Lian, F. Song, H. Ma, Z. Lian, Y. Liang, T. Qin, W. Chen and S. Wang, "Clinical features of severe patients infected with 2019 novel coronavirus: A systematic review and meta-analysis," Annals of Translational Medicine, vol. 8, no. 9, 2020.

Return to footnote 34 referrer

Footnote 35

N. Potere, E. Valeriani, C, M. eloro, M. Tana, E. Porreca, A. Abbate, S. Spoto, A. W. S. Rutjes and M. Di Nisio, "Acute complications and mortality in hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis," Critical Care (London, England), vol. 24, no. 1, p. 389, 2020.

Return to footnote 35 referrer

Footnote 36

S. Y. Robbins-Juarez, L. Qian, K. L. King, J. S. Stevens, S. A. Husain, J. Radhakrishnan and S. Mohan, "Outcomes for Patients With COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis," Kidney International Reports, vol. 5, no. 8, pp. 1149-1160, 2020.

Return to footnote 36 referrer

Footnote 37

M. Shao, X. Li, F. Liu, T. Tian, J. Luo and Y. Yang, " Acute kidney injury is associated with severe infection and fatality in patients with COVID-19: A systematic reviewand meta-analysis of 40 studies and 24,527 patients," Pharmacological Research, vol. 161, no. 0, p. 105107, 2020.

Return to footnote 37 referrer

Footnote 38

C. B. Oliveira, C. A. D. Lima, G. Vajgel, A. V. Campos Coelho, S and P. rin-Garcia, "High burden of acute kidney injury in COVID-19 pandemic: Systematic review and meta-analysis," Journal of Clinical Pathology., vol. 0, no. 0, 2020.

Return to footnote 38 referrer

Footnote 39

L. Ouyang, Y. Gong, Y. Zhu and J. Gong, "Association of acute kidney injury with the severity and mortality of SARS-CoV-2 infection: A meta-analysis," American Journal of Emergency Medicine, vol. 0, no. 0, 2020.

Return to footnote 39 referrer

Footnote 40

Y. Du, Y. Lv, W. Zha, N. Zhou and X. Hong, "Association of Body mass index (BMI) with Critical COVID-19 and in-hospital Mortality: a dose-response meta-analysis," Metabolism: clinical and experimental, vol. 0, no. 0, p. 154373, 2020.

Return to footnote 40 referrer

Footnote 41

A. Hussain, K. Mahawar, Z. Xia, W. Yang and S. El-Hasani, "Obesity and mortality of COVID-19. Meta-analysis," Obesity Research & Clinical Practice, vol. 14, no. 4, pp. 295-300, 2020.

Return to footnote 41 referrer

Footnote 42

P. Malik, U. Patel, K. Patel, M. Martin, C. Shah, D. Mehta, F. A. Malik and A. Sharma, "Obesity a predictor of outcomes of COVID-19 hospitalized patients-A systematic review and meta-analysi," Journal of Medical Virology, vol. 0, no. 0, 2020.

Return to footnote 42 referrer

Footnote 43

S. H. C. Sales-Peres, L. J. de Azevedo-Silva, R. C. S. Bonato, M. C. Sales-Peres, A. Pinto and J. F. Santiago Junior, "Coronavirus (SARS-CoV-2) and the risk of obesity for critically illness and ICU admitted: Meta-analysis of the epidemiological evidence," Obesity Research & Clinical Practice, vol. 14, no. 5, pp. 389-397, 2020.

Return to footnote 43 referrer

Footnote 44

Y. Tian, X. Qiu, C. Wang, J. Zhao, X. Jiang, W. Niu, J. Huang and F. Zhang, "Cancer associates with risk and severe events of COVID-19: A systematic review and meta-analysis," International Journal of Cancer., vol. 0, 2020.

Return to footnote 44 referrer

Footnote 45

I. Cheruiyot, V. Kipkorir, B. Ngure, M. Misiani and J. Munguti, "Cancer is associated with coronavirus disease (COVID-19) severity and mortality: A pooled analysis," American Journal of Emergency Medicine, vol. 0, no. 0, 2020.

Return to footnote 45 referrer

Footnote 46

A. A. Salunke, N, K. y, S. K. Pathak, J. Shah, M. Kamani, V. Kottakota, P. Thivari, P, A. ey, K. Patel, P. Rathod, S. Bhatt, P. Dave, P and S. ya, " Impact of COVID -19 in cancer patients on severity of disease and fatal outcomes: A systematic review and meta-analysis," Diabetes & Metabolic Syndrome, vol. 14, no. 5, pp. 1431-1437, 2020.

Return to footnote 46 referrer

Footnote 47

L. Y. W. Lee, J.-B. Cazier, T. Starkey, S. E. W. Briggs, R. Arnold, V. Bisht, S. Booth, N. A. Campton, V. W. T. Cheng, G. Collins, H. M. Curley, P. Earwaker, M. Fittall and S. Gennatas, "COVID-19 prevalence and mortality in patients with cancer and the effect of primary tumour subtype and patient demographics: a prospective cohort study," Lancet Oncology, vol. 21, no. 10, pp. 1309-1316, 2020.

Return to footnote 47 referrer

Footnote 48

W. A. Florez-Perdomo, S. A. Serrato-Vargas, P. Bosque-Varela, L. R. Moscote-Salazar, A. F. Joaquim, A. Agrawal, A. R. Soto-Angel and L. T. Tovar-Montenegro, " Relationship between the history of cerebrovascular disease and mortality in COVID-19 patients: A systematic reviewand meta-analysis," Clinical Neurology and Neurosurgery, vol. 197, no. 0, 2020.

Return to footnote 48 referrer

Footnote 49

M. Ghannam, Q. Alshaer, M. Al-Chalabi, L. Zakarna, J. Robertson and G. Manousakis, "Neurological involvement of coronavirus disease 2019: a systematic review," Journal of Neurology, vol. 267, no. 11, pp. 3135-3153, 2020.

Return to footnote 49 referrer

Footnote 50

A. MadaniNeishaboori, D. Moshrefiaraghi, K. Mohamed Ali, A. Toloui, M. Yousefifard and M. Hosseini, "Central Nervous System Complications in COVID-19 Patients; a Systematic Review and Meta-Analysis based on Current Evidence," Archives of Academic Emergency Medicine, vol. 8, no. 1, p. E62, 2020.

Return to footnote 50 referrer

Footnote 51

U. Patel, P. Malik, D. Shah, A. Patel, M. Dhamoon and V. Jani, "Pre-existing cerebrovascular disease and poor outcomes of COVID-19 hospitalized patients: a meta-analysis," Journal of Neurology, vol. 0, no. 0, 2020.

Return to footnote 51 referrer

Footnote 52

C. Bonanad, S. Garcia-Blas, F. Tarazona-Santabalbina, J. Sanchis, V. Bertomeu-Gonzalez, L. Facila, A. Ariza, J. Nunez and A. Cordero, "The Effect of Age on Mortality in Patients With COVID-19: A Meta-Analysis With 611,583 Subjects," Journal of the American Medical Directors Association, vol. 21, no. 7, pp. 915-918, 2020.

Return to footnote 52 referrer

Footnote 53

A. Neumann-Podczaska, S. R. Al-Saad, L. M. Karbowski, M. Chojnicki, S. Tobis and K. Wieczorowska-Tobis, "COVID 19 - Clinical Picture in the Elderly Population: A Qualitative Systematic Review," Aging & Disease, vol. 11, no. 4, pp. 988-1008, 2020.

Return to footnote 53 referrer

Footnote 54

B.B. Abate, A.M. Kassie, M.W. Kassaw, T.G. Aragie, S.A. Masresha, "Sex difference in coronavirus disease (COVID-19): a systematic review and meta-analysis," BMJ Open, vol. 0, p. e040129, 2020.

Return to footnote 54 referrer

Footnote 55

M. J. Nasiri, S. Haddadi, A. Tahvildari, Y. Farsi, M. Arbabi, S. Hasanzadeh, P. Jamshidi, M. Murthi and M. Mirsaeidi, "COVID-19 Clinical Characteristics, and Sex-Specific Risk of Mortality: Systematic Review and Meta-Analysis.," Frontiers in Medicine, vol. 7, no. 0, p. 459, 2020.

Return to footnote 55 referrer

Footnote 56

A. Ortolan, M. Lorenzin, M. Felicetti, A. Doria and R. Ramonda, " Does gender influence clinical expression and disease outcomes in COVID-19? A systematic review and meta-analysis," International Journal of Infectious Diseases, vol. 99, no. 0, p. 496, 2020.

Return to footnote 56 referrer

Footnote 57

C. R. Jutzeler, L. Bourguignon, C. V. Weis, B. Tong, C. Wong, B. Rieck, H. Pargger, S. Tschudin-Sutter, A. Egli, K. Borgwardt and M. Walter, "Comorbidities, clinical signs and symptoms, laboratory findings, imaging features, treatment strategies, and outcomes in adult and pediatric patients with COVID-19: A systematic review and meta-analysis.," Travel Medicine & Infectious Disease, vol. 37, no. 0, 2020.

Return to footnote 57 referrer

Footnote 58

J. Hewitt, B. Carter, A. Vilches-Moraga, T. J. Quinn, P. Braude, A. Verduri, L. Pearce, M. Stechman, R. Short, A. Price, J. T. Collins, E. Bruce, A. Einarsson, F. Rickard, E. Mitchell, M. Holloway, J. Hesford, F. Barlow-Pay, E. Clini and My, "The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohortstudy.," The lancet. Public Health, vol. 5, no. 8, pp. e444-e451, 2020.

Return to footnote 58 referrer

Footnote 59

H. Akhtar and C. Patel, "COVID-19 (SARS-CoV-2) Infection in Pregnancy: A Systematic Review," Gynecologic & Obstetric Investigation, vol. 85, no. 4, pp. 295-306, 2020.

Return to footnote 59 referrer

Footnote 60

K. Diriba, E. Awulachew and E. Getu, "The effect of coronavirus infection (SARS-CoV-2, MERS-CoV, and SARS-CoV) during pregnancy and the possibility of vertical maternal-fetal transmission: a systematic review and meta-analysis," European Journal of Medical Research, vol. 25, no. 1, 2020.

Return to footnote 60 referrer

Footnote 61

A. M. Kotlyar, O. Grechukhina, A. Chen, S. Popkhadze, A. Grimshaw, O. Tal, H. S. Taylor and R. Tal, " Vertical transmission of coronavirus disease 2019: a systematic review and meta-analysis," American Journal of Obstetrics & Gynecology, vol. 31, no. 0, p. 31, 2020.

Return to footnote 61 referrer

Footnote 62

A. Tanacan, S. A. Erol, B. Turgay, A. T. Anuk, E. I. Secen, G. F. Yegin, S. Ozyer, F. Kirca, B. Dinc, S. Unlu, E. G. Yapar Eyi, H. L. Keskin, D. Sahin, A. A. Surel and O. Tekin, "The rate of SARS-CoV-2 positivity in asymptomatic pregnant women admitted to hospital for delivery: Experience of a pandemic center in Turkey.," European Journal of Obstetrics & Gynecology & Reproductive Biology, vol. 253, no. 0, pp. 31-34, 2020.

Return to footnote 62 referrer

Footnote 63

H. e. a. Chi, ""Clinical features of neonates born to mothers with coronavirus disease-2019: A systematic review of 105 neonates," Journal of microbiology, immunology, and infection, vol. 20, pp. 1684-1182, 2020.

Return to footnote 63 referrer

Footnote 64

B. J. F. Huntley, E. S. Huntley, D. Di Mascio, T. Chen, V. Berghella and S. P. Chauhan, "Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review.," Obstetrics & Gynecology, vol. 136, no. 2, pp. 303-312, 2020.

Return to footnote 64 referrer

Footnote 65

A. Khalil, E. Kalafat, C. Benlioglu, P. O'Brien, E. Morris, T. Draycott, S. Thangaratinam, K. Le Doare, P. Heath, S. Ladhani, P. von Dadelszen and L. A. Magee, "SARS-CoV-2 infection in pregnancy: A systematic review and meta-analysis of clinical features and pregnancy outcomes," EClinicalMedicine, vol. 25, no. 0, 2020.

Return to footnote 65 referrer

Footnote 66

O. Turan, A. Hakim, P. Dashraath, W. J. L. Jeslyn, A. Wright and R. Abdul-Kadir, "Clinical characteristics, prognostic factors, and maternal and neonatal outcomes of SARS-CoV-2 infection among hospitalized pregnant women: A systematic review.," International Journal of Gynecology and Obstetrics, vol. 151, no. 1, pp. 7-16, 2020.

Return to footnote 66 referrer

Footnote 67

T. Zhang, W.S. Huang, W. Guan, Z. Hong, J. Gao, G. Gao, G. Wu, Y.Y. Qin, Risk factors and predictors associated with the severity of COVID-19 in China: a systematic review, meta-analysis, and meta-regression, J Thorac Dis 12(12) (2020) 7429-7441.

Return to footnote 67 referrer

Footnote 68

J. Sabatino, S. De Rosa, G. Di Salvo, C. Indolfi, Impact of cardiovascular risk profile on COVID-19 outcome. A meta-analysis, PLoS One 15(8) (2020) e0237131.

Return to footnote 68 referrer

Footnote 69

M.A. Barek, M.A. Aziz, M.S. Islam, Impact of age, sex, comorbidities and clinical symptoms on the severity of COVID-19 cases: A meta-analysis with 55 studies and 10014 cases, Heliyon 6(12) (2020) e05684.

Return to footnote 69 referrer

Footnote 70

S.S.W.R.M.-P.P.P.O.H.M.A.-V.N.H.J.S.E.E.G. Barrera FJ, “Prevalence of Diabetes and Hypertension and Their Associated Risks for Poor Outcomes in Covid-19 Patients, J Endocr Soc. 4(9) (2020) bvaa102.

Return to footnote 70 referrer

Footnote 71

A. Bhattacharyya, A. Seth, N. Srivast, M. Imeokparia, S. Rai, Coronavirus (COVID-19): A Systematic Review and Meta-analysis to Evaluate the Significance of Demographics and Comorbidities, Res Sq (2021).

Return to footnote 71 referrer

Footnote 72

M. Biswas, S. Rahaman, T.K. Biswas, Z. Haque, B. Ibrahim, Association of Sex, Age, and Comorbidities with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis, Intervirology (2020) 1-12.

Return to footnote 72 referrer

Footnote 73

V. Chidambaram, N.L. Tun, W.Z. Haque, M.G. Majella, R.K. Sivakumar, A. Kumar, A.T. Hsu, I.A. Ishak, A.A. Nur, S.K. Ayeh, E.L. Salia, E.A.A. Zil, M.A. Saeed, A.P.B. Sarena, B. Seth, M. Ahmadzada, E.F. Haque, P. Neupane, K.H. Wang, T.M. Pu, S.M.H. Ali, M.A. Arshad, L. Wang, S. Baksh, P.C. Karakousis, P. Galiatsatos, Factors associated with disease severity and mortality among patients with COVID-19: A systematic review and meta-analysis, PLoS One 15(11) (2020) e0241541.

Return to footnote 73 referrer

Footnote 74

C.S.G.-G. Cordero A., V. Bertomeu-Gonzalez, L. Facila, M. Rodriguez-Manero, D. Escribano, J. M. Castellano, P. Zuazola, J. Nunez, J. J. Badimon and J. R. Gonzalez-Juanatey, , Mortality associated with cardiovascular disease in patients with COVID-19, REC: CardioClinics 56(1) (2020) 30-33.

Return to footnote 74 referrer

Footnote 75

T. Dalia, S. Lahan, S. Ranka, P. Acharya, A. Gautam, A. Goyal, I. Mastoris, A. Sauer, Z. Shah, Impact of congestive heart failure and role of cardiac biomarkers in COVID-19 patients: A systematic review and meta-analysis, Indian Heart J 73(1) (2021) 91-98.

Return to footnote 75 referrer

Footnote 76

B.D.P.Z.L.e.a. de Almeida-Pititto, Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis, Diabetol Metab Syndr 12(75) (2020).

Return to footnote 76 referrer

Footnote 77

F. Del Sole, A. Farcomeni, L. Loffredo, R. Carnevale, D. Menichelli, T. Vicario, P. Pignatelli, D. Pastori, Features of severe COVID-19: A systematic review and meta-analysis, Eur J Clin Invest 50(10) (2020) e13378.

Return to footnote 77 referrer

Footnote 78

K. Dorjee, H. Kim, E. Bonomo, R. Dolma, Prevalence and predictors of death and severe disease in patients hospitalized due to COVID-19: A comprehensive systematic review and meta-analysis of 77 studies and 38,000 patients, PLoS One 15(12) (2020) e0243191.

Return to footnote 78 referrer

Footnote 79

Y. Du, N. Zhou, W. Zha, Y. Lv, Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis, Nutr Metab Cardiovasc Dis 31(3) (2021) 745-755.

Return to footnote 79 referrer

Footnote 80

M. Ebrahimi, A.S. Malehi, F. Rahim, COVID-19 Patients: A Systematic Review and Meta-Analysis of Laboratory Findings, Comorbidities, and Clinical Outcomes Comparing Medical Staff versus the General Population, Osong Public Health Res Perspect 11(5) (2020) 269-279.

Return to footnote 80 referrer

Footnote 81

A. Emami, F. Javanmardi, N. Pirbonyeh, A. Akbari, Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta-Analysis, Arch Acad Emerg Med 8(1) (2020) e35.

Return to footnote 81 referrer

Footnote 82

M. Fathi, K. Vakili, F. Sayehmiri, A. Mohamadkhani, M. Hajiesmaeili, M. Rezaei-Tavirani, O. Eilami, The prognostic value of comorbidity for the severity of COVID-19: A systematic review and meta-analysis study, PLoS One 16(2) (2021) e0246190.

Return to footnote 82 referrer

Footnote 83

X. Guo, Y. Zhu, Y. Hong, Decreased Mortality of COVID-19 With Renin-Angiotensin-Aldosterone System Inhibitors Therapy in Patients With Hypertension: A Meta-Analysis, Hypertension 76(2) (2020) e13-e14.

Return to footnote 83 referrer

Footnote 84

J.L. Honardoost M, Aghili R, Emami Z, Khamseh ME. , The Association between Presence of Comorbidities and COVID-19 Severity: A Systematic Review and Meta-Analysis., Cerebrovasc Dis. 2 (2021) 1-9.

Return to footnote 84 referrer

Footnote 85

F. Javanmardi, A. Keshavarzi, A. Akbari, A. Emami, N. Pirbonyeh, Prevalence of underlying diseases in died cases of COVID-19: A systematic review and meta-analysis, PLoS One 15(10) (2020) e0241265.

Return to footnote 85 referrer

Footnote 86

Z.A. Katzenschlager S, Gottschalk C, Grafeneder J, Seitel A, Maier-Hein L, Benedetti A, Larmann J, Weigand MA, McGrath S, Denkinger CM. , Can we predict the severe course of COVID-19 - a systematic review and meta-analysis of indicators of clinical outcome?, medRxiv [Preprint]. 12 (2020).

Return to footnote 86 referrer

Footnote 87

A.H. Khamis, M. Jaber, A. Azar, F. AlQahtani, K. Bishawi, A. Shanably, Clinical and laboratory findings of COVID-19: A systematic review and meta-analysis, J Formos Med Assoc (2020).

Return to footnote 87 referrer

Footnote 88

M.M.A. Khan, M.N. Khan, M.G. Mustagir, J. Rana, M.S. Islam, M.I. Kabir, Effects of underlying morbidities on the occurrence of deaths in COVID-19 patients: A systematic review and meta-analysis, J Glob Health 10(2) (2020) 020503.

Return to footnote 88 referrer

Footnote 89

M. Koeppen, P. Rosenberger, H. Magunia, COVID-19 Related Cardiovascular Comorbidities and Complications in Critically Ill Patients: A Systematic Review and Meta-analysis, Clin Med Insights Circ Respir Pulm Med 15 (2021) 1179548421992327.

Return to footnote 89 referrer

Footnote 90

L. Lu, W. Zhong, Z. Bian, Z. Li, K. Zhang, B. Liang, Y. Zhong, M. Hu, L. Lin, J. Liu, X. Lin, Y. Huang, J. Jiang, X. Yang, X. Zhang, Z. Huang, A comparison of mortality-related risk factors of COVID-19, SARS, and MERS: A systematic review and meta-analysis, J Infect 81(4) (2020) e18-e25.

Return to footnote 90 referrer

Footnote 91

K.J. Mahumud RA, Renzaho AMN. , The epidemiological burden and overall distribution of chronic comorbidities in coronavirus disease-2019 among 202,005 infected patients: evidence from a systematic review and meta-analysis, Infection. 48(6) (2020) 813-833.

Return to footnote 91 referrer

Footnote 92

K. Matsushita, N. Ding, M. Kou, X. Hu, M. Chen, Y. Gao, Y. Honda, D. Zhao, D. Dowdy, Y. Mok, J. Ishigami, L.J. Appel, The Relationship of COVID-19 Severity with Cardiovascular Disease and Its Traditional Risk Factors: A Systematic Review and Meta-Analysis, Glob Heart 15(1) (2020) 64.

Return to footnote 92 referrer

Footnote 93

M. Meng, Q. Zhao, R. Kumar, C. Bai, Y. Deng, B. Wan, Impact of cardiovascular and metabolic diseases on the severity of COVID-19: a systematic review and meta-analysis, Aging (Albany NY) 12(22) (2020) 23409-23421.

Return to footnote 93 referrer

Footnote 94

A.E. Mesas, I. Cavero-Redondo, C. Alvarez-Bueno, M.A. Sarria Cabrera, S. Maffei de Andrade, I. Sequi-Dominguez, V. Martinez-Vizcaino, Predictors of in-hospital COVID-19 mortality: A comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions, PLoS One 15(11) (2020) e0241742.

Return to footnote 94 referrer

Footnote 95

L.E. Miller, R. Bhattacharyya, A.L. Miller, Diabetes mellitus increases the risk of hospital mortality in patients with Covid-19: Systematic review with meta-analysis, Medicine (Baltimore) 99(40) (2020) e22439.

Return to footnote 95 referrer

Footnote 96

B. Moazzami, S. Chaichian, A. Kasaeian, S. Djalalinia, M. Akhlaghdoust, M. Eslami, B. Broumand, Metabolic risk factors and risk of Covid-19: A systematic review and meta-analysis, PLoS One 15(12) (2020) e0243600.

Return to footnote 96 referrer

Footnote 97

S. Momtazmanesh, P. Shobeiri, S. Hanaei, H. Mahmoud-Elsayed, B. Dalvi, E. Malakan Rad, Cardiovascular disease in COVID-19: a systematic review and meta-analysis of 10,898 patients and proposal of a triage risk stratification tool, Egypt Heart J 72(1) (2020) 41.

Return to footnote 97 referrer

Footnote 98

M. Mudatsir, J.K. Fajar, L. Wulandari, G. Soegiarto, M. Ilmawan, Y. Purnamasari, B.A. Mahdi, G.D. Jayanto, S. Suhendra, Y.A. Setianingsih, R. Hamdani, D.A. Suseno, K. Agustina, H.Y. Naim, M. Muchlas, H.H.D. Alluza, N.A. Rosida, M. Mayasari, M. Mustofa, A. Hartono, R. Aditya, F. Prastiwi, F.X. Meku, M. Sitio, A. Azmy, A.S. Santoso, R.A. Nugroho, C. Gersom, A.A. Rabaan, S. Masyeni, F. Nainu, A.L. Wagner, K. Dhama, H. Harapan, Predictors of COVID-19 severity: a systematic review and meta-analysis, F1000Res 9 (2020) 1107.

Return to footnote 98 referrer

Footnote 99

M.B. Naeini, M. Sahebi, F. Nikbakht, Z. Jamshidi, M. Ahmadimanesh, M. Hashemi, J. Ramezani, H.H. Miri, R. Yazdian-Robati, A meta-meta-analysis: Evaluation of meta-analyses published in the effectiveness of cardiovascular comorbidities on the severity of COVID-19, Obes Med 22 (2021) 100323.

Return to footnote 99 referrer

Footnote 100

W.H. Ng, T. Tipih, N.A. Makoah, J.G. Vermeulen, D. Goedhals, J.B. Sempa, F.J. Burt, A. Taylor, S. Mahalingam, Comorbidities in SARS-CoV-2 Patients: a Systematic Review and Meta-Analysis, mBio 12(1) (2021).

Return to footnote 100 referrer

Footnote 101

I.M. Noor FM, Prevalence and Associated Risk Factors of Mortality Among COVID-19 Patients: A Meta-Analysis, J Community Health. 45(6) (2020) 1270-1282.

Return to footnote 101 referrer

Footnote 102

R. Parveen, N. Sehar, R. Bajpai, N.B. Agarwal, Association of diabetes and hypertension with disease severity in covid-19 patients: A systematic literature review and exploratory meta-analysis, Diabetes Res Clin Pract 166 (2020) 108295.

Return to footnote 102 referrer

Footnote 103

N.M. Radwan, N.E. Mahmoud, A.H. Alfaifi, K.I. Alabdulkareem, Comorbidities and severity of coronavirus disease 2019 patients, Saudi Med J 41(11) (2020) 1165-1174.

Return to footnote 103 referrer

Footnote 104

H.S. Rahman, M.S. Aziz, R.H. Hussein, H.H. Othman, S.H. Salih Omer, E.S. Khalid, N.A. Abdulrahman, K. Amin, R. Abdullah, The transmission modes and sources of COVID-19: A systematic review, International Journal of Surgery Open 26(0) (2020) 125-136.

Return to footnote 104 referrer

Footnote 105

M. Sepandi, M. Taghdir, Y. Alimohamadi, S. Afrashteh, H. Hosamirudsari, Factors Associated with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis, Iran J Public Health 49(7) (2020) 1211-1221.

Return to footnote 105 referrer

Footnote 106

A. Silverio, M. Di Maio, R. Citro, L. Esposito, G. Iuliano, M. Bellino, C. Baldi, G. De Luca, M. Ciccarelli, C. Vecchione, G. Galasso, Cardiovascular risk factors and mortality in hospitalized patients with COVID-19: systematic review and meta-analysis of 45 studies and 18,300 patients, BMC Cardiovasc Disord 21(1) (2021) 23.

Return to footnote 106 referrer

Footnote 107

P. Ssentongo, A.E. Ssentongo, E.S. Heilbrunn, D.M. Ba, V.M. Chinchilli, Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis, PLoS One 15(8) (2020) e0238215.

Return to footnote 107 referrer

Footnote 108

E. Tan, J. Song, A.M. Deane, M.P. Plummer, Global Impact of Coronavirus Disease 2019 Infection Requiring Admission to the ICU: A Systematic Review and Meta-analysis, Chest 159(2) (2021) 524-536.

Return to footnote 108 referrer

Footnote 109

E.H. Taylor, Hofmeyr, R., Torborg, A., van Tonder, C., Boden, R., Earle, E., Nejthardt, M., Kabambi, K. F., Isaacs, M., Usenbo, A., Gerber, C., van der Spuy, K., Mrara, B., Ndhlovu, T., Chen, A., Swanevelder, J., Coetzee, J., & Biccard, B. M. , Risk factors and interventions associated with mortality or survival in adult covid-19 patients admitted to critical care: A systematic review and meta-analysis., Southern African Journal of Anaesthesia and Analgesia 26(3) (2020).

Return to footnote 109 referrer

Footnote 110

Z. Wang, H. Deng, C. Ou, J. Liang, Y. Wang, M. Jiang, S. Li, Clinical symptoms, comorbidities and complications in severe and non-severe patients with COVID-19: A systematic review and meta-analysis without cases duplication, Medicine (Baltimore) 99(48) (2020) e23327.

Return to footnote 110 referrer

Footnote 111

C.K.H. Wong, J.Y.H. Wong, E.H.M. Tang, C.H. Au, A.K.C. Wai, Clinical presentations, laboratory and radiological findings, and treatments for 11,028 COVID-19 patients: a systematic review and meta-analysis, Sci Rep 10(1) (2020) 19765.

Return to footnote 111 referrer

Footnote 112

J. Xie, Q. Wang, Y. Xu, T. Zhang, L. Chen, X. Zuo, J. Liu, L. Huang, P. Zhan, T. Lv, Y. Song, Clinical characteristics, laboratory abnormalities and CT findings of COVID-19 patients and risk factors of severe disease: a systematic review and meta-analysis, Ann Palliat Med 10(2) (2021) 1928-1949.

Return to footnote 112 referrer

Footnote 113

T. Yin, Y. Li, Y. Ying, Z. Luo, Prevalence of comorbidity in Chinese patients with COVID-19: systematic review and meta-analysis of risk factors, BMC Infect Dis 21(1) (2021) 200.

Return to footnote 113 referrer

Footnote 114

Y. Zhou, Q. Yang, J. Chi, B. Dong, W. Lv, L. Shen, Y. Wang, Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis, Int J Infect Dis 99 (2020) 47-56.

Return to footnote 114 referrer

Footnote 115

S. Nannoni, R. de Groot, S. Bell, H.S. Markus, Stroke in COVID-19: A systematic review and meta-analysis, Int J Stroke 16(2) (2021) 137-149.

Return to footnote 115 referrer

Footnote 116

P.A. Corona G, Vena W, Rastrelli G, Semeraro F, Isidori AM, Pivonello R, Salonia A, Sforza A, Maggi M. , Diabetes is most important cause for mortality in COVID-19 hospitalized patients: Systematic review and meta-analysis, Rev Endocr Metab Disord 22 (2021) 1-22.

Return to footnote 116 referrer

Footnote 117

S. Shoar, F. Hosseini, M. Naderan, J.L. Mehta, Meta-analysis of Cardiovascular Events and Related Biomarkers Comparing Survivors Versus Non-survivors in Patients With COVID-19, Am J Cardiol 135 (2020) 50-61.

Return to footnote 117 referrer

Footnote 118

X. Li, X. Pan, Y. Li, N. An, Y. Xing, F. Yang, L. Tian, J. Sun, Y. Gao, H. Shang, Y. Xing, Cardiac injury associated with severe disease or ICU admission and death in hospitalized patients with COVID-19: a meta-analysis and systematic review, Crit Care 24(1) (2020) 468.

Return to footnote 118 referrer

Footnote 119

M. Sahranavard, A. Akhavan Rezayat, M. Zamiri Bidary, A. Omranzadeh, F. Rohani, R. Hamidi Farahani, E. Hazrati, S.H. Mousavi, M. Afshar Ardalan, S. Soleiman-Meigooni, S.J. Hosseini-Shokouh, Z. Hejripour, E. Nassireslami, R. Laripour, A. Salarian, A. Nourmohammadi, R. Mosaed, Cardiac Complications in COVID-19: A Systematic Review and Meta-analysis, Arch Iran Med 24(2) (2021) 152-163.

Return to footnote 119 referrer

Footnote 120

K. Vakili, M. Fathi, A. Pezeshgi, A. Mohamadkhani, M. Hajiesmaeili, M. Rezaei-Tavirani, F. Sayehmiri, Critical complications of COVID-19: A descriptive meta-analysis study, Rev Cardiovasc Med 21(3) (2020) 433-442.

Return to footnote 120 referrer

Footnote 121

E. Yonas, I. Alwi, R. Pranata, I. Huang, M.A. Lim, E.J. Gutierrez, M. Yamin, B.B. Siswanto, S.S. Virani, Effect of heart failure on the outcome of COVID-19 - A meta analysis and systematic review, Am J Emerg Med (2020).

Return to footnote 121 referrer

Footnote 122

W. Wen, H. Zhang, M. Zhou, Y. Cheng, L. Ye, J. Chen, M. Wang, Z. Feng, Arrhythmia in patients with severe coronavirus disease (COVID-19): a meta-analysis, Eur Rev Med Pharmacol Sci 24(21) (2020) 11395-11401.

Return to footnote 122 referrer

Footnote 123

M. Vakhshoori, M. Heidarpour, D. Shafie, M. Taheri, N. Rezaei, N. Sarrafzadegan, Acute Cardiac Injury in COVID-19: A Systematic Review and Meta-analysis, Arch Iran Med 23(11) (2020) 801-812.

Return to footnote 123 referrer

Footnote 124

G.P. Granger C, Arnaud C, Guendouz S, Cimadevilla C, Kerneis M, Kerneis C, Zeitouni M, Verdonk C, Legeai C, Lebreton G, Leprince P, Désiré E, Sorrentino S, Silvain J, Montalescot G, Hazan F, Varnous S, Dorent R. , Clinical manifestations and outcomes of coronavirus disease-19 in heart transplant recipients: a multicentre case series with a systematic review and meta-analysis. , Transpl Int. (2021).

Return to footnote 124 referrer

Footnote 125

K.A. Bansal A, Patel D, Puri R, Kalra A, Kapadia SR, Reed GW. , Meta-analysis Comparing Outcomes in Patients With and Without Cardiac Injury and Coronavirus Disease 2019 (COVID 19). Am J Cardiol 141 (2021) 140-146.

Return to footnote 125 referrer

Footnote 126

L. Zeng, S. Wang, J. Cai, S. Sun, S. Wang, J. Li, L. Sun, Clinical characteristics of COVID-19 with cardiac injury: a systematic review and meta-analysis, Epidemiol Infect 148 (2020) e266.

Return to footnote 126 referrer

Footnote 127

L. Fu, X. Liu, Y. Su, J. Ma, K. Hong, Prevalence and impact of cardiac injury on COVID-19: A systematic review and meta-analysis, Clin Cardiol 44(2) (2021) 276-283.

Return to footnote 127 referrer

Footnote 128

Z. Huang, P. Huang, B. Du, L. Kong, W. Zhang, Y. Zhang, J. Dong, Prevalence and clinical outcomes of cardiac injury in patients with COVID-19: A systematic review and meta-analysis, Nutr Metab Cardiovasc Dis 31(1) (2021) 2-13.

Return to footnote 128 referrer

Footnote 129

N. Prasitlumkum, R. Chokesuwattanaskul, C. Thongprayoon, T. Bathini, S. Vallabhajosyula, W. Cheungpasitporn, Incidence of Myocardial Injury in COVID-19-Infected Patients: A Systematic Review and Meta-Analysis, Diseases 8(4) (2020).

Return to footnote 129 referrer

Footnote 130

Z. Zhong, H. Li, J. Zhu, P. Ji, B. Li, J. Pang, J. Zhang, X. Liang, Clinical characteristics of 2,459 severe or critically ill COVID-19 patients: A meta-analysis, Medicine (Baltimore) 100(5) (2021) e23781.

Return to footnote 130 referrer

Footnote 131

C. Liang, W. Zhang, S. Li, G. Qin, Coronary heart disease and COVID-19: A meta-analysis, Med Clin (Barc) (2021).

Return to footnote 131 referrer

Footnote 132

M.S. Gold, D. Sehayek, S. Gabrielli, X. Zhang, C. McCusker, M. Ben-Shoshan, COVID-19 and comorbidities: a systematic review and meta-analysis, Postgrad Med 132(8) (2020) 749-755.

Return to footnote 132 referrer

Footnote 133

M. Hashizume, Y. Kim, C.F.S. Ng, Y. Chung, L. Madaniyazi, M.L. Bell, Y.L. Guo, H. Kan, Y. Honda, S.M. Yi, H. Kim, Y. Nishiwaki, Health Effects of Asian Dust: A Systematic Review and Meta-Analysis, Environ Health Perspect 128(6) (2020) 66001.

Return to footnote 133 referrer

Footnote 134

G. Xiang, L. Xie, Z. Chen, S. Hao, C. Fu, Q. Wu, X. Liu, S. Li, Clinical risk factors for mortality of hospitalized patients with COVID-19: systematic review and meta-analysis, Ann Palliat Med (2021).

Return to footnote 134 referrer

Footnote 135

S. Biswas, Z. Sarfraz, A. Sarfraz, F. Malanyaon, R. Vijayan, I. Gupta, U. Arif, M. Sarfraz, G. Yatzkan, M.A. Sanchez-Gonzalez, Risk and Outcomes of COVID-19 Patients with Asthma: A Meta-Analysis, Asthma Allergy Immunology (2020) 1-8.

Return to footnote 135 referrer

Footnote 136

M.H. Hussein, R.M. Elshazli, A.S. Attia, T.P. Nguyen, M. Aboueisha, R. Munshi, E.A. Toraih, M.S. Fawzy, E. Kandil, Asthma and COVID-19; different entities, same outcome: a meta-analysis of 107,983 patients, J Asthma (2021) 1-8.

Return to footnote 136 referrer

Footnote 137

S. Liu, Y. Cao, T. Du, Y. Zhi, Prevalence of Comorbid Asthma and Related Outcomes in COVID-19: A Systematic Review and Meta-Analysis, J Allergy Clin Immunol Pract 9(2) (2021) 693-701.

Return to footnote 137 referrer

Footnote 138

L. Shi, J. Xu, W. Xiao, Y. Wang, Y. Jin, S. Chen, G. Duan, H. Yang, Y. Wang, Asthma in patients with coronavirus disease 2019: A systematic review and meta-analysis, Ann Allergy Asthma Immunol (2021).

Return to footnote 138 referrer

Footnote 139

A.P. Sunjaya, S.M. Allida, G.L. Di Tanna, C. Jenkins, Asthma and risk of infection, hospitalisation, ICU admission and mortality from COVID-19: Systematic review and meta-analysis, J Asthma (2021) 1-22.

Return to footnote 139 referrer

Footnote 140

C. Awortwe, I. Cascorbi, Meta-analysis on outcome-worsening comorbidities of COVID-19 and related potential drug-drug interactions, Pharmacol Res 161 (2020) 105250.

Return to footnote 140 referrer

Footnote 141

V. Jain, J.M. Yuan, Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis, Int J Public Health 65(5) (2020) 533-546.

Return to footnote 141 referrer

Footnote 142

I.M. Poly TN, Yang HC, Lin MC, Jian WS, Hsu MH, Jack Li YC. , Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis., 8 (2021) 620044.

Return to footnote 142 referrer

Footnote 143

R. Pranata, A.Y. Soeroto, I. Huang, M.A. Lim, P. Santoso, H. Permana, A.A. Lukito, Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19, Int J Tuberc Lung Dis 24(8) (2020) 838-843.

Return to footnote 143 referrer

Footnote 144

G. Rabbani, S.M. Shariful Islam, M.A. Rahman, N. Amin, B. Marzan, R.C. Robin, S.M. Alif, Pre-existing COPD is associated with an increased risk of mortality and severity in COVID-19: a rapid systematic review and meta-analysis, Expert Rev Respir Med (2021) 1-12.

Return to footnote 144 referrer

Footnote 145

Q. Zhao, M. Meng, R. Kumar, Y. Wu, J. Huang, N. Lian, Y. Deng, S. Lin, The impact of COPD and smoking history on the severity of COVID-19: A systemic review and meta-analysis, J Med Virol 92(10) (2020) 1915-1921.

Return to footnote 145 referrer

Footnote 146

A. Bansal, A.D. Singh, V. Jain, M. Aggarwal, S. Gupta, R.P. Padappayil, M. Nadeem, S. Joshi, A. Mian, T. Greathouse, D. Wells, M. Gupta, M.Z. Khan, The association of D-dimers with mortality, intensive care unit admission or acute respiratory distress syndrome in patients hospitalized with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis, Heart Lung 50(1) (2021) 9-12.

Return to footnote 146 referrer

Footnote 147

S.S. Hasan, T. Capstick, R. Ahmed, C.S. Kow, F. Mazhar, H.A. Merchant, S.T.R. Zaidi, Mortality in COVID-19 patients with acute respiratory distress syndrome and corticosteroids use: a systematic review and meta-analysis, Expert Rev Respir Med 14(11) (2020) 1149-1163.

Return to footnote 147 referrer

Footnote 148

X. Cui, Z. Zhao, T. Zhang, W. Guo, W. Guo, J. Zheng, J. Zhang, C. Dong, R. Na, L. Zheng, W. Li, Z. Liu, J. Ma, J. Wang, S. He, Y. Xu, P. Si, Y. Shen, C. Cai, A systematic review and meta-analysis of children with coronavirus disease 2019 (COVID-19), J Med Virol 93(2) (2021) 1057-1069.

Return to footnote 148 referrer

Footnote 149

Y. Xie, Z. Wang, H. Liao, G. Marley, D. Wu, W. Tang, Epidemiologic, Clinical, and Laboratory Findings of the COVID-19 in the current pandemic, Res Sq (2020).

Return to footnote 149 referrer

Footnote 150

J.J.Y. Zhang, K.S. Lee, L.W. Ang, Y.S. Leo, B.E. Young, Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis, Clin Infect Dis 71(16) (2020) 2199-2206.

Return to footnote 150 referrer

Footnote 151

R. Mou, X. Jin, W. Li, M. Wu, X. Liu, Z. Liu, S. Guo, X. Li, Y. Jia, Prostate cancer: a risk factor for COVID-19 in males?: A protocol for systematic review and meta analysis, Medicine (Baltimore) 99(43) (2020) e22591.

Return to footnote 151 referrer

Footnote 152

M.H. Antikchi, H. Neamatzadeh, Y. Ghelmani, J. Jafari-Nedooshan, S.A. Dastgheib, S. Kargar, M. Noorishadkam, R. Bahrami, M.H. Jarahzadeh, The Risk and Prevalence of COVID-19 Infection in Colorectal Cancer Patients: a Systematic Review and Meta-analysis, J Gastrointest Cancer 52(1) (2021) 73-79.

Return to footnote 152 referrer

Footnote 153

A. Desai, R. Gupta, S. Advani, L. Ouellette, N.M. Kuderer, G.H. Lyman, A. Li, Mortality in hospitalized patients with cancer and coronavirus disease 2019: A systematic review and meta-analysis of cohort studies, Cancer (2020).

Return to footnote 153 referrer

Footnote 154

G. Elgohary, COVID-19 infection in cancer patients: a systematic review and meta-analysis with emphasizing the risk and prognosis stratification, Hematol Transfus Cell Ther 42 (2020) 24-25.

Return to footnote 154 referrer

Footnote 155

V.G. Giannakoulis, E. Papoutsi, Siempos, II, Effect of Cancer on Clinical Outcomes of Patients With COVID-19: A Meta-Analysis of Patient Data, JCO Glob Oncol 6 (2020) 799-808.

Return to footnote 155 referrer

Footnote 156

H. Liu, D. Yang, X. Chen, Z. Sun, Y. Zou, C. Chen, S. Sun, The effect of anticancer treatment on cancer patients with COVID-19: A systematic review and meta-analysis, Cancer Med 10(3) (2021) 1043-1056.

Return to footnote 156 referrer

Footnote 157

R. Park, S.A. Lee, S.Y. Kim, A.C. de Melo, A. Kasi, Association of active oncologic treatment and risk of death in cancer patients with COVID-19: a systematic review and meta-analysis of patient data, Acta Oncol 60(1) (2021) 13-19.

Return to footnote 157 referrer

Footnote 158

M. Peravali, I. Joshi, J. Ahn, C. Kim, A Systematic Review and Meta-Analysis of Clinical Characteristics and Outcomes in Patients With Lung Cancer with Coronavirus Disease 2019, JTO Clin Res Rep 2(3) (2021) 100141.

Return to footnote 158 referrer

Footnote 159

A. Vijenthira, I.Y. Gong, T.A. Fox, S. Booth, G. Cook, B. Fattizzo, F. Martin-Moro, J. Razanamahery, J.C. Riches, J. Zwicker, R. Patell, M.C. Vekemans, L. Scarfo, T. Chatzikonstantinou, H. Yildiz, R. Lattenist, I. Mantzaris, W.A. Wood, L.K. Hicks, Outcomes of patients with hematologic malignancies and COVID-19: a systematic review and meta-analysis of 3377 patients, Blood 136(25) (2020) 2881-2892.

Return to footnote 159 referrer

Footnote 160

L. Yang, P. Chai, J. Yu, X. Fan, Effects of cancer on patients with COVID-19: a systematic review and meta-analysis of 63,019 participants, Cancer Biol Med 18(1) (2021) 298-307.

Return to footnote 160 referrer

Footnote 161

E. Yekeduz, G. Utkan, Y. Urun, A systematic review and meta-analysis: the effect of active cancer treatment on severity of COVID-19, Eur J Cancer 141 (2020) 92-104.

Return to footnote 161 referrer

Footnote 162

P. Zarifkar, A. Kamath, C. Robinson, N. Morgulchik, S.F.H. Shah, T.K.M. Cheng, C. Dominic, A.O. Fehintola, G. Bhalla, T. Ahillan, L. Mourgue d'Algue, J. Lee, A. Pareek, M. Carey, D.J. Hughes, M. Miller, V.K. Woodcock, M. Shrotri, Clinical Characteristics and Outcomes in Patients with COVID-19 and Cancer: a Systematic Review and Meta-analysis, Clin Oncol (R Coll Radiol) 33(3) (2021) e180-e191.

Return to footnote 162 referrer

Footnote 163

H. Zhang, H. Han, T. He, K.E. Labbe, A.V. Hernandez, H. Chen, V. Velcheti, J. Stebbing, K.K. Wong, Clinical Characteristics and Outcomes of COVID-19-Infected Cancer Patients: A Systematic Review and Meta-Analysis, J Natl Cancer Inst (2020).

Return to footnote 163 referrer

Footnote 164

Y. Gao, Y. Chen, M. Liu, M. Niu, Z. Song, M. Yan, J. Tian, Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis, Epidemiol Infect 149 (2021) e66.

Return to footnote 164 referrer

Footnote 165

J. Xu, W. Xiao, X. Liang, P. Zhang, L. Shi, Y. Wang, Y. Wang, H. Yang, The Association of Cerebrovascular Disease with Adverse Outcomes in COVID-19 Patients: A Meta-Analysis Based on Adjusted Effect Estimates, J Stroke Cerebrovasc Dis 29(11) (2020) 105283.

Return to footnote 165 referrer

Footnote 166

J. Zhang, H. Wang, M. Wei, H. Zhang, B. Xia, X. Wang, Y. Pei, L. Dong, Y. Li, Incidence of cerebrovascular disease as a comorbidity in patients with COVID-19: A meta-analysis, Aging (Albany NY) 12(23) (2020) 23450-23463.

Return to footnote 166 referrer

Footnote 167

T. Baldini, G.M. Asioli, M. Romoli, M. Carvalho Dias, E.C. Schulte, L. Hauer, D. Aguiar De Sousa, J. Sellner, A. Zini, Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: A systematic review and meta-analysis, Eur J Neurol (2021).

Return to footnote 167 referrer

Footnote 168

N. Brienza, F. Puntillo, S. Romagnoli, L. Tritapepe, Acute Kidney Injury in Coronavirus Disease 2019 Infected Patients: A Meta-Analytic Study, Blood Purif 50(1) (2021) 35-41.

Return to footnote 168 referrer

Footnote 169

K.W.Y. Chan, K. Y.; Lee, P. W.; Tang, S. C. , Renal involvement in coronavirus disease 2019 (record): A systematic review and meta-analysis., Journal of the American Society of Nephrology 31(0) (2020) 248.

Return to footnote 169 referrer

Footnote 170

F. Fabrizi, C.M. Alfieri, R. Cerutti, G. Lunghi, P. Messa, COVID-19 and Acute Kidney Injury: A Systematic Review and Meta-Analysis, Pathogens 9(12) (2020).

Return to footnote 170 referrer

Footnote 171

E.L. Fu, R.J. Janse, Y. de Jong, V.H.W. van der Endt, J. Milders, E.M. van der Willik, E.N.M. de Rooij, O.M. Dekkers, J.I. Rotmans, M. van Diepen, Acute kidney injury and kidney replacement therapy in COVID-19: a systematic review and meta-analysis, Clin Kidney J 13(4) (2020) 550-563.

Return to footnote 171 referrer

Footnote 172

P. Hansrivijit, C. Qian, B. Boonpheng, C. Thongprayoon, S. Vallabhajosyula, W. Cheungpasitporn, N. Ghahramani, Incidence of acute kidney injury and its association with mortality in patients with COVID-19: a meta-analysis, J Investig Med 68(7) (2020) 1261-1270.

Return to footnote 172 referrer

Footnote 173

L. Lin, X. Wang, J. Ren, Y. Sun, R. Yu, K. Li, L. Zheng, J. Yang, Risk factors and prognosis for COVID-19-induced acute kidney injury: a meta-analysis, BMJ Open 10(11) (2020) e042573.

Return to footnote 173 referrer

Footnote 174

Y.F. Liu, Z. Zhang, X.L. Pan, G.L. Xing, Y. Zhang, Z.S. Liu, S.H. Tu, The chronic kidney disease and acute kidney injury involvement in COVID-19 pandemic: A systematic review and meta-analysis, PLoS One 16(1) (2021) e0244779.

Return to footnote 174 referrer

Footnote 175

B. Wang, Q. Luo, W. Zhang, S. Yu, X. Cheng, L. Wang, X. Chen, Y. Chen, The Involvement of Chronic Kidney Disease and Acute Kidney Injury in Disease Severity and Mortality in Patients with COVID-19: A Meta-Analysis, Kidney Blood Press Res 46(1) (2021) 17-30.

Return to footnote 175 referrer

Footnote 176

Q. Yang, X. Yang, Incidence and risk factors of kidney impairment on patients with COVID-19: A meta-analysis of 10180 patients, PLoS One 15(11) (2020) e0241953.

Return to footnote 176 referrer

Footnote 177

Z. Zhang, L. Zhang, D. Zha, C. Hu, X. Wu, Clinical characteristics and risks of Chinas 2019 novel coronavirus patients with AKI: a systematic review and meta-analysis, Ren Fail 42(1) (2020) 926-931.

Return to footnote 177 referrer

Footnote 178

S. Zhou, J. Xu, C. Xue, B. Yang, Z. Mao, A.C.M. Ong, Coronavirus-associated kidney outcomes in COVID-19, SARS, and MERS: a meta-analysis and systematic review, Ren Fail 43(1) (2020) 1-15.

Return to footnote 178 referrer

Footnote 179

Y. Zhou, Q. Ren, G. Chen, Q. Jin, Q. Cui, H. Luo, K. Zheng, Y. Qin, X. Li, Chronic Kidney Diseases and Acute Kidney Injury in Patients With COVID-19: Evidence From a Meta-Analysis, Front Med (Lausanne) 7 (2020) 588301.

Return to footnote 179 referrer

Footnote 180

R. Cai, J. Zhang, Y. Zhu, L. Liu, Y. Liu, Q. He, Mortality in chronic kidney disease patients with COVID-19: a systematic review and meta-analysis, Int Urol Nephrol (2021).

Return to footnote 180 referrer

Footnote 181

R. Pranata, R. Supriyadi, I. Huang, H. Permana, M.A. Lim, E. Yonas, N.N.M. Soetedjo, A.A. Lukito, The Association Between Chronic Kidney Disease and New Onset Renal Replacement Therapy on the Outcome of COVID-19 Patients: A Meta-analysis, Clin Med Insights Circ Respir Pulm Med 14 (2020) 1179548420959165.

Return to footnote 181 referrer

Footnote 182

C.Y. Chen, S.C. Shao, Y.T. Chen, C.K. Hsu, H.J. Hsu, C.C. Lee, C.Y. Sun, Y.C. Chen, M.J. Hung, I.W. Wu, Incidence and Clinical Impacts of COVID-19 Infection in Patients with Hemodialysis: Systematic Review and Meta-Analysis of 396,062 Hemodialysis Patients, Healthcare (Basel) 9(1) (2021).

Return to footnote 182 referrer

Footnote 183

A. Bansal, Kumar, A., Bansal, R. M., Maheshwari, R., & Chaturvedi, S., The impact of comorbidities on clinical course and outcome, in kidney transplant recipients with COVID-19: A systematic review and analysis., Indian Journal of Transplantation 14(4) (2020).

Return to footnote 183 referrer

Footnote 184

M. Du, Y.X. Lin, W.X. Yan, L.Y. Tao, M. Liu, J. Liu, Prevalence and impact of diabetes in patients with COVID-19 in China, World J Diabetes 11(10) (2020) 468-480.

Return to footnote 184 referrer

Footnote 185

M.M. Faghir-Gangi, H.; Abdolmohamadi, N.; Nematollahi, S., The prevalence of type 2 diabetes in patients with COVID-19: a systematic review and meta-analysis., Clinical Diabetology 9(5) (2020) 271-278.

Return to footnote 185 referrer

Footnote 186

S. Hussain, H. Baxi, M. Chand Jamali, N. Nisar, M.S. Hussain, Burden of diabetes mellitus and its impact on COVID-19 patients: A meta-analysis of real-world evidence, Diabetes Metab Syndr 14(6) (2020) 1595-1602.

Return to footnote 186 referrer

Footnote 187

L. Palaiodimos, N. Chamorro-Pareja, D. Karamanis, W. Li, P.D. Zavras, K.M. Chang, P. Mathias, D.G. Kokkinidis, Diabetes is associated with increased risk for in-hospital mortality in patients with COVID-19: a systematic review and meta-analysis comprising 18,506 patients, Hormones (Athens) (2020).

Return to footnote 187 referrer

Footnote 188

L. Shang, M. Shao, Q. Guo, J. Shi, Y. Zhao, J. Xiaokereti, B. Tang, Diabetes Mellitus is Associated with Severe Infection and Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis, Arch Med Res 51(7) (2020) 700-709.

Return to footnote 188 referrer

Footnote 189

Z.H. Wu, Y. Tang, Q. Cheng, Diabetes increases the mortality of patients with COVID-19: a meta-analysis, Acta Diabetol 58(2) (2021) 139-144.

Return to footnote 189 referrer

Footnote 190

J. Yang, C. Tian, Y. Chen, C. Zhu, H. Chi, J. Li, Obesity aggravates COVID-19: An updated systematic review and meta-analysis, J Med Virol (2020).

Return to footnote 190 referrer

Footnote 191

T.I. Hariyanto, C. Putri, J. Arisa, R.F.V. Situmeang, A. Kurniawan, Dementia and outcomes from coronavirus disease 2019 (COVID-19) pneumonia: A systematic review and meta-analysis, Arch Gerontol Geriatr 93 (2021) 104299.

Return to footnote 191 referrer

Footnote 192

J. July, R. Pranata, Prevalence of dementia and its impact on mortality in patients with coronavirus disease 2019: A systematic review and meta-analysis, Geriatr Gerontol Int 21(2) (2021) 172-177.

Return to footnote 192 referrer

Footnote 193

N. Liu, J. Sun, X. Wang, M. Zhao, Q. Huang, H. Li, The Impact of Dementia on the Clinical Outcome of COVID-19: A Systematic Review and Meta-Analysis, J Alzheimers Dis 78(4) (2020) 1775-1782.

Return to footnote 193 referrer

Footnote 194

M.G. Zuin, P.; Roncon, L.; Cervellati, C.; Zuliani, G., Dementia and the risk of death in elderly patients with COVID-19 infection: Systematic review and meta-analysis, International Journal of Geriatric Psychiatry. 0(0) (2020).

Return to footnote 194 referrer

Footnote 195

S. Parsay, A. Vosoughi, A. Khabbaz, S. Sadigh-Eteghad, The Incidence and Mortality Ratio of Ischemic Cerebrovascular Accidents in COVID-19 Cases: A Systematic Review and Meta-Analysis, J Stroke Cerebrovasc Dis 30(3) (2021) 105552.

Return to footnote 195 referrer

Footnote 196

H. Shokri Afra, N. Amiri-Dashatan, F. Ghorbani, I. Maleki, M. Rezaei-Tavirani, Positive association between severity of COVID-19 infection and liver damage: a systematic review and meta-analysis, Gastroenterol Hepatol Bed Bench 13(4) (2020) 292-304.

Return to footnote 196 referrer

Footnote 197

J. Ampuero, Y. Sanchez, M.R. Garcia-Lozano, D. Maya-Miles, M. Romero Gomez, Impact of liver injury on the severity of COVID-19: a systematic review with meta-analysis, Rev Esp Enferm Dig 113(2) (2021) 125-135.

Return to footnote 197 referrer

Footnote 198

Z.H. Wu, D.L. Yang, A meta-analysis of the impact of COVID-19 on liver dysfunction, Eur J Med Res 25(1) (2020) 54.

Return to footnote 198 referrer

Footnote 199

K. Jayant, I. Reccia, F. Virdis, J.S. Pyda, P.J. Bachul, D. di Sabato, R.N. Barth, J. Fung, T. Baker, P. Witkowski, COVID-19 in hospitalized liver transplant recipients: An early systematic review and meta-analysis, Clin Transplant (2021) e14246.

Return to footnote 199 referrer

Footnote 200

M.A. Waleed, M. A.; Abdallah, M.; Younossi, Z. M.; Singal, A. K. , Disease severity and time since transplantation determine patient mortality among liver transplant recipients with COVID-19 infection: A meta-analysis., Hepatology 72(0) (2020) 271A.

Return to footnote 200 referrer

Footnote 201

M.P. Kumar, S. Mishra, D.K. Jha, J. Shukla, A. Choudhury, R. Mohindra, H.S. Mandavdhare, U. Dutta, V. Sharma, Coronavirus disease (COVID-19) and the liver: a comprehensive systematic review and meta-analysis, Hepatol Int 14(5) (2020) 711-722.

Return to footnote 201 referrer

Footnote 202

S. Vancsa, P.J. Hegyi, N. Zadori, L. Szako, N. Vorhendi, K. Ocskay, M. Foldi, F. Dembrovszky, Z.R. Domotor, K. Janosi, Z. Rakonczay, Jr., P. Hartmann, T. Horvath, B. Eross, S. Kiss, Z. Szakacs, D. Nemeth, P. Hegyi, G. Par, Pre-existing Liver Diseases and On-Admission Liver-Related Laboratory Tests in COVID-19: A Prognostic Accuracy Meta-Analysis With Systematic Review, Front Med (Lausanne) 7 (2020) 572115.

Return to footnote 202 referrer

Footnote 203

E. Merola, C. Pravadelli, G. de Pretis, Prevalence of liver injury in patients with coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis, Acta Gastroenterol Belg 83(3) (2020) 454-460.

Return to footnote 203 referrer

Footnote 204

A.M. Kamel, M. Sobhy, N. Magdy, N. Sabry, S. Farid, Anticoagulation outcomes in hospitalized Covid-19 patients: A systematic review and meta-analysis of case-control and cohort studies, Rev Med Virol (2020) e2180.

Return to footnote 204 referrer

Footnote 205

B. Kefale, G.T. Tegegne, A. Degu, M. Tadege, D. Tesfa, Prevalence and Risk Factors of Thromboembolism among Patients With Coronavirus Disease-19: A Systematic Review and Meta-Analysis, Clin Appl Thromb Hemost 26 (2020) 1076029620967083.

Return to footnote 205 referrer

Footnote 206

X. Li, Z. Xu, T. Wang, X. Xu, H. Li, Q. Sun, X. Zhou, G. Chen, Clinical laboratory characteristics of severe patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis, Clin Epidemiol Glob Health 9 (2021) 184-190.

Return to footnote 206 referrer

Footnote 207

C. Wang, H. Zhang, M. Zhou, Y. Cheng, L. Ye, J. Chen, M. Wang, Z. Feng, Prognosis of COVID-19 in patients with vein thrombosis: a systematic review and meta-analysis, Eur Rev Med Pharmacol Sci 24(19) (2020) 10279-10285.

Return to footnote 207 referrer

Footnote 208

G. Xiang, S. Hao, C. Fu, W. Hu, L. Xie, Q. Wu, S. Li, X. Liu, The effect of coagulation factors in 2019 novel coronavirus patients: A systematic review and meta-analysis, Medicine (Baltimore) 100(7) (2021) e24537.

Return to footnote 208 referrer

Footnote 209

Y. Zhu, C.J. Bloxham, K.D. Hulme, J.E. Sinclair, Z.W.M. Tong, L.E. Steele, E.C. Noye, J. Lu, Y. Xia, K.Y. Chew, J. Pickering, C. Gilks, A.C. Bowen, K.R. Short, A meta-analysis on the role of children in SARS-CoV-2 in household transmission clusters, Clin Infect Dis (2020).

Return to footnote 209 referrer

Footnote 210

A. Di Minno, P. Ambrosino, I. Calcaterra, M.N.D. Di Minno, COVID-19 and Venous Thromboembolism: A Meta-analysis of Literature Studies, Semin Thromb Hemost 46(7) (2020) 763-771.

Return to footnote 210 referrer

Footnote 211

Y. Liu, J. Cai, C. Wang, J. Jin, L. Qu, Incidence, prognosis, and laboratory indicators of venous thromboembolism in hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis, J Vasc Surg Venous Lymphat Disord (2021).

Return to footnote 211 referrer

Footnote 212

R.S. Loomba, G. Aggarwal, E.G. Villarreal, J.S. Farias, S. Flores, C.J. Lavie, S. Aggarwal, Factors associated with deep venous thrombosis in patients infected with coronavirus disease 2019: a meta-analysis, Blood Coagul Fibrinolysis 32(1) (2021) 23-28.

Return to footnote 212 referrer

Footnote 213

Y.F. Lu, L.Y. Pan, W.W. Zhang, F. Cheng, S.S. Hu, X. Zhang, H.Y. Jiang, A meta-analysis of the incidence of venous thromboembolic events and impact of anticoagulation on mortality in patients with COVID-19, Int J Infect Dis 100 (2020) 34-41.

Return to footnote 213 referrer

Footnote 214

M.B. Malas, I.N. Naazie, N. Elsayed, A. Mathlouthi, R. Marmor, B. Clary, Thromboembolism risk of COVID-19 is high and associated with a higher risk of mortality: A systematic review and meta-analysis, EClinicalMedicine 29 (2020) 100639.

Return to footnote 214 referrer

Footnote 215

T. Mir, H.B. Attique, Y. Sattar, N. Regmi, M.S. Khan, H. Youns, B. Qayoom, M.T. Jerger, M.C. Alraies, Does pulmonary embolism in critically ill COVID-19 patients worsen the in-hospital mortality: A meta-analysis, Cardiovasc Revasc Med (2020).

Return to footnote 215 referrer

Footnote 216

S. Nopp, F. Moik, B. Jilma, I. Pabinger, C. Ay, Risk of venous thromboembolism in patients with COVID-19: A systematic review and meta-analysis, Res Pract Thromb Haemost (2020).

Return to footnote 216 referrer

Footnote 217

A. Porfidia, E. Valeriani, R. Pola, E. Porreca, A.W.S. Rutjes, M. Di Nisio, Venous thromboembolism in patients with COVID-19: Systematic review and meta-analysis, Thromb Res 196 (2020) 67-74.

Return to footnote 217 referrer

Footnote 218

L. Roncon, M. Zuin, S. Barco, L. Valerio, G. Zuliani, P. Zonzin, S.V. Konstantinides, Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis, Eur J Intern Med 82 (2020) 29-37.

Return to footnote 218 referrer

Footnote 219

G.K. Sridharan, R. Vegunta, V.R.P. Rokkam, V. Meyyur Aravamudan, R. Vegunta, S.R. Khan, S. Ponnada, U. Boregowda, K. Prudhvi, G. Chamarthi, B.P. Mohan, Venous Thromboembolism in Hospitalized COVID-19 Patients, Am J Ther 27(6) (2020) e599-e610.

Return to footnote 219 referrer

Footnote 220

T. Wu, Z. Zuo, D. Yang, X. Luo, L. Jiang, Z. Xia, X. Xiao, J. Liu, M. Ye, M. Deng, Venous thromboembolic events in patients with COVID-19: a systematic review and meta-analysis, Age Ageing 50(2) (2021) 284-293.

Return to footnote 220 referrer

Footnote 221

R. Zhang, L. Ni, X. Di, X. Wang, B. Ma, S. Niu, C. Liu, Systematic review and meta-analysis of the prevalence of venous thromboembolic events in novel coronavirus disease-2019 patients, J Vasc Surg Venous Lymphat Disord 9(2) (2021) 289-298 e5.

Return to footnote 221 referrer

Footnote 222

S. Akiyama, S. Hamdeh, D. Micic, A. Sakuraba, Response to: 'Correspondence on 'Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis'' by Lee, Ann Rheum Dis (2021).

Return to footnote 222 referrer

Footnote 223

B.G. Pijls, S. Jolani, A. Atherley, R.T. Derckx, J.I.R. Dijkstra, G.H.L. Franssen, S. Hendriks, A. Richters, A. Venemans-Jellema, S. Zalpuri, M.P. Zeegers, Demographic risk factors for COVID-19 infection, severity, ICU admission and death: a meta-analysis of 59 studies, BMJ Open 11(1) (2021) e044640.

Return to footnote 223 referrer

Footnote 224

C. Yifan, P. Jun, Understanding the Clinical Features of Coronavirus Disease 2019 From the Perspective of Aging: A Systematic Review and Meta-Analysis, Front Endocrinol (Lausanne) 11 (2020) 557333.

Return to footnote 224 referrer

Footnote 225

J.F. Cohen, D.A. Korevaar, S. Matczak, M. Chalumeau, S. Allali, J. Toubiana, COVID-19-Related Fatalities and Intensive-Care-Unit Admissions by Age Groups in Europe: A Meta-Analysis, Front Med (Lausanne) 7 (2020) 560685.

Return to footnote 225 referrer

Footnote 226

I.J. Borges do Nascimento, T.C. von Groote, D.P. O'Mathuna, H.M. Abdulazeem, C. Henderson, U. Jayarajah, I. Weerasekara, T. Poklepovic Pericic, H.E.G. Klapproth, L. Puljak, N. Cacic, I. Zakarija-Grkovic, S.M.M. Guimaraes, A.N. Atallah, N.L. Bragazzi, M.S. Marcolino, A. Marusic, A. Jeroncic, D. International Task Force Network of Coronavirus, Clinical, laboratory and radiological characteristics and outcomes of novel coronavirus (SARS-CoV-2) infection in humans: A systematic review and series of meta-analyses, PLoS One 15(9) (2020) e0239235.

Return to footnote 226 referrer

Footnote 227

Z.J. Lim, A. Subramaniam, M. Ponnapa Reddy, G. Blecher, U. Kadam, A. Afroz, B. Billah, S. Ashwin, M. Kubicki, F. Bilotta, J.R. Curtis, F. Rubulotta, Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis, Am J Respir Crit Care Med 203(1) (2021) 54-66.

Return to footnote 227 referrer

Footnote 228

S.M.M. Aghili, M. Ebrahimpur, B. Arjmand, Z. Shadman, M. Pejman Sani, M. Qorbani, B. Larijani, M. Payab, Obesity in COVID-19 era, implications for mechanisms, comorbidities, and prognosis: a review and meta-analysis, Int J Obes (Lond) (2021).

Return to footnote 228 referrer

Footnote 229

C.W.S. Hoong, I. Hussain, V.M. Aravamudan, E.E. Phyu, J.H.X. Lin, H. Koh, Obesity is Associated with Poor Covid-19 Outcomes: A Systematic Review and Meta-Analysis, Horm Metab Res 53(2) (2021) 85-93.

Return to footnote 229 referrer

Footnote 230

Y. Chu, J. Yang, J. Shi, P. Zhang, X. Wang, Obesity is associated with increased severity of disease in COVID-19 pneumonia: a systematic review and meta-analysis, Eur J Med Res 25(1) (2020) 64.

Return to footnote 230 referrer

Footnote 231

L. Deng, J. Zhang, M. Wang, L. Chen, Obesity is associated with severe COVID-19 but not death: a dose-response meta-analysis, Epidemiol Infect (2021) 1-27.

Return to footnote 231 referrer

Footnote 232

J.S.Y. Ho, D.I. Fernando, M.Y. Chan, C.H. Sia, Obesity in COVID-19: A Systematic Review and Meta-analysis, Ann Acad Med Singap 49(12) (2020) 996-1008.

Return to footnote 232 referrer

Footnote 233

Y. Huang, Y. Lu, Y.M. Huang, M. Wang, W. Ling, Y. Sui, H.L. Zhao, Obesity in patients with COVID-19: a systematic review and meta-analysis, Metabolism 113 (2020) 154378.

Return to footnote 233 referrer

Footnote 234

V.S. Malik, K. Ravindra, S.V. Attri, S.K. Bhadada, M. Singh, Higher body mass index is an important risk factor in COVID-19 patients: a systematic review and meta-analysis, Environ Sci Pollut Res Int 27(33) (2020) 42115-42123.

Return to footnote 234 referrer

Footnote 235

A.Y. Soeroto, N.N. Soetedjo, A. Purwiga, P. Santoso, I.D. Kulsum, H. Suryadinata, F. Ferdian, Effect of increased BMI and obesity on the outcome of COVID-19 adult patients: A systematic review and meta-analysis, Diabetes Metab Syndr 14(6) (2020) 1897-1904.

Return to footnote 235 referrer

Footnote 236

X. Zhao, X. Gang, G. He, Z. Li, Y. Lv, Q. Han, G. Wang, Obesity Increases the Severity and Mortality of Influenza and COVID-19: A Systematic Review and Meta-Analysis, Front Endocrinol (Lausanne) 11 (2020) 595109.

Return to footnote 236 referrer

Footnote 237

R.K. Reddy, W.N. Charles, A. Sklavounos, A. Dutt, P.T. Seed, A. Khajuria, The effect of smoking on COVID-19 severity: A systematic review and meta-analysis, J Med Virol 93(2) (2021) 1045-1056.

Return to footnote 237 referrer

Footnote 238

A. Gulsen, B.A. Yigitbas, B. Uslu, D. Dromann, O. Kilinc, The Effect of Smoking on COVID-19 Symptom Severity: Systematic Review and Meta-Analysis, Pulm Med 2020 (2020) 7590207.

Return to footnote 238 referrer

Footnote 239

C.A. Jimenez-Ruiz, D. Lopez-Padilla, A. Alonso-Arroyo, R. Aleixandre-Benavent, S. Solano-Reina, J.I. de Granda-Orive, COVID-19 and Smoking: A Systematic Review and Meta-Analysis of the Evidence, Arch Bronconeumol 57 Suppl 1 (2021) 21-34.

Return to footnote 239 referrer

Footnote 240

A. Karanasos, K. Aznaouridis, G. Latsios, A. Synetos, S. Plitaria, D. Tousoulis, K. Toutouzas, Impact of Smoking Status on Disease Severity and Mortality of Hospitalized Patients With COVID-19 Infection: A Systematic Review and Meta-analysis, Nicotine Tob Res 22(9) (2020) 1657-1659.

Return to footnote 240 referrer

Footnote 241

E.P. Lansiaux, Pierre-Philippe & Picard, Jean-Laurent & Son-Forget, Joachim. , Meta-Analysis: COVID-19 Disease Severity Correlates with Smoking Status., Clinical Pulmonary Medecine 27 (2020) 99-104.

Return to footnote 241 referrer

Footnote 242

R. Patanavanich, S.A. Glantz, Smoking is associated with worse outcomes of COVID-19 particularly among younger adults: A systematic review and meta-analysis, medRxiv (2020).

Return to footnote 242 referrer

Footnote 243

R. Patanavanich, S.A. Glantz, Smoking Is Associated With COVID-19 Progression: A Meta-analysis, Nicotine Tob Res 22(9) (2020) 1653-1656.

Return to footnote 243 referrer

Footnote 244

H.M. Salah, T. Sharma, J. Mehta, Smoking Doubles the Mortality Risk in COVID-19: A Meta-Analysis of Recent Reports and Potential Mechanisms, Cureus 12(10) (2020) e10837.

Return to footnote 244 referrer

Footnote 245

A. Umnuaypornlert, S. Kanchanasurakit, D.E.I. Lucero-Prisno, S. Saokaew, Smoking and risk of negative outcomes among COVID-19 patients: A systematic review and meta-analysis, Tob Induc Dis 19 (2021) 09.

Return to footnote 245 referrer

Footnote 246

H. Zhang, S. Ma, T. Han, G. Qu, C. Cheng, J.P. Uy, M.B. Shaikh, Q. Zhou, E.J. Song, C. Sun, Association of smoking history with severe and critical outcomes in COVID-19 patients: A systemic review and meta-analysis, Eur J Integr Med 43 (2021) 101313.

Return to footnote 246 referrer

Footnote 247

A. Aminian, C. Tu, Association of Bariatric Surgery with Clinical Outcomes of SARS-CoV-2 Infection: a Systematic Review and Meta-analysis in the Initial Phase of COVID-19 Pandemic, Obes Surg (2021).

Return to footnote 247 referrer

Footnote 248

I. Lakbar, D. Luque-Paz, J.L. Mege, S. Einav, M. Leone, COVID-19 gender susceptibility and outcomes: A systematic review, PLoS One 15(11) (2020) e0241827.

Return to footnote 248 referrer

Footnote 249

U. Patel, P. Malik, M.S. Usman, D. Mehta, A. Sharma, F.A. Malik, N. Khan, T.J. Siddiqi, J. Ahmed, A. Patel, H. Sacks, Age-Adjusted Risk Factors Associated with Mortality and Mechanical Ventilation Utilization Amongst COVID-19 Hospitalizations-a Systematic Review and Meta-Analysis, SN Compr Clin Med (2020) 1-10.

Return to footnote 249 referrer

Footnote 250

YH. Peckham, N.M. de Gruijter, C. Raine, A. Radziszewska, C. Ciurtin, L.R. Wedderburn, E.C. Rosser, K. Webb, C.T. Deakin, Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission, Nat Commun 11(1) (2020) 6317.

Return to footnote 250 referrer

Footnote 251

R. Pranata, J. Henrina, M.A. Lim, S. Lawrensia, E. Yonas, R. Vania, I. Huang, A.A. Lukito, K. Suastika, R.A.T. Kuswardhani, S. Setiati, Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis, Arch Gerontol Geriatr 93 (2021) 104324.

Return to footnote 251 referrer

Footnote 252

K. Wang, C. Wu, J. Xu, B. Zhang, X. Zhang, Z. Gao, Z. Xia, Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis, EClinicalMedicine 29 (2020) 100612.

Return to footnote 252 referrer

Footnote 253

N. Pabalan, P. Tharabenjasin, P. Suntornsaratoon, H. Jarjanazi, C. Muanprasat, Ethnic and age-specific acute lung injury/acute respiratory distress syndrome risk associated with angiotensin-converting enzyme insertion/deletion polymorphisms, implications for COVID-19: A meta-analysis, Infect Genet Evol 88 (2021) 104682.

Return to footnote 253 referrer

Footnote 254

A. Raharja, A. Tamara, L.T. Kok, Association Between Ethnicity and Severe COVID-19 Disease: a Systematic Review and Meta-analysis, J Racial Ethn Health Disparities (2020).

Return to footnote 254 referrer

Footnote 255

S. Sze, D. Pan, C.R. Nevill, L.J. Gray, C.A. Martin, J. Nazareth, J.S. Minhas, P. Divall, K. Khunti, K.R. Abrams, L.B. Nellums, M. Pareek, Ethnicity and clinical outcomes in COVID-19: A systematic review and meta-analysis, EClinicalMedicine 29 (2020) 100630.

Return to footnote 255 referrer

Footnote 256

N. Liu, T. Zhang, L. Ma, H. Zhang, H. Wang, W. Wei, H. Pei, H. Li, The impact of ABO blood group on COVID-19 infection risk and mortality: A systematic review and meta-analysis, Blood Rev (2020) 100785.

Return to footnote 256 referrer

Footnote 257

F. Pourali, M. Afshari, R. Alizadeh-Navaei, J. Javidnia, M. Moosazadeh, A. Hessami, Relationship between blood group and risk of infection and death in COVID-19: a live meta-analysis, New Microbes New Infect 37 (2020) 100743.

Return to footnote 257 referrer

Footnote 258

B.B. Wu, D.Z. Gu, J.N. Yu, J. Yang, W.Q. Shen, Association between ABO blood groups and COVID-19 infection, severity and demise: A systematic review and meta-analysis, Infect Genet Evol 84 (2020) 104485.

Return to footnote 258 referrer

Footnote 259

J. Allotey, E. Stallings, M. Bonet, M. Yap, S. Chatterjee, T. Kew, L. Debenham, A.C. Llavall, A. Dixit, D. Zhou, R. Balaji, S.I. Lee, X. Qiu, M. Yuan, D. Coomar, M. van Wely, E. van Leeuwen, E. Kostova, H. Kunst, A. Khalil, S. Tiberi, V. Brizuela, N. Broutet, E. Kara, C.R. Kim, A. Thorson, O.T. Oladapo, L. Mofenson, J. Zamora, S. Thangaratinam, C.O.V.L.S.R.C. for Preg, Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis, BMJ 370 (2020) m3320.

Return to footnote 259 referrer

Footnote 260

G. Capobianco, L. Saderi, S. Aliberti, M. Mondoni, A. Piana, F. Dessole, M. Dessole, P.L. Cherchi, S. Dessole, G. Sotgiu, COVID-19 in pregnant women: A systematic review and meta-analysis, Eur J Obstet Gynecol Reprod Biol 252 (2020) 543-558.

Return to footnote 260 referrer

Footnote 261

F. Di Toro, M. Gjoka, G. Di Lorenzo, D. De Santo, F. De Seta, G. Maso, F.M. Risso, F. Romano, U. Wiesenfeld, R. Levi-D'Ancona, L. Ronfani, G. Ricci, Impact of COVID-19 on maternal and neonatal outcomes: a systematic review and meta-analysis, Clin Microbiol Infect 27(1) (2021) 36-46.

Return to footnote 261 referrer

Footnote 262

R.A. Kadir, T. Kobayashi, T. Iba, O. Erez, J. Thachil, S. Kazi, A.K. Malinowski, M. Othman, COVID-19 coagulopathy in pregnancy: Critical review, preliminary recommendations, and ISTH registry-Communication from the ISTH SSC for Women's Health, J Thromb Haemost 18(11) (2020) 3086-3098.

Return to footnote 262 referrer

Footnote 263

M. Jafari, A. Pormohammad, S.A. Sheikh Neshin, S. Ghorbani, D. Bose, S. Alimohammadi, S. Basirjafari, M. Mohammadi, C. Rasmussen-Ivey, M.H. Razizadeh, M. Nouri-Vaskeh, M. Zarei, Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: A systematic review and meta-analysis, Rev Med Virol (2021) e2208.

Return to footnote 263 referrer

Footnote 264

M.U. Bhuiyan, E. Stiboy, M.Z. Hassan, M. Chan, M.S. Islam, N. Haider, A. Jaffe, N. Homaira, Epidemiology of COVID-19 infection in young children under five years: A systematic review and meta-analysis, Vaccine 39(4) (2021) 667-677.

Return to footnote 264 referrer

Footnote 265

K.S. Dube R, COVID-19 in pregnancy: the foetal perspective—a systematic review, BMJ Paediatr Open 4(1) (2020).

Return to footnote 265 referrer

Footnote 266

R. Abou Ghayda, H. Li, K.H. Lee, H.W. Lee, S.H. Hong, M. Kwak, M. Lee, M. Kwon, A. Koyanagi, A. Kronbichler, L. Jacob, L. Smith, J.I. Shin, COVID-19 and Adverse Pregnancy Outcome: A Systematic Review of 104 Cases, J Clin Med 9(11) (2020).

Return to footnote 266 referrer

Footnote 267

I. Bellos, A. Pandita, R. Panza, Maternal and perinatal outcomes in pregnant women infected by SARS-CoV-2: A meta-analysis, Eur J Obstet Gynecol Reprod Biol 256 (2021) 194-204.

Return to footnote 267 referrer

Footnote 268

M. Soheili, G. Moradi, H.R. Baradaran, M. Soheili, M.M. Mokhtari, Y. Moradi, Clinical manifestation and maternal complications and neonatal outcomes in pregnant women with COVID-19: a comprehensive evidence synthesis and meta-analysis, J Matern Fetal Neonatal Med (2021) 1-14.

Return to footnote 268 referrer

Footnote 269

O. Irfan, F. Muttalib, K. Tang, L. Jiang, Z.S. Lassi, Z. Bhutta, Clinical characteristics, treatment and outcomes of paediatric COVID-19: a systematic review and meta-analysis, Arch Dis Child (2021).

Return to footnote 269 referrer

Footnote 270

W.C. Koh, L. Naing, L. Chaw, M.A. Rosledzana, M.F. Alikhan, S.A. Jamaludin, F. Amin, A. Omar, A. Shazli, M. Griffith, R. Pastore, J. Wong, What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors, PLoS One 15(10) (2020) e0240205.

Return to footnote 270 referrer

Footnote 271

B. Li, S. Zhang, R. Zhang, X. Chen, Y. Wang, C. Zhu, Epidemiological and Clinical Characteristics of COVID-19 in Children: A Systematic Review and Meta-Analysis, Front Pediatr 8 (2020) 591132.

Return to footnote 271 referrer

Footnote 272

R.M. Viner, O.T. Mytton, C. Bonell, G.J. Melendez-Torres, J. Ward, L. Hudson, C. Waddington, J. Thomas, S. Russell, F. van der Klis, A. Koirala, S. Ladhani, J. Panovska-Griffiths, N.G. Davies, R. Booy, R.M. Eggo, Susceptibility to SARS-CoV-2 Infection Among Children and Adolescents Compared With Adults: A Systematic Review and Meta-analysis, JAMA Pediatr 175(2) (2021) 143-156.

Return to footnote 272 referrer

Footnote 273

J.G. Wang, Z.J. Zhong, Y.F. Mo, L.C. Wang, R. Chen, Epidemiological features of coronavirus disease 2019 in children: a meta-analysis, Eur Rev Med Pharmacol Sci 25(2) (2021) 1146-1157.

Return to footnote 273 referrer

Footnote 274

V.D. Williams, N.; Suthar, R.; Moh; oss, V.; Jaiswal, N.; Kavitha, T. K.; Nallasamy, K.; Angurana, S. K. C, Clinicolaboratory Profile, Treatment, Intensive Care Needs, and Outcome of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2: A Systematic Review and Meta-analysis., Journal of Pediatric Intensive Care 0(0) (2020).

Return to footnote 274 referrer

Footnote 275

E. Dorantes-Acosta, D. Avila-Montiel, M. Klunder-Klunder, L. Juarez-Villegas, H. Marquez-Gonzalez, Survival and Complications in Pediatric Patients With Cancer and COVID-19: A Meta-Analysis, Front Oncol 10 (2020) 608282.

Return to footnote 275 referrer

Footnote 276

B.K. Tsankov, J.M. Allaire, M.A. Irvine, A.A. Lopez, L.J. Sauve, B.A. Vallance, K. Jacobson, Severe COVID-19 Infection and Pediatric Comorbidities: A Systematic Review and Meta-Analysis, Int J Infect Dis 103 (2021) 246-256.

Return to footnote 276 referrer

Footnote 277

W.A. Brown, E.M. Moore, D.A. Watters, Mortality of patients with COVID-19 who undergo an elective or emergency surgical procedure: a systematic review and meta-analysis, ANZ J Surg 91(1-2) (2021) 33-41.

Return to footnote 277 referrer

Footnote 278

J.-W. Li, T.-W. Han, M. Woodward, C. S. Anderson, H. Zhou, Y.-D. Chen and B. Neal, " The impact of 2019 novel coronavirus on heart injury: A Systematic review and Meta-analysis.," Progress in Cardiovascular Diseases, vol. 63, no. 4, pp. 518-524, 2020.

Return to footnote 278 referrer

Footnote 279

R. Tariq, S. Saha, F. Furqan, L. Hassett, D. Pardi and S. Khanna, " Prevalence and Mortality of COVID-19 Patients With Gastrointestinal Symptoms: A Systematic Review and Meta-analysis," Mayo Clinic Proceedings, vol. 95, no. 8, pp. 1632-1648, 2020.

Return to footnote 279 referrer

Footnote 280

J. Almqvist, T. Granberg, A. Tzortzakakis, S. Klironomos, E. Kollia, C. Ohberg, R. Martin, F. Piehl, R. Ouellette and B. V. Ineichen, "Neurological manifestations of coronavirus infections - a systematic review.," Annals of Clinical & Translational Neurology, vol. 7, no. 10, pp. 2057-2071, 2020.

Return to footnote 280 referrer

Footnote 281

X. Chen, S. Laurent, O. A. Onur, N. N. Kleineberg, G. R. Fink, F. Schweitzer and C. Warnke, "A systematic review of neurological symptoms and complications of COVID-19.," Journal of Neurology, vol. 20, no. 0, p. 20, 2020.

Return to footnote 281 referrer

Footnote 282

F. Gul, K. B. Lo, J. Peterson, P. A. McCullough, A. Goyal and J. Rangaswami, "Meta-analysis of outcomes of patients with COVID-19 infection with versus without gastrointestinal symptoms," Baylor University Medical Center Proceedings, vol. 33, no. 3, pp. 366-369, 2020.

Return to footnote 282 referrer

Footnote 283

R. Mao, Y. Qiu, J. S. He, J. Y. Tan, X. H. Li, J. Liang, J. Shen, L. R. Zhu, Y. Chen, M. Iacucci, S. C. Ng, S. Ghosh and M. H. Chen, "Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic reviewand meta-analysis.," The Lancet. Gastroenterology & Hepatology, vol. 5, no. 7, pp. 667-678, 2020.

Return to footnote 283 referrer

Footnote 284

T. H. Chua, Z. Xu and N. K. K. King, "Neurological manifestations in COVID-19: a systematic review and meta-analysis," Brain Injury, vol. 0, no. 0, 2020.

Return to footnote 284 referrer

Footnote 285

L. P. Samaranayake, K. S. Fakhruddin, P and C. uwawala, " Sudden onset, acute loss of taste and smell in coronavirus disease 2019 (COVID-19): a systematic review," Acta Odontologica Scandinavica, vol. 78, no. 6, pp. 467-473, 2020.

Return to footnote 285 referrer

Footnote 286

A. De Lorenzo, D. A. Kasal, B. R. Tura, C. C. Lamas and H. C. Rey, " Acute cardiac injury in patients with COVID-19," American Journal of Cardiovascular Disease, vol. 10, no. 2, pp. 28-33, 2020.

Return to footnote 286 referrer

Footnote 287

L. Zhang, T. G. Peres, M. V. F. Silva and P. Camargos, " What we know so far about Coronavirus Disease 2019 in children: A meta-analysis of 551 laboratory-confirmed cases," Pediatric Pulmonology, vol. 55, no. 8, pp. 2115-2127, 2020.

Return to footnote 287 referrer

Footnote 288

M. A. Ashraf, P. Keshavarz, P. Hosseinpour, A. Erfani, A. Roshanshad, A. Pourdast, P. Nowrouzi-Sohrabi, S. Chaichian and T. Poordast, "Coronavirus Disease 2019 (COVID-19): A Systematic Review of Pregnancy and the Possibility of Vertical Transmission," Journal of Reproduction and Infertility, vol. 21, no. 3, p. 157, 2020.

Return to footnote 288 referrer

Footnote 289

S. Fridman, M. Bres Bullrich, A. Jimenez-Ruiz, P. Costantini, P. Shah, C. Just, D. Vela-Duarte, I. Linfante, A. Sharifi-Razavi, N. Karimi, R. Bagur, D.B. Debicki, T.E. Gofton, D.A. Steven, L.A. Sposato, Stroke risk, phenotypes, and death in COVID-19: Systematic review and newly reported cases, Neurology 95(24) (2020) e3373-e3385.

Return to footnote 289 referrer

Footnote 290

A.H. Katsanos, L. Palaiodimou, R. Zand, S. Yaghi, H. Kamel, B.B. Navi, G. Turc, M. Romoli, V.K. Sharma, D. Mavridis, S. Shahjouei, L. Catanese, A. Shoamanesh, K. Vadikolias, K. Tsioufis, P. Lagiou, A.V. Alexandrov, S. Tsiodras, G. Tsivgoulis, The Impact of SARS-CoV-2 on Stroke Epidemiology and Care: A Meta-Analysis, Ann Neurol 89(2) (2021) 380-388.

Return to footnote 290 referrer

Footnote 291

T. Siepmann, A. Sedghi, E. Simon, S. Winzer, J. Barlinn, K. de With, L. Mirow, M. Wolz, T. Gruenewald, P. Schroettner, S. von Bonin, L.P. Pallesen, B. Rosengarten, J. Schubert, T. Lohmann, J. Machetanz, P. Spieth, T. Koch, S. Bornstein, H. Reichmann, V. Puetz, K. Barlinn, Increased risk of acute stroke among patients with severe COVID-19: a multicenter study and meta-analysis, Eur J Neurol 28(1) (2021) 238-247.

Return to footnote 291 referrer

Footnote 292

I. Siow, K.S. Lee, J.J.Y. Zhang, S.E. Saffari, A. Ng, B. Young, Stroke as a Neurological Complication of COVID-19: A Systematic Review and Meta-Analysis of Incidence, Outcomes and Predictors, J Stroke Cerebrovasc Dis 30(3) (2021) 105549.

Return to footnote 292 referrer

Footnote 293

M. Yamakawa, T. Kuno, T. Mikami, H. Takagi, G. Gronseth, Clinical Characteristics of Stroke with COVID-19: A Systematic Review and Meta-Analysis, J Stroke Cerebrovasc Dis 29(12) (2020) 105288.

Return to footnote 293 referrer

Footnote 294

L. Yang, J. Jin, W. Luo, Y. Gan, B. Chen, W. Li, Risk factors for predicting mortality of COVID-19 patients: A systematic review and meta-analysis, PLoS One 15(11) (2020) e0243124.

Return to footnote 294 referrer

Footnote 296

J. Amorim Dos Santos, A.G.C. Normando, R.L. Carvalho da Silva, A.C. Acevedo, G. De Luca Canto, N. Sugaya, A.R. Santos-Silva, E.N.S. Guerra, Oral Manifestations in Patients with COVID-19: A Living Systematic Review, J Dent Res 100(2) (2021) 141-154.

Return to footnote 296 referrer

Footnote 297

M. B. L. K. J. D. e. a. Banakar, "COVID-19 transmission risk and protective protocols in dentistry: a systematic review," BMC Oral Health, p. 75, 2020.

Return to footnote 297 referrer

Footnote 298

F. D. P. Cabrera-Tasayco, J. M. Rivera-Carhuavilca, K. J. Atoche-Socola, C. Pena-Soto and L. E. Arriola-Guillen, " Biosafety measures at the dental office after the appearance of COVID-19: A systematic review," Disaster medicine and public health preparedness, vol. 0, no. 0, pp. 1-16, 2020.

Return to footnote 298 referrer

Footnote 299

A. A. Siles-Garcia, A. G. Alzamora-Cepeda, K. J. Atoche-Socola, C. Peña-Soto and L. E. Arriola-Guillén, "Biosafety for dental patients during dentistry care after COVID-19: A review of the literature. Disaster Medicine and Public Health Preparednes," Disaster Medicine and Public Health Preparedness, vol. 0, no. 0, 2020.

Return to footnote 299 referrer

Footnote 300

M. Al-Halabi, A. Salami, E. Alnuaimi, M. Kowash and I. Hussein, "Assessment of paediatric dental guidelines and caries management alternatives in the post COVID-19 period. A critical review and clinical recommendations.," European Archives of Paediatric Dentistry: Official Journal of the European Academy of Paediatric Dentistry, vol. 21, no. 5, pp. 543-556, 2020.

Return to footnote 300 referrer

Footnote 301

E. Monaghesh, A. Hajizadeh, The role of telehealth during COVID-19 outbreak: a systematic review based on current evidence, BMC Public Health 20(1) (2020) 1193.

Return to footnote 301 referrer

Footnote 302

H. Achmad, M. Tanumihardja, Y.F. Ramadhany, Teledentistry as a solution in dentistry during the covid-19 pandemic period: A systematic review, International Journal of Pharmaceutical Research 1 (2020) 12.

Return to footnote 302 referrer

Footnote 303

P. Bastani, M. Mohammadpour, A. Ghanbarzadegan, K. Kapellas, L.G. Do, Global concerns of dental and oral health workers during COVID-19 outbreak: a scope study on the concerns and the coping strategies, Syst Rev 10(1) (2021) 45.

Return to footnote 303 referrer

Footnote 304

L. Aquilanti, A. Santarelli, M. Mascitti, M. Procaccini, G. Rappelli, Dental Care Access and the Elderly: What Is the Role of Teledentistry? A Systematic Review, Int J Environ Res Public Health 17(23) (2020).

Return to footnote 304 referrer

Footnote 305

G. Bedi, K.S. Vyas, M.T. Chung, S.D. Morrison, M. Asaad, S. Mardini, Telemedicine in International Cleft Care: A Systematic Review, Cleft Palate Craniofac J (2021) 1055665621989140.

Return to footnote 305 referrer

Footnote 306

S.G. Alonso, G. Marques, I. Barrachina, B. Garcia-Zapirain, J. Arambarri, J.C. Salvador, I. de la Torre Diez, Telemedicine and e-Health research solutions in literature for combatting COVID-19: a systematic review, Health Technol (Berl) (2021) 1-10.

Return to footnote 306 referrer

Footnote 307

E.B. de Moraes, J.B. Santos Garcia, J. de Macedo Antunes, D.V. Daher, F.L. Seixas, M.F. Muniz Ferrari, Chronic Pain Management during the Covid-19 Pandemic: A Scoping Review, Pain Manag Nurs (2020).

Return to footnote 307 referrer

Footnote 308

H. Kondylakis, D.G. Katehakis, A. Kouroubali, F. Logothetidis, A. Triantafyllidis, I. Kalamaras, K. Votis, D. Tzovaras, COVID-19 Mobile Apps: A Systematic Review of the Literature, J Med Internet Res 22(12) (2020) e23170.

Return to footnote 308 referrer

Footnote 309

S.S. Mahdi, Z. Ahmed, R. Allana, A. Peretti, F. Amenta, M. Nadeem Bijle, L.L. Seow, U. Daood, Pivoting Dental Practice Management during the COVID-19 Pandemic-A Systematic Review, Medicina (Kaunas) 56(12) (2020).

Return to footnote 309 referrer

Footnote 310

K.A. Turkistani, K.A. Turkistani, Dental Risks and Precautions during COVID-19 Pandemic: A Systematic Review, J Int Soc Prev Community Dent 10(5) (2020) 540-548.

Return to footnote 310 referrer

Footnote 311

M. Delikhoon, M.I. Guzman, R. Nabizadeh, A. Norouzian Baghani, Modes of Transmission of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) and Factors Influencing on the Airborne Transmission: A Review, Int J Environ Res Public Health 18(2) (2021).

Return to footnote 311 referrer

Footnote 312

B.A. Kathree, S.B. Khan, R. Ahmed, R. Maart, N. Layloo, W. Asia-Michaels, COVID-19 and its impact in the dental setting: A scoping review, PLoS One 15(12) (2020) e0244352.

Return to footnote 312 referrer

Footnote 313

M. Tysiac-Mista, S. Bulanda, The utilization of rapid serological tests in COVID-19 diagnostics - a high risk of false-negative results in outpatient care, with particular emphasis on dental treatment, Med Pr (2020).

Return to footnote 313 referrer

Footnote 314

A. Licina, A. Silvers and R. L. Stuart, "Use of powered air-purifying respirator (PAPR) by healthcare workers for preventing highly infectious viral diseases - A systematic review of evidence," Systematic Reviews, vol. 9, no. 1, 2020.

Return to footnote 314 referrer

Footnote 315

M. e. a. Zhang, "Masks or N95 Respirators During COVID-19 Pandemic-Which One Should I Wear?."," Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, pp. 31090-9, 2020.

Return to footnote 315 referrer

Footnote 316

L. P. Samaranayake, K. S. Fakhruddin, H. C. Ngo, J. W. W. Chang, P and C. uwawala, "The effectiveness and efficacy of respiratory protective equipment (RPE) in dentistry and other health care settings: a systematic review.," Acta Odontologica Scandinavica, vol. 0, no. 0, pp. 1-14, 2020.

Return to footnote 316 referrer

Footnote 317

N. A. D. & R. J. Shaukat, "Physical and mental health impacts of COVID-19 on healthcare workers: a scoping review.," Int J Emerg Med, vol. 13, p. 40, 2020.

Return to footnote 317 referrer

Footnote 318

S. Hegde, Which type of personal protective equipment (PPE) and which method of donning or doffing PPE carries the least risk of infection for healthcare workers?, Evid Based Dent 21(2) (2020) 74-76.

Return to footnote 318 referrer

Footnote 319

P. Bradford Smith, G. Agostini, J.C. Mitchell, A scoping review of surgical masks and N95 filtering facepiece respirators: Learning from the past to guide the future of dentistry, Saf Sci 131 (2020) 104920.

Return to footnote 319 referrer

Footnote 320

J.V. Gross, J. Mohren, T.C. Erren, COVID-19 and healthcare workers: a rapid systematic review into risks and preventive measures, BMJ Open 11(1) (2021) e042270.

Return to footnote 320 referrer

Footnote 321

D.P. Griswold, A. Gempeler, A.G. Kolias, P.J. Hutchinson, A.M. Rubiano, Personal protective equipment for reducing the risk of COVID-19 infection among healthcare workers involved in emergency trauma surgery during the pandemic: an umbrella review protocol, BMJ Open 11(3) (2021) e045598.

Return to footnote 321 referrer

Footnote 322

D.K. Chu, E.A. Akl, S. Duda, K. Solo, S. Yaacoub, H.J. Schunemann, C.-S.U.R.G.E.s. authors, Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis, Lancet 395(10242) (2020) 1973-1987.

Return to footnote 322 referrer

Footnote 323

K. Barycka, L. Szarpak, K.J. Filipiak, M. Jaguszewski, J. Smereka, J.R. Ladny, O. Turan, Comparative effectiveness of N95 respirators and surgical/face masks in preventing airborne infections in the era of SARS-CoV2 pandemic: A meta-analysis of randomized trials, PLoS One 15(12) (2020) e0242901.

Return to footnote 323 referrer

Footnote 324

D. Coclite, A. Napoletano, S. Gianola, A. Del Monaco, D. D'Angelo, A. Fauci, L. Iacorossi, R. Latina, G. Torre, C.M. Mastroianni, C. Renzi, G. Castellini, P. Iannone, Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review, Front Med (Lausanne) 7 (2020) 594269.

Return to footnote 324 referrer

Footnote 325

J. Brainard, N.R. Jones, I.R. Lake, L. Hooper, P.R. Hunter, Community use of face masks and similar barriers to prevent respiratory illness such as COVID-19: a rapid scoping review, Euro Surveill 25(49) (2020).

Return to footnote 325 referrer

Footnote 326

S. Gertsman, A. Agarwal, K. O'Hearn, R. Webster, A. Tsampalieros, N. Barrowman, M. Sampson, L. Sikora, E. Staykov, R. Ng, J. Gibson, T. Dinh, K. Agyei, G. Chamberlain and J. D. McNally, "Microwave- and heat-based decontamination of N95 filtering facepiece respirators: a systematic review," Journal of Hospital Infection., vol. 0, no. 0, 2020.

Return to footnote 326 referrer

Footnote 327

T. D. C. P. P. N. F.-M. C. M. R. N. A. Santos M, " Are cloth masks a substitute to medical masks in reducing transmission and contamination? A systematic review.," Braz Oral Res, vol. 30, no. 34, p. e123, 2020.

Return to footnote 327 referrer

Footnote 328

D. M. K. A. Fakheran O, "Saliva as a diagnostic specimen for detection of SARS-CoV-2 in suspected patients: a scoping review," Infect Dis Poverty, vol. 9, no. 1, p. 100, 2020.

Return to footnote 328 referrer

Footnote 329

D. D. W. G. e. a. Jackson T, "Classification of aerosol-generating procedures: a rapid systematic review," BMJ Open Respiratory Research, vol. 7, p. e000730, 2020.

Return to footnote 329 referrer

Footnote 330

A.S. van Doorn, B. Meijer, C.M.A. Frampton, M.L. Barclay, N.K.H. de Boer, Systematic review with meta-analysis: SARS-CoV-2 stool testing and the potential for faecal-oral transmission, Aliment Pharmacol Ther 52(8) (2020) 1276-1288.

Return to footnote 330 referrer

Footnote 331

N.R. Rahimi, R. Fouladi-Fard, R. Aali, A. Shahryari, M. Rezaali, Y. Ghafouri, M.R. Ghalhari, M. Asadi-Ghalhari, B. Farzinnia, O. Conti Gea, M. Fiore, Bidirectional association between COVID-19 and the environment: A systematic review, Environ Res 194 (2021) 110692.

Return to footnote 331 referrer

Footnote 332

W. Gwenzi, Leaving no stone unturned in light of the COVID-19 faecal-oral hypothesis? A water, sanitation and hygiene (WASH) perspective targeting low-income countries, Sci Total Environ 753 (2021) 141751.

Return to footnote 332 referrer

Footnote 333

N. Innes, I.G. Johnson, W. Al-Yaseen, R. Harris, R. Jones, S. Kc, S. McGregor, M. Robertson, W.G. Wade, J.E. Gallagher, A systematic review of droplet and aerosol generation in dentistry, J Dent 105 (2021) 103556.

Return to footnote 333 referrer

Footnote 334

E.B. McCarty, L. Soldatova, J.A. Brant, J.G. Newman, Innovations in otorhinolaryngology in the age of COVID-19: a systematic literature review, World J Otorhinolaryngol Head Neck Surg (2021).

Return to footnote 334 referrer

Footnote 335

J.E. Gallagher, C.S. K, I.G. Johnson, W. Al-Yaseen, R. Jones, S. McGregor, M. Robertson, R. Harris, N. Innes, W.G. Wade, A systematic review of contamination (aerosol, splatter and droplet generation) associated with oral surgery and its relevance to COVID-19, BDJ Open 6 (2020) 25.

Return to footnote 335 referrer

Footnote 336

E. P. P. M. N. M. S. G. V. J. Kumbargere Nagraj S, "Interventions to reduce contaminated aerosols produced during dental procedures for preventing infectious diseases," Cochrane Database of Systematic Reviews, no. 10, 2020.

Return to footnote 336 referrer

Footnote 337

C. J. G. B. G. A.-M. M. A. S. A. W. K. W. H. Burton MJ, "Use of antimicrobial mouthwashes (gargling) and nasal sprays by healthcare workers to protect them when treating patients with suspected or confirmed COVID‐19 infection," Cochrane Database of Systematic Reviews, no. 9, 2020.

Return to footnote 337 referrer

Footnote 338

K. L. Ortega, B. O. Rech, G. L. C. El Haje, C. B. Gallo, M. Perez-Sayans and P. H. Braz-Silva, "Do hydrogen peroxide mouthwashes have a virucidal effect? A systematic review.," The Journal of hospital infection, vol. 12, no. 0, 2020.

Return to footnote 338 referrer

Footnote 339

S. Singh, N. Sharma, U. Singh, T. Singh, D. Mangal and V. Singh, "Nasopharyngeal wash in preventing and treating upper respiratory tract infections: Could it prevent COVID-19?," Lung India, vol. 37, no. 3, pp. 246-251, 2020.

Return to footnote 339 referrer

Footnote 340

M. S. Moosavi, P. Aminishakib and M. Ansari, "Antiviral mouthwashes: possible benefit for COVID-19 with evidence-based approach," Journal of Oral Microbiology, vol. 12, no. 1, 2020.

Return to footnote 340 referrer

Footnote 341

L.P. Samaranayake, K.S. Fakhruddin, B. Buranawat, C. Panduwawala, The efficacy of bio-aerosol reducing procedures used in dentistry: a systematic review, Acta Odontol Scand 79(1) (2021) 69-80.

Return to footnote 341 referrer

Footnote 342

A. Butera, C. Maiorani, V. Natoli, A. Bruni, C. Coscione, G. Magliano, G. Giacobbo, A. Morelli, S. Moressa, A. Scribante, Bio-Inspired Systems in Nonsurgical Periodontal Therapy to Reduce Contaminated Aerosol during COVID-19: A Comprehensive and Bibliometric Review, J Clin Med 9(12) (2020).

Return to footnote 342 referrer

Footnote 343

M.J. Burton, J.E. Clarkson, B. Goulao, A.M. Glenny, A.J. McBain, A.G. Schilder, K.E. Webster, H.V. Worthington, Antimicrobial mouthwashes (gargling) and nasal sprays administered to patients with suspected or confirmed COVID-19 infection to improve patient outcomes and to protect healthcare workers treating them, Cochrane Database Syst Rev 9 (2020) CD013627.

Return to footnote 343 referrer

Footnote 344

N.A. Mohamed, N. Baharom, W.S.W. Sulaiman, Z.Z. Rashid, W.K. Ken, U.K. Ali, S.N. Othman, M.N. Samat, N. Kori, P. Periyasamy, N.A. Zakaria, A.N.K. Sugurmar, N.E.M. Kazmin, C.X. Khee, S.M. Saniman, I. Isahak, Early Viral Clearance among COVID-19 Patients When Gargling with Povidone-Iodine and Essential Oils: A Clinical Trial, International Medical Journal 27(6) (2020) 651-654.

Return to footnote 344 referrer

Footnote 345

B.L. Cavalcante-Leao, C.M. de Araujo, I.B. Basso, A.G. Schroder, O. Guariza-Filho, G.C. Ravazzi, F.M. Goncalves, B.S. Zeigelboim, R.S. Santos, J. Stechman-Neto, Is there scientific evidence of the mouthwashes effectiveness in reducing viral load in Covid-19? A systematic review, J Clin Exp Dent 13(2) (2021) e179-e189.

Return to footnote 345 referrer

Footnote 346

H. Taninokuchi, H. Nakata, Y. Takahashi, K. Inoue, S. Kasugai, S. Kuroda, Evaluation of a Cetylpyridinium Chloride-, Dipotassium Glycyrrhizinate-, and Tranexamic Acid-based Mouthwash after Implant Placement: A Double-blind Randomised Clinical Trial, Oral Health Prev Dent 19(1) (2021) 157-167.

Return to footnote 346 referrer

Footnote 347

A. Burela, A. Hernandez-Vasquez, D. Comande, V. Peralta, F. Fiestas, Chlorine dioxide and chlorine derivatives for the prevention or treatment of COVID-19: a systematic review, Rev Peru Med Exp Salud Publica 37(4) (2020) 605-610.

Return to footnote 347 referrer

Footnote 348

M. Tysiac-Mista, A. Dubiel, K. Brzoza, M. Burek, K. Palkiewicz, Air disinfection procedures in the dental office during the COVID-19 pandemic, Med Pr 72(1) (2021) 39-48.

Return to footnote 348 referrer

Footnote 349

L. Barbato, F. Bernardelli, G. Braga, M. Clementini, C. Di Gioia, C. Littarru, F. Oreglia, M. Raspini, E. Brambilla, I. Iavicoli, V. Pinchi, L, L. i, N. M. Sforza, R. Cavalcanti, A. Crea and F. Cairo, "Surface disinfection and protective masks for SARS-CoV-2 and other respiratory viruses: A review by SIdP COVID-19 task force.," Oral Diseases, vol. 0, no. 0, 2020.

Return to footnote 349 referrer

Footnote 350

A. Di Fiore, C. Monaco, S. Granata, E. Stellini, Disinfection protocols during COVID-19 pandemic and their effects on prosthetic surfaces: a systematic review, Int J Prosthodont (2021).

Return to footnote 350 referrer

Footnote 351

P.M.S. Shimabukuro, M.L. Duarte, A.M. Imoto, A.N. Atallah, E.S.B. Franco, M.S. Peccin, M. Taminato, Environmental cleaning to prevent COVID-19 infection. A rapid systematic review, Sao Paulo Med J 138(6) (2020) 505-514.

Return to footnote 351 referrer

Footnote 352

C.C.R. Ramos, J.L.A. Roque, D.B. Sarmiento, L.E.G. Suarez, J.T.P. Sunio, K.I.B. Tabungar, G.S.C. Tengco, P.C. Rio, A.L. Hilario, Use of ultraviolet-C in environmental sterilization in hospitals: A systematic review on efficacy and safety, Int J Health Sci (Qassim) 14(6) (2020) 52-65.

Return to footnote 352 referrer

Report a problem or mistake on this page
Please select all that apply:

Thank you for your help!

You will not receive a reply. For enquiries, contact us.

Date modified: