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Mormina M. Knowledge, Expertise and Science Advice During COVID-19: In Search of Epistemic Justice for the 'Wicked' Problems of Post-Normal Times. SOCIAL EPISTEMOLOGY 2022; 36:671-685. [PMID: 36483160 PMCID: PMC9721401 DOI: 10.1080/02691728.2022.2103750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A consistent claim from governments around the world during the Coronavirus pandemic has been that they were following the science. This raises the question, central to this paper, of what and whose knowledge is or should be sought, which is being side-lined through the choice of particular framings and discourses, and with what consequences for the creation and implementation of evidence-based policy to tackle wicked problems. Through the lens of Fricker's epistemic injustice, I problematise the expertise that has guided the COVID-19 response as epistemically narrow and argue that counteracting a monolithic culture of expertise requires tackling the structural inequalities in the systems of knowledge production to diversify the social and epistemological foundations of science. Drawing on Post-normal Science (PNS) theory, I suggest that the expertise needed to respond to the challenges of a post-COVID world is one that embraces greater pluralism, avoids groupthink, challenges the accepted orthodoxy and helps us revert old models and rigid path dependencies that so often neglect the lived realities and demands of those left behind. This can only be realised by overcoming epistemic injustice and embracing epistemic democracy in the practice of evidence-based policy.
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Affiliation(s)
- Maru Mormina
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
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2
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Feng Z, Zhang Y, Pan Y, Zhang D, Zhang L, Wang Q. Mass screening is a key component to fight against SARS-CoV-2 and return to normalcy. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:197-212. [PMID: 35862506 PMCID: PMC9274759 DOI: 10.1515/mr-2021-0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 02/19/2022] [Indexed: 06/01/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had highly transmissible and pathogenic, which caused serious economic loss and hazard to public health. Different countries have developed strategies to deal with the COVID-19 pandemic that fit their epidemiological situations, capacities, and values. Mass screening combined with control measures rapidly reduced the transmission of the SARS-CoV-2 infection. The COVID-19 pandemic has dramatically highlighted the essential role of diagnostics capacity in the control of communicable diseases. Mass screening has been increasingly used to detect suspected COVID-19 cases and their close contacts, asymptomatic case, patients attending fever clinics, high-risk populations, employees, even all population to identify infectious individuals. Mass screening is a key component to fight against SARS-CoV-2 and return to normalcy. Here we describe the history of mass screening, define the scope of mass screening, describe its application scenarios, and discuss the impact and challenges of using this approach to control COVID-19. We conclude that through a comprehension screening program and strong testing capabilities, mass screening could help us return to normalcy more quickly.
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Affiliation(s)
- Zhaomin Feng
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Yi Zhang
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Yang Pan
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Daitao Zhang
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Lei Zhang
- Queensland University of Technology, Brisbane, Australia
| | - Quanyi Wang
- Beijing Center for Disease Prevention and Control, Beijing, China
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3
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Wang Y, Zheng K, Gao W, Lv J, Yu C, Wang L, Wang Z, Wang B, Liao C, Li L. Asymptomatic and pre-symptomatic infection in Coronavirus Disease 2019 pandemic. MEDICAL REVIEW (BERLIN, GERMANY) 2022; 2:66-88. [PMID: 35658110 PMCID: PMC9047649 DOI: 10.1515/mr-2021-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/11/2022] [Indexed: 12/21/2022]
Abstract
With the presence of Coronavirus Disease 2019 (COVID-19) asymptomatic infections detected, their proportion, transmission potential, and other aspects such as immunity and related emerging challenges have attracted people's attention. We have found that based on high-quality research, asymptomatic infections account for at least one-third of the total cases, whereas based on systematic review and meta-analysis, the proportion is about one-fifth. Evaluating the true transmission potential of asymptomatic cases is difficult but critical, since it may affect national policies in response to COVID-19. We have summarized the current evidence and found, compared with symptomatic cases, the transmission capacity of asymptomatic individuals is weaker, even though they have similar viral load and relatively short virus shedding duration. As the outbreak progresses, asymptomatic infections have also been found to develop long COVID-19. In addition, the role of asymptomatic infection in COVID-19 remains to be further revealed as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants continue to emerge. Nevertheless, as asymptomatic infections transmit the SARS-CoV-2 virus silently, they still pose a substantial threat to public health. Therefore, it is essential to conduct screening to obtain more knowledge about the asymptomatic infections and to detect them as soon as possible; meanwhile, management of them is also a key point in the fight against COVID-19 community transmission. The different management of asymptomatic infections in various countries are compared and the experience in China is displayed in detail.
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Affiliation(s)
- Yutong Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Ke Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wenjing Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Centre for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Centre for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Lan Wang
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zijun Wang
- Peking University Centre for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Bo Wang
- Meinian Public Health Institute, Peking University Health Science Center, Beijing, China
| | - Chunxiao Liao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Centre for Public Health and Epidemic Preparedness and Response, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Centre for Public Health and Epidemic Preparedness and Response, Beijing, China
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Affiliation(s)
- Nicholas J Matheson
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Cambridge, UK
- Cambridge University Hospitals, Cambridge, UK
| | - Ben Warne
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, Cambridge, UK
- Cambridge University Hospitals, Cambridge, UK
| | - Michael P Weekes
- Cambridge University Hospitals, Cambridge, UK
- Cambridge Institute for Medical Research, Cambridge, UK
| | - Patrick H Maxwell
- Cambridge University Hospitals, Cambridge, UK
- Cambridge Institute for Medical Research, Cambridge, UK
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Hirschfeld G, von Glischinski M, Thiele C. Optimal Cycle Thresholds for Coronavirus Disease 2019 (COVID-19) Screening-Receiver Operating Characteristic (ROC)-Based Methods Highlight Between-Study Differences. Clin Infect Dis 2021; 73:e852-e853. [PMID: 33354720 PMCID: PMC7799283 DOI: 10.1093/cid/ciaa1883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Gerrit Hirschfeld
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
| | | | - Christian Thiele
- Faculty of Business and Health, University of Applied Sciences Bielefeld, Bielefeld, Germany
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Leber W, Lammel O, Siebenhofer A, Redlberger-Fritz M, Panovska-Griffiths J, Czypionka T. Comparing the diagnostic accuracy of point-of-care lateral flow antigen testing for SARS-CoV-2 with RT-PCR in primary care (REAP-2). EClinicalMedicine 2021; 38:101011. [PMID: 34278276 PMCID: PMC8277224 DOI: 10.1016/j.eclinm.2021.101011] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Testing for COVID-19 with quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) may result in delayed detection of disease. Antigen detection via lateral flow testing (LFT) is faster and amenable to population-wide testing strategies. Our study assesses the diagnostic accuracy of LFT compared to RT-PCR on the same primarycare patients in Austria. METHODS Patients with mild to moderate flu-like symptoms attending a general practice network in an Austrian district (October 22 to November 30, 2020) received clinical assessment including LFT. All suspected COVID-19 cases obtained additional RT-PCR and were divided into two groups: Group 1 (true reactive): suspected cases with reactive LFT and positive RT-PCR; and Group 2 (false non-reactive): suspected cases with a non-reactive LFT but positive RT-PCR. FINDINGS Of the 2,562 symptomatic patients, 1,037 were suspected of COVID-19 and 826 (79.7%) patients tested RT-PCR positive. Among patients with positive RT-PCR, 788/826 tested LFT reactive (Group 1) and 38 (4.6%) non-reactive (Group 2). Overall sensitivity was 95.4% (95%CI: [94%,96.8%]), specificity 89.1% (95%CI: [86.3%, 91.9%]), positive predictive value 97.3% (95%CI:[95.9%, 98.7%]) and negative predictive value 82.5% (95%CI:[79.8%, 85.2%]). Reactive LFT and positive RT-PCR were positively correlated (r = 0.968,95CI=[0.952,0.985] and κ = 0.823 , 95%CI=[0.773,0.866]). Reactive LFT was negatively correlated with Ct-value ( r = -0.2999, p < 0.001) and pre-test symptom duration (r = -0.1299,p = 0.0043) while Ct-value was positively correlated with pre-test symptom duration (r = 0.3733),p < 0.001). INTERPRETATION We show that LFT is an accurate alternative to RT-PCR testing in primary care. We note the importance of administering LFT properly, here combined with clinical assessment in symptomatic patients. FUNDING Thomas Czypionka received funding from the European Union's Horizon 2020 Research and Innovation Programe under the grant agreement No 101016233 (PERISCOPE). No further funding was available for this study.
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Affiliation(s)
- Werner Leber
- Centre for Primary Care, Wolfson Institute of Population Health, Barts School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Corresponding author.
| | | | - Andrea Siebenhofer
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
- Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | | | - Jasmina Panovska-Griffiths
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department for Medicine, University of Oxford, Oxford, UK
- The Queen's College, University of Oxford, Oxford, UK
- Institute for Global Health, University College London, London, UK
| | - Thomas Czypionka
- Institute for Advanced Studies, Vienna, Austria
- London School of Economics and Political Science, London, UK
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Berking T, Lorenz SG, Ulrich AB, Greiner J, Kervio E, Bremer J, Wege C, Kleinow T, Richert C. The Effect of Pooling on the Detection of the Nucleocapsid Protein of SARS-CoV-2 with Rapid Antigen Tests. Diagnostics (Basel) 2021; 11:1290. [PMID: 34359374 PMCID: PMC8303537 DOI: 10.3390/diagnostics11071290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/01/2023] Open
Abstract
The COVID-19 pandemic puts significant stress on the viral testing capabilities of many countries. Rapid point-of-care (PoC) antigen tests are valuable tools but implementing frequent large scale testing is costly. We have developed an inexpensive device for pooling swabs, extracting specimens, and detecting viral antigens with a commercial lateral flow test for the nucleocapsid protein of SARS-CoV-2 as antigen. The holder of the device can be produced locally through 3D printing. The extraction and the elution can be performed with the entire set-up encapsulated in a transparent bag, minimizing the risk of infection for the operator. With 0.35 mL extraction buffer and six swabs, including a positive control swab, 43 ± 6% (n = 8) of the signal for an individual extraction of a positive control standard was obtained. Image analysis still showed a signal-to-noise ratio of approximately 2:1 at 32-fold dilution of the extract from a single positive control swab. The relative signal from the test line versus the control line was found to scale linearly upon dilution (R2 = 0.98), indicating that other pooling regimes are conceivable. A pilot project involving 14 participants and 18 pooled tests in a laboratory course at our university did not give any false positives, and an individual case study confirmed the ability to detect a SARS-CoV-2 infection with five-fold or six-fold pooling, including one swab from a PCR-confirmed COVID patient. These findings suggest that pooling can make frequent testing more affordable for schools, universities, and similar institutions, without decreasing sensitivity to an unacceptable level.
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Affiliation(s)
- Tim Berking
- Institute of Organic Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569 Stuttgart, Germany; (T.B.); (S.G.L.); (A.B.U.); (E.K.); (J.B.)
| | - Sabrina G. Lorenz
- Institute of Organic Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569 Stuttgart, Germany; (T.B.); (S.G.L.); (A.B.U.); (E.K.); (J.B.)
| | - Alexander B. Ulrich
- Institute of Organic Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569 Stuttgart, Germany; (T.B.); (S.G.L.); (A.B.U.); (E.K.); (J.B.)
| | - Joachim Greiner
- Institute of Aircraft Design, University of Stuttgart, Pfaffenwaldring 31, 70569 Stuttgart, Germany;
| | - Eric Kervio
- Institute of Organic Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569 Stuttgart, Germany; (T.B.); (S.G.L.); (A.B.U.); (E.K.); (J.B.)
| | - Jennifer Bremer
- Institute of Organic Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569 Stuttgart, Germany; (T.B.); (S.G.L.); (A.B.U.); (E.K.); (J.B.)
| | - Christina Wege
- Institute of Biomaterials and Biomolecular Systems, University of Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany; (C.W.); (T.K.)
| | - Tatjana Kleinow
- Institute of Biomaterials and Biomolecular Systems, University of Stuttgart, Pfaffenwaldring 57, 70569 Stuttgart, Germany; (C.W.); (T.K.)
| | - Clemens Richert
- Institute of Organic Chemistry, University of Stuttgart, Pfaffenwaldring 55, 70569 Stuttgart, Germany; (T.B.); (S.G.L.); (A.B.U.); (E.K.); (J.B.)
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Bentley P. Error rates in SARS-CoV-2 testing examined with Bayes' theorem. Heliyon 2021; 7:e06905. [PMID: 33937546 PMCID: PMC8080131 DOI: 10.1016/j.heliyon.2021.e06905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/26/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022] Open
Abstract
The SARS-CoV-2 pandemic has created a demand for large scale testing, as part of the effort to understand and control transmission. It is important to quantify the error rates of test equipment under field conditions, which might differ significantly from those obtained in the laboratory. A literature review on SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) is used to construct a clinical test confusion matrix. A simple correction method for bulk test results is then demonstrated with examples. The required sensitivity and specificity of a test are explored for societal needs and use cases, before a sequential analysis of common example scenarios is explored. The analysis suggests that many of the people with mild symptoms and positive test results are unlikely to be infected with SARS-CoV-2 in some regions. It is concluded that current and foreseen alternative tests can not be used to "clear" people as being non-infected. Recommendations are given that regional authorities must establish a programme to monitor operational test characteristics before launching large scale testing; and that large scale testing for tracing infection networks in some regions is not viable, but may be possible in a focused way that does not exceed the working capacity of the laboratories staffed by competent experts. RT-PCR tests can not be solely relied upon as the gold standard for SARS-CoV-2 diagnosis at scale, instead clinical assessment supported by a range of expert diagnostic tests should be used.
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Affiliation(s)
- P.M. Bentley
- European Spallation Source ESS ERIC, Box 176, SE-221 00 Lund, Sweden
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Houston H, Gupta-Wright A, Toke-Bjolgerud E, Biggin-Lamming J, John L. Diagnostic accuracy and utility of SARS-CoV-2 antigen lateral flow assays in medical admissions with possible COVID-19. J Hosp Infect 2021; 110:203-205. [PMID: 33539935 PMCID: PMC7848576 DOI: 10.1016/j.jhin.2021.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Affiliation(s)
- H Houston
- Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - A Gupta-Wright
- Institute for Global Health, University College London, London, UK; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK; Ealing Hospital, London North West University Healthcare NHS Trust, London, UK.
| | - E Toke-Bjolgerud
- Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - J Biggin-Lamming
- Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - L John
- Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
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Peto J, Hunter DJ, Riboli E. Covid-19 mass testing: throwing the baby out with the bathwater? BMJ 2020; 371:m4782. [PMID: 33303582 DOI: 10.1136/bmj.m4782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Julian Peto
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - David J Hunter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elio Riboli
- School of Public Health, Imperial College London, and Imperial College Healthcare NHS Trust, London, UK
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11
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Townsend E. COVID-19 policies in the UK and consequences for mental health. Lancet Psychiatry 2020; 7:1014-1015. [PMID: 33069273 PMCID: PMC7561293 DOI: 10.1016/s2215-0366(20)30457-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 09/28/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham NG7 2RD, UK.
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12
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Raffle AE. Screening the healthy population for covid-19 is of unknown value, but is being introduced nationwide. BMJ 2020; 371:m4438. [PMID: 33214143 DOI: 10.1136/bmj.m4438] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Harding-Edgar L, McCartney M, Pollock AM. Test and trace strategy has overlooked importance of clinical input, clinical oversight and integration. J R Soc Med 2020; 113:428-432. [PMID: 33108948 PMCID: PMC7686522 DOI: 10.1177/0141076820967906] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Allyson M Pollock
- Institute of Population Health Sciences, Newcastle University, Newcastle upon Tyne, Tyne and Wear NE2 4AX, UK
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14
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Pollock AM. An update to Independent SAGE's recommendations for student return to campus. BMJ 2020; 371:m3849. [PMID: 33020117 DOI: 10.1136/bmj.m3849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Allyson M Pollock
- Population Health Sciences Institute, Newcastle University, Centre for Life, Newcastle upon Tyne, NE1 4EP
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