COVID-19 Infection in Rheumatic Patients on Chronic Antimalarial Drugs: A Systematic Review and Meta-Analysis

{ 'indexed': { 'date-parts': [[2022, 11, 22]], 'date-time': '2022-11-22T10:43:18Z', 'timestamp': 1669113798024}, 'reference-count': 58, 'publisher': 'MDPI AG', 'issue': '22', 'license': [ { 'start': { 'date-parts': [[2022, 11, 21]], 'date-time': '2022-11-21T00:00:00Z', 'timestamp': 1668988800000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0/'}], 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'abstract': '<jats:p>The ongoing chronic use of hydroxychloroquine or chloroquine (HCQ/CQ) in rheumatic ' 'patients might impact their outcomes after a SARS-CoV-2 infection. Therefore, we sought to ' 'assess the mortality in rheumatic patients with chronic HCQ/CQ use who developed a COVID-19 ' 'infection through a comparison between individuals chronically using HCQ/CQ with those not ' 'taking these drugs. We performed a systematic review and meta-analysis of studies on PubMed, ' 'Embase, and Cochrane Central. We included full-length reports, prospective observational ' 'cohorts, and clinical trials of adult patients (aged ≥ 18 years) who were diagnosed with a ' 'COVID-19 infection. Case studies, case series, letters, comments, and editorials were ' 'excluded. The main outcome was all-cause mortality. This study is registered with PROSPERO ' '(CRD42022341678). We identified 541 studies, of which 20 studies were included, comprising ' '236,997 patients. All-cause mortality was significantly lower in patients with prior chronic ' 'use of HCQ/CQ compared to those with no previous usage (OR 0.76; 95% CI 0.62–0.94; p = 0.01). ' 'There was a considerably lower incidence of hospitalization among patients with chronic ' 'HCQ/CQ use compared to their counterparts without HCQ/CQ usage (OR 0.80; 95% CI 0.65–0.99; p ' '= 0.04). All-cause mortality and hospitalization were significantly lower in rheumatic ' 'patients with chronic HCQ/CQ use who developed a COVID-19 infection.</jats:p>', 'DOI': '10.3390/jcm11226865', 'type': 'journal-article', 'created': { 'date-parts': [[2022, 11, 22]], 'date-time': '2022-11-22T08:13:41Z', 'timestamp': 1669104821000}, 'page': '6865', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'COVID-19 Infection in Rheumatic Patients on Chronic Antimalarial Drugs: A Systematic Review and ' 'Meta-Analysis', 'prefix': '10.3390', 'volume': '11', 'author': [ { 'given': 'Isabela', 'family': 'Landsteiner de Sampaio Amêndola', 'sequence': 'first', 'affiliation': []}, {'given': 'Jonathan', 'family': 'Aires Pinheiro', 'sequence': 'additional', 'affiliation': []}, {'given': 'Pedro', 'family': 'Póvoa', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0002-1865-1704', 'authenticated-orcid': False, 'given': 'Vicente', 'family': 'Cés de Souza Dantas', 'sequence': 'additional', 'affiliation': []}, { 'given': 'Rodrigo Bernardo', 'family': 'Serafim', 'sequence': 'additional', 'affiliation': []}], 'member': '1968', 'published-online': {'date-parts': [[2022, 11, 21]]}, 'reference': [ { 'key': 'ref_1', 'unstructured': 'World Health Organization (WHO) (2022). COVID-19 Dashboard, World Health ' 'Organization. Available online: https://covid19.who.int/.'}, { 'key': 'ref_2', 'doi-asserted-by': 'crossref', 'first-page': '2000547', 'DOI': '10.1183/13993003.00547-2020', 'article-title': 'Comorbidity and its impact on 1590 patients with COVID-19 in China: A ' 'nationwide analysis', 'volume': '55', 'year': '2020', 'journal-title': 'Eur. Respir. J.'}, { 'key': 'ref_3', 'doi-asserted-by': 'crossref', 'first-page': '930', 'DOI': '10.1136/annrheumdis-2020-219498', 'article-title': 'Factors associated with COVID-19-related death in people with rheumatic ' 'diseases: Results from the COVID-19 Global Rheumatology Alliance ' 'physician-reported registry', 'volume': '80', 'year': '2021', 'journal-title': 'Ann. Rheum. Dis.'}, { 'key': 'ref_4', 'doi-asserted-by': 'crossref', 'first-page': '16', 'DOI': '10.1038/s41421-020-0156-0', 'article-title': 'Hydroxychloroquine, a less toxic derivative of chloroquine, is ' 'effective in inhibiting SARS-CoV-2 infection in vitro', 'volume': '6', 'year': '2020', 'journal-title': 'Cell Discov.'}, { 'key': 'ref_5', 'doi-asserted-by': 'crossref', 'first-page': '269', 'DOI': '10.1038/s41422-020-0282-0', 'article-title': 'Remdesivir and chloroquine effectively inhibit the recently emerged ' 'novel coronavirus (2019-nCoV) In Vitro', 'volume': '30', 'year': '2020', 'journal-title': 'Cell Res.'}, { 'key': 'ref_6', 'doi-asserted-by': 'crossref', 'first-page': '1667', 'DOI': '10.1093/jac/dkaa114', 'article-title': 'COVID-19: A recommendation to examine the effect of hydroxychloroquine ' 'in preventing infection and progression', 'volume': '75', 'year': '2020', 'journal-title': 'J. Antimicrob. Chemother.'}, { 'key': 'ref_7', 'doi-asserted-by': 'crossref', 'first-page': '732', 'DOI': '10.1093/cid/ciaa237', 'article-title': 'In Vitro Antiviral Activity and Projection of Optimized Dosing Design ' 'of Hydroxychloroquine for the Treatment of Severe Acute Respiratory ' 'Syndrome Coronavirus 2 (SARS-CoV-2)', 'volume': '71', 'year': '2020', 'journal-title': 'Clin. Infect. Dis.'}, { 'key': 'ref_8', 'doi-asserted-by': 'crossref', 'unstructured': 'RECOVERY Collaborative Group, Horby, P., Mafham, M., Linsell, L., Bell, ' 'J.L., Staplin, N., Emberson, J.R., Wiselka, M., Ustianowski, A., and ' 'Elmahi, E. (2020). Effect of Hydroxychloroquine in Hospitalized Patients ' 'with Covid-19. N. Engl. J. Med., 383, 2030–2040.', 'DOI': '10.1056/NEJMoa2022926'}, { 'key': 'ref_9', 'doi-asserted-by': 'crossref', 'first-page': '2165', 'DOI': '10.1001/jama.2020.22240', 'article-title': 'Effect of Hydroxychloroquine on Clinical Status at 14 Days in ' 'Hospitalized Patients With COVID-19', 'volume': '324', 'year': '2020', 'journal-title': 'JAMA'}, { 'key': 'ref_10', 'doi-asserted-by': 'crossref', 'first-page': '467', 'DOI': '10.1016/S0950-3579(05)80004-4', 'article-title': 'Antimalarials in rheumatic diseases', 'volume': '4', 'year': '1990', 'journal-title': 'Baillieres Clin. Rheumatol.'}, { 'key': 'ref_11', 'doi-asserted-by': 'crossref', 'first-page': '303', 'DOI': '10.1111/j.1365-2125.1988.tb05281.x', 'article-title': 'A dose-ranging study of the pharmacokinetics of hydroxy-chloroquine ' 'following intravenous administration to healthy volunteers', 'volume': '26', 'year': '1988', 'journal-title': 'Br. J. Clin. Pharmacol.'}, { 'key': 'ref_12', 'doi-asserted-by': 'crossref', 'first-page': '1460', 'DOI': '10.1002/art.10307', 'article-title': 'Hydroxychloroquine concentration-response relationships in patients ' 'with rheumatoid arthritis', 'volume': '46', 'year': '2002', 'journal-title': 'Arthritis Rheum.'}, { 'key': 'ref_13', 'doi-asserted-by': 'crossref', 'first-page': '5', 'DOI': '10.1016/0002-9343(83)91264-0', 'article-title': 'Pharmacologic actions of 4-aminoquinoline compounds', 'volume': '75', 'year': '1983', 'journal-title': 'Am. J. Med.'}, { 'key': 'ref_14', 'doi-asserted-by': 'crossref', 'unstructured': 'Browning, D.J. (2014). Hydroxychloroquine and Chloroquine Retinopathy, ' 'Springer.', 'DOI': '10.1007/978-1-4939-0597-3'}, { 'key': 'ref_15', 'doi-asserted-by': 'crossref', 'first-page': '1657', 'DOI': '10.1001/jama.2015.3656', 'article-title': 'Preferred Reporting Items for a Systematic Review and Meta-analysis of ' 'Individual Participant Data: The PRISMA-IPD statement', 'volume': '313', 'year': '2015', 'journal-title': 'JAMA'}, { 'key': 'ref_16', 'unstructured': 'Wells, G.A., Shea, B., O’Connell, D., Peterson, J., Welch, V., Losos, ' 'M., and Tugwell, P. (2021). The Newcastle-Ottawa Scale (NOS) for ' 'Assessing the Quality of Nonrandomised Studies in Meta-Analyses, Ottawa ' 'Hospital Research Institute. Available online: ' 'http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.'}, { 'key': 'ref_17', 'doi-asserted-by': 'crossref', 'first-page': '5', 'DOI': '10.1186/1471-2288-7-5', 'article-title': 'Inclusion of zero total event trials in meta-analyses maintains ' 'analytic consistency and incorporates all available data', 'volume': '7', 'year': '2007', 'journal-title': 'BMC Med. Res. Methodol.'}, { 'key': 'ref_18', 'doi-asserted-by': 'crossref', 'first-page': '1351', 'DOI': '10.1002/sim.1761', 'article-title': 'What to add to nothing? Use and avoidance of continuity corrections in ' 'meta-analysis of sparse data', 'volume': '23', 'year': '2004', 'journal-title': 'Stat. Med.'}, { 'key': 'ref_19', 'doi-asserted-by': 'crossref', 'first-page': '3443', 'DOI': '10.1002/sim.2380', 'article-title': 'A modified test for small-study effects in meta-analyses of controlled ' 'trials with binary endpoints', 'volume': '25', 'year': '2006', 'journal-title': 'Stat. Med.'}, { 'key': 'ref_20', 'doi-asserted-by': 'crossref', 'first-page': '557', 'DOI': '10.1136/bmj.327.7414.557', 'article-title': 'Measuring inconsistency in meta-analyses', 'volume': '327', 'year': '2003', 'journal-title': 'BMJ'}, { 'key': 'ref_21', 'unstructured': 'Higgins, J., and Thomas, J. (2022). Cochrane Handbook for Systematic ' 'Reviews of Interventions, Cochrane. Available online: ' 'https://handbook-5-1.cochrane.org/chapter_9/9_7_sensitivity_analyses.htm.'}, { 'key': 'ref_22', 'doi-asserted-by': 'crossref', 'first-page': '1097', 'DOI': '10.1007/s00296-021-04857-9', 'article-title': 'Clinical characteristics and outcome of COVID-19 in patients with ' 'rheumatic diseases', 'volume': '41', 'year': '2021', 'journal-title': 'Rheumatol. Int.'}, { 'key': 'ref_23', 'doi-asserted-by': 'crossref', 'first-page': '441', 'DOI': '10.4103/injr.injr_327_20', 'article-title': 'COVID-19 and Rheumatic Diseases in Tamil Nadu—A multicenter ' 'retrospective observational study', 'volume': '16', 'year': '2021', 'journal-title': 'Indian J. Rheumatol.'}, { 'key': 'ref_24', 'first-page': 'e14442', 'article-title': 'Clinical outcomes of Covid-19 in patients with rheumatic diseases and ' 'the effects of the pandemic on rheumatology outpatient care: A ' 'single-centre experience from Turkey', 'volume': '75', 'year': '2021', 'journal-title': 'Int. J. Clin. Pract.'}, { 'key': 'ref_25', 'doi-asserted-by': 'crossref', 'first-page': '2057', 'DOI': '10.1007/s10067-021-05675-x', 'article-title': 'The impact of SARS-CoV-2 coronavirus infection in patients with ' 'systemic lupus erythematosus from a single center in Catalonia', 'volume': '40', 'year': '2021', 'journal-title': 'Clin. Rheumatol.'}, { 'key': 'ref_26', 'doi-asserted-by': 'crossref', 'first-page': '682', 'DOI': '10.1111/imj.15202', 'article-title': 'Prevalence of COVID-19 and seroprevalence to SARS-CoV-2 in a ' 'rheumatologic patient population from a tertiary referral clinic in ' 'Israel', 'volume': '51', 'year': '2021', 'journal-title': 'Intern. Med. J.'}, { 'key': 'ref_27', 'doi-asserted-by': 'crossref', 'unstructured': 'Fernandez-Ruiz, R., Masson, M., Kim, M., Myers, B., Haberman, R., Scher, ' 'J., Castillo, R., Guttmann, A., Carlucci, P., and Deonaraine, K. (2020). ' 'COVID-19 in Patients with Systemic Lupus Erythematosus. Arthritis ' 'Rheumatol., 72, Available online: ' 'https://acrabstracts.org/abstract/covid-19-in-patients-with-systemic-lupus-erythematosus/.', 'DOI': '10.1002/art.41450'}, { 'key': 'ref_28', 'doi-asserted-by': 'crossref', 'first-page': 'e689', 'DOI': '10.1016/S2665-9913(20)30305-2', 'article-title': 'Long-term hydroxychloroquine use in patients with rheumatic conditions ' 'and development of SARS-CoV-2 infection: A retrospective cohort study', 'volume': '2', 'year': '2020', 'journal-title': 'Lancet Rheumatol.'}, { 'key': 'ref_29', 'doi-asserted-by': 'crossref', 'first-page': '1887', 'DOI': '10.1007/s40744-021-00373-1', 'article-title': 'Antirheumatic Drug Intake Influence on Occurrence of COVID-19 Infection ' 'in Ambulatory Patients with Immune-Mediated Inflammatory Diseases: A ' 'Cohort Study', 'volume': '8', 'year': '2021', 'journal-title': 'Rheumatol. Ther.'}, { 'key': 'ref_30', 'doi-asserted-by': 'crossref', 'first-page': '611', 'DOI': '10.1016/j.cmi.2020.12.003', 'article-title': 'Effect of hydroxychloroquine pre-exposure on infection with SARS-CoV-2 ' 'in rheumatic disease patients: A population-based cohort study', 'volume': '27', 'year': '2021', 'journal-title': 'Clin. Microbiol. Infect.'}, { 'key': 'ref_31', 'doi-asserted-by': 'crossref', 'first-page': '673', 'DOI': '10.3904/kjim.2020.633', 'article-title': 'Baseline use of hydroxychloroquine or immunosuppressive drugs and the ' 'risk of coronavirus disease 2019', 'volume': '37', 'year': '2022', 'journal-title': 'Korean J. Intern. Med.'}, { 'key': 'ref_32', 'doi-asserted-by': 'crossref', 'unstructured': 'Macías, J., González-Moreno, P., Sánchez-García, E., Morillo-Verdugo, ' 'R., Pérez-Venegas, J.J., Pinilla, A., Macho, M., Martínez, M., ' 'González-Serna, A., and Corma, A. (2021). Similar incidence of ' 'coronavirus disease 2019 (COVID-19) in patients with rheumatic diseases ' 'with and without hydroxychloroquine therapy. PLoS ONE, 16.', 'DOI': '10.1371/journal.pone.0249036'}, { 'key': 'ref_33', 'doi-asserted-by': 'crossref', 'first-page': '1593', 'DOI': '10.1007/s00296-020-04676-4', 'article-title': 'Coronavirus disease 2019 (COVID-19) in autoimmune and inflammatory ' 'conditions: Clinical characteristics of poor outcomes', 'volume': '40', 'year': '2020', 'journal-title': 'Rheumatol. Int.'}, { 'key': 'ref_34', 'doi-asserted-by': 'crossref', 'first-page': 'rkab014', 'DOI': '10.1093/rap/rkab014', 'article-title': 'Failure of chronic hydroxychloroquine in preventing severe ' 'complications of COVID-19 in patients with rheumatic diseases', 'volume': '5', 'year': '2021', 'journal-title': 'Rheumatol. Adv. Pract.'}, { 'key': 'ref_35', 'doi-asserted-by': 'crossref', 'first-page': '1150', 'DOI': '10.1016/j.semarthrit.2020.06.012', 'article-title': 'COVID-19 in systemic lupus erythematosus: Data from a survey on 417 ' 'patients', 'volume': '50', 'year': '2020', 'journal-title': 'Semin. Arthritis Rheum.'}, { 'key': 'ref_36', 'doi-asserted-by': 'crossref', 'first-page': 'e19', 'DOI': '10.1016/S2665-9913(20)30378-7', 'article-title': 'Effect of pre-exposure use of hydroxychloroquine on COVID-19 mortality: ' 'A population-based cohort study in patients with rheumatoid arthritis ' 'or systemic lupus erythematosus using the OpenSAFELY platform', 'volume': '3', 'year': '2021', 'journal-title': 'Lancet Rheumatol.'}, { 'key': 'ref_37', 'doi-asserted-by': 'crossref', 'first-page': '192', 'DOI': '10.1016/j.rhum.2021.09.004', 'article-title': 'Effet d’un traitement par hydroxychloroquine prescrit comme traitement ' 'de fond de rhumatismes inflammatoires chroniques ou maladies ' 'auto-immunes systémiques sur les tests diagnostiques et l’évolution de ' 'l’infection à SARS-CoV-2: Étude de 871 patients', 'volume': '89', 'year': '2022', 'journal-title': 'Rev. Rhum. Ed. Fr.'}, { 'key': 'ref_38', 'doi-asserted-by': 'crossref', 'first-page': '970', 'DOI': '10.1136/annrheumdis-2021-221636', 'article-title': 'Characteristics associated with poor COVID-19 outcomes in individuals ' 'with systemic lupus erythematosus: Data from the COVID-19 Global ' 'Rheumatology Alliance', 'volume': '81', 'year': '2022', 'journal-title': 'Ann. Rheum. Dis.'}, { 'key': 'ref_39', 'first-page': '3000605221090363', 'article-title': 'Effect of chronic hydroxychloroquine use on COVID-19 risk in patients ' 'with rheumatoid arthritis and systemic lupus erythematosus: A ' 'multicenter retrospective cohort', 'volume': '50', 'year': '2022', 'journal-title': 'J. Int. Med. Res.'}, { 'key': 'ref_40', 'doi-asserted-by': 'crossref', 'first-page': '82', 'DOI': '10.1002/mco2.56', 'article-title': 'COVID-19 infection in patients with connective tissue disease: A ' 'multicity study in Hubei province, China', 'volume': '2', 'year': '2021', 'journal-title': 'MedComm'}, { 'key': 'ref_41', 'doi-asserted-by': 'crossref', 'first-page': '4309', 'DOI': '10.1007/s10067-021-05779-4', 'article-title': 'Risk of COVID-19 infection in patients with rheumatic disease taking ' 'disease-modifying anti-rheumatic drugs', 'volume': '40', 'year': '2021', 'journal-title': 'Clin. Rheumatol.'}, { 'key': 'ref_42', 'doi-asserted-by': 'crossref', 'first-page': '106007', 'DOI': '10.1016/j.ijantimicag.2020.106007', 'article-title': 'Excessive lysosomal ion-trapping of hydroxychloroquine and azithromycin', 'volume': '55', 'year': '2020', 'journal-title': 'Int. J. Antimicrob. Agents'}, { 'key': 'ref_43', 'doi-asserted-by': 'crossref', 'unstructured': 'Chen, Z., Hu, J., Zhang, Z., Jiang, S., Han, S., Yan, D., Zhuang, R., ' 'Hu, B., and Zhang, Z. (2020). Efficacy of Hydroxychloroquine in Patients ' 'with COVID-19: Results of a Randomized Clinical Trial. MedRxiv.', 'DOI': '10.1101/2020.03.22.20040758'}, { 'key': 'ref_44', 'doi-asserted-by': 'crossref', 'first-page': '72', 'DOI': '10.5582/bst.2020.01047', 'article-title': 'Breakthrough: Chloroquine phosphate has shown apparent efficacy in ' 'treatment of COVID-19 associated pneumonia in clinical studies', 'volume': '14', 'year': '2020', 'journal-title': 'Biosci. Trends'}, { 'key': 'ref_45', 'doi-asserted-by': 'crossref', 'first-page': '2411', 'DOI': '10.1056/NEJMoa2012410', 'article-title': 'Observational Study of Hydroxychloroquine in Hospitalized Patients with ' 'Covid-19', 'volume': '382', 'year': '2020', 'journal-title': 'N. Engl. J. Med.'}, { 'key': 'ref_46', 'doi-asserted-by': 'crossref', 'first-page': '2493', 'DOI': '10.1001/jama.2020.8630', 'article-title': 'Association of Treatment with Hydroxychloroquine or Azithromycin with ' 'In-Hospital Mortality in Patients With COVID-19 in New York State', 'volume': '323', 'year': '2020', 'journal-title': 'JAMA'}, { 'key': 'ref_47', 'unstructured': 'Randomised Evaluation of COVID-19 Therapy (2020). No Clinical Benefit ' 'from Use of Hydroxychloroquine in Hospitalised Patients with COVID-19, ' 'RECOVERY. Available online: ' 'https://www.recoverytrial.net/files/hcq-recovery-statement-050620-final-002.pdf.'}, { 'key': 'ref_48', 'unstructured': 'Food and Drug Administration (2022, August 15). Hydroxychloroquine and ' 'Chloroquine Letter, Available online: ' 'https://www.fda.gov/media/138945/download.'}, { 'key': 'ref_49', 'unstructured': 'World Health Organization (2020). WHO Discontinues Hydroxychloroquine ' 'and Lopinavir/Ritonavir Treatment Arms for COVID-19, WHO. Available ' 'online: ' 'https://www.who.int/news-room/detail/04-07-2020-who-discontinues-hydroxychloroquine-and-lopinavir-ritonavir-treatment-arms-for-covid-19.'}, { 'key': 'ref_50', 'first-page': '29', 'article-title': 'Optimizing the Use of Hydroxychloroquine in the Management of COVID-19 ' 'Given Its Pharmacological Profile', 'volume': '32', 'year': '2020', 'journal-title': 'J. Pharm. Res. Int.'}, { 'key': 'ref_51', 'doi-asserted-by': 'crossref', 'first-page': '775', 'DOI': '10.1002/cpt.1909', 'article-title': 'Prioritization of Anti-SARS-Cov-2 Drug Repurposing Opportunities Based ' 'on Plasma and Target Site Concentrations Derived from their Established ' 'Human Pharmacokinetics', 'volume': '108', 'year': '2020', 'journal-title': 'Clin. Pharmacol. Ther.'}, { 'key': 'ref_52', 'first-page': '1127', 'article-title': 'The Influence of Virus Infection on the Extracellular pH of the Host ' 'Cell Detected on Cell Membrane', 'volume': '7', 'year': '2016', 'journal-title': 'Front. Microbiol.'}, { 'key': 'ref_53', 'doi-asserted-by': 'crossref', 'first-page': '705', 'DOI': '10.1517/14740338.2011.566555', 'article-title': 'Hydroxychloroquine in systemic lupus erythematosus and rheumatoid ' 'arthritis and its safety in pregnancy', 'volume': '10', 'year': '2011', 'journal-title': 'Expert Opin. Drug Saf.'}, { 'key': 'ref_54', 'doi-asserted-by': 'crossref', 'first-page': '95', 'DOI': '10.3949/ccjm.25.2.95', 'article-title': 'Further observations on the use of 4-Aminoquinoline compounds in ' 'patients with rheumatoid arthritis or related diseases', 'volume': '25', 'year': '1958', 'journal-title': 'Clevel. Clin. Q.'}, { 'key': 'ref_55', 'first-page': '182', 'article-title': 'The value of Chloroquine in rheumatoid disease: A four-year study of ' 'continuous therapy', 'volume': '77', 'year': '1957', 'journal-title': 'Can. Med. Assoc. J.'}, { 'key': 'ref_56', 'doi-asserted-by': 'crossref', 'unstructured': 'Napoli, P.E., and Nioi, M. (2020). Global Spread of Coronavirus Disease ' '2019 and Malaria: An Epidemiological Paradox in the Early Stage of a ' 'Pandemic. J. Clin. Med., 9.', 'DOI': '10.3390/jcm9041138'}, { 'key': 'ref_57', 'doi-asserted-by': 'crossref', 'unstructured': 'Osei, S.A., Biney, R.P., Anning, A.S., Nortey, L.N., and ' 'Ghartey-Kwansah, G. (2022). Low incidence of COVID-19 case severity and ' 'mortality in Africa; Could malaria co-infection provide the missing ' 'link?. BMC Infect. Dis., 22.', 'DOI': '10.1186/s12879-022-07064-4'}, { 'key': 'ref_58', 'doi-asserted-by': 'crossref', 'first-page': '5', 'DOI': '10.1016/S1473-3099(20)30763-5', 'article-title': 'COVID-19 in malaria-endemic regions: Potential consequences for malaria ' 'intervention coverage, morbidity, and mortality', 'volume': '21', 'year': '2021', 'journal-title': 'Lancet Infect. Dis.'}], 'container-title': 'Journal of Clinical Medicine', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.mdpi.com/2077-0383/11/22/6865/pdf', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 11, 22]], 'date-time': '2022-11-22T10:06:09Z', 'timestamp': 1669111569000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.mdpi.com/2077-0383/11/22/6865'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2022, 11, 21]]}, 'references-count': 58, 'journal-issue': {'issue': '22', 'published-online': {'date-parts': [[2022, 11]]}}, 'alternative-id': ['jcm11226865'], 'URL': 'http://dx.doi.org/10.3390/jcm11226865', 'relation': {}, 'ISSN': ['2077-0383'], 'subject': ['General Medicine'], 'container-title-short': 'JCM', 'published': {'date-parts': [[2022, 11, 21]]}}