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T
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COV
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19
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a
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d
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m
ic
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su
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h
a
b
a
rrier
f
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e
a
lt
h
s
y
ste
m
s
a
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n
d
th
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w
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rld
in
c
lu
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in
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I
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d
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sia
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r
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th
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o
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h
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t
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ters
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m
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o
m
m
u
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it
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b
e
h
a
v
io
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i
n
e
f
f
o
rts
to
p
re
v
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n
t
COV
ID
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19
in
f
e
c
ti
o
n
a
n
d
th
e
g
o
v
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rn
m
e
n
t'
s
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p
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to
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d
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u
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th
e
f
u
tu
re
o
f
h
e
a
lt
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w
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K
ey
w
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s
:
B
ar
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s
an
d
c
h
allen
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es
C
OVI
D
-
19
Gen
er
al
p
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ac
titi
o
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er
s
P
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ca
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T
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is
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p
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c
c
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ss
a
rticle
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d
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CC B
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SA
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se
.
C
o
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s
p
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A
uth
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:
R
iz
m
a
A
d
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S
y
a
k
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Hea
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Fac
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lt
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Sri
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U
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R
a
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P
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b
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P
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ih
KM
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3
2
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O
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0
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d
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m
ail:
r
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m
a.
s
y
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ah
@
g
m
ail
.
co
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1.
I
NT
RO
D
UCT
I
O
N
On
Ma
r
ch
1
1
,
2
0
2
0
W
o
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ld
H
ea
lth
Or
g
an
izat
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n
(
W
HO)
h
a
s
d
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at
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n
a
v
ir
u
s
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s
a
g
lo
b
al
p
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m
ic
[
1
]
.
C
o
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n
av
ir
u
s
es
(
C
o
V)
is
t
h
e
m
ai
n
ca
u
s
e
o
f
C
O
VI
D
-
19
d
is
ea
s
e
w
h
ic
h
i
s
o
n
l
y
d
is
co
v
er
ed
in
2
0
1
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in
th
e
p
r
o
v
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n
ce
o
f
W
u
h
a
n
,
C
h
in
a
[
2
]
.
T
h
e
s
tatu
s
o
f
a
g
lo
b
al
p
an
d
e
m
ic
th
at
h
as
b
ee
n
est
ab
lis
h
ed
b
y
W
HO
in
d
icate
s
t
h
at
th
e
s
p
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ea
d
o
f
C
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19
m
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f
as
tl
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at
al
m
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s
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ca
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en
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at
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t
i
s
p
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tecte
d
f
r
o
m
th
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n
a
v
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u
s
[
2
].
I
n
I
n
d
o
n
esia,
f
ir
s
tl
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,
C
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19
ca
s
es
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r
d
ed
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0
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d
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5
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1
2
,
3
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s
as o
f
O
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b
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,
2
0
2
0
[3
]
-
[
5]
C
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D
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19
p
an
d
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m
ic
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s
s
u
c
h
a
b
ar
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ier
f
o
r
h
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lth
s
y
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m
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u
n
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th
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w
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ld
i
n
cl
u
d
in
g
I
n
d
o
n
esia.
P
r
im
ar
y
ca
r
e
is
th
e
f
ir
s
t
-
lin
e
in
co
n
tr
o
llin
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t
h
e
p
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m
ic
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co
m
m
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n
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t
y
lev
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b
u
t
m
a
n
y
b
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s
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ch
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s
f
ac
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y
d
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d
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r
in
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t
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p
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o
ce
s
s
ar
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n
o
t
f
u
l
l
y
r
ec
o
g
n
iz
ed
[
6
]
.
R
ap
id
in
cr
ea
s
e
o
f
t
h
e
n
ee
d
o
f
ca
r
e
f
o
r
p
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p
le
w
it
h
C
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D
-
19
is
ex
ac
er
b
ated
b
y
f
ea
r
,
m
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s
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n
f
o
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m
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n
,
a
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d
r
es
tr
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s
o
f
p
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p
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m
o
v
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m
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n
t
an
d
s
u
p
p
lies
t
h
at
i
n
ter
f
er
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w
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th
t
h
e
d
eli
v
er
y
o
f
f
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t
-
li
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ea
lt
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ca
r
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f
o
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ev
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n
e.
I
f
a
p
an
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m
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si
tu
a
tio
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eq
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ch
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a
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p
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p
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(
Dela
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601
w
it
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eq
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ate
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eso
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in
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w
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s
p
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tr
ain
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f
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ed
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p
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s
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el
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a
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ad
eq
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ate
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p
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f
p
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s
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n
al
p
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tectiv
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eq
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ip
m
e
n
t
.
B
esid
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d
u
e
to
t
h
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co
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u
s
f
o
cu
s
atte
n
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n
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n
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,
s
ev
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al
p
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ity
p
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a
m
s
w
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b
lo
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ed
an
d
ev
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d
is
ab
led
[
7
]
.
C
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19
p
an
d
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m
ic
h
a
s
s
p
ar
k
ed
co
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ce
r
n
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o
f
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f
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tio
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p
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t
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co
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tr
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l
f
o
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th
e
p
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ac
tice
an
d
w
o
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k
b
e
h
av
io
r
o
f
h
ea
lt
h
ca
r
e
w
o
r
k
er
s
.
Fo
r
ex
a
m
p
le,
t
h
e
c
o
n
s
is
ten
t
u
s
ed
o
f
p
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s
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n
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p
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tectiv
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eq
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m
en
t
(
PP
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)
ca
n
r
ed
u
ce
th
e
r
is
k
o
f
in
f
ec
tio
n
i
n
h
ea
lth
ca
r
e
w
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r
k
e
r
s
.
Ho
w
e
v
er
,
th
e
a
v
ailab
ili
t
y
o
f
P
P
E
m
a
y
n
o
t
b
e
s
u
p
p
o
r
tiv
e
[
8
]
.
B
y
id
en
ti
f
y
i
n
g
th
e
b
ar
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ier
s
an
d
c
h
alle
n
g
es
o
cc
u
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ed
in
p
r
ev
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n
ti
n
g
an
d
co
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tr
o
llin
g
C
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19
p
an
d
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m
ic,
r
esear
ch
er
s
ai
m
t
o
d
escr
ib
e
o
f
th
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b
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s
f
a
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d
b
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i
m
p
o
r
ta
n
t
r
o
le
as
f
o
r
ef
r
o
n
t
i
n
co
n
tr
o
llin
g
an
d
p
r
ev
e
n
ti
n
g
C
OVI
D
-
19
p
an
d
e
m
ic.
T
h
er
ef
o
r
e,
it
w
ill
b
e
ea
s
ier
to
id
en
ti
f
y
s
tr
ate
g
ies
t
h
at
w
ill
s
u
p
p
o
r
t
h
ea
lth
ca
r
e
w
o
r
k
er
s
to
ca
r
r
y
o
u
t
C
O
VI
D
-
19
p
an
d
e
m
ic.
2.
RE
S
E
ARCH
M
E
T
H
O
D
I
n
th
i
s
q
u
alitati
v
e
r
esear
c
h
,
th
e
t
y
p
e
o
f
r
esear
c
h
u
s
ed
is
d
escr
ip
tiv
e
r
esear
c
h
w
it
h
a
p
h
en
o
m
e
n
o
lo
g
ica
l
ap
p
r
o
ac
h
.
T
h
is
s
tu
d
y
a
i
m
s
to
id
en
ti
f
y
b
a
r
r
ier
s
an
d
ch
allen
g
e
s
at
h
ea
lt
h
ce
n
ter
s
an
d
/
cli
n
ic
s
d
u
r
in
g
t
h
e
C
OVI
D
-
19
p
an
d
e
m
ic.
T
h
e
tes
t
o
f
t
h
i
s
i
n
q
u
ir
e
ab
o
u
t
is
p
r
ac
tici
n
g
s
p
ec
iali
s
ts
in
p
r
i
m
ar
y
s
er
v
ice
s
w
h
o
w
er
e
in
ter
v
ie
w
ed
b
y
s
t
u
d
en
ts
o
f
th
e
2
0
1
7
Sri
w
ij
a
y
a
Un
i
v
er
s
it
y
m
ed
ical
f
ac
u
l
t
y
.
T
h
e
w
itn
e
s
s
e
s
w
er
e
ch
o
s
en
b
ased
o
n
p
u
r
p
o
s
iv
e
te
s
tin
g
w
h
o
m
e
t
th
e
f
o
llo
w
in
g
cr
i
ter
ia:
i
)
Do
cto
r
s
w
h
o
w
o
r
k
ed
in
p
r
i
m
ar
y
s
er
v
ices
a
m
id
t
h
e
C
OVI
D
-
19
p
an
d
e
m
ic,
ii
)
Hea
lt
h
f
ac
i
liti
e
s
a
f
f
ec
te
d
d
u
r
in
g
t
h
e
C
OVI
D
-
19
p
an
d
em
ic.
T
h
e
o
v
er
all
n
u
m
b
er
o
f
r
esp
o
n
d
en
t
s
in
t
h
i
s
s
tu
d
y
w
er
e
4
4
d
o
cto
r
s
w
h
o
p
r
a
ctice
d
at
th
e
h
ea
lt
h
ce
n
ter
s
/c
l
in
ic.
T
h
is
r
esear
ch
is
a
q
u
alitati
v
e
r
esear
ch
w
h
ic
h
is
co
m
p
r
is
ed
o
f
s
tep
s
to
class
i
f
y
a
n
d
clar
if
y
t
h
e
d
ata
g
o
tten
f
r
o
m
i
n
-
d
ep
th
in
ter
v
ie
w
s
.
I
n
ter
v
ie
w
s
w
er
e
co
n
d
u
cted
in
Octo
b
er
2
0
2
0
th
r
o
u
g
h
lo
n
g
-
d
i
s
ta
n
ce
c
o
m
m
u
n
icatio
n
m
ed
ia,
s
p
ec
i
f
icall
y
in
Z
o
o
m
a
n
d
W
h
at
s
Ap
p
to
av
o
id
tr
an
s
m
is
s
io
n
o
f
C
OVI
D
-
19
d
u
r
in
g
p
an
d
e
m
ic.
P
r
o
ce
s
s
in
g
t
h
e
r
e
s
u
lts
o
f
i
n
-
d
ep
th
i
n
ter
v
ie
w
s
is
g
o
tte
n
f
r
o
m
t
h
e
r
es
u
lt
s
o
f
ca
teg
o
r
izatio
n
/
co
d
in
g
an
d
co
n
te
n
t
a
n
al
y
s
i
s
ca
r
r
ied
o
u
t
i
n
a
f
e
w
s
tag
e
s
,
s
p
e
ci
f
icall
y
:
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)
C
o
llecti
n
g
all
r
es
u
lts
f
r
o
m
i
n
-
d
ep
t
h
in
ter
v
ie
w
s
,
ii
)
Ma
k
i
n
g
tr
an
s
cr
ip
ts
o
f
t
h
e
i
n
ter
v
ie
w
co
m
es
a
b
o
u
t,
iii
)
R
ec
o
g
n
izi
n
g
i
n
f
o
r
m
atio
n
o
b
tain
ed
,
iv
)
Re
-
r
ea
d
i
n
g
t
h
e
tr
an
s
cr
ip
ts
in
t
er
v
ie
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an
d
m
a
k
e
k
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y
w
o
r
d
s
,
an
d
v
)
C
o
n
d
u
cti
n
g
t
h
e
in
f
o
r
m
atio
n
d
eter
m
i
n
atio
n
ag
r
ee
in
g
to
th
e
c
h
o
s
e
n
th
e
m
e
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co
m
p
iled
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r
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g
to
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teg
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ies,
s
p
ec
if
icall
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in
s
e
r
v
ice
m
a
n
a
g
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m
e
n
t,
en
v
ir
o
n
m
e
n
t a
n
d
in
d
i
v
id
u
al
s
.
3.
RE
SU
L
T
S
A
ND
D
I
SCU
SS
I
O
N
I
n
f
o
r
m
a
n
t
i
n
t
h
is
s
tu
d
y
w
as
44
in
d
iv
id
u
al
s
w
ith
a
n
a
v
e
r
ag
e
ag
e
o
f
3
0
.
9
7
y
ea
r
s
,
c
o
m
p
r
i
s
in
g
26
g
en
er
al
p
r
ac
titi
o
n
er
s
,
1
5
in
ter
n
s
h
ip
d
o
cto
r
s
,
t
w
o
h
ea
d
s
o
f
Hea
lt
h
ce
n
ter
s
a
n
d
o
n
e
n
o
n
-
p
er
m
a
n
e
n
t
d
o
cto
r
.
T
h
e
en
tire
n
u
m
b
er
o
f
r
esp
o
n
d
en
ts
w
a
s
2
7
f
e
m
al
es
an
d
m
ale
r
esp
o
n
d
en
t
s
w
e
r
e
1
7
.
B
ased
o
n
th
e
p
r
ac
tice
ar
ea
,
th
er
e
w
er
e
3
2
Hea
lth
ce
n
ter
s
d
o
cto
r
s
an
d
1
2
clin
ic
d
o
cto
r
s
as
s
h
o
w
n
in
T
ab
le
1
(
s
ee
in
ap
p
en
d
ix
)
.
T
h
e
th
r
ee
f
u
n
d
a
m
e
n
tal
s
u
b
j
ec
ts
w
er
e
f
o
u
n
d
r
elate
d
to
th
e
b
ar
r
ier
s
an
d
ch
allen
g
es
t
h
at
o
cc
u
r
r
ed
in
p
r
im
ar
y
s
er
v
ice
s
a
m
id
t
h
e
C
OVI
D
-
19
w
id
es
p
r
ea
d
,
s
p
ec
if
i
ca
ll
y
in
s
er
v
ice
m
a
n
a
g
e
m
en
t,
en
v
ir
o
n
m
e
n
t,
an
d
in
d
iv
id
u
als.
3
.
1
.
Serv
ice
m
a
na
g
e
m
ent
T
h
er
e
ar
e
th
r
ee
is
s
u
es
t
h
at
en
d
ed
u
p
b
ar
r
ier
s
an
d
ch
allen
g
e
s
in
s
er
v
ice
m
a
n
a
g
e
m
en
t.
T
o
b
eg
in
w
it
h
,
th
e
co
m
m
u
n
i
t
y
f
i
n
d
s
it
tr
o
u
b
leso
m
e
to
ca
r
r
y
o
u
t
co
n
s
u
ltati
o
n
s
d
u
e
to
r
estricte
d
ti
m
e
an
d
w
a
y
s
o
f
co
m
m
u
n
icati
n
g
r
eg
ar
d
in
g
t
h
e
cu
r
r
en
t
w
id
e
s
p
r
ea
d
s
itu
atio
n
,
w
h
ic
h
i
n
f
lu
e
n
ce
s
th
e
d
ia
g
n
o
s
i
s
.
Seco
n
d
,
t
h
er
e
i
s
a
ch
an
g
e
w
i
th
i
n
th
e
n
u
m
b
er
o
f
p
atien
t
v
i
s
it
s
th
at
h
a
s
d
i
m
i
n
i
s
h
ed
,
u
s
u
all
y
th
e
e
f
f
ec
t
o
f
t
h
e
p
an
d
em
ic
w
h
ic
h
cau
s
e
s
p
atien
t
s
to
b
e
an
x
io
u
s
t
o
lo
o
k
f
o
r
tr
ea
t
m
e
n
t
s
tr
aig
h
t
f
o
r
w
ar
d
l
y
.
T
h
ir
d
,
i
m
p
le
m
e
n
ti
n
g
w
o
r
k
p
r
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r
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m
s
is
h
a
m
p
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ed
b
ec
au
s
e
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e
w
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d
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d
s
itu
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n
,
w
h
ich
m
a
k
es
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i
m
p
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s
s
ib
le
to
g
o
d
ir
ec
tl
y
to
th
e
f
ield
as
p
r
esen
ted
in
T
ab
le
2
.
3
.
1
.
1
.
E
nv
iro
n
m
ent
T
h
er
e
ar
e
tw
o
i
s
s
u
es
t
h
at
g
o
tt
en
to
b
e
b
ar
r
ier
s
an
d
ch
alle
n
g
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b
ased
o
n
th
e
e
n
v
ir
o
n
m
en
t.
T
o
b
eg
i
n
w
it
h
,
a
m
id
th
e
p
an
d
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m
ic,
th
e
s
u
p
p
l
y
o
f
P
P
E
w
as
ex
ce
p
tio
n
all
y
li
m
ited
;
th
is
w
as
s
in
ce
t
h
e
PP
E
s
u
p
p
ly
f
r
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m
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d
id
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v
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n
y
r
esu
lt
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n
a
n
ex
p
a
n
d
in
g
r
eq
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ir
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.
Seco
n
d
,
th
e
f
ac
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a
n
d
in
f
r
astr
u
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r
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ar
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s
till
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estricte
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s
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t
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th
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ea
lt
h
p
r
o
to
co
l c
an
n
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t b
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co
m
p
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y
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m
p
le
m
e
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ted
as s
h
o
w
n
i
n
T
ab
le
3
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.,
Vo
l.
10
,
No
.
3
,
Sep
tem
b
er
2021
:
600
–
6
0
7
602
T
ab
le
2
.
I
n
ter
v
ie
w
r
es
u
lt
s
r
elat
ed
to
b
ar
r
ier
s
an
d
ch
allen
g
es b
ased
o
n
s
er
v
ice
m
an
a
g
e
m
e
nt
T
h
e
me
s
I
n
t
e
r
p
r
e
t
a
t
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o
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s
S
o
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y
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i
f
f
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c
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s i
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c
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n
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u
l
t
i
n
g
d
u
r
i
n
g
t
h
e
C
O
V
I
D
-
19
p
a
n
d
e
mi
c
P
h
y
si
c
a
l
e
x
a
mi
n
a
t
i
o
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a
n
d
h
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s
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d
i
f
f
i
c
u
l
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t
o
p
e
r
f
o
r
m
[
9
]
1.
L
i
mi
t
e
d
o
f
t
i
me
a
n
d
a
c
t
i
o
n
t
h
a
t
h
i
n
d
e
r
t
h
e
p
r
o
c
e
ss
o
f
a
n
a
mn
e
si
s
a
n
d
p
h
y
si
c
a
l
c
h
e
c
k
i
n
g
2.
P
o
o
r
i
n
t
e
r
n
e
t
a
c
c
e
ss,
so
t
h
a
t
o
n
l
i
n
e
c
o
n
su
l
t
a
t
i
o
n
i
s
h
a
m
p
e
r
e
d
3.
D
i
st
a
n
c
e
b
e
t
w
e
e
n
d
o
c
t
o
r
a
n
d
p
a
t
i
e
n
t
mak
e
i
t
d
i
f
f
i
c
u
l
t
f
o
r
d
o
c
t
o
r
s
t
o
i
n
t
e
r
p
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t
t
h
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p
a
t
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e
n
t
's c
o
m
p
l
a
i
n
t
s
M
i
s
p
e
r
c
e
p
t
i
o
n
r
e
l
a
t
e
d
t
o
c
o
mm
u
n
i
c
a
t
i
o
n
[
1
0
]
1.
L
a
n
g
u
a
g
e
u
se
d
i
n
c
o
mm
u
n
i
c
a
t
i
o
n
h
a
v
e
t
o
a
d
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p
t
t
o
t
h
e
p
a
t
i
e
n
t
's l
a
n
g
u
a
g
e
2.
R
i
g
h
t
w
o
r
d
se
l
e
c
t
i
o
n
i
n
o
r
d
e
r
t
o
ma
k
e
t
h
e
m
u
n
d
e
r
st
a
n
d
D
i
f
f
i
c
u
l
t
i
e
s a
n
d
d
o
u
b
t
s
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n
d
i
a
g
n
o
si
s
[
1
1
]
1.
A
n
a
mn
e
si
s
a
n
d
p
h
y
si
c
a
l
c
h
e
c
k
i
n
g
d
a
t
a
a
r
e
i
n
c
o
m
p
l
e
t
e
2.
L
i
mi
t
e
d
t
i
me
i
n
d
i
a
g
n
o
si
n
g
,
so
t
h
a
t
d
o
c
t
o
r
s
d
o
n
o
t
h
a
v
e
mu
c
h
t
i
me
t
o
d
i
a
g
n
o
si
ng
t
h
e
p
a
t
i
e
n
t
's
c
o
m
p
l
a
i
n
t
s
T
h
e
c
h
a
n
g
e
o
f
n
u
m
b
e
r
o
f
p
a
t
i
e
n
t
v
i
si
t
s
d
u
r
i
n
g
t
h
e
C
O
V
I
D
-
19
p
a
n
d
e
mi
c
D
e
c
r
e
a
si
n
g
n
u
m
b
e
r
o
f
p
a
t
i
e
n
t
v
i
s
i
t
s
d
u
e
t
o
t
h
e
p
a
n
d
e
mi
c
[
1
2
]
1.
P
a
t
i
e
n
t
s fe
e
l
a
f
r
a
i
d
t
o
g
o
t
o
t
h
e
h
e
a
l
t
h
c
e
n
t
e
r
s
d
i
r
e
c
t
l
y
2.
R
e
st
r
i
c
t
i
o
n
n
u
m
b
e
r
o
f
v
i
si
t
s
d
u
e
t
o
t
h
e
i
m
p
l
e
me
n
t
i
n
g
o
f
h
e
a
l
t
h
p
r
o
t
o
c
o
l
s
3.
P
a
t
i
e
n
t
s p
r
e
f
e
r
o
n
l
i
n
e
c
o
n
su
l
t
a
t
i
o
n
b
e
c
a
u
se
t
h
e
y
f
e
e
l
safe
r
r
a
t
h
e
r
t
h
a
n
c
o
m
e
d
i
r
e
c
t
l
y
t
o
t
h
e
h
e
a
l
t
h
c
e
n
t
e
r
B
a
r
r
i
e
r
s
i
n
i
mp
l
e
me
n
t
i
n
g
w
o
r
k
p
r
o
g
r
a
ms
d
u
r
i
n
g
t
h
e
C
O
V
I
D
-
19
p
a
n
d
e
mi
c
I
mp
l
e
me
n
t
a
t
i
o
n
o
f
w
o
r
k
p
r
o
g
r
a
m i
s
h
a
mp
e
r
e
d
t
h
a
t
i
t
d
o
e
s n
o
t
r
e
a
c
h
t
h
e
st
a
n
d
a
r
d
s
[
1
0
]
1.
R
e
st
r
i
c
t
i
o
n
t
o
me
e
t
p
a
t
i
e
n
t
s i
n
p
e
r
so
n
b
e
c
a
u
se
o
f
p
a
n
d
e
mi
c
2.
D
e
l
a
y
a
n
d
e
l
i
mi
n
a
t
i
o
n
o
f
so
me
w
o
r
k
p
r
o
g
r
a
ms t
h
a
t
a
r
e
c
o
n
s
i
d
e
r
e
d
t
o
b
e
a
r
i
sk
i
n
t
h
e
sp
r
e
a
d
o
f
t
h
e
c
o
r
o
n
a
v
i
r
u
s
T
ab
le
3
.
I
n
ter
v
ie
w
r
es
u
lt
s
r
elat
ed
to
en
v
ir
o
n
m
en
ta
l b
ar
r
ier
s
an
d
ch
alle
n
g
e
s
T
h
e
me
s
I
n
t
e
r
p
r
e
t
a
t
i
o
n
s
T
h
e
a
v
a
i
l
a
b
i
l
i
t
y
o
f
P
P
E
a
n
d
i
t
s
u
se
d
u
r
i
n
g
t
h
e
C
O
V
I
D
-
19
p
a
n
d
e
mi
c
P
P
E
su
p
p
l
i
e
s
a
r
e
e
x
c
e
p
t
i
o
n
a
l
l
y
c
o
n
st
r
a
i
n
e
d
a
n
d
d
o
n
't
me
e
t
st
a
n
d
a
r
d
s
[
1
3
]
1
.
T
h
e
r
e
mo
t
e
w
o
r
k
i
n
g
a
r
e
a
c
a
u
se
s
t
h
e
d
i
st
r
i
b
u
t
i
o
n
o
f
P
P
E
t
o
b
e
v
e
r
y
l
i
mi
t
e
d
2
.
D
o
c
t
o
r
s sa
v
e
o
n
t
h
e
u
se
o
f
P
P
E
a
n
d
p
a
y
t
h
e
i
r
o
w
n
c
o
st
s
t
o
me
e
t
P
P
E
sh
o
r
t
a
g
e
s
3
.
T
h
e
a
v
a
i
l
a
b
i
l
i
t
y
o
f
P
P
E
p
r
o
v
i
d
e
d
b
y
t
h
e
g
o
v
e
r
n
me
n
t
i
s
v
e
r
y
l
i
mi
t
e
d
b
u
t
i
t
s
u
se
c
o
n
t
i
n
u
e
s
t
o
i
n
c
r
e
a
se
.
T
h
e
u
se
o
f
P
P
E
t
h
a
t
i
s
i
n
e
f
f
e
c
t
i
v
e
mak
e
s d
o
c
t
o
r
s u
n
c
o
mf
o
r
t
a
b
l
e
u
si
n
g
i
t
[
1
4
]
1
.
H
e
a
l
t
h
f
a
c
i
l
i
t
i
e
s d
o
n
o
t
su
p
p
o
r
t
2
.
D
o
c
t
o
r
s h
a
v
e
t
o
r
e
mo
v
e
p
a
i
r
s o
f
P
P
E
so
t
h
a
t
t
h
e
r
i
s
k
o
f
b
e
i
n
g
e
x
p
o
se
d
t
o
c
o
r
o
n
a
i
s
v
e
r
y
l
a
r
g
e
A
v
a
i
l
a
b
i
l
i
t
y
o
f
f
a
c
i
l
i
t
i
e
s
a
n
d
i
n
f
r
a
s
t
r
u
c
t
u
r
e
f
o
r
p
r
i
mary
se
r
v
i
c
e
s
d
u
r
i
n
g
t
h
e
C
O
V
I
D
-
19
p
a
n
d
e
mi
c
L
i
mi
t
e
d
f
a
c
i
l
i
t
i
e
s a
n
d
i
n
f
r
a
s
t
r
u
c
t
u
r
e
i
n
p
r
i
m
a
r
y
se
r
v
i
c
e
s
[
1
3
]
1
.
P
e
o
p
l
e
i
n
r
e
mo
t
e
a
r
e
a
s
d
i
f
f
i
c
u
l
t
t
o
a
c
c
e
ss
t
h
e
i
n
t
e
r
n
e
t
i
n
o
r
d
e
r
t
o
c
o
n
d
u
c
t
o
n
l
i
n
e
c
o
n
su
l
t
a
t
i
o
n
s,
a
n
d
h
e
a
l
t
h
f
a
c
i
l
i
t
i
e
s
a
r
e
st
i
l
l
l
i
mi
t
e
d
a
n
d
l
e
ss c
o
mp
r
e
h
e
n
si
v
e
2
.
A
v
a
i
l
a
b
i
l
i
t
y
a
n
d
d
e
v
e
l
o
p
me
n
t
o
f
i
n
f
r
a
st
r
u
c
t
u
r
e
t
h
a
t
i
s
n
o
t
max
i
mi
z
e
d
,
so
t
h
a
t
d
o
e
s
n
o
t
y
e
t
su
p
p
o
r
t
c
o
mm
u
n
i
t
i
e
s
t
o
i
m
p
l
e
me
n
t
h
e
a
l
t
h
p
r
o
t
o
c
o
l
s c
o
r
r
e
c
t
l
y
3
.
1
.
2
.
I
nd
iv
idu
a
l/p
er
s
o
na
l
Fro
m
t
h
e
r
e
s
u
lt
s
g
o
tte
n
,
t
h
er
e
ar
e
th
r
ee
is
s
u
e
s
t
h
at
en
d
e
d
u
p
b
ar
r
ier
s
a
n
d
ch
al
len
g
es
b
ased
o
n
p
eo
p
le/
in
d
iv
id
u
al.
T
o
b
eg
in
w
it
h
,
th
e
p
s
y
c
h
o
lo
g
ical
s
tate
an
d
s
tate
o
f
m
i
n
d
o
f
th
e
p
atie
n
t
ar
e
r
elate
d
to
th
e
h
ig
h
le
v
el
o
f
a
n
x
iet
y
a
n
d
f
ea
r
o
f
th
e
p
atie
n
t a
s
a
r
es
u
lt o
f
t
h
e
p
an
d
e
m
ic
cir
cu
m
s
tan
ce
.
Seco
n
d
,
th
e
lo
w
lev
e
l o
f
ed
u
ca
tio
n
an
d
t
h
e
p
atien
t
’
s
ec
o
n
o
m
y
m
a
k
e
it
tr
o
u
b
leso
m
e
t
o
p
r
o
v
id
e
ed
u
ca
tio
n
.
Usu
all
y
d
u
e
to
th
e
p
atien
t
’
s
lo
w
k
n
o
w
led
g
e,
s
o
t
h
e
y
ar
e
ef
f
o
r
tles
s
l
y
i
m
p
ac
ted
b
y
s
c
a
m
i
n
f
o
r
m
atio
n
an
d
d
i
s
tr
u
s
t
d
o
cto
r
s
.
T
h
ir
d
,
th
e
d
o
cto
r
’
s
p
s
y
c
h
o
lo
g
ical
co
n
d
iti
o
n
g
et
s
to
b
e
ir
r
itated
.
T
h
is
i
s
b
ec
au
s
e
t
h
e
b
u
r
d
en
s
a
n
d
d
u
tie
s
co
n
f
r
o
n
ted
d
u
r
i
n
g
th
e
w
id
esp
r
ea
d
ar
e
s
o
o
v
er
w
h
el
m
i
n
g
d
o
cto
r
s
f
ee
l o
n
ed
g
e
a
n
d
s
tr
ess
ed
as
s
h
o
w
n
in
T
ab
le
4
(
s
ee
in
ap
p
en
d
ix
)
.
A
cc
o
r
d
in
g
to
W
HO,
P
r
i
m
ar
y
Hea
lt
h
C
ar
e
is
an
ess
e
n
ti
al
h
ea
lt
h
s
er
v
ice
th
at
h
eld
b
ased
o
n
tech
n
o
lo
g
y
an
d
p
r
ac
tical
p
r
o
ce
d
u
r
es,
i
n
ac
co
r
d
an
ce
w
it
h
s
cien
ti
f
ic
p
r
in
cip
les
an
d
ac
ce
p
ted
b
y
t
h
e
s
o
ciet
y
,
w
h
ic
h
ca
n
b
e
ac
h
iev
ed
b
y
i
n
d
iv
id
u
al
s
a
n
d
f
a
m
ilie
s
in
s
o
ciet
y
b
y
ac
ti
v
e
r
o
le
[
5
]
.
Prim
ar
y
h
ea
lt
h
s
er
v
ices
w
il
l
n
o
t
b
e
s
a
m
e
i
n
e
v
er
y
r
eg
io
n
.
T
h
is
is
d
u
e
to
d
if
f
er
en
ce
s
i
n
g
eo
g
r
ap
h
ic
a
n
d
d
e
m
o
g
r
ap
h
ic
co
n
d
itio
n
s
,
r
eg
io
n
al
an
d
in
d
iv
id
u
al
p
h
y
s
ical
ab
il
ities
,
p
u
b
lic
h
ea
lt
h
s
tat
u
s
a
n
d
atten
tio
n
f
r
o
m
lo
ca
l
g
o
v
er
n
m
e
n
ts
i
n
h
ea
lt
h
d
ev
elo
p
m
en
t
o
n
e
ac
h
r
eg
io
n
.
Fro
m
th
o
s
e
s
e
v
er
al
d
if
f
er
en
ce
s
,
th
o
s
e
w
ill
b
e
th
e
f
o
cu
s
o
f
r
esear
ch
er
s
to
g
i
v
e
f
u
r
t
h
er
d
is
c
u
s
s
ab
o
u
t
t
h
e
b
ar
r
ier
s
an
d
ch
al
len
g
es
t
h
at
o
cc
u
r
i
n
p
r
i
m
ar
y
s
er
v
ices
d
u
r
i
n
g
C
O
VI
D
-
19
p
an
d
e
m
ic.
R
eg
ar
d
in
g
to
t
h
e
p
r
ev
io
u
s
r
esear
ch
,
r
esear
c
h
er
s
ca
te
g
o
r
ize
d
b
ar
r
ier
s
an
d
ch
al
len
g
es
b
ased
o
n
s
er
v
ic
e
m
an
a
g
e
m
e
n
t,
en
v
ir
o
n
m
e
n
t,
an
d
in
d
iv
id
u
al
s
[
1
6
]
.
3
.
1
.
3
.
B
a
rr
iers a
nd
cha
lleng
es ba
s
ed
o
n
m
a
na
g
e
m
ent
s
er
v
ice
A
cc
o
r
d
in
g
to
M
in
i
s
tr
y
o
f
Hea
l
th
R
ep
u
b
lic
I
n
d
o
n
esia
,
m
a
n
a
g
e
m
en
t
i
s
a
s
er
ies
o
f
p
r
o
ce
s
s
e
s
co
n
s
is
tin
g
o
f
p
lan
n
i
n
g
,
o
r
g
an
iz
in
g
,
i
m
p
l
e
m
en
tin
g
a
n
d
co
n
tr
o
llin
g
(
P
lan
n
i
n
g
,
Or
g
an
iz
in
g
,
A
ct
u
ati
n
g
,
an
d
C
o
n
tr
o
lin
g
)
to
ac
h
iev
e
g
o
als/
o
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[
1
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An
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m
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20
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er
e
s
h
o
r
tag
e
o
f
th
e
p
er
s
o
n
al
p
r
o
tectiv
e
eq
u
ip
m
en
t
(
P
P
E
)
n
ee
d
ed
b
y
h
ea
l
th
w
o
r
k
er
s
i
n
o
r
d
er
to
f
ig
h
t
ag
ai
n
s
t
C
OVI
D
-
19
p
an
d
e
m
ic
[
21
]
.
T
h
er
e
ar
e
f
o
u
r
p
o
s
s
ib
le
f
ac
to
r
s
th
at
ar
e
b
ei
n
g
t
h
e
m
ai
n
ca
u
s
e
s
b
eh
i
n
d
t
h
e
li
m
i
ted
s
u
p
p
l
y
o
f
P
P
E
.
First,
th
er
e
is
a
lar
g
e
d
em
a
n
d
s
h
o
ck
tr
i
g
g
er
ed
b
y
th
e
n
ee
d
f
o
r
th
e
h
ea
lth
ca
r
e
s
y
s
te
m
an
d
p
an
ic
m
ar
k
et
b
eh
a
v
io
r
d
ep
letes
P
PE
s
u
p
p
lies
.
Seco
n
d
,
t
h
e
g
o
v
er
n
m
e
n
t
f
ai
led
to
m
a
in
ta
in
a
n
d
d
is
tr
ib
u
te
d
o
m
e
s
tic
s
u
p
p
lies
.
L
a
s
t,
m
aj
o
r
d
is
r
u
p
ti
o
n
s
to
th
e
g
lo
b
al
P
P
E
s
u
p
p
l
y
led
to
a
s
h
ar
p
d
ec
r
ea
s
e
i
n
P
P
E
s
u
p
p
lies
.
Ma
r
k
et
an
d
g
o
v
er
n
m
e
n
t
f
ail
u
r
es
m
ak
e
p
r
o
cu
r
e
m
e
n
t
o
f
P
P
E
b
y
h
o
s
p
i
tals
,
h
ea
lt
h
ca
r
e
p
r
o
v
id
er
s
,
b
u
s
in
e
s
s
e
s
,
in
d
iv
id
u
als a
n
d
g
o
v
er
n
m
en
t
s
t
o
b
e
co
m
p
etitiv
e
a
n
d
ex
p
en
s
i
v
e
in
ter
m
s
o
f
ti
m
e
an
d
m
o
n
e
y
[
22
]
.
Fro
m
p
r
ev
io
u
s
s
tu
d
ie
s
,
it
w
as
s
aid
t
h
at
t
h
e
m
ai
n
f
ac
to
r
o
f
t
h
e
ca
u
s
ed
o
f
s
tr
u
ctu
r
al
w
ea
k
n
ess
i
n
t
h
e
h
ea
lt
h
ca
r
e
s
y
s
te
m
w
as
t
h
e
w
r
o
n
g
b
u
d
g
et
m
et
h
o
d
u
s
ed
b
y
t
h
e
h
o
s
p
ital.
26
B
ased
o
n
a
s
tate
m
en
t
f
r
o
m
t
h
e
o
cc
u
p
atio
n
al
s
af
e
t
y
an
d
h
ea
lt
h
ad
m
i
n
is
tr
atio
n
(
O
SH
A
)
o
r
g
a
n
izatio
n
,
w
h
ic
h
o
b
li
g
es e
m
p
lo
y
er
s
to
p
r
o
v
id
e
P
P
E
to
h
ea
lt
h
w
o
r
k
er
s
f
r
ee
o
f
ch
ar
g
e
[2
3
]
,
[
2
4
]
.
T
h
e
id
ea
l
P
P
E
b
u
d
g
etin
g
m
et
h
o
d
w
o
u
ld
ce
r
tain
l
y
al
ig
n
t
h
e
in
ter
est
s
o
f
e
m
p
lo
y
er
s
,
h
ea
lt
h
c
ar
e
w
o
r
k
er
s
a
n
d
p
atie
n
ts
w
it
h
th
e
n
ee
d
f
o
r
ef
f
ec
ti
v
e
an
d
e
f
f
i
cien
t
ca
r
e
f
ac
i
liti
e
s
th
at
ar
e
s
a
f
e
f
o
r
all
[
25
]
,
[
2
6
].
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8806
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.,
Vo
l.
10
,
No
.
3
,
Sep
tem
b
er
2021
:
600
–
6
0
7
604
3
.
1
.
4
.
B
a
rr
ierss
a
nd
cha
lleng
es ba
s
ed
o
n in
div
idu
a
l
s
C
OVI
D
-
19
p
an
d
e
m
ic
i
s
a
g
l
o
b
al
th
r
ea
t
th
at
i
s
c
u
r
r
en
tl
y
b
ein
g
an
at
ten
t
io
n
i
n
ev
er
y
co
u
n
tr
y
.
T
h
e
g
o
v
er
n
m
e
n
t
's
s
tr
ic
t
m
o
v
e
m
e
n
t
r
estrictio
n
s
to
r
ed
u
ce
t
h
e
s
p
r
ea
d
o
f
C
O
VI
D
-
19
ar
e
li
k
el
y
h
a
v
i
n
g
a
n
eg
at
iv
e
i
m
p
ac
t
o
n
p
eo
p
le'
s
m
en
ta
l
h
ea
lth
[
1
3
]
,
[
27
]
.
B
y
t
h
i
s
r
esear
c
h
,
a
p
a
n
d
e
m
ic
s
it
u
atio
n
as
n
o
w
b
ec
o
m
es
a
b
u
r
d
en
to
s
o
ciet
th
at
g
iv
e
s
th
e
r
i
s
e
to
p
s
y
ch
o
lo
g
ical
d
is
o
r
d
er
s
in
ter
m
s
o
f
b
o
th
p
atien
t
s
an
d
h
ea
l
th
p
r
o
f
ess
io
n
al
s
.
Fro
m
th
e
p
atien
t
s
'
p
o
in
t
o
f
v
ie
w
,
th
e
y
f
ee
l
a
n
x
io
u
s
ab
o
u
t
co
m
in
g
t
o
a
h
ea
lth
ch
ec
k
d
ir
ec
tl
y
to
a
h
ea
lt
h
s
er
v
ice
s
u
c
h
as a
clin
ic
o
r
h
ea
lt
h
ce
n
ter
s
.
T
h
is
i
s
b
ec
au
s
e
o
f
t
h
e
p
er
s
p
ec
ti
v
e
o
f
t
h
e
s
o
ciet
y
w
h
o
is
a
f
r
aid
to
co
m
e
a
n
d
h
a
v
e
a
d
ir
ec
t
co
n
tact
w
it
h
h
ea
lt
h
s
er
v
ices
b
ec
au
s
e
th
e
y
f
ee
l
t
h
at
t
h
e
r
is
k
o
f
b
ein
g
ex
p
o
s
ed
b
y
C
OVI
D
-
19
is
v
er
y
lar
g
e.
I
n
ad
d
itio
n
,
th
er
e
is
a
lo
t
o
f
i
n
f
o
r
m
atio
n
t
h
at
i
s
n
o
t
k
n
o
w
n
ab
o
u
t
i
ts
tr
u
t
h
,
w
h
ic
h
ac
t
u
all
y
m
ak
e
s
p
eo
p
le
b
ein
g
m
o
r
e
d
ep
r
ess
ed
an
d
s
tr
ess
ed
[
2
8
]
.
T
h
is
is
in
f
l
u
e
n
ce
d
b
y
t
h
e
lo
w
le
v
el
o
f
p
u
b
lic
ed
u
c
atio
n
,
s
o
it
i
s
v
er
y
ea
s
y
to
b
e
in
f
l
u
en
ce
d
b
y
t
h
e
w
r
o
n
g
i
n
f
o
r
m
atio
n
.
T
h
e
g
o
o
d
k
n
o
w
led
g
e,
p
r
ec
is
e,
v
alid
ca
n
i
m
p
r
o
v
e
o
n
e
'
s
b
eh
av
io
u
r
[
2
9
]
-
[
31]
.
T
h
e
r
o
le
o
f
a
d
o
cto
r
h
er
e
is
n
ee
d
ed
s
o
m
u
ch
in
ter
m
s
o
f
ed
u
ca
ti
o
n
to
p
r
o
v
id
e
m
o
r
e
k
n
o
w
led
g
e
an
d
i
m
p
r
o
v
e
t
h
e
p
u
b
lic
m
i
n
d
s
et
ab
o
u
t
t
h
e
s
tig
m
a
o
f
co
r
o
n
a.
Ho
w
ev
er
,
i
f
it
is
s
ee
n
f
r
o
m
a
d
o
cto
r
'
s
p
o
in
t
o
f
v
ie
w
,
t
h
is
ce
r
tain
l
y
b
ec
o
m
e
s
a
b
ig
b
u
r
d
en
a
n
d
r
esp
o
n
s
ib
il
it
y
.
I
n
t
h
is
ca
s
e,
d
o
cto
r
s
h
av
e
to
b
e
m
o
r
e
ac
tiv
e
i
n
p
r
o
v
id
in
g
co
u
n
s
eli
n
g
o
r
ed
u
ca
ti
n
g
to
s
o
ciet
y
an
d
b
e
m
o
r
e
o
b
j
ec
tiv
e
s
o
as
n
o
t
to
b
e
led
b
y
o
p
in
io
n
s
f
r
o
m
t
h
e
u
n
ce
r
tai
n
i
n
f
o
r
m
atio
n
.
I
n
ad
d
itio
n
,
d
o
cto
r
s
'
r
e
s
p
o
n
s
ib
ili
ties
ar
e
also
e
x
ac
er
b
ated
b
y
i
n
cr
ea
s
i
n
g
o
f
w
o
r
k
i
n
g
h
o
u
r
s
in
s
ev
er
al
h
ea
lt
h
ce
n
ter
s
s
o
th
at
it i
s
n
o
t o
n
l
y
m
en
tal
b
u
t a
l
s
o
p
h
y
s
ical
b
u
r
d
en
.
T
h
e
r
esu
lts
o
f
t
h
e
f
i
n
d
in
g
s
i
n
th
is
r
esear
c
h
ar
e
also
in
l
in
e
w
it
h
p
r
ev
io
u
s
s
t
u
d
ies,
t
h
at
u
n
ce
r
tain
t
y
h
ea
lt
h
s
i
tu
at
io
n
a
n
d
it
s
d
ev
elo
p
m
e
n
t
an
d
co
n
s
eq
u
e
n
ce
s
ca
n
l
ea
d
to
m
e
n
tal
d
is
o
r
d
er
s
s
u
c
h
as
s
tr
es
s
,
e
x
ce
s
s
iv
e
an
x
ie
t
y
,
a
n
d
d
ep
r
ess
io
n
.
Ov
er
all,
th
ese
r
es
u
lt
s
h
i
g
h
li
g
h
t th
e
en
o
r
m
o
u
s
p
s
y
c
h
o
lo
g
ical
i
m
p
a
ct
o
f
th
e
C
OVI
D
-
19
p
an
d
e
m
ic
o
n
t
h
e
p
o
p
u
latio
n
[2
9
]
-
[
32
]
.
B
esid
es,
th
er
e
ar
e
s
o
m
e
o
p
in
io
n
s
f
r
o
m
p
r
ev
i
o
u
s
r
esear
c
h
w
h
ic
h
s
u
g
g
e
s
ts
th
a
t
f
r
o
n
tli
n
e
h
ea
lth
ca
r
e
w
o
r
k
er
s
ar
e
g
e
n
er
all
y
v
u
ln
er
ab
le
to
t
h
e
e
m
o
tio
n
al
i
m
p
ac
t
o
f
a
p
an
d
e
m
ic
s
itu
a
tio
n
.
I
n
t
h
is
s
t
u
d
y
,
f
o
u
r
m
an
if
e
s
tatio
n
s
o
f
p
s
y
ch
o
lo
g
ic
al
d
is
tr
ess
w
er
e
id
en
tifie
d
a
m
o
n
g
h
ea
lt
h
w
o
r
k
er
s
,
n
a
m
e
l
y
f
ea
r
,
a
n
x
iet
y
,
f
r
u
s
tr
ati
o
n
,
an
d
a
n
g
er
[
16
]
,
[
15
]
,
[
33
]
.
I
n
t
h
is
ca
s
e,
t
h
er
e
ar
e
m
a
n
y
f
ac
to
r
s
tr
ig
g
er
ed
,
f
o
r
ex
a
m
p
le,
f
r
u
s
tr
atio
n
i
s
ca
u
s
ed
b
y
t
h
e
i
n
cr
ea
s
i
n
g
w
o
r
k
in
g
h
o
u
r
th
at
m
ak
e
s
d
o
cto
r
s
h
av
e
t
o
w
o
r
k
lo
n
g
er
t
h
an
u
s
u
al
w
it
h
m
o
r
e
ca
s
e
s
o
f
d
is
ea
s
e
h
a
n
d
led
.
T
h
e
l
a
r
g
e
n
u
m
b
e
r
o
f
C
O
V
I
D
-
19
i
n
c
i
d
en
ts
is
a
c
c
o
m
p
an
i
e
d
b
y
e
x
t
en
s
iv
e
in
f
o
r
m
a
ti
o
n
a
b
o
u
t
th
is
d
i
s
e
as
e,
b
u
t
th
e
r
e
is
s
ti
l
l
a
l
o
t
o
f
d
is
in
f
o
r
m
a
t
i
o
n
an
d
m
i
s
in
f
o
r
m
at
i
o
n
i
n
th
e
s
o
ci
e
ty
w
h
i
ch
l
ea
d
t
o
e
x
c
ess
iv
e
p
a
n
i
c
an
d
r
e
f
u
s
a
l
t
o
f
o
l
l
o
w
g
o
v
e
r
n
m
en
t
r
e
c
o
m
m
en
d
a
t
i
o
n
s
[
29
]
.
A
s
o
n
M
a
r
ch
2
0
2
0
t
o
6
A
p
r
i
l
2
0
2
1
,
T
h
e
M
i
n
is
t
r
y
o
f
C
o
m
m
u
n
i
c
a
ti
o
n
an
d
I
n
f
o
r
m
a
ti
c
s
(
K
em
en
k
o
m
in
f
o
)
r
e
c
o
r
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e
d
1
,
5
1
3
h
o
a
x
e
s
s
p
r
e
a
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v
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c
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ia
p
l
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m
s
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el
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t
e
d
t
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d
is
in
f
o
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m
a
t
i
o
n
a
b
o
u
t
th
e
c
o
r
o
n
a
v
i
r
u
s
(
C
O
V
I
D
-
19
)
[
34
]
.
T
h
e
am
o
u
n
t
o
f
in
f
o
r
m
at
i
o
n
is
s
u
p
p
o
r
t
e
d
b
y
th
e
d
e
v
e
l
o
p
m
en
t
o
f
th
e
in
t
e
r
n
et
a
n
d
th
e
ea
s
e
o
f
a
c
c
e
s
s
t
o
in
f
o
r
m
a
t
i
o
n
a
t
th
i
s
tim
e
.
T
h
is
c
i
r
cu
la
t
in
g
m
is
in
f
o
r
m
a
ti
o
n
ca
n
af
f
e
c
t
p
e
o
p
l
e'
s
k
n
o
w
le
d
g
e
,
s
o
th
at
i
t
c
an
h
a
v
e
an
im
p
a
c
t
o
n
p
e
o
p
l
e'
s
b
eh
av
i
o
r
.
T
h
e
d
e
ci
s
i
o
n
s
a
n
d
ch
o
ic
e
s
t
ak
en
a
r
e
m
o
s
t
ly
b
a
s
e
d
o
n
in
f
o
r
m
at
i
o
n
f
r
o
m
t
h
e
in
t
e
r
n
et
,
es
p
e
c
i
al
ly
s
o
c
i
al
m
e
d
ia
[
29
]
.
T
h
e
r
e
f
o
r
e
,
t
h
e
p
r
o
v
i
s
i
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n
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p
l
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n
t
C
O
V
I
D
-
19
[
26
]
,
[
35
]
-
[
37]
.
4.
CO
NCLU
SI
O
N
T
h
e
p
r
o
b
lem
s
th
a
t
ar
e
b
ar
r
ier
s
an
d
ch
alle
n
g
es
f
ac
ed
b
y
p
r
i
m
ar
y
ca
r
e
p
h
y
s
ician
s
d
u
r
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n
g
th
e
p
an
d
e
m
ic
s
u
c
h
as
th
er
e
w
as
a
d
ec
r
ea
s
e
in
th
e
n
u
m
b
er
o
f
p
atien
t
v
i
s
it
s
,
in
ad
eq
u
ate
h
ea
l
th
f
ac
ilit
ie
s
,
an
d
th
e
p
s
y
ch
o
lo
g
ical
co
n
d
itio
n
o
f
b
o
th
d
o
cto
r
s
an
d
p
atien
ts
b
ec
o
m
es
d
is
tu
r
b
ed
.
It
is
n
ec
es
s
ar
y
t
o
p
r
o
v
id
e
s
p
ec
if
ic,
v
alid
,
an
d
r
i
g
h
t
-
on
-
tar
g
et
k
n
o
w
led
g
e
in
i
m
p
r
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v
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g
co
m
m
u
n
i
t
y
b
eh
a
v
io
r
in
ef
f
o
r
ts
to
p
r
ev
en
t
C
OVI
D
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19
in
f
ec
tio
n
.
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n
ad
d
itio
n
,
t
h
e
i
m
p
o
r
tan
t
r
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le
o
f
th
e
g
o
v
er
n
m
e
n
t
to
b
e
m
o
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e
co
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ce
r
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o
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t
t
h
e
f
u
t
u
r
e
o
f
h
ea
lth
w
o
r
k
er
s
i
s
n
ee
d
ed
.
RE
F
E
R
E
NC
E
S
[1
]
Cu
c
in
o
t
ta
D.,
V
a
n
e
ll
i
M
.
W
HO
d
e
c
lare
s
COV
ID
-
19
a
p
a
n
d
e
m
ic.
Acta
Bi
o
M
e
d
ica
:
At
e
n
e
i
Pa
rm
e
n
sis
,
2
0
2
0
,
9
1
.
1
:
1
5
7
.
[2
]
L
i
H
.
,
L
iu
S
M
.
,
Yu
XH
.
,
T
a
n
g
S
L
,
a
n
d
T
a
n
g
CK.
,
“
Co
r
o
n
a
v
iru
s
d
ise
a
se
2
0
1
9
(
CO
V
ID
-
19
):
c
u
r
re
n
t
sta
tu
s
a
n
d
f
u
tu
re
p
e
rsp
e
c
ti
v
e
s,”
In
ter
n
a
ti
o
n
a
l
J
o
u
rn
a
l
o
f
A
n
ti
mic
ro
b
ia
l
Ag
e
n
ts
,
v
o
l.
5
5
,
n
o
.
5
,
p
.
1
0
5
9
5
1
,
2
0
2
0
.
[3
]
L
o
tf
i
M
.
,
Ha
m
b
li
n
M
R.
,
a
n
d
Re
z
a
e
i
N,
“
COV
ID
-
19
:
T
ra
n
sm
is
sio
n
,
p
re
v
e
n
ti
o
n
,
a
n
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p
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ten
ti
a
l
th
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p
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o
p
p
o
rt
u
n
it
ies
,
”
Cli
n
C
h
im
Act
a
,
v
o
l.
5
0
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,
p
p
.
2
5
4
-
6
6
,
2
0
2
0
,
d
o
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1
0
1
6
/
j.
c
c
a
.
2
0
2
0
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0
5
.
0
4
.
[4
]
T
h
e
T
a
s
k
F
o
rc
e
f
o
r
th
e
Ac
c
e
le
ra
ti
o
n
o
f
Ha
n
d
li
n
g
COV
ID
-
19
.
De
v
e
lo
p
m
e
n
t
o
f
P
o
siti
v
e
Co
n
f
irme
d
Ca
se
s
o
f
COV
ID
-
19
P
er
-
Da
y
,
2
0
2
0
.
[
On
li
n
e
]
.
A
v
a
il
a
b
le:
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tt
p
s://
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o
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1
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id
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p
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ta
-
se
b
a
ra
n
[
5
]
P
e
tt
ig
re
w
L
.
M
.
,
De
M
a
e
se
n
e
e
r
J.,
A
n
d
e
rso
n
M
.
I.
P
.
,
Essu
m
a
n
A
.
,
Kid
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M
.
R.
,
a
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d
Ha
in
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s
A
.
,
“
P
rim
a
r
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h
e
a
lt
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c
a
re
a
n
d
th
e
S
u
sta
in
a
b
le De
v
e
lo
p
m
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n
t
G
o
a
ls,
”
T
h
e
L
a
n
c
e
t
,
v
o
l.
3
8
6
,
2
1
1
9
-
2
1
2
1
,
2
0
1
5
.
[6
]
Zh
ij
ie
X
.
,
Yu
a
n
q
u
Y.,
Ya
n
g
W
.
,
Yi
Q
.
,
Jia
n
ji
a
n
g
P
.
,
Yiti
n
g
L
.
,
a
n
d
L
izh
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g
F
,
“
P
rim
a
r
y
Ca
re
P
ra
c
ti
ti
o
n
e
rs’
Ba
rriers
s
to
a
n
d
Ex
p
e
rien
c
e
o
f
COV
ID
-
19
Ep
i
d
e
m
ic
Co
n
tro
l
i
n
C
h
in
a
:
a
Qu
a
li
tativ
e
S
t
u
d
y
,
”
J
o
u
rn
a
l
o
f
Ge
n
e
ra
l
In
ter
n
a
l
M
e
d
icin
e
,
v
o
l.
35
,
n
o
.
1
1
,
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p
.
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0
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7
/s1
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6
0
6
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0
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-
3
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t.
J
.
P
u
b
lic
Hea
lth
Sci.
I
SS
N:
2
252
-
8806
B
a
r
r
iers
a
n
d
ch
a
llen
g
es fo
r
p
r
ima
r
y
ca
r
e
s
ervice
in
th
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C
OV
I
D
-
1
9
p
a
n
d
emic
(
Dela
E
r
ja
lia
)
605
[7
]
Co
ro
n
a
v
iru
s
d
ise
a
se
(
COV
ID
-
19
):
re
so
u
rc
e
s
f
o
r
p
ra
c
ti
ti
o
n
e
rs,
“
He
lp
f
u
l
g
u
id
a
n
c
e
f
o
r
f
ro
n
t
-
li
n
e
w
o
rk
e
rs
re
sp
o
n
d
in
g
to
th
e
COV
ID
-
19
p
a
n
d
e
m
ic,”
Ne
w
Yo
rk
:
Un
it
e
d
Na
ti
o
n
s
Ch
il
d
re
n
’s
F
u
n
d
;
2
0
2
0
.
[
On
l
in
e
].
A
v
a
il
a
b
le:
h
tt
p
s:/
/www
.
u
n
ice
f
.
o
rg
/co
ro
n
a
v
iru
s/
COV
ID
-
19
-
re
so
u
rc
e
s
-
p
ra
c
ti
ti
o
n
e
rs
[8
]
V
e
rb
e
e
k
JH
e
t
a
l.
,
“
P
e
rso
n
a
l
p
r
o
tec
ti
v
e
e
q
u
ip
m
e
n
t
f
o
r
p
re
v
e
n
ti
n
g
h
ig
h
ly
in
f
e
c
ti
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u
s
d
ise
a
se
s
d
u
e
to
e
x
p
o
su
re
t
o
c
o
n
tam
in
a
ted
b
o
d
y
f
lu
id
s
i
n
h
e
a
lt
h
c
a
re
sta
f
,
”
Co
c
h
ra
n
e
Da
ta
b
a
se
o
f
S
y
ste
ma
ti
c
Rev
iews
,
n
o
.
4
,
2
0
2
0
,
d
o
i:
1
0
.
1
0
0
2
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1
4
6
5
1
8
5
8
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1
1
6
2
1
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p
u
b
4
.
[9
]
Je
n
if
e
r
C
a
n
d
Ya
n
a
V
,
“
Co
n
tri
b
u
ti
n
g
f
a
c
to
rs
to
p
e
rso
n
a
l
p
r
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tec
ti
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e
e
q
u
ip
m
e
n
t
sh
o
rtag
e
s
d
u
rin
g
t
h
e
COV
ID
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19
p
a
n
d
e
m
ic,”
Pre
v
e
n
ti
v
e
M
e
d
icin
e
,
v
o
l.
1
4
1
,
n
o
.
2
0
2
0
,
2
0
2
0
,
d
o
i:
1
0
.
1
0
1
6
/j
.
y
p
m
e
d
.
2
0
2
0
.
1
0
6
2
6
3
.
[1
0
]
Zh
ij
ie
X
.
,
Yu
a
n
q
u
Y.,
Ya
n
g
W
.
,
Yi
Q
.
,
Jia
n
ji
a
n
g
P
.
,
Yiti
n
g
L
.
,
a
n
d
L
izh
e
n
g
F
,
“
P
rim
a
r
y
Ca
re
P
ra
c
ti
ti
o
n
e
rs’
Ba
rriers
s
to
a
n
d
Ex
p
e
rien
c
e
o
f
COV
ID
-
19
Ep
i
d
e
m
ic
Co
n
tro
l
i
n
C
h
in
a
:
a
Qu
a
li
tativ
e
S
t
u
d
y
,
”
J
o
u
rn
a
l
o
f
Ge
n
e
ra
l
In
ter
n
a
l
M
e
d
icin
e
,
v
o
l.
35
,
n
o
.
1
1
,
p
p
.
3
2
7
8
-
3
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8
4
,
2
0
2
0
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o
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1
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1
6
0
6
-
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6
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0
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-
3
.
[1
1
]
Ku
n
in
M
.
,
En
g
e
lh
a
rd
D.
,
P
it
e
rm
a
n
L
.
,
a
n
d
T
h
o
m
a
s
S
,
“
Re
sp
o
n
se
o
f
g
e
n
e
ra
l
p
ra
c
ti
ti
o
n
e
rs
to
in
f
e
c
ti
o
u
s
d
ise
a
se
p
u
b
li
c
h
e
a
lt
h
c
rise
s:
a
n
i
n
teg
ra
ti
v
e
s
y
ste
m
a
ti
c
re
v
ie
w
o
f
th
e
li
tera
tu
re
,
”
Disa
ste
r
M
e
d
Pu
b
li
c
He
a
lt
h
Pre
p
,
v
o
l.
7
,
n
o
.
5
,
p
p
.
5
2
2
-
5
3
3
,
2
0
1
3
,
d
o
i:
1
0
.
1
0
1
7
/
d
m
p
.
2
0
1
3
.
8
2
.
[1
2
]
Kise
l
y
S
.
,
W
a
rre
n
N.,
M
c
M
a
h
o
n
L
.
,
Da
lais
C.
,
He
n
ry
I.
,
S
isk
in
d
D,
“
Oc
c
u
rre
n
c
e
,
p
re
v
e
n
ti
o
n
,
a
n
d
m
a
n
a
g
e
m
e
n
t
o
f
th
e
p
sy
c
h
o
lo
g
ica
l
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e
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ts
o
f
e
m
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g
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v
iru
s
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t
b
re
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k
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o
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lt
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rk
e
rs:
ra
p
id
re
v
iew
a
n
d
m
e
ta
a
n
a
ly
sis,”
BM
J
,
v
o
l.
3
6
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,
p
p
.
1
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.
[1
3
]
W
a
n
g
C
e
t
a
l.
,
“
I
m
m
e
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iate
p
s
y
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h
o
lo
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l
re
sp
o
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se
s
a
n
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ss
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iate
d
f
a
c
to
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u
rin
g
th
e
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it
ial
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g
e
o
f
th
e
2
0
1
9
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o
ro
n
a
v
iru
s
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ise
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se
(
COV
ID
-
19
)
e
p
id
e
m
ic
a
m
o
n
g
th
e
g
e
n
e
ra
l
p
o
p
u
lati
o
n
in
Ch
in
a
,
”
In
ter
n
a
ti
o
n
a
l
J
o
u
r
n
a
l
o
f
En
v
iro
n
me
n
ta
l
Res
e
a
rc
h
a
n
d
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b
li
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lt
h
,
v
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l.
1
7
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n
o
.
5
,
p
p
.
1
-
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5
,
2
0
2
0
.
[1
4
]
L
i
DK
T
a
n
d
Zh
u
S
,
“
Co
n
tr
ib
u
ti
o
n
s
a
n
d
c
h
a
ll
e
n
g
e
s
o
f
g
e
n
e
ra
l
p
ra
c
ti
ti
o
n
e
rs
in
Ch
i
n
a
f
ig
h
ti
n
g
a
g
a
in
st
th
e
n
o
v
e
l
c
o
ro
n
a
v
i
ru
s crisis
,
”
F
a
m M
e
d
Co
m He
a
lt
h
,
v
o
l.
8
,
n
o
.
2
,
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p
.
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,
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0
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0
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m
c
h
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2
0
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0
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0
0
0
3
6
1
.
[1
5
]
L
a
i
J
e
t
a
l.
,
“
F
a
c
to
rs
A
ss
o
c
iat
e
d
w
it
h
M
e
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tal
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a
lt
h
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tco
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e
s
a
m
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n
g
He
a
lt
h
Ca
re
W
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rk
e
rs
Ex
p
o
se
d
to
Co
ro
n
a
v
iru
s Dise
a
se
2
0
1
9
,
”
J
AM
A
Ne
tw
Op
e
n
,
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l.
3
,
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o
.
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,
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0
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m
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n
e
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.
2
0
2
0
.
3
9
7
6
.
[1
6
]
Ho
u
g
h
to
n
C
e
t
a
l.
,
“
Ba
rriers
a
n
d
f
a
c
il
it
a
to
rs
to
h
e
a
lt
h
c
a
re
w
o
rk
e
rs’
a
d
h
e
re
n
c
e
w
it
h
in
f
e
c
ti
o
n
p
re
v
e
n
t
io
n
a
n
d
c
o
n
tr
o
l
(IP
C)
g
u
id
e
li
n
e
s
f
o
r
re
sp
irato
ry
in
f
e
c
ti
o
u
s
d
ise
a
se
s:
a
ra
p
id
q
u
a
li
t
a
ti
v
e
e
v
id
e
n
c
e
s
y
n
th
e
sis,”
Co
c
h
ra
n
e
Da
t
a
b
a
se
o
f
S
y
ste
ma
ti
c
Rev
iews
,
n
o
.
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,
2
0
2
0
,
d
o
i:
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0
.
1
0
0
2
/1
4
6
5
1
8
5
8
.
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1
3
5
8
2
.
[1
7
]
Re
g
u
latio
n
o
f
T
h
e
M
in
ister
o
f
He
a
lt
h
Re
p
u
b
li
c
In
d
o
n
e
sia
Nu
m
b
e
r
4
4
o
f
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0
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a
b
o
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t
P
u
b
li
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lt
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ter
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t
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te
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r
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.
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w
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o
f
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h
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f
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r
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m
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e
r
1
4
2
3
.
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k
a
rta.
2
0
1
6
[1
8
]
S
u
sa
n
,
E,
“
M
a
n
a
jem
e
n
su
m
b
e
r
d
a
y
a
m
a
n
u
sia
,
”
Ad
a
a
r
a
:
J
u
rn
a
l
M
a
n
a
jem
e
n
Pen
d
id
ika
n
Isl
a
m
,
v
o
l.
9
,
n
o
.
2
,
p
p
.
952
-
9
6
2
,
2
0
1
9
.
[1
9
]
Ca
h
y
a
d
i,
R.
“
In
o
v
a
si
k
u
a
li
tas
p
e
l
a
y
a
n
a
n
p
u
b
li
k
p
e
m
e
rin
tah
d
a
e
ra
h
,
”
Fi
a
t
J
u
sticia
J
u
rn
a
l
Ilm
u
Hu
k
u
m
Fa
k
u
l
ta
s
Hu
k
u
m Un
ive
rs
it
a
s L
a
mp
u
n
g
,
v
o
l
.
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,
n
o
.
3
,
p
p
.
5
6
9
-
5
8
6
.
2
0
1
6
.
[2
0
]
F
it
ria
K.
W
a
n
d
A
n
h
a
ri
A
,
“
A
n
a
l
y
sis
o
f
th
e
Ch
a
ra
c
teristics
a
n
d
P
e
rc
e
p
ti
o
n
s
o
f
S
e
rv
ice
Us
e
rs
o
n
th
e
Util
iza
ti
o
n
o
f
He
a
lt
h
c
e
n
ters
a
s
Ga
tek
e
e
p
e
rs
in
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o
Be
k
a
si
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y
He
a
lt
h
c
e
n
ters
in
2
0
1
6
,
”
J
u
rn
a
l
Ek
o
n
o
mi
Ke
se
h
a
t
a
n
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n
d
o
n
e
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0
1
6
,
v
o
l.
2
,
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o
.
1
,
p
p
.
3
9
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7
,
2
0
1
6
.
[2
1
]
Em
a
n
u
e
l
EJ
e
t
a
l.
,
“
F
a
ir
A
ll
o
c
a
ti
o
n
o
f
S
c
a
rc
e
M
e
d
ica
l
Re
so
u
rc
e
s in
th
e
T
i
m
e
o
f
COV
ID
-
19
,
”
Ne
w
En
g
l
a
n
d
J
o
u
r
n
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l
o
f
M
e
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icin
e
,
v
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l.
3
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o
.
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,
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p
.
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0
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0
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d
o
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6
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sb
2
0
0
5
1
1
4
.
[2
2
]
Je
n
if
e
r
C
a
n
d
Ya
n
a
V
,
“
Co
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tri
b
u
ti
n
g
f
a
c
to
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o
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e
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n
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l
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ti
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e
q
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ip
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e
n
t
sh
o
rtag
e
s
d
u
rin
g
t
h
e
COV
ID
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19
p
a
n
d
e
m
ic,”
Pre
v
e
n
ti
v
e
M
e
d
icin
e
,
v
o
l.
1
4
1
,
n
o
.
2
0
2
0
,
p
.
1
0
6
2
6
3
,
2
0
2
0
,
d
o
i:
h
tt
p
s:/
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rg
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.
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y
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e
d
.
2
0
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0
.
1
0
6
2
6
3
.
[2
3
]
Ba
rn
iv
R.
,
Da
n
v
e
rs
K.,
a
n
d
He
a
l
y
J.
,
“
T
h
e
i
m
p
a
c
t
o
f
m
e
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re
c
a
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ti
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a
y
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e
n
t
re
g
u
lat
io
n
o
n
h
o
sp
i
ta
l
c
a
p
it
a
l
e
x
p
e
n
d
it
u
re
s,”
J
o
u
r
n
a
l
o
f
Acc
o
u
n
ti
n
g
a
n
d
Pu
b
li
c
Po
li
c
y
,
v
o
l.
1
9
,
n
o
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1
,
p
p
.
9
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4
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,
2
0
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d
o
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0
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0
1
6
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2
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8
-
4
2
5
4
(
9
9
)
0
0
0
2
6
-
5
.
[2
4
]
OSHA
,
“
E
m
p
lo
y
e
r
P
a
y
m
e
n
t
f
o
r
P
e
rso
n
a
l
P
r
o
tec
ti
v
e
Eq
u
i
p
m
e
n
t;
F
in
a
l
Ru
le,”
Re
tri
e
v
e
d
f
ro
m
Was
h
in
g
to
n
,
DC
2
0
0
7
.
[
O
n
li
n
e
].
A
v
a
il
a
b
le:
h
tt
p
s:/
/www
.
o
sh
a
.
g
o
v
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a
w
s
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g
s/
f
e
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re
g
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2
0
0
7
-
11
-
15
-
0
[2
5
]
M
o
se
s
III,
H.,
M
a
t
h
e
so
n
D.H
.
M
.
,
Do
rse
y
E.
R.
,
G
e
o
rg
e
B.
P
.
,
S
a
d
o
f
f
D.,
a
n
d
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s
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im
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ra
S
.
,
2
0
1
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.
“
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h
e
a
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to
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o
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h
e
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lt
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a
re
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th
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it
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tate
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A
M
A,
v
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l.
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o
.
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8
,
p
p
.
1
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,
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o
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:
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tt
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s:/
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a
.
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3
.
2
8
1
4
2
5
.
[2
6
]
M
c
L
e
ll
a
n
R.
K.,
“
W
o
rk
,
h
e
a
lt
h
,
a
n
d
w
o
rk
e
r
w
e
ll
-
b
e
in
g
:
ro
les
a
n
d
o
p
p
o
rt
u
n
it
ies
f
o
r
e
m
p
lo
y
e
rs,”
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a
lt
h
Af
f.
,
v
o
l.
3
6
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o
.
2
,
p
p
.
2
0
6
-
2
1
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,
2
0
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7
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d
o
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0
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1
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7
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/
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lt
h
a
f
f
.
2
0
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6
.
1
1
5
0
.
[2
7
]
Qia
n
Z
a
n
d
X
i
n
p
i
n
g
Z,
“
In
u
e
n
c
e
o
f
w
o
rk
lo
a
d
,
m
e
n
tal
h
e
a
lt
h
a
n
d
p
ro
f
e
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io
n
a
l
q
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a
li
ty
o
f
li
fe
o
n
h
e
a
lt
h
c
a
re
w
o
rk
e
rs’
h
a
n
d
h
y
g
ien
e
b
e
h
a
v
io
r
in
m
e
d
ica
l
a
id
d
u
ri
n
g
COV
ID
1
9
p
a
n
d
e
m
ic,”
Res
e
a
rc
h
S
q
u
e
re
,
p
p
,
1
-
1
5
,
2
0
2
0
,
d
o
i
:
1
0
.
2
1
2
0
3
/rs.
3
.
rs
-
3
0
0
5
8
/v
1
.
[2
8
]
Ro
d
ríg
u
e
z
-
Re
y
R.
,
G
a
rrid
o
-
He
rn
a
n
sa
iz
H.,
a
n
d
Co
ll
a
d
o
S
.
,
“
P
sy
c
h
o
l
o
g
ica
l
I
m
p
a
c
t
a
n
d
A
s
so
c
iate
d
F
a
c
to
rs
Du
rin
g
th
e
In
it
ial
S
tag
e
o
f
th
e
Co
ro
n
a
v
iru
s
(
COV
ID
-
19
)
P
a
n
d
e
m
ic
Am
o
n
g
th
e
G
e
n
e
ra
l
P
o
p
u
lati
o
n
in
S
p
a
in
,
”
Fr
o
n
t
.
Psy
c
h
o
l
.
,
v
o
l
.
1
1
,
p
.
1
5
4
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2
0
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0
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d
o
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8
9
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p
sy
g
.
2
0
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0
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0
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5
4
0
[2
9
]
Je
sic
a
M
.
a
n
d
Rizm
a
A
.
S
,
“
Kn
o
w
led
g
e
re
late
d
to
Co
ro
n
a
v
iru
s
Dise
a
se
(
COV
ID
-
19
)
P
re
v
e
n
ti
o
n
Ef
f
o
rts
in
In
d
o
n
e
sia
,
”
HIG
EIA
,
v
o
l
.
4
,
n
o
.
3
,
p
p
.
3
3
3
-
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4
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0
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0
,
d
o
i:
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0
.
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5
2
9
4
/
h
ig
e
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4
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7
8
4
4
.
[3
0
]
F
a
d
il
a
h
M
.
,
S
u
sa
n
ty
M
.
,
S
a
m
sir,
N.
I.
,
T
risa
,
Y.,
a
n
d
S
y
a
k
u
ra
h
R.
A
,
“
T
h
e
In
f
lu
e
n
c
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[3
2
]
Bro
o
k
s
S
.
K
e
t
a
l.
,
“
T
h
e
p
s
y
c
h
o
lo
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m
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d
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it
:
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e
,
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L
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3
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Kise
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.
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rre
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c
M
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.
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n
ry
I.
,
S
isk
in
d
D
.
,
“
Oc
c
u
rre
n
c
e
,
p
re
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n
ti
o
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,
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n
d
m
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m
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t
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f
th
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p
sy
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h
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lo
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ff
e
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m
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in
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v
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[3
4
]
M
in
istry
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Co
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a
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d
In
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o
rm
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li
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.
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ter
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Ch
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.
APPENDI
X
T
ab
le
1
.
R
esp
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d
en
t c
h
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p
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P
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t
i
o
n
N1
N2
N3
N4
N5
N6
N7
N8
N9
N
1
0
N
1
1
N
1
2
N
1
3
N
1
4
N
1
5
N
1
6
N
1
7
N
1
8
N
1
9
N
2
0
N
2
1
N
2
2
N
2
3
N
2
4
N
2
5
N
2
6
N
2
7
N
2
8
N
2
9
N
3
0
N
3
1
N
3
2
N
3
3
N
3
4
N
3
5
N
3
6
N
3
7
N
3
8
N
3
9
N
4
0
N
4
1
N
4
2
N
4
3
N
4
4
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[
1
3
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1.
S
o
me
p
a
t
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e
n
t
s
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d
i
s
h
o
n
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2.
P
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1.
P
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s fe
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3.
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[
7
]
1.
I
n
t
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n
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t
t
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f
f
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c
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2.
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3.
P
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s w
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p
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4.
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T
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[
1
5
]
1.
C
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g
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d
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c
a
t
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2.
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man
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x
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w
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4.
D
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5.
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