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The eco
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co
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Hea
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Hea
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ca
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P
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T
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CC B
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Dep
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Facu
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2
3
[
1
]
.
Gen
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ally
,
p
a
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d
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h
it
all
h
ea
lth
attr
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tar
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p
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s
tatu
s
q
u
o
ar
e
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u
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tan
tial
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ter
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k
ed
[
2
]
.
T
h
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r
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s
o
n
in
g
f
ac
to
r
s
m
ay
b
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m
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if
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C
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to
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t,
as we
ll a
s
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m
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[
3
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
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372
I
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lo
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tim
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[
3
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am
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wh
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r
ed
h
ea
lth
s
y
s
tem
s
to
f
ail
in
co
n
tam
in
atio
n
,
an
d
s
o
m
e
co
u
n
tr
ies,
h
a
d
co
lla
p
s
ed
.
T
h
e
Sp
an
is
h
f
lu
p
an
d
e
m
ic
(
H1
N1
)
b
r
o
u
g
h
t
ab
o
u
t
a
d
ea
th
to
ll
o
f
a
r
o
u
n
d
20
-
5
0
m
illi
o
n
p
eo
p
le
a
n
d
a
r
o
u
n
d
1
6
%
lo
s
s
o
f
th
e
w
o
r
ld
g
r
o
s
s
d
o
m
esti
c
p
r
o
d
u
ct
(
GDP
)
[
4
]
.
I
m
p
o
r
tan
tly
,
th
ese
ca
u
s
alities
v
ar
ied
f
r
o
m
o
n
e
c
o
u
n
tr
y
to
a
n
o
th
er
d
ep
en
d
in
g
o
n
th
e
s
p
ec
if
ic
ca
u
s
in
g
f
ac
to
r
s
[
5
]
;
s
o
m
e
o
f
th
em
ar
e
th
e
“we
ak
h
ea
lth
s
y
s
tem
”
,
“p
o
o
r
h
y
g
ien
ic
c
o
n
d
itio
n
s
”,
an
d
“
wea
lth
q
u
an
tiles
”.
Alm
o
s
t
all
th
ese
cr
itical
r
ea
s
o
n
s
wer
e
co
m
b
in
ed
in
I
ta
ly
d
u
r
in
g
1
9
1
8
ca
u
s
in
g
th
e
h
ig
h
est
to
tal
d
ea
th
to
ll
in
th
e
wo
r
ld
b
y
3
5
%
[
6
]
.
An
o
th
er
r
ec
en
t
less
o
n
was
th
at
n
o
v
el
in
f
lu
e
n
za
b
r
o
k
e
o
u
t
i
n
Ma
r
ch
2
0
0
9
in
a
s
m
all
city
o
f
L
a
Glo
r
ia
E
ast
r
eg
io
n
o
f
Me
x
ico
;
th
e
p
an
d
em
ic
was
ca
u
s
ed
b
y
th
e
s
o
-
ca
lled
“T
r
ip
le
R
ea
s
s
o
r
tan
t”
r
esu
ltin
g
in
ar
o
u
n
d
1
8
,
5
0
0
ca
u
s
alities
wo
r
ld
wid
e
[
7
]
.
L
ik
e
th
e
Sp
an
is
h
f
lu
,
s
o
m
e
s
ch
o
lar
s
r
ef
er
to
th
e
wid
e
s
p
r
ea
d
o
f
th
e
p
a
n
d
em
ic
am
o
n
g
t
h
e
Me
x
ican
r
eg
io
n
s
d
u
e
to
th
e
cities’
d
e
n
s
ity
ca
u
s
in
g
p
r
ess
u
r
es
o
n
p
u
b
lic
h
ea
lth
as
th
ey
s
h
o
w
h
o
w
m
u
ch
th
e
in
f
ec
tio
n
m
a
p
an
d
th
e
p
o
p
u
latio
n
d
is
tr
ib
u
tio
n
wer
e
id
en
tical,
wh
ic
h
ev
e
n
tu
ally
led
to
s
o
ar
in
g
d
em
an
d
o
n
h
ea
lth
ca
r
e
s
er
v
ice
s
.
Desp
ite
m
ajo
r
d
if
f
er
en
ce
s
b
etwe
en
(
SAR
S
-
C
OV
-
2
)
an
d
th
e
Sp
an
is
h
f
lu
e
r
eg
ar
d
i
n
g
th
e
wid
e
s
p
r
ea
d
in
g
an
d
m
o
r
tality
r
ate,
2
.
4
%
f
o
r
C
OVI
D
-
19
an
d
2
.
5
%
f
o
r
th
e
Sp
an
is
h
f
lu
e
[
8
]
,
th
er
e
ar
e
m
ajo
r
d
if
f
er
en
ce
s
b
etwe
en
th
e
two
p
an
d
em
ics,
s
o
m
e
o
f
th
em
r
elate
d
to
th
is
s
tu
d
y
ar
e
th
e
ec
o
n
o
m
ic
im
p
ac
t
an
d
th
e
r
aisi
n
g
v
u
ln
e
r
ab
ilit
y
o
f
h
ea
lth
ca
r
e
s
y
s
tem
s
.
First,
th
e
Sp
an
i
s
h
f
lu
ca
u
s
ed
ar
o
u
n
d
9
$
b
illi
o
n
in
lo
s
s
es
ar
o
u
n
d
th
e
wo
r
ld
.
Alb
ite
th
is
,
th
e
r
e
al
lo
s
s
is
d
ee
m
ed
as
h
ar
d
to
ca
lib
r
ate
d
u
e
t
o
th
e
lack
o
f
d
ata
a
n
d
r
ec
o
r
d
ed
s
tatis
t
ics
d
u
r
in
g
th
is
tim
e
[
8
]
.
On
th
e
o
th
er
h
an
d
,
th
e
p
r
e
-
em
p
ti
v
e
p
r
o
ce
d
u
r
es
tak
en
b
y
d
if
f
er
en
t
g
o
v
e
r
n
m
en
ts
in
th
e
w
o
r
ld
h
av
e
led
to
a
n
im
m
ed
iate
h
alt
o
f
ec
o
n
o
m
ic
ac
tiv
ities
,
wh
ich
led
th
e
wo
r
ld
ec
o
n
o
m
y
to
b
e
d
ep
leted
b
y
5
.
7
6
$
to
6
.
1
7
$
tr
illi
o
n
d
ec
r
ea
s
es
in
th
e
wo
r
ld
GDP
[
8
]
.
Seco
n
d
,
tech
n
o
l
o
g
ical
in
n
o
v
atio
n
in
v
ac
cin
e
in
d
u
s
tr
ial
-
r
elate
d
s
ec
to
r
s
p
r
ev
ailed
n
o
wad
a
y
s
,
wh
ich
h
as
r
ap
id
ly
led
to
v
ac
cin
e
av
ailab
ilit
y
an
d
m
u
ch
q
u
ick
er
s
cr
ee
n
i
n
g
p
r
o
ce
s
s
es th
at
h
elp
in
d
ia
g
n
o
s
is
an
d
tr
ea
tm
en
t.
Av
ailab
le
wo
r
k
s
o
f
liter
atu
r
e
ab
o
u
t
th
e
im
p
ac
t
o
f
m
aj
o
r
p
an
d
em
ics
th
at
th
e
wo
r
l
d
h
as
w
itn
ess
ed
d
is
cu
s
s
ed
h
o
w
ea
c
h
p
a
n
d
em
i
c
h
as
led
to
th
e
h
ea
lth
s
y
s
tem
co
llap
s
e
r
e
g
ar
d
in
g
e
q
u
ip
m
e
n
t,
tim
elin
e,
a
n
d
t
h
e
n
u
m
b
er
o
f
d
aily
tr
ea
tm
e
n
ts
,
wh
ils
t
th
er
e
is
a
lack
o
f
liter
a
tu
r
e
d
is
cu
s
s
in
g
t
h
e
s
o
cio
-
ec
o
n
o
m
ic
cir
cu
m
s
tan
ce
s
s
u
r
r
o
u
n
d
in
g
h
ea
lth
wo
r
k
f
o
r
ce
am
id
an
in
te
n
s
e
wav
e
o
f
a
d
ea
d
ly
p
an
d
em
ic.
Acc
o
r
d
in
g
ly
,
th
is
p
ap
er
aim
s
to
d
is
cu
s
s
th
e
o
n
g
o
in
g
s
o
ci
o
-
ec
o
n
o
m
ic
cir
c
u
m
s
tan
ce
s
o
f
t
h
e
h
ea
lth
wo
r
k
f
o
r
ce
i
n
E
g
y
p
t
f
r
o
m
two
p
e
r
s
p
ec
tiv
es.
T
h
e
f
ir
s
t
p
er
s
p
ec
tiv
e
is
th
e
C
OVI
D
-
19
im
p
ac
t
o
n
t
h
o
s
e
s
p
e
cial
lab
o
r
er
s
an
d
th
eir
ca
p
ac
it
y
to
p
r
o
v
i
d
e
h
ea
lth
s
er
v
ices.
T
h
e
s
ec
o
n
d
o
n
e
is
th
e
C
OVI
D
-
19
im
p
ac
t
o
n
th
e
h
ea
lth
wo
r
k
f
o
r
ce
f
am
ilies
an
d
th
eir
ec
o
n
o
m
ic
co
n
d
itio
n
s
as
th
e
y
ar
e
t
h
e
m
o
s
t
v
u
ln
er
ab
le
s
eg
m
e
n
t
o
f
th
e
p
o
p
u
latio
n
an
d
alm
o
s
t
th
e
o
n
ly
s
ec
to
r
,
b
esid
es
th
e
s
ec
u
r
ity
ap
p
ar
at
u
s
,
th
at
r
ev
e
r
s
ely
wo
r
k
s
d
u
r
i
n
g
th
e
s
tatu
s
o
f
cu
r
f
ews
an
d
lo
c
k
d
o
w
n
p
r
o
ce
d
u
r
es
in
o
r
d
er
to
ac
ce
ler
ate
its
s
er
v
ices,
as we
ll
as,
p
u
s
h
in
g
m
o
r
e
h
ea
lth
wo
r
k
f
o
r
ce
to
th
e
f
r
o
n
t lin
e.
I
n
th
e
s
am
e
c
o
n
tex
t,
th
is
s
tu
d
y
tr
ies
to
d
is
co
v
e
r
h
o
w
m
u
ch
th
ese
two
af
o
r
e
m
en
tio
n
e
d
p
e
r
s
p
ec
tiv
es
ar
e
in
ter
d
e
p
en
d
e
n
t
a
n
d
i
r
r
ep
l
ac
ea
b
le
u
s
in
g
ec
o
n
o
m
etr
ic
m
o
d
elin
g
.
Als
o
,
th
e
s
tu
d
y
tr
ies
to
f
ig
u
r
e
o
u
t
th
e
ec
o
n
o
m
ic
b
eh
a
v
io
r
o
f
t
h
e
h
ea
l
th
wo
r
k
f
o
r
ce
d
u
r
in
g
tim
es
o
f
p
an
d
em
ics
d
e
p
en
d
i
n
g
o
n
d
if
f
e
r
en
t
wo
r
k
in
g
ar
ea
s
:
"u
r
b
an
o
r
r
u
r
al";
an
d
th
e
im
p
a
c
t
o
f
th
e
s
tate'
s
d
if
f
er
en
t
m
itig
atio
n
p
o
licies
o
n
th
e
p
r
ac
tice
o
f
v
a
r
io
u
s
m
e
d
ical
s
p
ec
ialties
.
2.
M
E
T
H
O
D
2
.
1
.
Study
des
ig
n
A
n
an
aly
tic
cr
o
s
s
-
s
ec
tio
n
al
s
t
u
d
y
aim
in
g
to
ass
ess
th
e
ec
o
n
o
m
ic
an
d
wo
r
k
b
u
r
d
en
o
f
th
e
C
OVI
D
-
19
p
an
d
em
ic
o
n
HW
F
in
E
g
y
p
t.
Stu
d
y
s
ettin
g
:
T
h
e
s
tu
d
y
t
o
o
k
p
lace
v
ia
an
elec
tr
o
n
ic
s
u
r
v
e
y
.
I
t
was
co
n
d
u
cte
d
th
r
o
u
g
h
o
u
t
a
p
er
i
o
d
o
f
s
ev
en
m
o
n
th
s
,
f
r
o
m
Octo
b
er
2
0
2
0
t
o
Ma
y
2
0
2
1
.
Stu
d
y
Par
ticip
an
ts
:
a
d
u
lts
o
f
a
n
y
a
g
e
af
f
iliated
with
th
e
h
ea
lth
ca
r
e
wo
r
k
f
o
r
ce
wer
e
ap
p
r
o
ac
h
ed
th
r
o
u
g
h
p
er
s
o
n
al
co
n
tact
with
th
e
r
esear
ch
team
.
−
E
l
i
g
i
b
i
li
t
y
c
r
i
t
e
r
i
a:
a
n
y
E
g
y
p
t
ian
a
d
u
l
t
(
li
v
i
n
g
i
n
E
g
y
p
t
d
u
r
i
n
g
t
h
e
C
OVI
D
-
19
p
a
n
d
e
m
i
c
)
,
a
f
f
i
l
i
a
te
d
w
it
h
t
h
e
h
e
a
l
t
h
c
a
r
e
w
o
r
k
f
o
r
c
e
(
p
h
y
s
i
c
ia
n
s
,
n
u
r
s
es
,
l
a
b
t
e
c
h
n
ic
i
a
n
s
,
an
d
p
h
a
r
m
a
c
i
s
ts
)
,
a
n
d
w
i
t
h
a
c
ce
s
s
t
o
el
e
c
t
r
o
n
ic
m
e
d
i
a
,
w
i
ll
i
n
g
t
o
p
a
r
t
ic
i
p
a
t
e
i
n
t
h
e
s
t
u
d
y
a
n
d
s
i
g
n
i
n
g
t
h
e
e
l
e
c
t
r
o
n
i
c
c
o
n
s
e
n
t
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Th
e
ec
o
n
o
mic
imp
a
ct
o
f
C
OV
I
D
-
19
p
a
n
d
emic
o
n
p
h
ysicia
n
s
/h
ea
lth
ca
r
e
…
(
R
e
h
a
b
A
b
d
elh
a
i A
h
med
)
373
−
E
x
c
l
u
s
i
o
n
c
r
i
t
e
r
i
a:
a
n
y
m
e
m
b
er
o
f
t
h
e
h
e
al
t
h
c
a
r
e
w
o
r
k
f
o
r
c
e
w
h
o
r
e
f
u
s
e
d
t
o
p
a
r
t
ic
i
p
a
t
e
.
OR
w
i
t
h
n
o
ac
c
es
s
t
o
e
l
e
c
t
r
o
n
i
c
m
e
d
ia
w
e
r
e
e
x
cl
u
d
ed
f
r
o
m
t
h
e
s
t
u
d
y
.
2
.
2
.
S
a
m
ple size
a
nd
t
ec
hn
iq
ue
A
n
o
n
-
p
r
o
b
a
b
i
l
i
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to
th
e
g
o
v
er
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m
en
tal
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ec
to
r
(
6
1
.
2
%),
with
ap
p
r
o
x
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ately
f
o
u
r
th
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r
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h
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al
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r
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tice.
Ma
jo
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ity
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r
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r
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g
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K
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/m
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with
m
o
r
e
th
an
9
0
%
o
f
th
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a
r
ticip
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t
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wer
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y
ea
r
s
’
ex
p
er
ien
ce
T
a
b
le
2
.
A
m
o
n
g
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ticip
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r
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g
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r
e
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n
5
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%
r
ed
u
ctio
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in
p
r
iv
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,
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h
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ician
s
wer
e
th
e
h
ig
h
est
ca
teg
o
r
y
(
5
3
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5
%).
W
h
en
co
m
p
ar
in
g
p
ar
am
ed
ics
with
p
h
y
s
ician
s
,
lo
wer
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ce
n
tag
e
o
f
th
em
(
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5
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m
en
tio
n
ed
af
f
ec
tio
n
o
f
p
r
iv
at
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r
k
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y
m
o
r
e
th
an
5
0
%.
I
n
th
e
cu
r
r
en
t
s
tu
d
y
it
was
d
em
o
n
s
tr
ated
th
at;
p
ar
ti
cip
an
ts
with
d
u
al
p
r
ac
tice
r
e
p
r
esen
ts
th
e
h
ig
h
est
p
er
ce
n
ta
g
e
(
6
2
.
2
%)
am
o
n
g
HC
W
w
ith
s
h
r
in
k
ag
e
in
p
r
iv
at
e
wo
r
k
(
b
y
m
o
r
e
th
a
n
5
0
%)
T
ab
le
3
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
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6
Th
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OV
I
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R
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375
Am
o
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p
ar
ticip
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ts
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p
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ess
in
g
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al
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ll n
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h
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id
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r
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ase
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r
ab
le
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last
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ix
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th
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r
wer
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lan
n
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g
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p
u
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ch
ase
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th
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r
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cti
o
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;
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er
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wasn
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if
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ated
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s
5
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6
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ab
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7
s
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3
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p
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o
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ed
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4
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d
u
e
to
C
OVI
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in
f
ec
tio
n
.
Als
o
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2
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5
%
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n
ly
o
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th
e
in
ter
v
iewe
d
HC
W
s
m
en
tio
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ed
c
h
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n
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th
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w
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atter
n
s
af
ter
b
ein
g
tr
ea
te
d
f
o
r
C
OVI
D
-
19
[
7
]
.
T
ab
le
2
.
E
m
p
lo
y
m
e
n
t a
n
d
in
c
o
m
e
s
tatu
s
o
f
s
u
r
v
e
y
r
esp
o
n
d
e
n
ts
V
a
r
i
a
b
l
e
N
(
%)
Emp
l
o
y
e
r
G
o
v
e
r
n
m
e
n
t
a
l
4
6
7
(
6
1
.
2
)
P
r
i
v
a
t
e
1
1
2
(
1
4
.
7
)
B
o
t
h
1
8
4
(
2
4
.
1
)
Ex
p
e
r
i
e
n
c
e
y
e
a
r
s
Le
ss
t
h
a
n
o
n
e
y
e
a
r
1
9
(
2
.
5
)
1
-
5
y
e
a
r
s
2
1
6
(
2
8
.
3
)
6
-
1
0
y
e
a
r
s
2
4
6
(
3
2
.
2
)
11
-
1
5
y
e
a
r
s
1
7
3
(
2
2
.
7
)
16
-
2
0
y
e
a
r
s
4
7
(
6
.
2
)
M
o
r
e
t
h
a
n
2
0
y
e
a
r
s
6
2
(
8
.
1
)
I
n
c
o
me
Le
ss
t
h
a
n
1
0
k
6
5
4
(
8
5
.
7
)
1
0
k
-
<
2
5
k
7
3
(
9
.
6
)
2
5
k
-
50k
3
2
(
4
.
2
)
M
o
r
e
t
h
a
n
5
0
k
4
(
0
.
5
)
O
w
n
p
r
i
v
a
t
e
c
l
i
n
i
c
/
p
h
a
r
ma
c
y
/
c
e
n
t
e
r
/
h
o
s
p
i
t
a
l
No
6
2
3
(
8
1
.
7
)
Y
e
s
1
4
0
(
1
8
.
3
)
W
o
r
k
a
t
p
r
i
v
a
t
e
c
l
i
n
i
c
/
p
h
a
r
ma
c
y
/
c
e
n
t
e
r
/
h
o
s
p
i
t
a
l
No
5
3
8
(
7
0
.
5
)
Y
e
s
2
2
5
(
2
9
.
5
)
T
ab
le
3
.
Priv
ate
wo
r
k
af
f
ec
tio
n
u
p
o
n
clo
s
u
r
e
V
a
r
i
a
b
l
e
P
r
i
v
a
t
e
w
o
r
k
a
f
f
e
c
t
i
o
n
u
p
o
n
c
l
o
su
r
e
N
o
t
a
f
f
e
c
t
e
d
Lo
w
e
r
b
y
>
5
0
%
H
i
g
h
e
r
b
y
>
5
0
%
N
(
%)
N
(
%)
N
(
%)
P
r
o
f
e
ssi
o
n
P
h
y
s
i
c
i
a
n
2
8
(
4
8
.
3
)
6
1
(
5
3
.
5
)
1
(
1
0
0
)
D
e
n
t
i
st
6
(
1
0
.
3
)
2
0
(
1
7
.
5
)
0
(
0
)
P
h
a
r
ma
c
i
s
t
2
0
(
3
4
.
5
)
1
9
(
1
6
.
6
)
0
(
0
)
P
h
y
s
i
c
a
l
t
h
e
r
a
p
i
s
t
1
(
1
.
7
)
9
(
7
)
0
(
0
)
V
e
t
e
r
i
n
a
r
i
a
n
1
(
1
.
7
)
3
(
2
.
6
)
0
(
0
)
N
u
r
se
2
(
3
.
4
)
2
(
1
.
7
)
0
(
0
)
P
r
o
f
e
ssi
o
n
(
p
h
y
si
c
i
a
n
s
a
n
d
o
t
h
e
r
s)
P
h
y
s
i
c
i
a
n
s
2
8
(
4
8
.
3
)
6
1
(
5
3
.
5
)
1
(
1
0
0
)
P
a
r
a
me
d
i
c
s
3
0
(
5
1
.
7
)
5
3
(
4
6
.
5
)
0
(
0
)
Emp
l
o
y
e
r
G
o
v
e
r
n
m
e
n
t
a
l
7
(
1
2
.
1
)
1
1
(
9
.
6
)
0
(
0
)
P
r
i
v
a
t
e
2
4
(
4
1
.
3
)
3
2
(
2
8
.
2
)
1
(
1
0
0
)
B
o
t
h
2
7
(
4
6
.
6
)
7
1
(
6
2
.
2
)
0
(
0
)
T
ab
le
4
.
I
n
co
m
e
a
f
f
ec
tio
n
u
p
o
n
clo
s
u
r
e
V
a
r
i
a
b
l
e
I
n
c
o
me
a
f
f
e
c
t
i
o
n
u
p
o
n
c
l
o
s
u
r
e
N
o
t
a
f
f
e
c
t
e
d
Lo
w
e
r
b
y
>
5
0
%
H
i
g
h
e
r
b
y
>
5
0
%
N
(
%)
N
(
%)
N
(
%)
P
r
o
f
e
ssi
o
n
P
h
y
s
i
c
i
a
n
3
1
(
5
0
)
5
9
(
5
7
.
3
)
1
(
5
0
)
D
e
n
t
i
st
6
(
9
.
7
)
2
0
(
1
9
.
4
)
0
(
0
)
P
h
a
r
ma
c
i
s
t
2
1
(
3
3
.
9
)
1
4
(
1
3
.
5
)
0
(
0
)
P
h
y
s
i
c
a
l
t
h
e
r
a
p
i
s
t
1
(
1
.
6
)
7
(
6
.
7
)
1
(
5
0
)
V
e
t
e
r
i
n
a
r
i
a
n
1
(
1
.
6
)
2
(
1
.
9
)
0
(
0
)
N
u
r
se
2
(
3
.
2
)
1
(
0
.
9
7
)
0
(
0
)
P
r
o
f
e
ssi
o
n
(
p
h
y
si
c
i
a
n
s
a
n
d
o
t
h
e
r
s)
P
h
y
s
i
c
i
a
n
s
3
1
(
5
0
)
5
9
(
5
7
.
3
)
1
(
5
0
)
P
a
r
a
me
d
i
c
s
3
1
(
5
0
)
4
4
(
4
2
.
7
)
1
(
5
0
)
Emp
l
o
y
e
r
G
o
v
e
r
n
m
e
n
t
a
l
1
1
(
1
7
.
7
)
1
0
(
9
.
7
)
0
(
0
)
P
r
i
v
a
t
e
2
7
(
4
3
.
5
)
2
7
(
2
6
.
2
)
1
(
5
0
)
B
o
t
h
2
4
(
3
8
.
7
)
6
6
(
6
4
.
1
)
1
(
5
0
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
3
7
1
-
380
376
T
ab
le
5
.
Pu
r
c
h
ased
h
o
m
e
d
ev
i
ce
/car
/ap
ar
tm
en
t p
ast
s
ix
m
o
n
th
s
V
a
r
i
a
b
l
e
P
u
r
c
h
a
se
d
h
o
me
d
e
v
i
c
e
/
c
a
r
/
a
p
a
r
t
me
n
t
p
a
s
t
s
i
x
mo
n
t
h
s
No
Y
e
s
N
(
%)
N
(
%)
R
e
si
d
e
n
c
y
U
r
b
a
n
5
3
9
(
8
8
.
4
)
7
1
(
1
1
.
6
)
R
u
r
a
l
1
3
9
(
9
0
.
8
)
1
4
(
9
.
2
)
P
r
o
f
e
ssi
o
n
P
h
y
s
i
c
i
a
n
2
7
9
(
8
6
.
1
)
4
5
(
1
3
.
9
)
D
e
n
t
i
st
6
3
(
8
6
.
3
)
1
0
(
1
3
.
7
)
P
h
a
r
ma
c
i
s
t
2
7
1
(
9
0
.
6
)
2
8
(
9
.
4
)
P
h
y
s
i
c
a
l
t
h
e
r
a
p
i
s
t
4
3
(
9
5
.
6
)
2
(
4
.
4
)
V
e
t
e
r
i
n
a
r
i
a
n
1
1
(
1
0
0
)
0
(
0
)
N
u
r
se
1
1
(
1
0
0
)
0
(
0
)
P
r
o
f
e
ssi
o
n
(
p
h
y
si
c
i
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o
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r
s)
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h
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i
c
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6
.
1
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4
5
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3
.
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)
P
a
r
a
me
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i
c
s
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)
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n
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o
me
Le
ss
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h
a
n
1
0
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0
.
4
)
6
3
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9
.
6
)
1
0
k
-
<
2
5
k
6
1
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8
3
.
6
)
1
2
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1
6
.
4
)
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5
k
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2
4
(
7
5
)
8
(
2
5
)
M
o
r
e
t
h
a
n
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k
2
(
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0
)
2
(
5
0
)
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ab
le
6
.
Plan
n
in
g
to
p
u
r
c
h
ase
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h
o
m
e
d
ev
ice/c
ar
o
r
ap
ar
tm
e
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t in
th
e
n
e
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t 1
2
m
o
n
t
h
s
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a
r
i
a
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l
e
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l
a
n
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o
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r
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h
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se
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e
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c
e
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a
r
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a
p
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r
t
men
t
n
e
x
t
1
2
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n
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h
s
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o
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(
%)
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e
s N (
%)
R
e
si
d
e
n
c
y
U
r
b
a
n
4
1
3
(
6
7
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7
)
1
9
7
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3
2
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)
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u
r
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l
9
4
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1
.
4
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5
9
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8
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)
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o
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e
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o
n
P
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y
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i
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n
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1
1
(
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5
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1
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1
1
3
(
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4
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9
)
D
e
n
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i
st
5
0
(
6
8
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5
)
2
3
(
3
1
.
5
)
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h
a
r
ma
c
i
s
t
1
9
8
(
6
6
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2
)
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0
1
(
3
3
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)
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t
e
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4
.
5
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(
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r
se
8
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7
2
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)
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p
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s)
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)
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r
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me
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c
s
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6
(
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7
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4
)
1
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3
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)
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n
c
o
me
Le
ss
t
h
a
n
1
0
k
4
3
7
(
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6
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2
1
7
(
3
3
.
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1
0
k
-
<
2
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5
0
(
6
8
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5
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3
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5
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0
(
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1
2
(
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r
e
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h
a
n
5
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0
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(
1
0
0
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T
ab
le
7
.
I
m
p
ac
t o
f
C
OVI
D
-
19
in
f
ec
tio
n
o
n
p
h
y
s
ician
s
V
a
r
i
a
b
l
e
N
(
%)
D
i
sea
s
e
d
u
r
a
t
i
o
n
i
n
d
a
y
s
Le
ss
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r
=
1
4
d
a
y
s
1
1
4
(
4
9
.
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)
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o
r
e
t
h
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n
1
4
d
a
y
s
1
1
7
(
5
0
.
7
)
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a
y
m
e
n
t
f
o
r
me
d
i
c
a
l
c
a
r
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e
r
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l
p
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y
me
n
t
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1
8
(
9
4
.
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u
b
l
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c
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n
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r
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n
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e
5
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.
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)
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r
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v
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t
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r
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n
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e
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n
c
o
me
a
f
f
e
c
t
i
o
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a
f
t
e
r
C
O
V
I
D
-
19
i
n
f
e
c
t
i
o
n
Le
ss
o
r
e
q
u
a
l
4
0
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o
f
n
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f
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o
d
c
o
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mp
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7
6
(
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6
.
2
)
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o
r
e
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h
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n
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%
o
f
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f
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o
d
c
o
n
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m
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t
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o
n
5
5
(
2
3
.
8
)
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o
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k
p
a
t
t
e
r
n
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h
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e
s
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f
t
e
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t
r
e
a
t
e
d
f
r
o
m
C
O
V
I
D
-
19
No
1
7
0
(
7
3
.
5
)
Y
e
s
6
1
(
2
6
.
5
)
T
h
e
h
ea
lth
ca
r
e
s
er
v
ices
h
av
e
b
ee
n
s
ig
n
if
ican
tly
af
f
ec
te
d
b
y
th
e
C
OVI
D
-
19
p
an
d
e
m
ic,
wh
ich
is
a
m
ajo
r
cr
is
is
in
th
e
h
ea
lth
ca
r
e
s
ec
to
r
.
I
n
th
e
f
ac
e
o
f
t
h
is
u
n
p
r
ec
e
d
en
ted
c
r
is
is
,
h
ea
lth
ca
r
e
p
r
o
v
id
er
s
h
a
v
e
en
co
u
n
ter
e
d
n
u
m
er
o
u
s
d
if
f
ic
u
lties
in
tr
ea
tin
g
p
atien
ts
wit
h
C
OVI
D
-
19
[
1
1
]
,
[
1
2
]
.
Hea
lth
ca
r
e
wo
r
k
er
s
ar
e
f
ac
in
g
an
in
cr
ea
s
ed
awa
r
e
n
ess
ab
o
u
t
th
eir
p
s
y
c
h
o
lo
g
ical
b
u
r
d
en
an
d
o
v
er
all
welln
ess
.
R
es
ea
r
ch
in
d
icate
s
th
at
h
ea
lth
ca
r
e
wo
r
k
f
o
r
ce
e
x
p
er
ie
n
ce
s
h
ig
h
r
ates
o
f
b
u
r
n
o
u
t,
p
s
y
ch
o
lo
g
ical
s
tr
ess
,
an
d
s
u
ici
d
e.
T
h
ese
n
eg
ativ
e
ef
f
ec
ts
in
clu
d
e
h
ig
h
r
ates
o
f
i
n
f
ec
tio
n
a
n
d
d
ea
th
,
ex
ce
s
s
iv
e
f
in
an
cial
h
ar
d
s
h
ip
s
,
s
tr
ess
r
elate
d
to
b
o
th
k
n
o
w
n
an
d
u
n
k
n
o
w
n
in
f
o
r
m
atio
n
,
a
n
d
f
ea
r
o
f
u
n
ce
r
tain
ty
r
eg
ar
d
in
g
th
e
c
o
n
tin
u
e
d
im
p
ac
t
[
1
3
]
,
T
h
e
s
y
s
tem
atic
p
r
ac
tice
o
f
th
e
g
o
v
e
r
n
m
en
t,
i
n
ad
d
itio
n
to
p
r
iv
ate
p
r
ac
titi
o
n
er
s
,
is
also
s
er
io
u
s
ly
af
f
ec
ted
b
y
th
e
p
an
d
em
ic
[1
4]
.
In
E
g
y
p
t,
f
r
o
m
J
an
u
ar
y
3,
2
0
2
0
to
Octo
b
er
26
,
2
0
2
2
,
th
er
e
h
av
e
b
ee
n
5
1
5
,
4
0
1
co
n
f
ir
m
e
d
ca
s
es
o
f
C
OVI
D
-
19
,
with
2
4
,
7
9
8
d
ea
t
h
s
r
ep
o
r
te
d
to
th
e
W
o
r
ld
Hea
lth
Or
g
an
izatio
n
(
W
HO)
[
1
5
]
–
[
1
7
]
.
T
h
e
C
OVI
D
-
19
p
a
n
d
em
ic
h
as
h
ad
a
p
r
o
f
o
u
n
d
im
p
ac
t
o
n
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
(
HC
Ps
)
,
p
ar
ticu
lar
ly
d
o
ct
o
r
s
,
p
h
ar
m
ac
is
ts
,
an
d
n
u
r
s
es
em
p
l
o
y
ed
i
n
p
u
b
lic
is
o
latio
n
f
ac
ilit
ies.
Acc
o
r
d
i
n
g
to
th
e
E
g
y
p
tian
m
ed
ical
s
y
n
d
icate
,
o
v
er
6
0
0
p
h
y
s
ician
s
lo
s
t
th
eir
liv
es
b
etwe
en
Feb
r
u
ar
y
2
0
2
0
an
d
J
an
u
ar
y
2
0
2
2
d
u
e
to
th
e
p
an
d
em
ic
[
1
8
]
.
T
h
is
is
wh
er
e
o
u
r
s
tu
d
y
p
er
s
p
ec
tiv
e
h
as
b
ec
o
m
e
cr
u
cial
to
elu
cid
ate.
Du
r
in
g
th
e
p
er
io
d
o
f
(
O
cto
b
er
2
0
2
0
to
Ma
y
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Th
e
ec
o
n
o
mic
imp
a
ct
o
f
C
OV
I
D
-
19
p
a
n
d
emic
o
n
p
h
ysicia
n
s
/h
ea
lth
ca
r
e
…
(
R
e
h
a
b
A
b
d
elh
a
i A
h
med
)
377
2
0
2
1
)
,
we
co
n
d
u
cted
a
s
tu
d
y
co
m
p
r
is
in
g
7
6
3
m
ed
ical
f
ield
wo
r
k
er
s
to
ass
ess
th
e
ec
o
n
o
m
ic
an
d
wo
r
k
b
u
r
d
en
o
f
th
e
C
OVI
D
-
19
p
a
n
d
em
ic
o
n
HW
F
in
E
g
y
p
t.
Ou
r
r
esu
lts
u
n
d
er
lin
e
d
th
at
8
8
.
2
%
o
f
th
e
s
u
r
v
ey
e
d
(
HC
W
)
wer
e
f
em
ales,
wh
ich
is
allied
with
th
e
wo
r
ld
wid
e
tr
e
n
d
in
g
p
atter
n
r
ep
o
r
ted
b
y
th
e
W
HO
in
Ma
r
ch
2
0
1
9
,
th
at
7
0
%
o
f
th
e
g
lo
b
al
h
ea
lth
an
d
s
o
cial
ca
r
e
wo
r
k
f
o
r
ce
ar
e
f
em
al
es,
eith
er
in
h
o
s
p
itals
,
clin
ics,
h
ea
lth
s
er
v
ices,
o
r
s
o
cial
ass
i
s
tan
ce
[
1
6
]
,
[
1
7
]
.
Als
o
,
th
e
r
esu
lts
o
f
th
e
cu
r
r
e
n
t
s
tu
d
y
h
ig
h
lig
h
te
d
th
at
d
u
a
l
p
r
ac
tice
am
o
n
g
t
h
e
p
ar
ticip
an
t
HC
W
ac
co
u
n
ts
f
o
r
2
4
.
1
%
o
f
th
e
t
o
tal
s
am
p
le.
T
h
is
was
in
ag
r
ee
m
e
n
t
with
a
s
tu
d
y
co
n
d
u
cted
in
C
am
b
o
d
ia
to
ass
ess
th
e
d
u
al
p
r
ac
tice
am
o
n
g
p
h
y
s
ician
s
,
wh
ich
r
ev
ea
led
t
h
at
2
5
.
4
%
o
f
th
e
s
u
r
v
e
y
ed
s
am
p
le
w
er
e
wo
r
k
in
g
in
b
o
th
th
e
p
u
b
lic
a
n
d
p
r
iv
ate
s
ec
to
r
s
[
1
9
]
.
T
h
is
was
ec
h
o
e
d
in
a
cr
o
s
s
-
s
ec
tio
n
al
s
u
r
v
ey
co
n
d
u
cte
d
am
o
n
g
p
h
y
s
ician
s
in
two
s
tates
in
B
r
az
il
to
h
ig
h
lig
h
t
ch
an
g
es
ex
p
e
r
ien
ce
d
in
te
r
m
s
o
f
wo
r
k
in
g
h
o
u
r
s
an
d
ea
r
n
in
g
s
in
th
e
s
ec
o
n
d
y
ea
r
o
f
th
e
p
a
n
d
em
ic,
wh
e
r
e
t
h
e
m
ajo
r
ity
o
f
th
e
s
a
m
p
le
(
6
1
.
6
%)
wer
e
en
g
a
g
ed
in
d
u
al
p
r
a
ctice
[
2
0
]
.
T
h
is
p
r
ev
alen
ce
o
f
d
u
al
p
r
ac
tice
m
ig
h
t
b
e
ju
s
tifie
d
b
y
th
e
n
ee
d
to
c
o
m
p
e
n
s
ate
f
o
r
in
s
u
f
f
icien
t
s
alar
ies,
wh
ich
lead
s
h
ea
lth
c
ar
e
wo
r
k
er
s
to
d
ep
e
n
d
o
n
in
d
iv
id
u
al
c
o
p
in
g
s
tr
ateg
ies.
N
u
m
er
o
u
s
clin
ician
s
co
m
b
in
e
t
h
eir
p
u
b
lic
-
s
ec
to
r
clin
ical
wo
r
k
,
wh
ich
is
s
alar
ied
,
with
a
p
r
iv
ate
clien
tele
t
h
at
p
ay
s
th
em
o
n
a
f
ee
-
f
o
r
-
s
er
v
ice
b
asis
.
T
h
is
d
u
al
p
r
ac
tice
is
o
f
ten
u
s
ed
b
y
HC
W
s
to
f
u
lf
ill
th
eir
b
asic
n
ee
d
s
,
in
d
icatin
g
t
h
at
th
e
h
ea
lth
m
in
is
tr
ies ar
e
u
n
ab
le
t
o
p
r
o
v
i
d
e
th
em
with
a
d
eq
u
ate
s
alar
ies an
d
wo
r
k
in
g
co
n
d
itio
n
s
[
2
1
]
.
Ou
r
s
tu
d
y
r
esu
lts
h
av
e
co
n
f
ir
m
ed
th
e
d
elete
r
io
u
s
ef
f
ec
t
C
OVI
D
-
19
h
ad
,
esp
ec
ia
lly
o
n
p
h
y
s
ician
s
in
E
g
y
p
t,
wh
er
e
m
o
r
e
th
an
h
alf
(
5
3
.
5
%)
o
f
th
o
s
e
ex
p
er
ie
n
ce
d
p
r
iv
ate
s
ec
to
r
r
ed
u
ctio
n
b
y
m
o
r
e
th
an
5
0
%
wer
e
p
h
y
s
ician
s
.
T
h
is
was
in
a
g
r
ee
m
en
t
with
an
o
n
lin
e
s
u
r
v
ey
co
n
d
u
cte
d
in
Ma
y
,
a
cc
o
r
d
in
g
t
o
th
e
T
e
x
as
Me
d
ical
a
s
s
o
ciatio
n
,
a
m
ajo
r
ity
o
f
p
r
ac
ticin
g
p
h
y
s
ician
s
h
av
e
b
ee
n
af
f
ec
ted
b
y
th
e
C
OVI
D
-
19
p
a
n
d
em
ic.
Ap
p
r
o
x
im
ately
,
6
8
%
o
f
p
h
y
s
ician
s
h
av
e
h
ad
to
r
ed
u
ce
th
eir
p
r
iv
ate
p
r
ac
tices,
wh
ile
6
2
%
h
av
e
ex
p
er
ie
n
ce
d
a
d
ec
r
ea
s
e
in
th
eir
s
alar
ies [
2
2
]
.
Ad
d
itio
n
ally
,
a
s
tu
d
y
was
co
n
d
u
cted
to
ev
alu
ate
th
e
im
p
ac
t
o
f
th
e
C
OVI
D
-
19
p
a
n
d
em
ic
o
n
p
r
iv
ate
p
r
ac
titi
o
n
er
s
in
I
n
d
ia
d
e
m
o
n
s
tr
ated
th
at
HC
Ps
wo
r
k
in
g
in
p
r
iv
ate
s
ec
to
r
wer
e
a
f
f
ec
ted
d
r
am
atica
lly
in
th
e
f
i
n
a
n
c
i
a
l
a
n
d
m
e
n
t
a
l
a
s
p
e
c
t
s
,
e
s
p
e
c
i
a
l
l
y
d
u
r
i
n
g
t
h
e
l
o
c
k
d
o
w
n
[
2
3
]
.
T
h
i
s
w
a
s
a
t
t
r
i
b
u
t
e
d
p
a
r
t
i
a
l
l
y
t
o
t
h
e
d
e
c
l
i
n
e
i
n
p
r
i
v
a
t
e
p
r
a
c
t
i
c
e
,
c
a
u
s
e
d
b
y
f
e
a
r
o
f
c
a
t
c
h
i
n
g
t
h
e
d
i
s
e
a
s
e
,
l
e
a
d
i
n
g
t
o
i
n
c
r
e
a
s
e
d
f
i
n
a
n
c
i
a
l
b
u
r
d
e
n
a
n
d
h
e
n
c
e
s
t
r
e
s
s
[
2
4
]
.
Als
o
,
b
ec
au
s
e
o
f
th
e
s
ig
n
if
ic
an
t
r
ed
u
ctio
n
i
n
th
e
p
r
iv
ate
m
ed
ical
p
r
ac
tice
w
o
r
k
lo
a
d
,
t
h
e
o
v
e
r
all
in
co
m
e
was
s
ig
n
if
ican
tly
r
ed
u
ce
d
(
lo
wer
ed
b
y
m
o
r
e
th
an
5
0
%)
b
y
5
7
.
3
%
o
f
th
e
in
ter
v
iewe
d
p
h
y
s
ician
s
.
T
h
is
was
in
ac
co
r
d
a
n
ce
with
a
c
r
o
s
s
-
s
ec
tio
n
al
s
u
r
v
ey
th
at
i
n
clu
d
ed
a
r
ep
r
esen
tativ
e
s
am
p
le
o
f
1
,
1
8
3
p
h
y
s
ician
s
f
r
o
m
two
B
r
az
ilian
s
tates,
São
Pau
lo
(
SP
)
an
d
Ma
r
an
h
ã
o
(
MA
)
,
to
u
n
d
er
s
tan
d
th
e
f
lu
ct
u
atio
n
s
in
wo
r
k
i
n
g
h
o
u
r
s
a
n
d
an
d
in
c
o
m
es
d
u
r
in
g
th
e
s
ec
o
n
d
y
ea
r
o
f
th
e
p
a
n
d
e
m
ic.
T
h
e
r
esu
lts
s
h
o
wed
th
at
m
o
r
e
t
h
an
h
alf
o
f
th
e
p
r
i
v
a
t
e
-
o
n
l
y
d
o
c
t
o
r
s
a
c
r
o
s
s
b
o
t
h
s
t
a
t
e
s
e
x
p
e
r
i
e
n
c
e
d
a
d
e
c
r
e
a
s
e
i
n
t
h
e
i
r
e
a
r
n
i
n
g
s
(
5
2
.
2
%
,
9
5
%
C
I
4
5
.
6
–
5
8
.
8
)
[
2
5
]
.
Fu
r
th
er
m
o
r
e
,
a
s
tu
d
y
was
co
n
d
u
cted
in
Qu
eb
ec
t
o
ex
p
lo
r
e
t
h
e
wo
r
k
l
o
ad
a
n
d
s
atis
f
ac
tio
n
o
f
HC
Ps
in
out
-
p
atien
t
clin
ics
d
u
r
in
g
th
e
p
an
d
em
ic
,
h
ig
h
lig
h
tin
g
th
at
s
h
o
w
th
at,
th
e
p
an
d
em
ic
h
as
v
ar
io
u
s
r
am
if
icatio
n
s
o
n
th
e
p
r
o
f
ess
io
n
al
life
o
f
H
C
Ps
,
wh
er
e
m
an
y
HC
Ps
wer
e
p
r
o
f
ess
io
n
ally
b
u
r
d
e
n
ed
b
y
l
o
ck
d
o
wn
m
ea
s
u
r
es,
with
o
n
e
-
th
ir
d
o
f
s
u
r
v
e
y
ed
HC
P
s
lo
s
in
g
wo
r
k
d
u
r
in
g
th
e
lo
ck
d
o
wn
p
e
r
io
d
[
2
6
]
.
T
h
e
o
v
er
all
d
ec
r
ea
s
e
i
n
in
co
m
e
am
o
n
g
h
ea
lth
p
r
o
f
ess
io
n
als
ca
n
b
e
attr
ib
u
ted
to
two
m
ain
f
ac
to
r
s
.
Firstl
y
,
a
s
ig
n
if
ican
t
r
ed
u
ctio
n
in
d
em
an
d
f
o
r
ca
r
e
h
as
led
to
a
s
u
b
s
tan
tial
lo
s
s
o
f
in
co
m
e
f
o
r
m
an
y
.
So
m
e
h
a
v
e
ex
p
er
ie
n
ce
d
a
d
ec
r
ea
s
e
in
elec
tiv
e
wo
r
k
,
wh
ile
o
th
er
s
h
a
v
e
s
ee
n
p
atien
ts
f
o
r
g
o
s
er
v
ice
s
.
Fo
r
in
s
tan
ce
,
Am
er
ican
r
ad
i
o
lo
g
is
ts
h
av
e
f
ac
ed
r
ed
u
ce
d
d
em
an
d
f
o
r
s
er
v
ices
d
u
e
to
f
ewe
r
tr
af
f
ic
in
j
u
r
ie
s
d
u
r
in
g
th
e
l
o
ck
d
o
wn
,
an
d
n
eu
r
o
l
o
g
is
ts
h
av
e
r
ep
o
r
ted
th
at
s
er
v
ices
wer
e
p
o
s
tp
o
n
ed
d
u
e
to
lim
ited
h
o
s
p
ital
ca
p
ac
ities
,
an
d
p
atien
ts
a
v
o
id
in
g
clin
ics
f
o
r
elec
tiv
e
ca
r
e
o
u
t
o
f
f
ea
r
o
f
c
o
n
tr
ac
tin
g
C
OVI
D
-
19
[
2
7
]
.
T
h
is
also
was
in
ac
co
r
d
an
ce
w
ith
th
e
W
o
r
ld
B
an
k
R
ep
o
r
t
d
em
o
n
s
tr
atin
g
th
e
ec
o
n
o
m
ic
b
u
r
d
en
o
f
C
OVI
D
-
19
I
n
f
ec
tio
n
s
am
o
n
g
s
t
HC
W
s
,
wh
er
e
th
e
r
esu
lts
r
ev
ea
led
th
at
o
v
er
all,
in
f
ec
tio
n
with
C
OVI
D
-
19
am
o
n
g
HC
W
s
led
to
cr
u
cial
s
o
cio
-
ec
o
n
im
ic
co
s
ts
.
Acc
o
r
d
in
g
to
th
e
r
ep
o
r
t,
t
h
e
ec
o
n
o
m
ic
im
p
ac
t
o
f
HC
W
in
f
ec
tio
n
s
is
s
ig
n
if
ican
t.
T
h
e
esti
m
ated
co
s
t
p
er
in
f
ec
tio
n
is
$
1
0
,
0
0
0
in
C
o
lo
m
b
ia,
wh
ich
i
s
1
.
5
tim
es
th
e
G
DP
p
er
ca
p
it
a.
T
h
e
b
u
r
d
e
n
is
ev
en
g
r
ea
ter
in
Ken
y
a,
wh
er
e
th
e
co
s
t
is
alm
o
s
t
$
3
4
,
0
0
0
(
1
8
tim
es
GDP
p
er
ca
p
ita)
,
an
d
i
n
E
s
watin
i,
wh
er
e
it
is
alm
o
s
t
$
3
6
,
0
0
0
(
9
tim
es
GDP
p
er
ca
p
ita)
[
2
8
]
.
Oth
er
s
tu
d
ie
s
claim
ed
th
at
o
u
t
o
f
p
o
ck
et
p
ay
m
en
ts
(
OOP
)
s
p
en
d
in
g
c
o
u
ld
h
a
v
e
a
u
g
m
e
n
ted
b
ec
au
s
e
m
o
r
e
p
atien
ts
with
C
OVI
D
-
19
u
s
ed
t
h
e
p
r
iv
ate
s
ec
to
r
(
wh
er
e
OOP
co
s
ts
ar
e
ad
v
a
n
ce
d
)
to
av
o
id
ex
p
o
s
u
r
e
to
C
OVI
D
-
19
in
th
e
p
u
b
lic
s
ec
to
r
[
2
9
]
,
[
3
0
]
.
Fo
r
l
an
ce
t
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
co
n
ce
r
n
in
g
ca
tast
r
o
p
h
ic
h
e
alth
ex
p
en
d
itu
r
e
wer
e
in
h
ar
m
o
n
y
with
a
s
tu
d
y
p
u
b
lis
h
ed
in
th
e
L
a
n
ce
t,
to
s
tu
d
y
th
e
c
atastro
p
h
ic
h
ea
lt
h
ex
p
en
d
itu
r
e
d
u
r
in
g
th
e
C
OVI
D
-
19
p
a
n
d
em
ic
in
f
iv
e
co
u
n
tr
ies
[
3
1
]
.
I
n
t
h
r
ee
o
f
th
e
f
iv
e
co
u
n
tr
ies
ex
am
in
e
d
,
h
ea
lth
s
y
s
tem
s
d
id
n
o
t
p
r
o
v
id
e
ad
eq
u
ate
f
in
an
cial
p
r
o
tect
io
n
o
r
m
ain
tain
h
ea
lt
h
ca
r
e
ac
ce
s
s
in
2
0
2
0
,
s
u
g
g
e
s
tin
g
a
f
ailu
r
e
to
u
p
h
o
ld
b
a
s
ic
f
u
n
ctio
n
s
.
T
h
e
C
OVI
D
-
19
r
esp
o
n
s
e
in
2
0
2
0
e
x
p
ed
ited
th
e
tr
an
s
itio
n
to
p
r
iv
a
te
h
ea
lth
ca
r
e
in
s
o
m
e
a
r
ea
s
.
Evaluation Warning : The document was created with Spire.PDF for Python.
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4.
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I
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a
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o
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r
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o
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f
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a
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c
a
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w
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r
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f
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