Table of Contents
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General:
List of Contributors
SARS-CoV-2 and Co-morbidities
Abstract
Highlights
INTRODUCTION
COVID-19: GENERAL CHARACTERISTICS, SUSCEPTIBILITY, AND ASSOCIATION WITH THE IMMUNE SYSTEM
COVID-19 and Co-morbidities
Diabetes Mellitus
Obesity and Metabolic Syndrome
Chronic Kidney Disease
Cardiovascular Diseases
Cancer
Sickle Cell
Chronic Obstructive Pulmonary Disease
Conclusion
MULTIPLE CHOICE QUESTIONS
List of Abbreviations
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
References
Diabetes Mellitus and COVID-19
Abstract
HIGHLIGHTS
INTRODUCTION
EPIDEMIOLOGY
PATHOPHYSIOLOGICAL ASSOCIATIONS BETWEEN DIABETES MELLITUS AND COVID-19
Advancing Age
Comorbidities
Obesity
Dysregulated Immune System
Angiotensin-Converting Enzyme 2 (ACE2) And Diabetes Mellitus
Coagulation
TWO-WAY INTERACTIONS BETWEEN DIABETES MELLITUS AND COVID-19
DOES GLYCEMIC CONTROL BEFORE, AT, AND AFTER ADMISSION PREDICT OUTCOMES IN COVID-19 PATIENTS WITH DIABETES MELLITUS?
Glycemic Control Before Hospital Admission
Plasma Glucose At Hospital Admission
In-Hospital Glycemic Control
ANTI-DIABETIC MEDICATIONS IN COVID-19
CONCLUSION
MULTIPLE CHOICE QUESTIONS
LIST OF ABBREVIATIONS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
COVID-19 and Diabetic Foot
Abstract
Highlights
INTRODUCTION
FOOT EXAMINATION AND COVID-19
Foot Inspection
Neurological Assessment
Vascular Assessment
DIABETIC FOOT INFECTIONS AND COVID-19 PANDEMIC
An Easy Guide to Antibiotic Therapy is as Follows
DFI, COVID-19 and Way Forward
Charcot Foot and COVID-19
Preventive Foot Care During COVID-19 Pandemic
Foot Care In Patients With Pre-Existing Wounds During COVID-19 Pandemic
Dressing of Foot Wound During COVID -19 Pandemic
Foot Care for DFI During COVID-19
Who Should be Hospitalized for Foot Complications?
Utilization of Tele-Health Services For Diabetic Foot During COVID-19
Promote Self care (Foot) during COVID-19
Precautions FOR Health CARE PROVIDERS
CONCLUSION
MULTIPLE CHOICE QUESTIONS
List of Abbreviations
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Gastrointestinal and Hepatobiliary Manifestations of COVID-19
Abstract
HIGHLIGHTS
INTRODUCTION
GI TROPISM OF SARS-COV-2
GI SYMPTOMATOLOGY
Relation of GI Symptoms with COVID-19 Severity
POSSIBILITY OF FECO-ORAL TRANSMISSION OF COVID 19?
GI HISTOPATHOLOGY OF PATIENTS WITH COVID-19
MANAGEMENT OF GI SYMPTOMS IN COVID-19
LIVER INJURY WITH COVID-19
MECHANISMS OF LIVER INJURY
Role of ACE 2 and Serine protease
Direct Cytopathic Effects
Cytokine Storm
Ischaemic Hepatitis And Drug Toxicity
HISTOPATHOLOGICAL FINDINGS IN THE LIVER
COVID-19 IN PATIENTS WITH CHRONIC LIVER DISEASE
LIVER FAILURE DUE TO COVID-19
LIVER TRANSPLANTATION AND COVID-19
GI ENDOSCOPY PRACTICES DURING COVID-19 PANDEMIC
CONCLUSION
MULTIPLE CHOICE QUESTIONS
List of Abbreviations
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
COVID-19 and Cardiovascular Manifestations
Abstract
Highlights
Introduction
Biology of SARS-CoV-2
Pathophysiology of SARS-Cov-2 Related Tissue Injury
ACE2 –A link to Cardiovascular (CV) Injury
COVID-19 and Cardiovascular Disease (CVD)
COVID-19 and Cardiovascular (CV) Effects
ACUTE CARDIOVASCULAR (CV) MANIFESTATIONS
Acute Cardiac Injury and Myocarditis
Management
Cardiac Arrhythmias
Management
Acute Coronary Syndromes (ACS)
Management
Venous Thromboembolism (VTE)
Management
Renin-Angiotensin-Aldosterone System (RAAS) Inhibitors And Cardiovascular Outcomes In COVID-19 Illness
Antiviral Drugs and their Cardiovascular Effects
Hydroxychloroquine (HCQ) and Azithromycin
Lopinavir-ritonavir
Long-term Cardiovascular Effects - Long COVID
Conclusion
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
COVID-19 and Hematological Manifestations
Abstract
HIGHLIGHTS
INTRODUCTION
COVID-19 AND HEMATOLOGICAL MANIFESTATIONS
Total Leukocyte Count and Differential Count
a. Lymphopenia
a.1 Pathophysiology of Lymphopenia
b. Neutrophilic Leukocytosis
c. Thrombocytosis and Thrombocytopenia
c.1 Pathophysiology of Thrombocytopenia
d. Composite Variables: NLR and PLR Ratios
e. What is the Clinical Utility of Following these Alterations in the CBC?
Coagulation System
COVID-19 Coagulopathy
THROMBOSIS AND THROMBOEMBOLISM
The Large vessel Thrombosis (Venous thromboembolism and Pulmonary Thromboembolism)
Large Vessel Thrombosis (Arterial, extracorporeal circuit thrombosis)
Microvascular Thrombosis and Autopsy data on thrombosis
Pathophysiology of VTE and Immunothrombosis in COVID-19
Acute Illness
Patient-related
SARS-CoV2 Related
COVID-19 vs. Non-COVID-19 Illness
Treatment Implications
CONCLUSION
MULTIPLE CHOICE QUESTIONS
LIST OF ABBREVIATIONS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
COVID-19 And Chronic Kidney Diseases
Abstract
INTRODUCTION: AKI/ACUTE on CKD in COVID-19
Prevalence of AKI in COVID-19
Pathophysiology of Acute Kidney Injury in COVID-19
Mechanisms
Systemic Effects
Fluid Imbalance
Congestion of Renal Vein
Rhabdomyolysis
Superimposed Infections
Cytokine Storm
Pathogenesis of AKI in CRS
Pro-inflammatory Cytokines
Activation-induced Cell Death
Activation of Procoagulation Pathways
Complement System Activation
Heme-Mediated Pathology
Systemic Endothelial Injury
Organ Crosstalk
Lung–Kidney Axis and Crosstalk
Mechanism of Lung–Kidney Crosstalk
Cytokine Overproduction
Renal Medullary Hypoxia
Heart–Kidney Rosstalk
Role of ACE2 in the Pathogenesis of Renal Injury
Site of ACE2 in Lungs/Kidneys
Entry of Virus into the Cell
Priming and Role of TMPRSS2
Angiotensin II
Direct Cytopathic Effect
Clinical Presentation
Incidence of AKI
Timing & Severity of AKI
Predictors of AKI
Kidney Abnormalities
Outcome
Renal Histopathology
COVAN
MANAGEMENT OF AKI
RECOGNITION, MONITORING, AND DIAGNOSIS OF AKI IN COVID-19 PATIENTS
Renal Replacement Therapy
Preferred Treatment Modality for AKI in COVID-19 Pandemic
Other Extracorporeal Therapies
CKD IN COVID-19
Management of Glomerular Diseases During COVID-19 Pandemic
IMMUNOSUPPRESSIVE TREATMENT IN VARIOUS KIDNEY DISEASES DURING COVID-19 PANDEMIC
Antiviral Therapy for Covid-19
Remdesivir
Hydroxychloroquine
Lopinavir–Ritonavir and Darunavir–Cobicistat
High-Dose Steroids
Tocilizumab and other Anti-Interleukin (IL)-6/IL-6R Monoclonal Antibodies (e.g., Sarilumab)
Intravenous Immunoglobulins
Ivermectin
USE OF ARBs DURING PANDEMIC
Paradoxical Effect of ACE2 Modulation in COVID-19 Outcome
COVID- 19 AND DIALYSIS
COVID 19 AND HEMODIALYSIS
Dialysis Patients and Dialysis Facilities
Disinfection and Disposal Practices in the Dialysis Unit
Bleach Solution
Alcohol-Based Solutions
CRRT
CRRT Dosing
Modifications to CRRT for COVID- 19 Positive
OTHER EXTRACORPOREAL THERAPY FOR COVID-19
ECOS Modifications in Relation to COVID-19
Extracorporeal Therapies in CRS
The Rationale of Using CytoSorb Therapy in Critically ill COVID-19 Patients
CytoSorb Therapy - Experience in Rx of COVID-19
Recommendations for Anti-Cytokine Storm Therapy
Recommendations from Italy
Recommendations from Italy
Recommendations from Panama
Practical Recommendations During COVID Pandemic
PERITONEAL DIALYSIS
Role of Acute PD in the Management of CoV-AKI
Advantages
Patients Already on CAPD
New Patient Planned for CAPD
Coronavirus Disease 2019–Specific Concerns for PD
Increased Intra-Abdominal Pressure in Mechanically Ventilated Patients
Prone Positioning
Convalescent COVID-19 Patients on Hemodialysis: When Should We End Isolation?
COVID 19 AND KIDNEY TRANSPLANTATION
Transplant Activity Report during this Pandemic
Data Published from India
Transmission of COVID-19 Infection During Transplantation
Essential Prerequisites for Transplant Center
Selection Criteria for Donor/Recipient During COVID-19 Pandemic
Donor and Recipient Screening
Timing
Deceased Donors
Clinical Criteria (Prasad et al., 2020a).
Epidemiological Criteria
Living Related Transplants
Transplantation Recipients
Post-Transplant Follows up Measures
Precautions for Personnel Working in the Program
Clinical Presentation, Disease Course, or outcomes in the Transplant Recipient
Evidence and Experiences from Data Published
Management of Immunosuppression During COVID-19 Pandemic
Potential Drug Interactions of Medications for COVID-19 With Immunosuppressive Drugs
MULTIPLE CHOICE QUESTIONS
LIST OF ABBREVIATIONS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
COVID-19 and Pulmonary Diseases
Abstract
HIGHLIGHTS
INTRODUCTION
PATHOPHYSIOLOGY
TRANSMISSION AND RISK FACTORS
PULMONARY INVOLVEMENT IN COVID-19
Clinical Features
Laboratory Abnormalities
Radiology
Clinical Spectrum
Diagnosis
Differential Diagnosis
TREATMENT
PROGNOSIS
PREVENTION
DISEASE-SPECIFIC CONSIDERATIONS
Asthma
COPD
Tuberculosis
Lung Cancer
Interstitial Lung Diseases
Bronchiectasis and Cystic Fibrosis
Pulmonary Hypertension
Sleep-Related Breathing Disorders
Lung Transplantation
SPECIAL CONSIDERATIONS DURING MANAGEMENT OF PATIENTS WITH PULMONARY DISEASES
Pulmonary Function Tests
Bronchoscopy
Transthoracic Procedures
Aerosol Therapy
Airway Suctioning
CONCLUSION
MULTIPLE CHOICE QUESTIONS
LIST OF ABBREVIATIONS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
COVID-19 and Pregnancy
Abstract
OVERVIEW
IMPACT ON MOTHER AND PREGNANCY
ANTENATAL CARE
Effect on Early Pregnancy
Preterm Labor
Prenatal Screening in the First or Second Trimester
Imaging
Non-Obstetrical Concerns
Third Trimester
Pre-Labour Preparation
Testing Policy
Segregation of Expectant Women
Vertical Transmission
Management of Positive SARS-CoV-2 Test
Intrapartum Concerns
Managing Late Referral
Route of Delivery
The Third Stage of Labour
GESTATIONAL DIABETES MELLITUS AND DIABETES WITH COVID- 19
POST PARTUM CARE IN COVID 19
Maternal Monitoring
Venous Thrombo-Embolism Prophylaxis
Resuscitation and Evaluation of the Neonate
Neonatal Testing
Rooming in (Colocation)
Co-Isolation of Positive or Suspect Mother- Baby Dyad
Temporary Separation (Separate Rooms)
Breast Feeding
Breast Milk Expression With a Manual or Electric Breast Pump
POSTPARTUM CONTRACEPTION
Permanent Contraception
Reversible Contraception
Postpartum Visit
Postpartum Depression
SAFETY OF DRUGS USED FOR COVID-19 IN PREGNANCY AND LABOUR
Drugs used During Pregnancy Conditions Include
Corticosteroids
Magnesium Sulphate
Antiviral Drug Therapy
Intrapartum Drugs
Managing PPH
PREGNANT HEALTH CARE PROVIDERS
Overlapping Medical Conditions
MANAGEMENT OF SEVERE COVID-19 PREGNANT WOMAN
SUMMARY
MULTIPLE CHOICE QUESTIONS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
Otolaryngological and Ocular Manifestations in COVID-19
Abstract
INTRODUCTION
DIAGNOSIS
ENT manifestations of COVID-19
Anosmia/Ageusia
Clinical Course of Anosmia in COVID-19
Pathophysiology of Anosmia in COVID-19
Treatment of COVID-19 Associated Anosmia/Agues
Sore Throat
Headache
Others
PAEDIATRIC OTOLARYNGOLOGY AND COVID-19
SUMMARY
OCULAR MANIFESTATIONS OF COVID-19
Background
Conjunctivitis
Ocular Symptoms as Rare Presenting Manifestations
Retinal Involvement
Retinal Vascular Occlusion
Treatment
SUMMARY
MULTIPLE CHOICE QUESTIONS
KEY POINTS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
COVID-19 in Children and Newborn
Abstract
INTRODUCTION
EPIDEMIOLOGY
ETIOPATHOGENESIS
CLINICAL PRESENTATION
Laboratory Findings
TREATMENT
SUPPORTIVE MEDICAL CARE
COVID SPECIFIC TREATMENT
MANAGEMENT OF MIS-C
Managing Newborns Born to COVID Positive Mothers
OUTCOME
PREVENTION
Others
CONCLUSION
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
COVID-19 in the Geriatric Population
Abstract
INTRODUCTION
THE DISEASE SPECTRUM
MODES OF TRANSMISSION
THE CLINICAL SCENARIO
DIAGNOSTIC MODALITIES
MANAGEMENT
COVID-19 IN GERIATRIC POPULATION
THE CLINICAL PRESENTATION
The Geriatric Conundrum
Stratification of Risk
Management
Advance Care Planning (ACP)
In Quarantine/LTCFs/Hospices
Caring for the Terminal Patient
CHALLENGES FOR HOSPICES, RETIREMENT HOMES, AND NURSING HOME
CONCLUSION and LEARNING FROM THE CRISIS
CONSENT FOR PUBLICATION
CONFLICT OF INTEREST
ACKNOWLEDGEMENTS
REFERENCES
COVID-19: Effects in Comorbidities and Special Populations
Edited by
Sanjay Kumar Bhadada
Department of Endocrinology
Postgraduate Institute of Medical Education & Research
Chandigarh-160012, India
Neeraj Mittal
Department of Endocrinology
Postgraduate Institute of Medical Education & Research
Chandigarh-160012, India
&
Chitkara College of Pharmacy
Chitkara University
Punjab, India
O. P. KatareUniversity Institute of Pharmaceutical Sciences
UGC Centre of Advanced Studies, Panjab University
Chandigarh-160014, India
&
Varun GargDepartment of Medical Affairs
Cadila Healthcare Limited
Ahmedabad-382421, Gujarat, India
BENTHAM SCIENCE PUBLISHERS LTD.
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PREFACE
The corona virus disease 2019 (COVID-19) has affected millions of people across the world. The clinicians and scientists across the globe need all the information of this pandemic disease at one platform. Today, apart from the management of COVID-19, it is very necessary to find out the association of COVID-19 with various comorbidities and its effect on special populations. It is the need of the hour to have a crisp, concise literature regarding the association of COVID-19 with various comorbidities like diabetes, CVD, etc. Thus we have decided to write this book in continuation with our previous book “COVID-19: Diagnosis and Management”.
This book is a concise and visual reference for this viral disease. The book will provide a comprehensive knowledge which will cover all the aspects of COVID-19 with respect to comorbidities, special populations and their management.
Key Features:
Chapter vise description and segregation of various comorbidities and COVID-19Twelve chapters covering all the aspects of COVID-19 making this a perfect text book for virologist and medical studentsMultiple tables and figures which summarizes and highlight important pointsMultiple choice questionsA detailed list of references, abbreviations and symbols
This book provides an essential reference for practicing and training virologists, pulmologists, medical students, scientists working in various research labs, pharmaceutical and biotechnology industries on COVID-19.
Sanjay Kumar Bhadada
Department of Endocrinology
Postgraduate Institute of Medical
Education & Research
Chandigarh-160012
IndiaNeeraj Mittal
Department of Endocrinology
Postgraduate Institute of Medical
Education & Research
Chandigarh-160012
India
&
Chitkara College of Pharmacy
Chitkara University
Punjab,
IndiaO. P. Katare
University Institute of Pharmaceutical Sciences
UGC Centre of Advanced Studies, Punjab University
Chandigarh-160014
India
&Varun Garg
Department of Medical Affairs
List of Contributors
Ani Abhishek SharmaDepartment of Medicine, MMIMSR, Ambala, Haryana, IndiaAshish BhallaDepartment of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, IndiaAshu RastogiDepartment of Endocrinology, PGIMER, Chandigarh-160012, IndiaAlka SehgalProfessor and Head, Govt. Medical College and Hospital (GMCH) Sector 32, Chandigarh, IndiaGanesh KasinadhuniDepartment of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, IndiaK.M. Venkat NarayanLaney Graduate School, Rollins School of Public Health, Global Health Department, Emory University, Atlanta, GA30322, USAKanika AroraDepartment of Otolaryngology and Head Neck Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaKuruswamy Thurai PrasadDepartment of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaManoj BhasinAflac Cancer and Blood Disorders Center, Children Healthcare of Atlanta,Department of Biomedical Informatics, Emory School of Medicine, Atlanta, GA30322Neelam AggarwalProfessor Department Obstetrics and Gynecology PGIMER, Chandigarh, IndiaNiranjan Shiwaji KhaireDepartment of Internal Medicine (Clinical Hematology), Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaNishant JindalDepartment of Internal Medicine (Clinical Hematology), Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaPankaj MalhotraDepartment of Internal Medicine (Clinical Hematology), Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaParminder SinghDepartment of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, IndiaRajesh VijayvergiyaDepartment of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, IndiaRimesh PalDepartment of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaRitin MohindraDepartment of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, IndiaRiya SachdevaDepartment of Pediatrics, Emory School of Medicine, Atlanta, GA30322Rohit MehtaniDepartment of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaRoshan DanielDivision of Neonatology, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, IndiaSanjay Kumar BhadadaDepartment of Endocrinology Post Graduate Institute of Medical Education and Research Chandigarh, India-160012,Simran KaurDepartment of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, IndiaSudhir MehtaDepartment of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, IndiaSunil TanejaDepartment of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, IndiaUdit NarangDepartment of Medicine, MMIMSR, Ambala, Haryana, IndiaVikas MakkarDepartment of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, IndiaVikas SuriDepartment of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Sector 12, Chandigarh, 160012, IndiaVineela ChikkamDepartment of Internal Medicine Southeast Alabama Medical Center Dothan, Alabama, United States of AmericaYara S. BeyhLaney Graduate School, Rollins School of Public Health, Global Health Department, Emory University, Atlanta, GA30322, USA
SARS-CoV-2 and Co-morbidities
Yara S. Beyh1,Riya Sachdeva2,K. M.Venkat Narayan1,Manoj Bhasin2,3,*
1 Laney Graduate School, Rollins School of Public Health, Global Health Department, Emory University, Atlanta, GA30322, USA
2 Department of Pediatrics, Emory School of Medicine,Atlanta, GA30322, USA
3 Aflac Cancer and Blood Disorders Center, Children Healthcare of Atlanta,Department of Biomedical Informatics, Emory School of Medicine,Atlanta, GA30322, USA
Abstract
In December 2019, cases of pneumonia emerged in Wuhan, China, which was indicated to be due to a novel coronavirus called SARS-CoV-2 or COVID-19. This virus shares a lot of similarities with the previous SARS-Cov and MERS-Cov, yet its spread has been recorded to be much faster, with more than 80 million cases and close to 1 million deaths in the USA by March 2022. Further, the CDC has released a list of health conditions that increase the risk of acquiring the virus and its severity by 12-folds. Those conditions include diabetes, cardiovascular diseases, chronic kidney disease, cancer, chronic obstructive pulmonary disease, sickle cell anemia, obesity, and immunocompromised states. The two common mechanisms increasing the susceptibility of patients with any of the aforementioned co-morbidities are 1) increased inflammation causing a “cytokine storm”; and 2) suppressed or delayed immune system response, which is expected to be highly responsive in infections. The “cytokine storm” is characterized by an increased release of cytokines that cause an impaired response of the macrophages and lymphocytes that are expected to be highly responsive under any state of infection. Further, these conditions are known to be states of chronic low-grade inflammation, which adds to the cytokine storm with the suppression of the immune response. This disruption equally influences the involvement of B-cells and T-cells in the resolution of infections. Finally, some conditions may suffer from disturbances at the levels of the respiratory system, such as difficulty breathing, accompanied by respiratory muscles inefficiency and inequality in ventilation perfusion, causing hypoxia and the increased need for mechanical ventilation and ICU admission. The objective of this chapter is to introduce the main chronic conditions mostly influenced by SARS-Cov-2, the severity of the virus, its prevalence among the recorded cases, and the consequence observed at the level of the immune system.
Keywords: B-cells, Cardiovascular diseases, Cancer, Chronic kidney disease, Chronic obstructive pulmonary disease, Co-morbidities, Cytokine storm, Diabetes, ICU-admission, Infection, Mechanical ventilation, Metabolic syndrome, Obesity, Respiratory system, SARS-Cov2, Sickle cell anemia, T-cells, Virus.
*Corresponding author Manoj K. Bhasin: Department of Pediatrics, Emory School of Medicine,Atlanta, GA 30322, USA and Aflac Cancer and Blood Disorders Center, Children Healthcare of Atlanta,Department of Biomedical Informatics, Emory School of Medicine, Atlanta, GA 30322, USA; Tel: 404-712-9849; E-mail: manoj.bhasin@ emory.edu
