Manejo clínico de casos pediátricos de COVID-19
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Keywords
Infecciones por Coronavirus, Pandemias, Pediatría
Resumen
El 9 de enero de 2020 fue anunciado un nuevo virus como la causa de un brote de neumonía grave en Wuhan, China. El 11 de marzo, la Organización Mundial de la Salud declaró la pandemia por SARS-CoV-2, virus causante de la enfermedad COVID-19. El virus se transmite por gotas, contacto y por vía aérea en procedimientos que generan aerosoles. En el caso de los niños, la fuente de contagio casi siempre es un contacto intradomiciliario. En los pacientes pediátricos, la enfermedad tiene un curso leve, incluso en los menores de un año. Los principales síntomas son: fiebre, tos seca o productiva, cefalea, malestar general y dificultad respiratoria, que es un signo de gravedad. El período de incubación es de 1 a 12.5 días (media 5-6). El grupo de edad más afectado son los escolares. La enfermedad puede presentarse como un cuadro leve de infección aguda de vías aéreas superiores o como neumonía. Muy pocos casos progresan a neumonía grave y a complicaciones como síndrome de distrés respiratorio agudo, choque y falla multiorgánica. Aún no hay tratamiento antiviral específico aprobado para su uso en niños. El presente documento tiene como objetivo guiar el manejo de los pacientes pediátricos sospechosos o confirmados de COVID-19.
Referencias
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16. Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh CL, Abiona O, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science 2020;267(6483):1260-63. doi:10.1126/science.abb2507
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19. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected Interim guidance 13 March 2020. Ginebra, Suiza:WHO;2020. Disponible en:https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
20. Jin Y, Cai L, Cheng Z, Cheng H, Deng T, Fan Y, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumoniae (standard version). Military Medical Research. 2020;7:4. doi:10.1186/s40779-020-0233-6
21. Gobierno de México. Secretaria de Salud. Lineamiento estandarizado para la vigilancia epidemiológica y por laboratorio de COVID-19. Ciudad de México, México:Secretaría de Salud;2020. Disponible en:http://cvoed.imss.gob.mx/secretaria-de-salud-lineamiento-estandarizado-para-la-vigilancia-epidemiologica-y-por-laboratorio-de-enfermedad-por-201-ncov
22. Kalil AC. Treating COVID-19—Off-Label Drug Use, Compassionate Use, and Randomized Clinical Trials During Pandemics. JAMA. March 2020. doi:10.1001/jama.2020.4742
23. Smith T, Bushek J, Prosser T. COVID-19 Drug Therapy –Potential Options. Amsterdam, Netherlands:Elsevier;2020. Disponible en:https://www.elsevier.com/__data/assets/pdf_file/0007/98⇈/COVID-19-Drug-Therapy_Mar-2020.pdf
24. Li H, Wang YM, Xu JY, Cao B. [Potential antiviral therapeutics for 2019 Novel Coronavirus]. Chinese Journal of Tuberculosis and Respiratory Diseases. 2020;43(0):E002. doi:10.3760/cma.j.issn.1001-0939.2020.0002.
25. Guangdong Provincial Department of Science and Technology and Guangdong Provincial Health and Health Commission's Multicenter Collaboration Group on Chloroquine Phosphate for New Coronavirus Pneumonia. Expert Consensus on Chloroquine Phosphate for New Coronavirus Pneumonia. Chinese Journal of Tuberculosis and Respiratory Diseases, 2020;43 (2020-02-20). doi:10.3760/cma.j.issn.1001-0939.2020.0019
26. Cortegiani A, Ingoglia G, Ippolito M, Giarrattano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care. 2020;pii:S0883-9441(20)30390-7. doi:10.1016/j.jcrc.2020.03.005
27. Yao TT, Qian JD, Zhu WY, Wang Y, Wang GQ. A Systematic Review of Lopinavir Therapy for SARS Coronavirus and MERS Coronavirus-A Possible Reference for Coronavirus Disease-19 Treatment Option. J Med Virol. 2020;1-8. doi:10.1002/jmv.25729
28. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 2020. doi:10.1056/NEJMoa2001282
29. Xu X, Han M, Li T, Sun W, Wang D, Fu B, et al. Effective Treatment of Severe COVID-19 Patients with Tocilizumab. ChinaXiv:202003.00026v1. Disponible en:https://www.ser.es/wp-content/uploads/2020/03/TCZ-and-COVID-19.pdf
30. Arabi YM, Deeb AM, Al-Hameed F, Mandourah Y, Almekhlafi GA, Sindi AA et al. Macrolides in critically ill patients with Middle East Respiratory Syndrome. Int J Infect Dis. 2019;81:184–190. doi:10.1016/j.ijid.2019.01.041
31. Gautret P, Lagier JC, Parola P, Hoang VT, Medded L, Mailhe M et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19:results of an open-label non-randomized clinical trial. Int J Antimicrob Agent. 2020;105949. doi:10.1016/j.ijantimicag.2020.105949
32. Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J, et al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA. 2020. doi:10.1001/jama.2020.4783
33. Food and Drug Administration. Investigational COVID-19 Convalescent Plasma - Emergency INDs. Maryland, USA:FDA;2020. Disponible en:https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/investigational-covid-19-convalescent-plasma-emergency-inds
34. World Health Organization. Planned or ongoing studies of drugs for the treatment of COVID-19. Geneva, Switzerland:WHO;2020. Disponible en:https://www.who.int/blueprint/priority-diseases/key-action/Table_of_therapeutics_Appendix_17022020.pdf?ua=1
35. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395(10223):473-475. doi:10.1016/S0140-6736(20)30317-2
36. Lee N, Allen-Chan KC, Hui DS, Ng EKO, Wu A, Chiu RWK et al. Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients. J Clin Virol 2004;31(4):304-09. doi:10.1016/j.jcv.2004.07.006
37. Lee DTS, Wing YK, Leung HCM, Sung JJY, Ng YK, Yiu GC et al. Factors associated with psychosis among patients with severe acute respiratory syndrome:a case-control study. Clin Infect Dis. 2004;39(8):1247-49. doi:10.1086/424016
38. Xiao JZ, Ma L, Gao J, Yang ZJ, Xing XY, Zhao HC et al. [Glucocorticoid-induced diabetes in severe acute respiratory syndrome:the impact of high dosage and duration of methylprednisolone therapy]. Zhonghua Nei Ke Za Zhi 2004;43(3):179-82. doi:https://www.ncbi.nlm.nih.gov/pubmed/15059370
39. Li YM, Wang SX, Gao HS, Wang JG, Wei CS, Chen LM et al. Factors of avascular necrosis of femoral head and osteoporosis in SARS patients'convalescence. Zhonghua Yi Xue Za Zhi. 2004;84(16):1348-53. Disponible en:https://www.researchgate.net/publication/8326988_Factors_of_avascular_necrosis_of_femoral_head_and_osteoporosis_in_SARS_patients'_convalescence
40. Ni YN, Chen G, Sun J, Liang BM, Liang ZA. The effect of corticosteroids on mortality of patients with influenza pneumonia:a systematic review and meta-analysis. Crit Care. 2019;23(1):99. doi:10.1186/s13054-019-2395-8.
41. McGee S, Hirschmann J. Use of corticosteroids in treating infectious diseases. Arch Intern Med. 2008;168(10):1034-46. doi:10.1001/archinte.168.10.1034.
42. Corneli HM, Zorc JJ, Mahajan P, Shaw KN, Holubkov R, Reeves SD et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med. 2007;357(4):331-39. doi:10.1056/NEJMoa071255
43. Shang L, Zhao J, Hu Y, Du R, Cao B. On the use of corticosteroids for 2019-nCoV pneumonia. Lancet. 2020;395(10225):683-684. doi:10.1016/S0140-6736(20)30361-5
44. Chen RC, Tang XP, Tan SY, Liang BL, Wan ZY, Fang JQ et al. Treatment of severe acute respiratory syndrome with glucosteroids:the Guangzhou experience. Chest 2006;129(6):1441-52. doi:10.1378/chest.129.6.1441
45. Li H, Yang SG, Gu L, Zhang Y, Yan X, Liang X et al. Effect of low-to moderate-dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia. Influenza Other Respir Viruses. 2017;11(4):345-54. doi:10.1111/irv.12456
46. Zhao JP, Hu Y, Du RH, Chen ZS, Jin Y, Zhou M et al. [Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(0):E007. doi:10.3760/cma.j.issn.1001-0939.2020.0007
47. Van Dorelamen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN et al. Aerosol and Surface Stability of SARS- CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020. doi:10.1056/NEJMc2004973
48. World Health Organization. Modes of transmission of virus causing COVID-19:implications for IPC precaution recommendations. Geneve, Switzerland:WHO;2020. Disponible en:https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations
2. Aragón-Nogales R, Vargas-Almanza I, Miranda-Novales MG. COVID-19 por SARS- CoV-2:la nueva emergencia de salud. Rev Mex Pediatr. 2019;86(6):213-218. doi:10.35366/91871
3. World Health Organization. Coronavirus disease 2019 (COVID-19) Situation report 85. Ginebra, Suiza:WHO;2020. Disponible en:https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200414-sitrep-85-covid-19.pdf?sfvrsn=7b8629bb_2
4. Secretaría de Salud. Comunicado Técnico diario. Nuevo Coronavirus en el mundo (COVID-19). Ciudad de México, México:Secretaría de Salud;2020 https://www.gob.mx/cms/uploads/attachment/file/546675/Comunicado_Tecnico_Diario_COVID-19_2020.04.14.pdf (fecha de acceso 14 de abril de 2020)
5. World Health Organization. Critical preparedness, readiness and response actions for COVID-19 Interim guidance. Ginebra, Suiza:WHO;2020. Disponible en:https://www.who.int/publications-detail/critical-preparedness-readiness-and-response-actions-for-covid-19
6. Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang Z. Novel Coronavirus infection in hospitalized infants under 1 year of age in China. JAMA. 2020;323(13):1313-1314. doi:10.1001/jama.2020.2131
7. Cai J, Xu J, Lin D, Yang z, Xu L, Qu Z et al. A Case Series of children with 2019 novel coronavirus infection:clinical and epidemiological features. Clin Infect Dis. 2020 Feb 28. pii:ciaa198. doi:10.1093/cid/ciaa198
8. Dong Y, Mo X, Hu Y, Qi X Jiang F, Jiang, Z. Epidemiological characteristics of 2143 pediatric patients with 2019 Coronavirus Disease in China. Pediatrics. 2020;16:16. doi:10.1542/peds.2020-0702
9. Ludvigsson JF. Systematic review of COVID-19 in children show milder cases and a better prognosis than adults. Acta Paediatr March. 2020. doi:10.1111/apa.15270
10. Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. JAMA 2020. doi:10.1001/jama.2020.4344
11. Centers for Disease Control and Prevention. Severe outcomes among patients with Coronavirus Disease 2019 (COVID-19) - United States, February 12-March 16, 2020. (CDC COVID-19 Response Team). MMWR Morb Mortal Wkly Rep. 2020;69(12):343-346. Disponible en:https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm
12. Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection:Different points from adults. Pediatric Pulmonology. 2020;1-6. doi:10.1002/ppul.24718
13. Tang A, Xu W, Shen M, Cheng P, Li G, Liu Y, et al. A retrospective study of clinical characteristics of COVID-19 infection in 26 children. MedRxiv. 2020. doi:10.1101/2020.03.08.20029710
14. Lu X, Zhang L, Du H, Zhang J, Li YY, Zhang W, et al. SARS CoV-2 infection in children. N Engl J Med. 2020 doi:10.1056/NEJMc2005073
15. Sun D, Li H, Lu XX, Xiao H, Ren J, Zhang FR, Liu ZS. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan:a single center´s observational study. World J Pediatr. 2020. doi:10.1007/s12519-020-00354-4
16. Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh CL, Abiona O, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science 2020;267(6483):1260-63. doi:10.1126/science.abb2507
17. Simon AK, Hollander GA, McMichael A. Evolution of the immune system in humans from infancy to old age. Proc Biol Sci. 2015;282(1821):20143085. doi:10.1098/rapb.2014.3085
18. Méndez-Echevarría A, Calvo C, del Rosal T, Baquero-Artigao F, Neth O, Epalza C, et al. Recomendaciones de tratamiento específico en caso de infección respiratoria por SARS- CoV2 en pacientes pediátricos con enfermedades crónicas de alto riesgo y en pacientes hospitalizados. Documento de manejo clínico del paciente pediátrico con infección por SARS-CoV-2. Madrid, España:Asociación Española de Pediatría:Marzo, 2020. Disponible en:https://www.aeped.es/sites/default/files/protocolo_seip_aep_secip_trata_miento_especifico_21.03.20.pdf
19. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected Interim guidance 13 March 2020. Ginebra, Suiza:WHO;2020. Disponible en:https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
20. Jin Y, Cai L, Cheng Z, Cheng H, Deng T, Fan Y, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumoniae (standard version). Military Medical Research. 2020;7:4. doi:10.1186/s40779-020-0233-6
21. Gobierno de México. Secretaria de Salud. Lineamiento estandarizado para la vigilancia epidemiológica y por laboratorio de COVID-19. Ciudad de México, México:Secretaría de Salud;2020. Disponible en:http://cvoed.imss.gob.mx/secretaria-de-salud-lineamiento-estandarizado-para-la-vigilancia-epidemiologica-y-por-laboratorio-de-enfermedad-por-201-ncov
22. Kalil AC. Treating COVID-19—Off-Label Drug Use, Compassionate Use, and Randomized Clinical Trials During Pandemics. JAMA. March 2020. doi:10.1001/jama.2020.4742
23. Smith T, Bushek J, Prosser T. COVID-19 Drug Therapy –Potential Options. Amsterdam, Netherlands:Elsevier;2020. Disponible en:https://www.elsevier.com/__data/assets/pdf_file/0007/98⇈/COVID-19-Drug-Therapy_Mar-2020.pdf
24. Li H, Wang YM, Xu JY, Cao B. [Potential antiviral therapeutics for 2019 Novel Coronavirus]. Chinese Journal of Tuberculosis and Respiratory Diseases. 2020;43(0):E002. doi:10.3760/cma.j.issn.1001-0939.2020.0002.
25. Guangdong Provincial Department of Science and Technology and Guangdong Provincial Health and Health Commission's Multicenter Collaboration Group on Chloroquine Phosphate for New Coronavirus Pneumonia. Expert Consensus on Chloroquine Phosphate for New Coronavirus Pneumonia. Chinese Journal of Tuberculosis and Respiratory Diseases, 2020;43 (2020-02-20). doi:10.3760/cma.j.issn.1001-0939.2020.0019
26. Cortegiani A, Ingoglia G, Ippolito M, Giarrattano A, Einav S. A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care. 2020;pii:S0883-9441(20)30390-7. doi:10.1016/j.jcrc.2020.03.005
27. Yao TT, Qian JD, Zhu WY, Wang Y, Wang GQ. A Systematic Review of Lopinavir Therapy for SARS Coronavirus and MERS Coronavirus-A Possible Reference for Coronavirus Disease-19 Treatment Option. J Med Virol. 2020;1-8. doi:10.1002/jmv.25729
28. Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 2020. doi:10.1056/NEJMoa2001282
29. Xu X, Han M, Li T, Sun W, Wang D, Fu B, et al. Effective Treatment of Severe COVID-19 Patients with Tocilizumab. ChinaXiv:202003.00026v1. Disponible en:https://www.ser.es/wp-content/uploads/2020/03/TCZ-and-COVID-19.pdf
30. Arabi YM, Deeb AM, Al-Hameed F, Mandourah Y, Almekhlafi GA, Sindi AA et al. Macrolides in critically ill patients with Middle East Respiratory Syndrome. Int J Infect Dis. 2019;81:184–190. doi:10.1016/j.ijid.2019.01.041
31. Gautret P, Lagier JC, Parola P, Hoang VT, Medded L, Mailhe M et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19:results of an open-label non-randomized clinical trial. Int J Antimicrob Agent. 2020;105949. doi:10.1016/j.ijantimicag.2020.105949
32. Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J, et al. Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma. JAMA. 2020. doi:10.1001/jama.2020.4783
33. Food and Drug Administration. Investigational COVID-19 Convalescent Plasma - Emergency INDs. Maryland, USA:FDA;2020. Disponible en:https://www.fda.gov/vaccines-blood-biologics/investigational-new-drug-ind-or-device-exemption-ide-process-cber/investigational-covid-19-convalescent-plasma-emergency-inds
34. World Health Organization. Planned or ongoing studies of drugs for the treatment of COVID-19. Geneva, Switzerland:WHO;2020. Disponible en:https://www.who.int/blueprint/priority-diseases/key-action/Table_of_therapeutics_Appendix_17022020.pdf?ua=1
35. Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet. 2020;395(10223):473-475. doi:10.1016/S0140-6736(20)30317-2
36. Lee N, Allen-Chan KC, Hui DS, Ng EKO, Wu A, Chiu RWK et al. Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients. J Clin Virol 2004;31(4):304-09. doi:10.1016/j.jcv.2004.07.006
37. Lee DTS, Wing YK, Leung HCM, Sung JJY, Ng YK, Yiu GC et al. Factors associated with psychosis among patients with severe acute respiratory syndrome:a case-control study. Clin Infect Dis. 2004;39(8):1247-49. doi:10.1086/424016
38. Xiao JZ, Ma L, Gao J, Yang ZJ, Xing XY, Zhao HC et al. [Glucocorticoid-induced diabetes in severe acute respiratory syndrome:the impact of high dosage and duration of methylprednisolone therapy]. Zhonghua Nei Ke Za Zhi 2004;43(3):179-82. doi:https://www.ncbi.nlm.nih.gov/pubmed/15059370
39. Li YM, Wang SX, Gao HS, Wang JG, Wei CS, Chen LM et al. Factors of avascular necrosis of femoral head and osteoporosis in SARS patients'convalescence. Zhonghua Yi Xue Za Zhi. 2004;84(16):1348-53. Disponible en:https://www.researchgate.net/publication/8326988_Factors_of_avascular_necrosis_of_femoral_head_and_osteoporosis_in_SARS_patients'_convalescence
40. Ni YN, Chen G, Sun J, Liang BM, Liang ZA. The effect of corticosteroids on mortality of patients with influenza pneumonia:a systematic review and meta-analysis. Crit Care. 2019;23(1):99. doi:10.1186/s13054-019-2395-8.
41. McGee S, Hirschmann J. Use of corticosteroids in treating infectious diseases. Arch Intern Med. 2008;168(10):1034-46. doi:10.1001/archinte.168.10.1034.
42. Corneli HM, Zorc JJ, Mahajan P, Shaw KN, Holubkov R, Reeves SD et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med. 2007;357(4):331-39. doi:10.1056/NEJMoa071255
43. Shang L, Zhao J, Hu Y, Du R, Cao B. On the use of corticosteroids for 2019-nCoV pneumonia. Lancet. 2020;395(10225):683-684. doi:10.1016/S0140-6736(20)30361-5
44. Chen RC, Tang XP, Tan SY, Liang BL, Wan ZY, Fang JQ et al. Treatment of severe acute respiratory syndrome with glucosteroids:the Guangzhou experience. Chest 2006;129(6):1441-52. doi:10.1378/chest.129.6.1441
45. Li H, Yang SG, Gu L, Zhang Y, Yan X, Liang X et al. Effect of low-to moderate-dose corticosteroids on mortality of hospitalized adolescents and adults with influenza A(H1N1)pdm09 viral pneumonia. Influenza Other Respir Viruses. 2017;11(4):345-54. doi:10.1111/irv.12456
46. Zhao JP, Hu Y, Du RH, Chen ZS, Jin Y, Zhou M et al. [Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia]. Zhonghua Jie He He Hu Xi Za Zhi. 2020;43(0):E007. doi:10.3760/cma.j.issn.1001-0939.2020.0007
47. Van Dorelamen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN et al. Aerosol and Surface Stability of SARS- CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020. doi:10.1056/NEJMc2004973
48. World Health Organization. Modes of transmission of virus causing COVID-19:implications for IPC precaution recommendations. Geneve, Switzerland:WHO;2020. Disponible en:https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations
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Cómo citar
1.
Montaño-Luna VE, Pacheco-Rosas DO, Vázquez-Rosales JG, Labra-Zamora MG, Fuentes-Pacheco Y, Sámano-Aviña M, et al. Manejo clínico de casos pediátricos de COVID-19. Rev Med Inst Mex Seguro Soc [Internet]. 2021 Oct. 15 [cited 2025 Jul. 17];58(Supl 2):S246-259. Available from: https://revistamedica.imss.gob.mx/index.php/revista_medica/article/view/3702