A Comparative Systematic Review of COVID-19 and Influenza
Abstract
:1. Introduction
2. Methods
3. Results
3.1. Included Citations in the COVID-19 vs. Influenza Review
3.2. Studies in Patients with COVID-19 and Influenza
3.2.1. Demographic and Clinical Findings
3.2.2. Laboratory Findings
3.2.3. Radiological Findings
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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References | Country | Study Type ** | Number of Patients/Studies * (COVID-19 vs. Influenza) |
---|---|---|---|
Jordan Cates et al. [6] | United States | Cohort | 9401 (3948 vs. 5453) |
Ying Luo et al. [7] | China (Hubei) | Cohort | 2167 (1027 vs. 1140) |
Jiangnan Chen et al. [8] | China (Shaoxing) | Case-Control | 380 (169 vs. 131; 80 healthy controls) |
Jiajia Qu et al. [9] | China | Retrospective Cohort | 366 (246 vs. 120) |
Jianguo Zhang et al. [10] | China | Retrospective cohort | 326 (211 vs. 115) |
Helene Faury et al. [11] | France (Paris) | Retrospective | 200 (100 vs. 100) |
Pengfei Li et al. * [5] | - | Systematic review and Meta-analysis | 197 (113 vs. 84) |
Mengqi Liu et al. [12] | China (Chongqing) | Retrospective | 180 (122 vs. 48) |
Xiao Tang et al. [13] | China (Wuhan) | Retrospective case-control | 148 (73 vs. 75) |
Natalie L. Cobb et al. [14] | United States (Washington) | Retrospective Cohort | 139 (65 vs. 74) |
Souheil Zayet et al. [15] | France | Retrospective | 124 (70 vs. 54) |
Hao Wang et al. [16] | China | Retrospective | 105 (13 vs. 92) |
Liaoyi Lin et al. [17] | China (Wenzhou) | Retrospective | 97 (52 vs. 45) |
Raija Auvinen et al. [18] | Finland | Prospective study | 61 (28 vs. 33) |
Zhilan Yin et al. [19] | China | Retrospective | 60 (30 vs. 30) |
Yi-Hua Lin et al. [20] | China (Xiamen) | A cross-sectional retrospective study | 57 (35 vs. 22) |
Jaehee Lee et al. [21] | South Korea (Daegu) | Retrospective | 29 (20 vs. 09) |
Stephen O. Onigbinde et al. * [3] | - | Review | 17 (09 vs. 08) |
References | Significant Clinical Features/Outcome | COVID-19 (%) | Influenza (%) | p-Value < 0.05 |
---|---|---|---|---|
Jordan Cates et al. [6] | Admitted to ICU | 36.5 | 17.6 | <0.001 |
Hospital mortality | 21 | 3.8 | <0.001 | |
Duration of hospitalization (median days, [IQR]) | 8.6 [3.9–18.6] | 3.0 [1.8–6.5] | <0.001 | |
Jiajia Qu et al. [9] | Fever | 78.5 | 89.2 | <0.05 |
Persistent fever | 50.4 | 74.2 | <0.01 | |
Jianguo Zhang et al. [10] | Cough | 69.7 | 86.1 | 0.001 |
Expectoration | 22.7 | 74.8 | <0.001 | |
Dyspnea | 14.7 | 27.8 | 0.004 | |
Chest pain | 13.7 | 27.8 | 0.002 | |
Vomiting | 1.4 | 9.6 | <0.001 | |
Helene Faury et al. [11] | Chronic pulmonary diseases | 12.0 | 27.0 | 0.01 |
Overweight/Obesity | 40.8 | 25.0 | 0.02 | |
Median BMI | 27.3 | 24.8 | 0.04 | |
Fatigue | 63.6 | 39.0 | 0.0006 | |
Diarrhea | 25.8 | 13.0 | 0.03 | |
Faintness | 12.1 | 3.0 | 0.02 | |
Anosmia/Ageusia | 7.0 | 0 | 0.01 | |
Sputum production | 12.0 | 36.0 | 0.0001 | |
Nasal Congestion | 8.3 | 21 | 0.02 | |
Secondary respiratory failure | 21.0 | 0 | <0.0001 | |
Acute Kidney failure | 17.0 | 7.0 | 0.048 | |
Pulmonary embolism | 6.0 | 0 | 0.03 | |
Heart congestion | 2.0 | 14.0 | 0.003 | |
Admitted to ICU | 31.0 | 12.0 | 0.002 | |
Duration of hospitalization (days, [IQR]) | 10 [4–17] | 4 [1–11] | <0.0001 | |
Oxygen therapy | 65.0 | 42.3 | 0.002 | |
Mortality rate | 20.0 | 5.0 | 0.002 | |
Pengfei Li et al. [5] | Cardiovascular disease/Hypertension | 28.76 | 14.11 | <0.0001 |
Diabetes | 16.38 | 11.12 | 0.012 | |
Asthma | 8.42 | 16.09 | 0.0033 | |
Chronic Obstructive Pulmonary disease | 4.93 | 9.52 | 0.0003 | |
Immunocompromised conditions | 4.39 | 9.99 | <0.0001 | |
Fever | 72.08 | 89.99 | <0.0001 | |
Cough | 57.99 | 85.31 | <0.0001 | |
Shortness of breath | 32.89 | 49.19 | 0.0249 | |
Rhinorrhea | 8.48 | 38.57 | <0.0001 | |
Sore throat | 9.48 | 37.28 | <0.0001 | |
Myalgia/Muscle pain | 18.97 | 30.12 | 0.0242 | |
Vomiting | 8.67 | 24.27 | <0.0001 | |
Mengqi Liu et al. [12] | Stuffy and runny nose | 7 | 23 | 0.002 |
Xiao Tang et al. [13] | Productive cough | 53.4 | 78.7 | 0.002 |
Fatigue | 63 | 18.7 | <0.001 | |
GI symptoms | 37 | 6.7 | <0.001 | |
Myalgia | 34.2 | 14.7 | 0.007 | |
Natalie L. Cobb et al. [14] | ARDS | 63 | 26 | <0.001 |
Hospital mortality | 40 | 19 | 0.006 | |
Souheil Zayet et al. [15] | Frontal headache | 25.7 | 9.3 | 0.021 |
Retro-orbital or temporal headache | 18.6 | 3.7 | 0.013 | |
Fever | 75.7 | 92.6 | 0.042 | |
Anosmia | 52.9 | 16.7 | <0.001 | |
Dysgeusia | 48.6 | 20.4 | 0.001 | |
Diarrhea | 40 | 20.4 | 0.021 | |
Sputum Production | 28.6 | 51.9 | 0.01 | |
Sneezing | 18.6 | 46.3 | 0.001 | |
Dyspnea | 34.3 | 59.3 | 0.007 | |
Sore throat | 20 | 44.4 | 0.006 | |
Conjunctival hyperemia | 4.3 | 29.6 | <0.001 | |
Tearing | 5.7 | 24.1 | 0.004 | |
Vomiting | 2.8 | 22.2 | 0.001 | |
Crackling sound | 38.6 | 20.4 | 0.032 | |
Ronchi sounds | 1.4 | 16.7 | 0.002 | |
Hao Wang et al. [16] | Cough | 30.8 | 82.6 | 0 |
Raija Auvinen et al. [18] | Pulmonary Diseases | 18 | 45 | 0.03 |
Current smoking | 4 | 30 | 0.008 | |
Headache | 85 | 52 | 0.004 | |
ARDS | 93 | 58 | 0.003 | |
ICU admission | 29 | 6 | 0.034 | |
Duration of hospitalization (days, [IQR]) | 6 [4–21] | 3 [2–4] | <0.001 | |
Zhilan Yin et al. [19] | Cough | 73.3 | 96.7 | 0.026 |
Expectoration | 43.3 | 80 | 0.007 | |
Yi-Hua Lin et al. [20] | Fever 38.0 °C–38.9 °C | 43 | 32 | 0.014 |
Fever ≥39.0 °C | 11 | 45 | 0.014 | |
Cough | 51 | 100 | <0.001 | |
Expectoration | 28 | 91 | <0.001 | |
Dyspnea | 9 | 59 | <0.001 | |
Chills | 23 | 55 | 0.015 | |
Jaehee Lee et al. [21] | Median heart rate (bpm) | 83 | 107 | 0.017 |
References | Significant Laboratory Findings | COVID-19 (%) | Influenza (%) | p-Value < 0.05 |
---|---|---|---|---|
Ying Luo et al. [7] | White blood cell count (×109 /L, median, [IQR]) | 5.45 [4.46–7.17] | 6.14 [4.66–8.24] | <0.001 |
Neutrophil (×109 /L, median, [IQR])) | 3.68 [2.68–5.16] | 4.09 [2.85–6.11] | <0.001 | |
Lymphocyte (%, median, [IQR]) | 22.0 [14.6–29.4] | 20.5 [13.3–28.6] | 0.009 | |
Monocyte (×109 /L, median, [IQR]) | 0.47 [0.34–0.61] | 0.52 [0.37–0.69] | <0.001 | |
Eosinophil (×109 /L, median, [IQR]) | 0.01 [0.00–0.05] | 0.02 [0.00–0.07] | <0.001 | |
Eosinophil (%, median, [IQR]) | 0.2 [0.0–2.9] | 0.3 [0.0–1.2] | <0.001 | |
Basophil (%, median, [IQR]) | 0.2 [0.0–0.3] | 0.2 [0.1–0.3] | <0.001 | |
Red blood cell count (×1012 /L, median, [IQR]) | 4.43 [4.00–4.84] | 4.37 [3.96–4.78] | 0.012 | |
Hemoglobin (g/L, median, [IQR]) | 134 [122–146] | 131 [119–143] | <0.001 | |
Hematocrit (%, median, [IQR]) | 39.7 [36.2–43.1] | 39.1 [35.5–42.4] | 0.002 | |
MCV (fL, median, [IQR]) | 89.1 [86.4–91.7] | 89.6 [86.7–92.4] | 0.003 | |
MCH (pg, median, [IQR]) | 30.6 [29.5–31.6] | 30.4 [29.3–31.3] | 0.002 | |
MCHC (g/L, median, [IQR]) | 343 [335–351] | 337 [329–346] | <0.001 | |
RDW-CV (Median, [IQR]) | 12.2 [11.9–12.8] | 12.5 [12.0–13.2] | <0.001 | |
RDW-SD (fL, median, [IQR]) | 39.5 [37.8–41.8] | 40.9 [38.8–43.2] | <0.001 | |
PDW (fL, median, [IQR]) | 12.0 [10.8–13.6] | 12.3 [11.0–13.9] | 0.021 | |
Alanine aminotransferase (U/L, median, [IQR]) | 25 [18–38] | 24 [16–36] | 0.019 | |
Aspartate aminotransferase (U/L, median, [IQR]) | 27 [21–36] | 25 [19–35] | <0.001 | |
Total Protein (g/L, mean) | 69.3 ± 5.6 | 68.5 ± 6.4 | 0.003 | |
Globulin (g/L, median, [IQR]) | 32.4 ± 4.4 | 31.8 ± 4.8 | <0.001 | |
Indirect Bilirubin (μmol/L, median, [IQR]) | 5.5 [4.2–7.3] | 4.9 [3.8–6.9] | <0.001 | |
GGT (U/L, median, [IQR]) | 30 [21–48] | 35 [21–54] | 0.003 | |
Alkaline Phosphatase (U/L, median, [IQR]) | 65 [56–78] | 75 [63–96] | <0.001 | |
LDH (U/L, median, [IQR]) | 260 [217–327] | 235 [196–298] | <0.001 | |
Triglyceride (mmol/L, median, [IQR]) | 1.75 ± 088 | 1.63 ± 0.84 | <0.001 | |
HDL-C (mmol/L, median, [IQR]) | 0.99 ± 0.19 | 0.97 ± 0.22 | 0.002 | |
LDL-C (mmol/L, median, [IQR]) | 2.45 ± 0.55 | 2.41 ± 0.68 | 0.004 | |
Creatinine (μmol/L, median, [IQR]) | 72 [61–87] | 69 [59–82] | <0.001 | |
Urea (mmol/L, median, [IQR]) | 5.89 ± 3.84 | 5.54 ± 3.41 | 0.001 | |
Uric acid (μmol/L, median, [IQR]) | 253 [206–313] | 260 [219–304] | 0.031 | |
Calcium (mmol/L, median, [IQR]) | 2.14 ± 0.11 | 2.17 ± 0.11 | <0.001 | |
Magnesium (mmol/L, median, [IQR]) | 0.87 ± 0.07 | 0.86 ± 0.09 | 0.001 | |
Chlorine (mmol/L, median, [IQR]) | 100.4 ± 4.2 | 101.4 ± 3.7 | <0.001 | |
Potassium (mmol/L, median, [IQR]) | 4.21 ± 0.42 | 4.15 ± 0.40 | <0.001 | |
Sodium (mmol/L, median, [IQR]) | 139.7 ±3.9 | 139.1 ± 3.4 | <0.001 | |
Phosphate (mmol/L, median, [IQR]) | 1.04 ± 0.26 | 1.05 ± 0.20 | 0.002 | |
HCO3 (mmol/L, median, [IQR]) | 24.5 ± 2.9 | 24.0 ± 3.1 | <0.001 | |
Hypersensitive CRP (mg/L, median, [IQR]) | 20.0 [5.8–45.8] | 15.7 [4.8–40.1] | 0.024 | |
ESR (mm/h, median, [IQR]) | 35 [24–47] | 27 [17–40] | <0.001 | |
Prothrombin time (s, mean) | 14.06 ± 1.09 | 14.09 ± 1.83 | <0.001 | |
APTT (s, mean) | 39.9 ± 4.5 | 39.6 ± 5.0 | 0.02 | |
Thrombin time (s, mean) | 16.9 ± 1.4 | 16.6 ± 2.0 | <0.001 | |
Prothrombin activity (%, mean) | 91 ± 11 | 92 ± 14 | <0.001 | |
Fibrinogen (g/L, mean) | 4.71 ± 1.08 | 4.27 ± 1.18 | <0.001 | |
D-Dimer (mg/L, median, [IQR]) | 1.24 [0.65–2.75] | 1.72 [0.85–3.30] | <0.001 | |
Jiangnan Chen et al. [8] | Monocyte (×109 /L, median, [IQR]) | 0.36 [0.28–0.48] | 0.55 [0.4–0.71] | 0 |
Monocyte (%, median, [IQR]) | 7.60 [6.20–9.95] | 9.0 [7.20–11.40] | 0 | |
Neutrophil (×109 /L, median, [IQR]) | 2.93 [2.26–3.79] | 4.26 [3.00–5.74] | 0 | |
Neutrophil (%, mean) | 64.50 ± 11.64 | 68.42 ± 14.69 | 0.011 | |
Lymphocyte (%, mean) | 26.30 ± 10.52 | 21.07 ± 12.85 | 0 | |
Eosinophil (%, median, [IQR]) | 0.60 [0.30–1.15] | 0.40 [0.10–1.10] | 0.038 | |
Basophil (%, median, [IQR]) | 0.20 [0.10–0.30] | 0.10 [0.10–0.30] | 0.001 | |
Jiajia Qu et al. [9] | Elevated lymphocyte | 0 | 5 | <0.01 |
Abnormal Urinary test | 32.11 | 21.67 | <0.05 | |
Urine protein positive | 16.26 | 8.33 | <0.05 | |
Elevated procalcitonin | 40.83 | 10.98 | <0.01 | |
Elevated white blood cells | 75 | 26.83 | <0.01 | |
Jianguo Zhang et al. [10] | Leukocytosis > 9.5 × 109 /L | 16.1 | 30.4 | 0.003 |
Neutrophilia > 75% | 32.2 | 50.4 | 0.001 | |
Lymphocytopenia < 20% | 46.9 | 68.7 | <0.001 | |
Creatine Kinase > 25 U/L | 11.8 | 3.5 | 0.013 | |
Helene Faury et al. [11] | White Blood cell count (G/L, median, [IQR]) | 5.88 [4.41–7.68] | 6.72 [5.15–9.42] | 0.01 |
Neutrophil (G/L, median, [IQR]) | 4.11 [2.99–5.65] | 5.06 [3.43–7.25] | 0.02 | |
Platelets (G/L, median, [IQR]) | 179 [145–225] | 199 [168–239] | 0.04 | |
Sodium (U/L, median, [IQR])) | 137 [135–139] | 138 [136–140] | 0.006 | |
Troponin (ng/L, median, [IQR]) | 9.2 [6.5–22.4] | 34.4 [8.8–72.2] | 0.007 | |
Albumin (g/L, median, [IQR]) | 30 [27–33] | 37 [33–39] | 0.04 | |
Aspartate aminotransferase (U/L, median, [IQR]) | 45 [34–76] | 34 [29–49] | 0.02 | |
LDH (U/L, median, [IQR]) | 397 [305–544] | 298 [248–383] | 0.04 | |
Xiao Tang et al. [13] | PaO2/FiO2 (Median, mm Hg) | 198.5 | 107 | <0.001 |
Aspartate transaminase (U/L) | 25.5 | 70 | <0.001 | |
LDH (U/L) | 483 | 767 | <0.001 | |
Troponin I (ng/mL) | 0.03 | 0.14 | <0.001 | |
CD3+ (Median, cells/mL) | 193 | 303 | 0.007 | |
CD4+/CD3+ (Median, cells/mL) | 97 | 185 | <0.001 | |
Natalie L. Cobb et al. [14] | White blood cells at admission (median, [IQR]) | 7240 [5430–11,820] | 9035 [6590–14,900] | 0.007 |
Neutrophil at admission (median, [IQR]) | 5405 [3880–9580] | 7210 [4990–11,890] | 0.02 | |
Early sputum cultures (positive) | 27.2 | 72.2 | 0.005 | |
Raija Auvinen et al. [18] | Leukocytes count ×109 /L (Median, [IQR]) | 5.1 (4.0–6.3) | 6.7 (5.4–10.9) | 0.002 |
Leukocytosis | 11 | 39 | 0.019 | |
Thrombocytopenia < 150 × 109 /L | 39 | 12 | 0.019 | |
Alanine aminotransferase (U/L, [IQR]) | 42 [19–127] | 23 [12–123] | 0.011 | |
Zhilan Yin et al. [19] | Neutrophil (×109 cells/L, median, [IQR]) | 3.57 [2.72–4.92] | 4.75 [3.15–7.00] | 0.037 |
Procalcitonin (ng/mL, median, [IQR]) | 0.04 [0.03–0.09] | 0.11 [0.09–0.37] | 0.002 | |
Yi-Hua Lin et al. [20] | White blood cells (×109 cells/L, mean) | 4.87 ± 2.04 | 7.59 ± 5.12 | 0.026 |
Leukocytosis | 3 | 32 | 0.002 | |
Neutrophil (×109 /L, mean) | 3.16 ± 1.73 | 6.20 ± 4.84 | 0.009 | |
Lymphocyte (×109 /L, mean) | 1.19 ± 0.59 | 0.88 ± 0.52 | 0.049 | |
Anemia | 0 | 41 | <0.001 | |
CRP (mg/L, median, [IQR])) | 9.56 [3.82–22.42] | 55.3 [33.97–102.77] | 0.001 | |
Procalcitonin (ng/L, median, [IQR]) | 0.05 [0.05–0.06] | 0.25 [0.08–2.28] | <0.001 | |
Urea Nitrogen (mmol/L, mean) | 3.76 ± 1.37 | 6.36 ± 3.30 | 0.002 | |
LDH (U/L, median, [IQR])) | 158.0 [142.0–196.0] | 243.5 [198.3–328.8] | <0.001 | |
PaO2/FiO2 < 200 mm Hg | 4 | 22 | 0.022 | |
Jaehee Lee et al. [21] | White blood cell (Median, cells/uL) | 7470 | 2680 | 0.027 |
References | Significant Radiological Findings | COVID-19 (%) | Influenza (%) | p-Value < 0.05 |
---|---|---|---|---|
Jianguo Zhang et al. [10] | Rounded opacities | 37.9 | 19.1 | <0.001 |
Bronchiolar wall thickening | 33.6 | 13 | <0.0001 | |
Air bronchogram | 29.9 | 13 | <0.001 | |
Consolidation | 26.1 | 15.7 | 0.031 | |
Interlobular septal thickening | 24.2 | 13.9 | 0.029 | |
Crazy paving pattern | 22.3 | 9.6 | 0.004 | |
Tree-in-bud | 13.7 | 5.2 | 0.018 | |
GGO with consolidation | 25.6 | 39.1 | 0.011 | |
Helene Faury et al. [11] | Pulmonary nodules | 8.8 | 50.0 | 0.001 |
Mengqi Liu et al. [12] | Predominant distribution: | |||
– Central | 2 | 6 | 0.022 | |
– Peripheral | 45 | 20 | ||
– Mixed | 53 | 74 | ||
Interlobular septal thickening | 66 | 43 | 0.014 | |
Rounded opacities | 35 | 17 | 0.048 | |
Nodules | 28 | 71 | <0.001 | |
Tree-in-bud | 9 | 40 | <0.001 | |
Pleural effusion | 6 | 31 | <0.001 | |
Pure GGO without nodules | 29 | 11 | <0.001 | |
Pure GGO + interlobular septal thickening | 21 | 6 | 0.042 | |
Rounded opacities without nodules | 22 | 0 | 0.002 | |
Interlobular septal thickening without nodules | 45 | 6 | <0.001 | |
Rounded opacities + interlobular septal thickening + absence of pleural effusion | 19 | 3 | 0.021 | |
Xiao Tang et al. [13] | GGO | 94.5 | 45.3 | <0.001 |
Consolidation | 28.8 | 45.3 | 0.042 | |
Natalie L Cobb et al. [14] | Bilateral opacities | 90 | 52 | <0.001 |
Hao Wang et al. [16] | Lesion Distribution: | |||
– Central | 7.7 | 75 | 0.000 | |
– Peripheral | 38.5 | 3.3 | ||
– Diffuse | 0 | 21.7 | ||
– Non-specific | 53.8 | 0 | ||
Lobe predomination: | ||||
– Superior lobe | 23.1 | 23.9 | 0.001 | |
– Inferior lobe | 15.4 | 57.6 | ||
– Middle lobe | 7.7 | 7.6 | ||
– Balanced predomination | 53.8 | 10.9 | ||
Lesion margin: | ||||
– Clear | 46.2 | 10.9 | 0.004 | |
– Vague | 53.8 | 89.1 | ||
GGO Involvement pattern: | ||||
– Patchy | 38.5 | 5.4 | 0.000 | |
– Cluster like | 7.7 | 77.2 | ||
– GGO + consolidation opacities | 46.2 | 6.5 | ||
– Whole consolidation | 7.7 | 10.9 | ||
Lesion Contour: | ||||
– Shrinking | 69.2 | 1.1 | 0.000 | |
– Non-shrinking | 30.8 | 98.9 | ||
Bronchial wall thickening | 0 | 32.6 | 0.018 | |
Liaoyi Lin et al. [17] | Close to the pleura | 69 | 40 | 0.005 |
Mucoid impaction | 2 | 13 | 0.047 | |
Pleural effusion | 0 | 22 | <0.001 | |
Axial distribution: | ||||
– Inner | 6 | 7 | <0.001 | |
– Outer | 67 | 24 | ||
– Diffuse | 12 | 36 | ||
– Random | 15 | 33 | ||
Raija Auvinen et al. [18] | Linear opacities | 14 | 42 | 0.024 |
GGO/Consolidation | 68 | 21 | < 0.001 | |
Zhilan Yin et al. [19] | Vascular enlargement | 67 | 93 | 0.037 |
Pleural Thickening | 63 | 90 | 0.03 | |
Linear opacification | 50 | 90 | 0.002 | |
Crazy-paving sign | 30 | 60 | 0.021 | |
Pleural effusion | 53 | 13 | 0.002 | |
Bronchiectasis | 30 | 3 | 0.012 | |
Yi-Hua Lin et al. [20] | GGO | 71 | 23 | < 0.001 |
Infiltration | 29 | 68 | 0.003 | |
GGO + reticular pattern | 63 | 0 | < 0.001 | |
Interlobular septal thickening | 71 | 27 | 0.001 |
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Osman, M.; Klopfenstein, T.; Belfeki, N.; Gendrin, V.; Zayet, S. A Comparative Systematic Review of COVID-19 and Influenza. Viruses 2021, 13, 452. https://doi.org/10.3390/v13030452
Osman M, Klopfenstein T, Belfeki N, Gendrin V, Zayet S. A Comparative Systematic Review of COVID-19 and Influenza. Viruses. 2021; 13(3):452. https://doi.org/10.3390/v13030452
Chicago/Turabian StyleOsman, Molka, Timothée Klopfenstein, Nabil Belfeki, Vincent Gendrin, and Souheil Zayet. 2021. "A Comparative Systematic Review of COVID-19 and Influenza" Viruses 13, no. 3: 452. https://doi.org/10.3390/v13030452