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21Оценивая варианты ответов в последнем случае, привлекает внимание большой процент ошибочных ответов (54%), связанных с безосновательным назначением антибиотиков в период разрешения кашля. Это обусловлено ложным представлением о хрипах, как о пневмоническом симптоме. На самом деле влажные, сухие, свистящие, проводные хрипы - клинический признак бронхита и связан он с движением мокроты с потоком воздуха по трахеобронхиальному дереву. Антимикробная терапия допустима только при доказанной бактериальной этиологии бронхита [2, с. 20]. В подавляющем большинстве случаев появление хрипов над легкими свидетельствует о переходе сухого кашля в продуктивную фазу на фоне эффективной муколитической терапии с последующим самостоятельным откашливанием патологического секрета. Важно отметить, что точкой отсчета для завершения мукоактивной терапии служит способность больного самостоятельно эффективно откашливать (у маленьких детей сглатывать) мокроту. Повторные или необоснованно длительные курсы (более 8 дней) лечения кашля могут привести к порочному кругу, а именно медикаментозная стимуляция образования мокроты будет приводить к сохранению кашля, что скажется на сроках выздоровления. К сожалению, в менее половине процентов случаев (46%) респонденты отдали предпочтение кинезитерапии, то есть дыхательной гимнастике и вибрационному массажу грудной клетки, что считается оптимальным и обязательным методом лечения детей с патологией нижних дыхательных путей.
В проведенном исследовании не выявлено корреляции между частотой ошибок в выборе схем лечения кашля на разных сроках ОРВИ, приведенных в разных клинических ситуациях, и стажем работы врачей (p > 0,5). Таким образом, квалификация специалиста определяется не количеством проработанных лет, а наличием хороших знаний и уровнем профессионального мышления.
Заключение. Представленное исследование не ставило своей целью уменьшить значимость статуса врача-педиатра в наступившее сложное время, поэтому исследование и было выполнено анонимно. Наша главная задача состояла в побуждении у респондентов на примере простых, повседневных клинических случаев, а также у читателей этой статьи, нешаблонного и обдуманного отношения к диагностическому и лечебному процессу, основанного на принципах доказательной медицины. Из рутинной ежедневной практики врачей всех специальностей не должен уходить главный принцип медицины - noli nocere (не навреди). «Искусство медицины состоит из трех элементов: болезнь, больной и врач» (Гиппократ).
Литература
1. Чучалин А.Г. Кашель / А.Г. Чучалин, В.Н. Абросимов - М.: ГЭОТАР-Медиа, 2016. - 160 с.
2. Бронхит. Клинические рекомендации. -М.: Союз педиатров России, 2020. - 41 с.
3. Детская пульмонология. Национальное руководство / под ред. Б.М. Блохина. - М.: ГЭОТАР-Медиа, 2021 - 960 с.
4. Острая респираторная вирусная инфекция у детей. Клинические рекомендации. - М.: Союз педиатров России, 2019. - 34 с.
WHO IS DYING MORE FROM COVID-19: MALE ELDERLY OR FEMALE ELDERLY? ANALYSIS OF CASE AND DEATH NUMBERS OF ELDERLY BY GENDER IN KAZAKHSTAN AND
WORLDWIDE
Izekenova A.,
PhD in Economics, associate professor, Department of Finance and Accounting, University ofInternational Business, Kazakhstan
Tolegenova A., Master of Public Health, assistant professor, Department of Epidemiology with course of HIV, Asfendiyarov Kazakh National Medical University
Izekenova A.,
PhD in Public Health, associate professor, Department of Epidemiology with course of HIV, Asfendiyarov Kazakh National Medical University
Rakhmatullina A.
PhD student, Master of Finance, University of International Business, Kazakhstan
ABSTRACT
As of September 13, 2021, this coronavirus has infected 225,538,879 people worldwide, the highest pandemic case number in human history. Despite its impact on all humanity, the elderly and male populations were found to be more affected with high mortality compared to other groups. Therefore, this paper aims to provide a brief review of the Covid-19 situation in the aging population by gender difference in Kazakhstan and compare it with other countries.
Keywords: COVID-19, Pandemics, Elderly, Gender, Review.
Introduction
Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) known now as a Covid-19 has shaken the world becoming one of the biggest pandemics in a world. It was recognized to originate from a family of viruses with crown-like spikes on their surface and positive-sense single-stranded RNA with a genome length of nearly 30 kilobases [1, 2]. Most of these viruses were known to be animal viruses that cause respiratory, gastrointestinal, hepatic, and neurological diseases in them, and only seven were identified as human viruses [3]. Four of these viruses were recognized to cause generally mild symptoms while three cause potentially severe symptoms, two of which are Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), very well known outbreaks. SARS-CoV-2 is the third human virus that causes acute, sometimes severe, and respiratory illnesses in humans [3].
As of September 13, 2021, this coronavirus has infected 225,538,879 (2.86%) people worldwide. The
United States of America is leading with 41,853,362 confirmed cases in the world, and it is followed by India with 33,264,175 cases for all age groups [4]. Brazil, UK, Russia, France, Turkey, Iran, Argentina, and Colombia follow these countries with the most confirmed cases (Figure 1). However, these top countries are changed when we look at the deaths per 1,000,000 population (Figure 2) [4]. Peru forge ahead with a 5,930 deaths/1 million population, and Hungary go after it with a 3,125 deaths/ 1 million population for all age groups. Bosnia and Herzegovina, North Macedonia, Gibraltar, Montenegro, Bulgaria, Czechia, Brazil, and San Marino come behind them by the deaths rate [4]. Compared to other worldwide countries, the total number of confirmed cases in Kazakhstan was 842,587, and the deaths per 1,000,000 population were 544 for all age groups as of September 13, 2021, making it 14th among Asian countries[4].
Figure 1. Top 10 Countries by Total Number of cases.
Figure 2. Top 10 Countries by Total Deaths Per 1,000,000 population.
Besides, several factors were found to increase the probability of getting severe conditions of Covid-19, and age with gender were the utmost highly correlated determinants of this disease. Nevertheless, to our knowledge, no studies were done exploring particularly the Covid-19 cases and mortality among the elderly population and gender variation in Kazakhstan. Therefore, this paper aims to provide a brief review of the Covid-19 situation in the aging population by gender difference in Kazakhstan and compare it with other countries.
How did it start?
Worldwide
In winter 2019, the world was quivered from the news about a neoteric virus that was discovered in Huanan Seafood Wholesale Market in Wuhan, China. Forty-four patients with pneumonia of unknown etiology have been reported of which 11 patients had severe conditions as of 3 January 2020 [5]. On 9 January, the World Health Organization announces mysterious Coronavirus-Related Pneumonia, and travel precautions were already at the forefront of concerns. Later, the first cases of Covid-19 were confirmed in the USA
from a Washington state resident who has returned from Wuhan [6]. After discovering the transmission way of the virus, Wuhan was closed off with an 18 million population. Following the United States, Germany, Japan, Vietnam, and Taiwan became the countries for the new infections of Covid-19 [7]. On 10 February, death numbers from novel coronavirus in China have surpassed the death numbers from SARS, totaling 908 reported deaths compared to 774 deaths [6]. Three months after the first cases, on March 13, 2020, WHO declared Covid-19 as a pandemic [5]. Many countries started to restrict and ban traveling. Moreover, national quarantine, social distancing, lockdown of public institutions, the application of an online format were, and so on were used as preventive policies by many countries. However, the number of cases and deaths did not change with these measures and as of September 28, 2020, the number of global deaths exceeded 1 million [7]. But, a month later, Food and Drug Administration, approved Remdesivir as the first Covid-19 drug, and later Moderna, Pfizer, BioNTech vaccines' high efficacy were announced [8]. By the end of the year 2020, almost 3 million people have received the vaccine and
14 million doses were distributed all around the world. Consequently, as of September 13, 2021, 42.1% of the world population has received at least one dose of the COVID-19 vaccines [9].
Kazakhstan
In Kazakhstan, the first case was identified in two Almaty residents who returned from Germany on March 13, 2020, on the day that Covid-19 was declared a pandemic [10]. Two days later, President has introduced a state of emergency throughout the country, but the measures were more strictly followed in two big cities, Almaty and Nur-Sultan [11]. However, before this first case, starting on January 26, the Ministry of Health began sanitary and epidemiological control, strengthening the border checkpoints and conducting special training sessions [12]. Due to the drastic increase of the cases overnight, on March 19 a quarantine was imposed in these two cities [13]. The function of the large trade objects was limited, and the activity of shopping and entertainment centers, cinemas, theaters, exhibitions, and other facilities with a mass gathering of people has been suspended. In addition, quarantine was introduced, large-scale sanitary and anti-epidemic measures were carried out, with the participation of structural divisions of the Ministry of Defense and internal affairs bodies operating in the field of sanitary and epidemio-logical well-being of the population [14]. Moreover, it was prohibited to hold mass events, sporting events and other events, as well as family and commemorative events. There were restrictions on entry into the territory of the country, as well as on exit from its territory by all modes of transport, except for the personnel of the diplomatic service of the Republic of Kazakhstan and foreign states [14]. The country also faced a shortage of masks, because of speculators who had bought in advance and sold them at inflated prices [15]. Unfortunately, after seven days, the first death from corona-virus was reported in a 64-year old resident from the village of Kosshi, Nur-Sultan, on March 26 [16]. Finally, after one year, on February 1 of 2021, the vaccination against coronavirus has begun with the Russian "Sputnik V" vaccine, which is produced by the pharmaceutical complex in Karaganda city in Kazakh-stan[17].
Risk factors
Patients with Covid-19 had presented asymptomatic, mild, severe, and critical symptoms. In case studies, 33% of patients nevermore developed any symptoms, when 81% reported having mild condi-tions[18,19]. Furthermore, 14% of patients developed severe symptoms like dyspnea, hypoxia, or more than 50% lung involvement on imaging[19]. And critical symptoms such as respiratory failure, shock, or multiorgan dysfunction were identified in 5 percent of patients with coronavirus before the delta variant[19].
Many studies have identified several risk factors that are associated with severe or critical symptoms of Covid-19. Those risk factors included co-existing health conditions such as heart diseases, immunosup-pression, malignancy, hypertension, and diabetes [20].Social factors such as poverty level and low income, migrant citizens, are also found to be the most
affected population and found to be highly associated with an infection of coronavirus [21].
Furthermore, both outbreak analysis in Hong Kong and Singapore has demonstrated that male sex was associated with a mortality risk with an odds ratio of 1.62 and 3.10 respectively [22, 23]. The same result was exhibited by the systematic analysis of 3,111,714 reported global cases, by concluding that male patients have almost three times the odds of requiring intensive treatment unit (ITU) admission and higher likelihoods of death compared to females [24]. This was supported by the other studies, identifying gender male as one of the risk factors. In addition to gender, older age has shown an increased risk, almost three times more probability, of mortality due to coronavirus [24].
On the other hand, one of the few studies conducted in Kazakhstan has also demonstrated similar risk factors associated with the critical symptoms of Covid-19. The severity of the disease correlated with co-existing health problems, pneumonia, the time when patients visit the doctor, the duration of the infection, as well as the presence of severe chronic diseases, and old age [25].
Prevalence and Death Rates among Elderly
Worldwide
The elderly population was the most affected group of people from the Covid-19 pandemic. The morbidity measures such as prevalence and mortality rates were found to be higher than other age groups in several study findings. One of those studies is a research from India, that estimated the prevalence of Covid-19 among older adults with an average age of 67.5 and found it to be 27.7%, and the prevalence of hospitalized elderlies was observed to be 8.5% [26]. Different study finding at a skilled nursing facility (SNF) in Illinois showed a prevalence of 26.19% (33 confirmed cases out of 126 residents), which was similar to the Indian study [27]. Nevertheless, another study in France discovered 65.9% of the prevalence of this infection among the elderly population[28]. In the research from Connecticut, 601 (28.3%) of 2117 residents (65 <) were tested positive to Covid-19 [29]. Another research of developing country China demonstrated that 87% of the Covid-19 confirmed cases were between 30 and 79 years, while 3% were 80 years of age or older [30]. Lastly, one of the neighboring countries of Kazakhstan, Uzbekistan, which also is located in Central Asia, showed a prevalence of 8.1% among the population at age 60 and older, which was lower than much of younger people at age 30-40 [31].
Meanwhile, in a study from Korea, one of the developed countries, the death rate among the elderly was significantly higher - 95.1% of the total 1,979 deaths. The death rate was 5.59% in patients aged 70-79 years and 18.77% in patients >80 years old compared to 0.26% in patients aged 50-59%[32]. Research from Sweden investigated 274,712 adults aged 70, of whom 1,301 died due to Covid-19, presenting the death rate of 473.59 per 100,000 population [33]. On 3 May 2020, in Malaysia, it was found that 99 of COVID-19 deaths were from the age group of 61-70 years with a rate of 32%, followed by the age group of 71-80 years with
19.2%, showing the highest rate of death among elderly than other age groups [34].
Kazakhstan
Lamentably, there have been done very few studies that sowed the prevalence and mortality of Covid-19 among different age groups in Kazakhstan. Research conducted by Zhusupov and his team presented the age-correlated prevalence of Covid-19 among patients [35]. In their study result, it was found to be 8.2 percent of patients were elderly population over 60 years old. One of the biggest projects conducted in Kazakhstan called the Sange project, demonstrated the prevalence for all age groups to be 4.6% for any symptoms, and the prevalence among patients with pneumonia was 3.8% [36]. Furthermore, they stated that the prevalence of infection was about 29.3% among people over 60 years old, while for the age group 30-39 years old - 26.4%, and among young people - 19.7% [36]. By September 13, 2021, Kazakhstan had the topmost number of confirmed cases (842,587), daily new cases (3,088), and new deaths (57) than all Central Asian countries. Uzbekistan, had 164 890 confirmed cases, 526 new cases, and 6 new deaths, Kyrgyzstan 177 226 cases, 68 new cases and 2 new deaths, and finally Tajikistan 17,084 cases and 20 new cases on the same day [4]. Unfortunately, there are no data available for Turkmenistan. A study done by one of scientists in Kazakhstan, Mau-kaeva and her team, eestablised that the mortality rate among patients over 60 years old is 83.3%, which is
higher compared to the USA, India and France, but similar to China and Korea [37].
If we compare Kazakhstan by both case fatality and deaths per 100,000 population for all ages to other stans, then we can notice that it is also leading there [4]. A clinical study conducted in Uzbekistan have found a mortality rate of 48.9% among geriatric patients, while according to the Kyrgyzstani health government, this rate was 61.0%, highest compared to other age groups, but still less than rates in Kazakhstan [38,39].
Cases and Deaths by Elderly and Gender
Worldwide
Numerous investigators have looked at the association of age and gender with the severity of the Covid-19. Therefore, we have analyzed cases and deaths among the elderly by gender globally and in Kazakhstan. First of all, in Figure 3 we have analyzed the cases worldwide by age and gender per 100,000 population. It can be seen that the number of cases per 100,000 is overall higher in Peru compared to other countries for both gender and elderly age groups. Moreover, all the countries showed higher cases in males at age 80+ than females, except the USA where the number of cases in females at age 80+ is greater than males. Overall, the number of cases in the age group 70-79 are lower than all age groups and genders, but then again with the domination of the male gender in a cluster. Interestingly, there were more cases in the age group 60-69 than 70-79, and similarly, males had higher cases in all countries (Figure 3) [40.41.42].
WORLDWIDE CASES BY AGE AND GENDER PER 100,000
POPULATION
m
ai -r» mco
MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE MALE FEMALE
PAKISTAN
HONG KONG
160 - 69 ■ 70 - 79 ■ 80+
Figure 3. Worldwide cases by age and gender per 100,000 population
PERU
Nevertheless, the mortality graph shows a different trend (Figure 4). It can be seen that regardless of gender, with the increase of age higher the mortality, death numbers per 100,000 population. Unfortunately, there was no available data on the death number by age and gender for Hong Kong therefore, instead of it Kyr-gyzstan was taken as one of the neighboring countries of Kazakhstan. Once more, Peru is the leading country
by the number of deaths of all ages and in both genders, and the number of death is almost twice higher in the age group 85+ in males than females. Similarly, we see the same trend in the USA, Italy, Pakistan, and Kyrgyzstan. Furthermore, for age groups 65-74 and 75-84 years we notice the identical trend for all countries, where the number of deaths among males is higher than the females (Figure 4) [40,41,42].
Figure 4. Worldwide deaths by age and gender per 100,000 population
Kazakhstan
For Kazakhstan, we can see a different trend for cases than the worldwide one (Figure 5). It can be seen that there are more cases per 100,000 in younger adults than in the aging elderly. The case numbers are almost five times lower in the age group 75+ than the age group 55-59 for both genders. Notwithstanding, we can still notice that even males lead with a higher rate than females in Kazakhstan too in the number of cases[43].
The death number in Kazakhstan, nonetheless, showed a similar tendency as worldwide one. It presents that the number of deaths increases with the age, with more death numbers in the age group 60+ than the young adults at an age between ages 40-49. Moreover, in Kazakhstan, the number of men who died from Covid-19 is also greater than the number of women. It has the same trend for all age groups in this country as upper mention countries, regardless of developing status [44]._
Cases by Age and Gender per 100,000 population in
Kazakhstan
■ Female 34,78 20,95 12,98 22,65 7,97
Male 37,43 27,87 23,39 29,43 8,54
Figure 5. Cases by age and gender per 100,000 population in Kazakhstan.
75+
70 - 74
65 - 69
60 - 64
55 - 59
0
5
10
15
20
25
30
35
40
55 - 59
60 - 64
65 - 69
70 - 74
75+
Death numbers by Age and Gender in Kazakhstan
■ Female 57 11 5
■ Male 68 31 10
Figure 6. Death numbers by age and gender in Kazakhstan
In conclusion, it can be said that Covid-19 pandemics has affected the lives of all level population, but brought an exceptional threat to the lives of the elderly population, especially the male half of them. This was aimed to explore the effect of Covid-19 on the elderly population by looking at the prevalence and death rates in Kazakhstan and compare it to the worldwide countries. The prevalence of Covid-19 was higher than its neighboring countries but similar to the overseas ones like the USA. However, the death rates among the elderly were higher than those in developed countries and Central Asian ones. Moreover, from this review, we could see the overall tendency toward the elderly male population in all countries in both cases and deaths per 100,000 population, showing that old men are highly at risk from infection and dying from Coronavirus disease. Accordingly, the world requires supplementary advanced policies and more investigations that can address the issues and enhance the lives of the elderly and especially the male population during the pandemics and afterward.
Funding
This research has been funded by the Science Committee of the Ministry of Education and Science of the Republic of Kazakhstan (Grant No.AP09058488)
Conflict of interest
The authors have no conflict of interest to declare.
References
1. Lauxmann M, Santucci N, Autran-Gomez A. The SARS-CoV-2 Coronavirus and the COVID-19 Outbreak. International braz j urol. 2020;46(suppl 1):6-18. doi:10.1590/s1677-5538ibju.2020.s101
2. Wang R, Simoneau C, Kulsuptrakul J et al. Genetic Screens Identify Host Factors for SARS-CoV-2 and Common Cold Coronaviruses. Cell. 2021;184(1):106-119.e14. doi:10.1016/j.cell.2020.12.004
3. Coronaviruses and Acute Respiratory Syndromes (COVID-19, MERS, and SARS) - Infectious Diseases - MSD Manual Professional Edition. MSD Manual Professional Edition. https://www.msdmanu-als.com/professional/infectious-diseases/respiratory-
viruses/coronaviruses-and-acute-respiratory-syn-dromes-covid-19-mers-and-sars#v47572273. Published 2021. Accessed September 15, 2021.
4. COVID Live Update: 226,799,482 Cases and 4,665,684 Deaths from the Coronavirus - Worldometer. Worldometers.info. https://www.worldome-ters.info/coronavirus/#countries. Published 2021. Accessed September 15, 2021.
5. Pneumonia of unknown cause - China. Who.int. https://www.who.int/emergencies/disease-outbreak-news/item/2020-D0N229. Published 2020. Accessed July 4, 2021
6. Staff A. A Timeline of COVID-19 Developments in 2020. AJMC. https://www.ajmc.com/view/a-timeline-of-covid19-developments-in-2020. Published 2021. Accessed September 15, 2021.
7. Coronavirus: the first three months as it happened. Nature.com. https://www.nature.com/arti-cles/d41586-020-00154-w. Published 2021. Accessed September 15, 2021.
8. Interim Clinical Considerations for Use of COVID-19 Vaccines | CDC. Cdc.gov. https://www.cdc.gov/vaccines/covid-19/clinical-con-siderations/covid-19-vaccines-us.html. Published 2021. Accessed September 15, 2021.
9. Ritchie H, Mathieu E, Rodes-Guirao L et al. Coronavirus Pandemic (COVID-19). Our World in Data. https://ourworldindata.org/covid-vaccinations. Published 2021. Accessed September 15, 2021.
10. Казахстан S, Казахстан S. В Казахстане зафиксированы первые два случая коронавируса. Sputnik Казахстан. https://ru.sput-nik.kz/health/20200313/13067637/kazakhstan-pervyy-sluchay-koronavirus.html. Published 2021. Accessed September 15, 2021.
11. President Tokayev announces one-month state of emergency. Inform.kz. https://www.in-form.kz/en/president-tokayev-announces-one-month-state-of-emergency_a3625158. Published 2021. Accessed September 15, 2021.
12. В Казахстане усилен санитарно -эпидемиологический контроль на госгранице Подробности: https ://regnum. ru/news/accidents/2839920. html Любое использование материалов допускается только
60+
0
10
20
30
40
50
60
70
80
60+
при наличии гиперссылки на ИА REGNUM. Reg-num.ru. https://regnum.ru/news/2839920.html. Published 2021. Accessed September 15, 2021.
13. COVID-19: Kazakhstan Locks Down Two Main Cities; Iran Warns Virus Could Kill 'Millions'. RadioFreeEurope/RadioLiberty. https://www.rferl.org/a/armenia-puts-restrictions-on-public-and-private-events-amid-spike-in-coronavirus-cases/30492284.html. Published 2021. Accessed September 15, 2021.
14. Указ Президента Республики Казахстан от 15 марта 2020 года № 285 «О введении чрезвычайного положения в Республике Казахстан». Информационная система ПАРАГРАФ. https://online.zakon.kz/Document/?doc_id=32648341. Published 2021. Accessed September 15, 2021.
15. Казахстан S, Казахстан S. Медицинские маски в казахстанских аптеках резко подорожали: что говорят в правительстве. Sputnik Казахстан. https://ru.sputnik.kz/soci-
ety/20200312/13059661/meditsinskie-maski-kazakh-stan-apteki.html. Published 2021. Accessed September 15, 2021.
16. Казахстанка умерла от коронавируса. Главные новости Казахстана - Tengrinews.kz. https://tengrinews.kz/kazakhstan_news/kazahstanka-umerla-ot-koronavirusa-396164/. Published 2021. Accessed September 15, 2021.
17. Month in Review: Central Asia in April 2021. CABAR.asia. https://cabar.asia/en/month-in-review-central-asia-in-april-2021. Published 2021. Accessed September 15, 2021.
18. Oran D, Topol E. The Proportion of SARS-CoV-2 Infections That Are Asymptomatic. Ann Intern Med. 2021;174(5):655-662. doi:10.7326/m20-6976
19. Wu Z, McGoogan J. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. JAMA. 2020;323(13):1239. doi:10.1001/jama.2020.2648
20. Li J, Huang D, Zou B et al. Epidemiology of COVID-19: A systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes. J Med Virol. 2020;93(3):1449-1458. doi:10.1002/jmv.26424
21. Sannigrahi S, Pilla F, Basu B, Basu A, Molter A. Examining the association between socio-demo-graphic composition and COVID-19 fatalities in the European region using spatial regression approach. Sustain Cities Soc. 2020;62:102418. doi:10.1016/j.scs.2020.102418
22. Karlberg, J., Chong, D. S. Y. & Lai, W. Y. Y. Do Men Have a Higher Case Fatality Rate of Severe Acute Respiratory Syndrome than Women Do? Am. J. Epidemiol. https://doi.org/10.1093/aje/kwh056 (2004).
23. Leong, H. N. et al. SARS in Singapore-predictors of disease severity. Ann. Acad. Med. Singap. 35, 326-331 (2006).
24. Peckham, H., de Gruijter, N.M., Raine, C. et al. Male sex identified by global COVID-19 meta-anal-ysis as a risk factor for death and ITU admission. Nat Commun 11, 6317 (2020). https://doi.org/10.1038/s41467-020-19741-6
25. Uninsurance I. Effects of Health Insurance on Health. Ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/books/NBK220636/. Published 2002. Accessed June 1, 2021.
26. Ranjan A, Muraleedharan V. Equity and elderly health in India: reflections from 75th round National Sample Survey, 2017-18, amidst the COVID-19 pandemic. Global Health. 2020;16(1). doi:10.1186/s12992-020-00619-7
27. Patel M, Chaisson L, Borgetti S et al. Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility. Clinical Infectious Diseases. 2020;71(11):2920-2926. doi:10.1093/cid/ciaa763
28. Bernadou A, Bouges S, Catroux M et al. High impact of COVID-19 outbreak in a nursing home in the Nouvelle-Aquitaine region, France, March to April
2020. BMC Infect Dis. 2021;21(1). doi:10.1186/s12879-021-05890-6
29. Parikh S, O'Laughlin K, Ehrlich H et al. Point Prevalence Testing of Residents for SARS-CoV-2 in a Subset of Connecticut Nursing Homes. JAMA. 2020;324(11):1101. doi:10.1001/jama.2020.14984
30. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China] Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. Zhonghua Liu Xing Bing Xue Za Zhi. 2020 Feb 10; 41(2):145-151
31. Статистика: возрастная структура заболеваемости и смертности от COVID-19 в Узбекистане. Газета.ш. https://www.gazeta.uz/ru/2020/09/06/covid-stats/. Published 2020. Accessed August 16, 2021.
32. Korea Centers for Disease Control and Prevention (KCDC) Status of COVID-19 in Korea. http://ncov.mohw.go.kr/bdBoardList_Real.do?brdId=1 &brdGubun=11 &ncvContSeq=&contSeq=&board_id =&gubun=. Published 2020. Accessed 29 May 2021.
3 3. Branden M, Aradhya S, Kolk M et al. Residential context and COVID-19 mortality among adults aged 70 years and older in Stockholm: a population-based, observational study using individual-level data. The Lancet Healthy Longevity. 2020;1(2):e80-e88. doi:10.1016/s2666-7568(20)30016-7
34. Abdullah, N. H. (2020a). Press statement 18 May 2020—Updates on the coronavirus disease 2019 (COVID-19) situation in Malaysia. https://kpkesihatan.com/2020/05/18/kenyataan-akhbar-kpk-18-mei-2020-situasi-semasa-jangkitan-penyakit-coronavirus-2019-covid-19-di-malaysia/
35. Zhussupov, B., Saliev, T., Sarybayeva, G., Altynbekov, K., Tanabayeva, S., & Altynbekov, S. et al. (2021). Analysis of COVID-19 pandemics in Kazakhstan. Retrieved 10 June 2021, from http://jrhs.um-sha.ac.ir/index.php/JRHS/article/view/6730
36. Sange.kz. http://sange.kz/wp-content/up-loads/2020/11/Sange_COVID-1-wave.pdf. Published
2021. Accessed July 4, 2021.
37. Maukayeva S. Epidemiologic Character of Covid-19 in Kazakhstan: A Preliminary Report. North Clin Istanb. 2020. doi:10.14744/nci.2020.62443
38. Статистика: возрастная структура заболеваемости и смертности от COVID-19 в Узбекистане. Газета.^. https://www.gazeta.uz/ru/2020/09/06/covid-stats/. Published 2020. Accessed August 16, 2021.
39. Никифорова В, Акопов П, Хроленко А, Кузьминых Ю. Минздрав назвал возраст умерших кыргызстанцев, у которых подтвердили COVID. Sputnik Кыргызстан. https://ru.sputnik.kg/soci-ety/20200720/1049074427/kyrgyzstan-minzdrav-voz-rast-smertnost.html. Published 2020. Accessed August 16, 2021.
40. Data.cdc.gov. https://data.cdc.gov/Case-Sur-veillance/COVID-19-Case-Surveillance-Public-Use-Data/vbim-akqf. Published 2021. Accessed September 15, 2021.
41. Epicentro.iss.it. https://www.epicen-tro.iss.it/coronavirus/bollettino/Bollettino-sorveglianza-integrata-COVID-19_11 -agosto-2021.pdf. Published 2021. Accessed September 15, 2021.
42. The COVID-19 Sex-Disaggregated Data Tracker | Global Health 50/50. Globalhealth5050.org. https://globalhealth5050.org/the-sex-gender-and-covid-19-project/the-data-tracker/?explore=coun-try&country=peru#search. Published 2021. Accessed September 15, 2021.
43. НЦОЗ. НЦОЗ. https://hls.kz/. Published 2021. Accessed September 15, 2021.
44. Ситуация с коронавирусом официально. Coronavirus2020.kz.
https://www.coronavirus2020.kz/. Published 2021. Accessed September 15, 2021
