A Randomised, Double-Blind, Placebo-Controlled Trial Evaluating Concentrated Phytochemical-Rich Nutritional Capsule in Addition to a Probiotic Capsule on Clinical Outcomes among Individuals with COVID-19—The UK Phyto-V Study

{ 'indexed': {'date-parts': [[2022, 4, 6]], 'date-time': '2022-04-06T02:17:06Z', 'timestamp': 1649211426528}, 'reference-count': 142, 'publisher': 'MDPI AG', 'issue': '4', 'license': [ { 'start': { 'date-parts': [[2022, 3, 22]], 'date-time': '2022-03-22T00:00:00Z', 'timestamp': 1647907200000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0/'}], 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'abstract': '<jats:p>Gut microflora dysbiosis affects the majority of individuals after COVID-19, ' 'contributing to both gastro-intestinal (GI) and non-GI symptoms. Natural phytochemicals have ' 'reported anti-viral properties and favourable effects on inflammatory and oxidative pathways, ' 'both important for tissue damage post-viral pneumonia. This study involved 147 participants ' 'with symptomatic COVID-19, randomised to receive a placebo (P) or a phytochemical-rich ' 'concentrated food capsule (PC) in addition to a pre/probiotic lactobacillus capsule. ' 'Participants taking the PC had an almost two-fold reduction in mean fatigue scores compared ' 'to P [p = 0.02], a three-fold reduction in cough score and more than a double improvement in ' 'overall well-being scores [p = 0.02]. Two (1.5%) participants reported mild, increased ' 'bloating which they felt was attributable to the capsules, although GI symptoms improved in ' '25 of 31 participants (82%) who reported them at baseline. Sedentary, older, previously ' 'hospitalised men with GI symptoms had a statistically significantly improvement among those ' 'given the probiotic. Although some participants with early disease would have improved ' 'spontaneously, such a rapid improvement observed in the majority of participants, who had ' 'been suffering for an average of 108 days, was clinically relevant and welcomed, especially ' 'among those more likely to have pre-existing gut dysbiosis. We are now evaluating whether ' 'this blend could also enhance antibody titres post-COVID-19 vaccination.</jats:p>', 'DOI': '10.3390/covid2040031', 'type': 'journal-article', 'created': {'date-parts': [[2022, 3, 22]], 'date-time': '2022-03-22T18:55:35Z', 'timestamp': 1647975335000}, 'page': '433-449', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': 'A Randomised, Double-Blind, Placebo-Controlled Trial Evaluating Concentrated Phytochemical-Rich ' 'Nutritional Capsule in Addition to a Probiotic Capsule on Clinical Outcomes among Individuals ' 'with COVID-19—The UK Phyto-V Study', 'prefix': '10.3390', 'volume': '2', 'author': [ { 'ORCID': 'http://orcid.org/0000-0002-3824-5615', 'authenticated-orcid': False, 'given': 'Robert', 'family': 'Thomas', 'sequence': 'first', 'affiliation': []}, {'given': 'Madeleine', 'family': 'Williams', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0002-9159-4646', 'authenticated-orcid': False, 'given': 'Jeffrey', 'family': 'Aldous', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0003-3710-9328', 'authenticated-orcid': False, 'given': 'Yuuki', 'family': 'Yanagisawa', 'sequence': 'additional', 'affiliation': []}, {'given': 'Rajeev', 'family': 'Kumar', 'sequence': 'additional', 'affiliation': []}, {'given': 'Rachel', 'family': 'Forsyth', 'sequence': 'additional', 'affiliation': []}, { 'ORCID': 'http://orcid.org/0000-0002-9043-2565', 'authenticated-orcid': False, 'given': 'Angel', 'family': 'Chater', 'sequence': 'additional', 'affiliation': []}], 'member': '1968', 'published-online': {'date-parts': [[2022, 3, 22]]}, 'reference': [ {'key': 'ref1', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/nu7010017'}, {'key': 'ref2', 'doi-asserted-by': 'publisher', 'DOI': '10.1101/2020.03.17.20037572'}, {'key': 'ref3', 'doi-asserted-by': 'publisher', 'DOI': '10.4161/gmic.1.3.11712'}, {'key': 'ref4', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.arcmed.2021.03.002'}, {'key': 'ref5', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/nrmicro.2016.142'}, {'key': 'ref6', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/gutjnl-2020-323020'}, { 'key': 'ref7', 'first-page': '147', 'article-title': 'Management of coronavirus disease-19 (COVID-19): The Zhejiang ' 'experience', 'volume': '49', 'author': 'Xu', 'year': '2020', 'journal-title': 'J. Zhejiang Univ. Med. Sci.'}, {'key': 'ref8', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/gutjnl-2021-324090'}, {'key': 'ref9', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S0140-6736(20)32656-8'}, {'key': 'ref10', 'doi-asserted-by': 'publisher', 'DOI': '10.1093/cid/ciaa709'}, {'key': 'ref11', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/gutjnl-2020-321195'}, {'key': 'ref12', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jnutbio.2012.04.001'}, {'key': 'ref13', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.virusres.2020.198018'}, {'key': 'ref14', 'doi-asserted-by': 'publisher', 'DOI': '10.1155/2019/4735040'}, {'key': 'ref15', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.antiviral.2005.07.002'}, {'key': 'ref16', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/s41538-020-00078-9'}, {'key': 'ref17', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S2213-2600(15)00427-0'}, {'key': 'ref18', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/molecules16032032'}, {'key': 'ref19', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fcimb.2020.00009'}, {'key': 'ref20', 'doi-asserted-by': 'publisher', 'DOI': '10.1128/mBio.01420-18'}, { 'key': 'ref21', 'first-page': '90', 'article-title': 'Lung microbiota in the acute respiratory disease: From coronavirus to ' 'metabolomics', 'volume': '9', 'author': 'Fanos', 'year': '2020', 'journal-title': 'J. Paediatr. Neonatal Individ. Med.'}, {'key': 'ref22', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.mehy.2020.110102'}, {'key': 'ref23', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/cmi.12966'}, {'key': 'ref24', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S2468-1253(20)30118-7'}, {'key': 'ref25', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fcimb.2021.747816'}, {'key': 'ref26', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fmicb.2018.02147'}, {'key': 'ref27', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s12016-018-8719-7'}, {'key': 'ref28', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/resp.12732'}, {'key': 'ref29', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fendo.2021.667066'}, {'key': 'ref30', 'doi-asserted-by': 'publisher', 'DOI': '10.1093/cdn/nzy005'}, { 'key': 'ref31', 'first-page': '1', 'article-title': 'Phytochemicals in Cancer Management', 'volume': '105', 'author': 'Thomas', 'year': '2017', 'journal-title': 'Curr. Res. Complement. Altern. Med.'}, { 'key': 'ref32', 'first-page': '1', 'article-title': 'The Influence of a blend of Probiotic Lactobacillus and Prebiotic ' 'Inulin on the Duration and Severity of Symptoms among Individuals with ' 'COVID-19', 'volume': '5', 'author': 'Thomas', 'year': '2021', 'journal-title': 'Infect. Dis. Diagn. Treat.'}, {'key': 'ref33', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/j.1572-0241.2000.02015.x'}, {'key': 'ref34', 'doi-asserted-by': 'publisher', 'DOI': '10.1155/2018/8063647'}, {'key': 'ref35', 'doi-asserted-by': 'publisher', 'DOI': '10.1186/s12974-019-1611-4'}, { 'key': 'ref36', 'first-page': '584', 'article-title': 'Probiotics for prevention of necrotizing enterocolitis in preterm ' 'infants', 'volume': '4', 'author': 'AlFaleh', 'year': '2014', 'journal-title': 'Cochrane Database Syst. Rev.'}, {'key': 'ref37', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/apt.12453'}, {'key': 'ref38', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/gut.51.5.659'}, {'key': 'ref39', 'doi-asserted-by': 'publisher', 'DOI': '10.1159/000342079'}, {'key': 'ref40', 'doi-asserted-by': 'publisher', 'DOI': '10.1023/A:1010979225018'}, {'key': 'ref41', 'doi-asserted-by': 'publisher', 'DOI': '10.1093/advances/nmy063'}, {'key': 'ref42', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/icb.2009.71'}, {'key': 'ref43', 'doi-asserted-by': 'publisher', 'DOI': '10.3109/09637486.2013.836738'}, {'key': 'ref44', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/ijerph15081679'}, {'key': 'ref45', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s12328-017-0813-5'}, {'key': 'ref46', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ebiom.2019.11.051'}, {'key': 'ref47', 'doi-asserted-by': 'publisher', 'DOI': '10.1210/er.2017-00192'}, {'key': 'ref48', 'doi-asserted-by': 'publisher', 'DOI': '10.3233/JAD-161141'}, {'key': 'ref49', 'doi-asserted-by': 'publisher', 'DOI': '10.1073/pnas.1000079107'}, {'key': 'ref50', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/nu10080988'}, {'key': 'ref51', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.nutres.2020.12.014'}, {'key': 'ref52', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/nu9050521'}, {'key': 'ref53', 'doi-asserted-by': 'publisher', 'DOI': '10.1210/jc.2012-4262'}, {'key': 'ref54', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/s41598-020-77806-4'}, {'key': 'ref55', 'doi-asserted-by': 'publisher', 'DOI': '10.2174/0929867323666161202150008'}, {'key': 'ref56', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S0016-5085(11)60075-9'}, {'key': 'ref57', 'doi-asserted-by': 'publisher', 'DOI': '10.1152/ajpgi.00105.2015'}, {'key': 'ref58', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.clnu.2018.10.028'}, { 'key': 'ref59', 'first-page': '1', 'article-title': 'The possible role of vitamin D in suppressing cytokine storm and ' 'associated mortality in COVID-19 patients', 'volume': '78', 'author': 'Daneshkhah', 'year': '2020', 'journal-title': 'MedRxiv'}, {'key': 'ref60', 'doi-asserted-by': 'publisher', 'DOI': '10.1002/jmv.26832'}, {'key': 'ref61', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s12602-014-9162-6'}, {'key': 'ref62', 'doi-asserted-by': 'publisher', 'DOI': '10.1080/19490976.2021.1961970'}, {'key': 'ref63', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ijantimicag.2020.106118'}, {'key': 'ref64', 'doi-asserted-by': 'publisher', 'DOI': '10.4172/2161-0517.1000e107'}, {'key': 'ref65', 'doi-asserted-by': 'publisher', 'DOI': '10.1046/j.1365-2672.2003.02026.x'}, {'key': 'ref66', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ajic.2013.04.005'}, {'key': 'ref67', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/j.1442-200X.2012.03647.x'}, {'key': 'ref68', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/lam.12340'}, {'key': 'ref69', 'doi-asserted-by': 'publisher', 'DOI': '10.4082/kjfm.2013.34.1.2'}, {'key': 'ref70', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/s41598-019-39602-7'}, {'key': 'ref71', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ejphar.2014.05.028'}, {'key': 'ref72', 'doi-asserted-by': 'publisher', 'DOI': '10.4187/respcare.07097'}, { 'key': 'ref73', 'doi-asserted-by': 'crossref', 'first-page': '133', 'DOI': '10.1007/978-3-0348-0927-6_4', 'article-title': 'Celery Seed and Related Extracts with Antiarthritic, Antiulcer, and ' 'Antimicrobial Activities', 'volume': '70', 'author': 'Powanda', 'year': '2015', 'journal-title': 'Prog. Drug Res.'}, {'key': 'ref74', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s10787-010-0049-1'}, {'key': 'ref75', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fnmol.2015.00024'}, {'key': 'ref76', 'doi-asserted-by': 'publisher', 'DOI': '10.1021/np050327j'}, {'key': 'ref77', 'doi-asserted-by': 'publisher', 'DOI': '10.1142/S0192415X0900703X'}, {'key': 'ref78', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fimmu.2021.670955'}, {'key': 'ref79', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S0006-2952(99)00380-9'}, {'key': 'ref80', 'doi-asserted-by': 'publisher', 'DOI': '10.1096/fj.02-0508fje'}, {'key': 'ref81', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.pharmthera.2020.107613'}, {'key': 'ref82', 'doi-asserted-by': 'publisher', 'DOI': '10.1042/BST0380050'}, {'key': 'ref83', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/0960-894X(94)80015-4'}, {'key': 'ref84', 'doi-asserted-by': 'publisher', 'DOI': '10.1089/aid.1996.12.39'}, {'key': 'ref85', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/antiox9100936'}, {'key': 'ref86', 'doi-asserted-by': 'publisher', 'DOI': '10.1155/2011/194586'}, {'key': 'ref87', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.exger.2010.03.014'}, {'key': 'ref88', 'doi-asserted-by': 'publisher', 'DOI': '10.1249/MSS.0b013e31819fe8e3'}, { 'key': 'ref89', 'first-page': '801', 'article-title': 'Effects of vitamin E supplementation on recovery from repeated bouts of ' 'resistance exercise', 'volume': '17', 'author': 'Avery', 'year': '2003', 'journal-title': 'J. Strength Cond. Res.'}, {'key': 'ref90', 'doi-asserted-by': 'publisher', 'DOI': '10.1006/niox.1996.0113'}, {'key': 'ref91', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.celrep.2019.06.018'}, {'key': 'ref92', 'doi-asserted-by': 'publisher', 'DOI': '10.1161/HYPERTENSIONAHA.113.02044'}, {'key': 'ref93', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.antiviral.2005.02.007'}, {'key': 'ref94', 'doi-asserted-by': 'publisher', 'DOI': '10.1186/1472-6882-14-171'}, {'key': 'ref95', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fchem.2021.638187'}, {'key': 'ref96', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fimmu.2020.01451'}, {'key': 'ref97', 'doi-asserted-by': 'publisher', 'DOI': '10.1086/429694'}, {'key': 'ref98', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/v12111242'}, {'key': 'ref99', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fphar.2021.675287'}, {'key': 'ref100', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.biopha.2016.03.037'}, { 'key': 'ref101', 'doi-asserted-by': 'crossref', 'first-page': '859', 'DOI': '10.1055/s-2003-43207', 'article-title': 'A New Anti-HIV Flavonoid Glucuronide from Chrysanthemum Morifolium', 'volume': '69', 'author': 'Lee', 'year': '2003', 'journal-title': 'Planta Medica'}, {'key': 'ref102', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.antiviral.2014.06.004'}, {'key': 'ref103', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/v7041613'}, {'key': 'ref104', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s00705-017-3417-y'}, {'key': 'ref105', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s11101-021-09759-z'}, {'key': 'ref106', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/molecules26226825'}, {'key': 'ref107', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jff.2020.104169'}, {'key': 'ref108', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/ijms21155423'}, { 'key': 'ref109', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.freeradbiomed.2019.02.023'}, {'key': 'ref110', 'doi-asserted-by': 'publisher', 'DOI': '10.1080/19490976.2015.1134082'}, {'key': 'ref111', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.cell.2016.05.041'}, {'key': 'ref112', 'doi-asserted-by': 'publisher', 'DOI': '10.1021/jf101475m'}, {'key': 'ref113', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/gutjnl-2020-322670'}, {'key': 'ref114', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/nature12820'}, {'key': 'ref115', 'doi-asserted-by': 'publisher', 'DOI': '10.1186/1477-7525-11-150'}, {'key': 'ref116', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/0022-3999(93)90081-P'}, {'key': 'ref117', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/gutjnl-2020-321013'}, {'key': 'ref118', 'doi-asserted-by': 'publisher', 'DOI': '10.3389/fpubh.2020.00186'}, {'key': 'ref119', 'doi-asserted-by': 'publisher', 'DOI': '10.22541/au.158999387.76467979'}, {'key': 'ref120', 'doi-asserted-by': 'publisher', 'DOI': '10.5195/ijms.2020.486'}, {'key': 'ref121', 'doi-asserted-by': 'publisher', 'DOI': '10.1080/19490976.2021.2018899'}, {'key': 'ref122', 'doi-asserted-by': 'publisher', 'DOI': '10.1101/2022.01.04.21268275'}, {'key': 'ref123', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/bmjnph-2021-000250'}, {'key': 'ref124', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S0140-6736(11)60607-7'}, {'key': 'ref125', 'doi-asserted-by': 'publisher', 'DOI': '10.3889/oamjms.2015.005'}, {'key': 'ref126', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s42399-020-00341-w'}, {'key': 'ref127', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.immuni.2013.08.013'}, {'key': 'ref128', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.tins.2013.10.003'}, {'key': 'ref129', 'doi-asserted-by': 'publisher', 'DOI': '10.1186/s40168-016-0171-4'}, { 'key': 'ref130', 'first-page': '30', 'article-title': 'Probiotics and Disease: A Comprehensive Summary-Part 3, Cardiometabolic ' 'Disease and Fatigue Syndromes', 'volume': '16', 'author': 'Williamson', 'year': '2017', 'journal-title': 'Integr. Med. A Clin. J.'}, {'key': 'ref131', 'doi-asserted-by': 'publisher', 'DOI': '10.1089/jmf.2014.7000'}, {'key': 'ref132', 'doi-asserted-by': 'publisher', 'DOI': '10.1186/1475-2891-8-4'}, {'key': 'ref133', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/j.1365-2982.2011.01861.x'}, {'key': 'ref134', 'doi-asserted-by': 'publisher', 'DOI': '10.1093/cid/civ085'}, { 'key': 'ref135', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ijfoodmicro.2007.08.015'}, {'key': 'ref136', 'doi-asserted-by': 'publisher', 'DOI': '10.1053/j.gastro.2020.05.060'}, { 'key': 'ref137', 'first-page': '1', 'article-title': 'Safety of probiotics used to reduce risk and prevent or treat disease', 'volume': '200', 'author': 'Hempel', 'year': '2011', 'journal-title': 'Evid. Rep. Technol. Assess.'}, {'key': 'ref138', 'doi-asserted-by': 'publisher', 'DOI': '10.4161/gmic.1.3.12127'}, {'key': 'ref139', 'doi-asserted-by': 'publisher', 'DOI': '10.1086/368080'}, {'key': 'ref140', 'doi-asserted-by': 'publisher', 'DOI': '10.1111/j.1574-6976.2006.00020.x'}, { 'key': 'ref141', 'first-page': '701', 'article-title': 'Probiotics in preventing and treating chemotherapy-induced diarrhoea: A ' 'meta-analysis', 'volume': '28', 'author': 'Lu', 'year': '2019', 'journal-title': 'Asia Pac. J. Clin. Nutr.'}, {'key': 'ref142', 'doi-asserted-by': 'publisher', 'DOI': '10.1086/342912'}], 'container-title': 'COVID', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://www.mdpi.com/2673-8112/2/4/31/pdf', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 3, 22]], 'date-time': '2022-03-22T19:25:08Z', 'timestamp': 1647977108000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.mdpi.com/2673-8112/2/4/31'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2022, 3, 22]]}, 'references-count': 142, 'journal-issue': {'issue': '4', 'published-online': {'date-parts': [[2022, 4]]}}, 'alternative-id': ['covid2040031'], 'URL': 'http://dx.doi.org/10.3390/covid2040031', 'relation': {}, 'ISSN': ['2673-8112'], 'subject': ['General Medicine'], 'container-title-short': 'COVID', 'published': {'date-parts': [[2022, 3, 22]]}}