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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">On the 31st of December 2019&#44; China had a total of 26 cases and 1 death with a diagnosis of pneumonia of unknown etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These cases originated in the Huanan Seafood Wholesale Market of Wuhan&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> On the 7th of January 2020&#44; the Chinese Center for Disease Control and Prevention identified the causal agent of the unknown pneumonia as a severe acute coronavirus related to severe acute respiratory syndrome &#40;SARS&#41;&#44; which was termed SARS-CoV-2&#44; due to its similarity with SARS coronavirus &#40;CoV&#41;&#44; discovered in 2003&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This type of virus causes disease in animals and humans&#44; which can be respiratory infections&#44; such as the common cold&#44; or more acute infections&#44; such as Middle East respiratory syndrome &#40;MERS&#41;-CoV and SARS-CoV&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Generally&#44; the viruses can be found in animal reservoirs&#58; MERS-CoV is transmitted from camels to humans&#44; whereas SARS-CoV is transmitted from exotic animals&#46; Bats are suspected to be the reservoir for SARS-CoV-2&#44; although this has not been completely verified&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> The World Health Organization &#40;WHO&#41; named this disease coronavirus disease 2019 &#40;COVID-19&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> On the 11th of March&#44; 2020&#44; COVID-19 was declared a pandemic&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It has been reported that COVID-19 can be transmitted from person to person through direct contact with an infected individual or when an individual coughs or sneezes&#44; creating tiny droplets that remain suspended in the air travelling up to approximately 1&#46;8&#8239;m&#46; Virus transmission has also been detected through contact with contaminated surfaces or fomites&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The most common symptoms of COVID-19 infection are sore throat&#44; fatigue&#44; dry cough&#44; myalgia and fever&#46; Some patients also experience headache&#44; vomiting&#44; hemoptysis&#44; diarrhea&#44; dyspnea&#44; sputum production and lymphopenia&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> These symptoms can appear within 5&#46;2 days&#44; the mean incubation time for the coronavirus&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Most patients have recovered spontaneously&#44; and some presented nonsevere pneumonia&#46; Individuals with fatal complications can develop pulmonary edema&#44; organ failure&#44; severe pneumonia&#44; septic shock and acute respiratory distress syndrome&#46; Deaths resulting from coronavirus occur after a mean delay of 14 days after contracting the infection &#40;range&#44; 6&#8211;41 days&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The number of infections caused by COVID-19 continues to grow quickly&#46; As of the 30th of April 2020&#44; COVID-19 has infected 3&#44;090&#44;445 people worldwide and has caused the deaths of 217&#44;769&#44; only 4 months after the first diagnosed case&#46; At this point in the pandemic&#44; governments are attempting to prevent the spread of infection among the population by restricting mobility&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">To confront this worldwide health problem&#44; we need transparency and the exchange of information between nations to evaluate the characteristics of this new disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> In response to this worldwide outbreak&#44; we summarize the current state of knowledge on COVID-19 in Mexico up to April 2020&#46; This information is valuable for understanding the expansion of the disease and the effect of containment measures in Mexico&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Data source</span><p id="par0040" class="elsevierStylePara elsevierViewall">Data on the confirmed cases and deaths due to COVID-19 infection in Mexico were obtained from the official website of the Mexican Ministry of Health through the Directorate General of Epidemiology&#46; These data are analyzed by the The Institute for Diagnosis and Epidemiological References &#40;Instituto de Diagn&#243;stico y Referencia Epidemiol&#243;gica&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study period covered the 27th of February to the 30th of April 2020&#46; Our data include the notification dates for all confirmed cases&#44; suspected cases and deaths&#44; the symptom onset date&#44; whether the case was local transmission&#44; of imported origin or contact with the imported case&#44; and the mortality rate distribution by sex and age &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Definitions</span><p id="par0050" class="elsevierStylePara elsevierViewall">A confirmed case is defined as a positive result for the COVID-19 laboratory test&#44; which consists of the real-time reverse transcription-polymerase chain reaction assay&#46; A suspected case is defined as a case that meets 2 of the following criteria&#58; fever&#44; radiographic evidence of pneumonia&#44; low or normal white blood cell count or low lymphocyte count&#46; An asymptomatic case is defined as a patient with confirmed COVID-19 with normal body temperature or minor discomfort&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The cases confirmed in the first FHS reports&#44; up to the 7th of April 2020&#44; were divided into 3 types&#58; imported cases&#44; imported contact and transmission and local infection&#46; An imported case is an individual who has traveled to an affected area outside the country in the 14 days prior to the disease onset&#46; Imported contact is an individual infected by direct contact with an imported case&#46; Local infection is an individual with no history of infection due to importation&#46; The index case&#44; or patient zero&#44; is an individual who is positive for COVID-19 with the earliest onset date in a specific setting&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Temporary milestones and control measures</span><p id="par0060" class="elsevierStylePara elsevierViewall">The first case &#40;or index case&#41; of COVID-19 in Mexico was detected on the 27th of February 2020 in Mexico City&#58; a Mexican who had traveled to Italy and had mild symptoms&#46; On the 28th of February&#44; 2 more cases were confirmed&#58; a 35-year-old Italian resident of Mexico City and a Mexican citizen from the state of Hidalgo who was in the state of Sinaloa&#46; The 2 individuals had recently traveled to Italy&#46; Phase 1 of COVID-19 in Mexico began that day&#46; In this phase&#44; the cases of infection were imported from abroad&#44; and there were no cases of local infection&#46; The number of people infected with the virus was small&#44; and there were no strict health measures&#44; except for efforts directed at disseminating preventive actions&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The fourth case was confirmed on the 29th of February 2020&#58; a youth in the state of Coahuila who had recently traveled to Milan &#40;Italy&#41;&#46; On the 1st of March&#44; a youth who studied in Italy was confirmed with COVID-19 in Tuxtla Guti&#233;rrez&#44; Chiapas&#44; thereby reaching 5 cases&#46; On the 6th of March&#44; the sixth case was confirmed in the state of Mexico&#58; a 71-year-old man who had traveled to Italy&#46; The seventh case&#44; confirmed on the 7th of March&#44; was a 46-year-old man from Mexico City&#46; On the 11th of March&#44; the same day the WHO classified COVID-19 as a pandemic&#44; 4 new cases were reported&#58; 2 in Mexico City&#44; 1 in Quer&#233;taro and 1 in the state of Mexico&#46; The patients from Mexico City and Queretaro had returned from a trip to Spain&#44; and their ages ranged from 30 to 41 years&#46; The case from the state of Mexico was a 64-year-old woman who had recently traveled to the United States&#46; Up to that date&#44; 11 cases had been reported in Mexico&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">On the 14th of March 2020&#44; the Ministry of Public Education moved up the Holy Week vacations and extended them to a month&#44; from the 23rd of March to the 20th of April for all educational institutions throughout the country&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">On the 18th of March&#44; 118 confirmed cases of COVID-19 were reported&#44; a 26&#37; increase compared with the previous day&#8217;s result &#40;93 cases&#41;&#46; That same day&#44; the Secretary of Health confirmed the first death by COVID-19 in Mexico&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The federal government decreed the 24th of March as the start of phase 2 of the COVID-19 pandemic in Mexico&#44; after recording the first local infections&#46; In this phase&#44; certain activities&#44; mainly financial&#44; were suspended&#44; massive congregations were restricted&#44; and the general population was advised to remain at home&#44; especially those older than 60 years and those with diagnosed arterial hypertension&#44; diabetes&#44; heart or lung disease and induced or acquired immunosuppression&#44; as well as pregnant and immediate postpartum women&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Starting the 26th of March&#44; nonessential activities of the federal government were suspended&#44; except those related to the departments of safety&#44; health&#44; energy and sanitation&#46; The recommendations include sneezing etiquette&#44; constant washing of hands and continuous disinfection of public-use areas&#46; Individuals who have symptoms and have been confirmed with COVID-19 have to use face masks to avoid infecting other people&#46; Medical care personnel should wear the necessary personal protection equipment to avoid infection when identifying patients at risk and when inside medical facilities&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">On the 30th of March&#44; the government issued a national health emergency in Mexico&#44; given the progression of confirmed cases and deaths by the disease&#46; This resulted in the establishment of additional measures for its prevention and control&#44; such as the immediate suspension of nonessential activities in all financial sectors of the country for 1 month&#44; up to the 30th of April&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">On the 21st of April 2020&#44; phase 3 of COVID-19 was assumed to have begun in Mexico&#44; given that there was already evidence of active outbreaks and propagation in the country&#44; with more than a thousand cases&#46; During this phase&#44; the nonessential activities of the public&#44; private and social sector were suspended&#44; and the National Healthy Distance Day was extended to the 30th of May&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">Since the first case on the 27th of February 2020&#44; to the 30th of April 2020&#44; COVID-19 has spread throughout Mexico&#46; To date&#44; 87&#44;372 diagnostic tests have been conducted throughout the country&#46; Of these&#44; 19&#44;224 have resulted positive&#44; and another 15&#44;520 diagnostic tests from suspected cases are still being analyzed&#46; The total number of deaths during the study period was 1859&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The analysis of the demographic characteristics of the 19&#44;224 confirmed patients in Mexico showed that 746 &#40;3&#46;88&#37;&#41; patients were imported cases from Italy&#44; Germany&#44; Spain&#44; United States&#44; France&#44; Great Britain&#44; Turkey&#44; Peru&#44; Switzerland&#44; Netherlands&#44; Czech Republic&#44; Colombia&#44; China&#44; Canada&#44; Brazil&#44; Argentina and Singapore&#46; In total&#44; there were 135 &#40;0&#46;70&#37;&#41; recorded cases of infection by direct contact with individuals reported as imported cases&#44; and 18&#44;343 &#40;95&#46;42&#37;&#41; cases had no history of contact with individuals who have traveled abroad and can therefore be defined as community or local infection &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">After the 13th of March&#44; the number of local confirmed cases began to exceed the number of imported cases&#46; Mexico also began to detect infections among healthcare personnel dedicated to treating people diagnosed with COVID-19 and in their treatment locations&#46; It is clear that COVID-19 is an infection with a high degree of person-to-person propagation&#46; Coupled with this&#44; there are mild cases that are not reported due to presenting symptoms of a common cold or common infection&#46; These individuals received no medical care and were not diagnosed&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Moreover&#44; we have individuals with asymptomatic infection who act as unidentified transmitters of the infection&#46; To date&#44; the proportion of mild cases of COVID-19 and of asymptomatic infections is unknown&#44; thereby hiding the virus&#8217; true epidemic potential at this time&#46; To quantify the actual reach of the virus&#44; we would need to perform the largest number of tests possible&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the distribution of COVID-19 cases between men and women&#46; Blue indicates the 11&#44;186 &#40;58&#46;18&#37;&#41; confirmed cases in men&#44; and pink indicates the 8038 &#40;41&#46;82&#37;&#41; cases confirmed in women&#46; The patients&#8217; mean age was 46 years&#44; with a range of 0&#8211;104 years&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The lowest number of infections were in individuals younger than 14 years&#44; given that they presented only 250 &#40;1&#46;3&#37;&#41; cases&#46; Among the 15&#8211;29-year age group&#44; 2360 &#40;12&#46;27&#37;&#41; cases were recorded&#46; The largest number of infections occurred in the 30&#8211;59-year age group&#44; with 12&#44;656 &#40;65&#46;85&#37;&#41; cases&#44; whereas the age range of 60&#8211;104 years had fewer cases &#40;3958 cases&#59; 20&#46;58&#37;&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Of the 19&#44;224 patients reported to date&#44; 11&#44;637 &#40;60&#46;53&#37;&#41; were outpatients&#44; which means that they were mild cases who did not require hospitalization and continued with the necessary care and isolation at home&#46; A total of 7587 &#40;39&#46;47&#37;&#41; patients required hospitalization due to presenting severe signs&#46; By the 30th of April&#44; 1859 of these 7587 hospitalized patients had died and 5728 remained hospitalized&#46; Of the hospitalized patients&#44; 1785 were stable&#44; 3068 had more severe symptoms and 875 were intubated with mechanical ventilation&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows a map of Mexico with its 32 states&#46; Using the available information reported by the Mexican Ministry of Health&#44; as of the 30th of April 2020&#44; as reference&#44; we can see that all states in Mexico reported COVID-19 infections&#46; The states with the most reported cases were Mexico City &#40;5209 confirmed infections&#41;&#44; the state of Mexico &#40;3130 cases&#41; and Baja California &#40;1557 cases&#41;&#46; The states with the lowest numbers of reported COVID-19 cases in Mexico were Campeche and Nayarit with 93 confirmed cases&#44; Zacatecas with 77&#44; Durango with 66 and Colima with 27 cases&#46; In addition to the measures implemented on a national scale&#44; each state has the authority to establish additional measures to contain the propagation of COVID-19&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> shows the distribution in Mexico of the 1859 registered cases of deceased individuals from the start of the pandemic to the 30th of April 2020&#46; Of these&#44; 337 died in Mexico City&#44; the most affected state&#44; with the highest number of deaths due to the pandemic&#46; The state of Mexico reported 239 deaths&#44; and the states of Baja California&#44; Sinaloa&#44; Tabasco and Quintana Roo reported 220&#44; 139&#44; 125 and 116 deaths&#44; respectively&#46; The states that presented the lowest number of deaths were the state of Colima with 3 deaths&#44; the state of Aguascalientes with 6 and the states of Chiapas&#44; Durango and San Luis Potosi&#44; with 7 deaths each&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>a shows the age distribution for the individuals who died from COVID-19&#46; The ages range from 0 to 104 years&#46; Of the submitted cases&#44; 68&#46;85&#37; were male and 31&#46;15&#37; were female&#46; For the male sex&#44; the largest mortality rate occurred for the 65&#8211;69 and 50&#8211;54-year age range&#44; with 9&#46;03&#37; of the total deaths&#44; followed by the 55&#8211;59 and 45&#8211;49-year ranges&#44; with 8&#46;76&#37; and 8&#46;55&#37;&#44; respectively&#46; For the female sex&#44; the age ranges with the highest mortality rates were the 65&#8211;69-year age range &#40;4&#46;67&#37;&#41; and the 55&#8211;59-year range &#40;4&#46;24&#37;&#41;&#46; The female sex presented 579 cases&#44; thereby showing a lower lethality rate in women to date&#46; At present&#44; COVID-19 has a lethality rate of 9&#46;67&#37; in Mexico&#44; which is higher than the worldwide rate of 7&#37;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>b presents the comorbidities of the 1859 patients who died in Mexico&#46; Comorbidities increased the risk of complications in the cases with COVID-19&#46; The patients who died had one or more comorbidities&#58; 43&#46;53&#37; of those who died had hypertension&#59; 39&#46;39&#37; had diabetes&#59; 30&#46;4&#37; had obesity&#59; 9&#46;56&#37; were smokers&#59; 7&#46;27&#37; had chronic obstructive pulmonary disease&#59; 6&#46;82&#37; had chronic renal failure and cardiovascular disease&#59; 4&#46;59&#37; were immunosuppressed&#59; 3&#46;06&#37; had asthma&#59; and 0&#46;64&#37; had HIV or AIDS&#46; A number of patients showed several comorbidities simultaneously&#44; which made them more susceptible to severe disorders due to COVID-19&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">The present study describes the epidemiological characteristics of COVID-19 in Mexico between February and April 2020&#46; In the study period&#44; there were 19&#44;224 confirmed cases and 1859 &#40;9&#46;67&#37;&#41; deaths&#46; In terms of the demographic characteristics&#44; there was a clear predominance of middle-aged patients &#40;30&#8211;59 years of age&#41; and a higher rate among men &#40;68&#46;85&#37;&#41;&#46; Among the deceased&#44; the most predominant underlying diseases were hypertension&#44; diabetes and obesity&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The comparison between Mexico and China of the epidemic&#8217;s characteristics in the first 64 days after diagnosing the index case reveal the following findings&#58; the number of confirmed diagnoses in Mexico was 76&#37; lower than in China&#44; which counted 80&#44;304 cases&#44; and the number of deaths was 37&#37; lower than that reported by China&#46; However&#44; the lethality rate in Mexico was 9&#46;67&#37;&#44; whereas the rate in China was 3&#46;66&#37;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The analysis of the confirmed data by country should be interpreted with caution&#44; because it depends on the total number of tests performed on the population&#46; Results differing from the actual situation could be generated if sufficient tests are not performed to estimate the number of infected people in a region&#44; given that a large number of asymptomatic cases can be left out of the study&#44; as well as people with mild symptoms or who died before the COVID-19 test was performed&#46; However&#44; the number of people who died from COVID-19 is a datum that allows us to measure the impact of the pandemic caused by SARS-CoV-2 on a particular region&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">We can observe this impact by comparing the lethality rates between Mexico and China&#46; Mexico presented a higher lethality rate than China&#44; but the number of deaths was lower in 1087 cases&#44; which means that the lethality rate varies with respect to the number of confirmed COVID-19 cases&#44; with the number of tests performed on the population an important factor&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In this respect&#44; the number of diagnostic tests that Mexico conducts is 0&#46;69 tests for every 1000 inhabitants&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> whereas in China&#44; the estimated number is 3 tests for every 1000 inhabitants&#46; Mexico is in last place in the number of tests conducted to identify COVID-19 among the 36 member countries of the Organization for Economic Cooperation and Development &#40;OECD&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> which represents a limitation in the ability to identify asymptomatic cases and accurately estimate the number of infected individuals&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">It is important to mention that diagnostic tests are our window into the pandemic and help us observe how the virus propagates in a certain area&#46; It is therefore of utmost importance to increase the number of diagnostic tests in Mexico&#46; This lack of testing might explain the higher lethality rate in Mexico&#44; a finding that could at first view give an erroneous impression of the impact of the COVID-19 pandemic in Mexico&#58; if we compare the data on deaths 64 days after the first diagnosed case&#44; there would be a lower impact in Mexico&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In terms of the control measures to mitigate the outbreak of the COVID-19 pandemic&#44; the government of China&#44; specifically the local government of Wuhan&#44; suspended all travel within the city&#44; isolating the population by means of a mandatory quarantine on the 23rd of January 2020&#46; They took these measures 24 days after the start of the outbreak&#44; and by that date there were already 571 cases of COVID-19&#46; In Mexico&#44; the federal government began suspending certain financial activities&#44; restricting mass congregations and recommending home protection for the general population on the 24th of March&#44; 26 days after the start of the outbreak&#44; with 405 reported cases&#46; It is worth mentioning that at the time the measures for preventing and containing the propagation of COVID-19 were implemented&#44; Mexico had 166 fewer cases than China&#44; i&#46;e&#46;&#44; 29&#37; fewer&#46; There is evidence that approximately 60&#37; of the Mexican population follow the measures taken by the federal government in the established quarantine&#59; however&#44; this percentage varies dramatically from one population to the next&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">This study presented the characteristics of COVID-19 in Mexico 64 days after the first confirmed case in the country&#46; The data for performing the analysis shown in the graphs are the data officially submitted by the Mexican Ministry of Health&#46; These data are taken from the symptom onset date and are recorded according to the patients&#8217; statements&#46; The initial or mild symptoms might therefore have gone unnoticed&#44; which could hinder the determination of the exact incubation time for COVID-19&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The pandemic caused by SARS-CoV-2 is still active in Mexico&#46; Specific data on the propagation speed and lethality of the outbreak in Mexico is therefore still not available&#46; To control the outbreak&#44; we need to conduct the largest number of tests possible to obtain more accurate results&#58; the early determination and investigation of the epidemiological characteristics of new infectious diseases is essential for limiting their transmission through prevention and control&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Moreover&#44; the financial impact on the population due to the travel restriction measures is an important factor that needs to be taken into account&#46; An extended period of quarantine or the emergence of new outbreaks could result in serious financial complications on a national scale&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusion</span><p id="par0205" class="elsevierStylePara elsevierViewall">COVID-19 constitutes a worldwide health emergency&#46; Up to the 30th of April 2020&#44; rigorous efforts have been undertaken worldwide to contain the virus by means of mandatory quarantines in some countries&#46; To date&#44; 4 months after the onset of the virus&#44; there are 3&#44;090&#44;445 laboratory confirmed cases of COVID-19 worldwide&#44; and more than 217&#44;769 people have died from the infection&#46; The rapid growth in the number of infections worldwide is therefore highly concerning&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The first case of COVID-19 detected in Mexico was on the 27th of February 2020&#46; Sixty-four days after the first diagnosed case&#44; the number of cases had increased rapidly&#44; following an exponential growth trend&#46; As of the 30th of April 2020&#44; the total number of cases of COVID-19 in Mexico was 19&#44;224&#44; including 1&#44;859 deaths&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">There is no doubt that more research is needed to help define the precise mechanism of person-to-person transmission&#46; It is clear that the pandemic potential of COVID-19 requires rigorous surveillance and continuous monitoring to accurately track outbreaks&#44; as well as their evolution&#44; transmissibility and pathogenicity&#46; The abovementioned factors are of considerable importance because they can define the actual lethality rate&#44; which can vary according to various characteristics&#44; such as the mean age of the population&#44; sex&#44; comorbidities present &#40;which often vary from country to country&#41; and the quantity of tests performed on the population&#46; It is therefore important that information on the virus flows from nation to nation so as to measure the impact that this virus can have in the future&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">In response to this worldwide outbreak&#44; we have summarized the current state of knowledge on COVID-19 in Mexico up to April 2020&#46; This information is valuable for understanding the spread of the disease and the effect of containment measures in Mexico&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Background"
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          "titulo" => "Materials and methods"
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              "titulo" => "Definitions"
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              "titulo" => "Temporary milestones and control measures"
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          "titulo" => "Results"
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          "titulo" => "Conflicts of interest"
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          "titulo" => "References"
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    "fechaRecibido" => "2020-04-25"
    "fechaAceptado" => "2020-05-15"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:6 [
            0 => "Coronavirus"
            1 => "COVID-19"
            2 => "SARS-CoV-2"
            3 => "Mexico"
            4 => "Quarantine"
            5 => "Infection"
          ]
        ]
      ]
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          "palabras" => array:6 [
            0 => "Coronavirus"
            1 => "COVID-19"
            2 => "SARS-CoV-2"
            3 => "M&#233;xico"
            4 => "Cuarentena"
            5 => "Infecci&#243;n"
          ]
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    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The first case of COVID-19 detected in Mexico was on the 27th of February 2020&#46; On the 30th of April&#44; 64 days after this first diagnosis&#44; the number of patients had increased exponentially&#44; reaching 19&#44;224 confirmed cases and 1859 &#40;9&#46;67&#37;&#41; deaths&#46; In response to this global outbreak&#44; we summarize the current state of our understanding regarding COVID-19 in Mexico&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We obtained the data from the official website of the Ministry of Health in Mexico&#46; The study period covered the 27th of February to the 30th of April 2020&#46; The cases were confirmed using real-time reverse transcription-polymerase chain reaction assays&#44; and we analyzed the epidemiological&#44; demographic and clinical data&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">In Mexico&#44; most cases of COVID-19 were located in Mexico City&#46; The mean age of the patients was 46 years&#46; Of the 12&#44;656 confirmed cases&#44; most infected individuals were between the ages of 30 and 59 years &#40;65&#46;85&#37;&#41;&#44; and there was a higher incidence rate for men &#40;58&#46;18&#37;&#41; than for women &#40;41&#46;82&#37;&#41;&#46; The patients who died had one or more comorbidities&#44; mainly hypertension &#40;45&#46;53&#37;&#41;&#44; diabetes &#40;39&#46;39&#37;&#41; and obesity &#40;30&#46;4&#37;&#41;&#46; In the first 64 days of the epidemic&#44; China had reported 80&#44;304 cases&#44; with a mortality rate of 3&#46;66&#37;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Our results indicate the early transmission of COVID-19 in Mexico&#46; The descriptive epidemiology shows similarities between the cases of COVID-19 in Mexico and those in China&#46; In the same period of the epidemic curve&#44; we observed a reduction in the number of confirmed cases of COVID-19 in Mexico and a higher mortality rate compared with that of China&#46;</p></span>"
        "secciones" => array:4 [
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El primer caso de COVID-19 se detect&#243; en M&#233;xico el 27 de febrero de 2020&#46; El 30 de abril&#44; 64 d&#237;as despu&#233;s de este primer diagn&#243;stico&#44; el n&#250;mero de pacientes aument&#243; exponencialmente&#44; alcanzando un total de 19&#46;224 casos confirmados y 1&#46;859 &#40;9&#44;67&#37;&#41; fallecidos&#46; En respuesta a este brote global&#44; resumimos el estado actual del conocimiento sobre COVID-19 en M&#233;xico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Los datos se obtuvieron del sitio web oficial del Ministerio de Salud en M&#233;xico&#46; El per&#237;odo analizado fue entre el 27 de febrero y el 30 de abril de 2020&#46; Los casos se confirmaron mediante RT-PCR en tiempo real y se analizaron los datos epidemiol&#243;gicos&#44; demogr&#225;ficos y cl&#237;nicos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La mayor&#237;a de los casos de COVID-19 se ubicaron en la Ciudad de M&#233;xico&#46; La edad promedio de los pacientes fue de 46 a&#241;os&#46; De los 12&#46;656 casos confirmados&#44; el mayor n&#250;mero de infectados ocurre en el rango de edad entre 30 y 59 a&#241;os &#40;65&#44;85&#37;&#41;&#44; y hubo una mayor incidencia en hombres &#40;58&#44;18&#37;&#41; que en mujeres &#40;41&#44;82&#37;&#41;&#46; Los pacientes fallecidos ten&#237;an una o m&#250;ltiples comorbilidades&#44; principalmente hipertensi&#243;n &#40;45&#44;53&#37;&#41;&#44; diabetes &#40;39&#44;39&#37;&#41; y obesidad &#40;30&#44;4&#37;&#41;&#46; En los primeros 64 d&#237;as de epidemia&#44; China hab&#237;a reportado 80&#46;304 casos con una tasa de mortalidad del 3&#44;66&#37;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados indican la transmisi&#243;n temprana de COVID-19 en M&#233;xico&#46; La epidemiolog&#237;a descriptiva muestra las similitudes entre los casos de COVID-19 de M&#233;xico y China&#46; En el mismo per&#237;odo de la curva epid&#233;mica&#44; observamos en M&#233;xico una reducci&#243;n en el n&#250;mero de casos confirmados de COVID-19 y una mayor tasa de mortalidad en comparaci&#243;n con China&#46;</p></span>"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Su&#225;rez V&#44; Suarez Quezada M&#44; Oros Ruiz S&#44; Ronquillo De Jes&#250;s E&#46; Epidemiolog&#237;a de COVID-19 en M&#233;xico&#58; del 27 de febrero al 30 de abril de 2020&#46; Rev Clin Esp&#46; 2020&#59;220&#58;463&#8211;471&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Distribution of symptom onset for patients with confirmed COVID-19 through laboratory testing&#58; imported cases &#40;orange&#41;&#44; imported contact cases &#40;grey&#41;&#44; local contact cases &#40;yellow&#41;&#46; The line in the figure shows the cumulative cases of COVID-19 between the 17th of February and the 30th of April 2020&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Distribution of deaths by COVID-19 in Mexico by state&#46;</p>"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">a&#41; Age and sex distribution of deaths by COVID-19 in Mexico&#46; b&#41; Comorbidities presented in the individuals who died due to COVID-19 in Mexico&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; AIDS&#44; acquired immune deficiency syndrome&#59; COPD&#44; chronic obstructive pulmonary disease&#59; HIV&#44; human immunodeficiency virus&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#91;0&#44;1&#8211;9&#93;Results of COVID-19 tests</th></tr><tr title="table-row"><th class="td" title="\n
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Total number of confirmed and suspected cases and deaths as of the 30th of April 2020&#44; as well as the distribution of cases and the mortality rate by sex and age&#46;</p>"
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Original article
Epidemiology of COVID-19 in Mexico: From the 27th of February to the 30th of April 2020
Epidemiología de COVID-19 en México: del 27 de febrero al 30 de abril de 2020
V. Suáreza,b,
Corresponding author
victorm_suarez@hotmail.com

Corresponding author.
, M. Suarez Quezadab, S. Oros Ruiza, E. Ronquillo De Jesúsc
a CONACyT - Universidad Autónoma Metropolitana-Iztapalapa, Departamento de Química, Ciudad de México, Mexico
b Unidad Profesional Interdisciplinaria de Ingeniería y Ciencias Sociales y Administrativas, Departamento de Química, Ciudad de México, Mexico
c Universidad Politécnica de Francisco I. Madero, Dirección de Ingeniería Agroindustrial, Hidalgo, Mexico
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        "titulo" => "Epidemiolog&#237;a de COVID-19 en M&#233;xico&#58; del 27 de febrero al 30 de abril de 2020"
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">a&#41; Age and sex distribution of deaths by COVID-19 in Mexico&#46; b&#41; Comorbidities presented in the individuals who died due to COVID-19 in Mexico&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; AIDS&#44; acquired immune deficiency syndrome&#59; COPD&#44; chronic obstructive pulmonary disease&#59; HIV&#44; human immunodeficiency virus&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">On the 31st of December 2019&#44; China had a total of 26 cases and 1 death with a diagnosis of pneumonia of unknown etiology&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These cases originated in the Huanan Seafood Wholesale Market of Wuhan&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> On the 7th of January 2020&#44; the Chinese Center for Disease Control and Prevention identified the causal agent of the unknown pneumonia as a severe acute coronavirus related to severe acute respiratory syndrome &#40;SARS&#41;&#44; which was termed SARS-CoV-2&#44; due to its similarity with SARS coronavirus &#40;CoV&#41;&#44; discovered in 2003&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">This type of virus causes disease in animals and humans&#44; which can be respiratory infections&#44; such as the common cold&#44; or more acute infections&#44; such as Middle East respiratory syndrome &#40;MERS&#41;-CoV and SARS-CoV&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Generally&#44; the viruses can be found in animal reservoirs&#58; MERS-CoV is transmitted from camels to humans&#44; whereas SARS-CoV is transmitted from exotic animals&#46; Bats are suspected to be the reservoir for SARS-CoV-2&#44; although this has not been completely verified&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> The World Health Organization &#40;WHO&#41; named this disease coronavirus disease 2019 &#40;COVID-19&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> On the 11th of March&#44; 2020&#44; COVID-19 was declared a pandemic&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It has been reported that COVID-19 can be transmitted from person to person through direct contact with an infected individual or when an individual coughs or sneezes&#44; creating tiny droplets that remain suspended in the air travelling up to approximately 1&#46;8&#8239;m&#46; Virus transmission has also been detected through contact with contaminated surfaces or fomites&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The most common symptoms of COVID-19 infection are sore throat&#44; fatigue&#44; dry cough&#44; myalgia and fever&#46; Some patients also experience headache&#44; vomiting&#44; hemoptysis&#44; diarrhea&#44; dyspnea&#44; sputum production and lymphopenia&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> These symptoms can appear within 5&#46;2 days&#44; the mean incubation time for the coronavirus&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Most patients have recovered spontaneously&#44; and some presented nonsevere pneumonia&#46; Individuals with fatal complications can develop pulmonary edema&#44; organ failure&#44; severe pneumonia&#44; septic shock and acute respiratory distress syndrome&#46; Deaths resulting from coronavirus occur after a mean delay of 14 days after contracting the infection &#40;range&#44; 6&#8211;41 days&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The number of infections caused by COVID-19 continues to grow quickly&#46; As of the 30th of April 2020&#44; COVID-19 has infected 3&#44;090&#44;445 people worldwide and has caused the deaths of 217&#44;769&#44; only 4 months after the first diagnosed case&#46; At this point in the pandemic&#44; governments are attempting to prevent the spread of infection among the population by restricting mobility&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">To confront this worldwide health problem&#44; we need transparency and the exchange of information between nations to evaluate the characteristics of this new disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a> In response to this worldwide outbreak&#44; we summarize the current state of knowledge on COVID-19 in Mexico up to April 2020&#46; This information is valuable for understanding the expansion of the disease and the effect of containment measures in Mexico&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Data source</span><p id="par0040" class="elsevierStylePara elsevierViewall">Data on the confirmed cases and deaths due to COVID-19 infection in Mexico were obtained from the official website of the Mexican Ministry of Health through the Directorate General of Epidemiology&#46; These data are analyzed by the The Institute for Diagnosis and Epidemiological References &#40;Instituto de Diagn&#243;stico y Referencia Epidemiol&#243;gica&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study period covered the 27th of February to the 30th of April 2020&#46; Our data include the notification dates for all confirmed cases&#44; suspected cases and deaths&#44; the symptom onset date&#44; whether the case was local transmission&#44; of imported origin or contact with the imported case&#44; and the mortality rate distribution by sex and age &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Definitions</span><p id="par0050" class="elsevierStylePara elsevierViewall">A confirmed case is defined as a positive result for the COVID-19 laboratory test&#44; which consists of the real-time reverse transcription-polymerase chain reaction assay&#46; A suspected case is defined as a case that meets 2 of the following criteria&#58; fever&#44; radiographic evidence of pneumonia&#44; low or normal white blood cell count or low lymphocyte count&#46; An asymptomatic case is defined as a patient with confirmed COVID-19 with normal body temperature or minor discomfort&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The cases confirmed in the first FHS reports&#44; up to the 7th of April 2020&#44; were divided into 3 types&#58; imported cases&#44; imported contact and transmission and local infection&#46; An imported case is an individual who has traveled to an affected area outside the country in the 14 days prior to the disease onset&#46; Imported contact is an individual infected by direct contact with an imported case&#46; Local infection is an individual with no history of infection due to importation&#46; The index case&#44; or patient zero&#44; is an individual who is positive for COVID-19 with the earliest onset date in a specific setting&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Temporary milestones and control measures</span><p id="par0060" class="elsevierStylePara elsevierViewall">The first case &#40;or index case&#41; of COVID-19 in Mexico was detected on the 27th of February 2020 in Mexico City&#58; a Mexican who had traveled to Italy and had mild symptoms&#46; On the 28th of February&#44; 2 more cases were confirmed&#58; a 35-year-old Italian resident of Mexico City and a Mexican citizen from the state of Hidalgo who was in the state of Sinaloa&#46; The 2 individuals had recently traveled to Italy&#46; Phase 1 of COVID-19 in Mexico began that day&#46; In this phase&#44; the cases of infection were imported from abroad&#44; and there were no cases of local infection&#46; The number of people infected with the virus was small&#44; and there were no strict health measures&#44; except for efforts directed at disseminating preventive actions&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The fourth case was confirmed on the 29th of February 2020&#58; a youth in the state of Coahuila who had recently traveled to Milan &#40;Italy&#41;&#46; On the 1st of March&#44; a youth who studied in Italy was confirmed with COVID-19 in Tuxtla Guti&#233;rrez&#44; Chiapas&#44; thereby reaching 5 cases&#46; On the 6th of March&#44; the sixth case was confirmed in the state of Mexico&#58; a 71-year-old man who had traveled to Italy&#46; The seventh case&#44; confirmed on the 7th of March&#44; was a 46-year-old man from Mexico City&#46; On the 11th of March&#44; the same day the WHO classified COVID-19 as a pandemic&#44; 4 new cases were reported&#58; 2 in Mexico City&#44; 1 in Quer&#233;taro and 1 in the state of Mexico&#46; The patients from Mexico City and Queretaro had returned from a trip to Spain&#44; and their ages ranged from 30 to 41 years&#46; The case from the state of Mexico was a 64-year-old woman who had recently traveled to the United States&#46; Up to that date&#44; 11 cases had been reported in Mexico&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">On the 14th of March 2020&#44; the Ministry of Public Education moved up the Holy Week vacations and extended them to a month&#44; from the 23rd of March to the 20th of April for all educational institutions throughout the country&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">On the 18th of March&#44; 118 confirmed cases of COVID-19 were reported&#44; a 26&#37; increase compared with the previous day&#8217;s result &#40;93 cases&#41;&#46; That same day&#44; the Secretary of Health confirmed the first death by COVID-19 in Mexico&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The federal government decreed the 24th of March as the start of phase 2 of the COVID-19 pandemic in Mexico&#44; after recording the first local infections&#46; In this phase&#44; certain activities&#44; mainly financial&#44; were suspended&#44; massive congregations were restricted&#44; and the general population was advised to remain at home&#44; especially those older than 60 years and those with diagnosed arterial hypertension&#44; diabetes&#44; heart or lung disease and induced or acquired immunosuppression&#44; as well as pregnant and immediate postpartum women&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Starting the 26th of March&#44; nonessential activities of the federal government were suspended&#44; except those related to the departments of safety&#44; health&#44; energy and sanitation&#46; The recommendations include sneezing etiquette&#44; constant washing of hands and continuous disinfection of public-use areas&#46; Individuals who have symptoms and have been confirmed with COVID-19 have to use face masks to avoid infecting other people&#46; Medical care personnel should wear the necessary personal protection equipment to avoid infection when identifying patients at risk and when inside medical facilities&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">On the 30th of March&#44; the government issued a national health emergency in Mexico&#44; given the progression of confirmed cases and deaths by the disease&#46; This resulted in the establishment of additional measures for its prevention and control&#44; such as the immediate suspension of nonessential activities in all financial sectors of the country for 1 month&#44; up to the 30th of April&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">On the 21st of April 2020&#44; phase 3 of COVID-19 was assumed to have begun in Mexico&#44; given that there was already evidence of active outbreaks and propagation in the country&#44; with more than a thousand cases&#46; During this phase&#44; the nonessential activities of the public&#44; private and social sector were suspended&#44; and the National Healthy Distance Day was extended to the 30th of May&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">Since the first case on the 27th of February 2020&#44; to the 30th of April 2020&#44; COVID-19 has spread throughout Mexico&#46; To date&#44; 87&#44;372 diagnostic tests have been conducted throughout the country&#46; Of these&#44; 19&#44;224 have resulted positive&#44; and another 15&#44;520 diagnostic tests from suspected cases are still being analyzed&#46; The total number of deaths during the study period was 1859&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The analysis of the demographic characteristics of the 19&#44;224 confirmed patients in Mexico showed that 746 &#40;3&#46;88&#37;&#41; patients were imported cases from Italy&#44; Germany&#44; Spain&#44; United States&#44; France&#44; Great Britain&#44; Turkey&#44; Peru&#44; Switzerland&#44; Netherlands&#44; Czech Republic&#44; Colombia&#44; China&#44; Canada&#44; Brazil&#44; Argentina and Singapore&#46; In total&#44; there were 135 &#40;0&#46;70&#37;&#41; recorded cases of infection by direct contact with individuals reported as imported cases&#44; and 18&#44;343 &#40;95&#46;42&#37;&#41; cases had no history of contact with individuals who have traveled abroad and can therefore be defined as community or local infection &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">After the 13th of March&#44; the number of local confirmed cases began to exceed the number of imported cases&#46; Mexico also began to detect infections among healthcare personnel dedicated to treating people diagnosed with COVID-19 and in their treatment locations&#46; It is clear that COVID-19 is an infection with a high degree of person-to-person propagation&#46; Coupled with this&#44; there are mild cases that are not reported due to presenting symptoms of a common cold or common infection&#46; These individuals received no medical care and were not diagnosed&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Moreover&#44; we have individuals with asymptomatic infection who act as unidentified transmitters of the infection&#46; To date&#44; the proportion of mild cases of COVID-19 and of asymptomatic infections is unknown&#44; thereby hiding the virus&#8217; true epidemic potential at this time&#46; To quantify the actual reach of the virus&#44; we would need to perform the largest number of tests possible&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the distribution of COVID-19 cases between men and women&#46; Blue indicates the 11&#44;186 &#40;58&#46;18&#37;&#41; confirmed cases in men&#44; and pink indicates the 8038 &#40;41&#46;82&#37;&#41; cases confirmed in women&#46; The patients&#8217; mean age was 46 years&#44; with a range of 0&#8211;104 years&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">The lowest number of infections were in individuals younger than 14 years&#44; given that they presented only 250 &#40;1&#46;3&#37;&#41; cases&#46; Among the 15&#8211;29-year age group&#44; 2360 &#40;12&#46;27&#37;&#41; cases were recorded&#46; The largest number of infections occurred in the 30&#8211;59-year age group&#44; with 12&#44;656 &#40;65&#46;85&#37;&#41; cases&#44; whereas the age range of 60&#8211;104 years had fewer cases &#40;3958 cases&#59; 20&#46;58&#37;&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Of the 19&#44;224 patients reported to date&#44; 11&#44;637 &#40;60&#46;53&#37;&#41; were outpatients&#44; which means that they were mild cases who did not require hospitalization and continued with the necessary care and isolation at home&#46; A total of 7587 &#40;39&#46;47&#37;&#41; patients required hospitalization due to presenting severe signs&#46; By the 30th of April&#44; 1859 of these 7587 hospitalized patients had died and 5728 remained hospitalized&#46; Of the hospitalized patients&#44; 1785 were stable&#44; 3068 had more severe symptoms and 875 were intubated with mechanical ventilation&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> shows a map of Mexico with its 32 states&#46; Using the available information reported by the Mexican Ministry of Health&#44; as of the 30th of April 2020&#44; as reference&#44; we can see that all states in Mexico reported COVID-19 infections&#46; The states with the most reported cases were Mexico City &#40;5209 confirmed infections&#41;&#44; the state of Mexico &#40;3130 cases&#41; and Baja California &#40;1557 cases&#41;&#46; The states with the lowest numbers of reported COVID-19 cases in Mexico were Campeche and Nayarit with 93 confirmed cases&#44; Zacatecas with 77&#44; Durango with 66 and Colima with 27 cases&#46; In addition to the measures implemented on a national scale&#44; each state has the authority to establish additional measures to contain the propagation of COVID-19&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> shows the distribution in Mexico of the 1859 registered cases of deceased individuals from the start of the pandemic to the 30th of April 2020&#46; Of these&#44; 337 died in Mexico City&#44; the most affected state&#44; with the highest number of deaths due to the pandemic&#46; The state of Mexico reported 239 deaths&#44; and the states of Baja California&#44; Sinaloa&#44; Tabasco and Quintana Roo reported 220&#44; 139&#44; 125 and 116 deaths&#44; respectively&#46; The states that presented the lowest number of deaths were the state of Colima with 3 deaths&#44; the state of Aguascalientes with 6 and the states of Chiapas&#44; Durango and San Luis Potosi&#44; with 7 deaths each&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>a shows the age distribution for the individuals who died from COVID-19&#46; The ages range from 0 to 104 years&#46; Of the submitted cases&#44; 68&#46;85&#37; were male and 31&#46;15&#37; were female&#46; For the male sex&#44; the largest mortality rate occurred for the 65&#8211;69 and 50&#8211;54-year age range&#44; with 9&#46;03&#37; of the total deaths&#44; followed by the 55&#8211;59 and 45&#8211;49-year ranges&#44; with 8&#46;76&#37; and 8&#46;55&#37;&#44; respectively&#46; For the female sex&#44; the age ranges with the highest mortality rates were the 65&#8211;69-year age range &#40;4&#46;67&#37;&#41; and the 55&#8211;59-year range &#40;4&#46;24&#37;&#41;&#46; The female sex presented 579 cases&#44; thereby showing a lower lethality rate in women to date&#46; At present&#44; COVID-19 has a lethality rate of 9&#46;67&#37; in Mexico&#44; which is higher than the worldwide rate of 7&#37;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a>b presents the comorbidities of the 1859 patients who died in Mexico&#46; Comorbidities increased the risk of complications in the cases with COVID-19&#46; The patients who died had one or more comorbidities&#58; 43&#46;53&#37; of those who died had hypertension&#59; 39&#46;39&#37; had diabetes&#59; 30&#46;4&#37; had obesity&#59; 9&#46;56&#37; were smokers&#59; 7&#46;27&#37; had chronic obstructive pulmonary disease&#59; 6&#46;82&#37; had chronic renal failure and cardiovascular disease&#59; 4&#46;59&#37; were immunosuppressed&#59; 3&#46;06&#37; had asthma&#59; and 0&#46;64&#37; had HIV or AIDS&#46; A number of patients showed several comorbidities simultaneously&#44; which made them more susceptible to severe disorders due to COVID-19&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">The present study describes the epidemiological characteristics of COVID-19 in Mexico between February and April 2020&#46; In the study period&#44; there were 19&#44;224 confirmed cases and 1859 &#40;9&#46;67&#37;&#41; deaths&#46; In terms of the demographic characteristics&#44; there was a clear predominance of middle-aged patients &#40;30&#8211;59 years of age&#41; and a higher rate among men &#40;68&#46;85&#37;&#41;&#46; Among the deceased&#44; the most predominant underlying diseases were hypertension&#44; diabetes and obesity&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The comparison between Mexico and China of the epidemic&#8217;s characteristics in the first 64 days after diagnosing the index case reveal the following findings&#58; the number of confirmed diagnoses in Mexico was 76&#37; lower than in China&#44; which counted 80&#44;304 cases&#44; and the number of deaths was 37&#37; lower than that reported by China&#46; However&#44; the lethality rate in Mexico was 9&#46;67&#37;&#44; whereas the rate in China was 3&#46;66&#37;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The analysis of the confirmed data by country should be interpreted with caution&#44; because it depends on the total number of tests performed on the population&#46; Results differing from the actual situation could be generated if sufficient tests are not performed to estimate the number of infected people in a region&#44; given that a large number of asymptomatic cases can be left out of the study&#44; as well as people with mild symptoms or who died before the COVID-19 test was performed&#46; However&#44; the number of people who died from COVID-19 is a datum that allows us to measure the impact of the pandemic caused by SARS-CoV-2 on a particular region&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">We can observe this impact by comparing the lethality rates between Mexico and China&#46; Mexico presented a higher lethality rate than China&#44; but the number of deaths was lower in 1087 cases&#44; which means that the lethality rate varies with respect to the number of confirmed COVID-19 cases&#44; with the number of tests performed on the population an important factor&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In this respect&#44; the number of diagnostic tests that Mexico conducts is 0&#46;69 tests for every 1000 inhabitants&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> whereas in China&#44; the estimated number is 3 tests for every 1000 inhabitants&#46; Mexico is in last place in the number of tests conducted to identify COVID-19 among the 36 member countries of the Organization for Economic Cooperation and Development &#40;OECD&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> which represents a limitation in the ability to identify asymptomatic cases and accurately estimate the number of infected individuals&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">It is important to mention that diagnostic tests are our window into the pandemic and help us observe how the virus propagates in a certain area&#46; It is therefore of utmost importance to increase the number of diagnostic tests in Mexico&#46; This lack of testing might explain the higher lethality rate in Mexico&#44; a finding that could at first view give an erroneous impression of the impact of the COVID-19 pandemic in Mexico&#58; if we compare the data on deaths 64 days after the first diagnosed case&#44; there would be a lower impact in Mexico&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">In terms of the control measures to mitigate the outbreak of the COVID-19 pandemic&#44; the government of China&#44; specifically the local government of Wuhan&#44; suspended all travel within the city&#44; isolating the population by means of a mandatory quarantine on the 23rd of January 2020&#46; They took these measures 24 days after the start of the outbreak&#44; and by that date there were already 571 cases of COVID-19&#46; In Mexico&#44; the federal government began suspending certain financial activities&#44; restricting mass congregations and recommending home protection for the general population on the 24th of March&#44; 26 days after the start of the outbreak&#44; with 405 reported cases&#46; It is worth mentioning that at the time the measures for preventing and containing the propagation of COVID-19 were implemented&#44; Mexico had 166 fewer cases than China&#44; i&#46;e&#46;&#44; 29&#37; fewer&#46; There is evidence that approximately 60&#37; of the Mexican population follow the measures taken by the federal government in the established quarantine&#59; however&#44; this percentage varies dramatically from one population to the next&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">This study presented the characteristics of COVID-19 in Mexico 64 days after the first confirmed case in the country&#46; The data for performing the analysis shown in the graphs are the data officially submitted by the Mexican Ministry of Health&#46; These data are taken from the symptom onset date and are recorded according to the patients&#8217; statements&#46; The initial or mild symptoms might therefore have gone unnoticed&#44; which could hinder the determination of the exact incubation time for COVID-19&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The pandemic caused by SARS-CoV-2 is still active in Mexico&#46; Specific data on the propagation speed and lethality of the outbreak in Mexico is therefore still not available&#46; To control the outbreak&#44; we need to conduct the largest number of tests possible to obtain more accurate results&#58; the early determination and investigation of the epidemiological characteristics of new infectious diseases is essential for limiting their transmission through prevention and control&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Moreover&#44; the financial impact on the population due to the travel restriction measures is an important factor that needs to be taken into account&#46; An extended period of quarantine or the emergence of new outbreaks could result in serious financial complications on a national scale&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conclusion</span><p id="par0205" class="elsevierStylePara elsevierViewall">COVID-19 constitutes a worldwide health emergency&#46; Up to the 30th of April 2020&#44; rigorous efforts have been undertaken worldwide to contain the virus by means of mandatory quarantines in some countries&#46; To date&#44; 4 months after the onset of the virus&#44; there are 3&#44;090&#44;445 laboratory confirmed cases of COVID-19 worldwide&#44; and more than 217&#44;769 people have died from the infection&#46; The rapid growth in the number of infections worldwide is therefore highly concerning&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The first case of COVID-19 detected in Mexico was on the 27th of February 2020&#46; Sixty-four days after the first diagnosed case&#44; the number of cases had increased rapidly&#44; following an exponential growth trend&#46; As of the 30th of April 2020&#44; the total number of cases of COVID-19 in Mexico was 19&#44;224&#44; including 1&#44;859 deaths&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">There is no doubt that more research is needed to help define the precise mechanism of person-to-person transmission&#46; It is clear that the pandemic potential of COVID-19 requires rigorous surveillance and continuous monitoring to accurately track outbreaks&#44; as well as their evolution&#44; transmissibility and pathogenicity&#46; The abovementioned factors are of considerable importance because they can define the actual lethality rate&#44; which can vary according to various characteristics&#44; such as the mean age of the population&#44; sex&#44; comorbidities present &#40;which often vary from country to country&#41; and the quantity of tests performed on the population&#46; It is therefore important that information on the virus flows from nation to nation so as to measure the impact that this virus can have in the future&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">In response to this worldwide outbreak&#44; we have summarized the current state of knowledge on COVID-19 in Mexico up to April 2020&#46; This information is valuable for understanding the spread of the disease and the effect of containment measures in Mexico&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The first case of COVID-19 detected in Mexico was on the 27th of February 2020&#46; On the 30th of April&#44; 64 days after this first diagnosis&#44; the number of patients had increased exponentially&#44; reaching 19&#44;224 confirmed cases and 1859 &#40;9&#46;67&#37;&#41; deaths&#46; In response to this global outbreak&#44; we summarize the current state of our understanding regarding COVID-19 in Mexico&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">We obtained the data from the official website of the Ministry of Health in Mexico&#46; The study period covered the 27th of February to the 30th of April 2020&#46; The cases were confirmed using real-time reverse transcription-polymerase chain reaction assays&#44; and we analyzed the epidemiological&#44; demographic and clinical data&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">In Mexico&#44; most cases of COVID-19 were located in Mexico City&#46; The mean age of the patients was 46 years&#46; Of the 12&#44;656 confirmed cases&#44; most infected individuals were between the ages of 30 and 59 years &#40;65&#46;85&#37;&#41;&#44; and there was a higher incidence rate for men &#40;58&#46;18&#37;&#41; than for women &#40;41&#46;82&#37;&#41;&#46; The patients who died had one or more comorbidities&#44; mainly hypertension &#40;45&#46;53&#37;&#41;&#44; diabetes &#40;39&#46;39&#37;&#41; and obesity &#40;30&#46;4&#37;&#41;&#46; In the first 64 days of the epidemic&#44; China had reported 80&#44;304 cases&#44; with a mortality rate of 3&#46;66&#37;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Our results indicate the early transmission of COVID-19 in Mexico&#46; The descriptive epidemiology shows similarities between the cases of COVID-19 in Mexico and those in China&#46; In the same period of the epidemic curve&#44; we observed a reduction in the number of confirmed cases of COVID-19 in Mexico and a higher mortality rate compared with that of China&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">El primer caso de COVID-19 se detect&#243; en M&#233;xico el 27 de febrero de 2020&#46; El 30 de abril&#44; 64 d&#237;as despu&#233;s de este primer diagn&#243;stico&#44; el n&#250;mero de pacientes aument&#243; exponencialmente&#44; alcanzando un total de 19&#46;224 casos confirmados y 1&#46;859 &#40;9&#44;67&#37;&#41; fallecidos&#46; En respuesta a este brote global&#44; resumimos el estado actual del conocimiento sobre COVID-19 en M&#233;xico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Los datos se obtuvieron del sitio web oficial del Ministerio de Salud en M&#233;xico&#46; El per&#237;odo analizado fue entre el 27 de febrero y el 30 de abril de 2020&#46; Los casos se confirmaron mediante RT-PCR en tiempo real y se analizaron los datos epidemiol&#243;gicos&#44; demogr&#225;ficos y cl&#237;nicos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La mayor&#237;a de los casos de COVID-19 se ubicaron en la Ciudad de M&#233;xico&#46; La edad promedio de los pacientes fue de 46 a&#241;os&#46; De los 12&#46;656 casos confirmados&#44; el mayor n&#250;mero de infectados ocurre en el rango de edad entre 30 y 59 a&#241;os &#40;65&#44;85&#37;&#41;&#44; y hubo una mayor incidencia en hombres &#40;58&#44;18&#37;&#41; que en mujeres &#40;41&#44;82&#37;&#41;&#46; Los pacientes fallecidos ten&#237;an una o m&#250;ltiples comorbilidades&#44; principalmente hipertensi&#243;n &#40;45&#44;53&#37;&#41;&#44; diabetes &#40;39&#44;39&#37;&#41; y obesidad &#40;30&#44;4&#37;&#41;&#46; En los primeros 64 d&#237;as de epidemia&#44; China hab&#237;a reportado 80&#46;304 casos con una tasa de mortalidad del 3&#44;66&#37;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados indican la transmisi&#243;n temprana de COVID-19 en M&#233;xico&#46; La epidemiolog&#237;a descriptiva muestra las similitudes entre los casos de COVID-19 de M&#233;xico y China&#46; En el mismo per&#237;odo de la curva epid&#233;mica&#44; observamos en M&#233;xico una reducci&#243;n en el n&#250;mero de casos confirmados de COVID-19 y una mayor tasa de mortalidad en comparaci&#243;n con China&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#91;0&#44;1&#8211;9&#93;Results of COVID-19 tests</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#91;0&#44;1&#8211;2&#93;Tests performed&#8239;&#61;&#8239;87&#44;372</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#91;0&#44;3&#8211;5&#93;Confirmed cases&#8239;&#61;&#8239;19&#44;224</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#91;0&#44;6&#8211;7&#93;Negative cases&#8239;&#61;&#8239;52&#44;628</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#91;0&#44;1&#8211;5&#93;Confirmed cases&#8239;&#61;&#8239;19&#44;224</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age group&#44; years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cases n&#8239;&#61;&#8239;19&#44;244&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;Total cases&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Men n&#8239;&#61;&#8239;11&#44;186&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Deaths n&#8239;&#61;&#8239;1&#44;859&nbsp;\t\t\t\t\t\t\n
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                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Total number of confirmed and suspected cases and deaths as of the 30th of April 2020&#44; as well as the distribution of cases and the mortality rate by sex and age&#46;</p>"
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      "titulo" => "References"
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                    0 => array:2 [
                      "titulo" => "Identification of a novel coronavirus causing severe pneumonia in human&#58; a descriptive study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Ren"
                            1 => "Y&#46; Wang"
                            2 => "Z&#46; Wu"
                            3 => "Z&#46;C&#46; Xiang"
                            4 => "L&#46; Guo"
                            5 => "T&#46; Xu"
                          ]
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                    0 => array:2 [
                      "doi" => "10.1097/CM9.0000000000000722"
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                        "tituloSerie" => "Chin Med J&#46;"
                        "fecha" => "2020"
                        "volumen" => "133"
                        "paginaInicial" => "1015"
                        "paginaFinal" => "1024"
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                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32004165"
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                      "doi" => "10.1002/jmv.25678"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Med Virol&#46;"
                        "fecha" => "2020"
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