Analysis: ‘Don’t Be Afraid of COVID’? Not Buying It, Unless Businesses Do Job Right

As stores, restaurants, airlines and offices try to lure clients back, this is what they need to do to earn my business: Make me feel safe — no, make me be as safe as possible. As I’ve begun to explore old haunts, some are doing a fabulous job. Others are not.

So my dollars will flow to the former, and I’ll effectively boycott the latter. Think of it as ethical shopping, with a safety twist: I’ll reward businesses that are seriously implementing recommended COVID-19 precautionary guidelines. And I’ll punish, in my own tiny way, those who don’t take them to heart.

Yes, I know businesses across the country have lost huge amounts of money because of the pandemic. But many did get billions of dollars of federal aid to sustain them.

All many of us got was a $1,200 check. Some who would not normally be eligible for unemployment benefits will be able to get them, and some beneficiaries got extended benefits. Some of those have since run out.

It is not that hard to make many businesses relatively COVID-friendly and safe, though it requires making that a priority, investing a bit and thinking out of the box.

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My local Trader Joe’s in Washington, D.C., did a stellar job. While I initially limited my shopping to once a week at the crack of dawn, I quickly came to view the store as a safe zone: Shoppers received a squirt of hand sanitizer at the door and were directed to a row of sanitized carts.

Mandatory masking was (politely) enforced, the number of customers in the store was limited, and customers waiting outside were carefully spaced in line at 6-foot intervals. Checkout clerks scanned your items from behind a plexiglass partition and placed them back in your cart.

Customers could put their groceries in their carrier bags on a frequently sanitized table outside. If you lived close by, you could simply use the cart to walk the groceries home. Used carts were gathered in an area for re-sanitizing.

Contrast that with a local CVS Pharmacy. Yes, there was a sign on the door indicating masking was required, and plexiglass partitions had been placed at checkout counters. But there was no active enforcement once inside, and it was sometimes crowded. The pile of baskets was, as always, inside the front door, and used ones were placed on top by shoppers as they left.

Some customers picking up medicines had masks around their necks, and even some of the employees — including sometimes the pharmacist — had pulled down their masks so both nose and mouth were exposed. I know wearing a mask for hours can feel stifling, but if surgeons can do it in the operating room, so can we. And if the coronavirus lingers in the air in enclosed spaces, as we now know it does, not masking could be a problem.

Last week, when I went to pick up a prescription that was not quite ready, I said I wouldn’t wait in a place where so many people were not following our local masking mandate. I left.

On a recent trip to my hometown, New York City, many restaurants in my neighborhood had erected outdoor seating areas on sidewalks and into the street. (Indoor dining was still prohibited at that time.)

But my (formerly) favorite eatery had merely put out a few tables on the sidewalk, which employees wiped down with the same damp cloth. Yes, the tables were (maybe) 6 feet apart. But tables don’t get infectious diseases, people do. The chairs, where potential COVID carriers would sit (without masks when they eat), were far closer together.

In contrast, the restaurant next door, whose food I normally consider mediocre, had sanitizer at check-in and had set up a tent hung with flowers in what was formerly a parking lane, under which tables were widely spaced with plexiglass partitions separating them.

The wait staff was scrupulous about social distancing. It limited dining to 90 minutes. The food tasted great. Did the restaurant have a new chef, or was it its lovely setup — which really allowed us to relax and not consider a world gone COVID-mad as we ate — that made us enjoy its food more than we ever had?

A high-end Mexican restaurant we visited in Brooklyn went one step further: Each diner had to give a cellphone number at the door in case contact tracing was required. It had created an online menu, so diners made their selections from their phones.

And don’t get me started on airlines, and their varying policies. The risk of in-flight transmission appears to be low if everyone is masked and doesn’t knowingly fly ill. But that’s a big if. Remember, the novel coronavirus’s cousin, SARS-CoV, a far more dangerous but less contagious virus, created an infamous outbreak on a two-hour flight from Hong Kong to Beijing in 2003.

There have been cases related to in-flight exposures in Europe and Asia. Yet Airlines for America, an industry group, said this month that there have been “no confirmed cases of COVID-19 transmission on U.S. flights [italics mine].” Are the Boeings and Airbuses somehow different in Europe than in the U.S.?

And let’s remember epidemiology: There may be demonstrated cases of in-flight transmission elsewhere only because people abroad have resumed a more normal life than America has. Very few people in the U.S. are flying these days because America still has tens of thousands of new cases a day and leads the world in deaths.

Some airlines, like Delta and Southwest, are not selling middle seats or are selling only about half their seats. United and American have been flying full whenever they can. On June 30, United’s chief communications officer Josh Earnest (yes, the former Obama White House spokesperson), dismissed the blocking of middle seats as “PR.”

“When you’re on board the aircraft, if you’re sitting in the aisle, and the middle seat is empty, the person across the aisle from you is within 6 feet of you,” he said. “The person at the window is within 6 feet of you. The people in the row in front of you are within 6 feet of you. The people in the row behind you are within 6 feet of you.”

But 3 feet is better than cheek-by-jowl. In fact, the World Health Organization says that 3 feet is acceptable for social distancing.

Yet that’s not so good if you take off your mask. So why do airlines distribute those little bags of pretzels and nuts, anyway? When my daughter flew to grad school in California, I insisted she fly Delta, though other carriers fly the same route.

Instead of trying to create a bit of social distancing, some airlines offer a few concessions. Says American: “Customers on all flights receive sanitizing wipes or gel.” United offers to rebook your flight without a change fee if it’s too full for your comfort the night before. It will notify “customers when we can if their flight is fairly full and give them the option to change it” — though you pay the price difference for a new ticket.

A friend of mine flying London to New York checked a United flight seating chart beforehand and — seeing the middle seat was free — prepared for a long, but relatively safe, flight. Shortly after they took their seat, another passenger sat in the middle seat next to them. If you’re going to start college or visit a sick relative, delaying (and paying a higher price) isn’t really a viable option.

Remember, airlines received tens of billions in taxpayer-funded loans to help them survive the pandemic. And — with their crowded, uncomfortable seats and an explosion of new fees — they do not have a good record in recent years of catering to customers’ needs.

So if the government won’t act to enforce some kind of COVID-era standards for customer satisfaction, we all can use our hard-earned dollars to do so.

Yes, COVID precautions often feel like overkill. There is little chance that I will get COVID-19 from one meal, one flight or one trip to the pharmacy. But multiply those odds by over 300 million Americans visiting millions of places. Many people — maybe someone you love — will.

One School, Two Choices: Families Brave COVID’s Tough Test

Cozbi Mazariegos stays in shape these days by running room to room inside her Marin City apartment to answer questions from her kids, ages 7, 10 and 12. They’re all working at home on laptops issued by their school, Bayside Martin Luther King Jr. Academy.

Meanwhile, Shannon Bynum’s son, Kamari, 10, and daughter, Keyari, 8, who live nearby, are back on the Bayside MLK campus. Bynum had warned them, however, that if he heard they weren’t wearing masks, they’d have to learn remotely, too.

The two households, less than 3 miles apart, have found different answers to one of the most perplexing questions this fall: Should parents send their children back to school for classes during an ongoing pandemic or keep them at home?

At Bayside MLK, a K-8 school serving the ethnically and economically diverse community of Marin City, 103 children are attending class in person, including the Bynum children. The Mazariegos kids are among 12 learning remotely.

In March, the coronavirus consigned nearly all of the nation’s 55 million schoolchildren to home schooling. One by one, school districts across the country are weighing the risks of reopening. Some that have reopened have seen a spike in coronavirus cases among students who returned to class.

Bayside MLK was one of 15 Marin County schools that received waivers from the local public health department to reopen full time on Sept. 8, but officials gave parents the choice whether to send their children to campus or keep them home.

The start of classes was delayed for a week when one school employee contracted the virus, said Principal David Finnane. Once they started, the challenges mounted.

“This is the most mind-numbing time I’ve ever had as an educator,” said Finnane, who’s been a school principal for two decades.

“These are crazy days of temperature checks, telling third grade Jenny she entered the second grade gate at the wrong time, telling Xavier to use sanitizer on his elbow after he sneezes, reminding students not to touch this thing or that thing. It’s a job this school has never had to do and now we’re doing it every day, all day long.”

Health and safety protocols enacted by the school include staggered arrival times for students (via parent drop-offs), smaller classes, spaced-out desks, routine temperature and health checks, and an intensified cleaning schedule.

Mazariegos, 52, spent a difficult summer deciding whether to send Emily, 12, Ezekiel Jr., 10, and 7-year-old Evelyn back to class if and when school reopened in the fall.

But her husband, Ezekiel, a 42-year-old construction worker, had made up his mind. “He said, ‘Are you crazy? We can’t send our kids back to school without a vaccine,’” she recalled. “‘How do we know they’d be safe?’”

Mazariegos, who was a schoolteacher in her native Guatemala but now stays at home with her kids, has juggled the roles of teacher, tech consultant and even hall monitor in recent weeks.

School hadn’t been back in session for a week before her home Wi-Fi connection crashed. The two eldest kids could not connect to their Zoom instruction sessions, so Mazariegos called the school for help. To make sure they didn’t resort to computer games in the interim, she gave them textbooks to read.

“The phone was ringing, the kids were all calling my name from different rooms,” she said. “It was crazy.”

Single father Bynum, on the other hand, chose to send his two kids back to school.

“Kids learn from other kids, not just teachers,” said the 29-year-old real estate developer. “In school, they know what’s expected of them. It’s the best place for them to be.”

Finnane, the principal, had hoped all 115 students would return to classrooms. “Many kids doing distance learning just don’t have the same support network,” he said. “They might not have the resources, a quiet place to work, a supportive adult right there who can mentor and encourage them.”

And then there are the technical issues. Students who have stayed at home have experienced internet failures, Zoom glitches and computer bandwidth problems — “or when a teacher gives out the wrong Zoom link, all of which has already happened,” Finnane said.

A recent study by the Economic Policy Institute on the educational challenges posed by the pandemic found that remote-learning programs are effective only if students have consistent access to the internet and computers and if teachers receive targeted training and support for online instruction.

While researchers acknowledged the risk of virus infection is greater at school, they found that students who have not returned to the classroom are falling behind.

“Children’s academic performance is deteriorating during the pandemic, along with their progress on other developmental skills,” the study said.

When Bayside MLK resorted to remote teaching for the entire school in the spring, officials identified 41 students who were demonstrably falling behind, Finnane said. Standardized tests given to students this academic year will provide a report card on students’ success, he added.

Over the summer, Bayside MLK teachers received one day of training to perform online classes in addition to their at-school duties.

“A full day of online-learning training helps, but when it comes to the constant challenges of teaching, especially those with special needs, I’m not sure that’s sufficient,” said Emma García, who co-authored the Economic Policy Institute study.

Mazariegos knows this all too well. Her daughter Emily has comprehension issues that have kept her back a grade.

A quiet girl who loves animals and science, and who one day wants to become a veterinarian, the sixth grader relies on her mother to spend extra time reviewing lessons.

“She has to touch and feel things, to have a lesson demonstrated before she can best understand,” her mother said. “She can’t just sit in front of a computer reading some concept over and over and over.”

Mazariegos understands her daughter may fall another year behind but says she’ll take that chance. “If we lose her to COVID-19, that year is nothing,” she said. “This is a hard decision for any mother. But Emily is so afraid of the virus that sending her back to school would just be traumatizing.”

Bynum, whose fourth grade son, Kamari, suffers from attention deficit disorder, believes the classroom is the best place for the restless child. In March, when the school was closed at the start of the pandemic, Bynum got a taste of the demanding task of being a teacher.

“With two kids in two different grades asking me questions, I struggled to explain things,” he said. “It would have been easy for me to just tell them the answer, but the object of a good instructor is to teach them to find it themselves. And I had to learn that.”

Bynum has developed his own protocol. He requires his children to shower the moment they return from school, and they get regular lectures about hand-washing and common sense.

“If I even suspect they’re not wearing their masks, I’ll say, ‘OK, it’s back to the house and your laptop,’ and they’ll say, ‘Oh yeah, Dad, I’m wearing my mask.’”

Mazariegos remains comfortable with her decision, especially when she reads about all the COVID-19 outbreaks at schools and colleges.

Her kids aren’t so sure.

Second grader Evelyn, an outgoing girl, recently joined a Zoom lesson that included classmates she hadn’t seen in person for months.

“She cried,” her mother said. “She wanted to be back at school to see her friends.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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How will Trump’s COVID-19 treatments work together?

In the four days since revealing he had COVID-19, President Donald Trump has been treated with three experimental drugs to bring the infection under control: monoclonal antibodies, the antiviral remdesivir and the steroid dexamethasone.

Individually, all three treatments have shown promising results in clinical trials. The U.S. Food and Drug Administration has issued emergency use authorization to give remdesivir to patients ill enough to require hospitalization. Several large studies have shown steroids can reduce the risk of death in critically ill patients. And biotechnology company Regeneron Pharmaceuticals just released preliminary antibody results on September 29 from an early-stage clinical trial with 275 COVID-19 patients suggesting a high-dose cocktail of lab-made immune proteins can help speed recovery.

But it’s unclear how the drugs might work when used together to treat patients, says Rajesh Gandhi, an infectious diseases physician at Massachusetts General Hospital and Harvard Medical School in Boston.

Here’s what we know so far about the treatments used to treat the president.

How do the treatments work?

In a news release on October 2, the White House announced that Trump had received a single dose of Regeneron’s antibody cocktail shortly after his diagnosis. (Regeneron, in Tarrytown, N.Y, is a major financial supporter of Society for Science & the Public, which publishes Science News.)

That cocktail includes a pair of monoclonal antibodies that each target a different part of the coronavirus’s spike protein. The virus uses the spike protein to pick a cellular lock, called ACE2, to break into cells and begin replicating. By binding to the spike, antibodies can neutralize the virus and curb the infection. Such monoclonal antibodies have been tested early in infection, in people who are not severely ill with COVID-19.

Later that day, physicians moved Trump to Walter Reed National Military Medical Center in Bethesda, Md., where he began a five-day course of remdesivir, a drug developed by biopharmaceutical company Gilead Sciences, which is based in Foster City, Calif. Remdesivir, which is given intravenously, mimics a building block of the coronavirus’s genetic material. It tricks the virus into incorporating the faux compound into the virus’s genetic blueprint, instead of incorporating a real building block, bringing viral replication to a halt.

Then, on October 3, the president also received dexamethasone, his medical team said in a news conference on October 4. The steroid, administered through a muscle injection or intravenously, is typically reserved for patients who require supplemental oxygen or are on a ventilator. The drug suppresses inflammation, an immune response that is behind some severe COVID-19 cases.

What do the data say so far about these drugs?

Some monoclonal antibodies, such as those from Indianapolis-based pharmaceutical company Eli Lilly and Regeneron have shown early hints of success, although the results are still preliminary (SN 9/22/20). The treatments appear to reduce levels of the virus in the body.

Such antibodies are likely best used early on, while the virus is still replicating in a patient’s body, Gandhi says.

Later during disease, viral replication wanes but severely ill patients may have massive amounts of inflammation from an overactive immune response. Without lots of virus circulating in the body, antibodies that dampen viral growth are less effective at making patients better.

So far, studies suggest that remdesivir and dexamethasone can help people who end up in the hospital, Gandhi says. Remdesivir may be best used early, before patients require hospital care, but it hasn’t yet been tested in mildly ill patients. The company is working on developing an inhaled version that could be administered earlier in an infection outside of a hospital setting.

Remdesivir was the first drug shown to curb viral replication and potentially speed recovery in hospitalized COVID-19 patients (SN: 4/29/20). Dexamethasone has been used for decades to treat a variety of ailments and was the first drug shown to reduce COVID-19 deaths among people who need supplemental oxygen (SN: 6/16/20). In September, the World Health Organization confirmed that steroids are beneficial for COVID-19 patients — specifically those who were severely or critically ill (SN: 9/2/20).

The WHO and U.S. National Institutes of Health do not recommend steroid use in people who are less sick, as the drugs can suppress their immune system’s response to the coronavirus and might make the disease worse, says Gandhi, who has helped write COVID-19 treatment guidelines for NIH as well as the Infectious Diseases Society of America. 

Trump received remdesivir and dexamethasone within a day or two, respectively, of his diagnosis. Such treatment may be a sign that Trump’s condition is more severe than reported, or it could be a preemptive measure to ensure his symptoms don’t become severe. Initially, his symptoms were described as mild, but his physicians have said that since his diagnosis, Trump had a high fever and has received supplemental oxygen when his blood oxygen level dipped.

What we know about how the drugs might work when combined?

“We don’t yet know how they work together,” Gandhi says.

Researchers have made strides in uncovering potential treatments, and trials for a wide variety of drugs are ongoing. But, so far, the use of remdesivir, monoclonal antibodies and dexamethasone in combination hasn’t been studied. Some efforts are under way to find answers. Participants in the treatment arm of one clinical trial for a monoclonal antibody, for instance, are receiving both the antibody and remdesivir to compare their use together with remdesivir alone.

“There are theoretical reasons to think that it would make sense to combine them,” Gandhi says. For instance, an antiviral drug like remdesivir should “shut down virus replication and then dexamethasone would mop up the inflammation.”

Inflammation is part of the body’s natural response to viral infection and normal levels help clear the virus from the body. If a patient is suffering from high amounts of inflammation and requires steroid treatments to suppress the response, it might be beneficial to have an antiviral on hand to help snuff out the infection.  

Because antivirals target the virus while the steroids dampen a potentially harmful immune response, such combination therapies shouldn’t overstimulate a patient’s immune system, he says. It’s unknown whether using the drugs together might help or hinder their effectiveness.  

“Sometimes we in medicine end up making decisions without perfect data,” Gandhi says. “Unfortunately, that’s the situation [in a pandemic], and then we use our best judgment.”

That judgment is under a bright spotlight thanks to Trump’s high profile. Saying that Trump “may not be entirely out of the woods yet,” White House physician Sean Conley on October 5 reported in a news conference that the president’s condition had improved enough that he was cleared to leave the hospital and return to the White House.  “If we can get through [another week] to Monday with him remaining the same — or improving, better yet — then we will all take the final deep sigh of relief.”

Actual Coronavirus Cases Worldwide May be 20 Times More than the Reported Cases, According to WHO

The World Health Organization (WHO) said on Monday that according to its best estimates around 10% of the world’s population have been infected by covid19. Dr. Michael Ryan, WHO’s head of emergencies, said these figures vary on the country to country basis, as well as between rural and urban settings and different groups of people. The figure according to the estimates is 20 times more than the actual coronavirus cases worldwide which stand at 35 million.

According to the estimates of the WHO, around 760 million people may have contracted coronavirus worldwide based on the current global population of nearly 7.6 billion. Moreover, the estimate also suggests that the coronavirus kills around 0.14 percent of people infected which is slightly deadlier than seasonal flu which kills 0.1 percent of its patients. The last estimate of WHO regarding the death rate of covid19 was 0.6 percent, in comparison. While 10% of the world population being infected with the virus might seem like a staggeringly high figure, the WHO and Dr. Ryan warn that 9 out of 10 people i.e. 90% of the world population are still vulnerable to the disease.

Also Read: Coronavirus in New York: New York City Plan to Reverse Reopening of Businesses and Schools in areas with High Covid19 Positivity Rates

According to WHO millions of infections were not picked up during the first wave of the coronavirus pandemic in which nations struggled to develop tests in time due to the exponential growth of the virus, and because of which the actual coronavirus cases worldwide stand at only 35 million. For example, in the UK an average of 9000 cases of the virus are being reported daily but the experts are of the view that the original figure was over 100,000 during April when the virus was at its peak in the country, but the country was unable to test people at the pace required to know how the virus was really spreading.

Dr. Ryan, while speaking to a meeting of 34 executive board members of the WHO, said that Southeast Asia is experiencing a surge in new cases of the virus while the eastern Mediterranean and Europe are seeing a rise in deaths again. According to him the situation in the Western Pacific and Africa is rather more positive.

Deaths from coronavirus around the world have reached one million last week, approximately nine months after the first person was infected with the virus in January in Wuhan, China. The United States has suffered the most deaths with more than 200,000 people died of the virus, followed by Brazil with more than 142,000 deaths, then India with 96000 deaths; Mexico with 76000 and the United Kingdom with 43000 deaths up till now. The deaths from covid19 doubled from half a million within only three months.

Every 24 hours around the world more than 5400 people are dying of the virus, according to calculations. That makes 226 people dying in an hour or one person dying every 16 seconds. It means that 340 people die on average in the time it takes to watch a soccer match.

Health experts around the world remain concerned that the official figure for coronavirus cases worldwide and also the deaths from the virus does not truly represent the real tally because of inadequate recording and testing and a prospect of concealment by some nations.

The post Actual Coronavirus Cases Worldwide May be 20 Times More than the Reported Cases, According to WHO appeared first on Spark Health MD.

Coronavirus in New York: New York City Plan to Reverse Reopening of Businesses and Schools in areas with High Covid19 Positivity Rates

Public health officials were concerned for many weeks about a second wave of the coronavirus which may hit New York City, which had done remarkably well in beating the outbreak which killed more than 20,000 residents during the spring, and on Sunday Mayor Bill de Blasio proposed that from Wednesday all the schools and non-essential businesses in nine zip codes with a high positivity rate of the coronavirus will be temporarily closed. This is a major setback for the residents as coronavirus in New York was in control over the last month.

The Mayor said that the decision to reverse the reopening of businesses will be difficult for people who have sacrificed so much in order to fight the crisis. He further added that it is necessary to stop the spread of the coronavirus in New York and it is necessary for the good of the whole city.

Also Read: Baby Born with With Coronavirus in His Body

The Mayor’s proposed plan, which is yet to be approved by the state, includes the closure of all public and private schools, daycares, and nonessential businesses. Also, the restaurants in the affected areas will have to stop indoor and outdoor dining but would be allowed to continue their pickup and delivery orders. If for a consecutive period of two weeks the positivity rates in the effected Zip codes remain below 3%, businesses and schools will be permitted to reopen. If not, the selected areas will be closed for a period of not less than 4 weeks.

The nine selected areas contain large populations of Jews communities, where the public health officials have found it difficult to persuade the residents to adhere to social distancing rules and wear masks. The positivity rates in those areas have been more than 3% percent in recent days and in some areas, it is as high as 8 percent, in contrast, the positivity rate of coronavirus in New York City is 1.5%. According to the mayor in another 11 Zip codes, the schools will be allowed to remain open but indoor dining would be banned. If Governor Andrew M. Cuomo approves the plan, it will go into effect beginning Wednesday.

The Zip codes that are included in the mayor’s proposal include:

  • Edgemere/Far Rockaway, ZIP code 11691
  • Borough Park, ZIP code 11219
  • Gravesend/Homecrest, ZIP code 11223
  • Midwood, ZIP code 11230
  • Bensonhurst/Mapleton, ZIP code 11204,
  • Flatlands/Midwood, ZIP code 11210
  • Gerritsen Beach/Homecrest/Sheepshead Bay, ZIP code 11229
  • Kew Gardens, ZIP code 11415
  • Kew Gardens Hills/Pomonok, ZIP code 11367

Dr. Anthony Fauci Director of the National Institute of Allergy and Infectious Diseases said that he is certainly not satisfied or pleased but is actually concerned and disturbed about the fact that the daily number of infections in the US is still stuck around 40,000. He believes that it is no place to be when trying to get your arms around a pandemic.

Around 7.4 million people have been infected with the virus in the United States and nearly 210,000 have died, according to data from Johns Hopkins University. On Friday the US recorded the highest daily number of cases of coronavirus in nearly two months.

 

The post Coronavirus in New York: New York City Plan to Reverse Reopening of Businesses and Schools in areas with High Covid19 Positivity Rates appeared first on Spark Health MD.

Hepatitis C discoveries win 2020 Nobel Prize in physiology or medicine

Three virologists have won the Nobel Prize in physiology or medicine for the discovery of the hepatitis C virus.

Harvey Alter, of the U.S. National Institutes of Health in Bethesda, Md., Michael Houghton, who is now at the University of Alberta in Edmonton, Canada, and Charles Rice now of The Rockefeller University in New York City will split the prize of 10 million Swedish kronor, or more than $1.1 million, the Nobel Assembly of the Karolinska Institute announced October 5.

About 71 million people worldwide have chronic hepatitis C infections. An estimated 400,000 people die each year of complications from the disease, which include cirrhosis and liver cancer. Today, the major way people get infected is through contaminated needles used for injecting intravenous drugs, but when the researchers made their discoveries in the 1970s, ’80s and ’90s, blood transfusions were an important source of hepatitis C infection.  

“This is a bit overdue,” says Dennis Brown, chief science officer of the American Physiological Society. It often takes decades before scientific achievements are recognized by the Nobel committee. One reason for the recognition this year may be COVID-19, Brown says. “This keeps virology and viruses in the public eye,” he says. “It might be a push to put science at the forefront, to say when we put money into this and when we have well-funded people working on these viruses, we can actually do something about them.”

The trio of winners of this year’s Nobel Prize in physiology or medicine — Harvey Alter, Michael Houghton and Charles Rice (from left) — all played a role in discovering the hepatitis C virus, which can cause a silent but ultimately deadly disease. “It’s hard to find something that is of such benefit to mankind,” Thomas Perlmann, Secretary General for the Nobel Committee, said. The discovery “has led to improvements for millions of people around the world.” (from left) NIH History Office/Flickr; Univ. of Alberta; The Rockefeller Univ.

Alter worked at a large blood bank at NIH in the 1960s when hepatitis B was discovered. (That discovery won the 1976 Nobel Prize in physiology or medicine (SN: 10/23/76).) Blood could be screened so that people wouldn’t get that virus from a transfusion, but patients were still developing hepatitis. Alter and colleagues showed in the mid- and late 1970s that a new virus, dubbed “non-A, non-B” was causing the infection, and that the virus could be used to transmit the disease to chimpanzees (SN: 4/1/78). 

Just over a decade later, Houghton, working at the pharmaceutical company Chiron Corp. (now part of Novartis), developed a way to pull fragments of the virus’s genetic material from the blood of infected chimpanzees and developed a test to screen out hepatitis C-infected blood (SN: 5/14/88) . It took so long to isolate the virus’s genetic material because Houghton “had to wait until the technology was available,” Brown says.

The blood test Houghton and colleagues developed was used to screen blood all around the world and dramatically decreased hepatitis C infections, said Gunilla Karlsson Hedestam, an immunologist at the Karolinska Institute in Stockholm who described the laureates’ contributions. Before then, “it was a bit like Russian roulette to get a blood transfusion” said Nils-Göran Larsson, a member of the selection committee.

But a question still remained about whether the hepatitis C virus alone was responsible for the infection. Rice and colleagues working at Washington University in St. Louis stitched together genetic fragments of the virus pulled from the blood of infected chimpanzees into a working virus and demonstrated that it could cause hepatitis in animals. “This provided conclusive evidence that the cloned hepatitis C alone could cause the disease,” Karlsson Hedestam said.

Thomas Perlmann, secretary general of the Nobel Assembly, had to try several times before he reached Alter and Rice to give them news of their win. Alter said he got up angrily the third time his phone rang before 5 a.m. EDT, but his anger soon turned to shock. “It’s otherworldly. It’s something you don’t think will ever happen, and sometimes don’t think you deserve to happen. And then it happens,” he said in an interview posted at nobelprize.org. “In this crazy COVID year, where everything is upside down, this is a nice upside down for me.”

‘An Arm and a Leg’: TikTok Mom Takes On Medical Bills

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Shaunna Burns went viral on TikTok, partly because of a series of videos dishing out real-talk advice on fighting outrageous medical bills. She said the way to deal with medical debt is to be vigilant about what debt you incur in the first place.

“What you can say is I don’t want you to run any tests or do any procedures or anything without running it by me,” she said.

Burns has three children of her own, and she has become the virtual mom that thousands of Gen Z followers love. She’s funny, smart and relatable — and she has stories that’ll make your hair stand on end. Oh, and she can swear like a sailor. So maybe listen to this episode when the kids aren’t around. Also, some of her stories are kind of intense.

(You can first check the transcript to see if this episode is one you want to share with your kids.)

“An Arm and a Leg” is a co-production of Kaiser Health News and Public Road Productions.

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Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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5 Things to Know About a COVID Vaccine: It Won’t Be a ‘Magic Wand’

President Donald Trump makes no secret he would like a COVID-19 vaccine to be available before the election. But it’s doubtful that will happen and, even after a vaccine wins FDA approval, there would be a long wait before it’s time to declare victory over the virus.

Dozens of vaccine candidates are in various testing stages around the world, with 11 in the last stage of preapproval clinical trials — including four in the U.S. One or more may prove safe and effective and enter the market in the coming months. What then?

Here are five things to consider in making vaccine dreams come true.

1. A vaccine is vital in fighting the virus, but it won’t be a quick pass back to our old lives.

Vaccines have helped rid the world of scourges like smallpox, but the process takes time and there are no guarantees. Until clinical trials have been completed on this first round of vaccine candidates, no one knows how effective they might prove to be.

The minimum requirement by the Food and Drug Administration for any COVID-19 vaccine is that it should at least prove 50% effective when compared with a placebo — that is, a neutral saline solution.

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By comparison, the annual influenza vaccine ranges between 40% and 60% effective in preventing the illness, depending on the recipient and the season examined. In contrast, a full course of the measles vaccine is about 97% effective.

“It’s very unlikely that a first-generation vaccine will be something like a measles vaccine,” notes Dr. Amesh Adalja, a physician with expertise in infectious diseases and senior scholar at the Johns Hopkins University Center for Health Security.

2. After vaccines gain approval, the real-world evaluation ensues.

Vaccines undergo a protracted testing process involving thousands of subjects. They win FDA approval only after they demonstrate safety and meet at least the minimum standard of effectiveness. Monitoring continues after they hit the market; effectiveness and any rare side effects or safety issues become more apparent after millions of doses are given.

Hypothetically, let’s say the first new COVID vaccines prove 70% effective at preventing the disease. That would mean seven of every 10 people who roll up their sleeves will be protected, but three will not.

While that’s good news for those protected, questions remain about who is covered and who is still vulnerable. It’s possible, Adalja said, that the vaccine would reduce the severity of disease in the remaining three people, thereby helping cut hospitalizations and severe side effects.

But it’s also true that regulators are focused on whether a vaccine prevents disease. Some vaccines can keep you from getting sick without preventing infection, in which case you could still spread the virus even without exhibiting symptoms.

Mysteries remain, at least for now. Scientists don’t know how long the protection will last, for instance. Will protection fade, requiring annual shots, as with influenza? Or will it last for years?

Also, the COVID vaccine candidates are being tested only in adults so far. Most vaccine makers have delayed testing among children or pregnant and breastfeeding women, for example. That could mean an initial lag in safety and efficacy data for those groups, complicating vaccination efforts for children or even front-line health care workers, many of whom are women of childbearing age.

For all those reasons — “if you are looking for a magic wand, you won’t find one in vaccines,” said Dr. William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University Medical Center in Nashville, Tennessee. “That said, vaccines will play a substantial role in reducing the epidemic.”

3. After a vaccine is approved, you still may need to wait awhile to get your shot.

Making vaccines is complicated. And so is distributing them. Vaccine makers say they are already producing vaccine in advance of knowing whether they will win approval. But simply having ample vaccine supply doesn’t mean manufacturers will have all the needed glass bottles, syringes or injectors to ship them right away. Indeed, some experts fear that a shortage of both production-line capabilities (special facilities are needed to make vaccines under strict sterile conditions) and limited supplies could hamper distribution of an approved vaccine. Many of the vaccine candidates must be shipped and stored at super-low temperatures, adding to the complexity.

“Even if you have the vaccine, that doesn’t mean you can ship it out. There are multiple, multiple steps, and all of them have to work,” said Dr. Ezekiel Emanuel, a vice provost at the University of Pennsylvania who has warned of potential shortages.

The Centers for Disease Control and Prevention and the National Academy of Sciences have issued a framework for who should get priority for the initial vaccine. State and local health departments will also have a say in how supplies roll out.

Current recommendations say first in line will be health care workers and people with medical conditions that put them at highest risk if they get the virus. People living in nursing homes and other congregate settings will also be higher on the list. Further down are average healthy adults.

Pay attention, and go when it’s your turn, said Schaffner.

“If they say it’s time for people who are middle-aged and have chronic underlying illness such as diabetes, heart disease and lung disease, you have to know what you have and understand it’s your turn,” he said. “You also have to understand if it’s not your turn yet. Be patient.”

Finally, many of the vaccines under consideration will require two doses spaced a few weeks apart, which would add to the delay. If more than one vaccine is approved, which is likely, people will need the second dose to come from the same manufacturer as the first. That could prove a record-keeping nightmare and lead to more delays — depending on how vaccine supplies hold up.

In testimony before Congress in mid-September, CDC Director Robert Redfield said that tens of millions of doses of vaccine may start to become available by late November or December. But the logistics of vaccine distribution means the country won’t be able to return to “regular life” until “late second quarter, third quarter 2021,” Redfield predicted.

4. So don’t throw out your masks yet.

Because any vaccine is likely to fall short of 100% effectiveness and won’t be in widespread distribution for a while, the use of masks and maintaining social distance will be required well into next year, experts say.

“The vaccine will be a start, but we’ll still need to do the things we’ve been discussing throughout — hand hygiene, wearing masks and continuing to remain specifically distant,” said Dr. Krutika Kuppalli, an assistant professor of infectious disease at the Medical University of South Carolina. “Those are the arsenal of tools we will need to use.”

5. What if I don’t want to get vaccinated?

Polls show a good percentage of Americans either don’t want a vaccine or want to wait a bit before getting one. Can they be required to get a shot?

Certain employers, such as hospitals or food production plants, could require their workers to be vaccinated, but a federal mandate is highly unlikely and probably would be unconstitutional, said professor Dorit Rubinstein Reiss, an expert on employer and vaccine law at the University of California-Hastings College of Law.

The likely approach of public health authorities is to educate people about the benefits and potential side effects of a vaccine — down to whether one might experience a sore arm.

“That’s what we do for every vaccine,” said Adalja of Johns Hopkins. A requirement of vaccination for the general public would create resistance and “foster conspiracy theories,” he said.

Most regulation of public health falls to state and local governments and health agencies, Reiss said. States would be “more likely to have narrow or specific mandates that could survive judicial review,” she said.

Schools, of course, require students to be vaccinated against a wide range of illnesses. But a school-age COVID vaccine mandate is doubtful, at least in the near term, because the vaccine hasn’t been tested on school-aged children.

Generally speaking, employers, including the federal government, have the power to require vaccinations, especially if they don’t have a unionized workforce with a contract that might limit their power. All employers, however, face limits set by civil rights and disability laws and may have to provide alternatives for people who can’t or won’t get vaccinated, Reiss said.

Not Pandemic-Proof: Insulin Copay Caps Fall Short, Fueling Underground Exchanges

DENVER — D.j. Mattern had her Type 1 diabetes under control until COVID’s economic upheaval cost her husband his hotel maintenance job and their health coverage. The 42-year-old Denver woman suddenly faced insulin’s exorbitant list price — anywhere from $125 to $450 per vial — just as their household income shrank.

She scrounged extra insulin from friends, and her doctor gave her a couple of samples. But as she rationed her supplies, her blood sugar rose so high her glucose monitor couldn’t even register a number. In June, she was hospitalized.

“My blood was too acidic. My system was shutting down. My digestive tract was paralyzed,” Mattern said, after three weeks in the hospital. “I was almost near death.”

So she turned to a growing underground network of people with diabetes who share extra insulin when they have it, free of charge. It wasn’t supposed to be this way, many thought, after Colorado last year was the first of 12 states to implement a cap on the copayments that some insurers can charge consumers for insulin. But as the COVID pandemic has caused people to lose jobs and health insurance, demand for insulin sharing has skyrocketed. Many patients who once had good insurance are now realizing the $100 cap is only a partial solution, applying just to state-regulated health plans.

Colorado’s cap does nothing for the majority of people with employer-sponsored plans or those without insurance coverage. According to the state chapter of Type 1 International, an insulin access advocacy group, only 3% of patients with Type 1 diabetes under 65 could benefit from the cap.

Such laws, often backed by pharmaceutical companies, give the impression that things are improving, said Colorado chapter leader Martha Bierut. “But the reality is, we have a much longer road ahead of us.”

The struggle to afford insulin has forced many people into that underground network. Through social media and word-of-mouth, those in need of insulin connect with counterparts who have a supply to spare. Insurers typically allow patients a set amount of insulin per month, but patients use varying amounts to control their blood sugar levels depending on factors such as their diet and activity that day.

Though it’s illegal to share a prescription medication, those involved say they simply don’t care: They’re out to save lives. They bristle at the suggestion that the exchanges resemble back-alley drug deals. The supplies are given freely, and no money changes hands.

For those who can’t afford their insulin, they have little choice. It’s a your-money-or-your-life scenario for which the American free-market health care system seems to have no answer.

“I can choose not to buy the iPhone or a new car or to have avocado toast for breakfast,” said Jill Weinstein, who lives in Denver and has Type 1 diabetes. “I can’t choose not to buy the insulin, because I will die.”

Exacerbated by the Pandemic

Surveys conducted before the pandemic showed that 1 in 4 people with either Type 1 or Type 2 diabetes had rationed insulin because of the cost. For many Blacks, Hispanics and Native Americans, the pinch was especially bad. These populations are more likely to have diabetes and also more likely to face economic disparities that make insulin unaffordable.

Then COVID-19 arrived, with economic stress and the virus itself hitting people in those groups the hardest.

This year, the American Diabetes Association reported a surge in calls to its crisis hotline regarding insulin access problems. In June, the group found, 18% of people with diabetes were unemployed, compared with 12% of the general public. Many are wrestling with the tough choices of whether to pay for food, rent, utilities or insulin.

Rep. Dylan Roberts, a Democrat who sponsored Colorado’s copay cap bill, said legislators knew the measure was only the first step in addressing high insulin costs. The law also tasked the state’s attorney general to produce a report, due Nov. 1, on insulin affordability and solutions.

“We went as far as we could,” Roberts said. “While I feel Colorado has been a leader on this, we need to do a whole lot more both at the state and national level.”

According to the American Diabetes Association, 36 other states have introduced insulin copay cap legislation, but the pandemic stalled progress on most of those bills.

Insulin prices are high in the U.S. because few limits exist for what pharmaceutical manufacturers can charge. Three large drugmakers dominate the insulin market and have raised prices in near lockstep. A vial that 20 years ago cost $25 to $30 now can run 10 to 15 times that much. And people with diabetes can need as many as four or five vials per month.

“It all boils down to cost,” said Gail deVore, who lives in Denver and has Type 1 diabetes. “We’re the only developed nation that charges what we charge.”

Before the COVID crisis triggered border closures, patients often crossed into Mexico or Canada to buy insulin at a fraction of the U.S. price. President Donald Trump has taken steps to lower drug prices, including allowing for the importation of insulin in some cases from Canada, but that plan will take months to implement.

The Kindness of Strangers

DeVore posts on social media three or four times a year asking if anybody needs supplies. While she’s always encountered demand, her last tweet in August garnered 12 responses within 24 hours.

“I can feel the anxiety,” deVore said. “It’s unbelievable.”

She recalled helping one young man who had moved to Colorado for a new job but whose health insurance didn’t kick in for 90 days. She used a map to choose a random intersection halfway between them. When deVore arrived on the dusty rural road after dark, his car was already there. She handed him a vial of insulin and testing supplies. He thanked her profusely, almost in tears, she said, and they parted ways.

“The desperation was obvious on his face,” she said.

It’s unclear just how widespread such sharing of insulin has become. In 2019, Michelle Litchman, a researcher at the University of Utah’s College of Nursing, surveyed 159 patients with diabetes, finding that 56% had donated insulin.

“People with diabetes are sometimes labeled as noncompliant, but many people don’t have access to what they need,” she said. “Here are people who are genuinely trying to find a way to take care of themselves.”

If insulin affordability doesn’t improve, Litchman suggested in a journal article, health care providers may have to train patients on how to safely engage in underground exchanges.

The hashtag #Insulin4all has become a common way of amplifying calls for help. People sometimes post pictures of the supplies they have to share, while others insert numbers or asterisks within words to avoid social media companies removing their posts.

Although drug manufacturers offer limited assistance programs, they often have lengthy application processes. So they typically don’t help the person who accidentally drops her last glass vial on a tile floor and finds herself out of insulin for the rest of the month. Emergency rooms will treat patients in crisis and have been known to give them an extra vial or two to take home. But each crisis takes a toll on their long-term health.

That’s why members of the diabetes community continue to look out for one another. Laura Marston, a lawyer with Type 1 diabetes who helped to expose insulin pricing practices by Big Pharma, said two of the people she first helped secure insulin, both women in their 40s, are in failing health, the result of a lifetime of challenges controlling their disease.

“The last I heard, one is in end-stage renal failure and the other has already had a partial limb amputation,” Marston said. “The effects of this, what we see, you can’t turn your back on it.”

The underground sharing is how Mattern secured her insulin before recently qualifying for Medicaid. When someone on a neighborhood Facebook group asked if anybody needed anything in the midst of the pandemic, she replied with one word: insulin. Soon, an Uber driver arrived with a couple of insulin pens and replacement sensors for her glucose monitor.

“I knew it wasn’t altogether legal,” Mattern said. “But I knew that if I didn’t get it, I wouldn’t be alive.”


This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Easier-to-Use Coronavirus Saliva Tests Start to Catch On

As the coronavirus pandemic broke out across the country, health care providers and scientists relied on the standard method for detecting respiratory viruses: sticking a long swab deep into the nose to get a sample. The obstacles to implementing such testing on a mass scale quickly became clear.

Among them: Many people were wary of the unpleasant procedure, called a nasopharyngeal swab. It can be performed only by trained health workers, putting them at risk of infection and adding costs. And the swabs and chemicals needed to test for the virus almost immediately were in short supply.

Some places, like Los Angeles County, moved early to self-collected oral swabs of saliva and sputum, with the process supervised at drive-thru testing sites by trained personnel swathed in protective gear. Meanwhile, researchers began investigating other cheaper, simpler alternatives to the tried-and-true approach — including dribbling saliva into a test tube.

But the transition has not been immediate. Regulators and scientists are generally cautious about new, unproven technologies and have an understandable bias toward well-established protocols.

“Saliva is not a traditional diagnostic fluid,” said Yale microbiologist Anne Wyllie, part of a team whose saliva-based test, called SalivaDirect, received emergency use authorization from the Food and Drug Administration in August. “When we were hit by a virus that came out of nowhere, we had to respond with the tools that were available.”

Eight months into the pandemic, the move toward saliva screening is gaining traction, with tens of thousands of people across the country undergoing such testing daily. However, saliva tests still represented only a small percentage of the more than 900,000 tests conducted daily on average at the end of September.

Yale is providing its protocol on an open-source basis and recently designated laboratories in Minnesota, Florida and New York as capable of performing the test. Besides the Yale test, the FDA has authorized emergency use of several others, including versions developed at Rutgers University, the University of Illinois at Urbana-Champaign, the University of South Carolina and SUNY Upstate Medical University. A further advance, an at-home saliva test, could be headed for FDA authorization, too.

Since the start of the pandemic, the Trump administration’s approach to testing has been hampered by missteps and controversy. As a key health agency during an unprecedented emergency, the FDA’s effectiveness relies on public trust in how it balances the need for speed in authorizing innovative products, like saliva tests and vaccines, with ensuring safety and effectiveness, said Ann Keller, an associate professor of health policy at the University of California-Berkeley.

“You obviously want to get new tests into the mix quickly in order to address the emergency, but you still need to uphold your standards,” Keller said. The White House’s public pressure on the FDA has complicated the agency’s efforts by undermining its credibility and independence, she said.

Respiratory viruses colonize areas inside the nasal cavity and at the back of the throat. Besides the nasopharyngeal approach, nasal samples obtained with shorter and less invasive swabs have proven effective for the coronavirus and have become widely adopted, although they also generally require a health care worker’s involvement. The millions of rapid tests that will be distributed across the country, per a recent White House announcement, rely on nasal swabs.

In the early months of the pandemic, some studies reported significant levels of the virus in oral secretions. In a Hong Kong study published in February, for example, the virus was found in the saliva of 11 of 12 patients with confirmed coronavirus infection.

In Los Angeles, which began using the oral swab test in late March, more than 10,000 samples are collected per day, said Fred Turner, chief executive of Curative, the company that developed it.

Turner sees an advantage to the swabbing strategy. The self-swab procedure takes only 20 to 30 seconds, while producing enough saliva for testing can take people two to three minutes, and sometimes longer, he said. “That might not sound like much difference,” Turner said, “but it is when you’re trying to push 5,000 people through a test site.”

Curative’s three labs process tens of thousands of tests from jurisdictions across the country in addition to L.A., Turner said. A test developed at SUNY Upstate Medical University, which is expected to become available at state labs around New York, also uses an oral swab.

For the Curative test, a health care worker is supposed to oversee the sample collection —reminding people to cough to bring up fluids, for example. When investigators at the University of Illinois launched what they called a “Manhattan Project” to develop a saliva test by mid-June, they hoped to make it possible for people to visit a collection site, drool into a test tube, seal it and drop it off without the aid of a health care worker.

The university is now testing more than 10,000 people a day at its three campuses and is seeking to expand access to communities across the state and country, said chemistry professor Paul Hergenrother, who led the research team. Like the similar Yale test, it is being made freely available to other laboratories. The University of Notre Dame, in Indiana, recently adopted it.

Like tests using nasopharyngeal and other kinds of nasal swabs, these saliva tests are based on PCR technology, which amplifies small amounts of viral genetic material to facilitate detection. Both the Yale and University of Illinois tests have managed to simplify the process by eliminating a standard intermediate step: the extraction of viral RNA. Their protocols also don’t require viral transport media, or VTM — the chemicals generally used to stabilize the samples after collection.

“You don’t need swabs, you don’t need health care workers, you don’t need VTM, and you don’t need RNA isolation kits,” Hergenrother said.

In correspondence published in the New England Journal of Medicine, the Yale team reported detecting more viral RNA in saliva specimens than in nasopharyngeal ones, with a higher proportion of the saliva tests showing positive results for up to 10 days after initial diagnosis.

The National Basketball Association provided $500,000 in support for the Yale project, said David Weiss, the NBA’s senior vice president for player matters. He said the Yale team’s decision to eliminate the process of RNA extraction, which separates the genetic material from other substances that could complicate detection, involved trade-offs but did not compromise the value of the test.

“Any molecular test that has an RNA extraction step is almost by definition going to be more sensitive, but it will also be more expensive and take longer and use supplies that are in shorter supply,” he said. “If we’re trying to look at surveillance testing to open up schools and nursing homes, a test that’s still very sensitive and a lot cheaper is an important innovation.”

Prices for coronavirus tests vary widely, running upward of $100. Tests based on the Yale or University of Illinois protocols, which require only inexpensive materials, could be available for as little as $10. The Curative testing service, which includes collection and transportation of samples as well as the laboratory component, averages around $150 per test depending on volume, said Clayton Kazan, chief medical director of the L.A. County Fire Department, which uses the tests.

Despite the advances in sample collection, tests using PCR — polymerase chain reaction — technology still require laboratory processing. Researchers have been investigating other approaches, including saliva-based antigen tests, that could be self-administered at home and would provide immediate results. (While PCR can detect coronavirus genetic material, antigen tests look for viral proteins that can signify a current infection.)

At least one company has announced it is seeking emergency use authorization for a saliva antigen test, although two others have dropped plans to develop their own versions as infeasible, according to The New York Times. Meanwhile, scientists at Columbia University, the University of Wisconsin and elsewhere are investigating the use of saliva with other kinds of rapid-test technologies.

“There’s tons of interest” in an at-home saliva test, noted Yvonne Maldonado, chief of pediatric infectious diseases at Stanford University School of Medicine.

“People really do want to get that pregnancy-type kit out there,” she said. “You could basically send people a little packet with little strips, and you pull off a strip every day and put in under your tongue.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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This story can be republished for free (details).