Coronavirus #157 9/12/21

Announcements:

First, there is now a Resources Page here for the most commonly asked questions I'm getting.

Happy to continue to answer your questions/concerns as best I can, so don't be shy about that.

News 

Kids and COVID: why young immune systems are still on top

Innate immunity might be the key to why children have fared better with the virus. But the Delta variant poses fresh unknowns.

Early last year, children’s hospitals across New York City had to pivot to deal with a catastrophic COVID-19 outbreak. “We all had to quickly learn — or semi-learn — how to take care of adults,” says Betsy Herold, a paediatric infectious-disease physician who heads a virology laboratory at the Albert Einstein College of Medicine. The reason: while hospitals across the city were bursting with patients, paediatric wards were relatively quiet. Children were somehow protected from the worst of the disease.

Data collected by the US Centers for Disease Control and Prevention from hospitals across the country suggest that people under the age of 18 have accounted for less than 2% of hospitalizations due to COVID-19 — a total of 3,649 children between March 2020 and late August 2021. Some children do get very sick, and more than 420 have died in the United States, but the majority of those with severe illness have been adults — a trend that has been borne out in many parts of the world.

This makes SARS-CoV-2 somewhat anomalous. For most other viruses, from influenza to respiratory syncytial virus, young children and older adults are typically the most vulnerable; the risk of bad outcomes by age can be represented by a U-shaped curve. But with COVID-19, the younger end of that curve is largely chopped off. It’s “absolutely remarkable”, says Kawsar Talaat, an infectious-disease physician at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. “One of the few silver linings of this pandemic is that children are relatively spared.”

https://www.nature.com/articles/d41586-021-02423-8

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An unpublished COVID-19 paper alarmed this scientist—but he had to keep silent

Thijs Kuiken faced a moral dilemma after reviewing a Lancet manuscript showing the new coronavirus spread between humans

On the train home from work on 16 January 2020, Thijs Kuiken made a troubling discovery. A veterinary pathologist at Erasmus University Medical Center in the Netherlands, Kuiken was reading a manuscript The Lancet had asked him that morning to review within 48 hours.

The paper, by researchers at the University of Hong Kong, described a family from Shenzhen, China, just across the border from Hong Kong, that had been struck by the new coronavirus, then provisionally named 2019-nCoV, after a trip to Wuhan, some 1000 kilometers to the north. Of six travelers, five had become infected. None had visited the infamous Huanan Seafood Wholesale Market there, which many known early cases had links to. After their return, a seventh family member who had not visited Wuhan became infected as well.

The researchers’ conclusion was clear: The new virus, now known as SARS-CoV-2, was transmissible between humans. And they reported two more disturbing findings: Two infected family members had no symptoms, suggesting the new disease could spread surreptitiously, and one did not have respiratory symptoms, the most common feature of the new disease, but diarrhea, which meant doctors might be overlooking cases. “It really scared me,” Kuiken says.

It also saddled him with a dilemma. Many already suspected 2019-nCoV was spread between people; 2 days earlier, the World Health Organization (WHO) had stated “there may have been limited human-to-human transmission of the coronavirus.” But the Chinese government, slow with details about the burgeoning crisis, had not provided confirmation. That Thursday evening, the evidence was in front of Kuiken’s eyes, and he felt the world needed to know.

But disclosing it could cost Kuiken his scientific reputation, he says. Journal reviewers are not allowed to share unpublished manuscripts under any circumstances.

https://www.science.org/content/article/unpublished-covid-19-paper-alarmed-scientist-he-had-keep-silent

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Rogue antibodies involved in almost one-fifth of COVID deaths

The self-targeting antibodies attack type 1 interferons that play a key role in fighting infection.

Antibodies that turn against elements of our own immune defences are a key driver of severe illness and death following SARS-CoV-2 infection in some people, according to a large international study. These rogue antibodies, known as autoantibodies, are also present in a small proportion of healthy, uninfected individuals — and their prevalence increases with age, which may help to explain why elderly people are at higher risk of severe COVID-19.

The findings, published on 19 August in Science Immunology1, provide robust evidence to support an observation made by the same research team last October. Led by immunologist Jean-Laurent Casanova at the Rockefeller University in New York City, the researchers found that around 10% of people with severe COVID-19 had autoantibodies that attack and block type 1 interferons, protein molecules in the blood that have a critical role in fighting off viral infections2.

“The initial report from last year was probably one of the most important papers in the pandemic,” says Aaron Ring, an immunologist at the Yale School of Medicine in New Haven, Connecticut, who was not involved in this work. “What they’ve done in this new study is really dig down to see just how common these antibodies are across the general population — and it turns out they’re astonishingly prevalent.”

The international research team focused on detecting autoantibodies that could neutralize lower, more physiologically relevant concentrations of interferons. They studied 3,595 patients from 38 countries with critical COVID-19, meaning that the individuals were ill enough to be admitted to an intensive-care unit. Overall, 13.6% of these patients possessed autoantibodies, with the proportion ranging from 9.6% of those below the age of 40, up to 21% of those over 80. Autoantibodies were also present in 18% of people who had died of the disease.

https://www.nature.com/articles/d41586-021-02337-5?

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Diagnostics:

still an incredible, negligent last of testing.

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Drugs and Vaccines:

Unvaccinated Americans consider vaccine mandates a greater health threat than COVID-19,

in a recent survey. “When unvaccinated adults say personal freedom is a higher priority than public safety, the time for education campaigns has passed,”

https://debeaumont.org/news/2021/unvaccinated-adults-vaccine-mandates-are-a-greater-threat-than-covid-19/

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The Pandemic Almost Killed Allie. Her Community’s Vaccination Rate Is 45%.

https://khn.org/news/article/covid-pandemic-mississippi-microcosm-vaccination-rates-delta-surge-teen-near-death-vaccine-hesitancy-mis-c/

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Major study finds convalescent plasma doesn't help seriously ill COVID-19 patients

A major study has found that convalescent plasma does not reduce the risk of intubation or death for COVID-19 patients. However, the study also revealed that the antibody profile in the blood of people who have had the virus is extremely variable and this may modify the response to the treatment.

https://medicalxpress.com/news/2021-09-major-convalescent-plasma-doesnt-ill.html?

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How the risk of side effects could change with Covid-19 vaccine boosters

Experts stressed that they were speculating...Not expected to be worse than #2

https://statnews.us11.list-manage.com/track/click?u=f8609630ae206654824f897b6&id=7b36fffbc0&e=f4c6ea30a0

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Interesting technology--not yet ready for prime time:

Researchers at the University of California San Diego have developed COVID-19 vaccine candidates using plant and bacteria viruses. Two big advantages: They are thermally stable, which means they don't require extreme low temperatures for storage and transport. They can also be used via self-administered microneedle patches.

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Probenecid, a medicine that treats gout, could also battle COVID-19

Probenecid is already FDA approved and has potent antiviral properties against SARS-CoV-2

As COVID-19 cases continue to skyrocket across the U.S. and the world, few options are available for treating patients infected with the SARS-CoV-2.

But new research from the University of Georgia offers hope for a viable therapeutic to combat the disease that has claimed more than 4 million lives worldwide.

Published in Nature’s Scientific Reports, the study found that probenecid has broad antiviral properties, making it a prime candidate to combat not only SARS-CoV-2 infection but also other common and deadly respiratory viruses like RSV and flu.

Probenecid is an FDA-approved medication that’s primarily used to treat gout, and it’s already widely available in the U.S. The drug has been on the market for over 40 years and has minimal side effects.

https://www.eurekalert.org/news-releases/927850

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COVID-19 vaccines don't raise miscarriage risk, 3 studies show

Pregnant women who received at least one dose of a COVID-19 vaccine were not at higher risk for miscarriage than their unvaccinated counterparts, according to a trio of new US studies.

https://www.cidrap.umn.edu/news-perspective/2021/09/covid-19-vaccines-dont-raise-miscarriage-risk-3-studies-show

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Odds of developing long COVID halved after vaccination, study finds

Being fully vaccinated reduces the odds of developing long COVID by about half compared with being unvaccinated, researchers reported in The Lancet Infectious Diseases.

They also reported a rate of breakthrough infections among fully vaccinated people that was well below 1%.

The findings are from a prospective study that used self-reported data submitted to a cell phone app by adults in the United Kingdom who received either a first or second COVID-19 vaccine dose between Dec. 8, 2020, and July 4, 2021.

https://www.healio.com/news/infectious-disease/20210908/odds-of-developing-long-covid-halved-after-vaccination-study-finds

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mRNA COVID vaccines not tied to serious side effects

Possible link to myocarditis, pericarditis (< from Covid infection)

The incidence of ischemic stroke per 1 million person-years during the risk and comparison intervals was 1,612 versus 1,781 (rate ratio [RR], 0.97), while it was 1,179 versus 1,345 (RR, 0.82) for appendicitis, 935 versus 1,030 (RR, 1.02) for heart attack, 952 versus 896 (RR, 1.16) for venous thromboembolism, and 822 versus 825 (RR, 1.00) for Bell's palsy.

https://www.cidrap.umn.edu/news-perspective/2021/09/mrna-covid-vaccines-not-tied-serious-side-effects

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India’s DNA COVID vaccine is a world first – more are coming

The ZyCoV-D vaccine heralds a wave of DNA vaccines for various diseases that are undergoing clinical trials around the world.

India has approved a new COVID vaccine that uses circular strands of DNA to prime the immune system against the virus SARS-CoV-2. Researchers have welcomed news of the first DNA vaccine for people to receive approval anywhere in the world, and say many other DNA vaccines may soon be hot on its heels.

ZyCoV-D, which is administered into the skin without an injection, has been found to be 67% protective against symptomatic COVID-19 in clinical trials, and will likely start to be administered in India this month. Although the efficacy is not particularly high compared to that of many other COVID-19 vaccines, the fact that it is a DNA vaccine is significant, say researchers.

It is proof of the principle that DNA vaccines work and can help in controlling the pandemic, says Peter Richmond, a paediatric immunologist at the University of Western Australia in Perth. “This is a really important step forward in the fight to defeat COVID-19 globally, because it demonstrates that we have another class of vaccines that we can use.”

Close to a dozen DNA vaccines against COVID-19 are in clinical trials globally, and at least as many again are in earlier stages of development. DNA vaccines are also being developed for many other diseases.

https://www.nature.com/articles/d41586-021-02385-x

Devices:

Why disinfecting your mask with alcohol or bleach is almost certainly a bad idea

Improper use of disinfectants can have negative effects on your health and the environment. That's always been true. But the pandemic has introduced a new wrinkle: some disinfectants could also hurt the efficacy of your face mask.

There is a study that found decontaminating face masks using alcohol and bleach can reduce N95 masks' filtration efficiency, mainly due to reduction of charge density on N95 filters. Studies have also found that some types of fabrics, including cotton, used in face masks can be destroyed by bleach, and reduce the covering's efficiency.

https://medicalxpress.com/news/2021-09-disinfecting-mask-alcohol-bad-idea.html?

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Reusable cloth masks hold up after a year of washing, drying

New study also confirms that layering a cotton mask on top of a surgical mask—properly fit on one’s face—provides more protection than cloth alone.

The reusable cloth masks people have been using for the past year or more may look a little worse for the wear. But new research from the University of Colorado Boulder finds that washing and drying them doesn’t reduce their ability to filter out viral particles.

“It’s good news for sustainability,” said lead author Marina Vance, assistant professor in the Paul M. Rady Department of Mechanical Engineering. “That cotton mask that you have been washing, drying and reusing? It's probably still fine—don't throw it away.”

The study, published in the journal Aerosol and Air Quality Research, also confirms previous research that layering a cotton mask on top of a surgical mask—properly fit on one’s face—provides more protection than cloth alone.

https://www.eurekalert.org/news-releases/928011

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Epidemiology/Infection control:

Clear-Cut Turning Point on COVID May Be Out of Reach

As the American public continues to wonder when and how there will be a return to normalcy, public health officials say there won't be a "quick and clear turning point" in the pandemic, Politico reported.

"It seems the narrow window to wipe the coronavirus completely off the face of the globe has slipped through our unvaccinated fingers," the article states. But that doesn't mean the U.S. is now in a worst-case scenario. U.S. Surgeon General Vivek Murthy, MD, told Politico that the country is now facing a manageable middle.

"It is really important that we convey that success does not equal no cases," Murthy told Politico. "Success looks like very few people in the hospital and very few dying."

https://www.politico.com/news/magazine/2021/09/06/why-we-cant-turn-the-corner-on-covid-509349

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Rationing. Death Panels.

For the first time since the pandemic started, Idaho activated its "crisis standards of care" in two districts in the northern part of the state due to staffing shortages and a lack of ICU beds; only four of the state's 400 ICU beds remain open. (Boise State Public RadioNew York Times)

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More than a fourth of the roughly 1 million new weekly cases involve childrenaccording to the American Academy of Pediatrics, with weekly cases in kids hitting its highest point for the pandemic.

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New study links COVID-19 susceptibility with blood clots, thrombophlebitis and circulatory diseases

The study used a Phenome-wide (PheWAS) analysis in up to 400,000 European ancestry individuals, derived from the UK Biobank, researchers aimed to identify traits and diseases associated with COVID-19 susceptibility and severity. PheWAS analysis allowed the team to construct the predictive COVID-19 genetic score, using the sum of COVID-19 risk alleles for each individual in the UK Biobank. This score was examined against all available traits and diseases in UK Biobank, adjusted for confounders, in a hypothesis-free manner.

The study found that genetically predicted COVID-19 is significantly associated with an 11 per cent increased risk of phlebitis and thrombophlebitis, a 10 per cent increased risk of blood clots in the leg and a 12 per cent increased risk of blood clots in the lung.

https://www.eurekalert.org/news-releases/927857

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Israeli study in children

SARS-CoV-2 spread more effectively and more rapidly among young children during the time of B.1.1.7 variant circulation in Israel. Transmission rates from children aged 0 to 9 years to other contacts were doubled during the time of B.1.1.7 circulation in Israel. However, hospitalization rates among children decreased. The latter finding is supported by studies in adults reporting increased contagiousness of the B.1.1.7 strain but not necessarily with increased severity.5,6

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783851?utm_

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United States boosts (sequencing) tracking of coronavirus strains as Mu variant draws scrutiny

Seven months ago, White House COVID-19 response coordinator Jeffrey Zients declared the scale of the U.S. effort to sequence the pandemic coronavirus “totally unacceptable.” At that point, the country had managed to read the genetic blueprints of just 0.36% of all the coronavirus samples collected from U.S. noses and throats—far too few to detect rare, potentially dangerous mutations early and prepare to fight them.

But today, even as new U.S. coronavirus cases exceed 160,000 a day—a number not seen since late January—public health experts have a much better sense of their foe’s changing genetics. By July, aided by $1.7 billion in funding from the American Rescue Plan, expanded sequencing operations were reading out 8.6% of new coronavirus cases.

At the moment, sequencers around the country are seeing a deluge of Delta. The highly contagious variant accounted for 99.1% of cases in the United States by late August, up from 7.5% in late May, according to CDC. “We saw Delta sweep in in the blink of an eye,” says integrative biologist Lauren Ancel Meyers of the University of Texas, Austin. “But that can change.”

https://www.science.org/content/article/united-states-boosts-tracking-coronavirus-strains-mu-variant-draws-scrutiny

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COVID-19 hospitalization rate 10 times higher among unvaccinated vs. vaccinated kids

Unvaccinated adolescents are hospitalized for COVID-19 at 10 times the rate of their vaccinated peers, and ED visits and hospital admissions for COVID-19 are highest in states with low vaccine coverage, according to two new MMWR reports.

The reports were published Friday amid an ongoing surge in COVID-19 cases caused by the delta variant of SARS-CoV-2, and as many schools in the United States have opened for in-person learning.

There has been an increase in pediatric hospitalizations from COVID-19. Source: CDC.

Only children aged 12 to 17 years are eligible for COVID-19 vaccination in the U.S., and experts estimate that younger kids may have access to vaccines by December.

https://www.healio.com/news/primary-care/20210903/covid19-hospitalization-rate-10-times-higher-among-unvaccinated-vs-vaccinated-kids CDC:  bit.ly/MMWR9321b

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High incarceration rates fuel COVID-19 spread and undermine US public safety

National study of anti-contagion policies is first worldwide to show reducing jail populations leads to community-wide public health benefits

  • Study shows that decarceration, along with mask mandates, school closures and nursing home restrictions, are the most important government policies for reducing COVID-19 spread
  • U.S. jails function as ‘infectious disease incubators’ for surrounding communities; high rates of viral transmission cause COVID-19 cases to multiply, ‘boomerang’ back to communities
  • Weekly turnover rate in U.S. jails is 55%, meaning infections in communities quickly spread to jails, vice versa
  • First study to link mass incarceration systems to pandemic vulnerability and international biosecurity

https://www.eurekalert.org/news-releases/927137

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The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network

Objectives:

To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infection (HAI) incidence in US hospitals, national- and state-level standardized infection ratios (SIRs) were calculated for each quarter in 2020 and compared to those from 2019.

Methods:

Central–line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), select surgical site infections, and Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia laboratory-identified events reported to the National Healthcare Safety Network for 2019 and 2020 by acute-care hospitals were analyzed. SIRs were calculated for each HAI and quarter by dividing the number of reported infections by the number of predicted infections, calculated using 2015 national baseline data. Percentage changes between 2019 and 2020 SIRs were calculated. Supporting analyses, such as an assessment of device utilization in 2020 compared to 2019, were also performed.

Results:

Significant increases in the national SIRs for CLABSI, CAUTI, VAE, and MRSA bacteremia were observed in 2020. Changes in the SIR varied by quarter and state. The largest increase was observed for CLABSI, and significant increases in VAE incidence and ventilator utilization were seen across all 4 quarters of 2020.

Conclusions:

This report provides a national view of the increases in HAI incidence in 2020. These data highlight the need to return to conventional infection prevention and control practices and build resiliency in these programs to withstand future pandemics.

https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/abs/impact-of-coronavirus-disease-2019-covid19-on-healthcareassociated-infections-in-2020-a-summary-of-data-reported-to-the-national-healthcare-safety-network/8197F323F4840D233A0C62F4726287E1

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Portugal COVID-19 update: Delta variant accounts for all infections

Portugal health officials reported 2,830 additional COVID-19 cases according to data released today. In addition, nine more fatalities were reported,.

To date, Portugal has reported 1,042,322 cumulative cases and 17,766 since the beginning of the pandemic.

Portugal reports 83.4% of the population are fully vaccinated against COVID-19.

http://outbreaknewstoday.com/portugal-covid-19-update-delta-variant-accounts-for-all-infections-24644/

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Blood donations and antibodies in US

Findings  In this repeated cross-sectional study that included 1 443 519 blood donation specimens from a catchment area representing 74% of the US population, estimated SARS-CoV-2 seroprevalence weighted for differences between the study sample and general population increased from 3.5% in July 2020 to 20.2% for infection-induced antibodies and 83.3% for combined infection- and vaccine-induced antibodies in May 2021. Seroprevalence differed by age, race and ethnicity, and geographic region of residence, but these differences changed over the course of the study.

https://jamanetwork.com/journals/jama/fullarticle/2784013?utm_source=

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Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Politics:

As Abbott bans abortions in Texas...

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Lawmakers Try to Ban Dishonorable Discharges for Troops Who Refuse Mandatory COVID-19 Vaccines

2 Sep 2021

Military.com | By Travis Tritten

House lawmakers have backed legislation prohibiting dishonorable discharges for troops who refuse the COVID-19 vaccine, as the Navy gave its sailors 90 days to get the shot this week and the Army and Air Force were poised Thursday to enforce their own timetables.

Legislation sponsored by Rep. Mark Green, R-Tenn., an Army veteran, requires only honorable discharges for anyone who is separated from the military over refusing to be vaccinated. It was added to the fiscal 2022 defense authorization bill, passed by the House Armed Services Committee on Thursday.

https://www.military.com/daily-news/2021/09/02/lawmakers-try-ban-dishonorable-discharges-troops-who-refuse-mandatory-covid-19-vaccines.html

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Judge approves Purdue’s controversial bankruptcy plan, paving the way for immunity for Sacklers

 After two years of contentious bargaining, a U.S. bankruptcy court judge on Wednesday approved a controversial plan that will dissolve Purdue Pharma, which has been blamed for triggering a widespread opioid crisis, and shield members of the Sackler family who control the company from future lawsuits.

The settlement calls for some Sackler family members to contribute more than $4.3 billion over nearly a decade to compensate people, local governments, and tribal communities that were harmed by the OxyContin painkiller. Another $175 million will be contributed after the Sackler family members relinquish control of several charitable institutions.

The drug maker, meanwhile, will be transformed into a new trust or public benefit company that will assume control of the Purdue product portfolio. The goal is to harness future sales of OxyContin and other medicines toward the overall settlement, although concerns remain that such an arrangement would entangle state and local government officials in the sale of prescription opioids.

The settlement follows nearly two decades in which nearly 500,000 overdoses and deaths related to opioids in the U.S., according to federal health officials. The ongoing crisis was sparked, in part, by false and misleading marketing by several companies that downplayed the risks of addiction and improperly persuaded physicians to prescribe the painkillers.

https://www.statnews.com/pharmalot/2021/09/01/purdue-bankruptcy-plan-approved-sackler/?

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full thread: https://t.co/Ke4BDHg7JT?amp=1

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Feel good du jour:

https://twitter.com/ZoneNature03/status/1434544486470885377?s=20

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Perspective/Poem

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https://twitter.com/tlhicks713/status/1434469482701918210?s=20

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--Bernadette Noll

Bits of beauty:

 

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