Coronavirus & Avian Flu Tidbits # 293, May 5, 2024

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 

Overall, transmission is trending down. Mike Hoerger: “Transmission continues to decline. About 1 in 161 people in the U.S. are infectious, the lowest levels since July 1. Transmission levels are higher than during 27% of the pandemic… the over-reporting in real-time data lead me to believe there's a 50-50 chance we see a May ‘wavelet’ versus continued decline for a couple months.

Check for your nearest wastewater treatment reports: https://data.wastewaterscan.org/

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WHO Overturns Dogma on Airborne Disease Spread. The CDC Might Not Act on It.

KFF Health News  By Amy Maxmen MAY 1, 2024

The WHO concluded that airborne transmission occurs as sick people exhale pathogens that remain suspended in the air, contained in tiny particles of saliva and mucus that are inhaled by others...

The change puts fresh emphasis on the need to improve ventilation indoors and stockpile quality face masks before the next airborne disease explodes. Far from a remote possibility, measles is on the rise this year and the H5N1 bird flu is spreading among cattle in several states. Scientists worry that as the H5N1 virus spends more time in mammals, it could evolve to more easily infect people and spread among them through the air.

Traditional beliefs on droplet transmission help explain why the WHO and the CDC focused so acutely on hand-washing and surface-cleaning at the beginning of the pandemic. ...

More than 3,600 health care workers died in the first year of the pandemic, many due to a lack of protection.

However, a committee advising the CDC [the HICPAC committee I have written about repeatedly] appears poised to brush aside the updated science when it comes to its pending guidance on health care facilities....

But the National Nurses United union obtained notes of the conversations through a public records request to the agency. The records suggest a push for more lax protection. “It may be difficult as far as compliance is concerned to not have surgical masks as an option,” said one unidentified member, according to notes from the committee’s March 14 discussion. Another warned that “supply and compliance would be difficult.”

The nurses’ union, far from echoing such concerns, wrote on its website, “The Work Group has prioritized employer costs and profits (often under the umbrella of ‘feasibility’ and ‘flexibility’) over robust protections.”

https://kffhealthnews.org/news/article/airborne-disease-transmission-who-cdc-new-evidence/?

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Immunocompromised still have disproportionate deaths from Covid:

Despite representing approximately 4% of the population, immunocompromised individuals still account for about a quarter of COVID-19 hospitalizations and deaths.

[This is part of why improving ventilation and what the HICPAC decides re masking and non-drug interventions is so important.]

https://www.astrazeneca-us.com/media/press-releases/2024/real-world-evidence-at-eccmid-2024-further-substantiates-the-continued-significant-and-disproportionate-risk-of-severe-covid-19-facing-immunocompromised-individuals.html

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Hospitals no longer required to report COVID-19 data to CDC

As of May 1. [How short-sighted is that???]

Action:  message HHS here if you want to request that COVID hospitalization data continue to be posted.

Please Support proposal (section P): CMS is proposing to replace the COVID-19 and Seasonal Influenza reporting standards for hospitals and CAHs with a new standard addressing acute respiratory illnesses to require that, beginning on October 1, 2024, hospitals and CAHs would have to electronically report information about COVID-19, influenza, and RSV. CMS is proposing that outside of a public health emergency (PHE), hospitals and CAHs would have to report these data on a weekly basis.

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Metformin

has antiviral activity against RNA viruses including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The mechanism appears to be suppression of protein translation via targeting the host mechanistic target of rapamycin pathway. In the COVID-OUT randomized trial for outpatient coronavirus disease 2019 (COVID-19), metformin reduced the odds of hospitalizations/death through 28 days by 58%, of emergency department visits/hospitalizations/death through 14 days by 42%, and of long COVID through 10 months by 42%.

https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciae159/7660393?

Participants on metformin showed a 3.6-fold reduction in mean viral load compared

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Interview w Akiko Iwaskaki with transcript

disease drivers--hypotheses: persistent viral infection, autoimmune disease, reactivation of herpes viruses; inflammation that occurs during the acute phase can sort of chronically change some tissue tone

https://erictopol.substack.com/p/akiko-iwasaki-the-immunology-of-covid

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@EricTopol
Our understanding of inflammation and immunity via the body-brain axis jumps forward via discovery of a new circuit (involving cNST, delineated via single-cell sequencing, functional imaging, spatial omics) nature.com/articles/s4158
See also https://www.nature.com/articles/d41586-024-01259-2 for more readable perspective.
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Long-term smell, but not taste, deficits seen after COVID-19

30.3 percent of individuals with prior COVID-19 and 21.0 percent of individuals without prior COVID-19 having some degree of dysfunction (odds ratio, 1.64)

Smell outcomes varied by the SARS-CoV-2 variant present at the time of , with individuals with original untyped and alpha variant infections showing more loss than those with other variant infections. Total to severe smell loss occurred in 23.8 percent of individuals with alpha variant infections, 13.5 percent with the original  infections, and 2.8 percent of individuals with no COVID-19 history.

https://medicalxpress.com/news/2024-05-term-deficits-covid.html?

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The FLiRT variant KP.2 begins its takeover for Covid cases in the US, now accounting for 1 in 4 cases covid.cdc.gov/covid-data-tra

the current booster (directed vs XBB.1.5) isn't providing very good protection against FLiRT variants

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Viral persistence:

SARS-CoV-2 is now confirmed to infect megakaryocytes  (platelet precursors) long-term.

Another group found “Viral RNA was distributed across ten different types of solid tissues, including liver, kidney, stomach, intestine, brain, blood vessel, lung, breast, skin, and thyroid.” This was associated with a 5x increase of Long Covid.

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(24)00171-3/fulltext?dgcid=raven_jbs_aip_email

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The economic cost of #LongCovid covid is staggering!

In the US, #LongCovid could result in 1.5 billion work hours lost in 2024 – a potential cost of more than US$152.6 billion A report by @TheEconomist

In the UK, #LongCovid could result in 251.8m work hours lost in 2024 – a potential cost of more than US$15.5bn

impact.economist.com/perspectives/h

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Avian Influenza:

H5N1 in the USA 2024 Timeline:

https://github.com/Emergent-Epidemics/H5N1_US2024_timeline?tab=readme-ov-file

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as of April 26, 2024, the virus has spread to at least 34 dairy
herds in nine states (Texas, Kansas, New Mexico, Idaho, Michigan, Ohio, North Carolina, South Dakota, and Colorado)
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Bird flu virus circulated in cows for four months before outbreak confirmed by USDA

The study’s authors suggest that the spread in cattle started from a single spillover event from birds in the Texas panhandle that may have happened in early December. The USDA didn’t confirm the presence of H5N1 in a Texas herd until March 25.

The USDA’s analysis found about two dozen mutations that have arisen in the H5N1 virus as it has circulated in dairy cattle that are known to make influenza viruses more deadly or more likely to be able to infect humans.

https://www.statnews.com/2024/05/02/bird-flu-virus-in-cows-four-months-before-h5n1-outbreak-confirmed/?

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The 2 newly reported outbreaks in cattle occurred in NM & were apparently confirmed on or before April 17, but only posted publicly April 30.

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Do Our Flu Antivirals Work on H5N1?

Probably, but testing is beginning.

The testing of virus from the one known human patient confirmed that "the H5N1 virus was susceptible to all commercially available FDA-approved and recommended neuraminidase inhibitors," (This includes oseltamivir (Tamiflu), zanamivir (Relenza), and peramivir (Rapivab). Testing is pending for the polymerase inhibitor baloxavir (Xofluza).

https://www.medpagetoday.com/special-reports/features/109891?

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They used the “gold standard” egg inoculation tests that many have been waiting for. Together with NIAID grantee studies and past publications, it’s pretty conclusive the milk is safe. -- @svscarpino
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H5N1: Reduced susceptibility to neuraminidase inhibitors
"CDC found one virus from a cow with a marker known to be associated with reduced susceptibility to the neuraminidase inhibitors (a change at NA-T438I)." CDC #H5N1 update https://www.cdc.gov/flu/avianflu/spotlights/2023-2024/avian-situation-update.htm
If this were to spread, it could render flu drugs in stockpile less effective. There are not many alternatives in abundant supply. - Rick Bright also:
This virus can change easily, can spread swiftly, and cause great harm. There has never been such widespread of this virus among mammals. We cannot be overly confident in our current vaccine / antiviral preparedness posture. We need to do more. Now is the time to act, not when there are more cases...

The current narrative is a bit overly confident they have things under control with 4+ year old candidate vaccine virus. This will be a suboptimal match to what would take off in 2024. It’s best to update the CVV now while we have time. We need the best vaccine in the fight, not one left over from 2020. Btw, ask @CDCDirector to release update seasonal flu vax efficacy from this season, for all ages....

Imp to note this likely originated from a single/limited infection (birds to dairy cattle in Texas), within a confined area. Meaning also, this could’ve been detected, contained, halted in a single area. It was likely spread across the country by transporting sick/infected cows.

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Transmission now likely from transporting asymptomatic cattle:
Imp to note this likely originated from a single/limited infection, within a confined area. Meaning also, this could’ve been detected, contained, halted in a single area. It was likely spread across the country by transporting sick/infected cows.
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Out of 33 dairy farms in 8 U.S. states (+1 dairy farm in Colorado), 23 people have been tested for highly pathogenic avian influenza H5N1 by states. Less than 1 person per farm. This seems a clear answer to the question: “Are we testing enough for H5N1?”
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CDC is recommending n95 respirators for workers in beef and poultry production
because of h5n1 influenza risk. Despite acne risks and lack of RCT evidence. cdc.gov/flu/avianflu/h   h/t David Fisman
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Bird flu outbreak in Jharkhand; 2 doctors, 6 others quarantined in Ranchi
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Unresolved questions:

How widespread is the virus in dairy cattle?

There's been little testing: preliminary results from nationwide samples of retail milk indicate about one in five samples are positive for viral traces (not live virus)

How exactly is the virus spreading?

Not clear. "We don't know if it's [surface] transmission. We don't know if there's aerosolization of the milk."

The USDA has also noted another concerning development — that there have been some instances of the virus moving from domesticated poultry to cattle.

Since 2022, there have been 26 human cases of H5N1 virus infection reported worldwide.

[Very little testing of farm workers has been done--CDC can't go in w/o invitation from the State. Many workers don't want to get tested.]

https://www.npr.org/sections/health-shots/2024/04/26/1247479100/bird-avian-flu-cows-cattle-milk-virus-unanswered-questions

Also: Celine Gounder: 4/25

Are pigs being tested? Pigs are the mixing vessel for bird and human flu strains. Historically, when they’ve mixed, the result has been scary Frankenstein flu strains that can cause epidemics or pandemics.

How much asymptomatic spread is occurring? Among cows? & to people?

What’s being done with milk from infected cows that’s known to be contaminated? That milk should be pasteurized and disposed of in such a way that other animals and humans won’t be exposed or infected.

How are pasteurization facilities inspected and by whom? How do we know it’s working and being done correctly? What’s the oversight?

Are workers being given personal protective equipment? And are they wearing it to protect themselves against infection?

Why has it been so hard for government agencies to give us a more complete picture of this outbreak?

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Cats:

the cats died shortly after they were fed raw colostrum from sick cows, highlighting the risk of spread from cows to other animals through contaminated milk.

The postmortem exams of cats who died of #H5N1 #BirdFlu on dairy farms show devastating effects on the heart, lung, eyes, & brain.

wwwnc.cdc.gov/eid/article/30

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Bottlenose Dolphin that contracted HPAI - Avian Flu and died;

“The virus in the mammal's brain and lungs, had mutated to become 18 times more resistant to current drug treatments.”

“The dolphin was found with brain Inflammation and Leptomeninges disease. UF scientists found symptoms similar to those in other Florida wildlife that had been infected with the Bird Flu.”

https://www.dailymail.co.uk/sciencetech/article-13362489/amp/Dolphin-Florida-common-bottlenose-die-bird-flu.html

https://www.wfla.com/news/florida/dead-florida-dolphin-was-infected-with-highly-pathogenic-bird-flu/amp/

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As suspected more than a month ago: H5 was detected at three [wastewater] plants located in a state with confirmed outbreaks of highly pathogenic avian influenza, H5N1 clade 2.3.4.4b, in dairy cattle, suggesting a large fraction of Influenza A virus inputs were H5 subtypes. At two of the wastewater plants, industrial discharges containing animal waste, including milk byproducts, were permitted to discharge into sewers. medrxiv.org/content/10.110

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An unidentified Subtype of #InfluenzaA virus detected in a southern prison in Thailand with over 3,500 cases, 25 hospitalizations and 2 deaths.

https://www.bangkokpost.com/thailand/general/2785347/influenza-outbreak-hits-jail

 

Diagnostics:

A study suggests that High-risk patients with COVID symptoms should use PCR rather than rapid tests

Study findings that reveal a sensitivity of 47% for COVID-19 rapid antigen tests (RATs) compared with reverse-transcription polymerase chain reaction (RT-PCR) tests during Omicron variant predominance should prompt clinicians to consider using the latter test in high-risk patients eligible for antiviral drugs, the authors say.

The study, published in Morbidity and Mortality Weekly Report, also showed a RAT sensitivity of 80% compared with viral culture.

https://www.cidrap.umn.edu/covid-19/high-risk-patients-covid-symptoms-should-use-pcr-rather-rapid-tests-study-suggests

HOWEVER...

PCRs are much more expensive and have a 1-2 day turnaround, so could well delay treatment. A likely better option is to do a rapid test (RAT) and, if negative and you are at high risk of complications, do a PCR.

Drugs and Vaccines:

COVID booster linked to 25% lower odds of long COVID

in new cross-sectional study published in Vaccine.

https://www.cidrap.umn.edu/covid-19/covid-booster-linked-25-lower-odds-long-covid

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WHO COVID vaccine advisers recommend switch to JN.1 strain

The FDA's vaccine advisory group will discuss the make-up of 2024-2025 vaccines at its meeting on May 16. ow.ly/aYx450Rra31

(but the FLiRT variant is increasing now.)

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Pronounced benefit of Paxlovid in hospitalized patients

out to year vs #LongCovid sequelae, including survival. More pronounced for age 65+ and those with 3-dose vaccination. thelancet.com/journals/lanin

Devices:

video/simulation showing how MERV 13 filters in a #corsirosenthalbox can outperform a HEPA air cleaner!

MERV outperforms HEPA: See this video demo:

https://x.com/dgleich/status/1781382168855351416

Epidemiology/Infection control:

Tips, general reading for public:

StayAtHome

Wash your hands.

Rinse and repeat.

Politics:

Abortion:

Comcast, Boeing, Chevron, JP Morgan Chase and Deloitte pledged to pay for employee travel costs to obtain abortions, but have donated more than $90,000 in the past year to Florida lawmakers who voted in support of the state’s six-week abortion ban.

https://www.citizensforethics.org/reports-investigations/crew-investigations/these-corporations-publicly-supported-abortion-access-then-donated-to-anti-abortion-lawmakers-in-florida/

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TFG/GOP:

Trump tells Time he doesn’t rule out political violence if he loses election: “I don't think we're going to have that. I think we're going to win. And if we don't win, you know, it depends. It always depends on the fairness of an election.”

Image

time.com/6972021/donald

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Greed:

A Doctor at Cigna Said Her Bosses Pressured Her to Review Patients’ Cases Too Quickly. Cigna Threatened to Fire Her.

Cigna tracks every minute that its staff doctors spend deciding whether to pay for health care. Dr. Debby Day said her bosses cared more about being fast than being right: “Deny, deny, deny. That’s how you hit your numbers,” Day said.

https://www.propublica.org/article/cigna-medical-director-doctor-patient-preapproval-denials-insurance

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Truth Social’s accounting firm has just been shut down and fined $14M by the SEC for “massive fraud”.

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Image

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Moderna refused to assist 15 countries working with WHO

to create mRNA vaccines for the global south, even by lending knowledge. They said they'll make their own plant in Kenya. Four yrs later, Moderna quietly abandons the plan.

https://www.thinkglobalhealth.org/article/moderna-cancels-kenya-vaccine-project-due-familiar-economic-hurdles?

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Fertilizer made from Treated Human Waste from the city of Fort Worth, Texas full of “PFAS”, is running off onto to ranchers land, killing their cattle, horses and fish.

[Note: Biosolids are rec by EPA to recycle nutrients.]

https://www.wfaa.com/article/news/investigations/texas-johnson-county-ranchers-forever-chemicals-pfas-fort-worth/287-85b7d4ce-c694-4c2a-b221-78bd94d6c8f6

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Six companies are responsible for a quarter of the Earth's plastic waste. Yes, you read that right. Six. Coca-Cola, PepsiCo, Nestlé, Danone, Altria, and Philip Morris International were the main culprits identified in a recent report.

https://www.motherjones.com/politics/2024/04/survey-study-companies-global-plastic-waste/

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Endangered Species act:

Despite bipartisan opposition, the U.S. House Representatives passed Rep. Boebert’s bill to remove Endangered Species Act protections for gray wolves

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Florida:

Florida charges people $50 a day for their stay in prison. The state wants this woman to pay $127,000 because she was sentenced to 7 years—even though she only served 10 months. A perfect example of how the gov’t sets people up to fail upon release.

The practice is called "pay-to-stay," leaves many former offenders with staggering debt.

https://reason.com/2024/04/24/she-only-served-10-months-behind-bars-florida-still-slapped-her-with-a-127000-bill/

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Louisiana:

Louisiana lawmakers are considering adding mifepristone and misoprostol — medications that induce an abortion — to the Controlled Substances Act.

https://www.wwno.org/public-health/2024-04-30/senate-bill-would-make-it-a-crime-to-possess-abortion-pills-in-louisiana

rollingstone.com/politics/polit

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Louisiana is allowing white people living in the suburbs to *secede* from majority Black & progressive Baton Rouge, the capitol of Louisiana, in order to create their own new city, St. George, which will have nearly 100,000 people, making it one of the state’s largest cities in population.

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Louisiana Supreme Court just made priests immune from civil liability in sexual abuse cases.

New Hampshire:

Dartmouth’s former Chair of Jewish Studies, Annelise Orleck has been banned from Dartmouth campus for six months for trying to protect her students from riot police. Many of these protesters are Jewish. Many of these faculty members are Jewish. Calling these protesters antisemitic is putting them in danger.

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Noem, South Dakota:

John Little, director of Native recruitment and alumni engagement at USD, posted that he was threatened with suspension and possible termination because he included his tribal affiliation and pronouns in his email signature.

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Virginia:

In Virginia, the State Senate and House of Delegates have passed two bills guaranteeing the right to obtain contraceptives and engage in contraception -- and also creating a "cause of action" that be implemented against anyone who infringes on that right. Common sense, right? It's currently on VA Governor Glenn Youngkin's desk. So, why hasn't he signed it? Because Mr. Youngkin wants a change that would allow medical providers to refuse coverage if contraception goes against their religious beliefs.

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Wyoming:

A code enforcement officer in Wyoming spent multiple days watching a 13-year-old girl and taking pictures of her while she sells Girl Scout cookies on her grandparents' driveway. Very cool and normal. Not at all fascist or creepy.

She was fined $400 for selling cookies...

cowboystatedaily.com/2024/04/23/wyo

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Wyoming removes anyone who didn't vote in the most recent election from voter rolls (in this case, the 2022 election). So the state just purged 28% of its voter registrations:

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Protests:

The NYPD crackdown on Columbia U students was led by a member of the school’s faculty. Rebecca Weiner is a Columbia prof who leads an NYPD intel division that maintains an office in Tel Aviv Weiner said student "rhetoric" necessitated the violent raid

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The chief of the Denver Police has come out defending the pro-Palestinian protestors at the Auraria college campus downtown & has refused to the request from the universities to remove them.

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Northern Ireland:

Northern Ireland to ban fracking and onshore oil and gas operations drillordrop.com/2024/04/29/nor 

Feel good du jour:

Scientists spot an orangutan using a plant to treat his own wound in the wild

A male orangutan chewed up a medicinal plant, applied the juice to a wound on his face, and used the leaves like a poultice.

https://www.statnews.com/2024/05/02/orangutan-self-treat-wound-medicinal-plant/

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Strangers help Sesame Street puppeteer Kathleen Kim, puppeteer for Muppet Ji-Young, after heirloom jade necklace was stolen

https://www.washingtonpost.com/lifestyle/2024/05/04/sesame-street-puppeteer-necklace-kim/

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Acie Holland III:  On his way to school, his bus driver passed out. Acie ran up, grabbed the steering wheel, moved the driver's foot from the pedal, applied the brake, and securely parked the bus, saving everyone on board. He's 14 years old.

Comic relief:

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Perspective/Poem:

“Dissent must never lead to disorder” - President Biden.

From Reverend Dr. Martin Luther King Jr.’s “Letter From Birmingham Jail,” written in 1963:

“I have almost reached the regrettable conclusion that the Negro's great stumbling block in the stride toward freedom is not the White Citizen's Council-er or the Ku Klux Klanner, but the white moderate who is more devoted to "order" than to justice; who prefers a negative peace which is the absence of tension to a positive peace which is the presence of justice; who constantly says "I agree with you in the goal you seek, but I can't agree with your methods of direct action;" who paternalistically feels he can set the timetable for another man's freedom; who lives by the myth of time and who constantly advises the Negro to wait until a "more convenient season."

Bits of beauty:

 

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