Coronavirus Tidbits #172 12/26/21

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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.

New Posts:

Let’s Stop Hand Hygiene Theater and Focus on Airborne Transmission

https://www.medscape.com/viewarticle/965238

News 

See What to do if newly infected, under Tips, below:

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Desperate times re HCW staffing

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Omicron is more contagious and requires more protective masks.

Wear mask indoors when around other people. Wear an N95 or K95 or KF94

. https://npr.org/sections/health-shots/2021/12/23/1066871176/mask-n95-omicron-contagious…

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Long-Acting Antibody Combo Retains Neutralizing Activity Against Omicron

Delaware-based AstraZeneca U.S. announced today Evusheld, a long-acting antibody combination to prevent COVID-19, retains neutralization activity against the Omicron SARS-CoV-2 variant (B.1.1.529).

https://www.precisionvaccinations.com/2021/12/23/long-acting-antibody-combo-retains-neutralizing-activity-against-omicron

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Breakthrough infections generate ‘super immunity’ to COVID-19, study suggests

Breakthrough infections greatly enhance immune response to variants of the virus that causes COVID-19, according to a newly published study from Oregon Health & Science University.

The laboratory results, published online ahead of print today in the Journal of the American Medical Association (JAMA), reveals that a breakthrough infection generates a robust immune response against the delta variant. Authors say the findings suggest the immune response is likely to be highly effective against other variants as the SARS-CoV-2 virus continues to mutate.

The study is the first to use live SARS-CoV-2 variants to measure cross-neutralization of blood serum from breakthrough cases.

“You can’t get a better immune response than this,” said senior author Fikadu Tafesse, Ph.D., assistant professor of molecular microbiology and immunology in the OHSU School of Medicine. “These vaccines are very effective against severe disease. Our study suggests that individuals who are vaccinated and then exposed to a breakthrough infection have super immunity.”

The study found that antibodies measured in blood samples of breakthrough cases were both more abundant and much more effective – as much as 1,000% more effective – than antibodies generated two weeks following the second dose of the Pfizer vaccine.

The study suggests each exposure following vaccination actually serves to strengthen immune response to subsequent exposures even to new variants of the virus.

https://www.eurekalert.org/news-releases/938330

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As Omicron Hits, COVID-19 Case Counts Don’t Mean What They Used To

America has begun the gradual process of accepting that COVID-19 is going to be endemic-meaning it will always be present in the population to some degree-due to inherent properties of the virus (animal reservoirs, high transmissibility, long period of infectiousness, symptoms similar to other pathogens), and will remain so for the foreseeable future. However, the U.S. has an impressive suite of tools to deal with this reality. Vaccine eligibility is widening and boosters are available for all adults who want one. Two effective oral antiviral drugs that prevent hospitalizations and death in people newly infected with COVID-19 are about to be authorized. There are also monoclonal antibody treatments for people whose immune systems do not mount a robust response to infection. The CDC signaled this important and realistic shift by acknowledging that herd immunity is not achievable. With this admission from our most important public health agency, policy must shift also.

…It no longer makes sense to assume “cases” equate to “disease” in areas of high vaccination coverage…

Marin County’s public health officer recently noted that hospitalizations were at a four-month low, and explained that going forward mask mandates would depend largely on hospitalization and vaccination metrics (instead of case counts) because in areas of high vaccination rates, hospitalizations became largely uncoupled from cases during the U.S. delta variant surge.

https://time.com/6129225/omicron-covid-19-case-counts/

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Severity of Omicron

…Deaths continue to increase, but also much, much lower than before. Is this because immunity is working or because Omicron is less severe? We don’t know yet. But an important preprint was released yesterday describing Omicron hospitalizations in South Africa. There was a lot in this paper, but, to me, the following was the biggest finding: Once someone got to the hospital, the odds of disease becoming severe was the same as Delta. So if the immune system was breached, Omicron did the same damage as Delta. This is consistent with another robust analysis of hospitalizations from the UK that found Omicron is not less severe than Delta.

Also, Omicron is convincing 1 in 8 unvaccinated to change their mind.

https://yourlocalepidemiologist.substack.com/p/omicron-update-dec-22

(another newsletter I am now subscribing to)

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Influenza

the H3N2 component of current flu vaccines won’t likely match the circulating H3N2 strain, which is currently the nation’s dominant strain. H3N2 is known to cause more serious complications in the youngest and oldest age-groups.

researchers reported yesterday in an medRxiv preprint that their lab studies involving serum samples from vaccinated people and human airway cells suggest that a unique H3N2 clade is circulating that has several differences from key antigenic sites on the hemagglutinin protein of the H3N2 vaccine strain. Antibodies from the Northern Hemisphere flu vaccine poorly neutralized the new H3N2 clade virus.

Scott Hensley, PhD, who led the group, said on Twitter that the data may explain the poor vaccine efficacy found during an outbreak at a University of Michigan campus. He added that despite the findings, it’s important to be vaccinated, because studies consistently show that flu vaccines prevent hospitalizations and deaths, even where there are large antigenic mismatches.

https://www.cidrap.umn.edu/news-perspective/2021/12/news-scan-dec-17-2021

Other news:

Severe COVID-19 significantly increases risk for mortality within 12 months of diagnosis

Patients with severe COVID-19 had more than twice the risk for mortality within 12 months of diagnosis compared with those who had mild or moderate disease or were not infected, data showed.

The increased risk for mortality was particularly high in individuals aged younger than 65 years, according to researchers.

 “Post-acute sequelae of COVID-19 is not well understood,” Arch G. Mainous III, PhD, a professor in the department of health services research, management and policy at the University of Florida, and colleagues wrote in Frontiers in Medicine.

https://www.healio.com/news/primary-care/20211222/severe-covid19-significantly-increases-risk-for-mortality-within-12-months-of-diagnosis

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At Their Breaking Point, Nurses Plead With Public in COVID Videos

– “Hospital staff are paying the price” of vaccine misinformation

https://www.medpagetoday.com/special-reports/exclusives/96302?

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What makes an mRNA vaccine so effective against severe COVID-19?

The first two vaccines created with mRNA vaccine technology-the Pfizer/BioNTech and Moderna COVID-19 vaccines-are arguably two of the most effective COVID vaccines developed to date. In clinical trials, both were more than 90% effective at preventing symptomatic infection, easily surpassing the 50% threshold the Food and Drug Administration had set for COVID-19 vaccines to be considered for emergency use authorization

https://medicalxpress.com/news/2021-12-mrna-vaccine-effective-severe-covid-.html?

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Diagnostics:

still an incredible, negligent lack of testing.

Review article:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02346-1/fulltext

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Wondering if #binaxnow works for Omicron? We tested the rapid Ag test w/ dilutions of Delta and Omicron samples from 2.5K to 250K copies. At expected limit of detection (>=100K copies), Binax worked for both. Larger studies needed, but reassuring that binax should be effective – Dr. Jonathan Li

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Study confirms COVID-19 PCR saliva test at least as accurate as nasal swabs

A paper published today in the New Zealand Medical Journal confirms the covidSHIELD PCR saliva test developed by the University of Illinois is a reliable option for detecting COVID-19.

https://medicalxpress.com/news/2021-12-covid-pcr-saliva-accurate-nasal.html?

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Drugs and Vaccines:

Coronavirus (COVID-19) Update: FDA Authorizes First Oral Antiviral for Treatment of COVID-19

Paxlovid Receives Emergency Use Authorization from FDA

Today, the U.S. Food and Drug Administration issued an emergency use authorization (EUA) for Pfizer’s Paxlovid (nirmatrelvir tablets and ritonavir tablets, co-packaged for oral use) for the treatment of mild-to-moderate coronavirus disease (COVID-19) in adults and pediatric patients (12 years of age and older weighing at least 40 kilograms or about 88 pounds) with positive results of direct SARS-CoV-2 testing, and who are at high risk for progression to severe COVID-19, including hospitalization or death. Paxlovid is available by prescription only and should be initiated as soon as possible after diagnosis of COVID-19 and within five days of symptom onset.

Paxlovid is not authorized for the pre-exposure or post-exposure prevention of COVID-19 or for initiation of treatment in those requiring hospitalization due to severe or critical COVID-19. Paxlovid is not a substitute for vaccination in individuals for whom COVID-19 vaccination and a booster dose are recommended.

Paxlovid consists of nirmatrelvir, which inhibits a SARS-CoV-2 protein to stop the virus from replicating, and ritonavir, which slows down nirmatrelvir’s breakdown to help it remain in the body for a longer period at higher concentrations. Paxlovid is administered as three tablets (two tablets of nirmatrelvir and one tablet of ritonavir) taken together orally twice daily for five days, for a total of 30 tablets.

From EPIC-HR, a randomized, double-blind, placebo-controlled clinical trial:Paxlovid significantly reduced the proportion of people with COVID-19 related hospitalization or death from any cause by 88% compared to placebo among patients treated within five days of symptom onset and who did not receive COVID-19 therapeutic monoclonal antibody treatment. In this analysis, 1,039 patients had received Paxlovid, and 1,046 patients had received placebo and among these patients, 0.8% who received Paxlovid were hospitalized or died during 28 days of follow-up compared to 6% of the patients who received placebo.

NOTE: Contraindications: Co-administration with drugs highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.

• Co-administration with potent CYP3A inducers where significantly reduced nirmatrelvir or ritonavir plasma concentrations may be associated with the potential for loss of virologic response and possible resistance. (4)

see https://www.fda.gov/media/155050/download for a list of meds. Extensive list incl: Coumadin, Amiodarone, Verapamine, Digoxin, Dilantin, Colchicine, HIV meds, statins, contraceptives.

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Vaccine for younger children ‘unlikely’ before mid to late 2022

Pfizer and BioNTech announced last week that they were evaluating the addition of a third 3 µg dose of their vaccine for children aged 6 months to 5 years after the two-dose series failed to produce the expected level of protection in study participants aged 2 to 5 years, although protection in participants aged 6 to 24 months matched that seen in adolescents and young adults.

If the three-dose series is successful, the companies said they would submit data to the FDA for an emergency use authorization “in the first half of 2022.”

https://www.healio.com/news/primary-care/20211222/vaccine-for-younger-children-unlikely-before-mid-to-late-2022

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Researchers fear growing COVID vaccine hesitancy in developing nations

Scientists worry that pools of unvaccinated people could be a source of new variants, such as Omicron.

Nature Smriti Mallapaty 23 December 2021

COVID-19 vaccine hesitancy has long been recognized as a problem in high- and middle-income nations. But in some of the world’s poorest countries, lack of access to vaccines has been a much bigger hurdle. Now researchers say that as doses are trickling in, resistance to getting vaccinated is also emerging as a major issue in those nations.

Scientists fear that persistent pools of unvaccinated people around the world will present a greater risk for the emergence of new variants of concern, such as Omicron. “When you have a lot of community transmission, that’s where variants will emerge,” says Jeffrey Lazarus, a global health researcher at the Barcelona Institute for Global Health, Spain. Addressing people’s hesitancy is therefore crucial, to curb viral spread and to avert hospitalizations and deaths, he says.

Scientists report that hesitancy might now be contributing to the slow uptake of vaccines in some nations where large proportions of the populations remain unvaccinated. These include South Africa – one of the nations where Omicron was first detected – Tanzania, the Democratic Republic of the Congo (DRC), Papua New Guinea and Nepal.

https://www.nature.com/articles/d41586-021-03830-7

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Vaccine Efficacy

the 2-dose mRNA vaccines remained estimated 74% (mRNA-1273) and 66% (BNT162b2) effective against symptomatic SARS-CoV-2 infections 6 months or longer after 2 doses during a period in which the Delta variant became the dominant strain,” they wrote.
Dec 22 JAMA Netw Open research letter

Latest: immunity following a second Pfizer vaccine wanes after the initial 90 days 

https://www.medicalnewstoday.com/articles/covid-19-protection-wanes-90-days-after-second-pfizer-vaccine#Waning-immune-protection

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4th vaccine doses beginning in Israel d/t waning immunity

  • Following the recommendation of its vaccine advisory group, Israel’s government yesterday said those 60 and older and health workers can receive a fourth vaccine dose, due to the fast pace of Omicron spread and waning antibodies after booster doses. Israel was one of the first countries to adopt booster doses. The fourth dose would be given 4 months after the third dose
  • 20% of the global supply is going toward booster doses, a situation that’s complicating vaccine equity. (WHO)

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Early Use of Convalescent Plasma May Help Outpatients with COVID-19 Avoid Hospitalization

(This is in contrast to other earlier studies)

Findings from Johns Hopkins-led study, posted to preprint site MedRXiv, support antibody-rich blood as an early treatment option

The results of a nationwide, multicenter clinical trial led by Johns Hopkins Medicine and the Johns Hopkins Bloomberg School of Public Health provides solid evidence for the use of plasma from convalescent patients – those who have recovered from the disease and whose blood contains antibodies against SARS-CoV-2, the virus that causes COVID-19 – as an early treatment. The researchers showed that convalescent plasma reduced the need for hospitalization by half for outpatients with COVID-19 who participated in the study.

The study found that 17 patients out of 592 (2.9%) who received the convalescent plasma required hospitalization within 28 days of their transfusion, while 37 out of 589 (6.3%) who received placebo control plasma did. This translated to a relative risk reduction for hospitalization of 54%.

https://www.hopkinsmedicine.org/news/newsroom/news-releases/early-use-of-convalescent-plasma-may-help-outpatients-with-covid-19-avoid-hospitalization

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Blueprint for making millions of doses of a new adenovirus-vector based vaccine within 100 days

The University of Oxford’s vaccine manufacturing research team has today published a pre-print paper demonstrating the feasibility of a step change in the speed and volume of production of adenovirus-vectored vaccines against new virus variants or other future pandemics.

https://medicalxpress.com/news/2021-12-blueprint-millions-doses-vaccine-days.html?

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Several people express concerns about Molnupiravir, e.g.,

“My concern with molnupiravir is because of the mechanism by which this particular drug works. Molnupiravir works as an antiviral by tricking the virus into using the drug for replication, then inserting errors into the virus’ genetic code once replication is underway. When enough copying errors occur, the virus is essentially killed off, unable to replicate any further. The FDA will soon be debating the safety of molnupiravir for high-risk individuals with Covid-19, something which I will explore in greater detail in my next piece. But my biggest concern with this drug is much larger than the health of any one person, it is molnupiravir’s ability to introduce mutations to the virus itself that are significant enough to change how the virus functions, but not so powerful as to stop it from replicating and becoming the next dominant variant.

https://www.forbes.com/sites/williamhaseltine/2021/11/01/supercharging-new-viral-variants-the-dangers-of-molnupiravir-part-1/?sh=237206456b15

see also https://threadreaderapp.com/thread/1473818094573441030.html from Michael Lin

 

 

Devices/Masks:

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How to fight seasonal depression amid the pandemic

While some welcome the changing leaves of fall and fresh snow of winter, others find themselves having difficulty waking in the morning, experiencing daytime fatigue, eating more carbohydrates, and feeling a general sense of depression this time of year. There’s a name for this-seasonal affective disorder, or SAD-a type of depression that comes and goes with the seasons. Onset typically begins in late fall and early winter, when temperatures drop and days are shorter, and can continue through spring. With the COVID-19 pandemic, some may feel the effects of seasonal depression even more than usual.

https://medicalxpress.com/news/2021-12-seasonal-depression-pandemic.html?

Epidemiology/Infection control:

Impacts of rainy weather on coronavirus outbreaks reveal economic benefits from earlier social distancing

What can a few rainy days teach us about the economics of combating the coronavirus pandemic? Quite a lot, as it turns out.

https://medicalxpress.com/news/2021-12-impacts-rainy-weather-coronavirus-outbreaks.html?

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Spain, Portugal face new limits despite vaccine success

https://medicalxpress.com/news/2021-12-spain-restrictions-high-vaccine.html

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Australian state reimposes masks after major spike in cases

Australia on Thursday reported a major spike in coronavirus infections, prompting the worst-hit state of New South Wales to reimpose mask wearing indoors, a day after Prime Minister Scott Morrison rejected lockdowns or mask mandates for the entire country to slow the spread of the omicron variant.

https://medicalxpress.com/news/2021-12-australian-state-reimposes-masks-major.html?

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Requirement for adults to wear masks in schools has major impact on COVID-19 transmissions, study finds

Adults wearing masks may decrease COVID-19 outbreaks at schools and preschools, shows a new study published in Frontiers in Public Health. The study found that the first identified cases (index cases) in schools were predominantly children, but outbreak events were more severe when an adult was the index case. Wearing a mask significantly lowered secondary cases. The researchers recommend obligatory mask wearing for adults working at schools and preschools to help prevent outbreaks.

https://medicalxpress.com/news/2021-12-requirement-adults-masks-schools-major.html?

Tips, general reading for public:

Tatiana Prowell (@tmprowell) and others have tips for newly infected and/or exposed:

1/ The first thing to say is that if someone has #COVID19 symptoms (#Omicron most common: nasal congestion/runny nose, scratchy sore throat, fever, & aches), you have to assume they have it. You may not have a test (urgent cares are still open & do) or they may still be neg.

2/ You, as the person exposed to the one with symptoms, have to assume that you both do & don’t have #Omicron too. Wait, what?  I mean: assume you could infect others now & take care to avoid exposing them, BUT don’t assume it’s too late for you to avoid getting it.

3/ Especially in households with #vaccinated (& #boosted) family members, I have seen people manage to limit #Omicron to the first person who was infected. This #CovidVariant is incredibly contagious, but It CAN be done. Don’t give up on the idea!

4/ If you have N95/KN95/KF94 masks, get in them immediately. If you have only 1, put the sick person in it for source control. If you have >1 but not enough for all put the sick one & the highest risk (older, #immunocompromised) people in them. Then get outside, & leave door open.

5/ Fresh air is a friend & shared air is an enemy. The more you can ventilate your , now & until this is over, the better. You want the concentration of #omicron in air as low as possible. This decreases odds of infection & may make you less sick if you do get infected.

6/ Plan to bundle up if you’re in a  climate, because you’re going to need to leave doors & windows open enough for air exchange, esp for next 5d or so, & a cross draft. If you have a fresh HVAC filter, change it. If a hardware place is open, get a MERV13 HVAC filter. (Amazon has too.)

7/ Run the fan on your thermostat on high. Filter that #Omicron ! If you need supplies of any kind, please do curbside pickup or same-day delivery or drive-thru. No one exposed should be indoors in public, & def not the one with symptoms, to prevent further spread.

8/ If you don’t have any N95/KN95/KN94 masks, please see if a nearby friend or neighbor has unused ones you can have & order them replacements. The nonprofit @projectn95  (http://projectn95.org) is a great place to get them. Your backup plan for right now is a surgical mask.

9/ A surgical mask (ASTM level 3, 3-ply is best) has good filtration but usually not good fit. There are often gaps. Knot ear loops where they join the mask & then tuck to improve the mask fit. Here’s a short video demo: https://youtu.be/GzTAZDsNBe0. Put a cloth mask over the surg mask.

10/ Now it’s time to create the space where the infected person or people will isolate for 10d to let #Omicron run its course. This prior  of mine covers what is helpful to have in there & other things to consider.

11/ This whole scenario assumes that things are going ok with the person who has #Omicron. How do you know if they are ok? As I mentioned before, if you have a pulse oximeter (O2 sat monitor)-the thing drs put on your fingertip to measure O2-use it. See guide in .

12/ If you don’t have a pulse oximeter, many pharmacies carry them. They are over the counter. Ask the pharmacist if you don’t see them. You can order them online from many places too. Get one highly rated by many people. They need not be expensive. $15 gets a very good one.

13/ Some of your devices (smart watches, fitness trackers) can detect heart rate (60-100 normal for adults) & less reliably O2 levels. If you have them & they read low O2 levels, def do call a dr or seek care. Video calls are helpful to check on the sick as well.

14/ If the person w/ #Omicron is high-risk (especially #immunocompromised, organ or bone marrow transplant, active #cancer, #pregnant, #diabetes, older, etc), they should contact a dr even if they seem ok. There are outpatient treatments that sig risk of being hospitalized.

15/ These include monoclonal antibodies (some brands no longer work vs #Omicron, but 1 called sotrovimab remains effective). It is given IV as a single dose. There are also two types of pills taken for 5d at home. All are in short supply at the moment. https://google.com/amp/s/abcnews.go.com/amp/Health/omicron-treatments-monoclonal-antibodies-work-variant/story%3fid=81893922….

16/ All of these things to treat outpatients w/ #Omicron, the monoclonal antibody sotrovimab, as well as the pills (Paxlovid: https://google.com/amp/s/www.nytimes.com/2021/12/22/health/pfizer-covid-pill-fda-paxlovid.amp.html…) & (molnupiravir: https://google.com/amp/s/www.nytimes.com/2021/12/23/health/covid-pill-merck.amp.html…) are new, so they are being reserved for higher-risk folks while supply increases. [Paxlovid is better imho] 17/ If you are not the sick person, but one of the exposed, & you can walk-up/drive-up (NOT indoors & ONLY in a !) to #GetVaccinated, do it. If age 16+ & 6+ mos post dose 2 of vaccine (or 2+ post J&J), go #GetBoosted now! The booster protects w/in a wk! 19/ If you are high-risk #immunocompromised or #immunosuppressed, we know that #vaccineswork less well in many of you. While you should still #GetVaccinated & #GetBoosted, an injection (Evusheld) can decrease your risk of #COVID19. It’s given every 6 mos. ~ ~ ~ Also #Remdesivir might be available as an outpatient for high-risk– (1.6%) in the remdesivir group and 21 of 252 (8.3%) hosp or death in placebo https://www.nejm.org/doi/full/10.1056/NEJMoa2116846 I suggest contacting the local health department +/- hospital to see where any of these drugs might be available. There are very limited supplies.

Politics:

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This seems a colossally stupid move and sends the wrong message:

 

Feel good du jour:

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Comic relief:

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Perspective/Poem

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Bits of beauty:

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