Coronavirus Tidbits #242, April 23, 2023

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.

Reminder, Resilience: One Family's Story... is increasingly pertinent, as some of our politicians shift rightward. All proceeds go to Holocaust education.

Available here.

 

 

News 

FDA authorizes second bivalent COVID boosters for seniors, other at-risk groups

The Food and Drug Administration (FDA) authorized second bivalent (two-strain) COVID-19 booster doses for people ages 65 and up and for those with weakened immune systems, a step designed to shore up immunity in the most vulnerable groups until fall.

In its announcement, the FDA also simplified the immunization recommendations for all age-groups to focus only on the bivalent vaccines. It said the Moderna and Pfizer-BioNTech monovalent (single-strain) vaccines are no longer authorized for use, though their full licensing remains intact for future supplemental actions.

COVID still a real risk for many people

The FDA said people ages 65 and older may receive a second bivalent dose at least 4 months after the initial bivalent dose. People with weakened immune systems can receive an extra bivalent dose at least 2 months following the last dose, with additional doses given at the discretion of healthcare providers.

https://www.cidrap.umn.edu/covid-19/fda-authorizes-second-bivalent-covid-boosters-seniors-other-risk-groups

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Covid is still a leading cause of death as the virus recedes -

free article from The Washington Post

Federal health officials say that covid-19 remains one of the leading causes of death in the United States, tied to about 250 deaths daily, on average, mostly among the old and immunocompromised...

Outside researchers also have pointed to a nationwide pattern of excess deaths, or the number of deaths exceeding what would have been predicted for that time period, which has surpassed the number of deaths attributed to covid.

https://www.washingtonpost.com/health/2023/04/16/covid-deaths-per-day/

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The NIH has poured $1 billion into #LongCovid research — with little to show for it

statnews.com/2023/04/20/lon And in the meantime, other promising endeavors struggle to get funding....

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Ed Yong's latest on Long Covid

Ed Yong explains why, even though 11% of US adults who have had Covid (6% of the US population) currently have LongCovid, you think you don't know anyone with it: "ignorance, denial, concerns about stigma."

https://www.theatlantic.com/health/archive/2023/04/long-covid-symptoms-invisible-disability-chronic-illness/673773/

@edyong209: writes about the current wave of attempts to downplay long COVID—less outright denial & more "it’s real but no big deal". Except: it very much is. It’s a substantial and ongoing crisis that still demands our attention. 1/

This piece addresses the gaping flaws in the most common downplaying arguments. It covers biomarkers, disability claims, the spectrum of severity, the oft-repeated “I don’t’ know anyone with long COVID” line, and more. 2/

A key point: The flaws in these arguments become clear if you actually talk to long-haulers (& clinicians with extensive experience in treating them). Their experiences are the ground truth against which all other data must be understood. 3/

I also look at why this problem persists--why the marginalization of long COVID and related conditions morphs into new guises but never goes away. They're mirrors on our society, and the image they reflect is deeply unflattering. 4/

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More on SARS-CoV2 causing Diabetes:

@EricTopol   Apr 20
When 12 studies all point in the same direction, it's quite a body of evidence Reviewed here erictopol.substack.com/p/new-diabetes #LongCovid

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Bird flu requires urgent national coordinated response

Scientists are sounding the alarm about dangerous changes in the highly pathogenic H5N1 avian influenza from seasonal to year-round infections. They say an urgent coordinated national response is needed to combat the virus.

We've been dealing with low pathogenic avian influenza for decades in the poultry industry, but this is different," said Jennifer Mullinax, assistant professor in the University of Maryland Department of Environmental Science & Technology and a co-author of a study published Wednesday.

"This high pathogenic virus is wiping out everything in numbers that we've never seen before," Millinax and the co-authors wrote in the journal Conservation Biology.

The University of Maryland-led team includes research scientists and partners of the Disease Decision Analysis Research Group at the U.S. Geological Survey, Eastern Ecological Science Center.

The team found that the deadly bird flu H5N1 is a novel virus for American birds, and they said it is likely to become endemic, potentially posing risks to food security and the economy.

Full text: https://www.upi.com/Science_News/2023/04/19/h2n1-bird-flu-dangerous/5491681913849/

Diagnostics:

still an incredible, negligent last of testing.

Drugs and Vaccines:

Dexamethasone still beneficial for some inpatients with COVID-19

Early administration of dexamethasone is associated with significantly reduced odds of mortality or discharge to hospice for inpatients with COVID-19 receiving supplemental oxygen or mechanical ventilation (MV) and/or extracorporeal membrane oxygenation (ECMO), according to a study published online April 18 in JAMA Network Open.

https://medicalxpress.com/news/2023-04-dexamethasone-beneficial-inpatients-covid-.html?

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No link found between mRNA COVID-19 vaccination and retinal vascular occlusion

Researchers at Case Western Reserve University and the Cleveland Clinic in Cleveland, Ohio, have investigated the potential link between new-onset retinal vascular occlusion (RVO) after receiving the COVID-19 vaccination and compared the relationship with two historically used vaccinations.

https://medicalxpress.com/news/2023-04-link-mrna-covid-vaccination-retinal.html?

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Narcan's over-the-counter price will still put it out of reach for many, experts say

The life-saving drug "Narcan" is expected to be available over-the-counter later this year, but its price tag is expected to put it out of reach for many below the poverty line.

https://medicalxpress.com/news/2023-04-narcan-over-the-counter-price-experts.html?

Devices and Masks:

@JuliaRaifman   April 19
"Mask use by health care providers should be codified into the definition of standard & universal precautions & become the 'new normal' for all healthcare institutions" - @IbukunMD (Duke), David Henderson (NIH), David Weber (UNC), Sarah Haessler (UMass) pubmed.ncbi.nlm.nih.gov/36762631/
"Universal masking... nearly eradicated transmission of other healthcare associated respiratory diseases, including influenza, pertussis, tuberculosis, measles, & mumps Universal masking is a horizontal infection prevention strategy that prevents transmission of many pathogens"
~ ~ ~   vs.
but Healthcare epidemiologists and infectious disease experts from 8 institutions say policies mandating universal masking in healthcare settings should end. Full text provides rationale, explains exceptions: ow.ly/jLzK50NLM2Y.
and a rebuttal:
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Encourage businesses and other venues to create more covid safety.

#CovidIsNotOver
#MaskUp

printable PDF to share offline: https://media2-production.mightynetworks.com/asset/57587984/Covid_Safety_is_Easy_Printable_Flyer.pdf

See also, Epidemiology, below

Epidemiology/Infection control:

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@CIDRAP   Apr 12
Study notes high rate of COVID-infected healthcare workers still caring for patients
Half of all HCWs with symptomatic #COVID19 continued to go to work, even if they were involved with direct patient care
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COVID-19 outbreak hits large Bay Area hospital, prompting new mask rules

Kaiser Permanente Santa Rosa Medical Center has reinstated a temporary mask mandate after more than a dozen hospital workers and patients at the medical center tested positive for the coronavirus this week, officials confirmed.

The outbreak came as California tallied an average of 1,330 new daily COVID-19 cases, or about 3.3 per 100,000 residents on Thursday — roughly the same figures as a month earlier. The state’s seven-day rolling coronavirus test positivity rate, which tracks the percentage of lab test results that are positive for the virus, ticked up slightly to 5.4%, with an average of 10 people dying each day due to the virus.

https://t.co/HNi4jEBtgX (paywalled)

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@NohaAboelataMD   Apr 21
At least 36 people infected at this BC hospital and extended care facility not even 2 weeks after ditching masks. Can someone please explain to me how this isn't negligent?

Tips, general reading for public:

Ventilate.

Mask.

Vax.

Politics:

Covid:

@LaSeletzky   Apr 16
“[H]ospitals cannot necessarily avoid liability by arguing that patients consent to unmasked care. Many patients cannot voluntarily consent to this…. Moreover… courts have generally rejected the argument that patients can consent to medical malpractice.”
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@juliairzyk   Apil 19
Workplace exposure to SARS-CoV-2 has been a source of morbidity and mortality from COVID-19, especially for “essential workers,” such as those employed in health care and meatpacking. Many family members of these workers also have become infected and died. If the employee’s exposure was the result of the employer’s negligence, the family member or the family member’s estate might be able to recover from the employer using the “take-home” liability theory first developed in asbestos cases. This article discusses the elements of these cases and how they relate to workers’ compensation, OSHA enforcement, and other aspects of workplace safety and health protections.
I encourage any litigators bringing cases about employment or medical settings to reach out to me or to my co-author (who is my father). We are happy to help. Removing masks in health care settings (and employment) is not good public health and may violate the law.
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@chrishendel
"An observational study of more than 2 million Medicare beneficiaries aged 65+ finds symptom-based testing identified #LongCovid in 30% of hospitalized patients & 17% of outpatients. ICD-10 codes captured only 2.6% & 0.49% of those cases, respectively."
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Covid was the No. 3 cause of death in America between 2020-2022.

It's receded a lot - but still on pace to be a top-10 cause of death this year.

“There are still people who are getting wicked sick," an infectious-disease doctor at Mass General told me. washingtonpost.com/health/2023

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Monkeypox: 

@reluctantlyjoe   Apr 14
In the US, almost 90% of MPOX deaths were in Black men. Nearly 95% of those deaths were in people with untreated HIV. If you think MPOX is over, ask yourself FOR WHOM?
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@RBReich    Apr 20
Something has gone terribly wrong when Fox News can claim a tax write-off for its $787M defamation settlement, yet school teachers only get a measly $300 deduction for buying their own supplies.
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Abortion/Reproduction:

The controversial article Matthew Kacsmaryk did not disclose to the Senate--he had submitted an article to a Texas law review criticizing Obama-era protections for transgender people and those seeking abortions and had his name removed.

https://www.washingtonpost.com/politics/2023/04/15/matthew-kacsmaryk-law-review/

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@CAKitchener   
New reporting from CNN reveals more items Kacsmaryk did not disclose to the Senate Judiciary Committee. He did not list two interviews with a Christian talk radio station, where he discussed contraception and gay rights. cnn.com/2023/04/20/pol
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@stevenmazie  April 21
Justice Alito says declining to grant the stays would have “simply” rolled the clock back on how mifepristone may be administered— narrowing the window from 10 weeks to seven, banning the distribution of mife through the mail, requiring three in person doctor visits. “Simply.”
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New Feinstein wrinkle. Democratic aide says the Judiciary Committee can’t issue a subpoena as part of a Clarence Thomas inquiry; that would require a majority on the panel and Democrats don’t have it without her. “So that option is out of the question.”
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see Florida
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Climate/Environment:

@propublica   Apr 14
If the new rules are adopted, the number of residents near these facilities who would be exposed to unacceptable cancer risk ultimately would drop by 96%, the EPA said. propub.li/3KCYn7J
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Judge temporarily blocks clean water rule in Alabama and 23 other states.
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This is a must-read Vox piece on what's causing the water crisis in the West: Cows.

There's no way around it. We're draining the Colorado river for cows. Everything else is a literal drop in the bucket. Municipal conservation cannot solve the problem. Drying up golf courses and lawns cannot solve the problem.

It's. The. Cows.

vox.com/the-highlight/23655640

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Greed:

The CEO-to-worker pay gap at America’s largest public companies is now 399-to-1. In 1965, the ratio was 20-to-1.

This explosion in CEO pay relative to the pay of workers isn’t because CEOs have become so much more valuable.

They've just gamed the system to line their pockets.

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Annual cost of SNAP: $113B
Annual revenue lost through billionaire tax evasion: $163B

GOP: Clearly the only solution to our debt crisis is starving the poor

MAGA GOP says they’ll raise the debt ceiling if they can cut food stamps for low income Americans. This is supervillian'esque behavior.

Just horrific. Low income people will needlessly starve as a result of this GOP cruelty.

Again, our problem isn't that we can't feed our neighbors in need—it's GOP can't satisfy billionaire greed.

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GOP:
@atrupar   
Wow. Peter Navarro told a Fox producer that Republican legislatures were ready to steal the election for Trump before Sidney Powell ruined it. (video clip interview)
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Even if you never watch Fox News, you're funding it. Tell your provider: #UnFoxMyCableBox.  Tell your cable providers to make 

@FoxNews  a special add-on, rather than a required component of basic cable, in light of the #DominionvFox revelations.
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Sick that the $787.5 million settlement from Fox is tax-deductible expense.
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Guns:

One-fifth of U.S. households purchased guns during the pandemic, a national arming that exposed more than 15 million Americans to firearms in the home for the first time, academic studies show.

Americans purchased nearly 60 million guns between 2020 and 2022, according to an analysis by The Trace, a nonprofit, nonpartisan news organization that tracks gun violence. Yearly gun sales are running at roughly twice the level of 15 or 20 years ago.

Americans bought almost 60 million guns during the pandemic

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LGBTQ:
@FFELouisiana   Apr 15
Hungarian parliament passes “snitch on your gay neighbor” law -
Hungary’s nationalist Prime Minister Viktor Orban, has publicly proclaimed he is a “defender of traditional family Catholic values.”
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see Florida and Missouri and Montana, below
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Voter Suppression plan:
@lawindsor   April 19
EXCLUSIVE AUDIO: Trump coup attorney Cleta Mitchell wants to "combat" voting on college campuses, citing North Carolina and Wisconsin, and says that when Republicans win the state Senate in Virginia, they can eliminate 45 days of early voting and same day voter registration.
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conservatives must band together to limit voting on college campuses, same-day voter registration and automatic mailing of ballots to registered voters,
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Musk/Twitter
@wealth   Apr 20
A dramatic 24 hours for Elon Musk has slashed his fortune by almost $13 billion, his biggest wealth wipeout this year trib.al/dR8xZAJ
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@AOC   Apr 20
Jokes aside, this (eliminating check marks) is setting the stage for major potential harm when a natural disaster hits and no one knows what agencies, reporters, or outlets are real. Not long ago we had major flash floods. We had to mobilize trusted info fast to save lives. Today just made that harder
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@BNODesk   
NWS has been told by Twitter that it will not receive API exemptions, putting the availability of tsunami and weather warnings at risk - Mashable
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@RobertMackey   
Mission accomplished. While everyone was distracted by his blue-check removals, Musks's Twitter deleted labels that alerted users that they were reading news from state-run propaganda outlets of authoritarian governments. Potemkin news channels now free to inject disinformation.
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Alabama:
Must watch video about Alabama harassing kind ladies for feeding cats #police run amok
@DavidBegnaud   Apr 16
Here’s our report from when they were convicted. You see me speak with the prosecutor, show the judge, pictures of the cats they were feeding, and give the basic allegations behind the breathtaking, heart pounding crime of year in Alabama: feeding cats.
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@WarOnDumb   
Alabama Gov. Kay Ivey, who promised to do better after she was caught lying about wearing blackface in college, has fired a Black state education official (Barbara Cooper) over a “woke” Pre-k teacher training manual.
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Arizona:
Arizona GOP must pay Secretary of State’s legal bills for 'bad-faith' election lawsuit bit.ly/3LldOTB #Tucson #Arizona
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@Yanazure
Teachers at Dysart, one of Arizona's largest districts, are now required to sign an acknowledgment that says they will not attend sessions on critical race theory or social and emotional learning at conferences
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Arkansas:
Conservatives argue that we don't need desegregation measures anymore because they worked--[working to repeal measures so that kids can go to religious schools/get vouchers] https://www.rawstory.com/arkansas-desegregation/
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Florida:
@AaronParnas   Apr 13
Fort Lauderdale, Florida had record breaking flooding overnight. Meanwhile, Ron DeSantis is campaigning in Ohio.
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Florida will now allow death penalty sentences with an 8-4 jury vote, they're looking to make sex crimes against children punishable by death, and soon being trans around kids will be a sex crime.

[Never mind that at least 30 people sentenced to death in Florida have been exonerated, more than in any other state.]

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@newrepublic   April19
Florida’s House of Representatives passed a bill Wednesday that would let the state take transgender minors away from their families if they are receiving gender-affirming care.
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So-called 'Don't Say Gay' rules expanded through 12th grade in Florida

Classroom instruction on sexual orientation and gender identity is limited.

abcnews.go.com/Politics/called

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@OurTallahassee   Apr 19
In Jefferson County, the all-white staff of prosecutors would discuss an “us versus them” mentality when referencing local migrant farm workers. Hayes says they often just called them “mexicans.”
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Florida poised to make DeSantis' travel records secret
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Disney’s response to DeSantis’s clownish press conference today, where he threatened to build a prison near Disney World among other idiotic things, was swift and epic:

@Disney   

The first-ever Disneyland After Dark: Pride Nite is coming to

@Disneyland during Pride Month in June! This separately ticketed event celebrating the LGBTQIA+ community & allies will have themed entertainment, Disney characters, specialty menu items & more: di.sn/6011Oz0rP
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@joncoopertweets   April 21
OUTRAGEOUS: A new bill proposed by Florida Republicans, and backed by Ron DeSantis, would give doctors and insurance companies the freedom to deny care to patients who are LGBTQ people or women. The so-called “Protections of Medical Conscience Act” was proposed by the Health & Human Services Committee and Healthcare Regulation Subcommittee of the Florida House of Representatives. The bill would allow healthcare providers to refuse to treat or pay for the treatment of people based on “conscience-based objections without… threat of adverse actions.” Under the law, doctors and insurance companies could deny treatment and payment if they feel the patient goes against their religious, moral or ethical beliefs. Critics say this would impact women and LGBTQ people directly, as doctors could claim they have religious, moral or ethical objections to treating LGBTQ patients, or providing medical care such as birth control, abortion referrals or gender-affirming care.  The bill also provides doctors and insurance companies with legal protection for their objections, and doesn’t require them to refer their patients to another doctor.
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Iowa:
@MorePerfectUS   Apr 18
The Iowa Senate passed a child labor law before dawn today. The bill lets 14-year-olds work 6-hour night shifts, 15-year-olds work on assembly lines, and 16- and 17-year-olds serve alcohol. The Senate went through the night, and voted on child labor at 4:52 a.m.
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Louisiana:
@SykesCharlie   Apr 16
Beyond parody. Republican state officials in Louisiana ask lawmakers to ban the study of racism at universities, citing divisive 'inglorious aspects' of US history
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Massachusetts: childcare in US
@jeremybney   
Massachusetts has the most expensive out-of-home childcare of any state in America, costing $20,913 annually or 64% more than in-state college tuition A parent will spend more on daycare than they will for in-state tuition for @UMassAmherst
The Department of Labor just released county-level data on childcare costs for the FIRST TIME EVER Turns out millions of Americans are spending painfully high amounts on childcare
The U.S. Department of Health and Human Services recommends that a family only spend 7% of their income on childcare. [Many spend 1/4 of their $]
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Missouri:
@edrabinski   Apr 19
Good to see this news out of Missouri: the Senate has restored funding to the library in its budget. Solidarity with colleagues organizing in that state! stltoday.com/news/local/gov
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There is an actual form on a government website [ago.mo.gov] where you can turn in your neighbors for being transgender for investigation by the lead prosecutor.

Do you not see where this is going?

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Mississippi:
@MSFreePress   Apr 20
Anti-vaccine activists are celebrating in Mississippi after a federal judge struck down the State’s long-standing childhood vaccine requirements for public or private school attendance, saying the State must allow religious exemptions.
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Montana:

Montana Republicans demand transgender house rep. Zooey Zephyr be censured for “inappropriate and uncalled-for language”.

What did Zooey say?

Facts.

"If you are denying gender-affirming care and forcing a trans child to go through puberty, that is tantamount to torture, and this body should be ashamed.

If you vote yes on this bill, I hope the next time you bow your heads in prayer, you see the blood on your hands."

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New York:
@AOC   Apr 19
What they aren’t telling you is that under the new NYC contract, many rank and file officers will now be in the top 10% of income earners in the US. The catch? It’s being paid for with devastating budget cuts to public schools, libraries, affordable housing, healthcare, & more. twitter.com/abughazalehkat
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Oklahoma:
@HeartlandSignal   Apr 17
On secretly recorded audio first reported by the McCurtain Gazette-News, GOP McCurtain County, Okla. officials — including the sheriff — talk about hiring hitmen to assassinate local journalists and complain that Black people now have the right to not be lynched.
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Tennessee:
@Phil_Lewis_   Apr 15
A Tennessee bill that allows students to report professors who teach "divisive concepts" passes House and Senate The list of "divisive concepts" bars discussions on biases, white privilege and racism's role in slavery
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Texas:
@NoLieWithBTC   
Holy shit. The convicted murderer who Greg Abbott (R) said he is moving to pardon for shooting a Black Lives Matter protestor just had his private texts released— they show him calling Black people “monkeys,” “animals,” and saying he wants to hunt them.
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Meanwhile, Black man was sentenced to 70 years in prison for spitting at a cop.
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18,000 cows are now dead due to an explosion in Dimmitt, Texas. Honest question: How does a dairy farm have an explosion so large that it kills 18,000 cows?
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A wheelchair, a boy and what came of those migrant buses sent to D.C.
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@Mike_Hixenbaugh   April 22
The Texas Senate has voted to establish an official period of prayer and Bible reading in public schools. From the author: “Our founders certainly never intended separation of God from government or schools, despite the left’s attempts to mislead people on this fact.”
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@stevanzetti   April 22
It's best to inform parents and children now that it would be unconstitutional to force them to pray or read any religious texts in schools and that they should not be afraid to refuse to participate
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Republicans passed a bill in Texas to end countywide-voting, which allows voters to choose polling locations that are convenient or have short lines, and a bill allowing the state to take over county election administration on flimsy pretexts.

If signed into law, the fix is in. Republicans will close locations in opposition areas to engineer impossibly long lines for democrats, but keep voting fast and easy for Republicans.

#RepublicanExtremism #TxLege #Texas

nbcnews.com/politics/politics-

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Russia:
@Billbrowder   Apr 20
The Chairpersons of the foreign affairs committees of the parliament’s of the UK, Ireland, Denmark, Poland, Czech, Slovakia, Iceland, Estonia, Latvia and Lithuania call for Magnitsky sanctions on the Russian officials involved in the political imprisonment of Vladimir Kara-Murza

Feel good du jour:

Former trash hauler enrolled at Harvard Law raises $70K for janitors, other workers there

washingtonpost.com/lifestyle/2023

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Quite the story:

@latifnasser   
Last year, a coworker randomly asked me to hand-deliver an antique violin across the country. I said yes, because why not. I had no idea what I was getting into, and now I need your help.
He had heard through a friend (about an Afghan violinist who had just escaped from Kabul and settled in LA (where I live). Problem was the guy had to leave his violin behind. Jeremy had a beautiful 110-year-old violin in his closet he used to play.
Sweetheart that he is, Jeremy wanted to gift it to this stranger, but wouldn’t dare to just put it in the mail. Would I take it through security and as carry-on on my flight home to LA? I said sure. I took the violin.
...His name is Ali (aka  @ALIESMAHI ). He got to the US a few months prior under one of those Special Immigrant Visas. The reason he fled was because the Taliban DESPISES musicians, has even killed them in the past. The US government helped him get here but not much more....
We are partnering with the nonprofit Teach to Learn, which also raises money for other Afghan musicians. Donate here: teachtolearn.life/donate.html (If you want your tax-deductible donation to go specifically to Ali, just write “for Ali” in the comments.)
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Perspective/Poem

@EricTopol   

What a great profile of @LongDesertTrain, a citizen scientist school teacher who became a #SARSCoV2 variant sleuth and has made multiple key contributions throughout the pandemic nature.com/articles/d4158

“Almost every major variant, except a few of the recent ones, originated in a chronic infection,” Hisner says. “That’s really under-recognized, so I’m trying to draw attention to that by documenting these lineages.”
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@Will_Bunch   Apr 18
The utter nihilism of racist 21-year-old Pentagon leaker is shocking but the alienation of his Discord crowd is not unusual from a Gen Z torn between rage, despair and hopeful activism Gen Z's real problem? The mess that boomers left them. My new column
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Essay on resilience: 
@winniemli   Apr 15
15 yrs ago, while hiking on my own, I was violently assaulted & raped. Every anniversary, I go for a solo hike to remind myself I can still do it, that there is great beauty to be found, even after trauma. Here’s today’s hike. And my essay I always post tinyurl.com/482k67e9  ‘On the Anniversary of Your Rape’
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@andtartary2   On helping others
There was a farmer who grew excellent quality corn. Every year he won the prize for the best corn grown. One year, a reporter interviewed him and discovered something interesting about the way he grew corn. The reporter discovered that the farmer shares his seeds with his neighbors. "Why does he share his best seeds with his neighbors if every year they compete with his own?" the reporter asked him. "Why, sir?" the farmer replied, "didn't you know? The wind picks up the pollen from the ripe corn and swirls it from one field to another. If my neighbors grow inferior corn, cross-pollination will constantly degrade the quality of my corn. If I want to grow good corn, I must help my neighbors grow good corn." The same is true of our lives. Those who want to live good and meaningful lives must help enrich the lives of others, because the value of a life is measured by the lives it touches, and those who choose to be happy must help others find happiness, because the well-being of each is linked to the well-being of all.

Bits of beauty:

 

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