Coronavirus Tidbits #243 April 30, 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.
New post:
Why Antibiotics Fail—And How We Can Do Better
News
Covid:
US: New Cases (Weekly Total) 88,330
New Deaths (Weekly Total) 1,052 (150 per day)
New Hospital Admissions (Daily Avg) 1,541
https://covid.cdc.gov/covid-
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COVID-19 vaccine appears more effective if received around midday
see below for details
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Long-COVID patients show abnormal brain activity on MRI while doing memory tasks
Long-COVID patients with neuropsychiatric symptoms such as brain fog showed abnormal brain activity on magnetic resonance imaging (MRI) while completing memory tests, with a shift from activity in brain areas normally used for memory to other brain regions, shows a study published yesterday in Neurology.
From February 2021 to February 2022, University of Maryland School of Medicine (UMSOM) researchers conducted functional MRI on 29 participants who had persistent symptoms after a COVID-19 diagnosis at least 6 weeks earlier and 21 never-infected matched controls. Among the COVID patients, the average interval between diagnosis and enrollment was 7 months.
Nine long-COVID patients were hospitalized for treatment of their infections, and 19 required supplemental oxygen or other treatments. The study was conducted primarily during the period of SARS-CoV-2 Delta predominance.
Participants completed three National Institutes of Health tests for cognitive and emotional health and movement, as well as tests from the Patient-Reported Outcomes Measurement Information System (PROMIS) on depression, anxiety, fatigue, and pain. They underwent MRI as they completed working-memory tasks.
The average age was 42 years in the long-COVID group and 41 in the control group, and 65% and 57%, respectively, were women.
Cognitive test scores similar
Long-COVID participants reported a high rate of problems with concentration (92.9%) and memory (78.6%), confusion (64.3%), headaches (57.1%), visual disturbances (50%), gait disturbances (50%), burning sensations in the extremities (42.9%), and incoordination (39.3%).
Loss of taste or smell persisted in 28.6% of long-COVID-19 patients. This group also had a high rate of new-onset fatigue (85.7%), depression or anxiety (67.9%), impaired sleep (64.3%), muscle pain (60.7%), lightheadedness (46.4%), and urinary issues (27.6%).
While long-COVID patients' cognitive test scores were similar to those of never-infected participants, those with persistently compromised memory and concentration and lingering fatigue had greater brain activation on MRI while completing working-memory tests.
Long-COVID patients also had lower scores on tests for dexterity and motor endurance than controls and reported more anger, sadness, stress, depression, anxiety, fatigue, and pain and lower life satisfaction, meaning, and purpose. Those in the long-COVID group who had more brain-activity changes were more likely to have lower test scores.
Possible brain reorganization
"Their [long-COVID patients'] brain activity differed from those without prior COVID-19, indicating that their brains compensated for their deficits by reorganizing the networks to maintain their performance," lead author Linda Chang, MD, said in a press release from the American Academy of Neurology, which publishes the journal.
The authors emphasize that the findings don't prove that SARS-CoV-2 caused the brain changes but rather only an association.
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Are repeat COVID infections dangerous? What the science says
Researchers disagree over how bad it is to be reinfected, and whether COVID-19 can cause lasting changes to the immune system.
Nature Cassandra Willyard 26 April 2023
When the coronavirus pandemic began in early 2020, the SARS-CoV-2 virus was a strange and terrifying adversary that plunged the world into chaos. More than three years later, the infection’s symptoms are all too familiar and COVID-19 is here to stay — part of a long list of common diseases that infect humans. Experts estimate that the majority of the world’s population has been infected at least once; in the United States, some estimates suggest that as many as 65% of people have had multiple infections1. And it’s likely that in the decades to come, we’re all destined to get COVID-19 many more times.
Just how much harm repeat infections will cause is a matter of debate. “There are some almost pathologically polarized opinions out there,” says Danny Altmann, an immunologist at Imperial College London. One side argues that SARS-CoV-2 is a run-of-the-mill respiratory virus, no worse than the common cold, especially for those who have been vaccinated. Others have said that repeatedly getting COVID-19 is a gamble. Each bout comes with a risk of damage — or at least changes — to the immune system, and long-term health repercussions. Both groups are armed with evidence. What do the data say about the risks of reinfection and the potential for COVID-19 to cause lasting consequences?
https://www.nature.com/articles/d41586-023-01371-9
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'You call it out': Health experts chronicle failures in U.S. Covid response in hopes of fixing them
A history of how the U.S. handled the Covid-19 pandemic doubles as a warning for the future. A book coming out tomorrow describes an underprepared country, polarizing politics, and a vacuum of leadership facing a deadly foe. Two authors from the Covid Crisis Group talked with STAT’s Helen Branswell.
What were the worst mistakes the U.S. made?
Carter Mecher: We spent January and February, when it was clear that this was moving pretty quickly and this was a significant event, to really get on a war footing and to get moving. The problems with our testing just meant … we really were flying blind.
The report says “the Covid war revealed a collective national incompetence in governance.” How does that get fixed?
Philip Zelikow: First of all, you call it out. And actually it’s fixable. Once people know that in big cities before blizzards, big city mayors buy snow plows, then you get in trouble if you don’t buy snow plows. And you hold people to a certain standard that you didn’t hold them to before we had snow plows. And that’s the thing that a book like this can do.
Worth a read: full interview at statnews.com/2023/04/24/chronicling-failures-us-covid-response/
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“Reported deaths from #covid (have) fallen by 95 percent since the beginning of this year... but an estimated one in ten infections now lead to what is commonly known as #LongCovid, “which suggests that hundreds of millions of people will need long-term care.”
- WHO chief Tedros Adhanom Ghebreyesu
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On NIH's screw-up with the RECOVER Trial:
A Billion Dollars Later, STAT Asks What’s Up with the RECOVER Long COVID Initiative?
https://www.healthrising.org/blog/2023/04/23/stat-long-covid-recover/
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NIH RECOVER trial designers seem oblivious to post-exertional malaise—one of the most debilitating symptoms of long COVID and ME/CFS—and how it upends the notion of exercise as a universal medicine. More at https://t.co/GqahdwmSSY by @kaelyn_lynch: Exercise should not just be a blanket prescription for p/w LC. In many cases, not only will it not help, it may harm.
“If exercise is medicine, you should treat it like medicine,” @PutrinoLab says. “You should understand what the contraindications are, who might have adverse effects of the medicine, and how to dose the medicine effectively for each person.” #LongCovid
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Study suggests mild COVID-19 can have harmful effects on cardiovascular health
New research suggests that even mild cases of COVID-19 can have long-term detrimental effects on cardiovascular health.
An international team of scientists were able to do this research using baseline measurements from a group of participants involved in a separate study that began pre-pandemic, also investigating arterial stiffness.
In those who had been diagnosed with mild COVID-19, artery and central cardiovascular function were affected by the disease two to three months after infection. Side effects include stiffer and more dysfunctional arteries that could lead to cardiovascular disease development.
The paper, published in the Journal of Clinical Medicine, revealed age and time from COVID infection is associated with increased aging of the arteries.
Co-author, Dr. Maria Perissiou from the University of Portsmouth's School of Sport, Health & Exercise Science, said, "We were surprised to observe such a decline in vascular health, which deteriorated even further with time since COVID-19 infection. Usually, you'd expect inflammation to decrease with time after infection, and for all the physiological functions to go back to normal or a healthy level.
"We can only speculate on what causes this phenomenon without further investigation, but emerging evidence suggests that it stems from COVID-19 triggering the auto-immune process that leads to vasculature deterioration."
https://medicalxpress.com/news/2023-04-mild-covid-effects-cardiovascular-health.html?
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Other:
Malaria outbreak in Costa Rica - Travel alert
If you plan to travel in Costa Rica, tell your doctor or nurse as soon as possible.
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As temperatures rise, the threat of Zika and dengue will too, study suggests
Many of the world’s deadly infectious diseases are spread by the prick of mosquitoes, which thrive in warm climates. And as global temperatures continue to rise, researchers expect viruses such as Zika and dengue to spread even faster. The findings, published yesterday in PLOS Neglected Tropical Diseases, are based on an analysis of historical temperature data from four regions of Brazil and temperature predictions in these regions between 2045 and 2049.
Scientists project that the reproduction number — the average number of people someone with the virus would infect — could jump as high as 2.7 for Zika and 6.8 for dengue, depending on the temperature. In other words, the study’s authors write, these viruses will be more likely to spark epidemics, and it’ll be extra important for public health systems to monitor for the earliest signs of transmission. -- Stat
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Did a Military Lab Spill Anthrax Into Public Waterways?
New Book Reveals Details of a US Leak kffhealthnews.org/MTY3ODc5NA
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Obscene: Health insurance CEOs receive record pay, again
Business has never been better for the largest health insurers in the country, which led to another record-setting windfall last year for their chief executives. In 2022, the CEOs of the seven major publicly traded health insurance and services conglomerates — CVS Health, UnitedHealth Group, Cigna, Elevance Health, Centene, Humana, and Molina Healthcare — combined to make more than $335 million, according to a STAT analysis of annual financial disclosures. That was 18% more than the record from 2021. High-flying stock prices again fueled a vast majority of the gains.
More than half of the total, $181 million, went to a single executive: Joseph Zubretsky, the CEO of Molina, an insurance company that gets all of its revenue from taxpayer-funded health programs. STAT’s Bob Herman breaks down why insurance CEO pay packages tend to be at the top of all the largest companies, aside from technology giants. Read more.
https://marketing.statnews.com/gene-therapy-trial-death-insurance-ceo-pay?
Diagnostics:
still an incredible, negligent lack of testing.
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Pilot program in California shows dogs able to accurately sniff out COVID-19
A team of medical researchers from the California Department of Public Health, Kaiser Permanente, and Early Alert Canines, has conducted a pilot program to look into the possibility of using dogs to sniff out COVID-19 infections in students. In their paper published in the journal JAMA Pediatrics, the group describes their testing setup using trained dogs in both public and private schools and what they learned from the experience.
Over two months in the spring of 2022, the dogs were taken to 27 schools in California where they sniffed 1,558 volunteer students. Testing was also done with antigen tests and in so doing, the team was able to see that the dogs were approximately 90% accurate in sniffing out infections while also ruling out those not infected. The dogs detected 383 infections and missed 18.
https://medicalxpress.com/news/2023-04-california-dogs-accurately-covid-.html?
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MIT researchers develop fastest test for Ebola to date
A test for Ebola that takes 10 minutes and can discriminate between Ebola, dengue fever, and yellow fever has been reported by researches at the Massachusetts Institute of Technology Institute for Medical Engineering and Science. The new test promises much faster triage in the field for viral hemorrhagic fevers than was possible before.
The technology is based on lateral flow technology. The technology is used in pregnancy tests. A strip of paper is coated in stripes containing different sized nanoparticles that change colors in the presence of the three different viruses. The nanoparticles are attached to antibodies that recognize Ebola, dengue fever, and yellow fever. The test takes 10 minutes. A person that cannot distinguish color visually can use a phone program or a computer program that can see color.
Drugs and Vaccines:
COVID-19 vaccine appears more effective if received around midday
by Julia Evangelou Strait, Washington University in St. Louis
A study from Washington University School of Medicine in St. Louis indicates that the COVID-19 mRNA vaccine may be more effective at preventing infections if doses are given around the middle of the day rather than at other times. The researchers believe circadian rhythm—the natural cycle of physical and other changes our bodies go through in a 24-hour period—may affect the body's response to the vaccine.
Further, they found that the correlation was strongest in children and teenagers, as well as adults over age 50.
The study is published April 25 in The Journal of Clinical Investigation.
"This type of information may be critical during a mass vaccination campaign, because if you can target priority groups—such as the young and the elderly, who our data suggest stand to benefit the most from midday COVID-19 vaccines—and vaccinate them during optimal times of day, that should create a significant societal benefit in reducing breakthrough infections," said senior author Jeffrey A. Haspel, MD, Ph.D., an associate professor of medicine in the Division of Pulmonary & Critical Care Medicine.
"Our data is specific to COVID-19 vaccination, but there are some small studies that also suggest vaccination for influenza may be more effective earlier in the day. Since these trends track with a basic biological phenomenon, it is possible this pattern is reflective of vaccinations in general. But we need more research to confirm that."
COVID-19 vaccine appears more effective if received around midday (medicalxpress.com)
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Study Raises Concerns SARS-CoV-2 Evolution Outpaces Vaccine-Generated Antibodies
A NIAID-led Phase 2 trial comparing two Pfizer bivalent mRNA COVID-19 boosters found that while both induced an immune response, neutralizing antibodies were less potent against some of the emerging SARS-CoV-2 variant viruses. This scenario led the researchers – part of the Coronavirus Variant Immunologic Landscape Trial, or COVAIL – to express concern about virus evolution leaving “not optimal” antibody responses that can be addressed with vaccine strain updates. Their study, published in Clinical Infectious Diseases, calls for continuous viral surveillance to assess potential for waning vaccine effectiveness as the virus continues to evolve.
https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciad209/7111740?
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Europe nears approval for first RSV vaccine for older adults
The European Medicines Agency recommended approval yesterday for the first vaccine for respiratory syncytial virus, or RSV, in older adults. Scientists have worked for decades to create a vaccine for the common respiratory virus that recently left hospitals overwhelmed with cases surging among infants and toddlers across the U.S. The European Commission must now sign off on the EMA’s recommendation on GSK’s Arexvy, which the FDA is also set to decide on next week.
https://marketing.statnews.com/gene-therapy-trial-death-insurance-ceo-pay?
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First pill for fecal transplants wins FDA approval (for C. difficile)
U.S. health officials on Wednesday approved the first pill made from healthy bacteria found in human waste to fight dangerous gut infections—an easier way of performing so-called fecal transplants.
The new treatment from Seres Therapeutics provides a simpler, rigorously tested version of stool-based procedures that some medical specialists have used for more than a decade to help patients.
The Food and Drug Administration cleared the capsules for adults 18 and older who face risks from repeat infections with Clostridium difficile, a bacteria that can cause severe nausea, cramping and diarrhea.
https://medicalxpress.com/news/2023-04-pill-fecal-transplants-fda.html
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BCG vaccine does not protect against COVID-19 in health care workers, finds clinical trial
A world-leading international trial into the immune boosting benefits of the tuberculosis vaccine, BCG, has found it does not protect health care workers against COVID-19.
The BRACE trial, led by Murdoch Children's Research Institute, to test whether the BCG vaccine could protect health care workers against SARS-CoV-2 in the first six months after vaccination found it did not reduce the risk of developing COVID-19 among those on the pandemic frontline.
https://medicalxpress.com/news/2023-04-bcg-vaccine-covid-health-workers.html
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Good resource:
Devices and Masks:
A desktop charger with enough voltage to replenish the electric charge on N95 and surgical masks
Get home, take off your mask and toss it in the bin. This daily ritual might change soon, however, thanks to scientists from the Institute of Industrial Science at The University of Tokyo.
The researchers have developed a compact system that can restore N95 respirators and surgical masks that have been exposed to moisture to 97% efficiency. By using a special circuit and a conductive plate, a large and uniform voltage distribution recharges the mask in about one minute. This machine can help address the need for high-performance masks while reducing plastic medical waste.
https://medicalxpress.com/news/2023-04-desktop-charger-voltage-replenish-electric.html
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Please, share important commentary! Epidemiologist leaders recommend masks for ALL patient encounters as "a new standard of care" @IbukunMD #DavidKHenderson #SarahHaessler #DavidJWeber https://t.co/AfAF6YztwM (science & patient autonomy >>hospital administrators recs based on $$) pic.twitter.com/WEzJdJFZsX
— Lara Jirmanus, MD, MPH (@lzj961) April 19, 2023
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Epidemiology/Infection control:
Brits urged to mask up as Arcturus spreads
Sensible 'public health' message.
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CDC meeting, intended to mark Covid progress, sees virus cases of its own
https://www.washingtonpost.com/health/2023/04/28/covid-cases-cdc-conference/
[No mention of masking, testing before attending? Vaccination status? Ventilation at the venue? and No guidance from CDC now on large gatherings.]
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We’re Still Getting Our Pandemic Preparation Horribly Wrong
Tips, general reading for public:
Ventilate.
Mask.
Vax.
Politics:
Covid:
The CDC will stop reporting #COVID community levels in May as the Public Health Emergency ends. But community levels was always a misleading metric that understated COVID transmission. We need to standardize and communicate risk levels with wastewater data!
https://www.cnn.com/2023/04/28/health/cdc-covid-community-levels
(Note: Allegany County stopped wastewater reporting last year)
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Science and outreach: the good, the bad and why to get involved.
-this is a bit of an old post of mine now but may still be useful to some.
https://virologydownunder.com/science-and-outreach-the-good-the-bad-and-why-to-get-involved/
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The Lancet on the end of the Public Health Emergency in the United States:
"The country may move on for now, but unless it faces up to the root causes of the harm COVID-19 did in the USA—health inequities, lack of access to health care, non-communicable diseases, a poisonous political discourse, and mistrust in public health institutions—it will likely find history repeating itself when the next pandemic comes."
https://www.thelancet.com/journals/lancet/
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Are repeat COVID infections dangerous? What the science says https://www.nature.com/articles/d41586-023
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Abortion/Reproduction:
@DrJenGunter
Send me your denied misoprostol prescriptions, apparently I am good at raising awareness -> Florida CVS Refusal to Fill Prescription for Pill Linked to Abortion https://www.miaminewtimes.com/news/vagina-
[Note: this Rx was for misoprostol, to be inserted intravaginally to help with procedure for "Stricture and stenosis of cervix uteri," and not mifepristone, the drug being battled over.]
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How can anyone say it’s ok to hold (inter)national scientific conferences in TX, FL, or other states that criminalized abortion?
— Ilan Schwartz MD PhD (@GermHunterMD) April 27, 2023
How can we ask pregnant trainees/colleagues to literally risk their lives to attend these meetings? pic.twitter.com/yiMlZucKOG
— Abortion is today's hot topic in women's health, but we're overlooking an equally important one
Severe maternal morbidity increased 5% nationally between 2018 and 2019; and, in 2019, the incidence was 1.9 times higher among Black mothersopens in a new tab or window (126.1 complications per 10,000 hospital deliveries) compared with White mothers (66.2). Interestingly, the increase was highest in four statesopens in a new tab or window: Nevada (29%), Pennsylvania (14%), Florida (11%), and Texas (9%).
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ACOG PAC Donated Over $1.2 M to Anti-Abortion Legislators
Of the 294 politicians who received support form Ob-GynPAC, 116 were anti-abortion and 70 of those were also anti-Roe. Over 60% were pro-abortion access, according to a research letter by Brown's group in JAMA Network Openopens in a new tab or window.
AI translation is jeopardizing Afghan asylum claims
Cost-cutting translations are introducing errors and putting refugees at risk.
“If we rely on machine translation, at least 40% of asylum seekers will be failed.”
https://restofworld.org/2023/ai-translation-errors-afghan-refugees-asylum/
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Book bans:
Teens and young adults ages 13 to 26 living anywhere in the U.S. can access the entire collection of e-books and audiobooks from the Seattle Public Library. "We believe in your right to read what you want, discover yourself and form your own opinions." Fill out the form to get a Books Unbanned card.
https://www.spl.org/programs-and-services/
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Climate/Environment:
A proposed machine gun range on #CapeCod was dealt a blow due to an EPA ruling on the environmental impact: https://www.wgbh.org/news/local-news/2023/04/27/epa-deals-major-blow-to-cape-machine-gun-range-report-finds-significant-danger-to-public-health
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In case you needed more evidence that our system of #environmentalreview is broken, the #SpaceX project that hurled chunks of concrete shrapnel into a protected habitat full of endangered shorebirds because #Elon didn’t think the #launchpad for the most powerful rocket in history needed standard noise- and fire-suppression systems DID NOT have to complete an #EIS (Environmental Impact Statement) under #NEPA.
https://open.substack.com/pub/esghound
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"The European Parliament approved a landmark deforestation law on Wednesday to ban imports into the EU of coffee, beef, soy and other commodities if they are linked to the destruction of the world's forests."
https://www.reuters.com/markets/europe/eu-
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Elon/Twitter:
GOP:
The movement to strip child labor law protections can be traced to one group
The conservative campaign to rewrite child labor laws
The Foundation for Government Accountability, a Florida-based think tank and lobbying group, drafted state legislation to strip child workplace protections, emails show
https://www.washingtonpost.com/business/20
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Black voting rights under threat in GOP supermajority states, lawmakers say
Black politicians and activists in the South say the Tennessee expulsions are just the tip of the iceberg in a region where White Republicans dominate state politics.
https://www.washingtonpost.com/nation/2023/04/28/southern-republicans-black-democrats-tennessee/
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ERA extension fails to pass d/t GOP:
The resolution would have voided the 1982 deadline for ratification and accepted three ratifications of the Equal Rights Amendment done between 2017 and 2020, putting the amendment into law. https://t.co/79Bw7stvyQ
Guns:
Colorado governor signs four gun bills into law in a historic change to the state’s firearm regulations
The bills expand the state’s red flag law, raise the minimum age to purchase guns, impose a three-day waiting period for firearm purchases and make it easier to sue the gun industry.
https://coloradosun.com/2023/04/28/col
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LGBTQ:
See hateful Montana
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New FOX News Poll shows that a huge majority of people view "families with transgender children being targets of political attacks" as a major problem.
— Erin Reed (@ErinInTheMorn) April 27, 2023
Only 15% of people say it's not a problem.
And this is a FOX NEWS poll!
Y'all, anti-trans politics are NOT popular. pic.twitter.com/RSJDVkxOw7
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Despite son's pleas, Governor Gianforte vetoes this bill to allow transition care.. Son is a member of the LGBTQ community.
montanafreepress.org/2023/04/26/mon
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DOJ Joins Challenge to Tennessee Transgender Youth Healthcare Ban
https://www.medpagetoday.com/special-reports/features/104267?
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Arizona:
California:
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Kentucky:
Truly wild piece of information in the NYT about Missouri Republicans' attempts to raise the standards on ballot measures in order to stop voters from restoring abortion rightshttps://t.co/4iRjLvsVqG pic.twitter.com/aSImRqMMtE
— Jessica Valenti (@JessicaValenti) April 24, 2023
Montana:
These votes were 10 days apart.
North Dakota GOP:
•Voted NO on free school lunches for hungry kids
•Then Voted YES on free breakfast, lunch, & dinner for themselves
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Pennsylvania:
Pennsylvania set to ban supervised drug use sites, in setback for harm reduction
Many politicians are wary of the controversy that accompanies supervised consumption, and the Pennsylvania law may represent an attempt to avoid a ballot-box liability in 2024,
https://www.statnews.com/2023/04/28/addiction-supervised-sites-pennsylvania-ban/?
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South Carolina:
see abortion, above
Texas:
Texas state agency orders workers to dress ‘consistent to their biological gender’
theguardian.com/us-news/2023/a
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bipartisan passage of Senate Bill 18, Eliminating Tenure at General Academic Institutions, by Sen. @CreightonForTX, R-Conroe:
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See Texas shooting under guns, above.
A Texas man firing an AR-15 in his front yard killed five people in a neighboring home after they asked him to stop shooting because a baby was sleeping.
There is no background check or safety training required to buy and own a long gun - like an AR-15 - in Texas. And the open carry of long guns in Texas does not require a background check, permit or training - there’s not even an age limit.
Two of the victims were killed while shielding children and he shot and killed an 8 year old. Republicans in Texas will let you nearly die before you can have an abortion because they’re “pro-life”, but just about anyone can buy an AR-15.
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Hungary:
Feel good du jour:
W. Kamau Bell created a powerful documentary called “1000% Me: Growing Up Mixed.” It's not just a documentary, it’s a powerful tool to help children around the world understand and celebrate their multiracial identities.
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A Michigan 7th grader Dillon Reeves pulled off the heroic act of stopping a school bus carrying around 66 students after his bus driver lost consciousness at the wheel
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Three years ago, Jon and Erin carpenter took a road trip and saw how important laundromats were in local communities.
— Goodable (@Goodable) April 25, 2023
They eventually bought a run down one, renovated it, and turned it into a community hub.
Today, it has picnic tables, a play area, and free laundry days. pic.twitter.com/iA4NMjcfhx
Comic relief:
Not even remotely sorry. pic.twitter.com/jDGyTj3Hkh
— Paul Bronks (@SlenderSherbet) April 28, 2023
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The Oscar goes to.... pic.twitter.com/FkjEvvXtrJ
— The Best (@Figensport) April 23, 2023
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https://twitter.com/buitengebieden/status/1652430869443821568?s=20
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Perspective/Poem
‘I did all that I could’: the tireless activism of Harry Belafonte