Coronavirus Tidbits #244, May 7, 2023

May 6, 2023 /

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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.

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:

The Buzz On Preventing Insect Bites: How To Repel Ticks And Mosquitoes

https://www.forbes.com/sites/judystone/2023/05/06/the-buzz-on-preventing-insect-bites-how-to-repel-ticks-and-mosquitoes/?sh=787eb92f4d58

 

News 

Daily Update for the United States

New Cases (Weekly Total)    New Deaths (Weekly Total)    New Hospitalizations

88,330 (12,619/day)                1,052 (150/day)                         1,402

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WHO Ends public health emergency

Tedros declared "Covid-19 over as a global health emergency" though the pandemic is not over. "WHO recorded 2.8 million new cases globally, and more than 17,000 deaths, from April 3 to 30, the most recent numbers available. As many countries have reduced their testing for Covid, these numbers also probably represent a significant undercount."

https://www.nytimes.com/2023/05/05/health/covid-who-emergency-end.html

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CDC scales back testing

CDC will cease tracking community levels of Covid and the percentage of tests that come back positive, a metric used to calculate transmission rates,

They will cont to count hospitalizations, but not demographics. The data the C.D.C. still plans to collect will not provide enough actionable information at the state and local level, said Sam Scarpino, a public health expert at Northeastern University.

https://www.nytimes.com/2023/05/05/health/cdc-covid-tracking.html

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Dr. Rochelle Walensky is retiring as head of CDC in June

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Many hospitals, UPMC and Hopkins among them, eliminate mask mandates within the hospitals.

This puts vulnerable patients at risk...the hospitals don't care. They responded that patients can request that staff mask around them. (leaving a vulnerable patient to alienate the staff taking care of them).

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The White House announced that it will end COVID-19 vaccine requirements for federal employees and international air travelers on May 11, the same day the public health and national emergencies for the pandemic are scheduled to end.

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May 11, CMS will no longer provide blanket coverage for the cost of over-the-counter COVID-19 tests, the agency said. Those enrolled in Medicare Part B will continue to have coverage with no out-of-pocket expenses for appropriate lab-based COVID-19 PCR and antigen tests, however, when a healthcare provider orders these tests.

Those enrolled in Medicaid or the Children's Health Insurance Program will continue to have access to COVID-19 over-the-counter and lab testing through the end of September, CMS said. After then, coverage may vary by state.

Private insurance plans, CMS noted, are not required by federal law to cover COVID-19 testing after May 11.

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@DrJudyStone   Apr 30
If you don’t take a temperature, you won’t find a fever @CDCgov @CDCDirector #COVID19 twitter.com/luckytran/stat
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US Causes of death - COVID the 4th-leading cause of death

COVID-19, the third leading cause of death in 2021, fell to fourth place in 2022, after heart disease, cancer, and unintentional injury (largely overdoses).

The age-adjusted rate of heart disease deaths increased for the third straight year since 2020.

https://www.precisionvaccinations.com/covid-19-related-fatalities-fall

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A new CDC report found that although the all-cause death rate dropped by 5.3% between 2021 and 2022, COVID remained the fourth-leading cause of death — underlying cause of 186,702 deaths and a contributing factor in another 58,284. washingtonpost.com/health/2023/05

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There's been a great deal of outrage and anxiety among the #LongCovid patients, in particular, about the removal of mask mandates in healthcare settings. On top of being worried about getting a new Covid infection, some physicians have been mocking the patients. There is a move to have letters written to their universities.

 

@NohaAboelataMD
Patients who participate in clinical trials make sacrifices for the greater good and are owed a debt of gratitude. Researchers making clear to patients that they have no intention of preventing they very condition they are studying is peak disrespect.
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Stanford Was Conducting a Long COVID Study. Then the Staff Stopped Masking.

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Rise in healthcare-associated infections during COVID

the average standard infection ratios for central line-associated bloodstream infections (CLABSIs), methicillin-resistant Staphylococcus aureus (MRSA) infections, and catheter-associated urinary tract infections (CAUTIs) rose by 60%, 37%, and 19%, respectively, compared with the period immediately before the pandemic. Thirty-two of 50 states saw significant increases in CLABSIs, 18 in MRSA infections, and 11 in CAUTIs....evidence that the pandemic's impact on hospital staffing and resources has impeded infection prevention and control efforts.

https://www.cidrap.umn.edu/healthcare-associated-infections/new-hospital-data-highlight-rise-healthcare-associated-infections

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@theodorepak   April 30   on Covid testing new hospital admissions

Many US hospitals have or will soon stop testing all admitted patients for COVID-19, per recent @SHEA_Epi recs In this op-ed, Chanu Rhee & Mike Klompas

@bwh_id, Julia Koehler @BostonChildrens, and I give seven arguments why testing should continue
1. Hospital-acquired COVID-19 remains common but under-reported and under-appreciated. Earlier studies found that ~15% of admitted patients with COVID-19 acquired it in hospitals. And Omicron has associated with an uptrend in hospital-onset cases.

     40,600 people likely caught Covid while hospital inpatients in England

     One in seven patients treated for Covid between 1 August 2020 and 21 March got       it while in hospital

     https://www.theguardian.com/society/2021/mar/26/40600-people-likely-caught-covid-while-hospital-inpatients-in-england

2. Presymptomatic and asymptomatic patients pose the highest risk. Viral loads are highest just before symptoms (if any) start. So most transmissions are from people without symptoms. If you don't screen all admissions, you'll never catch it in time.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774707

3. Transmission risk in shared patient rooms is high. The transmission rate from a patient with undiagnosed COVID-19 to an uninfected patient in the same room is 20-40%. Most US hospitals have lots of shared rooms. Patients don't pick their roommates.

https://academic.oup.com/cid/article/74/6/1097/6305137?login=false

4. Hospital-acquired COVID-19 still causes substantial morbidity and mortality. In vulnerable inpatients, Omicron is far from "mild." Crude mortality rates are 3-13%. We take huge measures to stop nosocomial infxns (MRSA, Cdiff) with much lower M&M... phw.nhs.wales/services-and-t

5. More testing is associated with fewer nosocomial cases and better outcomes. When England and Scotland stopped universal admission testing in Aug-Sep 2022, hospital-onset cases rose significantly compared to community-onset infections.

https://www.healio.com/news/infectious-disease/20230413/sarscov2-surged-in-hospitals-after-end-of-universal-screening

6. Potential downsides of asymptomatic testing are real, but can be mitigated. The cost ($55/patient in 1 study) is minimal compared to 1 inpatient-day ($3-10k) False positives occur, but retesting and d/c'ing precautions can be automated (as @MassGenBrigham  has done for years)

7. Hospitals have an ethical responsibility to protect patients from COVID-19. Forcing all patients to accept ↑risk of COVID-19 when they enter hospitals, for minimal benefit ($55?) violates non-maleficence and beneficence.

As COVID-19 has disproportionately harmed Black, Latinx, and Native American populations in the US, and continues to pose ↑risk to elderly, immunocompromised, and disabled people... Prematurely ending COVID-19 precautions will worsen systematic healthcare inequity in the US.

Side note: Universal masking in hospitals is also under fire, so invoking other protective layers as a reason to end admission testing is increasingly credulous. Ending masking & testing is like steering toward the icebergs AND shutting your eyes

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What really killed COVID-19 patients: It wasn't a cytokine storm, suggests study

Secondary bacterial infection of the lung (pneumonia) was extremely common in patients with COVID-19, affecting almost half the patients who required support from mechanical ventilation. By applying machine learning to medical record data, scientists at Northwestern University Feinberg School of Medicine found that secondary bacterial pneumonia that does not resolve was a key driver of death in patients with COVID-19. It may even exceed death rates from the viral infection itself.

https://medicalxpress.com/news/2023-05-covid-patients-wasnt-cytokine-storm.html?

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"There’s a roughly 20 percent chance during the next two years of an outbreak rivaling the onslaught of illness inflicted by the omicron variant."

washingtonpost.com/health/2023/05 w/

@SolidEvidence  @trvb @BarouchLab  and @EricTopol

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Other:

West Nile Virus is Endemic in Phoenix

West Nile is endemic now in Phoenix In 2021, Maricopa County, which includes the city of Phoenix, reported 1,487 WNV cases, 1,014 hospitalizations, and 101 (7%) deaths. This unfortunate data compared with only 3 #WNV cases in 2020.

https://www.precisionvaccinations.com/west-nile-virus-endemic-phoenix

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FDA approves nation's first RSV vaccine for people 60 and older

RSV is a highly contagious virus that infects the lungs and airways of people of all age-groups. RSV usually begins circulating in fall, peaking in winter. RSV is a common cause of lower respiratory tract disease (LRTD), which can cause life-threatening pneumonia and swelling of the small airways.

94.1% reduction in risk of severe illness

The vaccine, made by GlaxoSmithKline and sold under the brand name Arexvy, was approved on the basis of data from an ongoing randomized, controlled trial conducted among this age-group in in the United States and abroad showing its efficacy and safety. The approval follows the March 1 recommendation from the FDA's vaccine advisory group, which has also recommended Pfizer's RSV vaccine for the same age-group.

So far in the study, about 12,500 participants have received Arexvy, and 12,500 have received a placebo. Among all participants, the vaccine reduced the risk of RSV-related LRTD by 82.6% and lowered the risk of severe LRTD by 94.1%, the announcement said. The most common adverse effects among Arexvy recipients were injection-site pain, fatigue, muscle pain, headache, and joint stiffness and pain.

In another study, which involved concomitant administration of Arexvy and an FDA-approved flu vaccine, two participants developed acute disseminated encephalomyelitis, a rare type of inflammation of the brain and spinal cord, and one died. In a separate study, one participant developed Guillain-Barré syndrome (a rare disorder in which the body’s immune system damages nerve cells) 9 days after receiving Arexvy.

https://www.cidrap.umn.edu/respiratory-syncytial-virus-rsv/fda-approves-nations-first-rsv-vaccine-people-60-and-older

 

Diagnostics:

still an incredible, negligent last of testing.

Drugs:

@Dakota_150   Jan 6
"Could low-dose lithium treat long COVID? UB launches clinical trial to find out" 'Lithium has anti-inflammatory and neuroprotective effects' buffalo.edu/news/releases/

Devices:

Epidemiology/Infection control:

https://twitter.com/maolesen/status/1654324613004787713?s=20

The light green is total inpatient beds occupied, the dark green are those occupied due to COVID. The red line is HAI COVID (I used a 28-day moving av4rage to dampen the noise). HAI COVID numbers are on the right Y-axis.

We would expect to see higher amounts of COVID spread in the hospital during surges, and we have consistently seen that in the past. However, now HAI COVID is at the highest level since the start of the pandemic, even though COVID beds are in about the fourth lowest valley.

We MUST get mandatory respiratory protection back in healthcare settings. This is a disservice to patients, staff, and visitors. Worse, the CDC making the move to make tracking HAI optional is almost criminal. I don't know how they can justify doing so when the data is clear.

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Nearly half of HCWs with COVID-19 worked despite symptoms

“We saw quite a few health care workers (HCWs) come to work knowing they had COVID-19 symptoms,” Katherine LinsenmeyerMD, attending physician at Veterans’ Affairs Boston Healthcare System and assistant professor of medicine at Boston University, told Healio. “These HCWs both knew that COVID-19 was very transmissible and had paid leave available, so we wanted to understand why they continued to work.”

https://www.healio.com/news/infectious-disease/20230501/nearly-half-of-hcws-with-covid19-worked-despite-symptoms

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@loscharlos   May 3
Study from @MichaelPelusoMD at @UCSF “We observed #LongCovid symptoms, such as fatigue & neurocognitive dysfunction.. were independently associated with serological evidence suggesting recent EBV reactivation”
“Interestingly, participants who had serologic evidence of prior CMV infection were less likely to develop neurocognitive #LongCovid”
“Overall, these findings suggest differential effects of chronic viral coinfections on the likelihood of developing #LongCovid and association with distinct syndromic patterns. Further assessment during the acute phase of COVID-19 is warranted.”
pubmed.ncbi.nlm.nih.gov/36454631/
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@fitterhappierAJ   May 1
A while back many people who did not know what they were talking about spoke out of turn and claimed Covid did not increase susceptibility to fungal infection from immune harm The CDC now disagrees with them
cdc.gov/fungal/covid-f
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@drclairetaylor   May 1
Dr. Rae Duncan details that prior to the pandemic the average age of referrals to her cardiology clinic was aged 55-80yrs. Now it is 16-40yrs Now at least 50% are long Covid with cardiovascular symptoms.
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@DGBassani
Image
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@HarrySpoelstra
Bad news for many paediatricians and fake-experts: CHILDREN represent a major transmission vector, yesterday, today and tomorrow! "Children infected from diverse pediatric facilities can be a major source of widespread household transmission with the potential to facilitate community transmission in the era of omicron variant" Park E, et al. Widespread Household Transmission of SARS-CoV-... Yonsei Med J. 2023 May;64(5):344-348. doi.org/10.3349/ymj.20
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@CovidPledge   Apr 29
including those not directly providing patient care. This study early on in the pandemic showed that housekeeping staff in a Birmingham hospital had the same rates of infection as clinical staff. Universal masking should apply to all HCWs thorax.bmj.com/content/75/12/

Tips, general reading for public:

Ventilate.

Mask.

Vax.

Politics:

Covid:

@AstroKatie   Apr 29
I’m not sure how widely this is understood. It’s not that the chance of getting sick is actually low now, it’s that our leaders have decided that it’s time for us to just be cool with getting sick a lot now, and we’re all being socially pressured to act like it’s weird not to be. twitter.com/tryangregory/s… (On UK sees record sickness and zero productivity growth in 2022)
I wear a mask a lot because I don’t want to get sick and it breaks my brain to be constantly treated like that’s somehow pathological.

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@gregggonsalves   May 2
I think someone has to do a deep dive into @SHEA_Epi and its role in rolling back infection control in hospitals during a pandemic. Question for me: does @SHEA_Epi represent hospitals’ or patients’ interests? It’s the obvious, hidden in plain sight COI here. twitter.com/lakshmi_rkg/st

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@EpiEllie   May 1
The reason the role of children in this pandemic was ever questioned was that some very very rich people paid a lot of money to make us think that was true. Why? They valued the “economy” over the safety of you and your community. twitter.com/DGBassani/stat…
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Abortion/Reproduction:

@AP   May 1
A first-of-its-kind federal investigation has found two hospitals put a pregnant woman's life in jeopardy and violated federal law by refusing to provide an emergency abortion when she experienced premature labor at 17 weeks.
apnews.com/article/emerge
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Scotus: 

@DavidCayJ   May 1
Another SCOTUS scandal, per @LeverNews. Justice Clarence Thomas voted to end federal tenant protections that his billionaire benefactor Harlan Crow’s company says threatened its real estate profit margins. And another case is coming soon!
levernews.com/thomas-helped-
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@SawyerHackett   May 4
Clarence Thomas disclosed $1,200 in free car tires he received in 2002. But he didn’t disclose: - half a million dollar vacations - trips on private jets, yachts - a billionaire buying his mother’s home - $150,000 in tuition payments for his adoptive son
propublica.org/article/claren
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Conservative judicial activist Leonard Leo arranged Ginni Thomas to be paid ~$100k, "specifying that her name be left off billing paperwork.” Also in 2012,  the nonprofit, the Judicial Education Project, filed a brief to the Supreme Court in a landmark voting rights case.
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@4TaxFairness   May 1
Harlan Crow and his family's average yearly political contributions went up 862% after Citizens United was decided in 2010. Who provided a deciding vote for that case? Justice Clarence Thomas, a "family friend" they showered with luxury travel and gifts for 20+ years.
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@NoLieWithBTC   May 1
Oh wow. Clarence Thomas voted to end the federal tenant protections that his undisclosed billionaire benefactor Harlan Crow’s company says threatened its real estate profit margins. (@LeverNews) levernews.com/thomas-helped-
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Justice Roberts' Wife got $10.3 million from large law firms.
LGBT:
See Montana
@lance_cotten   May 1
That moment Taylor Swift Tells her dad she’s not staying quiet anymore! “@MarshaBlackburn is wrong and doesn’t stand for Christian values and Tennessee people” She is finally going to ignite her base! Listen till the end
Priorities:
@Public_Citizen   April 28  sipri.org/news/2023/worl
Military Spending:
China: $292B
Russia: $86.4B
India: $81.4B
Saudi Arabia: $75B
UK: $68.5B
Germany: $52.8B
France: $53.6B
S. Korea: $46.4B
Japan: $46B
Ukraine: $44B _____________________________ = TOTAL: $846,100,000,000 ***
US military: $877,000,000,000
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Greed:
@MorePerfectUS   May 1
Starbucks founder Howard Schultz had a meltdown when questioned by the Senate about union-busting. Then he sought revenge. Multiple workers were fired, including the founder of @SBWorkersUnited. The company also disciplined workers who dared to speak to Schultz in public.
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Guns:
Image
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Florida: 

@MerylKornfield   May 1
Charges from DeSantis’s election police have stumbled in court. But the consequences are felt: One man who was arrested lost his job and health insurance. His adult child has decided not to vote. Via @lori_rozsa
washingtonpost.com/nation/2023/04
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@MeachamDr   Apr 30
Holy shit! DeSantis wore a campaign-branded kippah at the Western Wall. Could he be more shameless?
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Montana:
@ErinInTheMorn
Oh my god. Remember the women who took up the bench yesterday so that Rep Zephyr would not have any seat outside the chamber? I am being told that the woman closest to the camera in blue pants is Speaker Regier's mother.
twitter.com/WinterForMT/st
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@ZoAndBehold   May 2
Someone just attempted to SWAT me as well (as her girlfriend). I am fine. An individual reported an anonymous tip targeting my home in Missoula, and the police recognized that it was likely a hoax and called me. I will say again. We will not be deterred. The fight for trans rights goes on. twitter.com/ZoAndBehold/st
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@ZoAndBehold   May 1  ACLU is suing to reinstate Rep Zephyr's rights
I'm suing. The recent actions violate my 1st amendment rights, as well as the rights of my 11,000 constituents to representation. Montana's State House is the people’s House, not Speaker Regier’s, and I’m determined to defend the right of the people to have their voices heard.
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New York:

‘A budget is a moral document’: why does the #NYPD need $29m a day?

theguardian.com/artanddesign/2

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North Carolina:

@TheTinaVasquez   May 4
This is NC Rep. Tricia Cotham sharing her abortion story in 2015 (video) as a Dem who opposed abortion restrictions. Last month she switched parties, giving the GOP a veto-proof supermajority to introduce anti-abortion bills. Last night Cotham voted in favor of NC's 12-week abortion ban. 
twitter.com/BryanRAnderson
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Texas:

@BFriedmanDC   Apr 30
As decent people across America condemn Abbott's appalling description of massacre victims as "illegal immigrants," it's worth remembering the Dallas Morning News editorial board endorsed him against the wishes of the vast majority of Dallas residents. twitter.com/GregAbbott_TX/
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#Texas guts ‘woke civics’. Now kids can’t engage in a key democratic process by outlawing all assignments involving “direct communication” between students and their federal, state or local officials
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@NoLieWithBTC   May 2
Whoa. Texas Republicans just voted give a GOP appointee the power to singe-handedly CANCEL election results in the state’s largest Democratic county. The new rule only applies to Harris County, which is one of the fastest-trending blue counties in the US. houstonchronicle.com/politics/texas
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@NoLieWithBTC   May 2
Republicans nationwide are now pushing to repeal no-fault divorce laws, which allow women to walk away from an unhappy marriage without having to prove abuse, infidelity, or other misconduct in court. The Texas GOP just added it to their platform. rollingstone.com/politics/polit
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@boltsmag   May 2
JUST IN: The Texas Senate passed a bill today that'd let sheriffs investigate themselves for deaths under their custody. It would roll back key provisions of the Sandra Bland Act, which brought more transparency into jails. Bolts covered it last month: boltsmag.org/texas-bill-jai
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@jamestalarico   May 3
Texas Republicans are trying to force public schools to display the Ten Commandments in every classroom. I told the bill author: “This bill is not only un-constitutional and un-American, it’s deeply un-Christian.” #txlege
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@TheBloggess   May 1
In case you're wondering how things are going in Texas, our district canceled all sex ed classes this year but is now required to offer kids training in bleeding control techniques, including "tourniquets approved for use in battlefield trauma care by the armed forces."
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@RachelBitecofer   Apr 30
They fled Honduras only to get executed by a neighbor in Texas. Think about that.
Ukraine:

Feel good du jour:

@KVOA   Apr 30
Diner provides free meals: According to the restaurant owner, the 'Everybody Eats' meal consists of two eggs cooked however the customer likes it and a side of home fries and toast. kvoa.com/diner-provides
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https://twitter.com/DrZedZha/status/1652646231401701378?s=20

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The Monster Pho restaurant owner shares what many get wrong about refugees and how his background has fueled his passion to help others in need.

huffpost.com/entry/tee-tran? 

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https://twitter.com/buitengebieden/status/1653788016832389124?s=20

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Tiny dolls appeared in mailbox with a note: ‘We’ve decided to live here’

washingtonpost.com/lifestyle/2023

Comic relief:

@craigtimes   May 2
Oh, #Florida! Man pulled over for erratic driving turned out to be arguing with his parrot. Driver wanted to go to the beach, but the parrot wanted to go home. patch.com/florida/clearw via @dannlwhite
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Perspective/Poem

Quote of the day: “If you hold onto anger, you’re just going to swap one prison for another,” Lamar Johnson, on his 28-year wrongful imprisonment.

washingtonpost.com/lifestyle/2023 #anger #forgiveness #injustice.

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@NobelPrize   May 3
On World Press Freedom Day we speak to @RanaAyyub, Indian investigative journalist, and speaker at this year’s #NobelPrizeSummit, on what journalists and media owners can do to help restore trust in news. Read the interview and register for the event: bit.ly/44mBs9H
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Ukraine:
@AleksandrX13   May 2
Two professors that my cousin Sasha studied under in university have been killed in combat in Bakhmut. These are irredeemable losses. That academics should voluntarily choose to go into combat to save a nation is the greatest of tragedies. 
How are we to replace such men - not in war, but in peace?
These men could have changed so many young lives, brightened so many futures. Instead of brightening the light, they had to give their lives to hold back the darkness.
It is unfortunate, indeed, that the most educated are often the most idealistic - yet the loss of them is something that will be deeply felt when the war is done, and there remains a nation yet to be built. Ukraine is now fighting its way out of the sphere of russian oppression, but when that fight is done, it will still have to forge itself into the nation it chooses to become. When we lose educators, we are losing 'warriors of the light' who would help in that future battle to take our entire nation into a future of light and civilization.

Bits of beauty:

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