<p>goaliedad, please post how it went when the flu is over. I’m glad you got tamiflu so quickly. Good luck!</p>
<p>2009-11-10
225 Variance Examination in the Ukraine
The delay in sequence publication from the Ukraine flashfire gives us pause, but also allows an opportunity to examine an item that we notably excluded from our expectation set for Eastern Europe.</p>
<p>Cases of hemorrhagic pneumonia are reported across the region and that clinical presentation requires discussion, further data collection and sequence evaluation. The prominent Pandemic Influenza expert, Dr. Henry Niman, has estimated that the exceptional lung involvement may suggest an RBD revision of D225N. Many of you will recall Dr. Niman’s background in tracking Influenza recombination and his astute prediction of RBD revision G228S in H5N1 during the mid-stage of Avian Influenza’s emergence. His independent analysis using a formidable database and proven hueristics arriving at D225N provides a backdrop for us to surface our thinking concerning protein 225. </p>
<p>Viral behaviour is certainly mediated by a substantially large group of factors that may be at work in the Ukraine today. Relatively cold winter temperatures, inadequate winter nutrition and, most importantly, the average person’s increase in Multiplicity of Exposure during October from a virus simmering since late August in the Ukraine may be interacting in a synergy to affect the equivalency of a strong RBD acquisition such as the Swine D225N. This cultural, political, environmental and microbiological interplay is well able to create the appearance of a deeper genetic change than has actually occurred. Like Dr. Niman, we note the strong lung involvement and search for the causality. The essential cause of that feature is held at question today and, for us, will remain at question.</p>
<p>An RBD SNP is the most plausible explanation; however, a co-variance alone at any one of several proteins from HA 186 to 192, including 190N, may also generate parity to the clinical and epidemiological picture in the Ukraine. A confounding factor in our equation concerning D225N is the confidence level on the death statistics. Although little clinical evidence exists correlating or suggesting causality for individual Influenza Flux revisions, in our reverse heuristics, the death count would be greater if 225N were even moderately implicated. We know that this facet of the statistics, deaths, cannot be fairly evaluated at this time. 174 Deaths from 50K Hospitalisations is either an aberration or a fabrication. </p>
<p>Time may provide the answer. All expository models work in varying degrees when given imprecise inputs. For our models, the death statistics are integral to the logic engine concerning RBD and Cleavage Area revisions. Though multiple backgrounds are certainly available to accept 225N in the Ukraine having patterns reminiscient of Brasil and Argentina, the complement of factors required for our research team is incomplete. Solid outputs may not be inferred in this region of the world, so we have determined to wait on noting a high potential for 225N until the data points are available under a higher confidence. Should 225N be announced before the death statistics are validated, we will applaud Dr. Niman again for his stellar prescience. </p>
<p>Tuning a model to the observed evidence is the hallmark of science. Measuring what we do know is fine, but aggresively excluding what we don’t know will velocitise our outcomes. The truth is in the sequences. </p>
<p>May we look at some please?
Posted by NS1 at 11:09
Labels: 225N, D225N
2009-11-09
225E Expectation in the Ukraine
PF11 SNP geographic analysis suggests that the Ukraine cases in the next two weeks may show a very similar genetic pattern to South America in August and the Mediterranean and Adriatic FlightPath in the past 8 weeks. </p>
<p>If the trend toward a higher infectivity of medical personnel continues as reported today of 687 doctors and 1,500 young specialists being ill, we would expect a higher death count in the coming days. Between 0.5% and 1.3% of all doctors in the country are ill (by region). Higher transmissibility is certain.</p>
<p>If a database of 100 sequences were to exist on the Ukraine, accurately cataloging a cross-reference of regions over 14 days of recent death and recovery cases, including major cities, rough expectations would indicate:</p>
<p>HA</p>
<p>225E
in moderate concentration (95% probability) with 206T</p>
<p>206T/225E/300S triplet
potential for introduction (1 sequence) (75% probability)</p>
<p>2E/206T/225E/298V quad combo
potential for appearance in very low count (1 to 2 sequences) (>25% probability)</p>
<p>2E/206T/225G/298V quad combo
potential for introduction (1 sequence) (<10% probability)</p>
<p>225G
potential, but certainly not widespread under current clinical reports (75% probability) with 206T</p>
<p>2E/206S/296H triplet
in low concentration (95% probability)</p>
<p>377K
potential for introduction (1 sequence) (25% probability)</p>
<p>270T
potential for introduction (1 sequence) (7% probability)</p>
<p>261V
potential for appearance in very low count (1 to 3 sequences) (>25% probability)</p>
<p>212 movement
potential for introduction (1 sequence) (7% probability)</p>
<p>208K
potential for introduction (1 sequence) (33% probability)</p>
<p>188/189/190 movement
potential for introduction (1 sequence) (>50% probability)</p>
<p>158E
potential for appearance in very low count (1 to 3 sequences) (>25% probability)</p>
<p>100N
potential for introduction (1 sequence) (>25% probability)</p>
<p>35I
potential for appearance in moderate count (<20% probability)</p>
<p>NA</p>
<p>106I, 248N pairing
potential in very low count (<20% probability)</p>
<p>106I, 248N, 286G triplet
potential for introduction (7% probability until the 8th week of the flashfire)
Posted by NS1 at 04:58
Labels: 100N, 106I, 158E, 189T, 208K, 225E, 225G, 248N, 261V, 270T, 296H, 298V, 35I, 377K, NA Dual Combination, NA Triple Combination</p>
<p>[Pandemic</a> Influenza H1N1 Genetic Acquisitions](<a href=“http://pf11.blogspot.com/]Pandemic”>http://pf11.blogspot.com/)</p>
<p>And in the Balkans:</p>
<p>Swine Flue Catches Up With Balkans
Belgrade, Bucharest, Sarajevo, Skopje, Pristina, Tirana | 10 November 2009 | Bojana Barlovac</p>
<p>Autumn brings swine flu to Balkans Countries in the Balkans are bracing themselves for a sharp increase in A/H1N1 influenza cases.</p>
<p>Governments have begun to close schools, limit access to hospitals, and are advising citizens to avoid crowds, in an attempt to curb the spread of the disease.</p>
<p>While Bulgaria appears to be the country that is hardest hit in the region, health ministries in all countries are preparing for a wider outbreak, as the World Health Organisation warns that the virus will spread quickly in the coming months.</p>
<p>They are waiting for purchased vaccines to arrive, and some have ordered additional subsequent doses. In the meantime, they are advising people to maintain personal hygiene, while some people are buying protective masks.</p>
<p>Health officials warn that there is no need for panic but stress that the situation should be taken seriously.</p>
<p>Below is a summary of how the disease is spreading, and what preparations each Balkan country has taken.</p>
<p>BULGARIA</p>
<p>Bulgaria appears to be the country that is the hardest hit in the region so far. The country’s health ministry on Friday declared a nation-wide epidemic as the number of swine flu cases reached an estimated 210 per 10,000 of the population.</p>
<p>The country’s Health Minister Bozhidar Nanev on Thursday announced that his ministry believes that a little over 100,000 Bulgarians have contracted the virus. Bulgaria’s Chief Epidemiologist, Angel Kunchev, on Monday said that 150,000 people are most likely currently ill.</p>
<p>Over 450 laboratory-confirmed cases of swine flu have been registered so far. The virus has claimed eight fatalities.</p>
<p>All schools in the country are closed for an emergency break until 16 November. Cinemas, theatres and other public areas remain open, but people have been advised to avoid crowds.</p>
<p>The government has been caught off guard by the pandemic, and has requested the urgent delivery of 200,000 anti-viral drugs from the EU. It has also called on pharmaceutical companies to help. The current government, in office for just over 100 days, has blamed the previous government for not adequately planning ahead.</p>
<p>SERBIA</p>
<p>The country has registered 254 cases of the A/H1N1 swine flu influenza so far and 11 fatalities. The Serbian government has provided additional funds to purchase three million doses of vaccine against the infection. Health Minister Tomica Milosavljevic announced last Friday that vaccination against the disease will begin in mid-December.</p>
<p>Vaccination will initially target priority groups including children, people with chronic conditions, pregnant women and health and public employees.</p>
<p>“My recommendation is that all the people receive the vaccine, because the benefit is much greater than the potential damage. The duration of the vaccine is 18 months, so that vaccination will be continued until all who wish to be inoculated have received the vaccine,” broadcaster RTS quoted Milosavljevic as saying.</p>
<p>The government has extended the school autumn break until 16 November, noting that it does not rule out the possibility of schools being closed for a longer period.</p>
<p>The number of children in Belgrade’s kindergartens has drastically fallen. “Some one third of the kids are missing today but we are taking strong hygiene measures and are following the children’s health,” Kaca Tosovic from the kindergarten Pitagora told Balkan Insight.</p>
<p>The head of the government’s working group for following the epidemic, Predrag Kon, announced on Monday that several municipalities have announced an epidemic, but a nationwide epidemic will only be announced if and when the virus spreads across the capital.</p>
<p>Serbia’s market is running out of protective face masks. Pharmacies in the town of Kragujevac, where the first fatality was registered, reportedly have run out of masks, as they were selling more than 3,000 pieces a day.</p>
<p>Mirko Kovacevic from the company for making the masks, ‘Septembar 9’ from the town of Gornji Milanovac, says that the company operates in two shifts per day and produces between 55,000 and 60,000 masks. Production of protective masks will soon be doubled, he said.</p>
<p>ROMANIA</p>
<p>A further 14 new swine flu cases were reported in past 24 hours. The total amount of the infected has reached 797 with no fatalities, the Health Ministry says.</p>
<p>The government has suspended teaching for seven days at a couple of schools where the virus was registered.</p>
<p>The country’s Health State Secretary Adrian Streinu-Cercel said on 1 November that 20,000 people could die of swine flu in the country. However, he was forced to resign from his post the next day for making the statement, which the government called inappropriate. A presidential adviser told broadcaster Realitatea that Streinu-Cercel “should no longer appear in public, because he causes panic”.</p>
<p>CROATIA</p>
<p>As many as 1,509 people have been infected with swine flu in Croatia, most in the capital of Zagreb, health officials estimate. An estimated 140 have been infected with the virus in Split where the first fatal outcome occurred.</p>
<p>The country registered its first swine flu fatality on last week in a 61-year-old man from the town of Split. The man was hospitalized on 21 October with high fever, pneumonia and kidney failures. Since then a second person has died.</p>
<p>One private high school has been closed after 60 of the 160 students fell ill. Health Minister Darko Milinovic said on Monday the disease has not reached epidemic proportions.</p>
<p>Epidemiologist Mladen Smoljanovic expects that between 20 and 60 people will die of the virus. He added that his predictions are extrapolated by drawing on statistics on the disease from the southern hemisphere.</p>
<p>MACEDONIA</p>
<p>Health officials say there were 40 newly registered cases over the weekend, raising the estimated total number reported to have been infected so far to 100.</p>
<p>Though there are no fatalities, several infected show heavier symptoms of the disease.</p>
<p>The authorities are urging people to be cautious, avoid public gatherings and maintain personal hygiene. The hospitals are advised to restrict outside visits.</p>
<p>The Ministry of Health says that there are enough supplies of the Tamiflu medicine. The Ministry has ordered some 800,000 vaccines against the flu and hopes that they will arrive in the country by the end of this month.</p>
<p>MONTENEGRO</p>
<p>The number of reported cases has reached 33. The latest cases have been reported in the coastal town of Herceg Novi, from where several have been taken to the hospital in nearby Kotor.</p>
<p>The hospital has sufficient quantities of antiviral medicine Tamiflu and there are also enough places for isolation and intensive care, the daily Pobjeda reports.</p>
<p>The country’s health ministry banned hospital visits on Saturday. The ministry’s working group for combating the flu has stated that the country’s health facilities are ready for the expected wave of swine flu cases.</p>
<p>Montenegrin Health Minister Miodrag Radunovic announced two weeks ago that vaccines will arrive in Montenegro early next year. Radunovic recalled that the ministry’s working group has decided to provide 50,000 vaccines, that will be sufficient, he said.</p>
<p>BOSNIA AND HERZEGOVINA</p>
<p>The country’s health authorities have registered 57 cases of the A/H1N1 swine flu virus.</p>
<p>‘‘There were no difficult clinical cases in the Federation and the situation is under control,’’ Federal Minister of Health Safer Omerovic announced last week. He added that the government has already ordered 30,000 vaccines against swine flu, which should be available by the year’s end. An additional 150,000 doses were ordered on Wednesday.</p>
<p>Omerovic added that there is no room for a panic. He called on citizens to maintain personal hygiene and avoid large gatherings.</p>
<p>KOSOVO</p>
<p>Four people are confirmed to have contracted the virus and are in hospital in northern Mitrovica, in serious condition, QIK news agency reported on Monday.</p>
<p>The hospital Director, Milan Jakovljevic, told media that 329 patients appeared with clinical signs of flu during the weekend. The biggest number of them is from Leposavic, Mitrovica, and Zvecan.</p>
<p>Kosovo’s Ministry of Health has transported 1,000 Tamiflu tablets to the clinic in nearby Gracanica.</p>
<p>The Institute of Public Health in Kosovo, IKSHP, has asked the ministry of education to order all schools to report on daily basis when pupils are missing, as this is the only way to follow up and verify whether any pupils have swine flu. The institute has also asked all schools to do additionally disinfect all surfaces and bathrooms</p>
<p>ALBANIA</p>
<p>Health officials have announced plans on Monday to vaccinate the public against the virus. Groups most at risk will be given priority including health care workers, patients with chronic conditions and pregnant women. The country’s first cases of swine flu were reported in July. </p>
<p><a href=“http://www.balkaninsight.com/en/main/news/23528/[/url]”>http://www.balkaninsight.com/en/main/news/23528/</a></p>
<p>Keylyme,
There is currently NO federal limitation on the Rx of Tamiflu. If your local doc does not give it to you when needed, you should approach a lawyer. As a doctor (and cochair of hospital infectious disease committee), I hate malpractice; but for gross mispractice as your docs are doing there is a place for them.</p>
<p>If your doc states that there need to be “special circumstances” for the Rx of it, they are totally wrong. This was true several years ago, but not now. You should DEMAND it.</p>
<p>^^I choose not to get Tamiflu. I would also never “DEMAND” anything; there is not generally the need to be overbearing. I am quite averse to threatening lawsuits as well.</p>
<p>I’d rather not fight about the merits of tamiflu, vaccines and the like. We all view the situation through different filters here.</p>
<p>In our case, I consulted the DW’s specialist first with regards to the effectiveness of tamiflu with DW’s condition before going to the Primary Care. Specialist’s office recommended it for me as well. When I asked whether I should be taking tamiflu as well, he told me not even to bother paying the co-pay for a visit and happily wrote out the script. </p>
<p>And our family experience with retro-virals (I believe this is how they classify tamiflu) has been postive as opposed to flu vaccines. Goaliegirl has has both the flumist (gave her the flu for 3 days, ugh!) and the vaccine (flu symptoms for 2 days, ugh!). It has been suggested to us that she has a very active immune system and that her illness from the vaccine is a sign of that. It is your immune system reaction that generally causes many of the side-effects of the flu. </p>
<p>The family had the experience of having the flu (they type that affects your ability to ingest liquids) together (my 1 and only time having the flu - and I always seem to be the caregiver for those who get it) about 10 years ago. Wiped the kids out for a week. Almost killed my DW(before the onset of her current immune system disorder), as I had to hospitalize her. They hung 4 bags before she would out-process any liquid. She was about ready to shut down. OTOH, I had it 5 days (M-F) and was able to work a full day on Tuesday and Thursday at the office (with yellow tape outside my cube). </p>
<p>So in our family, everyone has a different take on the flu. DW gets flu shots as soon as they are available to her (can’t use flumist due to immune problems). Unfortunately, this year it was too late. The rest of us either don’t tolerate the shot well or don’t seem to benefit from it (I actually had it the year we all had flu - so much for prevention).</p>
<p>As to the important things, DW finally came down for some soup at lunch today after sleeping 24 hours. Was up and around about an hour while the bed was changed and she bathed. Back to bed for some more sleep. Better than yesterday, but by no means through with the flu. So far, other than being run ragged taking care of her and my in-laws house/dog (they just came back from a trip a couple hours ago), I am hanging in.</p>
<p>Will post more when things change. </p>
<p>Peace.</p>
<p>Goaliedad,
I am glad that it worked for you and your d. You might ask your doc about keeping her on once a day dosage until the outbreak is over (my ds are as are most of the docs kids here).</p>
<p>keylyme, Fortunately (or unfortunately as placebo did have good cure rate), the days of docs being Gods are over. That is why (to our chagrin), drugs are advertised on TV. It is too bad that your doc is not like Goaliedads.</p>
<p>
Keeping my DW on tamiflu after she fights it off? Seems strange to me, as I thought once you beat most flu viruses, the likely hood of reinfection is minimal. </p>
<p>I thought generally from an epidemiological standpoint, most viruses die off primarily because enough of the population has developed resistance (through successfully outliving the virus) that there are not enough hosts who can infect to prepetuate the bug successfully. After a while (years if not decades), that resistance fades and the virus can then spread more effectively.</p>
<p>True.
However, did she have diagnosed s1n1 or simply symptoms that were treated. If she had the disease, she should be in best position of all. However, the regular flu and s1n1 symptoms are similar.<br>
</p>
<p>I’ve got 8 more pills to take and I do intend to take every single one of them. The only thing worse than getting this flu is to be the one whose body helps develop a drug-resistant variant because s/he didn’t complete the treatment.</p>
<p>Right now, they are treating all early cases of the flu (before Thanksgiving) locally as h1n1 and not testing as long as they present all of the major symptoms. DW had her regular flu shot a month ago, so we are fairly certain it is not the regular flu strain.</p>
<p>Goalie,
The “regular” flu shot is about 85% +/- effective as it does not hit all strains. Just the ones they felt most likely last year to hit now. Thus, every year people who get the shot, get the flu. However, odds are that she does have h1s1. </p>
<p>But, if her school has a large number of kids who are out sick, it might not be a bad idea to continue usage. $30 for most insurance plans and minimal side effects vs getting sick again.</p>
<p>P’sD,</p>
<p>I just realized you are confused about who got the flu and who got the shots. My DW (dear wife) is the one who has the flu right now and had a regular shot (H1N1 not available to her in time). She is the one who had to be hospitalized previously when she had the flu.</p>
<p>goaliegirl OTOH right now is perfectly healthy (knock on wood) and is the one who suffered flu side effects from both the mist and the shot in previous years. Given her track record with any flu vaccination (poor) and her relatively quick recovery from the same flu that hospitalized my wife (the 1 and only time she’s had the flu), we’ve elected not to vaccinate her. And in news from her school (talked to her this evening), it appears that the h1n1 infection rate seems to be dropping very quickly. The students who have had it have been returning to class. Can’t say whether they are dispensing tamiflu or not, as nobody is talking abou that (I’m sure HIPPA comes into play here).</p>
<p>And actually our health insurance covers the vaccinations for free anyplace we get it. We have just chosen to vaccinate based upon individual circumstances. </p>
<p>With regards to the flu, much like other diseases that kill off many people (like the plague), I’m convinced that pretty much 95% plus of a population will be exposed to it at some time. I’m also convinced that there are people who like with the plague are for whatever reason (usually genetic) protected from the worst of the symptoms, as not everyone gets seriously ill (or even ill at all) despite their exposure. These are things we don’t quite understand about viruses.</p>
<p>I know that in my family tree, between my 4 siblings and my parents, I can only count about perhaps a half-dozen cases of flu together in our lifetimes. I know my grandmother was in a nursing home where a flu outbreak ran rampant, yet she was one of a handful who never suffered. Go figure.</p>
<p>Perhaps we are “carriers”. That is one very good reason I am taking tamiflu, as I don’t want to unknowingly pass on a virus that may not be affecting me.</p>
<p>I’m afraid to say that modern medicine still has plenty to learn with regards to infectious diseases. We are starting to scratch the surface, but until we understand how and why certain organisms interact with our genetic makeup, we won’t have a grasp on how to predict infection.</p>
<p>I do understand your position of going with the best of known answers, though. Usually, the medical profession is correct (or at least not fatally incorrect) in its advice. Once in a while though it misses something completely (like thalidamide). </p>
<p>It would be interesting if we could simultaneously put the entire human population on tamiflu for a period to see if it truly would stop the infection in its tracks.</p>
<p>Goaliedad- what has really interested me is that at both my kids boarding schools, and my own town about an hour away, about 35% of the kids got the swine flu. What about the the 65% who did not get it? there be must be some factor that prevented it. Also, I personally have not heard of one single middle aged adult getting this thing. By the way, the boarding school now has enough vaccine for everyone, and they have an opt out policy, not opt in. If you don’t opt out, you’re getting it on the way into lunch!</p>
<p>I guess (although not specifically tested) you can count my wife as case 1 of the middle aged (50) adult getting the bug. However, you can put an asterisk by it, as she is on immuno-supressive drugs. </p>
<p>Interesting policy of opt-out. While goaliegirl’s school is pushing it, the parents must sign forms to opt in.</p>
<p>It is a bit disturbing to me to have an opt-out policy for a vaccination that is not required anywhere I know.</p>
<p>For example, I could understand an opt-out on chicken-pox vaccination, as many jurisdictions require it for public schools. </p>
<p>And actually the chicken-pox vaccination is one that I probably think will come back to bite us some day. </p>
<p>They seem to be vaccinating every kid as early as they can these days. The problem is that chicken-pox is almost never fatal and rarely significantly harmful in children under 12.</p>
<p>And once you get a significant case of it as a kid, you are pretty well set for life not worrying about the possibility of death. In rare cases you might get shingles later on, but not the potentially deadly full blown chicken-pox.</p>
<p>I guess chicken-pox vaccine works for a lifetime if you get it often enough. That said, I’d hate to make so many people keep track of when the last time they had a chicken-pox vaccine. Heck, 95% of Americans can’t tell you when the last time they had a tetinus shot. In about 30 years you will see a rise in deaths from chicken-pox just because so many parents have elected to have their children bypass those temporary, ugly, itchy blemishes.</p>
<p>I’d rather see the policy of not allowing children under the age of 11 to get the vaccine and then require it during their 12th year if they cannot provide a doctor’s diagnosis of having had the disease. That will reduce the number of adults who will need to keep track of their vaccinations and thus reduce the possibilities of death from chicken-pox.</p>
<p>I guess I’ve gone OT.</p>
<p>Son’s roommate has h1n1 virus. He’s been “quarantined” for the past 48 hours in the health center. His parents are 15 hours away in Seoul. A likeable kid; I sure hope he gets better fast.
Last week, I held my nose and signed the release for my son to receive the vaccine. So far, he feels fine; no flu-like symptoms, no adverse reaction to the shot. I think the school is counting the minutes until students depart next week for the end of the fall term. In the meantime, students are getting picked off, one by one, either by the seasonal or the h1n1 virus.</p>
<p>Article today by Perri Klaas about attitudes of parents to the H1N1 vaccine.</p>
<p><a href=“http://www.nytimes.com/2009/11/10/health/10klas.html?_r=1[/url]”>http://www.nytimes.com/2009/11/10/health/10klas.html?_r=1</a></p>
<p>PrincessDad…I do not think of our doctors as “Gods”. Far from it…I question everything and read to form my own point of view. My problem was with you stating that people should “demand” and speak to lawyers. It was just the attitude I had a problem with. That rubs me the wrong way. We have known our physicians for years; we respect them and consider them friends as well. I would never think to treat them in this way (or anyone, really).</p>
<p>keylyme,
Sorry, but you do have the right to “demand” from him/her and if “he” continues to deny you therapy that is the standard of care in America, it is your right to ask your lawyer to talk to him (or his supervisor if he is in a group practice). I am glad that “he” is your friend, but that may interfere with your medical care.</p>
<p>Goaliedad,
In our town people still throw “chicken-pox parties”.</p>
<p>I’m interested in why not everyone wants this vaccine for their family as much as I do (we still haven’t been able to get it). Here’s an article from the Washington Post that quotes some of the minority of doctors who are not recommending it for their patients, including high risk groups, and the reaction of public health professionals etc. </p>
<p>[url=<a href=“http://www.washingtonpost.com/wp-dyn/content/article/2009/11/07/AR2009110703116.html]washingtonpost.com[/url”>When it comes to H1N1 vaccine, some doctors are just saying no]washingtonpost.com[/url</a>]</p>
<p>A status update…</p>
<p>My wife is doing much better. No fever at any time today, so she will return to work tomorrow. Clearly the flu took a bite out of her and her other medical condition worsened as a result of the infection, but that too should improve with some time.</p>
<p>I am still symptom free as is my son who lives at home (but is not taking tamiflu). He has just been keeping distance. Not sure exactly the incubation period of the flu (3 days?), but with any luck we will be out of all potential issues this weekend.</p>
<p>And of course we (wife and I) will complete our prescribed boxes of tamiflu.</p>
<p>Thanks for the update, goaliedad, that’s great news. Scary having a person at risk who is ill.</p>