[Lekooks] Fwd: Omicron Update: Dec 4

Sat Dec 4 09:48:26 CST 2021

Great article summarizing the latest Omicron data from South Africa. Short
summary, esp for those of us older folks- get your booster now!
phil

---------- Forwarded message ---------
From: Mae <c.maesmith at gmail.com>
Date: Sat, Dec 4, 2021 at 9:10 AM
Subject: Fwd: Omicron Update: Dec 4
To: lynne smith sister <lynnethetwin at gmail.com>, Phil Smith <
psmithw318 at gmail.com>, Jesse Myerson <jesse.a.myerson at gmail.com>

FYI I’m subscribed to these updates from an epidemiologist who does a great
job breaking down latest data — especially useful for quickly evolving
omicron.

Begin forwarded message:

*From:* Katelyn Jetelina from Your Local Epidemiologist <
yourlocalepidemiologist at substack.com>
*Date:* December 4, 2021 at 9:38:36 AM EST
*To:* c.maesmith at gmail.com
*Subject:* *Omicron Update: Dec 4*
*Reply-To:* Katelyn Jetelina from Your Local Epidemiologist <
reply+qrkmt&e5h8c&&4e04ce5b63bef2ca2e04248a030b712951c59794027669a3064c7555e7ea9ebc at mg1.substack.com
>

It’s hard to believe it’s been one week since Omicron broke the news. While
we continue to wait on lab evidence, we’re getting a substantial amount of
epidemiological data every day. Here’s an update since my last… 1.
Reinfections are high against
Omicron ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌
‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌
‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌ ‌
Omicron Update: Dec 4
<https://email.mg2.substack.com/c/eJx1ksFyozAMhp8m3MKAcQwcfNhNNi3bkjbbTCb0whhbJE6MTcE0hadfNzntYWcka8aypPH_iTMLR9ONtDW99b6P0o4tUA3XXoG10HlDD10pBUVRHAcoIp6gWITJIvFkX9YdQMOkorYbwGuHSknOrDT6VpGEKEy9Ew05YRylBCcpcFYTElciZDhJwgUKQ0bug9kgJGgOFD6hG40GT9GTtW0_i37M0NrZaIZOGc4UtFJAI40yR9lbvx-q3jJ-8blp3LPWuWkk74yeD61wX5wL4HM8i9bWXEDPohWMv0OO9uMBqUt2NmM-8ShfZdNGXiV_SCexTtv3ZUY2q-1isyuCzfnSZ406CXeX74rpZVWMznG-vEp22Eyuh-SPe_m8y3C-y75e3rI-05uwkBnJ9M9PHm0tb_anIvrTVgjLeuuXfHr6eNDzt-Fcv46H7vnXx848PS7xpW3lap3LGr_3yTktXjNPUhQ4pVCAQxzFCPvIjwkGkVZ1BREECa58LVutkFIzHDRH9I8mXke53zDoG2lPLn_8RnZLOGKli82gpR1L0KxSIO4w7X0nbnjLI2jonJCiZJaGJEoISkgSJGl8Z-doY5wuCCap5yYL46o0_Q-vv5ur1xw>

<https://email.mg2.substack.com/c/eJxNUMtuwyAQ_JpwqwVrjPGBQy_9DYvH4tBgsAC38t-XJJdKq31oNJqdsbrhlsuljlwbeba1XQeqhL81YmtYyFmxrMEpGOeZwiiIU9wxOUkS6uoL4q5DVK2cSI7TxGB1Czm9GJIBW8hdCZTMc0DjPBfGO-2lnywTZmYAkzRvYX26gMmiwh8sV05Iorq3dtTb-HmDr171NLVp-xhs3vt5lOxDxL7BDDBTCh-P7ide6eMb-wxJk6CAAmNAOePjDHyAYRYc3WK8wRGp5GZI4UgRYrxxum8w_FchRdlh11j30O4d355mX0D3uva5nym0a8WkTUT3jqG903wFs26YsPSv3KqbYmKUAqSQVC7z23XPifNlElwspCu73FlJXfksMVsd8QgO95Bj3kJtfyMpkrM>
Katelyn Jetelina
<https://email.mg2.substack.com/c/eJxNUMtuwyAQ_JpwqwVrjPGBQy_9DYvH4tBgsAC38t-XJJdKq31oNJqdsbrhlsuljlwbeba1XQeqhL81YmtYyFmxrMEpGOeZwiiIU9wxOUkS6uoL4q5DVK2cSI7TxGB1Czm9GJIBW8hdCZTMc0DjPBfGO-2lnywTZmYAkzRvYX26gMmiwh8sV05Iorq3dtTb-HmDr171NLVp-xhs3vt5lOxDxL7BDDBTCh-P7ide6eMb-wxJk6CAAmNAOePjDHyAYRYc3WK8wRGp5GZI4UgRYrxxum8w_FchRdlh11j30O4d355mX0D3uva5nym0a8WkTUT3jqG903wFs26YsPSv3KqbYmKUAqSQVC7z23XPifNlElwspCu73FlJXfksMVsd8QgO95Bj3kJtfyMpkrM>
Dec 4
<https://email.mg2.substack.com/c/eJx1UkuPmzAQ_jXhVgS2eR04tJtmRdSQptoNTS_I2AMxGEzBJCG_vibZHnqoZM_Invnm-TGqoVLDHPdq1NYicj33EHdwHSVoDYM1jTDkgscIB4GDsG_xmHA39EJLjHk5ALRUyFgPE1j9VEjBqBaqeyBCF7mRdY4J8ZCPUVgiQpnn05A7HqdRGeAoDDgKnonpxAV0DGK4wDCrDiwZn7XuxxX-vEIbc2Y1DVIxKqEXHFqhpKrEqO1xKkZNWWMz1Ro32gsjL64RS2CjHjV-GoCypbYV3mjVgNFrmLcuQ8f5J5JNUqt5d2d4t07uqbgK9hrd-Sbqf70kfro-eOnbyUnrZky6rTxlqUOzaDIYQXrUJMafZhvHvG9pvSNpnZhbXb-9bHsTUezF9sqzRO_q6rarv3qLP8NHseBZezyf8I--QESUB7s-sbRk4j4Gt_L93T1-V9Px4uw2NFOv7Lovmt-HL29esZfZYYX8Sbf5aMbCwHTzdw4f_y1wMbVLl0v7loiRg1wXOcQlOEDERnbgE-BRURaAwQlJYXei7ySSckWctkL_DNYaYma3FMZW6LOxV0vQh8GsPTe6nTqh5xw6WkjgT0boJ7EeBeQVdDAYwvGc6tj1ceij0A-dMPoggKEMIZHnEz-yTGauDKqL_7P0P_wu8C4>
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Comment]
<https://email.mg2.substack.com/c/eJx1UktzmzAQ_jXmZgaEeB04tHad0AQnbjwekwsD0mLL1oMgEQd-fWW7PfTQGa1mZx_fPr4ltYGD6sesU9o4168yYweZhIvmYAz0zqChrxjNUBDHHgoih2aY-kmYOExXbQ8gasYz0w_gdEPDGakNU_KWkfjIT51j1kAcEhoGbZyGVk-s4pGWoBYjWlMc3QvXA2UgCWTwCf2oJDg8OxrT6VnwbYZW9o1q6LkiNYeOURBMcXVg2rh6aLSpydklStiwzooSjPRKzoeO2hHnFMgcW7MNECCNhVwZdQY5C5Yw_vQJ2o17xM_5SY3FRIJimU9rdmHkIZ3oKu3eF3m0Xm7C9bb01qezzgU_UmsrtuX0sixHK7hYXFi9X08Wg5HHHXve5rjY5l8vb7nO5dovWR7l8vsnCTaGiN2xDH51DcKs3bgVmZ4-HuT8bTi1r-O-f_7xsVVPjwt87jq2XBWsxe86OaXlaz5D0WBEpe0mCNju_47-xy6AskFcp7qy4rAMecj3kYd9HMQIu8iNIww0bdoGAvAS3LiSdZIjzmfYEwf0zy6dPiOuqEELZo7Wf7iC3hyW6eq6y0EyM1Yg64YDvR-Bud_SrYHqABJ6SwCtapP5UZBEKIkSL0njO-f2SjBOwwhHqWMrU2WzZPYfnn8D2mjsIg>
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Share]
<https://email.mg2.substack.com/c/eJx1Uk2P2jAQ_TXkRpTYJiSHHFoou-ku7NJFCPYSOfYEDP7Ixs7S8OvrQCu1h0oeS34zb0bz_Bh1cDBtnzfGumC4Stc3kGu4WAnOQRt0FtpS8Bzh6TRCOAl4TnicTtJA2LJuARQVMndtB0HTVVIw6oTRN0YaozgLjjmrkxpNppgSHnHGY57GMWdJFDGcVjVL74NpxwVoBjl8QtsbDYHMj841doS_jNDCn950rTSMSmgEByWMNAdhXWi7yjrKziEzypc1PowSrDV63DXcrzjmwMZkhBedU6X1XRiM8PwPbYSSAVfARac8ftvoN8iMdqDdUH2kLXiUsmG_vwBnzjC8of8eM7Ttd0iei5Ppl1eGl_PiuhIXwR6yK19kzfusSFbz9WS12Uer09kWSh65x5ab_fVlvu99kOXsIuhudfU9BHvciudNQZab4ufLW2ELvYr3okgK_fWT4bVjanvc4x9NhYio12HJrk8fD3r81p3q137XPn_72Jinxxk5N42YL5aiJu82PWX71yIQOYpQHKOIxARPEQlROE0I8KyqK8AQpaQKtWi0RFKOSKQO6B-dgzZnoaJglXBHnz8Mot0S3gVeNqU6LVxfgqaVBH43iLv77CZweQANrf8cXlKXxwlOE5QmaZRm07sfvIMIySYJSbLAT-bGs3T-Hw_8AvB99aw>

It’s hard to believe it’s been one week since Omicron broke the news. While
we continue to wait on lab evidence, we’re getting a substantial amount of
epidemiological data every day. Here’s an update since my last
<https://email.mg2.substack.com/c/eJx1kLuu4yAQhp8mdLEMJoALitPsa1gYxg5aboJhj_z2hyTbbLHSXIq5_p81CGeuly65IXmFDa8COsF3C4AIlfQGdfNOs0XKmS2COM0dVQ9FfNuOChCNDxprB1L6Hrw16HN6TyjK6Eqe-uDHfJhDSrPAA2bFrVTUGhBgBaxcfg6b7jwkCxr-QL1yAhL0E7G02_J1Y7-GXbnXkK0JULyD6HPIp284tb43NPb3ZHMcbWV4jt7WnO69uCHx7sDeGfGazYxSNnPKF8n4xCYpOLh1P3ZYXo_tU_IlBRbCjc_xZP-sJlXbKRpo0eNz1M-X8ndhCN9Gjj15vDZIZg_gPkzwg_ZNaTshQR3_uM2gpmJRgimhZrX-RTCgcb4-BBcrGZddHlNJ_0f2D-b3mU4>
…

*1. Reinfections are high against Omicron*

We got our first piece of solid scientific evidence yesterday (here
<https://email.mg2.substack.com/c/eJwlkM2OrCAQhZ-mWRIoEXHBYjbzGgahtMkgGMD2-vYX26RSdVI_OanPmoprypfeU6nkTlO9dtQRzxKwVszkKJgn7zR0w8Cgk8Rp4bjqFfFlWjLiZnzQNR9I9mMO3prqU_xeKA58JG9tpBVSLeA6YND34zhYKZd-VmDMgHZ8jM3hPEaLGj-YrxSRBP2udS-v7ucFvy3O86QbuvzPf2jKa-vYFCvG2hRnlHPGm2oevOk7gIOUTKoP0OUIge5uIV7fCxyY4KIbQFCggxToxnmZsUOmxEyj32OAEF6CbSvQcsylGvtHbdpI1pZuBsvm67vN1_v976B9P7W6HdHXa8Jo5oDuAVMfvl9U04oRc-PuJlM1l52SoKRiahweDo2cEGMvhRxJc3apXUV9pSOHZE3A3TvcfApp9aX-B6HglKA>).
A group of South African scientists leveraged a national dataset of all
positive COVID19 tests over time. This dataset includes data regardless of
the reason for testing or type of test (PCR or antigen). Using this
dataset, they assessed the reinfection rate in South Africa from March 2020
to November 27 2021.

The key findings of their analysis are in Panels A and C in the figure
below. Both graphs are infections plotted over time. Panel A is
*primary *infections,
so someone who never had a positive test ever before. Panel C is
*re*infections,
so someone who had a positive test (at least 90 days) before. The colored
background corresponds to different waves. This is what we see:

   -

   Purple was South Africa’s first COVID19 wave. This was all primary
   infections, as reinfections were impossible at this stage.
   -

   During the Pink and Orange wave, primary infections and reinfections
   largely reflected each other. They had a similar pattern but at different
   magnitudes.
   -

   Then you get to Omicron at the tail end of these graphs. While primary
   infections are increasing, reinfections have substantially more exponential
   growth. In fact, that blue line is almost as high as the previous Delta
   wave.

<https://email.mg2.substack.com/c/eJxVUk2P3CAM_TXJpUoEBAgcOGy36rU_IeLDk6FLIAtkp9NfXyY5VUL2ky37PWxbXWFN-an2VGr_Mkt97qAiPEqAWiH3R4G8eKfINM-ITLx3ijosmOh9WW4ZYNM-qJoP6PfDBG919SmeFQITLPu7wkgCM0TOs0OYWU64tAKwdgRJIbW8iPXhPEQLCr4gP1OEPqh7rXvppreO_GzPujiWw5Sq7cdo09ZCftMrNH-Dau_NP5aOfU_mN9j67dfpOvajI-92CX7ztaFbI6qpgc8LTG9rSu6VCMue05qhFP8FLV4qwN56XiIIe8lgLyHNmMN-QMvnARAzxgo6GK2ngU4zDJJhMWhnJmJgnqWgY5lGvem_KepHuZS3Hte4Tnh-o5wQG-MIRWQAx_hAEaeDFJMZNDjsJCMYz3KZOf4jCR73uPZeEdSiBFHc2AkdyThzCk6am4EJkKBmjH6PgYTQUbSt5L8h9lnZcdNQ2njuLb--9nkmmr6l-e2Ivj4XiNoEcNem63Uw5-6XFSLkdkhu0VVhPglOBBdIyPlabDsFSiXjlMu-MbvUqqJ6piOHZHWA3TvYfApp9aX-AxIz1vs>
Pulliam
et al., Increased risk of SARS-CoV-2 reinfection associated with emergence
of the Omicron variant in South Africa. Preprint here
<https://email.mg2.substack.com/c/eJwlkM2OrCAQhZ-mWRIoEXHBYjbzGgahtMkgGMD2-vYX26RSdVI_OanPmoprypfeU6nkTlO9dtQRzxKwVszkKJgn7zR0w8Cgk8Rp4bjqFfFlWjLiZnzQNR9I9mMO3prqU_xeKA58JG9tpBVSLeA6YND34zhYKZd-VmDMgHZ8jM3hPEaLGj-YrxSRBP2udS-v7ucFvy3O86QbuvzPf2jKa-vYFCvG2hRnlHPGm2oevOk7gIOUTKoP0OUIge5uIV7fCxyY4KIbQFCggxToxnmZsUOmxEyj32OAEF6CbSvQcsylGvtHbdpI1pZuBsvm67vN1_v976B9P7W6HdHXa8Jo5oDuAVMfvl9U04oRc-PuJlM1l52SoKRiahweDo2cEGMvhRxJc3apXUV9pSOHZE3A3TvcfApp9aX-B6HglKA>.

This is the first evidence to show us that the rate of reinfection with
Omicron is high—3 times higher than Delta. In other words,
infection-induced immunity is not doing a great job at stopping Omicron.

We now know this is the preliminary evidence WHO based their recommendation
<https://email.mg2.substack.com/c/eJwlkEuOrDAMRVdTmYFICCEMMujJ2wbKx0VFnQ9KzEPsvkMhWb6yriz7HqsRtlwuteeK5G4rXjuoBGcNgAiFHBXK6p1i4zwPbBTEKe6onCTxdX0XgKh9UFgOIPthgrcafU7fDUkZXchHWWsWOw96omIcpzc4rR1lUtPJGjdb8RzWh_OQLCj4D-XKCUhQH8S9vsafF_vX6jzP_vzk3ids0_1jE48QmzDZUdqxgdHu2F2L1eXU5ehtyYl4dRuUDZzycWa8Z_0sOLjFvA2MMEhu-uT3FFgILz7EjfX1MBW1_e1tjqQo20cNNXr8NH-7I3-NlnhtGo_k8VohaRPAPTDwYfrFs26QoLSn3KpRNQpSMCnkIJf5yd5ocb5MgouFtMsut62krnyUkK0OsHsH0eeQN1_xD_b1lAg>on
earlier this week: *People who have previously had COVID-19 could become
reinfected more easily with Omicron*. This is also another example of South
Africa’s incredibly swift work at finding early signals so the rest of the
world can prepare.

*2. South Africa State of Affairs *

South Africa is having explosive spread. Yesterday they had 16,055
<https://email.mg2.substack.com/c/eJxFUcuOhCAQ_JrhplFAxQOHvexvGB49TmcRDOC4ztcvo5vdhECoqk51VxuVYQ7xkGtImbyvKR8rSA97cpAzRLIliBNaSdkwNJT1xEpuW9EJgmm6R4BFoZM5bkDWTTs0KmPwZ4VoaTuShzRgBRs6To0WXI_irpVmbOhNN9yBdsNlrDaL4A1IeEI8ggfi5CPnNd3Yx41-lrPve-3R2FqZ-qUKYDGBSpAqVb0q9Ba-_8HrX5nwRFu1YyHSFp-AzqliUkVYQ8ypwP5sWLk_aWXLRMevoggIStrQtqUNbzkbKK9pPfQc7KjvGhg0ZajS1-odde7Gm2Wmddp0ysp81SYsJEpTLwrSgvlR-Pmd2EmUwKbyLpvHfEzglXZgryzztZIz3WkGD7Gsyk4qy7ZnoqeiF40Yf6MrYXM-dj3vR1KcbShVXh5hiy4Y5WBFCwsGF2ZM-Qdfl6u3>
new cases in one day. Using Delta’s doubling rate, we hypothesized
<https://email.mg2.substack.com/c/eJwlUMuOhSAM_ZrLbgwizwWL2cxvGB7VSwbBAI7x7wevSdOmbdrzcKbBmsul91wbutPcrh10grNGaA0KOiqUOXhNJiEwmTjymvpRMolCnZcCsJkQdSsHoP2wMTjTQk6fCzmSUaG3XrCQGMTiLGUYK-bsxBT3njlBzMLgATaHD5AcaPiDcuUEKOp3a3t9Td8v8tPjPM_BWje4vPXu5ngPc4n-yyylI38xRfkkhUJBE0zGkWA60kkQOpBBcApe2cXCBFhSO6Swp0hifFG8rWSoh63NuN_7PSraDZuBuoX27vv1FvlZdI1zr9uRQrtmSMZG8I_89rj4MWReIUHp7vrZND12UpxILrFU4lHb_aFUMU65Qh3Z536V9JWPErMzEfbgYQs55jXU9g-IhY7h>South
Africa would break 10,000 daily cases by next week. Omicron has far
outpaced this. The test positivity rate in South Africa is 24%, which is
bad as Omicron is spreading faster than we can detect it.
<https://email.mg2.substack.com/c/eJxVUsuO3SAM_ZpkUyUKrwALFtNW3fYTIh5OLh0CKZCZ3n59ucmqErKPbNnnYNvqClvKT3WkUvuXWerzABXhswSoFXJ_FsiLdwoTzidM5t4p6pBgovdlWTPArn1QNZ_QH6cJ3urqU7wqBMJI9g_lmOESOzCr5JiLWbp15gJRx4VmlNCbWJ_OQ7Sg4APyM0Xog3rUepSOvHX4R3vWxbGcplRt30eb9hbyu96g-RWqfTT_uXTsazK_wNYvPy_Xse8d_maX4HdfG1obUU0N_L4BedtScq9EWI6ctgyl-A9o8VIBjtbzFoHZSwZ7CWnGnPYdWj4PMDFjrKCD0ZoMlHAYJENi0M4QbIBzKehYyKh3_TdF_Vlu5a3HPa4LXt8oF5SgkeMzHZBmbKBWwiAInwdtVyIcATmvchFo-sMmOh5x673CE0YITxQ1dkxHPLZycNKsBghMgpox-iMGHEJHp33D_w2xz8qOu4bSxvNo-e21zyvR9C3N72f09blA1CaAuzdd74O5dr9sECG3Q3KLrgrNRMxYzGISkt-LbadAqWQznWXfmF1qVVE905lDsjrA4R3sPoW0-VL_AR5I170>
(NCID
-Source Here
<https://email.mg2.substack.com/c/eJxFUcuOhCAQ_JrhplFAxQOHvexvGB49TmcRDOC4ztcvo5vdhECoqk51VxuVYQ7xkGtImbyvKR8rSA97cpAzRLIliBNaSdkwNJT1xEpuW9EJgmm6R4BFoZM5bkDWTTs0KmPwZ4VoaTuShzRgBRs6To0WXI_irpVmbOhNN9yBdsNlrDaL4A1IeEI8ggfi5CPnNd3Yx41-lrPve-3R2FqZ-qUKYDGBSpAqVb0q9Ba-_8HrX5nwRFu1YyHSFp-AzqliUkVYQ8ypwP5sWLk_aWXLRMevoggIStrQtqUNbzkbKK9pPfQc7KjvGhg0ZajS1-odde7Gm2Wmddp0ysp81SYsJEpTLwrSgvlR-Pmd2EmUwKbyLpvHfEzglXZgryzztZIz3WkGD7Gsyk4qy7ZnoqeiF40Yf6MrYXM-dj3vR1KcbShVXh5hiy4Y5WBFCwsGF2ZM-Qdfl6u3>
)

If we zoom into South Africa’s epicenter—Gauteng—case acceleration for this
new wave (black line) is just unbelievable. The spread is near vertical
compared to other waves.
<https://email.mg2.substack.com/c/eJxVUsuunDAM_ZphU4FCHpAssri3Vbf9BJSHYXJvSCgJdzr9-npgVSmyj2z5-MS2MxWWvD_1lkttXmaqzw10gkeJUCvszVFgn4LXlI0joWxovOa-l0I2oUzzDrCaEHXdD2i2w8bgTA05nRWyp71q7loIMVgCAhwZDVFiVLOfjXCE8N76QVyNzeEDJAcavmB_5gRN1Pdat3Jjbzf6E5_zqSuHLdW4z87lFUNhNQugn6G6O_rHdBPv2X6Aq99-ne4mftzodzfFsIaKaMZGNSP4fQH2tuTsX4k4bXtediglfAHGSwXYkPMSQcVLhngJQWMP9wmY31sgwloneWuNYS1nI7RK9LI13jJqYRyV5F1hnVnN35zMo1zKkeMa1wnPb5QTKtUDYUglrUI-SngrOUBLCDVg7MBnBRNG5Z9esKH72GBpgqaE9j1GexRAeUe7ceDglZ0tMCCS2y6FLUUa442TdaH_zbHZtetWAwUndMf88lrpmUCJE_r1SKE-J0jGRvDXsut1M-f6pwUS7HhLfjJV9wOTA5WDJFKN127xGjhXYuCDarCzz1iV9DMfe8zORNiChzXkmJdQ6j-UVNhy>
Twitter:
Ridhwaan Sulliman
<https://email.mg2.substack.com/c/eJwlkMGOhCAMhp9mOBpARDxw2Mu8hkHoOM0iGKg78e0Xx6Rp0zTt3-_3jmDN5bR7rsSuNNO5g03wqRGIoLCjQpkxWNmPI5e9ZsGqIMxgGNb5VQA2h9FSOYDtxxLRO8KcvhtGSDGxt1XQe5g4n7waHAjNnXzJwWslBQevzS3sjoCQPFj4g3LmBCzaN9FeH_3PQz5b0Aevlzqft9YVDII-AFQZWsmlEJIrofpRqk52o1YQpuW1QA_cqKVLuKcoY3wovq2yq8dSyfnf6xgr1nebg7ohvdt8vZC-g0Y0t7odCemcIbklQrhh6fbsiz-vkKA0L8PsyArdGy2NNtxM483W3FBqGrTSE2vKIbetZM98lJi9i7BjgA1zzCtW-gdu04nd>

Hospitalizations in South Africa have started to slowly rise. Because
hospital trends lag case trends by 3-4 weeks, we still don’t know if, and
how, Omicron impacts severe disease and death. We are at the mercy of time.
<https://email.mg2.substack.com/c/eJxVUsuOnTAM_RrYVCDyIIRFFtNW3fYTUB6Gm05IaBJmevv19YVVpcg-smX7xMdWV9hSfqojldq-zFKfB6gInyVArZDbs0BevFOUTdNAmWid4o7IUba-LGsG2LUPquYT2uM0wVtdfYpXhSSUzO1DESOMhFFSwQY6ETrIWcA6cmr5QIy292B9Og_RgoIPyM8UoQ3qUetRGvbW0B_4rIt9OU2p2r73Nu0Y8rveAP0K1T7Qfy7N-DWZX2Drl5-Xa8bvDf1ml-B3XxGtOKgmBL9vwN62lNwrEZYjpy1DKf4DMF4qwIE9bxJ0fNEYX0TQmNO-A-ZzB8NojJW8M1qzjrMJunkkstPOMGpgmmbJ-8J6veu_KerPcjPHHve6Lnh9o1yQzXoyYE1nRw4dF052Utq102yWs9VMODIvdODyD-Fc9EfcWq_oQAnulROcT3lP-0lwcLNZDTAYJDd99EcMNISGD_tG_1tjm5Xtdw0FF_TA_PZS9EogwwX9fkZfnwtEbQK4W-t6n8yl_rJBhIyn5BZdFRFMCiqFRJmnW1o8Bs7nUXAxtzjZJayK6pnOHJLVAQ7vYPcppM2X-g8e_dgl>

We got a little peak into these hospitalizations during a brief
<https://email.mg2.substack.com/c/eJwlkMuOhCAQRb-mWRooEWXBYjaT-YbZGB7VNhkEA9jGvx9ak0pVpR65ucfqikvKp9pSqeST5npuqCIeJWCtmMleMM_eKejHkUIviFPcsWmYiC_zMyOu2gdV845k203wVlef4vUxMWCSvJTkkmpumdQDoACQDuUgjeN2kJxrewvr3XmMFhW-MZ8pIgnqVetWHv3XA75bHMfRPbVFk9JfZ9PaRj-oQ339fg7e3mEqrQHaj4LKps2EENAmxCugwBhQzng_Au-gGwVHJ83TYI904qaLfosBQnhwui7Qld2Uqu0lRLKy3aqxrL6-2n75eL4WzfLc6rpHX88ZozYB3U2j3lAvPvOCEXOD7WZdFRP9JGASE53keJtvuDiXg-BCkqbsUvuK6kx7DsnqgFszt_oU0uJL_QdRhpID>
yesterday hosted by the National Department of Health (South Africa). South
Africa is actively investigating the vaccination status of patients in
hospitals. Unfortunately there is still lot of “unknown” data, but the data
they do have shows that among 1,351 hospitalized 23% patients are
unvaccinated and 2% of patients vaccinated. Until we can get more complete
data, I wouldn’t come to sweeping conclusions with this. But it’s welcoming
news that the vaccinated aren’t piling up at the hospital.
<https://email.mg2.substack.com/c/eJxVUsuOnTAM_RrYVCDIg4RFFtNW3fYTUB6Gm05IaBJmevv19YVVpcjnyJbtE9tWV9hSfqojldq-zFKfB6gInyVArZDbs0BevFOECjEQOrVOMTdKLltfljUD7NoHVfMJ7XGa4K2uPsUrQ45knNuHEhKkhWmgIEZKRkktIWK1IPQwyFXTu7E-nYdoQcEH5GeK0Ab1qPUoDX1ryA981sW-nKZUbd97m3Z0-V1vgLhCtQ_Ez6XhX5P5BbZ--XlBw7835Jtdgt99RbZio5qQ_L4JfdtScq9AWI6ctgyl-A9Af6kAB9a8RRD-ksFfQtCY074DxnMHAzfGStYZrWnHqIBu5qPstDOUGBBilqwvtNe7_pui_iy3cqxxj-ui1zfKRYcVx0L51HGjScckVtbMmY46vs6ToNKZaUH4Q-XYH3FrvSIDGUcysBG7E9aTXkwM3GxWAxQGyUwf_REDCaFhw76R_4bYZmX7XUPB8Twwvr32eQVQ34K4n9HX5wJRmwDu3nS9D-ba_bJBhIyH5BZd1ThRORE5yUHO4l4sngJjM5_YNLfY2SXMiuqZzhyS1QEO72D3KaTNl_oP9PLXjw>
National
Department of Health (South Africa)

During the briefing, South Africa also presented the age distribution of
hospitalized patients. It’s apparent that younger people are going to the
hospital at a higher rate during this Omicron wave (orange bars below)
compared to the Delta wave (blue bars below). This pattern is specifically
apparent with kids less than 5 years old.
<https://email.mg2.substack.com/c/eJxVUsuunDAM_RrYVKCQB4RFFve26rafgPLwMLk3JDQJdzr9-npgVSmyj2zZ58S21RXWlJ9qT6W2L7PU5w4qwqMEqBVyexTIi3eKsmkilI2tU9wNUsjWl-WWATbtg6r5gHY_TPBWV5_iWSEHOsztXVkwkzSESD1bLh0IydCOXIz6ZgQnF7E-nIdoQcEX5GeK0AZ1r3UvDXtr6E981sW-HKZUbT97mzYM-U2vgP4G1d7RP5ZGvCfzAbZ--3W6Rvxo6He7BL_5iuiGRDUh-H0B9ram5F6JsOw5rRlK8V-A8VIBdux5iaDiJUO8hKAxh_0EzOcOiDDGSt4ZrVnH2QTdLAbZaWcYNTBNs-R9Yb3e9N8U9aNcyrHHNa4Tnt8oJ4SJCzbNpuOjJB3XDPtRCx1YQgRILqXmyzyOfwRn_ccOa-sVJXQYKOED0lPe034aObjZ3AwwIJKbPvo9BhpCw8m20v-m2GZl-01DwfncMb--FnomUOCCfjuir88FojYB3LXqel3MufxlhQgZL8ktuqphZHKkEsXLebo2i7fA-SxGPs4tMruEVVE905FDsjrA7h1sPoW0-lL_AZzV2DY>
National
Department of Health (South Africa)

South Africa is actively investigating *why*. I think there are a few
things that could be explaining this:

   1.

   Kids aren’t vaccinated and may be the last group for the virus to reach.
   Parents may have avoided infection by altering behaviors until now.
   2.

   Adults around these kids aren’t vaccinated. Infection-induced immunity
   doesn’t protect well against Omicron while it largely did before. So
   parents could be bringing the virus home and infecting kids.
   3.

   Because so little is known about Omicron, kids may be hospitalized out
   of precaution at a higher rate than before.
   4.

   Omicron induces more severe disease for kids than previous variants.
   5.

   A combination of all of the above.

My guess is a combination of #1-3. Keep in mind what happens in one country
doesn’t always happen in others. Landscapes between countries are very
different: vaccination rates, behaviors, environment, genetics, and unknown
unknowns. We need to carefully track epidemiological data by age to see if
this is a generalizable signal. As a parent, I don’t really want to wait to
find out though.

*3. United States State of Affairs*

This virus is well on its way as it has reached more than 11 states. Some
cases have no ties to South Africa travel indicating (and confirming) that
Omicron is spreading throughout our communities. The key question we have
in the States is: *Does Omicron outcompete Delta?* We need more data to see
whether this is happening.
<https://email.mg2.substack.com/c/eJxVUsuOnTAM_RrYVCDIm0UW01bd9hOiPAw3nZDQJMz09uubC6tKkX1kyz4ntq2usKX8lEcqtX8ZVZ8HyAifJUCtkPuzQFbeSYQ5nxBmvZPEzYKK3he1ZoBd-yBrPqE_ThO81dWneFWIGc1L_5B40cwZxAxDsCIhOMWa8xms1hOlzt3E-nQeogUJH5CfKUIf5KPWo3T4rUM_2rMujuU0pWr7Ptq0t5Df9QbNr1Dto_lP1dGvyfwCW7_8vFxHv3fom1XB7742tDaimhr4fQP8tqXkXomgjpy2DKX4D2jxUgGO1vMWgehLBn0Jacac9h1aPg8wUWOsIIPRGg8EcxgWOotBO4ORAc4XQcaCR73rvynqz3Irbz3ucV3w-ka5IFiqiWV2WLCmA2GABt1mNQiD8GrNMvGVq4WRPwyL8Yhb7yWa0DyjicyNHZERjZwRcItZDWCYBDFj9EcMKISOTPuG_htin6Uddw2ljefR8ttrn1ei6VPN72f09akgahPA3Zuu98Fcu1cbRMjtkJzSVc5NFkOCiUks_F5sOwVCFsoIW_rG7FKrivKZzhyS1QEO72D3KaTNl_oPUd7YhQ>
(NYT
<https://email.mg2.substack.com/c/eJwlkE2OwyAMhU9Tdo2AUJIsWMxmrhERcBJr-InAaZXbD20lhAH78Z4-Zwm2XC5z5Ersvc10HWASvGoAIijsrFBm9Eb2w8Blr5k3yovxMTKs81oAosVgqJzAjnMJ6CxhTh_FKKSY2G4ePYATg-Va8kWvsFohpnVpXc3XQfZfY3t6hOTAwBPKlROwYHaio976n5v8bev1enXpIoxQO5dje8HUIlpH-IR2k1yKVnawgfZ2cLnkZJ9Yznp_2oI20Z3a-B-UbqcYGJq3REiuhOoHqTrZDVqBn5Z1gR74qJYu4ZGCDOGmeNxkV8-lUvviHYAV47pooUZsfopvbxSfRiMxtxrPhHTNkOwSwH8h0Zf1B9u8QWr5CfxsyQjdj1qOeuTjNHyZNIpKTQ-t9MSas89NlcyVzxKyswEO9BAxh7xhpX_BPp4N>
)

Nonetheless, we’re seeing case growth across the nation with 94,926
<https://email.mg2.substack.com/c/eJwlUEuOrDAMPE1nNwhCCGGRxWzeNVBIDG1NPigxjbj9C41k2bLLVrnKGoIt5UvvqRC700zXDjrCWTwQQWZHgTyj07wfx5b3kjktXKcGxbDMawYIBr2mfADbj8WjNYQpfi9Ux7uJvbUAO4CTgxsEGKhTwzmoFVYjzdrK4SE2h0OIFjR8IF8pAvP6TbSXV__74v9qnOfZxIswQGlsCnWCsb5oLOEHasdb3tVylJps-qD7sabU3TcFz1DfcMdb0Yl-5KLhzSgFuGlZF-ihVWJpIu7Rc-9fog0bb8qxFDL27yZjWdsmGCgB6V3x7Zb9BarqudZwRKRrhmgWD-4xhB5fvxbNG8T6K4GbDelO9kpyJVWrpvHRXx0TYhqkkBOrzC7Vq6ivdGSfrPGwo4OAyacNC_0HkvOWrw>
new cases per day. Hot spots are clustered in the Northern states who were
largely untouched by Delta during the summer, but all geographic areas in
the United States are increasing.

Delta and the Thanksgiving holiday are largely driving spread right now.
Omicron may be adding a little fuel, but certainly not a main factor yet.
<https://email.mg2.substack.com/c/eJxVUsuOnTAM_RrYVKCQB4RFFtNW3fYTUB6Gm05IaBJmevv19YVVpcg-shWf44fVFbaUn-pIpbYvs9TnASrCZwlQK-T2LJAX7xRl00QoG1unuBukkK0vy5oBdu2DqvmE9jhN8FZXn-L1Qw50mNuH4mBA0pU7Nq7TalZnmLRC6NUNk6MDv4n16TxECwo-ID9ThDaoR61HadhbQ3_gsy725TSlavve27RjyO96A_QrVPtA_7k04msyv8DWLz8v14jvDf1ml-B3XxGtSFQTgt83YG9bSu6VCMuR05ahFP8BGC8V4MCatwgqXjLESwgac9p3wHzugAhjrOSd0Zp1nE3QzWKQncYuqYFpmiXvC-v1rv-mqD_LrRxr3OO64NVGuaAgTo6E8I5ISzo-C9rNzvGOGsokHwFg4stAZ_Jn5KQ_4tZ6RQkdBkr4gPSU97SfRg5uNqsBBkRy00d_xEBDaDjZN_rfFNusbL9rKDifB-a310KvBApc0O9n9PW5QNQmgLtXXe-LuZa_bBAh4yW5RVc1jEyOVI6SyHm6N4u3wLGRkY9zi8wu4a-onunMIVkd4PAOdp9C2nyp_wApV9ga>

Not nearly enough people are fully protected going into the Winter months.
Only 59.7%
<https://email.mg2.substack.com/c/eJw1kN3OpCAMhq9mONMoMIgHHHwn322YAh2HLIKBOhvvfhnNJk2b_uVtHweEay6n2XMl9nULnTuahH9rRCIs7KhYluANF9M0cKGYN9KP-qlZqMurIG4QoqFyINsPG4MDCjldG3rk48zeRozCcnAT6KcEP00wD5MdnqiUQG3B3sJw-IDJocEPljMnZNG8ifb6ED8P_tvM5U_wvfOuX_Pnf955IOiogPuD5ZoTH3AupOuOunyTjjJB7MBvIXWl_XwXWDB84OPIBzlKMXHZ835SEv1sXxYFDlraPoU9RR7jQw7byvt62EpNq3d5Y8W4fgOsW6B3669fFFejkVha3I4U6FwwgY3ob0h0s76wLSsm_N7jFyAzKqEV10oPep5uJo2ilPNTSTWzpuxz20rmzEeJ2UHEPXjcQo55DZX-AR4Rnmc>
of the United States is fully vaccinated (which the CDC defines as *not*
having a booster, which really needs to change). Only 22%
<https://email.mg2.substack.com/c/eJw1kN3OpCAMhq9mONMoMIgHHHwn322YAh2HLIKBOhvvfhnNJk2b_uVtHweEay6n2XMl9nULnTuahH9rRCIs7KhYluANF9M0cKGYN9KP-qlZqMurIG4QoqFyINsPG4MDCjldG3rk48zeRozCcnAT6KcEP00wD5MdnqiUQG3B3sJw-IDJocEPljMnZNG8ifb6ED8P_tvM5U_wvfOuX_Pnf955IOiogPuD5ZoTH3AupOuOunyTjjJB7MBvIXWl_XwXWDB84OPIBzlKMXHZ835SEv1sXxYFDlraPoU9RR7jQw7byvt62EpNq3d5Y8W4fgOsW6B3669fFFejkVha3I4U6FwwgY3ob0h0s76wLSsm_N7jFyAzKqEV10oPep5uJo2ilPNTSTWzpuxz20rmzEeJ2UHEPXjcQo55DZX-AR4Rnmc>
of 18+ are boosted and, even more concerning, only 46% of those aged 65+
<https://email.mg2.substack.com/c/eJw1kN3OpCAMhq9mONMoMIgHHHwn322YAh2HLIKBOhvvfhnNJk2b_uVtHweEay6n2XMl9nULnTuahH9rRCIs7KhYluANF9M0cKGYN9KP-qlZqMurIG4QoqFyINsPG4MDCjldG3rk48zeRozCcnAT6KcEP00wD5MdnqiUQG3B3sJw-IDJocEPljMnZNG8ifb6ED8P_tvM5U_wvfOuX_Pnf955IOiogPuD5ZoTH3AupOuOunyTjjJB7MBvIXWl_XwXWDB84OPIBzlKMXHZ835SEv1sXxYFDlraPoU9RR7jQw7byvt62EpNq3d5Y8W4fgOsW6B3669fFFejkVha3I4U6FwwgY3ob0h0s76wLSsm_N7jFyAzKqEV10oPep5uJo2ilPNTSTWzpuxz20rmzEeJ2UHEPXjcQo55DZX-AR4Rnmc>.
I found the graph
<https://email.mg2.substack.com/c/eJwlkc2OrCAQhZ-m2WkAEXXBYjb3NQxCqWT4C-A1vv1UdyekKjmVQ518ZXSDI5VH5VQbeZe1PRlUhLt6aA0KuSqU1VnFh2mifJDEKmHZPM7E1XUvAEE7r1q5gORr887o5lL8OGbG2UJOBXqf2KYNhYlqThksHKycxnGXRggpvov1ZR1EAwr-Q3lSBOLV2Vqur-Hnxf_hu--7B5NiCq623qSA2lF0Pp3pLDTMgQKnnGFjHAsdsJzp7nKBrAvYbk-lQ7spKXYodDpAwcidjraDq6QMxKn3F4xTwcQwcdHzfpIC7LLtGwxAZ7H10eXoufcvQcPB-3pttWnz-85EijJ90FCDayfOjzefzwDxrNjDFV17Voh682C_5Nr3AB-W6wERCh7GrropJodZ8lnOdF6mLyhEK8QySiEXgpttQldUT7qKT0Z7yM5CcMmnAzH9AcWpo-w>below
useful in displaying poor booster coverage in the United States. If you
know someone that’s 65+, call them right now and encourage them to get a
booster if they don’t already have one. It’s not too late.
<https://email.mg2.substack.com/c/eJxVUsuO3SAM_ZpkUyVKeLNgMW3VbT8h4uHk0iGQApnp7deXm6wqIfvIFj7HD6srbCk_1ZFK7V9mqc8DVITPEqBWyP1ZIC_eKYQ5nxBmvVPEzYKK3pdlzQC79kHVfEJ_nCZ4q6tP8fohZjTL_qEcZysHMEZrzlfDKJ7sLKVkBjHQbL6J9ek8RAsKPiA_U4Q-qEetR-nwW4d-tGddHMtpStX2fbRpbyG_6w2aX6HaR_OfS0e_JvMLbP3y83Id_d6hb3YJfve1obUR1dTA7xvgty0l90qE5chpy1CK_4AWLxXgaDVvEYi-ZNCXkGbMad-h5fMAEzXGCjK07vBAMIdB0lkM2hmMDHAuBRkLHvWu_6aoP8utvNW4x3XBq41yQTEZO7lpHYTjdCBCokFwjAYqMdhJoFU7WASRfyjF4xG33is0oXlGE5kbOyIjGjkj4KRZDWCYBDFj9EcMKISOTPuG_htin5Uddw2ljefR8ttrn1ei6Vua38_o63OBqE0Ad2-63gdz7X7ZIEJuh-QWXdXMsGBIMDEJye_FtlMgRFJGmOwbs0vtV1TPdOaQrA5weAe7TyFtvtR_UcXYNQ>
(Economist)

*Bottom Line*: Previous infections are largely not protective against
Omicron. Omicron is in the United States and spreading quickly. Let’s take
advantage of this warning from South Africa to mount a proactive (rather
than reactive) response.

Love, YLE

P.S. I typically get many messages asking what I’m doing with my girls who
are under 5. We haven’t changed our behaviors with Omicron news just yet.
We are already boosted, wear masks inside, and avoid large indoor events.
The girls are still going to child care (but all teachers are fully
vaccinated and wear masks). We still have our plane tickets to CA for
Christmas. But my husband and I got on the same page last night and both
agreed that we need to closely watch how this unfolds in the coming weeks.
This may mean cancelling Christmas plans with unvaccinated family members
or cancelling plane tickets last minute. The name of the game is
flexibility.
------------------------------

*“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH
PhD— an epidemiologist, biostatistician, professor, researcher, wife, and
mom of two little girls. During the day she has a research lab and teaches
graduate-level courses, but at night she writes this newsletter. Her main
goal is to “translate” the ever-evolving public health science so that
people will be well-equipped to make evidence-based decisions, rather than
decisions based in fear. This newsletter is free thanks to the generous
support of fellow YLE community members. To support the effort, please
subscribe here:*

Subscribe now
<https://email.mg2.substack.com/c/eJx1Ustu2zAQ_BrrVoGkZD0OPLh-JDJquwGCuOlFoMi1TJkPQaLqyF9fyg4C9FCAJMCdXezM7nDmoLbdSFvbu2B6Sje2QA1cewXOQRcMPXSlFJREaYpIlASCxgJn8yyQfXnqADSTirpugKAdKiU5c9Kae0WGCc6DMyXC1yYpIIGyLOcoQ_x0qgARVuVzzNGjMRuEBMOBwh_oRmsgUPTsXNvPosWMbPwZ7dApy5mCVgrQ0ipby96F_VD1jvFLyK32adOXd7KCWbRx9gJmFq1g3GJO3sZfRF2Kxo67G492q-K2l1fJjhvkYx_7Zhfvm8Lf-vpjuVXwvJCHZk32q_W4axbksFr0hVY3PhZJYb7jd4nGw4S9XqTPv4ljIQ9y27Cnt4aRHIvlNg83H0vUCSjTCr-s09v28Hq87qr3J31o1-rl-feH_TlvU9k45EUmg9OlBiEHPXGeJvsZ7L107gWtvsR9u0pRg_vEuTUOjPMJcZzPkzjJA0kJIhgTFOM4SkkckjBNYhB55WcfAcriKjSyNYooNYuRrsk_gww6ykPNoNfSnT1eT2zugF-z76f1YKQbSzCsUiAeDnAPI92ZlzUY6LzBRMkcxUmUJSRLMpTl6WPh3iJfZH1nYX2Vof9Z8l-jCOlB>
<https://email.mg2.substack.com/c/eJx1UkuPmzAQ_jXhVgS2eR04tJtmRdSQptoNTS_I2AMxGEzBJCG_vibZHnqoZM_Invnm-TGqoVLDHPdq1NYicj33EHdwHSVoDYM1jTDkgscIB4GDsG_xmHA39EJLjHk5ALRUyFgPE1j9VEjBqBaqeyBCF7mRdY4J8ZCPUVgiQpnn05A7HqdRGeAoDDgKnonpxAV0DGK4wDCrDiwZn7XuxxX-vEIbc2Y1DVIxKqEXHFqhpKrEqO1xKkZNWWMz1Ro32gsjL64RS2CjHjV-GoCypbYV3mjVgNFrmLcuQ8f5J5JNUqt5d2d4t07uqbgK9hrd-Sbqf70kfro-eOnbyUnrZky6rTxlqUOzaDIYQXrUJMafZhvHvG9pvSNpnZhbXb-9bHsTUezF9sqzRO_q6rarv3qLP8NHseBZezyf8I--QESUB7s-sbRk4j4Gt_L93T1-V9Px4uw2NFOv7Lovmt-HL29esZfZYYX8Sbf5aMbCwHTzdw4f_y1wMbVLl0v7loiRg1wXOcQlOEDERnbgE-BRURaAwQlJYXei7ySSckWctkL_DNYaYma3FMZW6LOxV0vQh8GsPTe6nTqh5xw6WkjgT0boJ7EeBeQVdDAYwvGc6tj1ceij0A-dMPoggKEMIZHnEz-yTGauDKqL_7P0P_wu8C4>
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<https://email.mg2.substack.com/c/eJx1UktzmzAQ_jXmZgaEeB04tHad0AQnbjwekwsD0mLL1oMgEQd-fWW7PfTQGa1mZx_fPr4ltYGD6sesU9o4168yYweZhIvmYAz0zqChrxjNUBDHHgoih2aY-kmYOExXbQ8gasYz0w_gdEPDGakNU_KWkfjIT51j1kAcEhoGbZyGVk-s4pGWoBYjWlMc3QvXA2UgCWTwCf2oJDg8OxrT6VnwbYZW9o1q6LkiNYeOURBMcXVg2rh6aLSpydklStiwzooSjPRKzoeO2hHnFMgcW7MNECCNhVwZdQY5C5Yw_vQJ2o17xM_5SY3FRIJimU9rdmHkIZ3oKu3eF3m0Xm7C9bb01qezzgU_UmsrtuX0sixHK7hYXFi9X08Wg5HHHXve5rjY5l8vb7nO5dovWR7l8vsnCTaGiN2xDH51DcKs3bgVmZ4-HuT8bTi1r-O-f_7xsVVPjwt87jq2XBWsxe86OaXlaz5D0WBEpe0mCNju_47-xy6AskFcp7qy4rAMecj3kYd9HMQIu8iNIww0bdoGAvAS3LiSdZIjzmfYEwf0zy6dPiOuqEELZo7Wf7iC3hyW6eq6y0EyM1Yg64YDvR-Bud_SrYHqABJ6SwCtapP5UZBEKIkSL0njO-f2SjBOwwhHqWMrU2WzZPYfnn8D2mjsIg>
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