Swerd

Swerd

Audioholic Warlord
They can estimate as much as they want, but some people will say they aren't going to get it just to feel accepted in their particular group, then get it anyway. I've already seen people get called out for it, whether or not the posts are real...
We all know of one orange-haired former US president who kept it secret from the public when he and his wife were vaccinated in January, shortly before he left office.
 
NINaudio

NINaudio

Audioholic Samurai
If you think Indiana's roads are awful, you'll really hate what we have here- WI was rated D+ by the American Society of Civil Engineers.


I think they were being generous.
That's still better than the D that Illinois got. :eek:
 
NINaudio

NINaudio

Audioholic Samurai
Just took my 1st Moderna shot today, I go back for the 2nd in 28 days. They give me a COVID-19 Vaccination Record Card which is from CDC.
Glad to see you changed your mind about getting it.
 
Swerd

Swerd

Audioholic Warlord
I'm unrepentant, because this bureaucratic thinking will cost lives, and lots of them.
I am aware that you're unrepentant – unrepentantly wrong. If you worked for a pharmaceutical maker as a medical officer and you acted like that with the FDA, you'd loose your job as soon as someone could call out "Security! Someone escort Dr. Carter out the door!"

The FDA is what protects the American public from snake oil pharmaceuticals. Thalidomide and inadequately inactived Salk Polio vaccine (not to mention the SV40-virus-contamination in Salk vaccine) are two well-known examples of why the US FDA is so unrepentant about rigorous and safety and efficacy testing. I worked for many years on the receiving end of the FDA's unrepentant attitude in the development of anti-cancer drugs. It earned my reluctant respect over the years. They are quite intelligent, and they can be persuaded by facts and reason. They fully understand what constitutes medical needs and medical emergencies. They are certainly not bureaucratic pin-heads as you accuse them.
 
Swerd

Swerd

Audioholic Warlord
Moderna testing new COVID-19 vaccine as potential booster shot | Reuters

Now I'll have to get a third shot. I haven't even received my second dose yet.
Not yet. Those new tests are of a different kind of nanoparticle coating, intended to allow refrigerated storage instead of deep freeze (-70° C) storage. I'm not aware that these test involve mRNA with a different Spike protein sequence. Those are probably in the works, but not yet ready for early phase clinical trials.
 
TLS Guy

TLS Guy

Seriously, I have no life.
I am aware that you're unrepentant – unrepentantly wrong. If you worked for a pharmaceutical maker as a medical officer and you acted like that with the FDA, you'd loose your job as soon as someone could call out "Security! Someone escort Dr. Carter out the door!"

The FDA is what protects the American public from snake oil pharmaceuticals. Thalidomide and inadequately inactived Salk Polio vaccine (not to mention the SV40-virus-contamination in Salk vaccine) are two well-known examples of why the US FDA is so unrepentant about rigorous and safety and efficacy testing. I worked for many years on the receiving end of the FDA's unrepentant attitude in the development of anti-cancer drugs. It earned my reluctant respect over the years. They are quite intelligent, and they can be persuaded by facts and reason. They fully understand what constitutes medical needs and medical emergencies. They are certainly not bureaucratic pin-heads as you accuse them.
This is totally different. You can negate these assertions from a quick mining of the database of the NHS for instance. This might be a little more difficult in the US because of fragmentation of the health care system which is decentralized. However the UK can put nonsense like this to rest fast and with certainty. I can be absolutely certain the AstraZeneca vaccine does not cause DVTs and thromboembolism.
 
Irvrobinson

Irvrobinson

Audioholic Spartan
I deliberately choose Boeing as an example. They tested their new airliner, the 737 Max, were well aware of it's problems, but concluded that it was good to go. The Federal Aviation Administration's (FAA) toothless certification method allowed Boeing to both perform the tests and evaluate the results, resulting in a fatally flawed airliner. Boeing's own actions ruined their previously stellar reputation. No one benefited from cutting corners.
I don't agree with your 737 MAX conclusions, but this isn't the appropriate thread for that discussion.
 
GO-NAD!

GO-NAD!

Audioholic Spartan
While individual European countries are suspending the use of the AstraZeneca vaccine, the European Medicines Agency is making no such recommendation.
Major European nations suspend use of AstraZeneca coronavirus vaccine amid blood clotting concerns | CP24.com
The World Health Organization and the EU’s European Medicines Agency have also said that the data does not suggest the vaccine caused the clots and that people should continue to be immunized.

“Many thousands of people develop blood clots annually in the EU for different reasons,” the European Medicines Agency said. The incidence in vaccinated people “seems not to be higher than that seen in the general population.”

The agency said that while the investigation is going on, “the benefits of the AstraZeneca vaccine in preventing COVID-19, with its associated risk of hospitalization and death, outweigh the risks of side effects.”
Health Canada is not recommending any suspension of its use either and the government is following that advice. The kerfuffle over the AZ vaccine is quite bemusing.
 
highfigh

highfigh

Seriously, I have no life.
According to the charity Thrombosis UK, up to one in 1,000 people each year will experience a dangerous blood clot in a vein, known as a venous thrombosis. That means about 66,000 people in Britain might be expected to suffer a blood clot annually – or 1,269 a week.

According to AstraZeneca, there have been 15 events of deep vein thrombosis (DVT) and 22 events of pulmonary embolism (PE) reported among those given the vaccine so far across the EU and UK, based cases up to March 8.

The company estimates that 17 million AstraZeneca vaccines have been delivered in that time. That means that the risk of suffering from DVT or a PE after vaccination is 37 in 17 million, or roughly one in 460,000.
At the current prevalence rate, in a population of 17 million we might expect 326 cases to naturally show up in the week following a vaccine, so 37 starts to look very low.
The National Institute for Health and Care Excellence (Nice) estimates the risk of a blood clot is even higher - around one in 500 - meaning that even more cases would be expected.
Even if all 37 cases were linked to the vaccine – which is highly unlikely – the risk is still far lower than that of dying from coronavirus, which has an infection fatality rate of between 0.5 and one per cent.
Dr Peter English, the immediate past chair of the BMA Public Health Medicine Committee, said: "When a vaccine is administered to millions of people, it is inevitable that some adverse events, that would have happened anyway, will happen shortly after vaccination.
"It is most regrettable that countries have stopped vaccination on such 'precautionary' grounds. It risks doing real harm to the goal of vaccinating enough people to slow the spread of the virus, and to end the pandemic."
Another factor that must be taken into account is the characteristics of the vaccinated population.
Both DVT and PE are most common in people aged 50 and over, as well as those with underlying health conditions and those who are overweight or obese. In other words, they are most common in the very population which is being prioritised for the jabs.
For people under 40 years the annual incidence a blood clot is 1 in 10,000, whereas for people over 80 years the incidence rises to 1 in 100.
Jo Jerrome, the CEO of Thrombosis UK, said: "We need to remember the risk of DVT/PE increases with age and that we are currently vaccinating the very oldest in our population.
"If the figure is 37 per 17 million, who will be mainly over-60s, we think this is very low and less than the background risk associated in the general population, so would agree with current statements from the Medical and Healthcare products Regulatory Agency and the WHO that there appears to be no association."
In Britain at least, the numbers of incidents of DVT and PE do not differ between the vaccines.
Michael Makris, professor of Haemostasis and Thrombosis at the University of Sheffield, pointed to reports showing that there have been 13 cases of pulmonary embolism in 10 million doses of the AstraZeneca jab, and 15 cases in the Pfizer/BioNTech vaccination.

And there is one more possibility. Blood clotting is very common in people suffering from coronavirus itself, so the figures could be picking up people who caught the virus around the time of vaccination.
Stephen Evans, professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, said: "Coagulation disorders are very common in patients with Covid-19. Early reports from China noted over 30 per cent of patients reaching hospital had thrombocytopenia.

The British regulator has not, and does not, intend to stop vaccinations proceeding apace, and that is the correct decision.
I see comments all over from people who say they can't wait to be able to go outside and do things and that a lot of people have gained weight since quarantine began- I have to think a huge number of people have been sitting on their butts the whole time and we already know that sitting for long periods raises the chance of DVT- is anyone checking into the physical activity level in the people with blood clots? If not, they need to.
 
highfigh

highfigh

Seriously, I have no life.
That's still better than the D that Illinois got. :eek:
I think the grading is an average- statewide, WI may be at D+, but in MKE, it's terrible. I saw a news video from a local TV channel saying the city has received fewer complaints about the roads than in the past- well, that's hardly surprising now that the city has taken away the ability to easily sue for damages caused by badly-maintained roads, so I have to imagine people have just given up. I have seen chunks of concrete laying on top of the pavement, 2'+ diameter holes that were more than a couple of inches deep in concrete and asphalt, large cracks, chunks of the curb that had been broken by cars and plows.....I even saw that a round manhole cover was missing, then watched a guy rolling it along to take it to a scrap yard, for cash. Yeah, I called about that one and some of the others.

Oh, yeah- WI has wasted more than 2000 doses of the vaccine, too. Well done, Wisconsin- well done.
 
M

Mr._Clark

Audioholic Samurai
Agree we had this old die hard biker guy that said " I 'm not getting any dam shot, its all made up poop, a Govt way to get rid of people". I said, so your mother who had the shot wil be dead soon I guess and the majority of the doctors and lab people, Doesn't make sense, what are you smoking, get real. . Well his wife got Covid, she healed and as soon as the vaccine center opened he had an appointment for his first. I asked him what happened to the MR Macho crap you were talking about,, he said " well this Covid poop is real", . My work was done. LOL
Reality can be quite persuasive.
 
M

Mr._Clark

Audioholic Samurai
I am aware that you're unrepentant – unrepentantly wrong. If you worked for a pharmaceutical maker as a medical officer and you acted like that with the FDA, you'd loose your job as soon as someone could call out "Security! Someone escort Dr. Carter out the door!"

The FDA is what protects the American public from snake oil pharmaceuticals. Thalidomide and inadequately inactived Salk Polio vaccine (not to mention the SV40-virus-contamination in Salk vaccine) are two well-known examples of why the US FDA is so unrepentant about rigorous and safety and efficacy testing. I worked for many years on the receiving end of the FDA's unrepentant attitude in the development of anti-cancer drugs. It earned my reluctant respect over the years. They are quite intelligent, and they can be persuaded by facts and reason. They fully understand what constitutes medical needs and medical emergencies. They are certainly not bureaucratic pin-heads as you accuse them.
There seems to be wide agreement that government oversight with regards to safety is a good thing. The debate seems to be whether or not the reports of clotting are significant enough to warrant a pause based on the facts as known. What is the threshold requirement for a pause? What should it be? These are basically rhetorical questions; I'm assuming the requirements vary from country to country and what they "should" be is subjective. IMHO it wouldn't make sense to pause vaccination just because one person out of 100 million sneezes after getting a jab. On the other hand, if 90% of people getting a jab had a heart attack and dropped dead within 5 minutes, a pause would obviously be in order.

The statement in the Reuters article below that Germany had no choice but to act is not necessarily inconsistent with the statement that the risk of dying of COVID is orders of magnitude greater. Even assuming the clotting was caused by the vaccine, it's conceivable that the threshold for a pause is low enough that the pause results in more fatalities than continuing the vaccinations. It's also conceivable that a pause will ultimately save lives, but I'm having a hard time seeing how this could be the case.

My impression is that the threshold requirements for a pause in most countries are largely independent of the risk due to the pause itself (i.e. the downside risk of a pause appears to be a minor factor in the decision). However, I don't know if this is actually true. If someone has information that contradicts my impression, I'm all ears so to speak.

Of course, I have zero input on any of these decisions, so my opinion means zip.

So far, in most EU countries the AZ vaccine is about 15%-20% of the total.

1615899223950.png


>>>European epidemiologists remained baffled that similar cases had not occurred in unusual numbers in Britain, which began using AstraZeneca earlier and has administered more than 10 million doses.

“These symptoms have not yet been observed there,” said Stephan Becker, head of the Institute for Virology at Philipps University Marburg. . . .

Nicola Magrini, the director general of Italy’s medicines authority AIFA, told daily la Repubblica in an interview that the choice to suspend the AstraZeneca shot was “political”.

He said it was safe and said its benefit to risk ratio was “widely positive”. There have been eight deaths and four cases of serious side-effects in Italy following vaccinations, he added. . . .

Sources said Germany had no choice but to act after its vaccine watchdog identified an unusual number of cases of rare cerebral vein thrombosis. Of 1.6 million people in Germany who had got AstraZeneca, seven fell ill and three died.

Yet the risk of dying of COVID is still orders of magnitude greater, especially among those most vulnerable such as the elderly, said Dirk Brockmann, an epidemiologist at the Robert Koch Institute for infectious diseases.

“One is probably 100,000 times more likely to die of COVID than because of an AstraZeneca vaccine,” Brockmann told ARD public television.<<<


 
GO-NAD!

GO-NAD!

Audioholic Spartan
Sources said Germany had no choice but to act after its vaccine watchdog identified an unusual number of cases of rare cerebral vein thrombosis. Of 1.6 million people in Germany who had got AstraZeneca, seven fell ill and three died.

Yet the risk of dying of COVID is still orders of magnitude greater, especially among those most vulnerable such as the elderly, said Dirk Brockmann, an epidemiologist at the Robert Koch Institute for infectious diseases.
Cerebral Venous Thrombosis - StatPearls - NCBI Bookshelf (nih.gov)
"Cerebral venous thrombosis is a rare disorder with an annual incidence estimated to be three to four cases per million."

So, the German stats aren't really out of line with normal frequency of occurrence. Maybe they should investigate whether anyone has been run over by a car after getting the AZ vaccine and see if the numbers are out sync with the norm. It could be causing people to walk out in front of moving vehicles...
 
TLS Guy

TLS Guy

Seriously, I have no life.
The European Medical Agency, has reiterated that the AstraZeneca vaccine is safe. The italians have blown the cover and admitted that the reason to pause the vaccine was political. The German political establishment is tearing itself apart over the issue.

A lot of this I think has arisen because of the French Precautionary Principle which they enshrined in their constitution, that has spread like a paralysing virus throughout the EU. It demands a reverse of policy if the slightest risk is even brooked. It is a totally absurd idea, and is stultifying the EU at a phenomenal rate.

So they have now run the data on their Pfizer vaccine developed in Germany. That has a slightly higher, but not significantly higher rate of blood clots than the AstraZeneca vaccine. So now the Europeans are stuck in a massive political crisis of their own making.

I know Irv will find this incredible, but this really was driven to a large extent, over the UK leaving the EU, which the EU are increasingly bitter about.

This will be costly in lives, and German economists say, this will cost the German Economy alone 1.7 billion Euros.

This is a self inflicted disaster for the EU, and leading to massive vaccine hesitancy among their public, which now has to be reversed.

The bottom line here, is that in a crucial public health emergency with a large number of lives at stake, then the decision to suspend, or halt a vital pharmaceutical's distribution, should require as much rigorous data and analysis, as to approve the pharmaceutical in the first place. In other words halting a vital resource is as dangerous as approving a dangerous one, and both require the same rigor.

Swerd will probably disagree, but what the EU countries have done, and NOT their regulator, is appalling. The fact that there are underlying political overtones is truly vile.
 
Swerd

Swerd

Audioholic Warlord
I don't agree with your 737 MAX conclusions, but this isn't the appropriate thread for that discussion.
It is appropriate because Boeing and the FAA failed to identify an unsafe airliner. It took two crashes, hundreds of dead passengers & crew, plus more than 1½ years of a No-Fly Hold on the 737 MAX before the problem was fixed. The damage to Boeing's sales and reputation will go on for years or decades. This disaster could have been avoided if the FAA had more regulatory power.

Instead of fatal air crashes, we are talking about rare instances of cranial blood clots in people who received a newly approved vaccine. I do hear people citing the rarity of cranial blood clots as evidence that it is unrelated to the vaccine. But I don't hear people defending the 737 MAX by saying that those two crashes were very rare compared to all of the plane's successful flights.

Instead of 1½ years of no flights and no sales, we are talking about 2 week hold on using the AZ vaccine, to allow a detailed assessment of what may have caused these rare blood clots.

I think the FDA's level of regulation is an example of how safety regulation can be done. I do agree that there are limits in comparing the aviation industry to the pharmaceutical industry, but the aviation industry and the FAA could learn quite a lot about safety regulation from the FDA.
 
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Swerd

Swerd

Audioholic Warlord
This is totally different. You can negate these assertions from a quick mining of the database of the NHS for instance. This might be a little more difficult in the US because of fragmentation of the health care system which is decentralized. However the UK can put nonsense like this to rest fast and with certainty. I can be absolutely certain the AstraZeneca vaccine does not cause DVTs and thromboembolism.
To the best of my knowledge, no medical database anywhere is trusted well enough to consider it as validated for medical diagnosis.

You claim that a quick mining of the NHS database puts the worry about cranial blood clots to rest – that these blood clots happen with similar rare frequency among non-vaccinated people as with vaccinated people. I reiterate: Databases cannot prove anything. Databases have nothing to say about possible linkages between rare but serious medical problems and new medications, such as vaccinations. At best, databases can provide background evidence that suggests something may or may not be happening. To put to rest the worries and concerns, the detailed medical histories of each individual blood clot case must be examined by qualified professionals. A 2-week clinical hold on new vaccinations is a quite reasonable time frame for this. The result may very well be that no link could be found between the vaccine and the blood clots. And, if so, the clinical hold will be removed. I don't see any harm in investigating this.
 
M

Mr._Clark

Audioholic Samurai
WaPo has an article on the topic of the pauses in Europe (link below) entitled "European Medicines Agency ‘firmly convinced’ that benefits of AstraZeneca vaccine outweigh risks, director says"

I'm not an expert with regards to medical ethics (if you don't believe me, just keep reading!), but, at least on the face of it, the principle "first do no harm" does not take into account the potential harms caused by inaction. If this were to be taken literally, it would be unethical to perform surgery because the act of cutting the patient undoubtedly causes some harm. For what it's worth, according to wiki, a commonly used oath includes "I will prevent disease whenever I can, for prevention is preferable to cure." (https://en.wikipedia.org/wiki/Hippocratic_Oath)

>>>The head of the European Medicines Agency said Tuesday that health regulators remained “firmly convinced” that the benefits of the AstraZeneca coronavirus vaccine outweighed the risks amid concerns that the shots caused blood clots in some people.

An expert panel is investigating the potential link between vaccinations and a small number of extremely rare brain clots, and it is slated to release its conclusions Thursday, Emer Cooke, the agency’s executive director, said at a news conference. There was “no indication” that the vaccine caused the adverse events, which seemed not to be higher in vaccinated people than in the general population, Cooke said.<<<

 
TLS Guy

TLS Guy

Seriously, I have no life.
It is appropriate because Boeing and the FAA failed to identify an unsafe airliner. It took two crashes, hundreds of dead passengers & crew, plus more than 1½ years of a No-Fly Hold on the 737 MAX before the problem was fixed. The damage to Boeing's sales and reputation will go on for years or decades. This disaster could have been avoided if the FAA had more regulatory power.

Instead of fatal air crashes, we are talking about rare instances of cranial blood clots in people who received a newly approved vaccine. I do hear people citing the rarity of cranial blood clots as evidence that it is unrelated to the vaccine. But I don't hear people defending the 737 MAX by saying that those two crashes were very rare compared to all of the plane's successful flights.

Instead of 1½ years of no flights and no sales, we are talking about 2 week hold on using the AZ vaccine, to allow a detailed assessment of what may have caused these rare blood clots.

I think the FDA's level of regulation is an example of how safety regulation can be done. I do agree that there are limits in comparing the aviation industry to the pharmaceutical industry, but the aviation industry and the FAA could learn quite a lot about safety regulation from the FDA.
To the best of my knowledge, no medical database anywhere is trusted well enough to consider it as validated for medical diagnosis.

You claim that a quick mining of the NHS database puts the worry about cranial blood clots to rest – that these blood clots happen with similar rare frequency among non-vaccinated people as with vaccinated people. I reiterate: Databases cannot prove anything. Databases have nothing to say about possible linkages between rare but serious medical problems and new medications, such as vaccinations. At best, databases can provide background evidence that suggests something may or may not be happening. To put to rest the worries and concerns, the detailed medical histories of each individual blood clot case must be examined by qualified professionals. A 2-week clinical hold on new vaccinations is a quite reasonable time frame for this. The result may very well be that no link could be found between the vaccine and the blood clots. And, if so, the clinical hold will be removed. I don't see any harm in investigating this.
With respect, that is not the action that any rational practicing physician would countenance. Your thinking is actually the place where the EU is at. Now when you are going to vaccinate whole populations, in fact the whole world there are going to be people who get seriously ill after vaccination, that is unavoidable. You can't possibly put a two week hold on to investigate everyone who gets a serious illness, or dies after a vaccination. Good databases are perfectly adequate for showing trending away from the normal curve. It is only when you see a significant trend away from the previous curve that you need to investigate. If you do what the EU are doing we will all be doomed. The UK are correct to oppose this type of thinking and really be vociferous about it.
I have to say Swerd your logic is exactly the dangerous harmful logic prevalent in the EU right now.

Personally even if there was an adverse effect of the vaccine, if the adverse events were significantly less than the risk of catching the virus, I would NOT halt vaccination. We have to get control of this, and the old British saying: "He Who Dares Wins", is operative at this point. Thank Heavens the UK did not think like many European nations in 1939 and 1940, or the world would be a very different place right now. The same approach is just as apt now, as we are in fact fighting a very dangerous enemy once more. This is why Spitfires and Hurricanes have taken to air so often in the last year, to bring that association home. That has not been lost on the Queen who has not so subtly made the association during the past year. That is why vaccines are being rolled out at breakneck speed, and in a highly orderly manner, with citizens waiting for their call, and considering it their patriotic duty to be vaccinated, which it is, the same as for US citizens.
 
Irvrobinson

Irvrobinson

Audioholic Spartan
It is appropriate because Boeing and the FAA failed to identify an unsafe airliner. It took two crashes, hundreds of dead passengers & crew, plus more than 1½ years of a No-Fly Hold on the 737 MAX before the problem was fixed. The damage to Boeing's sales and reputation will go on for years or decades. This disaster could have been avoided if the FAA had more regulatory power.

Instead of fatal air crashes, we are talking about rare instances of cranial blood clots in people who received a newly approved vaccine. I do hear people citing the rarity of cranial blood clots as evidence that it is unrelated to the vaccine. But I don't hear people defending the 737 MAX by saying that those two crashes were very rare compared to all of the plane's successful flights.

Instead of 1½ years of no flights and no sales, we are talking about 2 week hold on using the AZ vaccine, to allow a detailed assessment of what may have caused these rare blood clots.

I think the FDA's level of regulation is an example of how safety regulation can be done. I do agree that there are limits in comparing the aviation industry to the pharmaceutical industry, but the aviation industry and the FAA could learn quite a lot about safety regulation from the FDA.
The vaccine and the MAX situations are not at all similar. First of all, while I seriously question Boeing's strategy of using key design aspects of the original 737 airframe for the MAX to reduce time-to-market, there is no evidence that the MAX is "fatally flawed". Proof? There were no mechanical or propulsion changes made to the plane to get it re-certified. The changes were making two previously optional instrumentation features mandatory (both crashed planes lacked these features), changes to selected aspects of the MCAS software, and changes to pilot training for the MAX. The history of MCAS and why it was necessary, and whether or not Boeing's implementation was optimal, is fascinating, but beside the point for the purpose of this response. Boeing was trying to make the MAX transparent to 737NG pilots, and that was a flawed strategy. The Airbus A320neo series didn't require unique training, so Boeing got too aggressive for their own good. It is not clear what role the airlines played in pressuring Boeing. Some sources also say Boeing assumed a greater level of pilot training and experience than what was typical in certain Asian and African airlines.

Personally, I think Boeing needs top-to-bottom change, and there's no published evidence of that happening yet. But using the MAX situation as a comparison to the Euro AZ vaccine decision isn't valid.
 
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NINaudio

NINaudio

Audioholic Samurai
I think the grading is an average- statewide, WI may be at D+, but in MKE, it's terrible. I saw a news video from a local TV channel saying the city has received fewer complaints about the roads than in the past- well, that's hardly surprising now that the city has taken away the ability to easily sue for damages caused by badly-maintained roads, so I have to imagine people have just given up. I have seen chunks of concrete laying on top of the pavement, 2'+ diameter holes that were more than a couple of inches deep in concrete and asphalt, large cracks, chunks of the curb that had been broken by cars and plows.....I even saw that a round manhole cover was missing, then watched a guy rolling it along to take it to a scrap yard, for cash. Yeah, I called about that one and some of the others.

Oh, yeah- WI has wasted more than 2000 doses of the vaccine, too. Well done, Wisconsin- well done.
Ahh, sounds like the roads in my hometown in NJ. I'll find the picture I took to send to a friend in Oregon who thought they had bad roads.
 
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