Help me help someone with ivermectin

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When the pfizer pill gets EUA I hope to see the same level of push back over the study submitted bc it isn’t a strong study. But you can count on me to try it for those that need it.
"The scheduled interim analysis showed an 89% reduction in risk of COVID-19-related hospitalization or death from any cause compared to placebo in patients treated within three days of symptom onset (primary endpoint); 0.8% of patients who received PAXLOVID™ were hospitalized through Day 28 following randomization (3/389 hospitalized with no deaths), compared to 7.0% of patients who received placebo and were hospitalized or died (27/385 hospitalized with 7 subsequent deaths). The statistical significance of these results was high (p<0.0001). Similar reductions in COVID-19-related hospitalization or death were observed in patients treated within five days of symptom onset; 1.0% of patients who received PAXLOVID™ were hospitalized through Day 28 following randomization (6/607 hospitalized, with no deaths), compared to 6.7% of patients who received a placebo (41/612 hospitalized with 10 subsequent deaths), with high statistical significance (p<0.0001). In the overall study population through Day 28, no deaths were reported in patients who received PAXLOVID™ as compared to 10 (1.6%) deaths in patients who received placebo."



Tell me how ivermectin efficacy compares.
 
Anybody here have any experience with fluvoxamine? I have been asked about it by a few friends in the last month when they had breakthrough infections. The studies are encouraging but there sure doesn't seem to be any enthusiasm about it. I don't know if it just gets lumped into the Ivermectin/HCQ bucket in people's minds or if there's just more anticipation of Paxlovid's approval.
 
Anybody here have any experience with fluvoxamine? I have been asked about it by a few friends in the last month when they had breakthrough infections. The studies are encouraging but there sure doesn't seem to be any enthusiasm about it. I don't know if it just gets lumped into the Ivermectin/HCQ bucket in people's minds or if there's just more anticipation of Paxlovid's approval.

Just get vaccinated bro jesus christ
 
Pgg I have always respected your post in the past but lately I think the pandemic has gotten to you.
It really has gotten to me.

How could it not? Every time I put on PPE to trach and PEG some ignorant antivaxxer who's needlessly occupied an ICU bed for a couple weeks and delayed or denied care to another person who needed that bed, it gets to me.

Every time I see a doctor who panders to the ivermectin peddlers or is an ivermectin peddler himself, it gets to me. (Or hydroxychloroquine, or ...) Because they're part of the problem, as they give people a reason to think they can just take ivermectin and be fine if they catch covid. They give the antivax crusaders a convenient person to quote. It normalizes their recklessness and it makes them less likely to get vaccinated. It's irresponsible. It's bad medicine. It's outside the standard of care.

I find myself caring less and less if the unvaccinated live, or die, or go to rot in a rehab facility. And to be honest, the unexpected fact that I don't care about them any more, also gets to me. I never thought I'd reach the point as a physician where there'd be a cohort of sick people for whom I would just shrug off their deaths. Yes, you could say the pandemic has gotten to me.
 
It really has gotten to me.

How could it not? Every time I put on PPE to trach and PEG some ignorant antivaxxer who's needlessly occupied an ICU bed for a couple weeks and delayed or denied care to another person who needed that bed, it gets to me.

Every time I see a doctor who panders to the ivermectin peddlers or is an ivermectin peddler himself, it gets to me. (Or hydroxychloroquine, or ...) Because they're part of the problem, as they give people a reason to think they can just take ivermectin and be fine if they catch covid. They give the antivax crusaders a convenient person to quote. It normalizes their recklessness and it makes them less likely to get vaccinated. It's irresponsible. It's bad medicine. It's outside the standard of care.

I find myself caring less and less if the unvaccinated live, or die, or go to rot in a rehab facility. And to be honest, the unexpected fact that I don't care about them any more, also gets to me. I never thought I'd reach the point as a physician where there'd be a cohort of sick people for whom I would just shrug off their deaths. Yes, you could say the pandemic has gotten to me.
And you dont have to interface with their ****ing crazy family on a daily basis for months on end like the hospitalists/intensivists/LTACH docs where we get accused on a routine basis of not trying to get them better or be willing to 'try everything.' It has worn us all down and we are all completely sick of these ****ers.
 
Just get vaccinated bro jesus christ
Whoaaaa there, hold your
horses. I am vaccinated. As was everyone who asked me about it. Just curious, not trying to trigger anyone.
 
I agree current evidence that is there isn’t strong but there is evidence for both hydroxy and ivermectin to suggest that it does have antiviral properties and that it may show benefit but as always needs larger trials which likely won’t occur bc COViD is no longer treated with just a single drug as touched on above.
Isn’t all this antiviral business based on in vitro tests …. It’s essentially idea provoking, but in no way suggestive that the drug would actually even work in a human being.
 
"The scheduled interim analysis showed an 89% reduction in risk of COVID-19-related hospitalization or death from any cause compared to placebo in patients treated within three days of symptom onset (primary endpoint); 0.8% of patients who received PAXLOVID™ were hospitalized through Day 28 following randomization (3/389 hospitalized with no deaths), compared to 7.0% of patients who received placebo and were hospitalized or died (27/385 hospitalized with 7 subsequent deaths). The statistical significance of these results was high (p<0.0001). Similar reductions in COVID-19-related hospitalization or death were observed in patients treated within five days of symptom onset; 1.0% of patients who received PAXLOVID™ were hospitalized through Day 28 following randomization (6/607 hospitalized, with no deaths), compared to 6.7% of patients who received a placebo (41/612 hospitalized with 10 subsequent deaths), with high statistical significance (p<0.0001). In the overall study population through Day 28, no deaths were reported in patients who received PAXLOVID™ as compared to 10 (1.6%) deaths in patients who received placebo."



Tell me how ivermectin efficacy compares.
I always like to stay optimistic. Personally in a world pre pandemic I would look for larger “Independent” trials but then again I wouldn’t be debating Ivermectin. So then I jump to active ingredients and look at side effect profile and that is where I pause a little and will have to do more reading.
 
I always like to stay optimistic. Personally in a world pre pandemic I would look for larger “Independent” trials but then again I wouldn’t be debating Ivermectin. So then I jump to active ingredients and look at side effect profile and that is where I pause a little and will have to do more reading.

Yeah, stay away from those pesky studies. You're right to not want to debate them. What are we here, physicians scientists? Hah! I agree - focus on active ingredients. That'll show you the way. Think critically, like Joe Rogan and Aaron Rodgers. Keep getting advice from political hacks posing as doctors or celebrities. Stay strong, padawan.
 
Yeah, stay away from those pesky studies. You're right to not want to debate them. What are we here, physicians scientists? Hah! I agree - focus on active ingredients. That'll show you the way. Think critically, like Joe Rogan and Aaron Rodgers. Keep getting advice from political hacks posing as doctors or celebrities. Stay strong, padawan.
I guess my point was I wouldn’t be using either ivermectin or the Pfizer pill based on the current studies pre pandemic. The above press release on the Pfizer study was a very small sample size and done by the company who is selling it…does that study pass your pre pandemic criteria for strong and I will use on all my patients? In regards to active ingredients the pill contains 2 medications…one of which is an older antiviral with some significant side effects which is why I pause.
 
I guess my point was I wouldn’t be using either ivermectin or the Pfizer pill based on the current studies pre pandemic. The above press release on the Pfizer study was a very small sample size and done by the company who is selling it…does that study pass your pre pandemic criteria for strong and I will use on all my patients? In regards to active ingredients the pill contains 2 medications…one of which is an older antiviral with some significant side effects which is why I pause.

Nothing, other than hype and politics, supports ivermectin currently. Your question initially was what can help in the early stages, to avoid hospitalization and death. Assuming one is vaccinated and they still get sick, paxlovid seems a better option than ivermectin based on available studies, first and foremost because it appears to work. On side effects, ritonavir most commonly causes nausea, diarrhea, vomiting, fatigue, and parasthesias. All of those side effects appear superior to being hospitalized and dying. My guess is had Pfizer not used it, the anti-vaxx nutso political hacks would've adopted ritonavir as one of their own. I believe they have touted other HIV meds.

I guess I can, only some level, understand resistance to Pfizer, Merck, and the rest of 'big pharma'. But here's the thing, their stuff actually works! At least as far as I can tell. Political hackery continues its assault on vaccines and meds like paxlovid - but they actually keep you out of the hospital and alive! There's nothing definitive so far suggesting hcq, ivermectin, etc. does anything other than cause controversy because of who is supporting it.
 
It really has gotten to me.

How could it not? Every time I put on PPE to trach and PEG some ignorant antivaxxer who's needlessly occupied an ICU bed for a couple weeks and delayed or denied care to another person who needed that bed, it gets to me.

Every time I see a doctor who panders to the ivermectin peddlers or is an ivermectin peddler himself, it gets to me. (Or hydroxychloroquine, or ...) Because they're part of the problem, as they give people a reason to think they can just take ivermectin and be fine if they catch covid. They give the antivax crusaders a convenient person to quote. It normalizes their recklessness and it makes them less likely to get vaccinated. It's irresponsible. It's bad medicine. It's outside the standard of care.

I find myself caring less and less if the unvaccinated live, or die, or go to rot in a rehab facility. And to be honest, the unexpected fact that I don't care about them any more, also gets to me. I never thought I'd reach the point as a physician where there'd be a cohort of sick people for whom I would just shrug off their deaths. Yes, you could say the pandemic has gotten to me.
I hear you…nothing about the last couple years have been normal and or easy. The medical community is in a bad spot if any of us are shrugging off deaths of a subset of our patients while mourning the deaths of a separate subset of the population who passed from the same disease. I wish I had an answer on how to break the divide causing the above emotions…probably why I spend some time on this forum arguing alternative view points that I personally support. The pandemic does not have a monolithic path to recovery so it is important to be open and listen. Before someone calls me another random name which I assume is suppose to be derogatory in nature…I am pro vaccine, I recommend vaccines bc vaccines have clearly shown to improve outcomes for those that acquire COVID. My recent post are discussing treatment of COViD and I haven’t read anything suggesting to treat COVID with a vaccination.
 
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I guess my point was I wouldn’t be using either ivermectin or the Pfizer pill based on the current studies pre pandemic. The above press release on the Pfizer study was a very small sample size and done by the company who is selling it…does that study pass your pre pandemic criteria for strong and I will use on all my patients? In regards to active ingredients the pill contains 2 medications…one of which is an older antiviral with some significant side effects which is why I pause.
The use of ritonavir is primarily to inhibit the cytochrome p450 enzymes to allow the actual drug concentrations to remain high.

Ritonavir is an irreversible inhibitor of those enzymes so I’m not sure they need to use a dose high enough to cause the typical ritonavir side effects.
 
I always like to stay optimistic. Personally in a world pre pandemic I would look for larger “Independent” trials but then again I wouldn’t be debating Ivermectin. So then I jump to active ingredients and look at side effect profile and that is where I pause a little and will have to do more reading.
I can almost guarantee you that you don't care about (or are not aware of) the fact that a hundred other efficacious drugs you use won full FDA approval (not just an EUA) through submission of an industry sponsored study.

And as far as the study being "larger," this wish is a canard since the p value for reducing hospitalization or death was already <0.0001 .
 
If people applied their anti-vax logic consistently, they wouldn’t be asking for HCQ, Ivermectin, or Regeneron, etc. None of them of FDA approved for the treatment of COVID, all their studies have smaller Ns than the vaccine studies, all of them have poorer outcomes than the vaccine, and long term outcomes are unknown, if you don’t know what an mRNA is you probably don’t know what a monoclonal antibody is etc.

And IMO, and if the vaccine was studied like other treatments for other diseases, the study would’ve stopped long ago as the control arm is doing so poorly and everyone in the study would’ve been vaccinated.

I get the feeling, in 100 years, people will be asking ‘The scientists has this ground-breaking vaccine yet lots of people didn’t get it. Were the scientists hiding this treatment from the public like they did with Tuskegee?’
 
What to tell them? Tell them that humans don’t get their medicine over the counter from the feed store.
And meta analysis is garbage science.
And if it did work, the pharmaceutical companies would happily mass produce it and provide it to you for a fabulous profit.
 
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I can almost guarantee you that you don't care about (or are not aware of) the fact that a hundred other efficacious drugs you use won full FDA approval (not just an EUA) through submission of an industry sponsored study.

And as far as the study being "larger," this wish is a canard since the p value for reducing hospitalization or death was already <0.0001 .
I can almost guarantee you that you don't care about (or are not aware of) the fact that a hundred other efficacious drugs you use won full FDA approval (not just an EUA) through submission of an industry sponsored study.

And as far as the study being "larger," this wish is a canard since the p value for reducing hospitalization or death was already <0.0001 .
I do care and and with most medications I tend to wait to see how the administration of each medication plays out over time.

I am not concerned about the p value…a larger sample size helps reduce error and variabilities associated with such a small sample size. I am confident the medication will be used in my system and I hope it works as well as advertised to replace all other antivirals to help prevent hospitalization.
 
If people applied their anti-vax logic consistently, they wouldn’t be asking for HCQ, Ivermectin, or Regeneron, etc. None of them of FDA approved for the treatment of COVID, all their studies have smaller Ns than the vaccine studies, all of them have poorer outcomes than the vaccine, and long term outcomes are unknown, if you don’t know what an mRNA is you probably don’t know what a monoclonal antibody is etc.

And IMO, and if the vaccine was studied like other treatments for other diseases, the study would’ve stopped long ago as the control arm is doing so poorly and everyone in the study would’ve been vaccinated.

I get the feeling, in 100 years, people will be asking ‘The scientists has this ground-breaking vaccine yet lots of people didn’t get it. Were the scientists hiding this treatment from the public like they did with Tuskegee?’
No one on this thread is arguing against getting the vaccine. People are still getting sick with or without the vaccine. We are debating how to treat those individuals.
 
The use of ritonavir is primarily to inhibit the cytochrome p450 enzymes to allow the actual drug concentrations to remain high.

Ritonavir is an irreversible inhibitor of those enzymes so I’m not sure they need to use a dose high enough to cause the typical ritonavir side effects.
Agreed
 
Nothing, other than hype and politics, supports ivermectin currently. Your question initially was what can help in the early stages, to avoid hospitalization and death. Assuming one is vaccinated and they still get sick, paxlovid seems a better option than ivermectin based on available studies, first and foremost because it appears to work. On side effects, ritonavir most commonly causes nausea, diarrhea, vomiting, fatigue, and parasthesias. All of those side effects appear superior to being hospitalized and dying. My guess is had Pfizer not used it, the anti-vaxx nutso political hacks would've adopted ritonavir as one of their own. I believe they have touted other HIV meds.

I guess I can, only some level, understand resistance to Pfizer, Merck, and the rest of 'big pharma'. But here's the thing, their stuff actually works! At least as far as I can tell. Political hackery continues its assault on vaccines and meds like paxlovid - but they actually keep you out of the hospital and alive! There's nothing definitive so far suggesting hcq, ivermectin, etc. does anything other than cause controversy because of who is supporting it.
Agreed, I hope it works as well as the study suggest.
 
I do care and and with most medications I tend to wait to see how the administration of each medication plays out over time.

I am not concerned about the p value…a larger sample size helps reduce error and variabilities associated with such a small sample size. I am confident the medication will be used in my system and I hope it works as well as advertised to replace all other antivirals to help prevent hospitalization.
Well, you should be concerned about the p value. Because your complaint is that you think the study is underpowered.

But some basic stats for you: power is determined by the sample size, the effect size, the result variability, and the alpha (significance). The paxlovid study had a statistically enormous effect (90% reduction vs say the 30% reduction with molnupiravir), low variability, and an alpha that was highly, highly significant, so much so that the odds of that effect occurring secondary to chance were less than 1 in 10,000. When all those things are true, then having a sample size of 1200 means the study was adequately powered.
 
People are still getting sick with or without the vaccine.

People still get injured in car accidents when they wear seat belts. Military still get injured when they wear bulletproof vest. Cyclists are still getting hurt when they wear helmets. People still get home after they have one drink too many.

That phrase over simplifies the problem is overlooks the true outcomes. If we applied that logic to the military, they never would've started wearing helmets. (When they started wear helmets, numbers of injuries significant increased....)
 
Well, you should be concerned about the p value. Because your complaint is that you think the study is underpowered.

But some basic stats for you: power is determined by the sample size, the effect size, the result variability, and the alpha (significance). The paxlovid study had a statistically enormous effect (90% reduction vs say the 30% reduction with molnupiravir), low variability, and an alpha that was highly, highly significant, so much so that the odds of that effect occurring secondary to chance were less than 1 in 10,000. When all those things are true, then having a sample size of 1200 means the study was adequately powered.
And this is from Stank811 who posted a study as evidence with a sample size of 24.
 
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Well, you should be concerned about the p value. Because your complaint is that you think the study is underpowered.

But some basic stats for you: power is determined by the sample size, the effect size, the result variability, and the alpha (significance). The paxlovid study had a statistically enormous effect (90% reduction vs say the 30% reduction with molnupiravir), low variability, and an alpha that was highly, highly significant, so much so that the odds of that effect occurring secondary to chance were less than 1 in 10,000. When all those things are true, then having a sample size of 1200 means the study was adequately powered.
I am concerned with P value and I agree it showed a significance. But we also agree larger sample sizes reduces random error and variability. We both are aware of many drugs and therapies which showed great promise only to fail once widely used…and all those had studies that had great p values.
 
People still get injured in car accidents when they wear seat belts. Military still get injured when they wear bulletproof vest. Cyclists are still getting hurt when they wear helmets. People still get home after they have one drink too many.

That phrase over simplifies the problem is overlooks the true outcomes. If we applied that logic to the military, they never would've started wearing helmets. (When they started wear helmets, numbers of injuries significant increased....)
Again we agree with vaccinations. But again they aren’t treatments. So to say just get vaccinated is also an over simplification.
 
I am concerned with P value and I agree it showed a significance. But we also agree larger sample sizes reduces random error and variability. We both are aware of many drugs and therapies which showed great promise only to fail once widely used…and all those had studies that had great p values.
You’re making a trivial, generalized statement without actually acknowledging the facts at hand, and you’re presenting an opinion implying you’d simply feel better because other unrelated studies could’ve had bigger sample sizes, which is neither here nor there.

I’ve already pointed out most p values aren’t like the Paxlovid study where a highly efficacious (90%) endpoint was met with an alpha of 0.0001. And you know that most studies, which typically use p values of 0.05, are nowhere near this, right?

If you actually have a rigorous retort of the statistics I’d love to hear it, but at this point you’re essentially arguing that we need a larger sample size to determine if parachutes are efficacious.
 
And I’ll just say what everyone’s thinking: you’re invested in the notion, regardless of the facts, that the data from some of these novel oral agents are preliminary and equivocal and rushed. Why? Because if the data looks like sht for those novel drugs then you can continue to justify the absurd notion being propagated that ivm and hcq use should also be routine based on the sht data that exist for them
 
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Anybody here have any experience with fluvoxamine? I have been asked about it by a few friends in the last month when they had breakthrough infections. The studies are encouraging but there sure doesn't seem to be any enthusiasm about it. I don't know if it just gets lumped into the Ivermectin/HCQ bucket in people's minds or if there's just more anticipation of Paxlovid's approval.

I think the evidence is strong enough and have been using it for the past month (I'm EM). Several positive trials going back to last year, while nearly everything else hasn't panned out (asa, colchicine, antihelmenthics and antimalarials). My usual cocktail on discharged patients (people w/ reasonably high risk of progression, ie not teenagers) is fluvox + inhaled budesonide. I usually council patients that the evidence is reasonable but not definitive.

I'm not sure if many others are using these or not. I see a lot of patient's who've been prescribed dexamethasone or azithromycin by urgent cares or other docs though, both of which I would say are strongly not beneficial in early/mild covid.
 
I think the evidence is strong enough and have been using it for the past month (I'm EM). Several positive trials going back to last year, while nearly everything else hasn't panned out (asa, colchicine, antihelmenthics and antimalarials). My usual cocktail on discharged patients (people w/ reasonably high risk of progression, ie not teenagers) is fluvox + inhaled budesonide. I usually council patients that the evidence is reasonable but not definitive.

I'm not sure if many others are using these or not. I see a lot of patient's who've been prescribed dexamethasone or azithromycin by urgent cares or other docs though, both of which I would say are strongly not beneficial in early/mild covid.
Tread lightly. To even suggest that ANYTHING might offer the slightest benefit that hasn't been researched extensively in studies that, by the way, are sufficiently powered that only big money could have done so, would be heresy and could result in immediate cancellation with extreme prejudice. Levels of evidence!!!
 
Tread lightly. To even suggest that ANYTHING might offer the slightest benefit that hasn't been researched extensively in studies that, by the way, are sufficiently powered that only big money could have done so, would be heresy and could result in immediate cancellation with extreme prejudice. Levels of evidence!!!
Keep me out of the crypto-fascist Q nutter bubble please and thank you.
 
Just get vaccinated bro jesus christ

Screenshot 2021-12-18 000511.png

If only Israel had given the fourth shot before the 3rd wave...
 
3rd wave infections up and deaths down. Either vaccination worked or they pumped ivermectin into the water supply. I guess we’ll never know.
Or, a large part of the high risk population died during the first part of the pandemic. To me it's counter intuitive to say that the vaccine works when infections are high in highly vaccinated populations. Look at the graph for Cuba: big spike in deaths eventhough 100% of the population has had 2 doses.
 
Or, a large part of the high risk population died during the first part of the pandemic. To me it's counter intuitive to say that the vaccine works when infections are high in highly vaccinated populations. Look at the graph for Cuba: big spike in deaths eventhough 100% of the population has had 2 doses.

Saying a vaccine decreases disease severity and mortality isn't the same thing as saying that vaccinated populations are completely immune from getting sick
 
. Look at the graph for Cuba: big spike in deaths eventhough 100% of the population has had 2 doses.
Ok let's look at the graphs for Cuba

Screenshot_20211219-072117_Chrome.jpg



Ouch, pretty big Delta spike starting in June. But how many people were vaccinated at the time?

Screenshot_20211219-072007_Chrome.jpg



Nowhere close to 100%. Barely looks to have been 20% fully vaccinated at around May 31 of this year.
 
Or, a large part of the high risk population died during the first part of the pandemic. To me it's counter intuitive to say that the vaccine works when infections are high in highly vaccinated populations. Look at the graph for Cuba: big spike in deaths eventhough 100% of the population has had 2 doses.
Do you understand the concept of herd immunity in vaccinated populations and how it relates to infections? Also the variable immune response within a population? I’m about 15 years removed from learning about that stuff and even I can figure out why covid infections and deaths are still a thing in highly vaccinated countries.
 
Do you understand the concept of herd immunity in vaccinated populations and how it relates to infections? Also the variable immune response within a population? I’m about 15 years removed from learning about that stuff and even I can figure out why covid infections and deaths are still a thing in highly vaccinated countries.
So that's why we also have a lot of polio, HepB and smallpox?
 
Ok let's look at the graphs for Cuba

View attachment 347010


Ouch, pretty big Delta spike starting in June. But how many people were vaccinated at the time?

View attachment 347011


Nowhere close to 100%. Barely looks to have been 20% fully vaccinated at around May 31 of this year.
Yes i was looking at a graph were the scale was messed up.
 
Saying a vaccine decreases disease severity and mortality isn't the same thing as saying that vaccinated populations are completely immune from getting sick
The problem is the goal posts have been moved back every step of the way: the vaccine was going to first get rid of covid then it was going to limit it's spread then hospitalizations then icu admissions and now deaths.
I'm contending with the notion that the vaccines are very effective and therefore should be mandatory for everybody as they are progressively doing in Europe. Why are we vaccinating people under 25? It doesn't make much sense.
 
So that's why we also have a lot of polio, HepB and smallpox?
Are any of those positive sense RNA viruses?

The problem is the goal posts have been moved back every step of the way: the vaccine was going to first get rid of covid then it was going to limit it's spread then hospitalizations then icu admissions and now deaths.
I'm contending with the notion that the vaccines are very effective and therefore should be mandatory for everybody as they are progressively doing in Europe. Why are we vaccinating people under 25? It doesn't make much sense.
Nobody who actually followed the data thought your first 'goalpost' was going to happen though many on the right seemed to think that was the goal for some reason. And the vaccine effectively does all other 3 things you mention there. Do you not think the vaccine is effective?
 
So that's why we also have a lot of polio, HepB and smallpox?
You clearly don’t understand. Also, Hep B is rampant throughout the world. And we still have clusters of polio.
 
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