Elias Kass
@DrDadSays
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Pediatric primary care + infant feeding. Former engineer, now vaccine advocate & dad. Tweets are not medical advice. #ImmunizeUnder5s 🏳️🌈 he/him
Seattle, WA
Joined July 2008
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Nbd just a Seattle public school going remote because of measles. Do they know how long the incubation period is?!
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Seriously what is it going to take to get masks back on? Seattle Children's is full/on divert, we still have no vaccines for under 5, we can't boost 5+ until Western States meets, but still no masks?
@WADeptHealth
@WaHealthSec
@KCPubHealth
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I wish
@DrCaliff_FDA
could see the number of kids dropping off the schedule because a day or 2 or 3 before their longed-after vaccine, they test positive. The delays did nothing for confidence and everything for incidence. Heartbreaking.
#ImmunizeUnder5s
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it's been 2 weeks since FDA approval of the new covid vaccine and we still have no pediatric stock of Moderna. our order was 12+ was approved but not shipped, and our order of <12 hasn't even been approved yet.
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I will say again that the most covid vaccine hesitant *group* in my pediatric practice are those whose kids had covid already, and every day that group grows. Don't simultaneously bemoan low vaccine uptake and delay vaccines.
@SecBecerra
@DrCaliff_FDA
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This would be a really good time to ramp back up free tests, drive up PCR, masking in healthcare settings, alllll the things.
@WaHealthSec
People are sick and not thinking to test, or don't have tests, or if families have tests left they're often expired/fail control.
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i'm going to whisper this so it doesn't un-happen, but we were able to place an order for moderna 6m-11y!
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my friend's kid is immunosuppressed, has been getting boosters every 6 months. sept 19 there was no booster because the FDA deauthorized the bivalent. now she's got covid w/ severe resp complications, at ED last night, today driving halfway across their state for remdesivir.
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Joyful day of vaccinating in the sunshine! Thank you to DOH Care-a-van for all your help, and all our volunteers. We vaccinated 358 kids!
#ImmunizeUnder5s
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we received both our shipments! slight mishap when the fedex truck backed into our building. whoops! vaccines arrived safely though, and are safely tucked into the appropriate cold storage!
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@KaraKarlson
@CDCDirector
I don't think people understand the gravity of small children having nothing. We're not talking about boosters. We're talking about having no vaccines with which to give 6-month-olds their first inkling of protection against a virus that's all around them.
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This is becoming a pediatric pandemic. If this were a de novo outbreak, a mysterious virus killing on average 1 kid under 5 each day, would there be more interest? If we had a vaccine, would we be dragging our feet on using it?
#ImmunizeUnder5s
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If I hadn't already cancelled
@nytimes
this would be it for me. You spent years minimizing covid, covid in kids, and vaccines for kids. You prophesied low uptake so the distribution infrastructure didn't get built. There's nowhere to stand in line, assholes.
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Like what is the metric because it seems like this should trigger something. There are no beds. Masking should resume in schools and childcare. Please.
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re: running out, it would be awesome if, instead of throwing away up to 9 doses of pfizer pediatric 10 mcg vaccine at the end of the day, i could give them off label to kids under 5. reduce waste, prevent deaths, win win!
#offlabelu5
#immunizeunder5s
Are we just not going to talk about: Rochelle Walensky mandating all CDC employees be masked inside again? Fauci low key admitting were going to have to ration boosters because we're straight about to run out? ECDC listing BA.4 and BA.5 as Var. of concern? No? Okay, cool.
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so much low demand!
@nytimes
Demand for vax for 6 months to <5 year olds is so high, all of our pediatric doses were claimed in minutes.
We can no longer accept appts & are unable to accommodate walk-ins for this age group at our mobile clinics this week.
We ordered more doses & will add appts ASAP!
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@DrCaliff_FDA
Basic facts about 0-4yos:
- 6% of US population
- 20M people
- 5x the rate of hospitalization during omicron than delta
- many can't wear a mask
- no therapeutics
- no vaccines
@ImmunizeUnder5s
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for such a low uptake vaccine we're sure booked out to the end of october
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how do you measure delay? in missed storytimes, in missed therapies, in unmet grandparents, in missed preschool, in ED visits, in hospitalizations, in lost lives?
#ImmunizeUnder5s
The under 5 vaccine trials have been plagued with delays. From what’s visible to the public, Moderna has been delayed by regulators 3 times. Pfizer has been delayed once by the FDA and a second time by their own under-dosing.
The history of the u5 vaccine trials: a thread 🧵
1/
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@Eromenos3
@thedailyangle
@EricRobinson00
You can see the moment the acid surges through her esophagus
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@fakebertuzzi44
@NohaAboelataMD
In our clinic all providers, staff, students are in N95, and this is our front door -- Kf94s in kids and adult sizes.
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@thepedipals
our well visits are 45-60 mins but that's still not enough, plus insurance almost never pays for the extra time spent addressing all the non-well issues. more time AND more compensation are needed!
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@violin_health
I don't think there's been a secondary case identified yet, but the index case attended school while contagious...
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apparently mckesson is treating covid vaccines like all other childhood vaccines - shipping within 2 weeks.
with other childhood vaccines we have existing stock, forecast need, and order in time to avoid gaps.
with covid we were told on 9/11 to stop using existing vaccine.
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@BadMedicalTakes
I heard from a reliable source that 1 day in the US is equivalent to 2 years in Japan
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The pediatric infrastructure is separate and should be considered separately. Schools, daycares, pediatric clinics and hospitals all serve exclusively pediatric populations whose vaccine access and therapeutic access are completely different than adults. We don't have the tools.
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As of tomorrow, 100,000 babies will have been denied a start to their primary COVID vaccine series. 10,000 babies turning 6 months old each day*. 10 days since bivalent pulled with nothing to replace it.
*not accounting for our infant mortality rate
@DrCaliff_FDA
@XavierBecerra
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uh i don't think you get to compare kids dying from a vaccine-preventable disease to being struck by lightning when deciding whether or not to give kids vaccines. ergo, meissner thinks you should swim during a lightning storm on a room holding a metal stick.
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so many of the
#ACIP
members spoke eloquently yesterday about not "chasing the rainbow" of preventing all infections, that what we need is to be preventing serious infections, hospitalizations and death. how is the
@US_FDA
so divorced from this reality?
@ImmunizeUnder5s
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It's time for universal masking,
@SeattleSchools
-- medium community risk means masking in crowded indoor spaces. That's another way of saying "school."
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indeed, moderna 6m-11y is not available to order. why not be transparent about it? why not explain in the emails why it's not available and when it will be available? i don't understand why the
@WADeptHealth
doesn't try to treat the early adopters better. 1/
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dr offit with legit point about how parents need to understand that kids are *not* protected after 2 doses of pfizer, no protection until after the 3rd dose.
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dana walker -- parent of an 8mo speaking to covid as a leading cause of death in kids under 5, increasing risks of hospitalizations in kids under 5, risks of organ damage.
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@1goodtern
if covid were visible it would be a lot easier. people here are very willing to wear masks when the air is smokey. they'll keep their distance when there's a gnarly rash. we just need some lesions!
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@CDCDirector
would absolutely love to vaccinate my preschooler and all my 0-4yo patients. could start today with the pfizer 10mcg vaccine in the fridge, if the CDC and FDA would allow off-label use.
#ProtectTheirFuture
#ImmunizeUnder5s
#VaxU5
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NEW FROM UNITED AIRLINES: Effective immediately, snacks will no longer be individually wrapped. We'll pass the giant tub of animal crackers around and you just dig your grubby hands right in there.
NEW FROM UNITED AIRLINES: “Effective immediately, masks are no longer required at United on domestic flights, select international flights (dependent upon the arrival country’s mask requirements) or at U.S. airports.”
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Why vaccinate for things they've never seen when they can't vaccinate for something dogging them right now? In delaying u5 vaccines the foundation is being kicked out of the whole program. It's a serious problem.
Parents are now coming to pediatricians with the same questions about routine immunizations that they had about the Covid-19 vaccine. "‘Is it worth it? Do my kids need this vaccine?’" My latest for
@politico
with/
@meganmesserly
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Seattle pediatric practices need to get going on vaccinating their own patients. This is insane. We are literally the smallest practice, we can't handle Ballard Peds plus Virginia Mason plus Providence. We just can't.
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@Alexander_Tin
@CDCgov
@pfizer
@BioNTech_Group
this makes no sense. the pfizer primary series was 3 doses. why would they not be able to get a booster after their primary series?
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"we're concerned people might not want to keep getting boosters" "so we should prioritize an effective 2-dose vaccine for kids instead of a 3-dose vaccine, right?" "..." "right?"
@FDASpox
@US_FDA
@ImmunizeUnder5s
#ImmunizeUnder5s
#EUAinMay
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my little clinic is
#4
in the county behind KP (giant), SeaMar (giant), retail pharmacy (giant)!
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I'm concerned that this is a reference to Moderna's application potentially covering 0-17y. The under-5s who have NO OTHER ACCESS to vaccines should be prioritized.
Marks: "Just remember that we can’t actually finish our reviews until we actually have complete applications." & "Some of these are complicated because they are relatively larger covering larger swaths of the pediatric population than others." (Presumably referring to Moderna)
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Now being recognized at the playground as "hey you gave my kids their covid vaccines!" ☺️
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Our youngest children deserve protection from COVID-19. Therapeutics are limited, and hospitalizations have risen in the Omicron wave. We demand timely review of the
@moderna_tx
EUA submission and APPROVAL if safe and effective.
#ImmunizeUnder5s
#EUAinMay
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@snarkypeds
"Townsend had coined the term 'Haemorrhagic disease of the newborn' in 1894 but it was not until the discovery of vitamin K ('Koagulation vitamin') by Dam and others in the 1930s that the condition became understood, allowing treatment and prophylaxis."
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@LASchools
Do you have any students under age 12, for whom there are no therapeutics? Do you have any medically vulnerable students? Do you actively distribute tests and masks? What is your air cleaning protocol?
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you can't be surprised that uptake is low when it's so, so, so, so difficult to get your babies vaccinated. 3/3
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Today was the first time someone told me not to put a face diaper on my kid. 2+ years into this. At QFC. I told her I'm a doctor and am in no mood. "Well you must not have done your homework." "Yeah I'm sure THAT'S the case."
#COVIDisAirborne
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fourth up -
@jeffreytran
telling heart wrenching stories of parents choosing -- or having no choice -- about protecting their kids
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@lucyveepee
I think people don't have an image of what the future would look like if we didn't go back to how things were. They can't see a different future so they just revert to the past.
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"my son has been stripped of a normal upbringing ... missing out on memories with his grandparents and the childhood i wanted for him"
#acip
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@alexmeshkin
I did. We first started vaccinating parents of our pediatric patients then opened it up to the community. We've given lots and are preparing to give 5-11s in the coming weeks. We'll keep screwing over the little kids though.
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@benryanwriter
@nytimes
They were vaccinated in order to interrupt transmission. Which takes a public health response that acknowledges transmission isn't restricted to MSM.
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Mandates help protect the people who don't have the social capital to make unpopular decisions. Already have parents worried their ex won't allow their children to mask once the mandate is lifted.
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@clhubes
i don't understand what i was doing with all the time i had before i had kids. like, i remember feeling busy. but... doing what?
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We were kicking around options for scheduling second doses and realized we're going to need to do it again again for flu vaccine, then boosters. We need an ongoing mass vaccination infrastructure that includes young peds.
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went back through my emails.
sept 8 "Once the ACIP issues recommendations, COVID-19 vaccine orders will start to process. We anticipate the first updated COVID-19 vaccines to be delivered within a few days."
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dr cohn rightfully skeptical about the supposedly high VE of pfizer 30 days after dose 3, with very small numbers and huge confidence intervals, saying not to use that VE in communication
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thank you dr portnoy -- death is not the only thing. i've always said when counseling parents about vaccines, there's a lot of room for suffering between healthy and dead. we want to prevent that suffering.
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it is absolutely fucking insanity that there is NO PRIORITIZATION to covid vaccines. why? WHY?
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"Parents, this is your captain speaking. Don't you worry, the minute we get authorization for our under 5s, those masks will drop right down."
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we really need an official statement on whether spikevax 0.5 mL vial can be split into two 0.25 mL doses for < 12yos. this would alleviate some of the shipping pressures.
@moderna_tx
@CDCgov
@DrCaliff_FDA
@SecBecerra
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This is fine. Just as long as nobody is asked to wear a mask.
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@1goodtern
I think because it's info with no action. If there was a call to action, new recommendations, new regulations, it would get attention. But for most people it's going to land as "so what? it's too late for me now."
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IF we get a lull, that's even more reason to
@ImmunizeUnder5s
as quickly as possible so little kids have some protection before the next wave... which will be
#7
by then?
#8
? The urgency is NOT DISSIPATING, it's just far away from you.
@CDCDirector
@DrCaliff_FDA
@ScottGottliebMD
I missed
@margbrennan
on
@FaceTheNation
today who I can always count on to ask about kids under 5 because she’s a mom too.
Here is what
@ScottGottliebMD
said. full interview here worth a read
#pedsTwitter
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@SecBecerra
@cvspharmacy
@POTUS
would love for you to acknowledge the delays in distribution of pediatric vaccines. it's awesome that you can walk into a pharmacy and get vaccinated, but parents are small children have been actively looking for vaccines for 2 weeks and haven't found any.
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"the littlest children seem left out altogether." yes, thank you
@lisamjarvis
for your ongoing attention to this problem!
I feel for parents of the littlest kids, who are being given very little info on when Covid shots will be available. I also worry next year's rollout might not be much smoother given the challenge of syncing vaccine arrival w/the arrival of a Covid wave.
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commercialization of the vaccine shouldn't have happened. it is absolutely no benefit to the public.
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@NWAsthmaAllergy
How many of your asthma patients have viral respiratory infections as triggers? How many of those infections and subsequent exacerbations will be caused by visiting your clinics without universal masking?
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sooo does this mean that Moderna 6mo-11y will not be available to order 9/15? it's not mentioned anywhere in the text. if not tomorrow, then when? and still sticking with no mix-and-match for kids?
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We started giving nirsevimab yesterday. Everyone was so excited and grateful. Really hope supply constraints ease up...
(My kid says I should post this photo of this unrelated neighborhood mushroom.)
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"All this delay reinforces the feeling that there must be something unsafe about the vaccines, or the government wouldn’t be choosing to allow children to be infected with a novel, deadly pathogen instead of vaccinating them." THIS THIS THIS
This is a🧵 on the regulatory dysfunction that has abandoned children under age 5 without access to safe covid vaccines. I’ll do a second one on what we might do about it.
#immunizeunder5s
#offlabelU5
1/n
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#Seattle
, any suggestions for donut places that might want to donate/sponsor/set up at our big
#ImmunizeUnder5s
party on 6/24?
@Toppot
?
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Lincoln Pharmacy in Tacoma WA is vaccinating down to 6 months old! Walk in.
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@lisa_iannattone
Optional gloves available for those who choose to glove up -- we should respect their choices even if it's just their anxiety!
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@KSteffner
@ASlavitt
@inthebubblepod
@US_FDA
@ImmunizeUnder5s
there's a whole genre of game now that basically boils down to "is this number bigger than this other number" so here is my contribution:
#ImmunizeUnder5s
#ProtectionOverPolitics
#vaxU5s
@ImmunizeUnder5s
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I can't even come up with an analogy for this. Some people don't wear seatbelts so we're not going to manufacturer car seats for babies? You're really going to deny an entire cohort of babies and children vaccines because of the lousy reasoning of *other* families?
@DrWoodcockFDA
So bc FDA couldn't convince enough people to vax kids, they will deny MILLIONS of other children vaccines? Kids have suffered enough: Don't make them pay the price with their lives because SOME people have been hesitant to vaccinate. Tell
@DrWoodcockFDA
this is NOT ok!
#VaxU5
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"with each passing day my child seems more like a sitting duck"
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third comment -- Dr Kailey Soller, PhD chemist and mom to 2yo, speaking to the importance of vaccinating kids under 5
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@DrShazmaMithani
i mean in the US we pay out the nose and EDs are still overcrowded because of *waves hands* the whole system.
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@EthicsElizabeth
I'll just be over here screaming into my pillow about all the 4yos who could have been vaccinated months ago
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@Dr_Oubre
just look at the RVUs for primary care vs procedures, and then look at who's on the RVU committee. and then tell the family who's in for a well child that you can't treat the eczema or whatever because insurance won't pay for E&M & prev on same day, so they have to come back.
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all children deserve protection. even the 4-year-olds. even the 3-year-olds (even though they're jerks). even the 2-year-olds (some of whom can't even jump with two feet off the ground). even the 1-year-olds! even the BABIES.
#ImmunizeUnder5s
#EUAinMay
#NotMildForEveryChild
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what has been happening though:
- lots of frantic messages about vaccines
- lots of morose messages about their baby testing positive for covid and asking what to do
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How do we get press for THIS?
@bylenasun
@Alexander_Tin
@DrDadSays
@nytimes
@yannotyam
The clinic at our local peds group was filled up immediately. They say there is huge demand!
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ordering is "intermittently closed" because of the backlog of orders that haven't shipped.
the failed vax-only strategy is a super duper failure when you have no vaccines. 2/2
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Police took back the East Precinct, put up a big wall, and started doing everything they falsely accused CHAZ of doing.
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Intrauterine exposure to RSV was linked to fetal inflammation, with several inflammatory mediators detected in cord blood at delivery. Lower birth weight, worse discharge weights for the newborn. 1/
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