Part Two – added March 17, 2020
*This update was added on March 17, 2020. If you haven’t read part 1 of this article please click here.

A lot has changed in the last two weeks since my original post. SARS-CoV-2, the virus that causes the disease COVID-19, is now a global pandemic meaning that a coordinated global response is needed to prepare health systems to meet this challenge.

We are all experiencing various levels of disruption in our daily lives and it doesn’t appear that this will change any time soon. Here are some important updates as you navigate the weeks and months ahead.

Understanding social distancing, self-isolation, and quarantine

The goal of social distancing is not the elimination of the disease, but slowing the outbreak to reduce overwhelming the capacity of the health care system. Regardless of the measures we continue to take, COVID-19 is here to stay.

China is now starting to relax their quarantine restrictions, Italy is at the height of it, while the US is just now headed into tighter restrictions. We know that social distancing is a very effective measure to limit the spread of a virus. So if this is the case, why are we all not implementing it immediately upon the discovery of a new virus?

It is very important to start at the appropriate time when benefits to quarantine outweigh the risks. And, there are significant risks that come with quarantine – financial, mental health from lack of socialization, disruption in schooling, lack of childcare for working parents, and increased demands on food supply to name a few.

With any global health crisis of this magnitude, there will also be significant costs to the global economy. So, to mitigate unnecessary costs it’s important to make the decision at the right time for each individual community based on the data from that area.

Early and widespread testing and accurate disease reporting are critical issues to ensure that the most appropriate recommendations for social distancing are made.

Please visit your local authorities’ website to see the recommendations in your area.

It’s important to talk to your children about social distancing

SARS-CoV-2 is primarily spread by healthy young people who do not know that they carry the virus, so it is very important to talk to your children about staying home more than is normal right now and away from group settings.

To reduce any worry that can arise from confusion about this situation, take some time to go over age-appropriate information and practice hand washing.

The current recommendations in the US for the next 15 days

Stay home from work, school, all social engagements, and public areas if:

  • You are sick
  • Your child is sick

Do not leave your home if:

  • Someone has tested positive for SARS CoV-2 in your household
  • If you are an older person (age 60+)
  • If you have a serious chronic health condition that impairs your lung, heart, or immune function

To slow the spread of the virus:

  • Work and school from home if possible and as recommended by your local authorities
  • Do not visit nursing homes, retirement, or long-term care facilities
  • Avoid discretionary travel, shopping, and social visits
  • Avoid restaurants, bars, and food courts
  • Use drive-thru, pickup, and delivery options to limit contact with others
  • Avoid social gatherings with groups >10 people
  • If you work in a critical infrastructure industry (healthcare, pharmaceutical, food supply) maintain your normal work schedule and follow CDC guidance to protect your health at work

The responsibility of businesses:

  • In states with evidence of community transmission all schools, bars, restaurants, food courts, gyms, movie theaters, churches, and indoor/outdoor venues should be closed

Practice good hygiene:

  • Wash hands frequently for 20 seconds after leaving the home or touching any frequently used item or surface
  • Avoid touching your face
  • Sneeze or cough into a tissue and immediately dispose of it, or if not available, the inside of your elbow
  • Disinfect frequently used surfaces – door handles, computers, phones

I also believe it is important to:

  • Avoid wearing rings
  • Keep your nails cut short

Problems with SARS CoV-2 testing

South Korea is among the most effective rapid responding countries to this crisis and found that a large number of the asymptomatic carriers (people who have the virus but not showing signs of illness) are young healthy people ages 20-29.

People tested for SARS CoV-2 by comparison:

South Korea has tested ~274,000 people
Italy ~134,000 tests
US ~25,000 specimens tested according to the CDC and ~50,000 according to the COVID Tracking Project

Coronavirus tests per 1 million people:

In the United States, the response to the outbreak has been slow and the release of testing delayed for many reasons. As more tests become available there will likely be an initial big surge in the number of infected people. This should not alarm you that the rate of transmission has suddenly skyrocketed, but that appropriate testing has not yet been done in the US.

How likely am I to contract the virus in the near future?

Harvard epidemiologist Marc Lipsitch suggests that the virus will likely affect 40-70% of the world’s population this year, with other experts suggesting similar infection rates, which would result in millions of deaths. However, the majority of people will be asymptomatic or have mild disease.

How to know if you need to get tested

It’s a tense time and every sneeze can be worrying. I’m getting lots of questions from people who are dealing with symptoms and want to know if they should get tested. This is what you need to know –

The big difference between COVID-19 and a cold is that COVID-19 primarily affects the lower airways leading to cough and breathing issues, while colds primarily impact the upper airways leading to sneezing and runny nose. If you have a runny nose and are sneezing, you unlikely have COVID-19.

You need to contact your healthcare provider and seek testing if you develop symptoms such as fever, cough, and/or difficulty breathing. Also, if you have been in close contact with a person known to have COVID-19 or have recently traveled from an area with an ongoing spread of COVID-19.

Older people age 60+ and individuals who have severe underlying medical conditions or are immunocompromised should contact their healthcare provider early, even if their illness is mild.

Isn’t this just another virus like the flu? Are we overreacting?

This virus is much more deadly than the flu. And, it’s important to know that this a novel (new) virus meaning that we are just now learning about the illness it produces, how to effectively treat it, how virulent it will become, and how fast it will spread.

The major risk if we do not take appropriate public health measures is that it will overwhelm the ability of healthcare facilities to respond and there will be many unnecessary deaths.

Fatality rate updates

As a point of comparison, this year’s death rates of influenza A and B is 0.05% in the US.

On Feb 28th the death rates of COVID-19 were reported to be:
3.57% in China
1.43% outside of China

As of March 16th, the WHO reports the death rates* to be:
3.96% in China
3.91% outside of China

*It is likely that the rates are still inaccurate since we are not testing everyone and do not know how many asymptomatic carriers there are.

If I contract COVID-19 how long am I infectious?

*This information is from new small studies that are still being peer-reviewed

The viral load (the measurement of how much virus is contained in the material) in throat swab and sputum samples peak at around 5-6 days after symptom onset for mild disease. This means that you are most infectious around 5-6 days after you first notice symptoms.

But remember, you can spread the illness to others up to 14 days prior to symptoms and up to 13 days after onset of the symptoms.

Will things get better as outdoor temperatures rise?

We don’t yet know if this virus will react with seasonal changes in the same way as other pathogens, like those that cause the common cold or influenza. There are some yet to be peer-reviewed studies that suggest that the virus transmission may weaken in warmer temperatures and higher humidity.

But, don’t let this give you false hope because we may now be in a situation where significant public health measures still need to be taken to slow the spread of the virus.

What does it mean when a virus mutates and is this a good or bad thing?

Headlines making claims about dangerous mutations are often baseless and misinformed. The evolution of virulence is highly complex and a highly debated topic amongst experts. But, in summary, mutations are a natural part of the virus life cycle and rarely impact outbreaks dramatically.

Mutations can make a virus either more or less virulent, but becoming more virulent does not necessarily result in more transmission if those who are affected are too sick to transmit it to other people.

It looks like SARS-CoV-2 may have already mutated into one more and one less aggressive strains. However, it’s unlikely to be something to be concerned with at this stage.

Does mutation impact the development of a vaccine?

It is unlikely that a mutation would impact the development of a vaccine given that the viruses remain so similar genetically.

When might a vaccine be available?

A vaccine will likely be developed with unprecedented speed given that China sequenced the genetic material and shared it in January which has allowed research groups around the world to begin studying it very quickly, and the vaccines there were being created for SARS and MERS can be repurposed for Sars-CoV-2.

The first human trials are set to start in April. However, due to the clinical trials that are needed to produce an effective and safe vaccine we shouldn’t expect that it will be available before 18-months.

Are there any treatments that are currently working to treat people with COVID-19?

No drugs or biologics have been proven to be effective for the prevention or treatment of COVID-19. But, numerous antiviral agents, immunotherapies, and vaccines are being investigated and developed as potential therapies.

Currently being investigated for use:
Chloroquine (a cheap drug used to treat and prevent malaria)
Remdesivir (broad-spectrum antiviral agent developed to treat Ebola)
Plasma from recovered patients
Methylprednisolone (a steroid used to treat inflammatory conditions)

A note on fevers

Fever is the body’s normal response to infection. High temperature triggers the body’s production of infection-fighting white blood cells and inhibits the growth of viruses and bacteria. If you lower the fever with medications such as paracetamol/acetaminophen, aspirin, or ibuprofen, you may be affecting the body’s ability to respond to the infection.

Short-lived fevers (>38.3°C or 101°F) come and go without any long-term complications, however, the aches and pains that you feel during your illness may be in part due to the fever. So, lowering your fever with medication may improve comfort but will not help with the virus to run its course. In fact, it may lengthen the amount of time that you are sick. Instead of immediately reaching for the antipyretic medications, try taking a bath with 1-2 cups of Epsom salt or applying cool compresses for comfort.

The biggest source of concern with fevers is that you must stay hydrated! Dehydration during illness can lead to serious complications. Adequate water intake (about 1 L per 30 kg of body weight for the average healthy person) and minerals from drinking broth are very important when body fluids are being lost from sweating.

Note: Infants of <3 months are an exception and should always be seen by their doctor with any fever. Do not give children <18 years of age aspirin since it has been linked to the deadly disease Reye’s syndrome.

The most important steps that you need to take for your immune system continue to be:

  • Social distancing – stay greater than 6 feet (2 meters) from others
  • Regular hand washing for 20 seconds
  • Daily fresh air and sunshine
    Staying in closed areas with lack of sunlight is associated with higher viral transmission
  • Daily exercise and movement
  • Stress management practices and mental health support
    Turn off the news if it’s creating more stress!
  • Sleep 7+ hours nightly
    Lack of sleep impairs your immune system making you more likely to get sick
  • Eat fresh whole foods, reduce the intake of processed foods
    High amounts of processed carbs and refined fats interfere with the immune system
  • Proper daily hydration
    About 1 L per 30kg of body weight for the average healthy person
  • Immune support supplements*

*These are preventative measures that I’m currently taking:

  • 1g of vitamin C 2x/day
    Reduces the duration of cold symptoms if taking regularly before getting sick
  • Propolis throat spray or echinacea gargle 3x/day
    Antimicrobial
  • Elderberry syrup (Sambucas nigra) 1tsp 2x/day
    Antimicrobial
  • Zinc lozenges
    Reduce symptom severity and viral replication in the back of the throat
  • A high-quality brand Multivitamin
  • Mushroom immune formula with Cordyceps, Reishi, Maitake, Lion’s Mane, and Chaga
  • Vitamin D
    Vitamin D is a steroid hormone that controls the activity of close to 5% of the protein-encoding human genome. Many vitamin D-regulated genes are involved in immune function. A meta-analysis of 25 randomized controlled trials found conducted in 14 countries found that vitamin D supplementation cut the risk of infection with respiratory illnesses by 50% in people that were vitamin D deficient and by 10% in people with normal vitamin D levels. According to the endocrine society, blood levels of 25-hydroxyvitamin D below 20ng/ml is considered deficient, less than 30ng/ml is inadequate. Individuals with levels between 30-60ng/ml are considered adequate. Meta-analyses have shown that people with serum levels between 40-60ng/ml have the lowest all-cause mortality. Studies have shown that typically supplementation with 1,000 IU of vitamin D3 per day can raise serum levels by ~5 ng/ml. Rhonda Patrick PhD

If you get sick, I would also include:

  • Resveratrol – 500mg 3x/day
    There is at least one in vivo study that suggests resveratrol may provide effective inhibition of MERS-CoV, another coronavirus

What do I need to do to get my home and family ready?

You should be prepared for the outbreak to last a long time in your community. Do not rush out to panic buy supplies as this leads to shortages. Take what you need for a couple of weeks at a time and restock as needed.

Create a household plan of action using the CDC’s recommendations.

Where do we go from here and why we need to pay attention to how Taiwan responded

This type of situation will happen again in the future and it is crucial that we learn from this and create faster and more effective response protocols when novel viruses are identified.

Taiwan, despite its close proximity to China, has maintained some of the lowest infection and death rates due to the fast response upon hearing that a novel virus had been identified in China – 1.29% death rate compared to 3.96% in China and only 77 confirmed cases with 1 death in the entire country.

Read more about Taiwan’s rapid response that included border control from the air and sea, case identification using new data and technology, quarantine of suspicious cases, educating the public while fighting misinformation, negotiating with other countries, and formulating policies for schools and businesses.

In conclusion

There are precautions, preparations, and sacrifices that we will all need to make as we navigate the road ahead.

To panic is like taking action without first having accurate information and a plan. So, take this time to take a deep breath, educate yourself, and prepare. Make sure to follow reliable regular reporting on this issue and block out all the rest.

I will continue to update this article as important information develops.

Stay safe and healthy!

..

Part One – added Feb 29, 2020

Everyone is talking about the coronavirus. You’ve heard it being discussed constantly in the media and it’s made its way into everyday conversation. Given that this variant of the coronavirus is new, there has been much speculation as scientists determine the specifics of this novel variant.

As of Feb 29, 2020, this is what I believe you need to know about the virus and how to protect yourself and your loved ones.

Note: I will continue to add updates to this article as new information becomes available. Please consider joining my Facebook group if you would like to be notified.

What is COVID-19?

SARS-CoV-2 is the final name that has been given to the virus that causes COVID-19. COVID-19 is a new variant of a large family of coronaviruses that cause illnesses ranging from the common cold to more severe diseases such as SARS-CoV (severe acute respiratory syndrome) and MERS-CoV (Middle East respiratory syndrome). At the time of publishing this article, COVID-19 has spread to more than 50 countries since it first broke out in Wuhan, Hubei Province, China, in December 2019. There have been 85,403 confirmed global cases, with 79,394 cases (2838 deaths) in China and 6,009 cases (86 deaths) outside of China.

Common symptoms

The majority of people who get sick only develop mild disease. The most common symptoms are fever, dry cough, shortness of breath, and, as with any viral illness, fatigue. Some people experience muscle aches, confusion, headache, sore throat, nasal congestion, runny nose, chest pain, diarrhea, and nausea and vomiting.

How does it spread?

COVID-19 is spread from person to person by respiratory droplets that are produced when a person coughs or sneezes. The current incubation period (the time between catching the virus and beginning to have symptoms of the disease) as reported by the WHO is 1-14 days (with one report of 27 days) and most commonly around 5 days. This means that someone can spread the virus to others before they are showing any signs that they are sick.

It is still unknown how long the virus that causes COVID-19 survives on surfaces such as metal, glass, and plastic, but it seems to behave like other coronaviruses and may range from a few hours to nine days and can be efficiently inactivated by surface disinfection procedures with 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute.

Who is likely to get sick?

This virus is more likely to affect older males with underlying health problems such as high blood pressure, heart disease, and diabetes. This population is also more likely to develop serious illness leading to pneumonia, SARS, kidney failure, and death.

Currently, there is no evidence that children are more susceptible to the virus. There have been cases reported in children, but most of the confirmed cases are in adults. There have been very few reports of the clinical outcomes in children, but of which the disease appears to be mild.

There is no solid evidence that pets such as cats and dogs can be infected with coronavirus or spread it to humans. There is one case of a dog in Hong Kong who tested a weak positive but scientists are not sure if the dog just picked up the virus from a contaminated surface with its mouth or nose.

Is COVID-19 more deadly than the seasonal flu?

Yes, it appears that it is with the information that we currently have.

Current death rates of COVID-19:
3.57% in China*
1.43% outside of China
*Dr. Paul Herscu suggests that the death rates outside of China may be a better indicator of the true death rates given the inaccuracies in disease reporting that have come from China.

This year’s death rates of influenza A and B:
0.05% in the US

Is all of the hype and fear surrounding COVID-19 really necessary?

On Feb 29, the World Health Organization (WHO) raised the global level of risk to “Very High” which is the highest marker on their alert scale. The level was raised due to the difficulty in identifying cases and the potential for undetected transmission, as well as the potential for major impact on healthcare systems in affected countries.

So, it is important to educate and prepare yourself; however, not to the level of complete hysteria that some media outlets would have you believe. It’s important to find and follow reputable reporting on this issue and many of these resources are included in this article.

What contributes to much of the confusion and fear?

Any time a new virus develops and starts to spread there is a lot that is unknown as researchers begin to study the new virus and the people whom it infects. These unknowns include the incubation period, effective treatments, and how easily the virus spreads and how virulent, or deadly, it can be. Developing testing for the virus and the dissemination of those tests is also a problem that needs to be solved quickly on a global scale.

Disease reporting itself is also a big area of confusion and here’s why:

  • Different countries report on the disease differently. Although China has recently taken some measures to improve it’s reporting of COVID-19 the reported cases and death rates have been drastically changing. For example, with the seasonal flu, China reports only death caused directly by influenza and not those who die from complications of the flu.
  • Reporting methods in China did change to include anyone who has tested positive with a telltale pattern of pneumonia. This may, however, miss people with milder symptoms and is highly dependant on the skill of the doctor reading the CT scan.
  • Testing for COVID-19 has also had its challenges. Insufficient samples and faulty test kits, as well as lack of supplies, all account for inaccuracies in the reporting. Some people have initially tested negative, but have then gone on to test positive at a later date.
  • The confirmed cases do not include people who are asymptomatic but who also have the disease. If this number was included we would assume the death rate would reduce drastically.

What tools do scientists use to predict if a virus will become an epidemic/pandemic?

In epidemiology, the measure that scientists use to estimate how contagious or easily a virus spreads is known as the basic reproduction number or R0 (pronounced R-nought). This is the estimate of the average number of people who catch the virus from a single infected person. So, if the R0 is 1.3, as it tends to be with the seasonal flu, people with the flu tend to infect 1.3 other individuals, on average.

For a point of comparison:
Seasonal flu = R0 of 1.3
SARS = R0 of 2-5
HIV = R0 of 2-5
Measles = R0 of 12-16

R0 is important because if it’s greater than 1, the infection will probably keep spreading (but doesn’t tell you how fast), and if it’s less than 1, the outbreak will likely die out. However, it’s very important to note that R0 is hard to calculate and tricky to interpret.

The current R0 estimates for COVID-19 range from 1.4-5.5, with the WHO estimate from 1.4-2.5.

Where do we go from here?

How to get prepared and take proper precautions for COVID-19 and ANY viral illness

Prevention

As with any virus, these sanitary measures can be the most important thing that prevents you from getting sick and passing it on to others:

  • Regularly wash your hands with soap and water for 20 seconds, especially before eating.
  • *Use alcohol-based hand sanitizers with 60-95% alcohol only when handwashing is not possible. Regular handwashing with soap and water is far superior.
  • Avoid touching your face, eyes, nose, and mouth with unwashed hands.
  • Cover your mouth and nose with your bent elbow or a tissue when you sneeze and throw the tissue in the trash. Tissues are preferred because the virus may continue to live on your clothing.
  • Limit handling doorknobs and other public surfaces.
  • Avoid close contact with people who are sick.
  • Avoid large crowds and places with poor ventilation.
  • Stay home if you feel unwell!
  • **The use of a specialized face mask (N95 respirators) should only be used by health workers and caregivers at this time and is not recommended for public use.

*A note on alcohol-based hand sanitizers – Coronavirus is an enveloped virus and in general, these types of viruses are easily killed or inactivated by alcohol. However, makers of hand sanitizers have been known to make unsubstantiated health claims about the efficacy of their products against viruses and there are problems with the usage. Hand sanitizers do not remove dirt and are less effective on dirty hands, can give people a false sense of security leading to less hand washing, and they can break down the protective skin barrier if used too frequently and in people with skin conditions. It is not recommended to make your own hand sanitizer.

**A note on face masks Wearing a regular surgical mask will not protect you from the virus. However, surgical masks can help prevent infected people from spreading the virus further by blocking any respiratory droplets that could be expelled from their mouths.

If you are sick with a fever, cough, and shortness of breath:

  • Contact your local health department for the next steps
  • Stay at home and avoid going to public places and using public transport
  • Separate yourself from other people and animals in your home

Effective supportive treatments for COVID-19 all viral illnesses

To date, there is no vaccine and no specific antiviral medication to prevent or treat COVID-2019. Although, this will likely soon change. High-risk individuals and people with serious illnesses should be hospitalized.

My must-have list for the treatment of mild viral illness:

  • Buy a reliable digital thermometer
  • Low-sugar electrolyte tablets such as NUUN, coconut water, and/or keep a supply of broth in your freezer, such as Osso Good. Avoid highly sweetened or drinks with artificial sweeteners such as Gatorade, Powerade, and Pedialyte. Here is an easy natural sports drink recipe that you can make at home.
  • Collection of antiviral herbal formulas including licorice root (not to be taken if you have high blood pressure), North American ginseng, elderberry, echinacea, and garlic. These can typically be found at local health food stores, as well as iHerb.
  • Drink hot tea with lemon and organic honey. Studies suggest that honey is a better cough suppressant than cough medicine.
  • Zinc lozenges – these are the most effective, although not the best tasting
  • A good quality multivitamin – Thorne, Smarty Pants
  • Use a humidifier. Higher air humidity reduces virus survival of influenza and this may also apply to COVID-19. Add a few drops of the essential oil Eucalyptus to help with breathing, as well as for the antimicrobial effects.

Additional steps to prevent viral illness and improve your immune system:

  • Prioritize sleep! Getting 7.5+ hours each night of good quality sleep is crucial to a healthy immune system. Need something to help track your sleep? I recommend the Oura ring.
  • If you are feeling run down, take the day off. Being run down makes you more susceptible to contracting an illness.
  • Eat a whole-foods based diet rich in antimicrobial and anti-inflammatory herbs and spices such as garlic, ginger, cinnamon, and turmeric.
  • Avoid eating sugars and refined food, as well as limiting alcohol.
  • Exercise and move your body regularly. Your muscles act as a pump to your lymphatic tissue, which is part of the body’s immune system that helps to protect you from infection.
  • Practice daily stress reduction – mindfulness, meditation, journaling, prayer, gratitude, sunshine, fresh air, time with family and friends, play, pets, hobbies, self-care, etc. High cortisol levels from high stress negatively impact the immune system. My favorite ways to practice daily mindfulness are: HeadSpace, CALM, Muse brain-sensing headband, and 10% Happier.
  • Decrease or discontinue smoking, as well as avoid all second-hand smoke. Need help to stop smoking? Read this book.
  • Make sure that you are addressing any chronic health ailments! Healthy people with healthy immune systems are less likely to come down with a viral illness.

A note on fevers

Fever is the body’s normal response to infection. High temperature triggers the body’s production of infection-fighting white blood cells and inhibits the growth of viruses and bacteria. If you lower the fever with medications such as paracetamol/acetaminophen, aspirin, or ibuprofen, you may be affecting the body’s ability to respond to the infection.

Short-lived fevers (>38.3°C or 101°F) come and go without any long-term complications, however, the aches and pains that you feel during your illness may be in part due to the fever. So, lowering your fever with medication may improve comfort but will not help with the virus to run its course. In fact, it may lengthen the amount of time that you are sick. Instead of immediately reaching for the antipyretic medications, try taking a bath with 1-2 cups of Epsom salt or applying cool compresses for comfort.

The biggest source of concern with fevers is that you must stay hydrated! Dehydration during illness can lead to serious complications. Adequate water intake (about 1 L per 30 kg of body weight for the average healthy person) and minerals from drinking broth are very important when body fluids are being lost from sweating.

Note: Infants of <3 months are an exception and should always be seen by their doctor with any fever. Do not give children <18 years of age aspirin since it has been linked to the deadly disease Reye’s syndrome.

Should I stock up on supplies?

It’s never a bad idea to be prepared in case you become ill and are unable to leave the house for an extended period. Some recommended supplies include:

Travel restrictions during COVID-19

Are you thinking about traveling right now or do you have an upcoming trip? Check out the WHO’s travel advisory as well as the CDC’s travel advisory map.

In Conclusion

As is the nature of viruses, once it has escaped the region of origination and made its way across the globe it will likely stay with us. New viruses eventually become commonplace over time, such as the cold and annual flu. We just don’t know how much it will change over time and how virulent it will remain.

One of the main experts that I follow on the topic of epidemics, Dr. Paul Herscu, believes that the current information suggests that we “might just miss another scary global epidemic”. However, this outbreak brings to the forefront just how important the topic of epidemics is and the inevitability of new viruses that will continue to appear throughout our lifetime.

So, rather than panic, please take this opportunity to educate yourself and prepare.

Note: I will continue to add updates to this article as new information becomes available. Please consider joining my Facebook group if you would like to be notified.

Medical Disclaimer
This medical information is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your healthcare provider before making any healthcare decisions or for guidance about a specific medical condition.


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