Board of Health – Isolation and Masking of Children – Feb 20th 2021 – The Whole Story

What Happened: Synopsis

I tried to address an issue that had been identified by me regarding public health orders put in place by Wellington Dufferin public health and their health board. 

Point by point, this is what happened:

February 20th Letter

Download the original letter in PDF (which includes the graphics in the correct spots)

To the WDG Public Health Board, I would like to be a delegate at your next meeting. I would like to discuss mandatory masking of children in schools. Specifically, expansion of masking mandates and increased rules around mandatory masking. I would also like to understand exactly what metrics we are using to measure our lockdowns. Here is a news article with Dr. Mercer advising the UGDSB trustees of best practices regarding masking. https://www.cbc.ca/news/canada/kitchener-waterloo/ugdsb-masks-required-covid-19-1.5691742

First and perhaps most importantly, has there been an impact study of masking vs no masks on children? Who completed it and where can we read it? Any cost benefit analysis that has an accurate assessment of potential drawbacks of mandatory masks, including physical, psychological, developmental as well as defined outcome metrics / expectations (what you expected vs what actually happened)? If not, how can we possibly continue to experiment with our children like this? If so, where can I read it? 

 

What did the study identify as potential health impacts, developmental impacts and any other potential drawbacks to masking children for prolonged periods? How many 6 year olds were studied, how long were they forced to wear a mask for per day and what were their outcomes? How many 8 year olds? How many 12 year olds in the studies? Isn’t informed consent a necessary part of any medical intervention? Why are we not informed of the potential drawbacks of mandating masks on children? Nearly a year in! 

 

There is a large body of policy-level evidence that backs up the idea that wearing a mask when healthy is not beneficial. There is also evidence that non-pharmaceutical interventions (NPI’s) 2 like lockdowns, masking and physical distancing do not meaningfully change case numbers, death numbers or infection numbers. I will go through a small sample of that evidence now. 

 

In 2015 and 2018, the Ontario Nurses Association successfully argued that the “Vaccine or Mask” (VOM) policy violated the nurses basic rights and is “illogical and makes no sense” and “is the exact opposite of being reasonable.”

 https://www.ona.org/news-posts/ona-wins-vaccinate-or-mask-flu-policy/ 

In 2015 this is what the arbitrator said: 

 

3 https://www.cbc.ca/news/canada/toronto/union-says-ontario-nurses-can-t-be-forced-to-wear-ma sks-in-flu-season-1.3222702 

In light of this expert’s opinion, which was echoed by the WHO at the beginning of the pandemic in 2020 (https://twitter.com/WHOWPRO/status/1243171683067777024?s=20), can you outline in detail (with links to the information) what has changed about mask efficacy? What the WHO said: “If you do not have any respiratory symptoms, such as fever, cough, or runny nose, you do not need to wear a medical mask. When used alone, masks can give you a false feeling of protection and can even be a source of infection when not used correctly.” https://bit.ly/2QN3QOp Here is one recent study from Germany that has looked at mandatory masking of 25,000 students and the negative impacts of that mandatory masking. The impacts are significant, as illustrated here (3rd paragraph):

 

 4 https://www.independent.co.uk/news/german-children-suffer-from-psychological-issues-in-pand emic-children-children-researchers-families-children-b1800396.html?utm_content=Echobox&ut m_medium=Social&utm_source=Twitter#Echobox=1612980377

 

 https://www.researchsquare.com/article/rs-124394/v2 https://montanadailygazette.com/2021/01/25/new-study-finds-masks-hurt-schoolchildren-ph ysically-psychologically-and-behaviorally/ Here is the original study: 5

 https://www.researchsquare.com/article/rs-124394/v1

 

 And here is a registry that is being used in the United States. You can read the negative impact of masking from first hand accounts of parents who have no options. https://nomasksforkids.com/ 

 

6 Sweden has banned masking and PPE from schools and even demanded teachers remove masks: https://sverigesradio.se/artikel/halmstad-forbjuder-munskydd-i-skolan A student was suspended from a school in Guelph for removing their mask for a breathing break.

 

 https://twitter.com/Whitney46535074/status/1362731274633379842 

 

7 Guelph has had mandatory masks in place since July 2020, but it has not averted multiple lockdowns. Nor has it prevented outbreaks in Long Term Care homes, places of employment etc.

 

 If you are convinced that masking reduces the spread by a percentage amount, do you have anything other than models to back up your claim? 

 

What is the percentage amount that infection was reduced due to masking in Guelph, according to your data? Please share everything you have showing this, including source data, name and date as well as output of model and modeling inputs. The issue is that we have examples of places that did not have the same restrictions as we did, and it appears that they did not have a worse outcome. 

 

That data shows that the NPI’s used did not impact the curves. Most “curves” look the same regardless of NPI’s in place. To be clear, this means that the argument of “it would have been worse without the masks” is null. That is NOT seen in the actual data of places that did not mandate masks. Here is a graph that shows when mandatory masks were started and further lockdown measures attempted. It had no effect on the curve. (you can see a larger version at the link)

 https://twitter.com/Milhouse_Van_Ho/status/1346325686496194560?s=20

 Source: https://covid-19.ontario.ca/data 

 

The yellow notes on the graph say: July 7 – Mandatory Masks, Oct 10 ban on indoor dining, Nov 14: Totonto 2nd lockdown 

 

8 Are we to believe that the lockdown that started in Toronto in October is only now starting to take effect? Are we to ignore seasonality completely as well? We have data from Sweden, Florida and multiple states with similar populations to Ontario and we have seen that masks make little difference in the respective curves. In fact, globally it looks a lot like a yearly seasonal curve to quite a lot of people. 

 

Here is that data: Florida, Georgia and South Carolina have been Open since April, Sept and Oct. They have a ranking by state of deaths per million. Florida is 26th, Georgia is 23 and South Carolina is 20th. No mass death is equated with 3 large populations that have no mask mandates in place.

 https://twitter.com/jeffreyatucker/status/1359144860935159813?s=20 https://www.worldometers.info/coronavirus/country/us/ 

 

Multiple states on one graph: Source cited by graphs: 

https://covidtracking.com/ https://twitter.com/ianmSC/status/1360319669635190787?s=20 9 

 

Mississippi and Alabama: 

 

10 

https://twitter.com/ianmSC/status/1358149572250505224?s=20 https://twitter.com/ianmSC/status/1360323405099061248 11 

Idaho and Utah – Utah had a mask mandate, Idaho did not: https://twitter.com/ianmSC/status/1360396841372721153 12 13 https://twitter.com/ShrubberyBanana/status/1360404241458688000?s=20 

 

Seasonality curve around the world:

 

 https://twitter.com/ClareCraigPath/status/1356539867530936321?s=20 14 15 

 

Here is Germany 2020 vs Flu 2018 

 

https://twitter.com/DaFeid/status/1294393266654318592 

 

Florida – Fully open since September 2020 https://www.google.com/search?q=covid+graph+for+florida&oq=covid+graph+for+florida&aqs=c hrome..69i57j0i22i30l2j0i390l2.2826j0j1&sourceid=chrome&ie=UTF-8 16 17 

 

Sweden – Never Closed https://www.google.com/search?q=covid+graph+for+sweden&oq=covid+graph+for+sweden&aq s=chrome..69i57j0i390l2.4401j0j1&sourceid=chrome&ie=UTF-8 18 19 Ontario – 

 

Full lockdown, eased restrictions in the summer then ineffective lockdowns https://www.google.com/search?q=covid+graph+for+ontario&oq=covid+graph+for+ontario&aqs= chrome..69i57j0i390l4.3378j0j1&sourceid=chrome&ie=UTF-8 20

 

 Florida has more than double the cases of Ontario, and yet their economy is open and they are not reporting mass death or casualties from Covid19. Why is that? Do you have a good explanation why these curves look similar to the seasonal curves noted around the world? When the data shows that mandatory masking in Ontario starting in July didn’t meaningfully stop the case numbers from getting to the point of needing new lockdowns in the fall and winter, and the evidence of no overwhelmed hospitals and no mass deaths from places that are fully open, would it not be reasonable to reassess our strategy? 

If we have had a failing strategy for a year, with dire financial, economic and cultural impacts then that failure should be addressed. Our strategy must be adjusted with the data! In BC wearing a mask is left up to the family with regard to wearing during school. Why are there different rules for different health units? How can these policies possibly be science driven? What science (not provincial order, what SCIENCE) is currently driving the mandatory masking in our health unit? If it were accepted science wouldn’t everyone adopt the same measures? Further, the measures that have been adopted don’t seem to be successful at the goal of “reducing the impact” of the virus. I say that, because I can’t find the specific goals of the lockdown other than some vague statements from different levels of leadership. How are we to  measure our success without any meaningful metrics and with constantly shifting goalposts? Can you clearly articulate the goal of the previous most recent lockdown?

 

 https://twitter.com/Milhouse_Van_Ho/status/1359564556192927749?s=20 https://www.tricitynews.com/local-news/what-you-need-to-know-about-bcs-new-mandatorymask-rules-at-schools-3355357 

In light of the new data, based on real world observations and not models, and pending questions about efficacy of masks (do they work to stop the spread of respiratory virus? How is their success measured? Does the protection offered outweigh the potential harms? What are those harms?), the mandatory masking of children in schools should be stopped immediately pending review of the impacts and informed consent of the guardians who have to comply with these masking standards. Informed consent is not possible at this time as no one has been briefed on the potential drawbacks of prolonged masking of children. Speaking of clear metrics, what metrics are we using to lock down our businesses and economy? 

On Dec 28th we had 6 people in the hospital and 163 cases per 100k. That was the beginning of a 45 day lockdown. The hospitalizations have not changed over that period of time. We have consistently had between 3 – 10 people in hospital, but mostly between 4-6 people. During that time the occupancy has been below the 5 year average, staying below 90% and getting as low as 75.2%. Test positivity rate fluctuates as well from 3.6 at the beginning of the lockdown to 5.9% 12 days into the lockdown started on December 26. It sat at 4.2-4.4% until Feb 1 and then it started declining. You can see every day from our public health stats to illustrate my point, but here are the 3 days in question. Dec 28 and Feb 11 and Feb 17.

 

 How is it decided to put Guelph into Red level? What metrics are driving the decision? What criteria do we need to achieve to get to Yellow level as it seems the colour coded system isn’t being arbitrarily followed. How can we run a society with ever changing rules, decided upon by a single, unelected bureaucrat? 22 https://canadareport.co/guelph-2020-lockdown-2/ 

 

 Here are the criteria for the colour coded system that was in place prior to the Dec 26th lockdown. https://toronto.ctvnews.ca/here-s-how-ontario-s-colour-coded-covid-19-system-works-1.5172308 

As you can see, the only metrics that puts us in the Red – Control group are cases per 100k and test positivity. As of Feb 17 we were at 39 cases per 100k. Case numbers clearly don’t tell the whole story, but case numbers are falling, hospitalizations are steady. Help me understand what metrics are driving the continued economic misery in our city. Why don’t we have a clear understanding of how this process operates and how restrictions are decided upon? 

Similarly can you give me a number for 2015 – 2020 for pneumonia deaths in Guelph for January – March so we can compare the deaths in this January – March timeline? Is 20 deaths normal for this time of year in a typical flu season? Despite the numbers demonstrating quite well over the last 45 days that case numbers do not impact hospitalization numbers (case numbers doubled during the lockdown, while hospitalizations were stable) we have endured more than 45 days of lockdown and economic misery (of a stated 28 days), for what gain? Can you clearly demonstrate what has been accomplished with these damaging policies? 

Who can the public hold accountable? This situation has not come about because of a virus. It has come about because of bad policies. We have examples of other places in the world that have not suffered nearly as much because their leadership refused to implement lockdowns and other failed policies. Here is a recent one from Florida. https://twitter.com/GovRonDeSantis/status/1360616518434910208?s=20 

 

I will be publishing this as a public letter. Looking forward to addressing the board in March. 

 

Thank you for your time. Mark Paralovos

 

 P.S. Often, as with a snow storm, dire predictions can end up being very wrong. Here is a good example with covid. 

The 4th surge never came. (image on next page, along with some supplemental reading): https://twitter.com/ianmSC/status/1360319669635190787?s=20 29 Some further reading: 

 

The Milgram Experiment 

https://en.wikipedia.org/wiki/Milgram_experiment 

In this experiment a person in authority (like public health) tells a subject (who is being measured for compliance to authority) to administer an electric shock to an unseen person on 30 the other end of a speaker. The subject is instructed by the person in authority to continue administering the electric shocks periodically after the “volunteer” gets a question wrong. These are recorded responses, and they plead with the subject to stop shocking them. 

The experiment continues until the “volunteer” stops responding (after saying that they have a heart condition and that they can’t take it anymore). You can watch a video of a documentary on it here: https://youtu.be/rdrKCilEhC0?t=426 This parallels very well to masking our children. Parents are being told by people in authority to mask their children. Parents are being told masking is good for the children while not being told of potential drawbacks, even though we know there are potential drawbacks! What the Milgram experiment shows is that people will inflict harm on other people if told to do so by a person in authority. 

You are that authority in this case. Another well known experiment regarding the developmental side of child / caregiver interactions: This is what happens to infants who have emotional displays removed from their interactions. 

I hope you read this. still face experiment

 https://www.gottman.com/blog/research-still-face-experiment/

 

 Here is a thread outlining the flawed conclusions of the 2020 mask “Studies.” https://twitter.com/IAmTheActualET/status/1350212693190455298?s=20 

Here is a visual demonstration of why masks do not impede any kind of vapor. We just can’t see it. https://twitter.com/TonyRogers1256/status/1357111815671545856 

 

A further study on the covid restrictions in Ontario 31 https://ocla.ca/wp-content/uploads/2021/02/OCLA-Report-2021-1-4th-science-review-for-covid-p olicy-Reg-364-20-7f.pdf May 2020 –

 Masks not always the answer https://www.cbc.ca/news/canada/new-brunswick/nb-wearing-masks-1.5560578 impact of masks in UK https://twitter.com/Stat_O_Guy/status/1359148708475113475?s=20

 

 I would ask why we’re not pursuing therapeutics, but that will wait until I can address you in April, I suppose. treatment https://twitter.com/DrP_MD/status/1361859838029017089?s=20 Early treatment https://twitter.com/robinmonotti/status/1362038625333088258

March 3 Delegation

Here is the video of the March 3rd delegation. My part starts at 2 min in. 

Thank you to the board of health for allowing me time to address you. I respect the work that is done to ensure public health.

For context, I’m going to speak briefly about my personal background and experience. I have a long history of working in helping professions. I spent 15 years in children’s mental health and working in schools. Before that I had an intimate knowledge of the foster care system in Guelph. I was also an active union steward through my years in education / mental health. So I have a deep understanding of policy development. Along with a deep understanding of child protection and best practices with regard to policy making for at risk populations of youth.

That’s why i’m speaking out. What is going on in our city and our province is abhorrent and unacceptable. It violates our basic rights. The recommended abuse by public health for children who are healthy yet deemed high risk contacts is frightening as it’s been brought to light and ignored by leadership at the provincial level.

The Milgram experiment, referenced in my letter is a good example of what we’re currently living through. In Milgram they measured the public’s compliance with authority. What it found was that if a person in authority told a “teacher” to administer an electric shock to a “learner” the “teacher” would be upset, would beg the person in authority to stop the trial, but they would comply. They would administer those electric shocks until the subject’s death. That is exactly what’s happening right now with mandatory masking across the health unit. You have created a situation where basic rights don’t matter and authority figures (you) are telling parents through public orders to harm their children. And they are complying. You are the only ones who can stop this horrific abuse.

The damage being done by mask mandates is very concerning. We have had a child suspended in Guelph for accessing his exemption at school. He was distanced and got punished for removing his mask. This is despite a large body of evidence that mandatory masking does not reduce the spread of respiratory virus. I outline the data in my letter, so i won’t rehash it here. We have had public health recommend isolating children by themselves for 14 days if they are deemed “high risk contacts.” If i were to do that to a child outside of public health’s direction I would very likely have my children removed from my care. Yet the “leadership” has said nothing. This is shocking and abhorrent. It is now your responsibility to stand up for our children.

Early in the pandemic there was caution by many doctors and public health that wearing masks for healthy people is not beneficial because people fiddle with them and touch their face a lot more when wearing masks. What studies or data have been released that nullify that concern?

What are the potential developmental impacts, physical impacts? Are instances of bacterial pneumonia or hypoxia considered? Instances of impetigo? What are the developmental impacts to children under 7 of being forced to wear a mask for extended periods multiple days in a row? Was the still face experiment taken into consideration? (referenced in my letter) Are parents informed of these potential risks? If not why not, as informed consent is necessary for any medical intervention? Where is that handout that outlines the risk factors for prolonged masking of children or the risk factors for prolonged masking of humans?

Now that you’re aware of the damage being inflicted to children in our health unit, what compelling evidence do you have that masking works? How are you measuring the efficacy of masks in the school setting? Specifically what studies and what data are being used to drive the decision to continue to force children to wear masks all day?

Further – what criteria need to be achieved to repeal this damaging and ineffective intervention?

Infection curves in places with mandatory masking are the same as curves in places without mandatory masking. How and why is that being ignored?

Similar to lockdown metrics, it seems that the data used to continue the mandatory masking of children is not robust and is not public. Without a clear way to measure success or failure it is impossible to gauge our progress , regarding both masks and lockdowns.

Why did this health unit remove the number of active cases in the hospital from the data dashboard? What rationale was used to justify removing this information from public consumption?

When children become victims of bad policy it is time to act. The child who was suspended in Guelph because he removed his mask was complying with the law. Because the people in authority (public health) have the section 22 mandate in place this child’s right to decide if he needed to breathe freely was removed. He was punished for having the gall to do it anyway. Suspended from education. For the crime of removing his mask. When the exemption is clearly written into the law. Was this the intent of the mask mandate?

When children become victims of bad policy it’s time to act. We have far too many victims in this pandemic anyway, we don’t need to create more by continuing bad policy. One more story.

When a peer in a class gets sick and a healthy child is deemed a high risk contact they still get a letter sent home telling parents the child must isolate for 14 days even with a negative covid test. The guidelines around this self isolation are not appropriate and would constitute abuse/neglect in another context. Parents have followed this advice.

If you don’t act, and act now, who will? Who can?

March 16 Letter from WDG Public Health

Download the original PDF of the letter here

 

WDGPH does not have the mandate or resources to execute the type of studies you refer to in

your email, but relies on provincial and national evidence-based medical guidance, while also
aligning ourselves with what we consider to be the present scientific consensus regarding
best practices for reducing the risks to the community arising, as a result of the COVID-19
pandemic.
We understand that you may disagree, however it was and remains our understanding that
requiring the use of masking in indoor places is necessary to control the spread of a disease
that can cause serious illness or death, especially in circumstances where it is difficult to
ensure social distancing.
It is also our understanding that the use of masks and social distancing will increase our
ability to safely open-up the economy, as soon as possible.
In the specific context of schools, we believe that, at this point, masks are necessary to protect
students, staff and the families of students and staff to the greatest degree possible in order to
permit in-school instruction. The fact that some people would prefer not to wear masks must
be balanced against the risks to other members of the community. If there are particular
students who, for medical reasons, are genuinely unable to safely wear masks, then schools
are permitted to provide accommodations.
While it is not our intent or our role to get into a back-and-forth debate with you regarding
the weight to be given to the various articles and social media posts that you are citing, we do
note that the article concerning the German study regarding the psychological effects of mask
wearing has the following editorial comment:

 

EDITORIAL NOTE:
This study is based on a survey regarding the adverse effects of mask wearing in children. Due
to multiple limitations, this study cannot demonstrate a causal relationship between mask
wearing and the reported adverse effects in children. Most of the respondents were parents,
and the survey was distributed preferentially in social media forums that, according to the
authors, “criticize the government’s corona protection measures in principle”. The limitations
of the study include sampling bias, reporting bias, and confounding bias as well as lack of a
control group. The use of masks, together with other precautionary measures, significantly
reduces the spread of COVID-19 and is considered safe for children over the age of two years
old.
Even if this study were to be taken at face value, which, for the reasons stated in the editorial
note, we do not, it is also necessary to consider the psychological and practical benefits to
children and their families of in-school instruction even if masks are required to permit this to
be done in a safe and sustainable manner.
Finally, to avoid misunderstandings, WDGPH has not issued an Order requiring that children
be isolated from members of their households in cases where a classmate has tested positive.
Although no Order has been issued, we do recommend that children who have tested positive
or who are experiencing symptoms consistent with Covid-19, should be isolated from other
members of the household but only to the extent that it is possible to do so without
compromising their care.
Sincerely,
Dr. Nicola Mercer, MD, MBA, MPH, FRCPC, C.Dir
Medical Officer of Health and CEO
Wellington-Dufferin-Guelph Public Health

March 22 - Toronto Sun publishes Dr. Bridle's Account

“I am a viral immunologist who conducts COVID-19 research, so I am speaking from an incredibly well-informed position,” the letter states. “I am also a parent. From both perspectives, these policies for children who have had a classmate test positive for COVID-19 are nothing short of abusive.”

Bridle attached a copy of the letter his household received from Wellington-Dufferin-Guelph Public Health, which instructed them to have their child “isolate in a separate room” for 14 days and to keep a distance of two metres from other family members.

Bridle’s son has Down syndrome and there were no separate guidelines sent out concerning children with special needs.

Dr. Bridle
Viral immunologist

See the full article here:

https://torontosun.com/news/provincial/viral-immunologist-speaks-out-against-abusive-child-quarantine-policies

Sample of Letter sent from WDG Public Health

March 23 Follow up Regarding Toronto Sun Paper

Hello Dr. Mercer,

 
Please help me understand something that has come to light. I will be asking about this in person on April 7, but this is egregious and shocking and i want to make sure i’m clear on what happened.
 
 
On March 3 I begged the board of health to act on language sent from this health board that is forcing parents to abuse their children, by order of public health. Peel and other school boards walked back this language after it became apparent that it was instructing abusive actions.
 
 
In your signed letter to me you stated:
 
 
“Finally, to avoid misunderstandings, WDGPH has not issued an Order requiring that children be isolated from members of their households in cases where a classmate has tested positive. Although no Order has been issued, we do recommend that children who have tested positive or who are experiencing symptoms consistent with Covid-19, should be isolated from other members of the household but only to the extent that it is possible to do so without compromising their care.  “
 
 
 
Attached is a copy of the letter instructing parents to isolate a healthy child due to being a high risk contact. If no order was issued, why is this letter being sent out instructing parents to abuse their children? You said no order has been issued, therefore, no letter should be sent. And yet, attached is the letter sent to parents.
 
 
Also, here is a media piece that covered the open letter sent by Dr. Bridle expressing exactly the same concerns that I had.
 
 
 
 
 
Why lie? If you lie about this, what else are you lying about? Your credibility is shot. Do you have any reasonable explanation for this egregious lie that enabled abuse of children to continue?
 
 
If you sit on this health board, were you aware of this lie? Were you aware of the language being sent out to parents? Would you be able to send your 8 year old daughter to her room for 14 days as is instructed? If you were aware then you are as complicit in the inaction. If you were not aware, it is time you started asking some questions!!
 
 
I am shocked, saddened and sickened by your lie and your lack of action. Shame on you. What about the children who suffer because of your lie and your inaction!!!!!
 
 
I will be publishing this as an open letter, and will be following up with new data for my delegation on April 7.
 
 
Mark Paralovos

March 23 - Response from WDG Public Health

March 25 Response from Mark

Good Morning George,

 
This is in reply to your letter from yesterday.  I have included the letter for easy reference.
 
Please give me concrete examples of any hostility or aggressive actions taken by me. As aggression and hostility is not my intent your feedback will be used to ensure easier communication in the future. My main goal is having my concerns addressed meaningfully by the public servants during these unprecedented times.
 
Please explain why the April 7th board of health meeting is now a closed meeting and is no longer an open public meeting?  I will formally request an investigation if the answer is not satisfactory. Please consider this as my request to be a delegate at the next public meeting.
 
Please explain why you did not mention the change in status of the meeting in your letter to me?
 
Please explain which policy, procedure or by-law gives you the ability to deny me my requested 5 min? In a public meeting I don’t see any way for you to deny my request based on your claims in the letter from yesterday.
 
Finally, you said yesterday that my concerns had been heard and addressed. That is not true. The letter sent by Dr. Mercer contained a lie. One that I am very interested in hearing an explanation for.  Having a public servant lie to members of the public in a letter is a big deal. Finding out why that happened is as important as protecting our children. If it was not a lie, please explain my misunderstanding.
 
Thank you for your time. Looking forward to your quick response. As usual, this will be posted as a public letter.

March 30th Mercury Tribune Article

This article does not address any of the concerns or issues raised by myself or Dr. Bridle. It is the job of public health to be accountable to the public they serve. This articles contradicts itself multiple times, but only because public health contradicts themselves. These orders are abusive and should be ignored. Public health needs to be held accountable. 

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