Post 56. October 30, 2020. CORONAVIRUS. “Trump’s now back in charge. It’s not the doctors.”

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I’m old enough to remember the polio epidemic of the late 1940’s when Americans came fully together until a vaccine ended the public health crisis.

At its peak in the 1940s and 1950s, polio would paralyze or kill over half a million people worldwide every year. (R)

In 2009, a new H1N1 (“swine flu) influenza virus emerged, causing the first global flu pandemic in 40 years.  

From April 12, 2009 to April 10, 2010, the CDC estimates there were 60.8 million cases, 274,304 hospitalizations,  and 12,469 deaths  in the United States due to the virus.

By April 21, 2009, CDC had begun working to develop a virus that could be used to make a vaccine to protect against the new virus. Following preparation for distribution beginning in June, the first doses were administered in October 2009. (S)

Again we all listened to the public health experts.

With the ominous threats of ZIKA and EBOLA , we were guided by the experts.

But with Coronavirus its politics v. science and if politics prevails or it becomes too late for science we will achieve herd immunity with terrifying consequences.

Here’s what the “battle” looks like today.

___________

“In a taped interview on April 18, Kushner told legendary journalist Bob Woodward that Trump was “getting the country back from the doctors” in what he called a “negotiated settlement.” Kushner also proclaimed that the U.S. was moving swiftly through the “panic phase” and “pain phase” of the pandemic and that the country was at the “beginning of the comeback phase.”

“That doesn’t mean there’s not still a lot of pain and there won’t be pain for a while, but that basically was, we’ve now put out rules to get back to work,” Kushner said. “Trump’s now back in charge. It’s not the doctors.” The statement reflected a political strategy. Instead of following the health experts’ advice, Trump and Kushner were focused on what would help the president on Election Day. By their calculations, Trump would be the “open-up president.”” (A)

__________

“More than one-third of healthcare workers hospitalized for COVID-19 were nurses, underscoring the need for continued infection prevention and control practices.

During the early months of the pandemic, nurses and nursing assistants were hit particularly hard, accounting for a large percentage of healthcare workers hospitalized with COVID-19, according to an analysis released by the CDC.

The CDC says it examined 6,760 adult hospitalizations from COVID-19 in 13 states from March to May and found that nearly 6% were healthcare workers.

Of those, 36% were in nursing-related occupations. Nearly 28% of hospitalized healthcare workers were admitted to an intensive care unit, 16% required invasive mechanical ventilation, and 4% died.

Ninety percent of healthcare workers hospitalized had at least underlying condition, according to the analysis.” (B)

“Healthcare workers and their families account for a sixth (17%) of hospital admissions for COVID-19 in the working age population (18-65 years), finds a study from Scotland published by The BMJ today.

Although hospital admission with COVID-19 in this age group was very low overall, the risk for healthcare workers and their families was higher compared with other working age adults, especially for those in “front door” patient facing roles such as paramedics and A&E department staff, say the researchers.

As such, they say these findings have implications for the safety and wellbeing of healthcare workers, and their households.

Many healthcare staff work in high-risk settings for contracting COVID-19 and transmitting it to their household, workplace contacts, or both. Yet the extent of these risks are not well understood, as studies are lacking or have been beset by quality issues…

However, patient-facing healthcare workers were three times more likely to be admitted to hospital for COVID-19, while members of their households were nearly twice as likely to be admitted to hospital for COVID-19 than other working age adults.

Those working in “front door” roles, such as paramedics and A&E department staff, were at the highest risk of hospital admission for COVID-19…”  (C)

__________

“Doctors, nurses and caregivers at smaller and poorer hospitals and medical facilities across the country are still struggling to obtain the protective gear, personnel and resources they need to fight the coronavirus despite President Donald Trump’s repeated assertions that the problems are solved.

Health care workers at all types of facilities scrambled for scarce masks, gloves and other life-protecting gear at the beginning of the pandemic. The White House was letting states wage bidding wars against one another, rather than establish a central national manufacturing, supply and distribution chain.

But now, health care workers say a clear disparity has emerged and persisted. Larger and richer hospitals and practices outbid their smaller peers, sometimes for protective gear, sometimes to fill in staffing gaps. And some of those having the hardest time are precisely where the virus is spreading….

Months ago, city hospitals were fighting over essential medical supplies as Covid cases surged. That’s not happening anymore. But doctors, nurses and caregivers say they’re still struggling with resources.

Health care administrators say the smaller and poorer facilities are also being outbid in the labor market, as providers compete for a limited pool of trained nurses and specialists who can care for Covid-19 patients amid chronic staff shortages and pandemic-induced industry upheaval. Their descriptions illustrate the shortcomings of a federal response that was initially focused on major hospitals while scores of smaller providers fell through the cracks.

The resulting disparities, especially among long-term care providers who often continue to care for patients after they leave the hospital or whose patients don’t require hospitalization but are still infectious, puts an asterisk on Trump’s claim that “they’re very much stocked up, they’re in great shape,” as he put it at one of his recent briefings.

“There’s not a single building I work in that has adequate Covid-19 supplies,” said a nursing home worker in Colorado, who requested anonymity.

The challenges may persist. On Friday, the FDA included surgical gowns, gloves, masks, certain ventilators and various testing supplies on its list of medical devices in shortage, based on manufacturer reports. The agency has required companies to report potential supply disruptions since May under the CARES Act.

The shortages of personal protective gear, or PPE, has taken a toll. Without adequate protection against a contagious pathogen, thousands of health workers have fallen ill, and at least 922 have died, according to a 50-state tracking project by Kaiser Health News and the Guardian…

Health care leaders said these shortages stem from a mismatch of resources, as well as the pandemic’s shifting nature. While Congress made available $175 billion in coronavirus relief payments to help hospitals, doctors, nursing homes and other care providers, much of the initial funding went to well-resourced hospital systems regardless of need, with more targeted funding rounds coming later.

“Unfortunately, at every level of government, there has not been a coordinated response,” said Mark Parkinson, president and CEO of the American Health Care Association (AHCA) and National Center for Assisted Living. “And there have been some public health mistakes that were made. Early on, everyone thought that every hospital in the country was going to be overrun with Covid. So the decision was made to put all the resources in the hospitals.”

That’s not to say PPE shortages are completely resolved in hospitals. Some front-line workers, even at well-resourced hospitals, say ongoing shortages have forced them to clean and reuse masks and gowns that were intended for single use.” (D)

“For weeks, U.S. government officials and hospital executives have warned of a looming shortage of ventilators as the coronavirus pandemic descended.

But now, doctors are sounding an alarm about an unexpected and perhaps overlooked crisis: a surge in Covid-19 patients with kidney failure that is leading to shortages of machines, supplies and staff required for emergency dialysis.

In recent weeks, doctors on the front lines in intensive care units in New York and other hard-hit cities have learned that the coronavirus isn’t only a respiratory disease that has led to a crushing demand for ventilators.

The disease is also shutting down some patients’ kidneys, posing yet another series of life-and-death calculations for doctors who must ferry a limited supply of specialized dialysis machines from one patient in kidney failure to the next. All the while fearing they may not be able to hook up everyone in time to save them.

It is not yet known whether the kidneys are a major target of the virus, or whether they’re just one more organ falling victim as a patient’s ravaged body surrenders. Dialysis fills the vital roles the kidneys play, cleaning the blood of toxins, balancing essential components including electrolytes, keeping blood pressure in check and removing excess fluids. It can be a temporary measure while the kidneys recover, or it can be used long-term if they do not. Another unknown is whether the kidney damage caused by the virus is permanent….

Outside of New York, the growing demand nationwide for kidney treatments is fraying the most advanced care units in hospitals at emerging hot spots like Boston, Chicago, New Orleans and Detroit.

Kidney specialists now estimate that 20 percent to 40 percent of I.C.U. patients with the coronavirus suffered kidney failure and needed emergency dialysis, according to Dr. Alan Kliger, a nephrologist at Yale University School of Medicine who is co-chairman of a Covid-19 response team for the American Society of Nephrology…

The shortages involved not only the machines, but also fluids and other supplies needed for the dialysis regimen. Having enough trained nurses to provide the treatment has also been a bottleneck. Hospitals said they have called on the federal government to help prioritize equipment, supplies and personnel for the areas of the country that most need it, adding that manufacturers had not been fully responsive to the higher demand…

Some hospitals are also struggling to find enough nurses and technicians to provide dialysis, especially after some who were most skilled at providing the therapy fell sick with the virus themselves. “We did lose nurses to illness,” Dr. Murphy of Mount Sinai said. “We’re just getting some of those nurses back, but it’s been a challenge. We’ve exhausted every avenue that we have within the state with regards to being able to increase nursing.” (E)

“An ICU nurse in Las Vegas said that staffing levels at her small hospital fell noticeably while elective procedures were paused, and did not fully rebound when they resumed. She described the harrowing experience of caring for multiple unstable patients in the dead of night without the ability to call for backup because of thin staffing.

“The feeling you have when no one shows up to help you, it’s like ice in your veins, you never forget it,” she said. She added that while other nearby hospitals had bolstered nursing staff with $1,000 hiring bonuses, her workplace has not.

Adequate nurse staffing was already a contentious issue before the pandemic — for years, nursing unions have pushed for policies that mandate a minimum ratio of nurses-to-patients. California was the only state to enact such a mandate, but hospitals in the state since March have been able to apply for temporary waivers excusing them from the requirement…

Many hospitals that did have funds to hire nonetheless struggled to find staff with specialist training and experience dealing with a highly contagious respiratory disease.

“You have people going there that in many cases had literally no idea what they are doing,” said Sunny Jha, an anesthesiologist at the University of Southern California. “They’ve never worked in an ICU, they’ve never worked in a disaster field, they had never worked with Covid patients, and in some cases they had never worked period — this was their first job out of school.”” (F)

‘New Mexico hospitals face staffing shortages as COVID hospitalizations continue to rise

“What I’m told by the leaders of the university, Presbyterian, Lovelace, St. Vincent is that they really are facing staffing challenges right now,” Dr. Srase said.

Dr. Scrase said nursing staff levels dropped in late summer, but did not specify by how much.

“We all know that almost 1,000 New Mexicans have died, and most of them have died on the watch of these what I would call health care heroes in intensive care units, hospital floors that are taking care of these people— so, that takes a toll,” he said.

Dr. Scrase said he does not want to use field hospitals or the old Lovelace Hospital on Gibson because of staffing difficulties.

Amid the challenges at hospitals, Dr. Scrase also said New Mexico is seeing a record number of new cases across all age groups

“That’s particularly worrisome because it’s the 50 and older group that has a much higher hospitalization rate, and that’s where pressure comes in on hospital beds, ICU beds and staffing,” he said.”  (G)

“COVID-19 cases are surging in rural places across the Mountain States and Midwest, and when it hits health care workers, ready reinforcements aren’t easy to find.

In Montana, pandemic-induced staffing shortages have shuttered a clinic in the state’s capital, led a northwestern regional hospital to ask employees exposed to COVID-19 to continue to work and emptied a health department 400 miles to the east.

“Just one more person out and we wouldn’t be able to keep the surgeries going,” said Dr. Shelly Harkins, chief medical officer of St. Peter’s Health in Helena, a city of roughly 32,000 where cases continue to spread. “When the virus is just all around you, it’s almost impossible to not be deemed a contact at some point. One case can take out a whole team of people in a blink of an eye.”

In North Dakota, where cases per resident are growing faster than any other state, hospitals may once again curtail elective surgeries and possibly seek government aid to hire more nurses if the situation gets worse, North Dakota Hospital Association President Tim Blasl said.

“How long can we run at this rate with the workforce that we have?” Blasl said. “You can have all the licensed beds you want, but if you don’t have anybody to staff those beds, it doesn’t do you any good.”

The northern Rocky Mountains, Great Plains and Upper Midwest are seeing the highest surge of COVID-19 cases in the nation, as some residents have ignored recommendations for curtailing the virus, such as wearing masks and avoiding large gatherings. Montana, Idaho, Utah, Wyoming, North Dakota, South Dakota, Nebraska, Iowa and Wisconsin have recently ranked among the top 10 U.S. states in confirmed cases per 100,000 residents over a seven-day period, according to an analysis by The New York Times.

Such coronavirus infections — and the quarantines that occur because of them — are exacerbating the health care worker shortage that existed in these states well before the pandemic. Unlike in the nation’s metropolitan hubs, these outbreaks are scattered across hundreds of miles. And even in these states’ biggest cities, the ranks of medical professionals are in short supply. Specialists and registered nurses are sometimes harder to track down than ventilators, N95 masks or hospital beds. Without enough care providers, patients may not be able to get the medical attention they need.

Hospitals have asked staffers to cover extra shifts and learn new skills. They have brought in temporary workers from other parts of the country and transferred some patients to less-crowded hospitals. But, at St. Peter’s Health, if the hospital’s one kidney doctor gets sick or is told to quarantine, Harkins doesn’t expect to find a backup.

“We make a point to not have excessive staff because we have an obligation to keep the cost of health care down for a community — we just don’t have a lot of slack in our rope,” Harkins said. “What we don’t account for is a mass exodus of staff for 14 days.”

Some hospitals are already at patient capacity or are nearly there. That’s not just because of the growing number of COVID-19 patients. Elective surgeries have resumed, and medical emergencies don’t pause for a pandemic.

Some Montana hospitals formed agreements with local affiliates early in the pandemic to share staff if one came up short. But now that the disease is spreading fast — and widely — the hope is that their needs don’t peak all at once.

Montana state officials keep a list of primarily in-state volunteer workers ready to travel to towns with shortages of contact tracers, nurses and more. But during a press conference on Oct. 15, Democratic Gov. Steve Bullock said the state had exhausted that database, and its nationwide request for National Guard medical staffing hadn’t brought in new workers…

Back in Helena, Harkins said St. Peter’s Health had to close a specialty outpatient clinic that treats chronic diseases for two weeks at the end of September because the entire staff had to quarantine.

Now the hospital is considering having doctors take turns spending a week working from home, so that if another wave of quarantines hits in the hospital, at least one untainted person can be brought back to work. But that won’t help for some specialties, like the hospital’s sole kidney doctor.

Every time Harkins’ phone rings, she said, she takes a breath and hopes it’s not another case that will force a whole division to close.

“Because I think immediately of the hundreds of people that need that service and won’t have it for 14 days,” she said.” (H)

“The healthcare industry, long challenged by a shortage of physicians, nurses and other well-qualified staff, is facing even more of a dire need to the COVID-19 pandemic.

A new challenge are disruptors that are looking at the same pool of talent. Companies that formerly represented no competition to healthcare organizations, such as Amazon, Uber and Apple, are now well integrated into the industry, and they’re targeting both future and current employees.

“This is why it’s imperative for organizations to create a culture and employee experience that negates expensive and time-consuming tasks that push your company out of the market,” said Chas Fields, a human capital management strategic advisor at Kronos in the HIMSS20 Digital session, “HCM for the modern workforce: Becoming the employer of choice.”

To prevent employee turnover and improve their commitment to the workplace, organizations must curate an exceptional employee experience, Fields said.

To do this, four challenges need to be addressed: the talent shortage, competition among workplaces, creating a culture that matters and disruptors to the industry.

Talent shortages are especially prevalent among nurses and physicians. In fact, 40% of registered nurses are over the age of 50, meaning they will soon retire. Many physicians are also close to retirement age, which adds to the shortage among workers.”  (I)

__________

“Health policy specialists questioned White House officials’ claim that federal rules on essential workers allow Vice President Mike Pence to continue to campaign and not quarantine himself after being exposed to the coronavirus.

Campaigning is not an official duty that might fall under the guidelines meant to ensure that police, first responders and key transportation and food workers can still perform jobs that cannot be done remotely, the health experts said.

A Pence aide said Sunday that the vice president would continue to work and travel, including for campaigning, after his chief of staff and some other close contacts tested positive. Pence tested negative on Sunday and decided to keep traveling after consulting White House medical personnel, his aides said.

Pence’s chief of staff, Marc Short, was among those who tested positive. President Donald Trump, said early Sunday that Short was quarantining.

That usually means isolating oneself for 14 days after exposure in case an infection is developing, to prevent spreading the virus to others.

Pence was holding a rally Sunday in North Carolina, events in Minnesota and Pennsylvania on Monday and more events in North Carolina and South Carolina on Tuesday. The most recent numbers show COVID-19 cases are rising in 75% of the country.

On Sunday, National Security Advisor Robert O’Brien told reporters that Pence “is following all the rules” from federal health officials. He called Pence “an essential worker” and said, “essential workers going out and campaigning and voting are about as essential as things we can do as Americans.”

However, the guidelines on essential workers from the U.S. Centers for Disease Control and Prevention are aimed at folks like police, first responders and key transportation and food workers.

The Department of Homeland Security spells out 16 categories of critical infrastructure workers, including those at military bases, nuclear power sites, courthouses and public works facilities like dams and water plants.

“I don’t see campaigning on the list,” said Dr. Joshua Sharfstein, vice dean for public health practice at Johns Hopkins University and former Maryland state health department chief. “Anything that does not have to be done in person and anything not related to his job as vice president would not be considered essential.”..

If Pence’s official work as vice president was considered essential, the CDC guidelines say he should be closely monitored for COVID-19 symptoms, stay at least 6 feet from others and wear a mask “at all times while in the workplace.”  (J)

“A man in the United States has caught Covid twice, with the second infection becoming far more dangerous than the first, doctors report.

The 25-year-old needed hospital treatment after his lungs could not get enough oxygen into his body.

Reinfections remain rare and he has now recovered.

But the study in the Lancet Infectious Diseases raises questions about how much immunity can be built up to the virus.

The man from Nevada had no known health problems or immune defects that would make him particularly vulnerable to Covid…

Scientists say the patient caught coronavirus twice, rather than the original infection becoming dormant and then bouncing back. A comparison of the genetic codes of the virus taken during each bout of symptoms showed they were too distinct to be caused by the same infection.

“Our findings signal that a previous infection may not necessarily protect against future infection,” said Dr Mark Pandori, from the University of Nevada.

“The possibility of reinfections could have significant implications for our understanding of Covid-19 immunity.”

He said even people who have recovered should continue to follow guidelines around social distancing, face masks and hand washing.

Scientists are still grappling with the thorny issue of coronavirus and immunity.

Does everyone become immune? Even people with very mild symptoms? How long does any protection last?

These are important questions for understanding how the virus will affect us long-term and may have implications for vaccines and ideas such as herd immunity.”  (K)

“Cases of patients testing positive for both flu and COVID-19 have emerged in California and Tennessee as experts warn of a “twindemic” this winter….

In California, Solano County announced Thursday that its first resident had tested positive for COVID-19 and seasonal influenza at the same time. The patient is under age 65, the county said in a news release.

The case appears to be one of California’s first reported flu and COVID-19 co-infections this flu season.

Information about the interplay between influenza and COVID-19 remains limited because the latter is a novel virus, but both are respiratory diseases that weaken the immune system, especially in older adults, and each can result in hospitalization in severe cases.” (L)

“The shortage of medical equipment, including gowns and gloves, triggered by the coronavirus outbreak may be helping to spread dangerous germs within health care facilities, according to officials who warned of a potentially deadly fungus in a Los Angeles County health care facility.

L.A. County officials are warning about multiple reports of the fungus, known as Candida auris, in health care facilities; there is also an increase in reports of the fungus in Orange County.

At least one outbreak has been identified at a facility in L.A. County, according to an advisory, intended for health care professionals, issued by the Department of Public Health.

C. auris is a fungus that was first identified in 2009 in Japan but since has been declared by the U.S. Centers for Disease Control and Prevention a “serious global health threat.” The yeast “can cause bloodstream infections and even death, particularly in hospital and nursing home patients with serious medical problems,” the CDC said, noting that the fungus causes death in more than 1 in 3 patients who suffer from an invasive infection, such as one affecting the blood, heart or brain.

C. auris is considered particularly dangerous because antifungal medications are often ineffective against it. The fungus can live on surfaces for several weeks and can spread through hospitals and nursing homes by contact with infected people and contaminated surfaces and equipment.

The fungus can survive many routinely used disinfectants, county officials said.” (M)

__________

“Trump first said in a virtual Nevada tele-rally on Aug. 31 that the U.S. was “rounding the final turn” on the virus, repeating the line again at a Sep. 3 Pennsylvania rally “we are rounding that turn, and vaccines are coming along great.”

The biggest gap came when Trump contracted the virus himself at the beginning of October and briefly receded from public view, though he began saying it once again on Oct. 8.

“I say that all the time,” Trump said of the line earlier this month, calling those who disagree “cynics and angry partisans and professional pessimists,” and later declaring the U.S. is “rounding the turn with or without the vaccine,” even as the country reported a daily record of over 85,000 cases that day.

Trump has said the phrase every day for the last 15 days, even as daily average cases of the virus have risen sharply over the same period, hitting new records beyond the previous peak in July.

“Until November 4th., Fake News Media is going full on Covid, Covid, Covid,” Trump tweeted early Tuesday morning, adding “We are rounding the turn. 99.9%,” an incorrect reference to the survival rate of people who have contracted the disease, which has killed over 225,000 Americans, according to the CDC.

Trump has taken issue with using cases as a measure of the pandemic’s severity, arguing that increased testing accounts for the spike despite U.S. testing lagging compared to cases and deaths ticking up by 14% over the last 14 days, according to the New York Times.

The U.S. has since logged more than 43,000 deaths from the virus since Trump began saying the U.S. is “rounding the final turn” on Aug. 31, according to data from Johns Hopkins University’s Coronavirus Resource Center.

Trump has readily admitted his willingness to play down the realities of the pandemic to avoid panic, even if it means concealing the truth about its severity. After telling Washington Post reporter Bob Woodward in February the virus is “deadly stuff,” Trump nonetheless told him in March, “I wanted to always play it down. I still like playing it down, because I don’t want to create a panic.”  (N)

“White House coronavirus coordinator Dr Deborah Birx has reportedly boycotted Donald Trump’s coronavirus task force due to misinformation.

The leading physician was said to have walked out of a meeting of the White House coronavirus task force this summer, and decided never to return again.

CNN reported that Dr Birx, who advised the US president over many months, decided to deliver messages directly to the public, in part due to the appointment of Dr Scott Atlas.

She told colleagues that she would side-step any meetings with Dr Atlas, a controversial White House adviser without any background in infectious diseases or public health.

Mr Trump appointed him to the coronavirus taskforce in August, after appearing on Fox News for several months to challenge lockdowns, masks and other preventative measures.

“I hate to use the term doctor shopping, but it almost feels like if this is what President Trump did until he found someone in the medical field that agrees with him,” said CNN’s Kate Bennett on the report.

Dr Atlas had suggested last week that masks did not work to control the coronavirus’s spread, in a Twitter post that was censored as misinformation.

He also previously said there was “zero reason to panic” when Mr Trump was hospitalised with Covid-19, and pushed a herd immunity approach to end the pandemic – in what experts predict would cause an exceptionally high death toll…

Dr Birx has reportedly travelled more than 20,000 miles and visited 40 states since August, conducting meetings with local health officials to advise on how to combat the pandemic.” (O)

“Dr. Deborah Birx emerged from a meeting at the White House one day in late summer with a new resolution: Never again would she sit in a meeting with Dr. Scott Atlas and listen to him pontificate on the pandemic. CNN’s Kate Bennett reports.” (P)

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“Hospitals in Utah are full and poised to start rationing care. They’re also filling up in Montana and Idaho. Colorado is trying to avoid those states’ fate.

As new COVID-19 cases surge across the country, hospitals in Rocky Mountain states are among those struggling to keep up. In Utah, hospital leaders have told the governor they’re on the cusp of rationing access to intensive care beds. Idaho and Montana doctors are having trouble finding places to treat infected patients. John Daley, reporter at Colorado Public Radio, is watching this unfold from Denver, joins us now to explain. And, John, I want to get right into that warning from Utah, which I think is very striking for people. What does it mean for hospitals to consider rationing care?

JOHN DALEY, BYLINE: Well, Audie, in Salt Lake, that means they’re approaching that point where the number of patients simply overwhelms the ability of providers to care for them as they normally would. The hospitals there say they’ve prepared what are called crisis standards of care. This is essentially an emergency triage type of posture where tough decisions would have to be made about who gets care. In practical terms, that’s essentially a system of grading patients, of rationing care based on things like age, overall health and ability to survive. Doctor Estelle Harris at the university hospital said Utah’s hospitals are now seeing five or six times more COVID-19 patients than a few months ago.

ESTELLE HARRIS: I do think that although we currently are operating over 100% capacity of our normal ICU beds with COVID, we do have some good plans in place if we have to use them. But that will come with an enormous strain on the COVID care providers.” (Q)

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    grsydB I truly appreciate this post. I have been looking all over for this! Thank goodness I found it on Bing. You ave made my day! Thx again

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