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Wuhan Coronavirus - are you prepared?

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Posted (edited)

@ShanesPlanet
It is all about the hospital capacity... 
I have found an mp4 file that shows the effects of social distancing:

 

Edited by Roland
added text

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Posted (edited)
41 minutes ago, Roland said:

@ShanesPlanet

There is a nice article that shows how those partially effective quarantines work. 


https://www.washingtonpost.com/graphics/2020/world/corona-simulator/

Korea, Singapur and Taiwan did enough contact tracing and testing and quaratine measures early enough that they do not have the problems that the rest of us has or will have soon ... 

 

This is very important information! I hope everybody is reading this article. Thank you for sharing! That is what proactivity means. 👍 

Edited by Toshio Uemura

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14 minutes ago, Roland said:

@ShanesPlanet
It is all about the hospital capacity... 
I have found an mp4 file that shows the effects of social distancing:

 

 

I just hope our government and everybody who is responsible for enforcing this is watching this! Thanks for sharing!

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20 minutes ago, Toshio Uemura said:

People who lived through this in Wuhan strongly recommend for families to stay apart from each other and live separately if possible. 

My wife has been off work for over 3 months from a back injury. She returns to work this Wednesday. Being an RN who works in a high risk OBYN area of the hospital I may follow this recommendation and move into my pole barn. 

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6 hours ago, Rehab1 said:

I’ve informed my employees that there maybe mandatory layoffs if the trend continues beyond a few weeks. My two secretaries already had an emotional fight this morning. 

It occurred to me that with unemployment insurance being something all employees pay into yet often don't use, would you want to lay off your workers as soon as possible so they can collect benefits? You do not have the cash reserve to ride this out for two months, not of you're paying salaries, benefits, and office space.

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1 minute ago, Rehab1 said:

My wife has been off work for over 3 months from a back injury. She returns to work this Wednesday. Being an RN who works in a high risk OBYN area of the hospital I may follow this recommendation and move into my pole barn. 

I realize this is a very difficult decision for you to make, but I think you both should contemplate such a decision. Personally I believe it offers more advantages then disadvantages and it is not for ever. I think as long as you stay in close contact via Skype or FaceTime and support each other, this may be the way you want to go. Our family is staying in pairs of two in four different locations. We keep outdoor clothes and shoes separated and outside and always wear our mask 😷 outside. Stay safe! Go with you gut feeling however you decide on this! 

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6 minutes ago, LanghamP said:

It occurred to me that with unemployment insurance being something all employees pay into yet often don't use, would you want to lay off your workers as soon as possible so they can collect benefits? You do not have the cash reserve to ride this out for two months, not of you're paying salaries, benefits, and office space.

I think, such decisions should be made mutually together with employees after considering all the risks and options. Otherwise you will loose the trust of your employees and might come out all right financially, but have are hard time to restart your business later without your trusted team.

 

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Posted (edited)
1 hour ago, LanghamP said:

Critical condition doesn't mean dead. They'll recovery and be just fine, but old people die.

Now just try to go the extra mile and imagine your health care system is overloaded (which it probably will be in the US and in many other countries by the end of May, if not earlier, and with few exceptions).with none of these ventilators available. Just imagine the decisions that have to be made. Do all doctors go young before old?!
Starts to get a bit frightening, isn’t it.
But a bit frightened is good ... keeps you sharp ... ask any veteran!
 

9BB98120-2DC4-4276-96DC-3DB923AE9B6D.jpeg

Edited by Toshio Uemura

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Posted (edited)

Here is a picture from a study from the Robert-Koch-Institute in the year 2012:Graph-from-German-Study-engl.png.05889ae9b34c21335e05721ae65b4e5d.png
This shows a ficticous pandemic outbreak scenario in germany: 
Link: http://dipbt.bundestag.de/dip21/btd/17/120/1712051.pdf
I have translated part of the study with the help of google san - Brace for wall of text: 

The risk analysis "Pandemic caused by Virus Modi-SARS" was carried out under the technical leadership of the Robert Koch Institute and the participation of other federal authorities 13.

Here too, a corresponding scenario was first developed by the inter-agency working group. 
The probability of occurrence of such a pandemic and the extent of the damage to be expected were then determined. The scenario describes an unusual epidemic that is based on the spread of a novel pathogen. For this, the hypothetical "Modi-SARS" pathogen, but with realistic properties, was used. A SARS-like virus was chosen against the background that the natural variant in 2003 quickly pushed very different health systems to their limits. 

The past has already shown that pathogens with novel properties that trigger a serious epidemic event can suddenly appear (e.g. SARS coronavirus (CoV), H5N1 influenza virus, Chikungunya virus, HIV) .14 

Using simplified assumptions for this Modi-SARS virus, the hypothetical course of a pandemic in Germany is modeled, which is both federally relevant and plausible.15 

The scenario describes a worldwide spread of a hypothetical new virus from Asia, which is named Modi-SARS virus. Several people enter Germany before the authorities receive the first official warning from WHO. Among them are two infected people who, through a combination of a large number of contact persons and high infectivity, contribute strongly to the initial spread of the infection in Germany.
 
Although the measures provided for by the Infection Protection Act and pandemic plans are implemented quickly and effectively by the authorities and the health system, the rapid spread of the virus cannot be stopped effectively due to the short interval between two infections.

At the height of the first wave of illness after approx. 300 days, approx. 6 million people in Germany contract Modi-SARS. 
The health system is facing immense challenges that cannot be overcome. Assuming that maintaining the function of vital infrastructures is given top priority and key positions remain occupied, large-scale supply failures can be avoided in the other infrastructure sectors. 
After the first wave subsides, two more, weaker waves follow until a vaccine is available three years after the first diseases appear. 

The special thing about this event is that, firstly, it affects the entire area of Germany and all population groups to the same extent, and secondly, it occurs over a very long period. 
If such a pandemic occurred, three separate waves with immensely high casualty numbers and serious effects on different protected areas could be expected over a period of three years. 
For this scenario, both the probability of occurrence to be assumed for such an epidemic and the extent of damage to be expected when it occurred were then determined using the method of risk analysis for civil protection at the federal level. 
The results of the risk analysis (probability of occurrence, extent of damage, scenario) are attached to the report in Appendix 4.


 


1. Definition of the hazard / type of event 

A pandemic is a global spread of disease.

 Exceptional epidemics can have natural causes, e.g .: 

x recurrence of known pathogens (measles, typhoid) 

x imported cases of diseases with rare highly contagious and / or highly pathogenic pathogens (Ebola, Lassa fever) 

x pandemics with variations of known pathogens (influenza pandemic) 

x occurrence of new types of pathogens (serious Acute Respiratory Syndrome (SARS). 

In exceptional cases, epidemics can also result from accidental or intentional release, e.g. For example: 

x accidental release due to a laboratory accident (as in individual cases after the SARS pandemic or the H1N1 influenza in 1977, the so-called "Russian flu", which was probably the result of a laboratory release (Scholtissek et al., 1978; Zimmer and Burke, 2009)) 

x intentional release in the area of food blackmail or with a bioterroristic background (the best-known example here is the "Anthrax Letters" in the USA 2001). 

The present scenario describes an unusual epidemic that is based on the spread of a novel pathogen. The scenario is based on the hypothetical pathogen "Modi-SARS", the properties of which are described in the information sheet (see Appendix) and which is very closely based on the SARS virus. The past has shown that pathogens with novel properties that trigger a serious epidemic can suddenly appear. (e.g. SARS coronavirus [CoV], H5N1 influenza virus, Chikungunya virus, HIV).

A current example of a new pathogen is a corona virus ("novel corona virus"), which is not closely related to SARS-CoV. 
This virus has been detected in six patients since summer 2012, two of whom have died. One patient was treated in Germany and could be discharged as healed. In contrast to SARS-CoV, however, this virus does not appear to be or can only be transmitted very poorly from person to person, so that the current risk assessment assumes that the risk of illness as a result of transmission from person to person is low (status November 26, 2012). 

For the human population, SARS-CoV and HIV were “new”, previously unknown viruses with a high lethality that could only be reduced for HIV after years and extremely costly research. 
In contrast, Chikungunya viruses and H5N1 viruses were already known; properties altered by mutations, however, led to better transferability to humans in these viruses. 
SARS-CoV and H5N1 are transmitted via the respiratory tract, Chikungunya is transmitted via a vector (mosquito). 

This makes these diseases more difficult to control than HIV, which is transmitted through sexual intercourse or through contact with HIV-positive blood. While HIV control in Germany and other countries in Western Europe or North America has been relatively successful, this is not the case in many other countries with less good health infrastructure - an indication of how essential control measures are in limiting the spread.

2. Description of the event

The hypothetical Modi-SARS virus is identical to the natural SARS-CoV in almost all properties. 
The incubation period, i.e. the time from the transmission of the virus to a human being until the first symptoms of the disease, is usually three to five days, but can range from two to 14 days. 
Almost all infected people also fall ill. The symptoms are fever and dry cough, the majority of the patients have shortness of breath, changes in the lungs visible in X-rays, chills, nausea and muscle pain. Diarrhea, headache, rash (rash), dizziness, cramps and loss of appetite may also occur. 
The mortality rate1 is high at 10% of those affected, but is different in different age groups. Children and adolescents generally have easier disease courses with a lethality of around 1%, while the lethality for over 65-year-olds is 50%. 
The duration of the disease also differs depending on the age of the patient; younger patients often got over the infection after just one week, while seriously ill, older patients had to be treated in the hospital for around three weeks, and treatment needs of up to 60 days were also described for the SARS-CoV. 
This age-dependent course of infection with SARS-CoV was not assumed for Modi-SARS. 
When modeling the numbers of sick and affected people in the scenario, we assume that all age groups are affected equally. 
Other parameters that can modify the course, such as human contacts and mobility in metropolitan areas or social networks, were also not taken into account. 
The transmission is mainly via droplet infection, but since the virus can remain infectious for a few days on inanimate surfaces, smear infections are also possible. 

When the first symptoms appear, the infected people are contagious.

This is the only difference in the transferability between the hypothetical SARS mode and the SARS CoV - the naturally occurring pathogen can only be transmitted from person to person if a person already shows clear symptoms of the disease. 
No medication is available for treatment, so treatment can only be symptomatic. 
A vaccine is also not available for the first three years. 
In addition to compliance with hygiene measures, protective measures in this sense can only be taken by isolating the sick or suspected of infection, and by using protective equipment such as protective masks, protective glasses and gloves. 
Isolation, isolation and quarantine are only of limited effectiveness, since there is a very pronounced infectivity at the onset of symptoms (Fraser et al., 2004). 
The infectious disease spreads sporadically and in clusters. 
Transmission takes place in particular via household contacts and in the hospital environment, but also in public transport, at work and in leisure time. 
For the modes SARS scenario, only a mutation-related change in the transferability of the virus is assumed; further possible variants, even with a multifactorial form, would be conceivable (Reichenbach, 2008) 2, but are not considered in this scenario.
 

2.1 Place of occurrence / spatial expansion

Where does the event happen / which area is affected by the event? 

The event occurs globally (mainly Asia, North America, Europe). 
The spread in Germany takes place via a trade fair city in northern Germany and a university city in southern Germany (Æ see 2.4 Duration and course). 
In the initial phase of the event, a total of ten cases are registered in Germany. 
Two cases are of particular importance here, since they occupy key positions for the dissemination (see 2.3 Triggering events). 
The other cases concern travelers who contribute to the spread. 
The distribution takes place across Germany, analogous to the population density. 
This assumption reflects a theoretical, simplified model, in the case of a natural “real” outbreak, geographical differences can be expected, the complexity of which cannot be shown here. 
A map of the spatial distribution of the number of sufferers at the peak of the first wave of infection is attached to the scenario.



2.2 Time

When does the event happen? (Season / time of day if applicable) 

The event begins in February in Asia, but is only recognized there a few weeks later in its dimension / importance. 
The first identified Modi SARS case occurs in Germany in April. 
This point in time forms the starting point of the present scenario.



2.3 Triggering events

Which events lead to this event? / How is the event triggered? 

The pathogen comes from Southeast Asia, where the pathogen found in wild animals was transmitted to humans via markets. 
Since the animals themselves do not fall ill, it was not recognizable that there was a risk of infection. Infectious chains set in motion by this zoonotic transmission could only be traced retrospectively; this did not succeed in all cases. 
Domestic pets and farm animals cannot be infected by Modi-SARS and therefore do not contribute to the spread or maintenance of the infection chain. 
Two of the first cases that are brought into Germany concern people who have been infected in the same Southeast Asian country. 
One person flies to Germany the same evening to take care of a stand at a trade fair in a northern German city, the other person flies back to Germany a day later to resume studying in a southern German university town after a semester abroad in China. 
In Germany, these two people are two of the index patients through which the infection is spread further.3 
They are of particular interest because both people come into contact with an extraordinarily large number of people and thus contribute greatly to the initial spread. 
There are other cases that are imported to Germany, so that a total of ten infected people are assumed to be responsible for the first wave of infection.


2.4 Duration and course
How long does the event and / or its direct impact last? 

New cases can be expected until a vaccine is available. A total period of three years is assumed for the present scenario, with the assumption that a vaccine will be developed, released and available in sufficient quantities after this time. The pathogen changes over the course of the three years through mutations in such a way that people who have already had an infection become susceptible to an infection again. This results in a total of three disease waves of different intensities. 

Which period after the start / occurrence of the event must be taken into account when determining the extent of the damage? 

The extent of the damage is calculated as the sum for the entire period of three years. 

How is the event going? 

Starting from the first occurring cases in northern and southern Germany, the pandemic is spreading in waves with increasing numbers. Basically, especially in metropolitan areas, due to the high population density and the movement patterns (high mobility, use of mass transport, etc.), correspondingly higher numbers of illnesses can be expected. 

It is believed that each infected person infects three people on average, and each one
takes three days for the next transmission to occur. So-called "Super Spreader"
not are not considered. Furthermore, it is believed that the population is fully susceptible to the virus. A reduction in the number of susceptible people will result from going through
infection. The number of people who can be infected decreases because the sick die or
develop temporary immunity. 

The spread is also slowed down and limited due to the use of anti-epidemic Measures. 
Such measures are quarantine for Contact persons of infected people or other seclusion measures such as the treatment of highly infectious patients in isolation stations with special attention to Infection protection measures. 
Means of containment include school closures and Cancellation of major events. In addition to these measures which can put into force following the Infection Protection Act there are further recommendations to the personal protections, e.g. in occupationally exposed persons, such as compliance with Hygiene recommendations. 
The anti-epidemic measures begin after ten patients in Germany have died from the infection. The arrangement of the measures take place in the Regions first in which cases occur; the population depends on the measures subjective feeling differently. 
Generally, measures are taken between day 48 and Day 408 described as effective. 
This results in the following course of events if effective anti-epidemic Measures in a population with no immunity to the virus (fully susceptible) are taken: See translated Graph … 

Graph-from-German-Study-engl.png.19523204b2e1ec56c4a487876564df30.png

Graph description and details: 

5 The modeling of the epidemic assumes the following:
The total population is 80 million. The average latency is 3 days, the time from the onset of
Infectivity to the manifestation of symptoms 0.1 days, the length of the infectious phase is 13.1 Days, the disease duration is 13.5 days; for people who need to be hospitalized, this is Duration 19 days, the average intensive care is 13.5 days. 
It will be assumed that a person is immune for 360 days after experiencing the infection with Modi-SARS, after that this person can be infected again by a mutated version of the virus. The modeling is based on population density, it includes factors such as different disease courses in different age groups or different mobility (from age groups or in certain
Regions). 
It is a susceptible-infected-recovered (SIR) model, it was created with Stata 12 software.
 

Edited by Roland
better formatting

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Posted (edited)
17 hours ago, Toshio Uemura said:

Ibuprofen is used for keeping down the body temperature 🤒 Aspirin and other similar medicaments are widely used in Italy to treat CoViD-19 patients there. Some sources suggest that this may be the reason for the high mortality in Italy. It is the highest in Europe.

So. Suppressing the fever might not be a good idea at all.

I am not a doctor, but I myself would try to ride it out naturally without lowering the body temperature by using drugs like Aspirin or Ibuprofen. 

I am a dentist, about 20 years ago in physiology class, (I have always remembered and applied this) we saw that fever is not an illness, it is a response to a foreign body, or an invader, a very effective defense mechanism against viruses, which do not withstand high temperatures, We have been accustomed to lowering the fever with NSAIDs, which has caused our bodies to lose the ability to raise the temperature we had as children, in my country the vast majority believe that high fever can cause meningitis, when in fact high fever is one of the responses to the presence of this

Translated with www.DeepL.com/Translator (free version)

 

Treatments that seem to work are chloroquine (a cheap malarial drug), Gilliad's remdesivir with interferon-beta (in clinical trials from COV-19), plasma from recovered patients, and a steroid (methylprednisilone). Doctors in US are now using remdesivir off-label...

SARS-CoV2 attacks pneumocytes in lung, intestine, heart & cells lining blood vessels. In lung, CoV2 prevents cells from making biological detergents to keep lung passages open. Acute respiratory distress follows. O2 levels fall..but there's may be a dangerous underlying process..

..new work out of China yesterday says COVID-19 might also involve abnormal blood production. CoV genes 1 & 8 are predicted to interfere with heme, the red compound in blood, by kicking out the iron. Would explain why chloroquine seems effective as a treatment

Chloroquine is predicted to prevent orf1ab, ORF3a and ORF10 from attacking heme (red in red blood cells) and inhibit the binding of ORF8 to heme. Although 99% of the virus is seemingly stable, what's disturbing is ORF 1 and 8 are mutating the fastest.....Positions nt28144 in ORF 8 and nt8782 in ORF1 are evolving. Samples out of China show they'd mutated 30.53% (29/95) and 29.47% (28/95), respectively. I'm currently figuring out why these are the ones mutating and how that would change the situation...

It may explain why diabetics and elderly are more susceptible. Blood sugar levels usually increase as we get older, increasing the amount of glycated hemoglobin (HbA1c) (I've tweeted about this before). The authors suggest these people would be more susceptible to because...

...the virus could more easily disrupt the heme in red blood cells. If so, the virus is very smart: it destroys the lung so patients can't take up oxygen AND reduces the body's ability to carry oxygen. (For this & other reasons, you should eat healthily the next 2 years)...

These ideas are testable. COVID-19 should correlate with HbA1c levels (seems true). Patients should have abnormalities in heme/porphyrin & they might have higher levels of free iron in tissues & blood. I will update with more info as it comes in. Stay safe. Below are links...

Edited by Mauricio

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@esaj
Thats in line with the risk study I posted above. 
The assumption in that hypothetical pandemic was that only after 3 years the crisis would be overcome.
Also 3 waves (see graph) because of mutations... Only a vaccine will end this for good. 

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Senator Mitt Romney proposed giving every US citizen $1000 each month until this Coronavirus is over.

even some fiscally conservative Republicans agree that giving money directly to people might be the best response. Today, Senator Mitt Romney proposed sending every U.S. adult a $1,000 check to help with short-term obligations

The Atlantic nor Mitt Romney nor anyone interviewed mention every US citizen has already been billed $4600 by the Federal government as part of their quantitative easing of banks. The Federal government has ever so kindly purchased the worst assets of banks while allowing the banks to keep their cash reserves.

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9 hours ago, LanghamP said:

Today, Senator Mitt Romney proposed sending every U.S. adult a $1,000 check to help with short-term obligations

Would you please ask him for us, if this is a one time deal or if it will happen every month until a vaccine is available for everyone? 🤣 

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3 hours ago, LanghamP said:

In NYC, eBikes are allowed to make food deliveries. They had been banned previously.

https://electrek.co/2020/03/17/illegal-e-bikes-ok-in-nyc-food-delivery-coronavirus-crisis/

That is great news and probably one of those few positive outcomes of this crisis.Let’s push for allowing EUCs as well. 😝 

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Posted (edited)
40 minutes ago, Toshio Uemura said:

Would you please ask him for us, if this is a one time deal or if it will happen every month until a vaccine is available for everyone? 🤣 

Us? I didnt realize that the USA senators are part of the US of japan? I'd imagine this is a 'take it as it comes' type issue. Asking for assurances for longer term plans is a little much. It does say every month, but who really knows?  Apologies if YOU are a usa citizen, tho my remark about asking about assurances, stands. If $1000 a month will make or break you, you are part of the 'poor' class. I fear in the end, the gap between poor and rich will widen. With a low interest rate, people that can, are already buying up lots. Hell, what if another country bounces back fast enough and THEY purchase up parts of the USA because we are so far in debt and interest is so low, we allow it? In the end, the richest will prevail victorious. ON the flip side, it doesnt help like the USA thinks it will, EVERY DAMN TIME, we give people free money. The wrong assumption is that the citizens will use it wisely. SO many programs aimed at helping the lowest common denominator, for naught. One also has to ask... where is this money coming from, as the Government collects and distributes money, not makes it. Yes, they print it, but do they manufacture things of value for ALL to gain from? Can you hear that? Its the eery sound of small business' across USA, locking their doors forever.

Edited by ShanesPlanet

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Here is another important paragraph from the german 2012 Study:
(http://dipbt.bundestag.de/dip21/btd/17/120/1712051.pdf)

Excursus: Course without anti-epidemic measures 
 

The scenario presented here assumes that anti-epidemic measures are taken early in the course of the procedure, which means that each infected person infects not 3 but 1.6 people on average. Countermeasures are only taken for the period from day 48 to day 408. If one were to assume that no countermeasures would be used and that every infected person would infect three more people (until the vaccine is available), the outcome would be even more drastic. 
 

On the one hand, the absolute number of those affected would be higher, on the other hand, the course would also be much faster. 
 

While the peak of the first wave is reached after around 300 days in the model presented, this would be the case after around 170 days without anti-epidemic measures. This time saved by anti-epidemic measures can be used very efficiently, e.g. manufacture, distribute personal protective equipment and inform about their correct use. 
The number of people affected differs significantly in both scenarios. 

If protective measures are introduced and take effect, around 6 million (1st wave), 3 million (2nd wave) and 2.3 million (3rd wave) are affected at the peak of the waves. 
Without countermeasures, there are around 19 million (1st wave), around 6.5 million (2nd wave) and around 3.3 million (3rd wave). The numbers for hospitalized patients or patients who need intensive care treatment behave similarly.

 

So the take away is that even with a R0 of 1.6 you will get those brutal numbers ... I wonder what our R0 is right now?

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9 hours ago, ShanesPlanet said:

In the end, the richest will prevail victorious. ON the flip side, it doesnt help like the USA thinks it will, EVERY DAMN TIME, we give people free money.

We've already given rich people money by zero interest rates, no required reserves for banks, and Federal buyback of stocks at above market value.

Rich people have already reached into our pockets to take out $4,600 per person in the US just for this epidemic.

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Posted (edited)
10 hours ago, ShanesPlanet said:

Us? I didnt realize that the USA senators are part of the US of japan?

Well, now you do! Isn’t that the wet dream of many Americans? SAIpan .... JApan!

One island more! Why not dreaming it to the end. 🤣

Just kidding!

Edited by Toshio Uemura

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10 hours ago, ShanesPlanet said:

Can you hear that? Its the eery sound of small business' across USA, locking their doors forever.

Yes! Still distant. But yes! And it is an utterly scaring sound! I hope for your people that it doesn’t come to this.

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Posted (edited)
25 minutes ago, Toshio Uemura said:

Well, now you do! Isn’t that the wet dream of many Americans? SAIpan .... JApan! Why not dreaming it to the end. 🤣

That reminds me of this great scene from ... well you know it when you see it ... 

 

Also - wupps ... this really does not have anything to do with the problem at hand... - still a cool scene  - shame i did not find the subtitled version...

 

 

Edited by Roland

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