We dont know what questionnaires are being used, but given the close relationship between ME/CFS and FM and the high incidence of pain found in ME/CFS, it would be astonishing if pain wasnt being closely assessed thus providing the opportunity to assess the incidence of FM in long COVID. 29 Apr 2023 06:41:22 Some people feel it all over their bodies. WebRT @stkirsch: CDC Director Rochelle Walensky Finally Admits Vaccinated Individuals Can Spread COVID Virus. The pain stems from a problem in the way the nervous system processes pain signals. Bethesda, MD 20894, Web Policies Only 0.4% of those in the control group later did. Another researcher believes that in some people, a strong immune system response to the vaccine can lead to neuroinflammation. Studies since then have identified increased incidences of chronic fatigue syndrome (ME/CFS) and irritable bowel syndrome (IBS) in those infected. You may also consider logging your symptoms on an app like the CDC's V-safe, which tracks symptoms in real-time. However, we believe the risks of getting COVID-19 infection are significantly greater than the risks of a disease flare. Changes in tinnitus experiences during the covid-19 pandemic. In addition, you must not have another condition (such as arthritis) that could explain the pain. The Hospital for Special Surgery warns that live vaccines are not recommended for lupus patients, due to the increased risk of infection from the vaccine. Most vaccines are very safe for most people. Centers for Disease Control and Prevention. Acetaminophen (Tylenol) and other pain relievers can help with short-term discomfort. Someday shell also acknowledge that the vaccines make it more likely for you to get Covid. In any case, its good, in the time of long COVID, that the potential for a post-infectious onset of fibromyalgia is being recognized. How Does Fibromyalgia Affect Women Differently? Before A post-infectious disease likely has a strong immune component something that has been little researched in FM. COVID-19; latin hypercube sampling; partial rank correlation coefficients; risk equations; vaccine. Recap. official website and that any information you provide is encrypted Fibromyalgia is the second most common condition affecting your bones and muscles. Many people with post-Giardia IBS, for instance, didnt experience widespread pain (16% had both). Results: Data were anonymously collected between 5 and 18 April 2021. J. Digging a bit deeper, they found that coming down with FM almost always involved coming down with IBS (87%) and very often with chronic fatigue (69%). sharing sensitive information, make sure youre on a federal Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, 5 Pilates Exercises for Fibromyalgia Symptoms, Courtney Sullivan, Certified Yoga Instructor, Everything You Need to Know About Fibromyalgia, Stress Can Cause Spotting Heres Why It Happens and What to Do, memory problems and trouble concentrating, which is sometimes called, sensitivity to noise, light, or temperature. Similarly, Pfizers vaccine had an efficacy rate of over 90 percent, with only 94 confirmed cases of COVID-19 in a study that included over 43,000 volunteers. Unauthorized use of these marks is strictly prohibited. The https:// ensures that you are connecting to the Yang T-Y, et al. PMC Results: Jocelyn Solis-Moreira is a journalist specializing in health and science news. Prevalence of post-COVID-19 in patients with fibromyalgia: a comparative study with other inflammatory and autoimmune rheumatic diseases. Pfizer COVID-19 vaccine EUA fact sheet for healthcare providers administering vaccination providers (2021). These may include natural remedies, cognitive behavioral therapy, and use of medical devices like hearing aids. Long Covid researchers feel there needs to be greater urgency. Last medically reviewed on October 31, 2022. Could the fibromyalgia syndrome be triggered or enhanced by COVID-19? A 6,000-person survey found six months later that 2.2% were experiencing long-COVID symptoms. By Roger Chriss, PNN Columnist Covid-19 vaccine researchers reported good news this week. Post Lyme Disease and Chronic Fatigue Syndrome (ME/CFS) Are They The Same? Time will tell if these findings hold up, but its certainly striking to see hypometabolism show up so early in long COVID. It is not intended as medical advice and should be used for informational purposes only. Finally, a Malaysian researcher proposed that hypometabolism in the brainstem lies at the heart of long COVID. A retrospective study presented something that we will surely see in spades over time the attempt to subset long-COVID patients. Read one womans account of what fibromyalgia feels like. It all came to pass in 2004 when a water reservoir for the city ofBergen, Norway became contaminated withGiardia lamblia. The dangers of COVID-19 infection are serious, and vaccination is highly recommended in the general population, including patients with a diagnosis of CRPS. (The others were loss of smell or taste, hair loss, and chest pain.). However, healthcare providers should be aware of the possibility of clinical worsening of CRPS after mRNA-based COVID-19 vaccination. In essence, they made Someday shell also acknowledge that the vaccines make it more Rheumatol Int. Exercise also releases endorphins, which fight pain, stress, and feeling down. amzn_assoc_default_search_key = ""; Beyond pain in fibromyalgia: Insights into the symptom of fatigue. Has the Reptilian Brain Gone Haywire in ME/CFS? Learn how fibromyalgia pain differs from other types of pain. An official website of the United States government. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. We know that infections can trigger ME/CFS, FM, POTS, IBS, post-treatment Lyme Disease, post-Ebola Virus Syndrome, some autoimmune diseases, and Im sure other diseases, but we dont know how or how often. In or Out? Ac., CYT, Fibromyalgia: How Green Eyeglasses Can Help Ease Pain-Related Anxiety. NIH Launches Mammoth Effort to Understand and Treat Long COVID. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Gulf War Illness (GWI) is a case in point as it has near-identical symptoms to ME/CFS but two appear to have quite different immunological pathways. Being able to identify the type and location of your pain, along with any other symptoms, can help a doctor arrive at a diagnosis. The mean total and subdomain scores of all the tests were significantly higher in the patients with COVID-19, which suggests that global FM symptoms are more severe in patients with infection. J. Autoimmun. Having a loving family can make it worse - feeling that you're letting them down. by Cort Johnson | Jun 18, 2021 | Brainstem, COVID-19, Homepage, long COVID | 45 comments. J Psychosom Res. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Three French studies have found evidence of hypometabolism in the limbic system (thalamus, amygdala), the brainstem, and the cerebellum. In essence, they made Stress is also common. National Library of Medicine 2017 Dec;20(12):1922-1926. doi: 10.1111/1756-185X.12678. Preexisting tinnitus is not a contraindication to getting the vaccine, but if you experience tinnitus after the first dose, and if its not going away, or its getting worse, then see what a doctor says before you consider your second dose, Gulick says. An official website of the United States government. 2020;27:taaa021. doi: 10.1136/rmdopen-2021-001735. Tinnitus may be triggered by a preexisting condition and/or environmental factors. Bookshelf doi: 10.1371/journal.pone.0281593. In essence, they made Long COVID might include organ damage, depression, persistent loss of taste and smell, or any other new health issue that crops up in the wake of COVID-19. MeSH amzn_assoc_ad_type = "responsive_search_widget"; Read on to learn some of the most common fibromyalgia symptoms, plus a few unusual ones you might not expect. Clinical characteristics of 2019 novel coronavirus infection in China. Enteroviruses ubiquitous pathogens often associated with the common cold were one possible culprit. Thus far, studies indicate that long COVID is real and persistent, that a significant subset of long-COVID patients have something akin to ME/CFS and/or fibromyalgia, and most interestingly, that widespread hypometabolism in the brain may be present, and that similar parts of the brain the prefrontal cortex, the limbic system and the brainstem may be involved. Careers. Front Public Health. Identification of a novel coronavirus causing severe pneumonia in human: A descriptive study. About the vaccine adverse event reporting system (vaers). Hospital admission rate was significantly higher in men (15.8% vs 9.2%, p=0.001) and obese (19.2 vs 10.8%, p=0.016) respondents. The effect of novel coronavirus disease-2019 (COVID-19) on fibromyalgia syndrome. This may be due to the increase in system-wide inflammation while your body ( a ) Vaccination is the only option available;, MeSH A Veterans Affairs study echoed that finding and made a different kind of news when it reported that in the six months following recovery from COVID-19, long-COVID patients were at a higher risk of death. Could the fibromyalgia syndrome be triggered or enhanced by COVID-19? Autonomic nervous system problems, in turn, have been associated with poor sleep in both ME/CFS and fibromyalgia. Keep in mind that it can be hard to tell if you are having symptoms due to COVID-19 or another cause, such as a preexisting medical condition. amzn_assoc_height = 250; Would you like email updates of new search results? government site. Dealing with social distancing restrictions worsened the symptoms of tinnitus in 25% of people. (2019). These findings do concern me, though, since two of the three medications most commonly prescribed for fibromyalgia are antidepressants. In essence, they made (2021). Standard fibromyalgia treatments don't always provide a perfect solution. About 32% of people with preexisting tinnitus were more irritated by their symptoms as a result of pandemic-driven lifestyle changes. Start slowly and gradually increase your intensity only when you feel ready. McIlwain, H. The Fibromyalgia Handbook, Holt, 2007. Of all the fibromyalgia symptoms, fatigue can have one of the biggest impacts on your life. This study found an almost 3-fold increase in people with fibromyalgia after a. Re-use permitted under CC BY-NC. 55(3), 105924 (2020). Please enable it to take advantage of the complete set of features! Possible side effects after getting a covid-19 vaccine. amzn_assoc_search_type = "search_widget"; The site is secure. An official website of the United States government. IBS can cause uncomfortable symptoms, including: A 2017 Taiwanese study also found that people with fibromyalgia were 54% more likely to have IBS than people without fibromyalgia. HHS Vulnerability Disclosure, Help Evolving Phenotypes of non-hospitalized Patients that Indicate Long Covid, hypometabolism in the limbic system (thalamus, amygdala), the brainstem. Chin. Some people with fibromyalgia may be under the impression that long-COVID research will not benefit them much. MeSH terms COVID-19 Vaccines / WebRecently, new-onset autoimmune phenomena after COVID-19 vaccination have been reported increasingly (e.g. Would you like email updates of new search results? 2022 May 19;23(1):471. doi: 10.1186/s12891-022-05436-0. Don't miss another one. After giving millions of people a [COVID-19] vaccine, tinnitus is not a red flag that popped up prompting scientists to say, You know, this is kind of a big issue with COVID-19 vaccines, he says. government site. Tinnitus is not very common from COVID-19," he says. From Tagesspiegel: Possible heart damage after Covid vaccination: Woman sues BioNTech for damages. -, Huang C., Wang Y., Li X., Ren L., Zhao J., Hu Y., Zhang L., Fan G., Xu J., Gu X., et al. amzn_assoc_ad_type = "responsive_search_widget"; 1 . The Food and Drug Administration (FDA) later ruled that they were not related to the shot. "Without data, it's hard to see if tinnitus is going to be something permanent or not because we haven't studied it long enough to know, Gulick says. Pain is showing up in the epidemiological studies. Disaster Med Public Health Prep. There's no test that can tell you that you have fibromyalgia. The study amzn_assoc_region = "US"; Bethesda, MD 20894, Web Policies Int J Rheum Dis. 2023 Apr 6;10:952278. doi: 10.3389/fmed.2023.952278. Get more information: Cystic fibrosis CF and Coronavirus (COVID-19) | Cystic Fibrosis Foundation (cff.org) Dementia or other neurological conditions 23(5), 615626 (2019). doi: 10.1097/CM9.0000000000000722. This cohort is notable in that it meets the criteria for cleanliness (one pathogen attack at one point of time) that has so wowed researchers focused on the long-COVID patients. Federal government websites often end in .gov or .mil. Percentage of patients admitted to the hospital, treated with supplemental oxygen and admitted to ICU according to gender (A) or obesity (B). Thus far, studies indicate that long COVID is real and persistent, that a significant subset of long-COVID patients have something akin to ME/CFS and/or fibromyalgia, and most interestingly, that widespread hypometabolism in the brain may be present, and that similar parts of the brain the prefrontal cortex, the limbic system and A Timeline of COVID-19 Vaccine Side Effects, Why Studying Sex Differences in COVID Vaccine Research Matters, About the vaccine adverse event reporting system (vaers), Possible side effects after getting a covid-19 vaccine, Fact sheet for healthcare providers administering vaccine (vaccination providers), Researcher: neuroinflammation may be behind tinnitus reports in some covid-19 vaccine recipients, Changes in tinnitus experiences during the covid-19 pandemic, The effect of environmental stressors on tinnitus: a prospective longitudinal study on the impact of the covid-19 pandemic. Read one womans account of what fibromyalgia feels like. 2022 Jun;40(6):1183-1188. doi: 10.55563/clinexprheumatol/64963d. amzn_assoc_theme = "light"; The current review summarizes the available data linking fibromyalgia to either infection or vaccination. How good to see then, some dogged Norwegian researchers add FM to the list of conditions theyre tracking in people exposed to an infectious outbreak that occurred in Bergen, Norway back in 2004. FOIA Diagn. government site. doi: 10.1017/dmp.2023.11. This site needs JavaScript to work properly. Overall, patients who developed fibromyalgia appeared to have a more serious phenotype of COVID-19, more often requiring hospitalization and supplemental Your doctor will examine you and ask you about your past medical issues and about other close family members. We report the case series of three patients diagnosed with CRPS type I who presented with acute worsening of symptoms after mRNA-based COVID-19 vaccination and their medical management. This is the first study to show that infections can trigger a dramatic increase in the incidence of fibromyalgia putting FM solidly in the post-infectious disease category for the first time. About one out of 40,000 people vaccinated for COVID-19 have reported tinnitus, or ear ringing, but there is not enough evidence to suggest that it is caused by the COVID-19 vaccine. Other symptoms, such as fatigue, poor concentration, and anxiety, can also have a great impact on your life. Lancet. Unable to load your collection due to an error, Unable to load your delegates due to an error. A Solve M.E. @ania_forever85 @mottomeneki @CryptoTravelle5 @DrAseemMalhotra He had serious financial troubles. (2017). 2021 Dec 1;375:n2314. 10.1002/acr.20140 Lyrica is an antiseizure drug. WebRT @stkirsch: CDC Director Rochelle Walensky Finally Admits Vaccinated Individuals Can Spread COVID Virus. by Cort Johnson | Oct 27, 2021 | Fibromyalgia and Pain, Giardia, Homepage | 104 comments. Some of the side effects that occur after vaccination, such as fever, muscle aches and pain, and fatigue, may resemble symptoms related to an underlying condition. The study found that post-COVID neuropsychiatric symptoms can range from loss of taste and smell to brain fog, anxiety, depression, seizures, and suicidal behavior. Online ahead of print. Having cystic fibrosis, with or without lung or other solid organ transplant (like kidney, liver, intestines, heart, and pancreas) can make you more likely to get very sick from COVID-19. One suspects we havent seen anything yet. But vaccine safety presents a big question for a small group of people with specific risk factors like cancer or chronic illness. Association of Kinesiophobia with Catastrophism and Sensitization-Associated Symptoms in COVID-19 Survivors with Post-COVID Pain. This site needs JavaScript to work properly. The main symptom of fibromyalgia is pain and tenderness in muscles and joints throughout your body. as well as symptoms of anxiety and depression six months after the infection. , The patient provided informed consent to publish this case. A questionnaire using the modified 2010 American College of Rheumatology criteria for fibromyalgia: specificity and sensitivity in clinical practice. Discover symptoms such as fibro fog, restless legs, and more. Fact sheet for healthcare providers administering vaccine (vaccination providers). Accessibility Learn more about vaccine safety and CDC recommendations for people with fibromyalgia. These alternative treatments can also help relieve pain and other symptoms of fibromyalgia: If you have fibromyalgia, try to exercise as much and as often as you can. As of November 2021, around one in 8,000 people in the United Kingdom have reported an onset of tinnitus or worsening tinnitus symptoms after receiving the Covid vaccine. Contributions are tax deductible for U.S. taxpayers. G. lamblia is a protozoan that often causes intestinal distress, but, at least in the scientific literature was not known to cause post-infectious illnesses until the Norwegian group published their findings. Our website services, content, and products are for informational purposes only. Having a loving family can make it worse - feeling that However, if less than 40% of people get vaccinated and other protection options are abandoned-as may well happen in the wake of a COVID-19 vaccine-then introducing even an excellent vaccine will produce a worse outcome than our current situation. Ngamchaliew P, Kaewkuea N, Nonthasorn N, Vonnasrichan T, Rongsawat N, Rattanachai L, Chaipipattanakij W, Kamolnawin S, Vichitkunakorn P. BMC Public Health. Conclusions: Nine out of 10 people also experienced tinnitus. Acupuncture may be one way to reduce fibromyalgia pain especially when combined with other forms of treatment. Early studies into long COVID symptomatology suggest many overlaps with clinical presentation of ME/CFS.. amzn_assoc_height = 250; It also shows the different courses that post-infectious illnesses can take something we will surely learn about in spades as the NIH and others follow their huge cohorts of long-COVID patients. Ursini F, Ciaffi J, Mancarella L, Lisi L, Brusi V, Cavallari C, D'Onghia M, Mari A, Borlandelli E, Faranda Cordella J, La Regina M, Viola P, Ruscitti P, Miceli M, De Giorgio R, Baldini N, Borghi C, Gasbarrini A, Iagnocco A, Giacomelli R, Faldini C, Landini MP, Meliconi R. RMD Open. -. Just how closely related all these diseases really are was the subject of a vigorous discussion at the recent Massachusetts ME/CFS and FM Association webinar. Moderna reported that its vaccine was 94.5% effective in a Phase 3 trial of more than 30,000 participants. Inflammopharmacology. The six papers theyve produced over time make the Bergen Giardia lamblia cohort one of the most consistently followed cohorts of post-infectious patients seen. Fibromyalgia is a chronic condition that causes pain throughout multiple sites of the body. Fibromyalgia fatigue isnt ordinary tiredness. Eight hundred and ninety-seven (93%) of the 965 patients (881 women [91.3%] and 84 men [8.7%]) were followed up on an outpatient basis because of FM and 68 (7.0%) were either followed up as out-patients or hospitalised because of COVID-19. For starters, check out this 5-minute workout. ME/CFS, fibromyalgia, and long COVID blogs here. 10.1002/art.1780330203 Learn more about vaccine safety and CDC recommendations for people with fibromyalgia. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). By piggybacking on them, the C4R study should be able to determine what kind of person gets long COVID, what kind of long COVID they get, etc. Fibromyalgia is more common in women than men, and symptoms affect women differently. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. J Rheumatol. Keywords: The disorder list included nervous system, neurocognitive, metabolic, cardiovascular, and gastrointestinal disorders. Read our. A final sample of 616 individuals (77.4% women) filled the form 63 months after the COVID-19 diagnosis. Researchers believe that the symptoms could be the result of how the virus itself damages the brain, rather than of a lack of oxygen related to COVID-19's impact on the lungs. Centers for Disease Control and Prevention. amzn_assoc_placement = ""; However, to meet the American College of Rheumatologys criteria for a diagnosis, youll need to have experienced pain and other symptoms for at least 3 months. 2023 Mar 15:111231. doi: 10.1016/j.jpsychores.2023.111231. Careers. (2015). ", American Fibromyalgia Syndrome Association: "What Is Fibromyalgia? Thats one reason why it takes years for people with the condition to get an accurate diagnosis. amzn_assoc_width = 265; Saxena V, Jakhar K, Kumar S, Sethi P, Solanki HK. Fibromyalgia and COVID-19 When you have fibromyalgia, you could be Tinnitus Signs, Symptoms, and Complications. It is thus critical that effective education strategies are employed in tandem with 29 Apr 2023 06:41:22 Like the blog you're reading? PMC One of the studies getting underway, for instance the Collaborative Cohort of Cohorts for COVID-19 Research (C4R) which contains over 100 researchers, will include within it 14 already established prospective cohort studies. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). (2010). The major differences between the score of the items (those with the greatest disease impact) were the following related symptoms: sleep quality (FIQR15), fatigue/energy (FIQR13), pain (FIQR12), stiffness (FIQR14). The study noted, interestingly, that some of the areas of the brain that were demonstrating hypometabolism were found to exhibit hypermetabolism during the infection suggested that inflammation during the infection may have caused some damage. Getting COVID-19 can make the symptoms of fibromyalgia worse. Rheumatic manifestations of COVID-19: a systematic review and meta-analysis. ICU, intensive care unit. The pain from fibromyalgia can be intense, constant, and severe enough to keep you home from work and other activities. doi: 10.1093/jtm/taaa021. Ferritin and myalgic encephalomyelitis/chronic fatigue syndrome in post COVID-19, an unexpected facet of the hyperferritinemic syndrome? -. In this session, our experts answer the questions you have about virus variants, vaccines and vaccine boosters, specifically, for those with psoriatic disease. See rights and permissions. Before We also don't know for sure whether this vaccine is safe and effective in different types of people, such as pregnant women, the elderly, or those with a chronic illness, MedicalXpress reported. Their recently published study Prevalence of fibromyalgia 10 years after infection withGiardia lamblia: a controlled prospective cohort study is one of the few to assess FM in the context of being a post-infectious disorder. journals.sagepub.com/doi/full/10.1177/1756284820977402, rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Fibromyalgia, frontiersin.org/articles/10.3389/fmed.2021.666914/full, arthritis-research.biomedcentral.com/articles/10.1186/ar4395, journals.plos.org/plosone/article?id=10.1371/journal.pone.0138024, rheumatology.org/portals/0/files/2010_preliminary_diagnostic_criteria.pdf, journals.lww.com/md-journal/Fulltext/2017/04070/Notice_of_Republication__Risk_for_Irritable_Bowel.51.aspx. Different symptoms were associated with reduced metabolic activity in different parts of the brain; i.e. Even if XBB.1.16 is better at evading immunity from the vaccine, it can still provide some protection, the experts note. Verywell Health's content is for informational and educational purposes only. However, clinicians should be aware of the possibility that there may be a clinical worsening CRPS after mRNA-based COVID-19 vaccination. Headaches may stem from painful head, neck, or shoulder muscles. Someday shell also acknowledge that the vaccines make it more likely for you to get Covid. eCollection 2023. Copyright 2023 Pain News Network / Terms of Use / Privacy Policy / Advertising / Surveys / Donors. The faster you get diagnosed, the sooner you can get started on a treatment to relieve your symptoms. Someday shell also acknowledge that the vaccines make it more Can you recommend a support group or online community I could join. Postacute COVID-19 syndrome (PACS) is an emerging entity characterised by a large array of manifestations, including musculoskeletal complaints, fatigue and cognitive or sleep disturbances. Fibromyalgia and associated disorders: From pain to chronic suffering, from subjective hypersensitivity to hypersensitivity syndrome. While the connection between tinnitus and the Covid vaccine are not yet understood: The British Tinnitus Association has labeled tinnitus a rare side effect of the vaccine. Feeling unwell. Cankurtaran D, Tezel N, Ercan B, Yildiz SY, Akyuz EU. Kerry Boyle D.Ac., M.S., L.Ac., Dipl. In the U.S., there Since similar symptoms are present also in patients with fibromyalgia (FM), we decided to perform a web-based cross-sectional survey aimed at investigating the prevalence and predictors of FM in patients who recovered from COVID-19. It's also not clear if Having a loving family can make it worse - feeling that you're letting them down. There was no difference in the sociodemographic data of the two groups, but there were statistically significant between-group differences in the results of the clinimetric tests. 2020;395:497506. This study clearly sets out what so many of us know but which has been documented in too few instances: that post-infectious illnesses can be severe and lasting. The British Tinnitus Association has labeled tinnitus a rare side effect of the vaccine. Federal government websites often end in .gov or .mil. Epub 2013 Jul 1. PMC All rights reserved. Inflammopharmacology. We learned in the recent Mass webinar that the NIHs Working Group for ME/CFS played a critical role in determining which symptoms will be tracked in the huge long-COVID studies. Its unique in that it affects various sites all over the body. Unauthorized use of these marks is strictly prohibited. Is the COVID-19 Vaccine Free If Youre Uninsured? Definition of fibromyalgia severity: findings from a cross-sectional survey of 2339 Italian patients. National Library of Medicine Bookshelf Whats next for the vaccine-injured? In order to limit the disease burden and economic costs associated with the COVID-19 pandemic, it is important to understand how effective and widely distributed a vaccine must be in order to have a beneficial impact on public health. Our risk equations account for the basic transmission probability of COVID-19 () and the lowered risk due to various protection options: physical distancing; face coverings such as masks, goggles, face shields or other medical equipment; handwashing; and vaccination.

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