Iqbal A, Iqbal K, Arshad Ali S, et al. Oronsky B, Larson C, Hammond TC, Oronsky A, Kesari S, Lybeck M, Reid TR. Yes. It appears from the previous publications that post-COVID pain symptoms are fixed and presented (50%) among the top ten post-COVID-19 symptoms. Its important that patients get plenty of fluids to increase their blood volume, Altman said, and avoid alcohol and caffeine, which dehydrate. A consensus guidance statement co-authored by Dr. William Niehaus, assistant professor of Physical Medicine and Rehabilitation at CU (and a provider in the UCHealth Post-COVID Clinic) underscores her point. It is a self-limiting condition but needs to be differentiated from more serious causes of chest pain such as a heart attack. PubMed Central https://doi.org/10.1016/j.bja.2020.05.021. Heart failure: Could a low sodium diet sometimes do more harm than good? It is mandatory to procure user consent prior to running these cookies on your website. Article According to preset criteria, a total of 58 articles were included in this review article. The study evaluated the impact of a completely digital program in patients with chronic musculoskeletal pain. Crit Care Med. 2018;30:94100. https://doi.org/10.1097/NNR.0000000000000565. Lack of physical activities, impacting patients who relied on physical therapy or exercise programs as part of their pain management regiment. I have suffered from some weakness attacks for many months. A person should consult a doctor to determine the diagnosis and treatment. Severe post-COVID-19 costochondritis in children. Puntillo KA, Max A, Chaize M, Chanques G, Azoulay E. Patient recollection of ICU procedural pain and post ICU burden: the memory study. 1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study. Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Why do I feel weak, dizzy, numbness in face and jaws, and nasal congestion post-COVID? Laboratory testing should be kept to a minimum, possibly just an ESR or CRP, which will usually be normal. Trkyilmaz GG, Rumeli S. Attitude changes toward chronic pain management of pain physicians in Turkey during the COVID-19 pandemic. (2021). By Shamard Charles, MD, MPH There is no correlation between attacks and stress. It is in no way a substitute for a qualified medical opinion. The exclusion criteria included non-English-language articles, failure to get the full articles, post-COVID pain in children, case report, editorials, or expert opinions. 2021;87:82832. Case studies have shown that colchicine may be an effective treatment for costochondritis, especially when conventional therapies have failed. Wear a mask when you are in crowded areas, especially with people of unknown vaccination status. A systematic review and meta-analysis of neuropathic pain associated with coronavirus disease 2019. Simply put, Trying to avoid infection overall is preferable, Altman said. Eur J Pain. In severe cases, myocarditis can lead to heart failure and irregular heart rhythms. Changing the practice from face-to-face consultations to telemedicine or mixed services needs more comprehensive work and evidence before replacing the current practices [22, 117]. Medications for myocarditis include corticosteroids and intravenous immunoglobulin (IVIG). Niehaus and his colleagues maintain that treating fatigue in long COVID requires addressing problems like inadequate sleep and nutrition; infectious and autoimmune diseases; and heart, lung and nerve disorders. Some of the pain related to COVID-19 is related to hospitalization and treatment -- and these are types of pain were somewhat familiar with. Bileviciute-ljungar I, Norrefalk J, Borg K. Pain burden in post-COVID-19 syndrome following mild COVID-19 infection. 2020;9:45366. Trigo J, Garcia-Azorin D, Planchuelo-Gomez A, Martinez-Pias E, Talavera B, Hernandez-Perez I, Valle-Penacoba G, Simon-Campo P, de Lera M, Chavarria-Miranda A, Lopez-Sanz C, Gutierrez-Sanchez M, Martinez- Velasco E, Pedraza M, Sierra A, Gomez-Vicente B, Arenillas JF, Guerrero AL. A huge number of patients were seeking medical advice because of chest pain [95]. Muller JE, Nathan DG. Various definitions have been developed to define different stages of COVID-19 based on the durations and clinical presentations. Expansion of the pain procedures that exclude steroids due to their immune-suppressant effects such as radiofrequency ablations, regenerative injections (e.g., platelets-rich plasma PRP, bone marrow extracts and stem cells injections). Persistence of somatic symptoms after COVID-19 in the Netherlands: an observational cohort study. Post-COVID-19 muscular pain, or myalgia, can feel different for everyone who has it. Gentle stretching and flexibility exercises such as yoga and tai chi can help. Do people with costochondritis have a greater chance of serious complications from COVID-19 than others? Headache as an acute and post-COVID-19 symptom in COVID-19 survivors: a metaanalysis of the current literature. This category only includes cookies that ensures basic functionalities and security features of the website. weakness. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. The other symptoms including headache, anosmia, chest pain, or joint pain was lower and more variable [41]. A doctor may prescribe stronger, narcotic pain relief medications for people with severe pleuritic pain. World Health Organization World Health Statistics, COVID-19. Patient perspective on herpes zoster and its complications: an observational prospective study in patients aged over 50 years in general practice. Google Scholar. It is best for anyone having chest discomfort to get medical attention for this reason. Compared to traditional viral myocarditis, the tachycardia condition is very different. Effective treatment of post-COVID headache should take into consideration the type of headache (migrainous vs. tension-type-like), comorbidities, and if present, additional post-COVID-19 symptoms such as insomnia, mood disorders, and cognitive difficulties [15, 74]. 2023 Springer Nature Switzerland AG. 2020;7(10):87582. 2021;10:181209. Many recover initially from COVID-19 only to suffer weeks later from sometimes confounding symptoms that can affect all parts of the body. Use of analgesics/antipyretics in the management of symptoms associated with COVID-19 vaccination. A recent meta-analysis has revealed that more than 60% of patients exhibited at least one post-COVID-19 symptom. They may also notice: A doctor will initially prescribe medications to relieve pain, reduce inflammation, and calm the immune system. Complications associated with proning sedated patients include brachial plexopathy, joint subluxation, and soft tissue damage. Angina requires a range of possible treatments depending on its severity. Jacobson KB, Rao M, Bonilla H, et al. Evidence is promising that new tools such as telemedicine and mobile opioid treatment programs can help to provide ongoing services to chronic pain patients. Professional Bio: Dr.Vivek Pillai is a Cardiologist. There are no shortcuts to helping patients with the problem. We try to piece it all together.. 2022;23:93. https://doi.org/10.1186/s10194-022-01450-8. Kosek E, Cohen M, Baron R, et al. Muscle pain is one of the most common complaints during both the acute stage and post COVID-19. Delaying or stopping treatment for patients who are suffering from severe pain will have negative consequences, including increases in pain, disability, and depression. If pain is slowing you down after having COVID-19, make sure to bring that up with your doctor and ask for guidance on how you can best manage how you feel while still working on regaining your strength and emotional well-being. Arca KN, Starling AJ. Edition 124. https://www.who.int/publications/m/item/weekly-epidemiological-update-on-COVID-19---4-january-2023. https://doi.org/10.1097/j.pain.0000000000002564. The neuropathic pain symptoms was positively associated with the duration of post-COVID pain, anxiety levels, and kinesiophobia level. We have gotten good at sorting out each patients symptoms and then developing a personalized plan based on our findings.. Vaccination reduces your risk of hospitalization and death. 2018;38(1):1211. Triptans have been considered as acute therapeutic options [72, 74]. To evaluate patients, assess pain, and plan treatment of chronic pain [30]. 2022;163:122031. Patients triaging according to the risk of COVID-19 infection with social distancing and isolations should be applied when required [16, 121]. Lichtenstein A, Tiosano S, Amital H. The complexities of fibromyalgia and its comorbidities. A good way to start is with recumbent biking and rowing, which helps to exercise the heart while reducing strain on the joints and muscles. Accessed 31 Aug 2021. Delaying, or stopping, treatment will have negative consequences on chronic pain patients. Important: The opinions expressed in WebMD Blogs are solely those of the User, who may or may not have medical or scientific training. Given that prospect, its vital for all people with any condition that heightens the high risk of complications from COVID to get vaccinated, Altman said. Soares FHC, Kubota GT, Fernandes AM, et al. The most commonly reported symptoms of post- COVID-19 syndrome include: Fatigue Symptoms that get worse after physical or mental effort Fever Lung (respiratory) symptoms, including difficulty breathing or shortness of breath and cough Other possible symptoms include: Chest pain and coronary endothelial dysfunction after recovery from COVID-19: A case series Chest pain and coronary endothelial dysfunction after recovery from COVID-19: A case series Clin Case Rep. 2022 Apr 8;10 (4):e05612. Post-COVID chronic pain might include a newly developed chronic pain as a part of post-viral syndrome; worsening of preexisting chronic pain due to the associated changes in the medical services, or a de novo chronic pain in healthy individuals who are not infected with COVID. Its not predictable who is going to have long COVID. Its even rarer to see myocarditis in patients post-COVID, although it occurs occasionally. While patients who were hospitalized are more susceptible, even those with . Comparison of clinical efficacy of epidural injection with or without steroid in lumbosacral disc herniation: a systematic review and meta-analysis. Basically if everything is negative and you feel pain in your chest/rib cage especially with movement or when being touched it's likely to be costochondritis. All rights reserved. Another study compared two groups of patients, one group admitted to the hospital due to COVID-19 infection and the other group admitted due to other causes. Fear of infection or the health care facilities get infected. That may be an easier way for the virus to get into the heart muscle, Altman said. Nociceptive pain is more prevalent than neuropathic pain. Association between vitamin D supplementation and COVID-19 infection and mortality. Kelly-Davies G. Why COVID infections leave some patients in chronic pain. Bradykinins contribute to pro-inflammatory state and also sensitize the sensitive fibers, leading to hyperalgesia [56, 57, 61, 64]. Weve also seen very different symptoms and presentations and learned to develop patient-specific treatment regimens.. JAMA Neurol. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association. It has changed our lives and our approach to medicine. Still, it can be extremely painful and debilitating, especially in children. The best treatment is to increase your fluid intake and add salt to the diet. Pleuritic COVID-19 pain due to pericarditis may start to feel better when a person sits up and leans forward and may briefly feel better while taking shallow breaths. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Zis P, Ioannou C, Artemiadis A, Christodoulou K, Kalampokini S, Hadjigeorgiou GM. OKelly B, Vidal L, McHugh T, Woo J, Avramovic G, Lambert JS. First double living-donor kidney and liver transplant in the Rocky Mountain region saves life of former Olympic ski jumper, Nurse midwives needed to bridge rural-urban reproductive health care divide. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. However, more research is needed to understand the actual problem of post-COVID pain, the possible pathophysiological mechanisms, and the target-directed prevention and management of post-COVID chronic pain. Should I get the COVID-19 vaccine if I develop costochondritis? Scholtens S, Smidt N, Swertz MA, et al. By continuing to use this site you are giving us your consent. Chronic pain after COVID-19: implications for rehabilitation. Chest discomfort frequently gets better or goes away if the underlying health conditions are treated. I think COVID-19 reactivated my old problems or destroyed something in my body, or maybe it is an entirely other cause. After COVID-19 infection, there are four patterns of musculoskeletal involvement, including myalgia 37.5%, arthralgia 5.7%, new-onset backache 6.8%, and generalized body ache 50%. Endothelial cell infection and endotheliitis in COVID-19. Caronna E, Pozo-Rosich P. Headache as a symptom of COVID-19: narrative review of 1-year research. Some common symptoms that occur alongside body aches are: pain in a specific part of the body. . Myocarditis may cause no symptoms at all. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. It includes both ongoing symptomatic COVID-19 (from 4 to 12weeks) and post-COVID-19 syndrome (12weeks or more). Cephalalgia. They also recommend developing strategies to help patients return to activity gradually; conserve their energy; eat healthy foods; stay hydrated; and follow, if necessary, a regimen of medications and herbal and vitamin supplements. Availability of screening tests as well as different vaccinations with millions of people became vaccinated. COVID-19 may exacerbate preexisting pain or be associated with the appearance of new pain. Pleuritic pain can develop due to inflammation of the pleura, a layer of cells between the lungs and the chest wall. Past studies have shown that nerve changes can persist for years after an ICU stay. Individuals who have recovered from Covid-19 can have symptoms similar to those of a heart attack, including chest pain and occasionally shortness of breath. Pain in COVID Era. https://doi.org/10.1007/s40122-020-00190-4. Pain medications may interact with the immune system or mask the signs or symptoms of COVID-19 infection. Children and teens ages 6 months-17 years Adults 18 years and older After a second shot or booster Common symptoms include fatigue, shortness of breath, cognitive dysfunction, but also others, and generally have an impact on everyday functioning. Currently, no studies have determined the number of cases of costochondritis. Dose escalation and before increasing the dose, it is important to differentiate between disease progression from other opioid drawbacks, e.g., tolerance and hyperalgesia. Geneva 2021. https://www.who.int/data/gho/publications/world-health-statistics. https://doi.org/10.1080/00207411.2022.2035905. These cookies will be stored in your browser only with your consent. JoAnn K LeQuang: design, editing, revision of final draft. How to protect yourself and others. My symptoms are chest pressure almost all the time, the pain in muscles and spine (mainly upper side like arms and between blade bones), difficulty breathing (but spO2 is usually above 95), pressure in the head and sometimes in temples (not a headache but pressure like it can explode), sometimes dizziness and lightheaded feeling (have to lie because it is hard to walk or sit), time to time weak legs (generally whole body, and lack of sensations in limbs, and problems with walking. All of these factors contribute to making the delivery of effective pain management more challenging. Like many of my own patients, you may be interested in doing more to treat to pain than just relying on medications, but you arent sure where to start. https://doi.org/10.1097/PR9.0000000000000884. A recent comprehensive systematic review and meta-analysis estimated the prevalence of long COVID, regardless of hospitalization status, and showed that the ten most frequent symptoms are fatigue/weakness, breathlessness, impaired usual activities, taste, smell, depression, muscle pain/myalgia, joint pain, affected sleep, and gastrointestinal symptoms [7]. Management of post-COVID chronic pain should be directed to involve post-COVID pain syndromes, persistent pain and discomfort, pain-associated treatment, intermittent procedural pain and tenderness from multiple types of pain conditions, as well as preexisting chronic pain issues [67, 121]. Globally, with the end of 2022 and the beginning of a new year, the COVID-19 epidemiological update showed that there have been 657,977,736 confirmed cases of COVID-19, including 6,681,433 deaths globally. There is preliminary evidence supporting that neuropathic pain at early post-COVID can be associated with serum levels of neurofilament light chain (NFL) as a potential biomarker [83], while secondary analysis found no association between serological biomarkers at the acute phase of COVID-19 and the development of long COVID neuropathic pain symptoms at 6months and 1year after infection [84, 85]. J Formos Med Assoc. In immune-compromised patients, epidural injection with the lowest dose of steroids or without steroids should be considered. Approximately 1020% of acute infection with COVID-19 patients go on to develop prolonged symptoms that may be post-COVID-19 condition [1]. Many pending answers on COVID-19 and its sequelae remain unclear and will remain a challenge for the foreseeable future [2, 3]. Curr Pain Headache Rep. 2021;25(11):73. Pain Ther. This syndrome is characterized by a wide range of health problems including brain fog with cognitive disturbances, fatigue, dyspnea, myalgia and muscle weakness, depression, and persistent headaches [6]. Mansfield KE, Sim J, Jordan JL, Jordan KP. The exact connection between costochondritis and coronavirus (COVID-19) is unknown. What to Know About Costochondritis and COVID-19. Researchers adjusted for pre-existing conditions and found that after one year, those who had COVID-19 were 63% more likely to have some kind of cardiovascular issue, resulting in about 45 additional cases per 1,000 people. Other risk factors include social isolation during hospital admission and post discharge. Many patients come to me with similar complaints, especially after the second wave of COVID-19 (Coronavirus Disease-2019), which hit our country a few months before Read full, Will there be difficulty in holding food and have pain above the belly button after COVID? Chest pain after COVID-19 is among the concerning symptoms cardiologists are seeing, even as hospitalizations from the latest surge of COVID-19 cases recede. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. Continuation of pain management protocols is highly recommended to avoid the negative impacts on the patients with more suffering, disability, and psychological stresses. Steroid injections for pain managements may affect the efficacy of COVID-19 vaccines. Warning the health care services by the weaknesses and deficiencies during the hard times such as the pandemic and how to prioritize the services according to the available resources. The prevalence of chest pain in non-hospitalized patients was 14.7% compared to 9.1% in hospitalized patients 99 (104). Pain Ther. Musculoskeletal pain: The Pain Task Force of the (IASP), defines Chronic Primary Musculoskeletal Pain (CPMP) as chronic pain in the muscles, bones, joints, or tendons that is characterized by significant emotional distress (i.e., anxiety, anger, frustration, and depressed mood) or functional disability [9, 18]. COVID-19 is having a profound effect on patients with chronic pain. That highlights again the benefits of a multidisciplinary clinic and approach to care. World Health Organization (WHO, 2021): Illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 infection, usually within 3 months from the onset of COVID-19, with symptoms and effect that last for at least 2 months, that cannot be explained by an alternative diagnosis [1]. The methods of treatment depend on the origin of the chest discomfort. Costochondritis, a painful chest pain due to swelling of the cartilage that attaches to the sternum, is a rare post-COVID symptom that some children may experience. Stay home if you are not feeling well, and. The main causes of chest pain in Post Covid Recovery patients are: 1) Post respiratory problems like ARDS and interstitial pneumonia specially after a prolonged critical illness period. 2021;398:747. Headache is one of the most disabling symptoms of long COVID and may manifest alone or in combination with other symptoms such as muscle weakness, dizziness, and vertigo as well as insomnia or other sleep impairments that may occur with long COVID-19 [67]. One simple and accessible treatment to consider Coming out of the pandemic, it's time to reflect on lessons learned and make some changes. 2020;21(1):94. Kisiela MA, Janols H, Nordqvist T, Bergquist J, Hagfeldt S, Malinovschi A, Svartengren M. Predictors of post-COVID-19 and the impact of persistent symptoms in non-hospitalized patients 12 months after COVID-19, with a focus on work ability. 2021;22:131. (Epub 2020 Jun 12). Crit Care. Results showed that COVID-19 infection was associated with a significantly higher prevalence of de novo chronic pain, chronic daily headache, and new-onset pain in general, which was associated with persistent anosmia [32]. Those patients require cardiac referral, proper evaluation, and urgent interventions in other cases [100]. Angina causes pain in the chest that can feel like pressure or tightness. Costochondritis is the inflammation of the cartilages that attach your ribs to the breastbone (sternum). Musculoskeletal pain may occur three different ways: first, de novo musculoskeletal pain following COVID-19; second, exacerbation of preexisting musculoskeletal pain after COVID-19 infection; third, increasing musculoskeletal pain in non-infected individuals as a result of COVID-19-associated factors, e.g., lockdown, isolation, unreachable medical services [94]. You also have the option to opt-out of these cookies. Exercise may cause muscular chest pain after COVID-19. It has been reported in 2162.5% of the patients according to different meta-analysis studies [67, 105, 106]. Chest pain can be a long-term symptom of infection by SARS-Cov-2. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in NPJ Vaccines. The presence of insomnia in COVID-19 patients correlates with the presence of more new-onset pain (83.3%) compared to those who did not (48.0%, p=0.024) [32, 38]. Time to re-evaluate. The novel teaching point is that COVID-19 myocarditis can present with acute manifestations such as chest pain and transient ST-segment elevation even several weeks after complete recovery from the initial infection. 2021:19. UpToDate Dec 2022; Topic 129312 Version 59.0. It was found that almost 25% of previously hospitalized COVID-19 survivors with de novo post-COVID pain reported a neuropathic pain component [30, 31]. Mutiawati E, Kusuma HI, Fahriani M, Harapan H, Syahrul S, Musadir N. Headache in post-COVID-19 patients: its characteristics and relationship with the quality of life. SN Compr Clin Med. Any chest pain should be evaluated, so clinicians can determine the specific . 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Chest discomfort is one of the typical signs of pneumonia, which is an infection of the lungs. Oral or injectable steroids (e.g., used for interventional pain procedures) are immunosuppressive. Its an uphill battle, made easier by working with a group of focused specialists like what we have assembled in the Post-COVID clinic at the University of Colorado Hospital.. Pan American Health Organization. 2022;163:e98996. In addition, some studies showed a strong correlation between the epidural volume and pain relief irrespective of the steroid dose [24, 75]. Factors associated with the presence of headache in hospitalized COVID-19 patients and impact on prognosis: a retrospective cohort study. They therefore benefit from multidisciplinary care, which is available at the UCHealth Post-COVID Clinic. Some studies showed a higher prevalence of both myalgia and arthralgia in males compared to females [12], while a significant number of studies showed the opposite [107, 108]. Patients with severe exacerbation of chronic pain: a short-term electronic prescription after evaluation via telemedicine is reasonable. Myositis is muscle inflammation caused by metabolic abnormalities, which may be triggered by COVID-19 infection. COVID-19 Pain in the chest from COVID-19 could occur on one or both sides of the chest. Medications not affected by the antiviral medications: Morphine, buprenorphine, and tapentadol are not dependent on CYP450 enzymatic activity and can be used safely with antiviral therapy [130, 131]. Cherry CL, Wadley AL, Kamerman PR. Neurol Sci. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Not suitable in some areas, such as rural areas and developing countries with restricted facilities [9, 30]. Post-COVID chronic pain might include: a newly developed chronic pain which is a part of post-viral syndrome due to organ damage; exacerbation of preexisting chronic pain due to the abrupt changes, limited access to medical services and the associated mental health problems; or newly developed chronic pain in healthy individuals who are not infected with COVID due to associated risk factors (e.g., poor sleep, inactivity, fear of infection, anxiety, and depression) [30]. Google Scholar. Less access to treatment facilities due to isolation, social distancing, and fear of infection, lifting opioid tolerant patients struggling with addiction. Telemedicine, or eHealth, has emerged as a unique technology to facilitate efficient communication to provide essential health care services during the pandemic. The prevalence of post-COVID musculoskeletal pain increased at 60days, but decreased later on after 180days [42, 67, 92]. The main causes of chest pain in Post Covid Recovery patients are: 1) Post respiratory problems like ARDS and interstitial pneumonia specially after a prolonged critical illness period. However, Altman said it is rare for COVID-19 patients to develop myocarditis, a conclusion supported by CDC research. Fatigue is most commonly prevalent among women of middle age and older patients [115]. The use of new technology such as telemedicine showed great advances, more orientation, specifically oriented tools for the assessment and management of chronic pain, as well as published guidelines for the use of telemedicine in pain management. These persistent symptoms, which can change over time, confirm that post-COVID-19 chronic pain has a multi-systemic involvement even after mild infection in healthy younger individuals. When reported, the cases have especially been in adolescents and young adult males within several days after mRNA COVID-19 vaccination (Pfizer-BioNTech or Moderna). Lancet. Furthermore, any successful treatment protocol should include a clear plan based on the patients symptoms, underlying cause, and associated comorbidities. The COVID-19 pandemic has had unforeseen impacts on the health care services. We know that COVID-19 can directly affect the nervous system, sometimes in profound ways, which can contribute to prolonged pain symptoms. The inflammation may be caused by repeated coughing from the infection. https://doi.org/10.14744/agri.2019.01878. Several features such as social distancing and isolation at home in addition to the mental health specific problems such as depression, anxiety, post-traumatic stress disorder (PTSD), and cognitive impairment, have well-recognized with chronic pain [25]. Cell. The following definitions can be used to differentiate different stages of both ongoing or post-COVID-19 signs and symptoms [1, 11, 12]. More often after the second dose SN Comprehensive Clin Med. Some of these symptoms can last for 3 months or longer. 2009;9:50917. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: a systematic review and meta-analysis. Pain Report. Vaccination, while not 100% effective, offers further protection against those uncertainties.
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