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Is it fair to infer based on this that they are a symptom and not a cause? Or at least, not a primary cause, though their presence may crate a feedback loop?

I would think it is a good idea to assume they are a symptom but could also cause further problems.

Just like sneezing/coughing does occur normally, but is also a symptom of many different health issues, and in the worst cases could lead to broken ribs, etc.

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