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Wisconsin Officials Urge People to Stop Vaping After Sudden Rise in Lung Disease (gizmodo.com)
130 points by lnguyen 77 days ago | hide | past | web | favorite | 98 comments



I sort of hate these articles, because the comments always boil down to three main categories:

1. I vape and this hasn’t happened to me, therefore I’m an expert on public health policy

2. I vape and because it’s better than cigarettes, it’s safe on those terms alone

3. What the hell is wrong with you idiots, safer than cigarettes is not the same as safe

You’re either irrationally defensive (1, 2) because you feel attacked, or you’re a smug dick (3) that trivializes addiction.


I agree on the smug dick part, but is 3 really trivializing addiction? Or is it perhaps a useful counter to the egregious motivated reasoning that goes along with addiction?

I certainly think we should be sympathetic with addicts and help them where we can. But I don't think that requires accepting the obvious bullshit that addicts come up with in justifying their behavior. And it's not like vaping is the only way to kick a nicotine habit.


Another huge problem is people rarely accept the realities on the ground in these abstract debates. That people will continue to smoke cigarettes otherwise or find black market means to vape even when its heavily regulated or banned. As a consequence it simply pushes people into completely unsafe vendors and shady people, pushing good kids into the justice system, encouraging related criminal activity which black markets help finance, etc creating a net-worse situation.

High school kids have been able to find weed for decades despite various stringent laws. Many drug dealers are high school kids themselves. I wouldn't be surprised to find kids selling vape oil and cheap chinese vape pens.

This should ultimately be about balancing real alternatives, doing our best to minimize harm, and educating the people who will do it anyway. Although most education attempts have laughably failed like those 90s TV spots by out of touch ad companies paid for by the gov.

People like to argue in some fantasy idealistic world where people will stop engaging in non-violent activity which harms themselves because policy makers say so.


I agree with the general thrust of your point, but I'm not sure it applies here. People smoke weed because it's fun or because it is medically useful. But from the tobacco smokers and ex-smokers I know, that's never the case. It's not fun; it's a very hard-to-kick addiction.

It's also an addiction provided on a for-profit basis. That means strong incentives to create new addicts. I don't think it's at all unreasonable for us as a society to work against that.


But that would force it into hiding. Much fewer people could run out for a short five minute vaping break in plain sight of everyone. So they’d save it for the evenings and their homes, which means they’d do it much more rarely, which means that much fewer people would get addicted. And nicotine as a drug isn’t all that fun.


There are three pretty clear facts

1. There is has been a sharp drop in the number of smokers

2. There is has been an even sharper jump in the number of the vapers, especially concerning among youth.

3. The available evidence says that the inherent risks of vaping are an order of magnitude less than smoking.

As a society we're discussing whats the optimal public health policy to reduce vaping and smoking. Unfortunately these are substitutes so as we crack down on the availability of one we increase consumption of the other. And this is why it's important to understand the relative risks of vaping versus smoking. If they're similarly unsafe then it doesn't really matter how hard we crack down on vaping. But if smoking is far more dangerous than vaping(which the evidence points to) then we need to be much more careful about reducing vaping availability.


Among my peers at least people vape for the stimulant effects. Helps with work, and helps at the bar. Its also easier to manage than coffee which stains teeth, taints breath, and makes you poop.


>What the hell is wrong with you idiots, safer than cigarettes is not the same as safe

I don't see anything wrong with the second part of that statement. Of course, the first part comes across as being an pretentious twat, but it's important to remind people who actually believe vapes are perfectly safe and can do no harm.


Mitigating risk is what it is all about. Methadone is less risky than Heroin, which is why you can get a prescription for the one at a drug treatment facility but not the other.


Methadone isn't actually safer than known purity heroin, and in fact many opiate addicts say that methadone causes much stronger dependence than heroin/the morphones/the contins. The only "socially good" things about it are the consistent availability and long duration of action, which prevent desperation and petty crime


> which is why you can get a prescription for the one

And you can't buy either at a corner store. Methdone > heroin and vaping > cigarettes but we still should not encourage vaping. It is dangerous and we should treat it as such.


So is drinking alcohol, but you don’t see stop drinking commercials on TV.


Have you ever heard the phrase "please drink responsibily"?

Besides, it's a different issue. It is general knowledge that alcohol has some serious health consequences.


That language replaced “Don’t drink and drive” in alcohol advertisements because the manufacturers wanted the lede to be “Please drink...” instead of “Don’t drink...”. It’s there either because there’s legislation requiring anti-drunk-driving statements in the ads or to head off legislators adding such a requirement.


Actually there are/were places in Europe where addicts could get an actual prescription for heroin. It greatly reduced harm.


> 3. What the hell is wrong with you idiots, safer than cigarettes is not the same as safe

I wouldn't say this to anyone who was previously addicted to cigarettes and switched to vaping as a safer alternative.

I would, however, say (a nicer version of) it to any non-smoker who wants to try vaping. And, I would push back against anyone who vapes and thinks it's safe, lest they create more people in the aforementioned category.


Think link is about 11 cases identified (and a cluster of 8, whatever they mean by that).

That would not point to "vaping" being specifically dangerous, but a specific dangerous product batch either vaporizer or fluid causing lung disease. It wouldn't be surprising given the loosely/unregulated status of many of these things and the ease of importing supplies from questionable origins.


Some of the liquids causing this particular “pandemic” were obtained on the black market and included THC... May not even really be a case of something slipping by the professional sales of eliquids.


Not to be confused with a computing cluster, this is a reference to analytical methods.

In medicine and medical jargon, the verb “to cluster” and noun “cluster” have a specialized definition. It’s a loaded term, intended to signal that observations of coincidental medical conditions found close together and at around the same time are presumed to be strongly related in an as yet unknown way.

It’s usually stated in a public health context, when an alert or warning is announced.

Example: A sudden spike in food poisoning at restaurants is noticed by way of shared reporting between hospitals. If there are 10,000 incidents within 48 hours in the entire state of Texas, statistical “clustering” helps shake out the unrelated noise of the usual incidental food poisoning, to locate the unexpected events according to shared qualities. Same restaurant chain, correlated ingredients across chains (all lettuce), associated factories or farms, suppliers, freight shipping company, style of prep work, common equipment (all had same blender or mixer brand), and so on.

It’s a way of problem solving during fluid events as they unfold, in an attempt to get out in front of a problem, as it happens.


I think in (3) you should separate the smoker -> vapers versus the non smoker -> vapers. I've seen a lot of the latter amongst younger people, which really sucks IMO.


As it turns out, “irrationally defensive” is the overwhelmingly dominant response in humans faced with analyzing their own behavior in any situation.


so adding more divisive comments, instead of discussing facts is the way to go?

The official recommendation from the NHS in the UK is now that vaping is indeed less harmful than cigarettes:

Public Health England's 2015 independent evidence review found that, based on the available evidence, vaping is around 95% less harmful than smoking. The Royal College of Physicians came to a similar conclusion in its 2016 report 'Nicotine without smoke: tobacco harm reduction'.

- https://www.nhs.uk/smokefree/help-and-advice/e-cigarettes

Perhaps we don't have enough data yet, but as a matter of public health policy it is definitely useful to know which is less harmful for you.


Or you take the metaposition and the next person lists (4) categories of comments


Metasmugness is the best position one could take in any topic. Rising above the ones who rise above others, holier-than-holier-than-thou, etc.


Oh but it's smugness all the way down, thou holier of holies. ;)


Here is my obnoxiously unsolicited opinion: I vape copious amounts of cannabis and recently have been noticing trouble with my lungs filling with phlem... guess it's time for me to slow down.


on my side it's mostly that studies only cover a few kind of liquids.. and still no regulation came out to only sell safe ones.


Out of curiosity, where do you sit? I think I am mostly 3.


[flagged]


How do you know they're paid by the companies?

I've made a comment similar to that before and I stand by it. Wish I would've known I could get paid to post it!


For each specific post you can't tell.


I have some friends who have said it to me in person too. I wonder which of them are the shills?


This had been flagkilled. I vouched it because it is a serious point.

None of them obviously. But the standards of trust I have in my friends is higher than in strangers.

I'm not certain that there really are paid shills on this particular topic online (I actually somewhat doubt it because it would open the companies up to serious legal issues). But we should always be aware that the interests of strangers may not align with ours.


Note that the black vape on the right in the photo is very much unlike the other two.

It’s a dry herb cannabis vaporizer —- oddly, one of the very few that’s a certified medical device. (it’s a storz and bickel crafty)

There’s a vast difference between concentrate/ejuice/distillate vapes and something like a crafty.

It would be nice if the two categories of vapes could be separated more cleanly when discussing health effects because it would separate a lot of the variables.


Agreed but I wouldn't try to infer from a stock photo to the substance of the story. The vast majority of vapes used, especially those by young adults and teens, are not black vapes.


It clearly says in the story they had all vaped 'THC', AKA a catch all term these days for dodgy shit.

More than likely, given how this hasn't happened in the rest of the WORLD, they vaped something extremely dodgy that they knew was dodgy.

if you need me to spell this out for you, this has NOTHING to do with vaping and everything to do with dodgy drug dealers.


Yeah this smells like “someone bought a street cart”. You can buy unfilled 510 carts that claim to be Brass Knuckles or any other major brand, on alibaba, for pennies. Fill it up with whatever you want.

pro tip, don’t buy carts unless it’s from a dispensary. And even then, flowers nicer :)


IIRC the crafty itself is not medically certified but S&B at one time did have a medically certified version.


they sell separately coded crafty/mighty/volcano. They hit slightly lower max temperatures, and you can claim them as medical devices; they’re otherwise identical to their non medical counterparts.

S&B makes awesome gear; i just prefer on-demand.


They likely got a bad batch of THC cartridges, there's a ton of black market ones going around all over, with who knows what in them.

Millions of people use nicotine vaporizers daily with no ill effects.


Yeah, a local cluster of ~8-20 cases and the patients say they were using 'THC' cartridges in a state where it's illegal?

People were putting synthetic cannabinoids in e-juice over a decade ago, and I'd be surprised if there wasn't still a market for it. I'd also be surprised if the actual chemicals being used haven't evolved to keep up with regulations - at this point they'd probably be dozens of analogues away from what was presented in the original Huffman papers, huh?

I think it's probably a very bad idea to knowingly use that sort of thing, but I guess the underground market might not have very well-regulated labeling standards.


Yes, from own experiences, the cheap carts [dank/mario cart] which are black market only labels use thc analogues while the ones that make it here that are sold in dispensaries are generally legit [rove/tko]

From what I've read about opiate analogues, whatever thc analogues they're using ~15 years after the Huffman paper are far removed from their original state.

I can also confirm there is a tremendous demand for thc carts in non-legal states.


Very interesting to see JWH discussed on HN. This stuff was BIGGG about a decade ago, and then I stopped hearing about it. It's crazy to see they are still playing the game of cat and mouse with these analogues, and even getting them into the black market carts.

I have medical so thankfully I don't need to mess with the black market at this point. I would _highly_ advise against using any synthetic cannabinoids.


> I would _highly_ advise against using any synthetic cannabinoids.

Any specific reasons to say this? Medical knowledge, personal experience or other?

I did have one experience with a synthetic cannabinoid and it was very bad indeed, took me days to recover. FYI. I'd not rule out trying it again but with great care. Though now it's illegal in the UK, so prob won't happen.


I remember there being a number of deaths from some cannabinoids, but after doing some research I can't confirm. This is what I found:

AMB-FUBINACA caused a "zombie outbreak" which sent 33 people to the hospital in Brooklyn: https://www.nytimes.com/2016/12/14/nyregion/zombielike-state...

Anecdotally, AM-2201 seems to cause enlarged liver and other health problems with long-term use: https://www.erowid.org/experiences/exp.php?ID=95702

I remember CP-55,940 and WIN-55,212 having serious side effects but I couldn't find information..


Comprehensive answer. I particularly appreciate you made it clear what you couldn't verify, or what was anecdotal. I wish I could upvote it twice for that alone.


Many of them are full agonists on the cannabanoid receptors, which leads to GABA levels that are dangerously low when the receptors are saturated. THC proper lowers GABA somewhat, but not nearly as much.

They've lead to seizures and have been linked to at least a few deaths.


They aren't. Parent is misinformed.


I likely am, it was speculation on my part. Thank you for providing more concrete information, I should've noted that I was speculating.


Not analogs. The analogs can kill you via overdose. That's not happening here.


I'd imagine that would depend on the analogue


There aren't any that mimic cannabis closely enough to have it's self-limiting affinity for endocannabinoid synapses.


Not disputing, but do you have a source handy?


Natural cannabinoids only have a limited affinity for the endocannabinoid synapse.

>Studies have found that these compounds tend to activate the CB1 receptor to a greater degree than does THC, suggesting that synthetic marijuana compounds have the ability to induce far more intense effects than marijuana, according to the review.

https://www.livescience.com/57747-synthetic-marijuana-risks....

>Much of our understanding of cannabinoid tolerance, dependence and withdrawal has been based on studies involving Δ9-THC, a relatively weak partial agonist at CB1 and CB2 receptors. However, the SCBs commonly found in quasi-legal commercial products such as K2 and Spice are typically full cannabinoid receptor agonists. Importantly, a drug's efficacy determines how “powerful” its maximal effects may be in biological systems. A low efficacy cannabinoid like Δ9-THC will have a less pronounced maximal effect than a higher efficacy cannabinoid, such as the SCBs present in commercial products, and this difference in maximal effects cannot be overcome simply by increasing the dose of Δ9-THC. In other words, no amount of Δ9-THC can stimulate cannabinoid receptors to the same degree as the SCBs currently emerging as drugs of abuse. This has left researchers working with these high efficacy SCBs in the unusual position of having to determine whether their effects are related to the unprecedented degree of cannabinoid receptor stimulation elicited by these compounds, or whether they are produced by interactions with other, non-cannabinoid receptor systems.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582439/


Yeah the clustering makes me think they got a tainted cartridge as opposed to it being an inherent risk of vaping.


There's an Instagram user who independently tests, meaning he pays to have an independent lab test the samples, (THC) carts for pesticides and solvents and posts the results for all to see. He's a hero, as far as I'm concerned.

There's so much shit in these cartridges. They are concentrated, so pesticides used during growth can also be concentrated in the cartridges.

It's completely absurd to me that this stuff isn't more regulated.


100% agree but every time anyone comments that vaping should be regulated, the wolves come out shouting at the top of their lungs how safe vaping is, and how much better vaping is than smoking, and saying that you're basically forcing people to keep smoking by doing anything to regulate vaping.


A recent study here in Europe as found that some low-quality CBD e-liquids contain traces of solvent (used to extract said CBD) that are above safety level and may trigger adverse reaction in vapers. I assume THC e-liquid goes through the same sort of process and may have the same issue.


Yes, residual solvents are possible with the THC extraction process. I prefer to use THC concentrates extracted with CO2 to avoid inhaling residual solvents.


Co2 iirc is a physical extraction, like bubble hash, while this is concerning solvent hash, a different product.

The correct way to extract solvents is under vacuum.


Supercritical CO2 is a (very non-polar) solvent. I can't imagine what would make that a physical or mechanical extraction.

Good CO2 extraction uses two passes at different pressures. One to extract the terpenes and one for the cannibinoids.


Can you tell only CO2 was used?


I would love it if you had a link to that study. A relative of mine is on the lookout for CBD oils and I said I'd help find what there is.


I don't have a direct link to the study, but this is from the BBC (https://www.bbc.com/news/health-48950483):

"The researchers also found the presence in seven products of the solvent dichloromethane, which can cause wheezing and shortness of breath, at levels above food safety limits."


Are food safety limits the appropriate limit for something that will be largely exhaled?


> Millions of people use nicotine vaporizers daily with no ill effects.

The movement against tobacco hasn't failed, but it is in the trough of its cycle.


This is what happens when you make the drugs that have been safe for years illegal. People who make marijuana illegal don't care about children - they would rather have a few die as a moralistic lesson to others than allow anyone to get high. Because they're assholes. Full stop.


Is their research on people who have ONLY vaped? Most people who vape are former/current smokers. For me, I vape when not drinking and smoke cigarettes when drinking. This means I smoke about 2-3 packs a month, the rest is vape.

It's harm reduction for me and allows me to still perform at a reasonable cardio level in beer leagues. Now my evidence is shotty, but my lungs "feel" better and I have a noticeable improvement in cardio when I haven't touch a cigarette in a few days and have just been vaping. My ability to stay on the ice (I play hockey) is noticeably better. I don't start getting really tired until the third period, whereas with cigarettes I am dead by the second period.


I've quit smoking and drinking, work out 5 times a week and run once or twice a day. Vape has allowed me to loose 12kg and quit drinking and smoking. If you're gonna say that it might just irritate my lungs a little more than walking about the street at the o'smog hour on hottest summer day then be it.


> Is their research on people who have ONLY vaped?

It might be given the issue is apparently with young people. One of the controversial aspects of vaping is it has been sometimes marketed to teens, potentially creating a new generation of nicotine addicts — maybe a dark side to a tool otherwise seen as being beneficial as a safer alternative for smokers.


This reasoning seems pretty strange to me. Why not quit entirely?


There are often quite a few psychiatric issues that nicotine helps out with. Also, probably a good chunk o population has issues that are just slightly below threshold of what is considered a condition, but niccotine helps them out a lot.

As an ADHD-diagnosed person, to function properly I need some sort of a stimulant. It's really "choose your adventure" kind of a situation - I need either sugar, ritalin or nicotine, and the less I take of one the more I need of another to function properly.

Keep that in mind when you see someone smoking - unless you're 100% sure that they are neurotypical, you don't know if it's addiction or self-medication.


Because it's really difficult to do so. That might not be a valid "why" in some people's eyes, but it's the reason smokers switch to vaping. They've tried to quit entirely, and have failed to do so many times.

Then this new nicotine delivery method comes along, smokers try it, and find it an acceptable substitute.

The "they" above is me. I switched a couple years ago and have had nothing but improvement in my health. My stamina is better, my chronic cough went away, and I don't hear that faint whistle when I breath in.

I'm sure if and when I give up nicotine completely, I'll feel better still. But right now I'm taking this partial win.


https://www.youtube.com/watch?v=0PCCF1bX-a4

(For those who can't listen to this right now, it's a short Mitchell and Webb radio sketch that humorously illustrates that it's quite difficult to stop an addiction simply because you know it'd be good for you.)


Having quit smoking before for a year and vaping for 9 months. I had to entirely quit drinking to do it. I started drinking again. It's dumb, I know. I need to quit drinking for a few months again, taper down with vape like I did last time, and then just not pick up a smoke again. Instead, just use a vape when I'm drunk if I feel the need.


What's a beer league?



Ha! Stupid me thought it was some sort of a beer-lover's group in which the commenter hoped to improve his performance, a sort of organized pub crawl.


10 people go blind drinking moonshine, Wisconsin officials urge people to stop drinking. Wtf is wrong with them giving this overreaction after a cluster of bad cases of people who smoked “THC” juice.


meh. Inhaling a bunch of chemicals was always gonna be a roll of the dice.

Better question is whether it's more dangerous than smokes cause people will want their nicotine fix one way or the other


So, I am just trying to understand how it's worse than caffeine.

I vape but I simply don't get how bad it is compared to the normal smog and other impure air we breathe. Nicotine aside,what makes vaping risky? Like are there specific chemical substances? When i starter it I assumed it was nictone,water vapor and flavorings which have no known side effects on the lung.


It’s not water vapour, it’s vegetable glycerin and/or propylene glycol plus flavourings. Some flavourings can be seriously bad, look up popcorn lungs.


>it’s vegetable glycerin and/or propylene glycol

Both of which have a long record of safety as an inhaled vapor. They're the standard ingredients in theatrical fog machines, so have been investigated in detail by occupational health and safety agencies; the worst identified risks are minor respiratory irritation.

https://www.cdc.gov/niosh/hhe/reports/pdfs/1990-0355-2449.pd...

>Some flavourings can be seriously bad, look up popcorn lungs.

All reputable manufacturers removed diacetyl from their products years ago, as soon as the risk came to the attention of the industry. Popcorn lung is extremely rare, with only one known case involving non-occupational exposure.

http://blog.mtbakervapor.com/diacetyl/


Theatrical fog machines are not assumed to be safe daily for 50+ years.

Many things are harmful, but not obvious at low doses. People used to use lead as a sweetener. https://en.m.wikipedia.org/wiki/Lead(II)_acetate

The current consensus is that vaping is harmful. https://www.lung.org/stop-smoking/smoking-facts/impact-of-e-...

However, it’s not really been around long enough for long term effects to be obvious.


> Theatrical fog machines are not assumed to be safe daily for 50+ years.

The first link in my comment is a report on precisely that - workplace health and safety for theatrical performers and technicians who spend every day in close proximity to high-volume fog machines.

>The current consensus is that vaping is harmful.

There are undoubtedly some harms associated with vaping (nicotine is associated with a somewhat elevated risk of cardiovascular disease), but the evidence overwhelmingly indicates that it is vastly safer than smoking, which is the most pertinent point of comparison.

I haven't thoroughly reviewed the references in your linked article, but one issue leaps out at first glance. The article states "E-cigarettes also contain acrolein, a herbicide primarily used to kill weeds", which is a substantial misrepresentation of the facts. Acrolein is used in some niche applications as an aquatic herbicide, but it is a naturally-occuring byproduct of the thermal decomposition of glycerol and is found in most fried foods. The acrolein content of e-cigarette vapour is far lower than cigarette smoke, and can be reduced to negligible levels through the use of a temperature-controlled vaping device.

https://assets.publishing.service.gov.uk/government/uploads/...

https://escholarship.org/uc/item/9s90850c


“Thirty-seven symptomatic and 68 non-symptomatic performers made up the Phase II study population of 105 performers.” This is at levels that where considered safe at the time.

So, your link demonstrates harm from these smoke machines and recommends limited exposure mentioning a range of respiratory issues. The only thing they say is not linked is Asthmatic symptoms.


"E-cigarettes produce a number of dangerous chemicals including acetaldehyde" - just like alcohol and hangover, this is metabolite of alcohol. 20% of becomes acetaldehyde. for some reason I don't get hangover from vaping, though I did have pretty horrible feeling smoking. Probably worse than occasional hangover.


> Theatrical fog machines are not assumed to be safe daily for 50+ years.

Occupational hazards (chronic exposure) might be expected to show something if it had serious long term effects.

> However, it’s not really been around long enough for long term effects

Long term effects often have early outliers (the tail of the graph leading up to a long term problem) - we would likely be seeing something measurable already if there were a very serious problem.

And for many users, it's a very good bet that vaping is safer than long term smoking.


Vaping represents a significant increase in nicotine use for young people. If it was limited to 40+ year old lifetime smokers, then that would be different.


So what? Do we stop "young" people from eating junk food or being targeted by advertising? The risks of vaping are strongly indicated to be far less than many other recreational activities young people do (drinking and taking random drugs being one obvious thing I see in my community, that seems to still be on the increase).

And if there are extra vapers, but fewer smokers, then it seems probable everyone is way better off. Weigh a small unknown risk against a large known risk.

Out of interest: do vapers show the same physical signs of damage as smokers?

Someone who smokes significantly for say two years has clearly visible changes to their skin, and often obvious indicators of unhealthy lungs: strong indicators of long term damage effects. I don't know well enough any people that have only ever vaped for me to have a inkling about the visible side-effects of vaping (to use as a proxy for making a guess at long term damage compared to smoking).


> extra vapers, but fewer smokers

That does not seem to follow. Based on existing trends you just get extra vapers without fewer young people smoking.

In terms of health issues for young teenagers vaping is fairly high on the list largely due to simple numbers. If we need to have young teens taking nicotine, why not the patch or gum which seem to be safer.


a while back there was a scare that some vapes had lots of tiny metal particles in their vapor, which would be really really bad for you. Dunno what the resolution to that was, but it’s probably worth following up on.


The concentration of metals found in that study were below the legal limits for inhalational medicines. The type of vaping device studied was something called a "cartomizer" of a design which is now broadly obsolete; these cartomizers feature heating elements with solder joints which remain immersed in the e-liquid solution, whereas more modern devices generally use a heating element comprising a single piece of stainless steel.

https://journals.plos.org/plosone/article?id=10.1371/journal...


What do the ingredients on your packet say?


Vegetable glycerin,propylene glycol,flavors,nicotine. There is also a "state of california" warning about possible exposure to formaldehyde.

Can't they test this on rats and monkeys easily to see if there is an obvious side effect? Or maybe they have and the results are inconclusive?


Vegetable Glycerin, Propylene Glycol, Natural and Artificial Flavorings, Nicotine


Natural lung disease flavor.

Seriously, could they be any more vague than "Natural and Artificial flavorings?"


Is there a better source than Gizmodo? It's basically a tabloid


The very first link in the article is the original source - a press release from Wisconsin's Department of Health: https://www.dhs.wisconsin.gov/news/releases/080219.htm




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