What I want to concentrate on - is “personal” corona virus protection advice.
I also want this advice to be fairly realistic and practical.
This advice represents a personal opinion.
The coronavirus “COV ID – 19” is a respiratory virus.
You predominantly catch it when people breathe on you, or cough on you or talk to you. Small microscopic droplets of fluid are vibrated out of the airways when you breathe/cough/talk – and there are viral particles embedded in these microscopic droplets. When you breathe these in, they deposit in the upper respiratory tract. The virus then has a chance to infect the new person. My assessment is that approximately 90% of transmission for Corona Virus is by this method. Big droplets (over 5 µm) will land on the back of the throat of the new person being infected. Small droplets (1 to 5 µm) may go further down into the airways.
You can catch coronavirus by contact. The droplets that have been breathed out /coughed out/talked out of the airways of an infected person – can land on surfaces. If you touch these with your fingers and then touch your mouth this can introduce the infection inside you.
A typical example would be picking up a pen with contaminated fingers and then putting the pen inside your mouth. Another typical example would be using cutlery contaminated by your touch or by being breathed on/coughed on/talked on – and putting this cutlery into your mouth. My assessment is that approximate 10% of transmission is by this method.
The virus can last on surfaces for some time –probably hours - but not forever. Viruses exposed to the sun will be destroyed by UV fairly quickly. Viruses on warm dry surfaces are likely to be damaged by drying – which will distort and tear apart the virus.
Because the main method of catching the virus is by people breathing on you/coughing on you/talking over you – this knowledge should guide you in protecting yourself.
Keep a good distance between yourself and another person. Currently the advice is to have 1 - 1.5 m of separation.
Vaccination will be available soon at both Toombul Medical Centre and at MDC Clinic. To my knowledge the vaccines are safe - both short and long term. If you get a vaccine , you can get your life and freedom back as well. I would recommend every one have a vaccine. I will certainly be having a vaccine myself.( Actually two doses for the Astra-Zeneca vaccine which is being made / produced in Australia).
I will now introduce a new concept called “infective dose”.
If you are exposed to a lot of the virus, you are likely to be a lot sicker. If you are exposed to only a bit of the virus, you are likely to be only a bit sick. Even if you have not fully avoided being exposed to the virus, reducing your “infective dose”, can make a big difference to you.
Don’t let people breathe on you. Standing beside or behind people is a lot safer for you, than standing facing people. Face-to-face carries the highest risk of being exposed to virus within respiratory droplets. If you are both breathing forward, even if you are in close proximity, your “infective dose” will be substantially reduced.
If you have a sick person in the family, you can look after them. However, even if you are exposed – this is not a reason to give up all precautions.
I will say the mantra of “infective dose” again. If you are exposed to a lot of the virus, you are likely to be a lot sicker. If you are exposed to only a bit of the virus, you are likely to be only a bit sick. Even if you have not fully avoided being exposed to the virus, reducing your “infective dose”, can make a big difference to you.
Having lots of respiratory droplets within your own airways, is going to help the germ / virus spread. Do use decongestants in your nose to reduce postnasal drip and the amount of respiratory droplets being breathed from your own nose area, deeper into your airways. ( Nasal spray decongestants give high effect locally with little effect throughout the rest of the body).
Identifying the Coronavirus Infection
The symptoms of the coronavirus essentially are not very different from any flu or other respiratory illness which you may catch. It is essentially impossible to determine by assessing the symptoms whether you may have coronavirus or not. People who catch an illness which is significant – different from something they would routinely experience in their lives – become suspicious that perhaps it could be coronavirus based on all the media hype creating worry. It is for this reason that they volunteer for testing, not because the viral symptoms are unique enough to suggest that it is a coronavirus infection.
In short coronavirus looks very much like anything else you can get sick with – perhaps on the worse side of usual – this being the most distinctive aspect of the infection. You could say that perhaps coronavirus infection looks like just another bad flu. The flu virus causes a range of illnesses and deaths in a range of ages. However there is no general or population immunity to the coronavirus, so that the deaths concentrate in the older age groups – predominately in corona virus infections.
A preponderance of the deaths attributable to coronavirus infection that we are seeing is in the over 70 age group, especially those with multiple medical problems.
Do not “Mouth- Breathe”. This dries and damages throat linings making them easier to infect.
Betadine (the antiseptic which is used on wounds) in my opinion can be useful.. Prepare a dilution of this antiseptic of 1 in 20. That is take 1ml of Betadine antiseptic – put this in a small cup – and either add 19 mls of water or fill up to the 20 ml line on the small cup.
Then: one option is to lie down and hold this fluid on the back of your throat. This gives you a very good contact time if you lie there for 2 to 3 minutes.
Alternately: gargle the fluid while standing. This gives you deeper contact right down to your vocal cords. Betadine kills everything – including viruses, bacteria and fungi.
By using Betadine on your throat, you will reduce some of the “infective dose”. In my opinion this may make a difference to how sick you become because the amount of virus reaching deeper into the body especially into your lungs, may be reduced.
Other natural health strategies:
Using a multivitamin. If you have a deficiency of B12 or Folate especially- your immune system can be compromised.
Use high-dose zinc and vitamin C. You can take up to 9 zinc pills a day (short-term) if you wish to try to enhance the action of your immune system – to try to reduce infection. Take this as 3 pills @ 3 times a day with food.
Zinc is very poorly absorbed. The vitamin C taken with each lot of zinc pills will help absorption. Zinc comes as 20 to 30 mg “elemental” pills. This means that the amount of zinc “metal” in each zinc pill weighs approximately 20 to 30 mg.
Another way of describing these pills is that the pills are 200 to 300 mg of zinc as an amino acid chelate.
This is exactly the same as the 20 to 30 mg of elemental zinc. In one method of weighing the pill, we just weigh the zinc metal. In the other way of weighing the pill, we weigh the zinc and its chemical packing. These 2 sets of numbers essentially represent the same sized pill.
Other medications: There is some suggestion that zinc and hydroxychloroquine can be useful in controlling viral infection. There is some suggestion that one of the anti-HIV protease drugs (boosted Lopinavir= Kaletra), may have some effect in controlling viral infection. The use of drugs such as these are hospital issues , not general practice issues. A specific drug : Remdesivir may well be available in the future.
Catching 2 things at the time is not good. Stay healthy and try to treat things early to avoid complications. Coronavirus plus other illness together will make you extra sick. This leads into the use of antibiotics as your GP may prescribe. Antibiotics kill bacteria. They are directly useless against the coronavirus.
However the virus will damage the linings of your airways – your bronchi and throat area in particular and probably your nose as well.
Once the linings are damaged bacteria, can multiply and attack into the tissues – enhancing damage and helping the virus to enter the tissues. So even if you have the coronavirus and even if this is causing your sore throat – it is unlikely that your sore throat will stay wholly due to your being infected with coronavirus for very long. Within 24 hours there is likely to be a significant bacterial infection enhancing and accelerating the existing viral infection.
In short , if you treat a 24-hour mark viral infection you can kill the bacteria coexisting with the coronavirus and accelerating the infection. This strategy with antibiotics will only work for a day or two . At this point in time, another option is to then use a different antibiotic to try to limit a different group of bacteria which were resistant to the first antibiotic and have now taken the opportunity to invade the tissues damaged by the coronavirus.
Antibiotics may not help to kill the coronavirus. But they may well help to limit the spread of the coronavirus by limiting the "indirect" amount of tissue damage. In short viruses – cause damage – which allow bacteria to grow – accelerating infection.
Antibacterial Antibiotics may help you deal with viral infection indirectly.
Having 2 problems at one time is not good. Using immuno-suppressants during an epidemic may be dangerous. (Steroids and methotrexate are the more common type of immuno-suppressant medications used). Having uncontrolled diabetes is likely to exacerbate a coronavirus infection. In short, see your doctor about your general health. Work with your doctor to get you as well as you can be.
Our Surgery’s policies are designed to enable the doctors to keep on giving care for longer to more people. This means that doctors need to be safe and this means that people are therefore treated more safely.
Patients are asked whether they have flu like symptoms. If you have flulike symptoms you need to attend a pop up clinic such as exist at hospitals for example Royal Brisbane Hospital or Prince Charles Hospital or Princess Alexandra Hospital.
If you have respiratory illness symptoms that are unlikely to be caused by coronavirus, you can attend the GP clinic – but you will be isolated from other patients in the clinic – to minimise the spread of infection.
Anybody who looks ill will have their temperature taken by the nurse with an Infrared thermometer. These can take temperatures in multiple parts of the body, in real time and at a variable distance. This means we can identify sick people and still have everyone keep their distance to reduce the risk of other people catching an infection.
We have a few reasons for our policy. We cannot help the sick by joining them. We cannot help patients by being sick ourselves. There is an example of a medical clinic in Melbourne which was shut down after one of the doctors became infected. You don’t need us to put you at risk either.
One of the major problems for us lies in the availability of protective equipment.
Firstly Medicare makes it un-economic for us to use fresh disposable protective equipment supplies for every person coming to see us. We can’t afford them – and people seeing us won’t pay for them. Some people have even suggested that all safety equipment must be changed between patient contacts. The cost of this is in excess of the Medicare rebate and is an economic impossibility.
The medical beaurocracy insists on full protective equipment being used when a doctor undertakes contact with potentially ill people. No exceptions. It is a compulsory requirement for doctors working with potential corona virus patients that full protective gear is used.
Secondly, disposable protective equipment is essentially not available. We have had a supply of N95 masks on backorder for our clinic for some time. The problem with our gaining access to these supplies is essentially a magnitude greater than the toilet paper problem. At the outbreak of the epidemic – the government appropriated all supplies throughout the country for its National stockpile. This meant that no one else could get any of these disposable protective equipment supplies. The government has decided to distribute these to at risk sites and to aboriginal healthcare centres. Unfortunately being the closest major medical centre to Brisbane airport does not put us in a “need to support” category.
So we made the decision that we are unable to supply a high level of protective equipment such as may be provided in a pop up clinic – or government centre – or major public hospital. Hence since the government sites have greater levels of safety – this is where we are directing people with flulike symptoms and potential coronavirus infected individuals.
In short our policy is : he who works safest – works longest. We can be most available for more people longer by not taking any chances. This keeps us safe. This keeps you safe. This keeps the medical system functioning and available.
About time! New Zealand has just brought in a policy of all people flying into the country from another country must undergo a period of 2 weeks of self-imposed isolation. They must stay home and keep away from other people. This 2 weeks will allow a possible coronavirus infection to run its course and for your immune system to kill the virus, (to a substantial extent at least).
This unfortunately can add a lot of time to international travel, but will definitely slow down disease spread and transmission. (It would mean that you fly to a country such as New Zealand, go into self-imposed isolation for 2 weeks, spend 2 weeks travelling, then return home and then spend a further 2 weeks in self-imposed isolation.) For a respiratory virus, such a strategy is about the only possible way of minimising spread.
In this world, disease travels fast. In my experience with the previous epidemic of swine flu, I had patients in my surgery with proven illness 24 hours before the news hit the media. They had left South America and flown directly to Brisbane on the day prior. Sick people can travel to anywhere on the planet within 24 hours.
If we had been properly serious about the Corona virus outbreak – travel restrictions should have been imposed much much quicker than they have been.
There are a few basic issues with air travel. Planes constantly cycle air from the atmosphere outside the plane to inside. Often this air is then passed through a HEPA filter (high efficiency particulate air) filter as well.
Search Results: re Plane Air Filtration
Ventilation can be expressed in "outside air changes/hour", or how often the total volume of air is replaced by new air. Airplanes have 10-15 changes/hour (every 4-6 minutes), which is 2-3 times more changes/hour than hospital delivery and operating rooms, and 4-15 times more than a typical building.
You can still increase the amount of clean fresh air to which you are exposed when flying by turning on the air vent above you to the on position and directing the air onto you. This minimises your exposure to the air which may be contaminated by the people around you.
Coronavirus is a respiratory virus. Seeing teams of germ warfare suited people spraying some odd substance in city streets makes for good TV, but has very little relevance to reality. Corona virus spreads by people coughing on each other/breathing on each other/or talking to each other predominately.
There is possibly a role for disinfection in environments such as cafes. In this environment, people may well have coughed/talked or breathed upon the table tops – contaminating the table tops. It makes sense to wipe down a table top in a cafe after people have left a table and before new people arrive at that table. It’s the sort of thing that should have been happening routinely for some time – for lots of reasons besides coronavirus. This sort of thing should be so routine that it should be barely noticeable or even newsworthy.
I watched on TV the other night as footballs at a football match were washed. It is of course possible to transmit infection by touching contaminated footballs. It is however 99% more likely to transmit infection through the in-your-face activities associated with sport. Also activity such as sharing water bottles, huddling in small groups, and sharing towels are probably far more dangerous. I’m not sure that washing footballs does much more than make for an interesting TV clip. It is unlikely to be useful and promoting such activities takes people’s attention away from avoiding many other far more risky activities.
Still, doing anything to protect you from infection is better than doing nothing.
Masks have a complex effect on infection. They really do not do what most people think, which is to filter viruses away from the person wearing the mask.
Usual rectangular facemasks: When a person coughs/breathes /talks wearing a mask – some big particles may embed on the mask internal lining – but most particles will just come out the sides of the mask.
If both people are wearing a mask – people can sit facing each other with more safety.
If both people are wearing a mask – people sitting beside each other have increased risk of infection exposure.
Some masks have a small central area which allows air to travel through for breathing purposes and have tighter seals to the sides of the mask to stop sideways spread of germs. It is unfortunately very difficult to filter the air down to a 1 to 5 µm range and still allow for easy breathing. The small particle size that needs to be filtered , demands using a very tight dense filter that is hard to breathe through.
Masks are very difficult to use. In using a mask in normal work situations – glasses often get fogged up making vision difficult. Also they can get very uncomfortable due to the pressure on the nose and ears. Someone can wear these masks relatively comfortably for the first 30 minutes, but as hour after hour goes by, they become increasingly uncomfortable and difficult to continue wearing.
Being isolated at home.
Don’t get too panicky about this in most of our cities. Woolworths and Coles will deliver food and supplies to your door – stuff that you may order through the Internet. Your pharmacy will probably deliver to your door as well, if you pay for your items and deliveries using a credit card. Toilet paper can be ordered just as much as any other foods. Having a credit card and access to the Internet is a good idea though. Have a look at the online ordering sites of Woolworths and Coles.
Update: I have heard that some woollies/Coles have frozen home delivery and pick up services and perhaps even cancelled pick up orders as well . If this affects you: check with your local supermarket. The situation is very variable between supermarkets.
So what are we likely to achieve
with our current disease control strategies?
Currently we are using public health strategies to control the spread of infection. We have seen this work extremely well for infections such as Ebola which spreads through contact predominately. We have seen very poor usefulness of these strategies for respiratory droplet spread infections.
The probability is we are spreading out the infection epidemic. Instead of one “ short” burst of infection and then the virus dying away – we’re going to have a long ongoing infection epidemic going on for some months before the rise in herd immunity/(other) makes the infection die off.
Vaccines take time to develop – and we’re not likely to see one pop-up to help us to control this infection spike. (There is also the bad example of the US accelerating the production of influenza vaccine for an anticipated influenza epidemic – and having widespread contamination of the flu vaccines with green monkey virus).
Anti-viral antibiotics take time to develop. They take even longer to get into production. There is currently an anti-viral antibiotic (remdesivir) available for coronavirus, (and strangely enough also effective against Ebola virus). However to push a drug through phase I and phase II trials takes up to 10 years. Unless the world is threatened with extinction, I don’t think it is likely that new drugs will be publicly available any time soon – except perhaps in an experimental and limited capacity as a part of the phase I trial.
Too many of the strategies we have implemented have been too slowly introduced. It will take 2 weeks to see the consequences resulting from a single infected person attending a football match and being embedded amidst many many other people. While we have banned gatherings of over 500 people, we need to be a bit more realistic about how we interact with others. A person attending a football match probably closely interacts with about a dozen people – most of whom are sitting in very close proximity to the individual. Whether there are 10 people or 500 or 50000 people attending a function – the number of people exposed by close contact is likely to be the same.
So what else are we likely to achieve with our current strategies?
If we reduce the intensity of the epidemic, we increase the capacity of our hospitals to cope with volumes of sick people. I am told that a state such as Queensland has approximately 20 ventilator beds available to support/ventilate people who may have a viral pneumonitis. If the epidemic took longer to burnout – we would have these 20 beds available to more people over time with the potential of saving more people over time.
We do get a lot of experience in dealing with the next big one. If there is a Zombie Virus epidemic , we will definitely be a lot more prepared than we have been for this corona virus epidemic outbreak.
We will certainly have learned more about what restrictions need to be in place to stop infections from spreading. Managing disease can be difficult. But managing the social strategies to control the spread of disease can be just as difficult as the actual medicine.
My friends tell me that the media and the bureaucracy have adopted some definitions of illness which are not intuitive. Currently a case of coronavirus is defined as someone who has symptoms and who tests positive for the virus. (Except where the media gets hold of the report).
So if you have no symptoms and have a positive test for of the virus you are not recorded as being a Corona virus victim.
This has the effect of reducing the number of people who apparently have caught the coronavirus infection. This has the effect of increasing the number of people who seem to have died from the coronavirus infection. This distorted statistic has the effect of making it look like the government’s policies are working and that less people are coming down with the coronavirus – and that the infection must be a nasty one because so many people are dying.
I have seen media reports of between 1/20 to 1/ 50 people dying of coronavirus. But this may not be a true reflection of circumstances. It is possible there are many more victims of coronavirus who have such a mild infection that they are not recognised as having coronavirus infection.
My own personal experience with influenza virus is that some of the people infected with the virus can be very mildly infected indeed. In some years it can be very difficult to identify flu virus infections in individuals because they are so mild that they do not look like the “classical” influenza case.
The corona virus : it is unknown how much variation in illness severity occurs.
How will the viral epidemic end?
The typical end of a viral epidemic comes when the herd immunity is such that the virus finds that most potential victims are immune to infection and the virus is unable to find new victims to spread to. So many people in essence are immune to the illness that the person suffering from acute viral infection finds that most people with whom they have contact cannot catch the virus as they are immune to it.
There are other methods by which viral epidemics end.
Vaccination: not going to happen
Genetic Drift: the classical example is the disappearance of Yersinia pestis infection on our planet. (This is the agent of the Black Death). We believe that evolution trained the bacteria to become less virulent. The original bacterial agents were so deadly that they killed all their hosts readily and consequently exterminated themselves as well. Surviving bacteria were the ones that were much slower and much less deadly – and consequently much more likely to hang around longer and to transmit themselves.
Nucleotide typing of DNA/RNA is a well-established science. It is also a routine and readily available science, able to be undertaken with minimal financial cost and financial investment. I currently have seen no reports that we may be typing successive viral isolations to see whether the virus is moving away from the Chinese nucleotide type. For a complex virus like Corona, genetic drift is a realistic possibility.
One of the biggest impacts of the Corona virus epidemic is the effect on how we live and work. At this point in time we are resisting the push to close schools. Unfortunately schools are a major infection risk because so many people come from so many places to mix with so many other people in a confined space. In essence , the school environment almost guarantees infection transmission.
I think this decision is the correct one for the type of illness which we are currently facing – namely the coronavirus. Although there is a substantial risk of infection, the risk of death is much higher in the over 70 age-group. So most children who catch coronavirus will recover. Mortality is likely to be very low. The problem with children is the issue of cross transmission of infections to families and to other families.
If the kids go to school: infection may spread.
If the kids stay home: carers change their behaviour and perhaps increased mixing and spread of the virus can occur as well.
If the infection were facing were far more serious, for example such as an Ebola outbreak, I think that schooling via the TV may well be the new reality of the 21st century. A minimum of 12 channels of pay-TV could deliver education to every schoolchild essentially till the end of high school. Whether this is an appropriate learning environment which encourages education is arguable. Whether students are able to teach themselves using a system like this which avoids interaction and social incentivisation to study is a different issue – but not one for us today.
If the Infection we are facing was a respiratory infection spread variant of Ebola Virus with a death rate of 25-90%, we would have to grade our infection control strategies as “FAIL”. Luckily for us, Corona Virus is no where near as deadly.
Isolation is the single most useful strategy for reducing the spread of infection. However , does what we are saying that we should do - make sense? Currently the proposal is that every person travelling internationally should self-isolate for a period of 2 weeks. Every person who is infected with the virus should self-isolate for a period of 2 weeks. Significant Contacts of known cases should self-isolate for 2 weeks. (Current thinking suggests that it takes approximately 15 minutes of close contact to generate a new case of coronavirus Infection.
Unfortunately, isolation for 2 weeks creates social and economic devastation. Most people do not have the economic resources to function in isolation without income for a period of 2 weeks.
So how essential is it to self-isolate for 2 weeks?
2 weeks of self-isolation is important in a world where testing does not exist. We are diagnosing the virus by using PCR amplification technology, not by serology. PCR tests detect the virus by testing for whether the antigen (actual bits of the virus) is present. Serology tests rely on the development of antibodies – which typically develop at 2 weeks after an infection. It therefore becomes obvious that by the use of PCR testing, the need to self-isolate for 2 weeks can probably be reduced to a period of approximately one week.
It suggests that people who self-isolate for 6 days and then undertake a PCR detection test for coronavirus can know their infected status – either positive or negative for the coronavirus – at the 7 day mark (one week), which is much sooner than the 2 week mark.
In short, isolation times can be reduced and economic and social impacts can be reduced as well. The problem of course comes as to whether the person may have infected other family members – requiring extension of the isolation period not for the sake of the first isolated potentially affected individual – but for the sake of evaluating potentially 2nd or infected family members.
This type of system is my opinion only. It is not what we are currently recommending to do. It does have some reasoning behind it as a method of guiding our choices by the use of reason. It does however depend on the availability of coronavirus PCR testing and on the quick availability of results.
The other issue relating to economic impact is how everyone insists that the government should help. The government sector of our whole economy is approximately 10% of the economy. This means that 90% of the people and resources in our community work outside of the government – the private sector.
So this means that while the government can do some things to assist us, the government actually has only about 10% of the resources available as the private sector community. The government also has structural responsibilities for its 10% resources – namely pensions, education, health, defence. In short it has very little unallocated money to spend on disaster recovery and to assist with the economic impact arising from self-isolation.
So a sensible attitude to self-isolation is critical if you want to get more bang for our buck.
Touching other people/cleaning up.
The current recommendation is that we do not shake hands with other people. The replacement activity is either an elbow bump or a knuckle touch. Overall I think this is a good change to undertake. My personal observations suggest that someone of the order of 70% of men who attend a public toilet do not wash their hands after the event. Probably about time we made some changes to our social repertoire – for our own good.
There is a lot of emphasis on cleaning up surfaces. Droplets from the airwaves range from about .6 to 1000 µm. Big droplets land quickly. Small droplets are essentially permanently airborne. Hence if you sit at a table talking to someone, it is thought that the table will be covered with many small particles. This is- sort of -true. People who sit and talk to each other for a while at a table, perhaps should indeed clean down the table to remove potential viral contamination of the surface – and to minimise the chance that fingers touching the surface may then touch your mouth through the instrument of a pen, food implements and even glasses.
However , the situation can be fairly complicated. Let’s look at the concept of humidity. Many parts of Australia have an arid or dry climate. Particles that are breathed out will evaporate quickly especially in many parts of inland Australia and in the southern states of Australia. Evaporation will tend to be much reduced in the coastal tropical zones (typically with high humidity).
So in humid climates particles from our airways (that are breathed out/coughed out/talked out) stay heavier for longer and tend to fall down faster, contaminating surfaces such as table tops.
Surface decontamination is therefore much more important in humid climates where people stay in close proximity to a surface such as a table top for significant periods of time.
But here is where the situation gets much more complex. Drying while it helps keep particles airborne longer also is likely to damage the viral structure. Particles that dry out, fall apart and lose their infectivity. Humid zones tend to be more to the northern coastal areas of the country. Here while the particles persist for long times (not drying out) – there is generally a lot more UV – which is extremely damaging to most biological agents such as viruses.
Probably one issue that many people have never considered is to what extent their income will continue while they are self-isolating. People on Casual Awards can expect no income. If someone is self-isolating, they technically still have a job. Therefore they will not be eligible for benefits , such as through Centrelink. Interestingly, many Queensland government employees such as cleaners in schools for example work on casual awards.
All the Pathology Companies in Brisbane offer a CoVid testing service :
Sullivan and Nicolaides Pathology.
Information is available online. It will makes things a lot easier for you to get a vaccine testing form from your doctor.
And as General Medical Advice:
Careful who you party with . CoVid may end up be in the least of your problems.
ToombulDoc.com Go To Home Page ToombulDoc.com
Dr Andrew Pluta
UMC North Lakes Doctors
26 Torres Crescent, North Lakes
P: 3482 3123
Short Version ( Dr Pluta's Story) .
Long Version (Dr Pluta's Story).