COVID-19 Coronavirus (and Monkeypox) UK and World News Update Friday 29th July 2022

World: 580,003,877 reported cases and 6,415,501 losses of life.

"Many people now are boasting about the fact "I've had this four times". I wouldn't like to have COVID19 four times. And I do think there's some evidence to suggest that sequential COVID19 infections do result in higher risk of long term Long COVID, or cardiovascular or neurologic complications. You don't want to get this disease once if you can avoid it, and you don't want to get it four times for sure.

Dr Mike Ryan, Executive Director of WHO Health Emergencies Programme.

"The risk of monkeypox to the public remains low in the UK.

If you develop symptoms, stay at home and call 111 or a sexual health clinic.

The NHS is vaccinating at-risk groups and thousands more will be invited shortly. If eligible, please come forward when contacted."

Message there from the UK Government.

UK COVID hospital admissions are down - everyone together "Hurrah!"

The lovely COVID Actuaries have summarised neatly for us:

"Hospital admissions with COVID are now falling rapidly across England.

7-day average is down 19% week-on-week. Implied R estimate is below 0.9.

Regionally, falls of between 14% (East and NW) and 25% (London).

Bed occupancy with COVID is also falling, down 15% week-on-week."

Nice...

COVID-19 Coronavirus UK and World News Update 22nd July 2022

UK: 23,212,565 reported cases and 182,727 losses of life (within 28 days of a positive test) as of July 15th. 

World: 573,017,988 reported cases and 6,398,940 losses of life.

"The UK Commission on Covid Commemoration has been established to secure a broad consensus from across the whole of the United Kingdom on how we commemorate the COVID-19 pandemic and mark this distinctive period in our history at a national and community level. The Commission is expected to report to the Prime Minister [whoever that may be] by the end of March 2023."

COVID-19 Coronavirus UK and World News Update Friday 15th July 2022

UK COVID Statistics:
In England from 2nd to 8th July 691 people died within 28 days of a positive coronavirus test. This shows an increase of 32.6% compared to the previous 7 days.
In Scotland 4th July to 10th July there were 83 deaths involving COVID-19 (22 more than the previous week). The provisional total number of all deaths registered in Scotland in week 27 was 1,089 (62 or 6% above the 5-year average).
In Wales and Northern Ireland I cannot find any figures more recent than weeks old, so we'll leave that. They're basically using the ONS random sampling rather than stats from testing, which frankly is probably a lot closer to the truth now that testing is not free or easily accessed. 

Rep. Of Ireland Wednesday 13th July: 1,628,745 cases (+1,207) and 7,571 losses of life (+35).

World: 565,855,152 reported cases and 6,383,315 losses of life.

I wrote most of this on my phone on a train again, and I've had another incredibly busy week, so sorry if I missed anything! 

ONS (Office for National Statistics) figures show that over 200,000 people in the UK have now had their life cut short by COVID. 

The latest data from the ONS random sampling (COVID19 Infection Survey) shows infection rates have continued to climb across all four UK countries. For the week ending 6th July for England, Wales and Northern Ireland, and 7th July  for Scotland:
England, estimate 2,873,600, equating to 5.27% of the population, or around 1 in 19 people.
Wales, estimate 183,500, equating to 6.04% of the population, or around 1 in 17 people.
Northern Ireland, estimate 107,600, equating to 5.86% of the population, or around 1 in 17 people.
Scotland, estimate 334,000, equating to 6.34% of the population, or around 1 in 16 people.

We have infection levels higher than the 2020 Alpha variant peak, but the good news is that the number of people who die is way way lower. 

COVID-19 Coronavirus UK and World News Update 8th July 2022

UK COVID Statistics on 6th July according to Medriva:
Cases: 22,883,995 (+142,930 over the previous 5 days, average 28,586 per day)
Losses of Life: 180,718 (+301 over previous 5 days, average 60 per day)

Rep. Of Ireland: 1,614,631 cases and 7,503 losses of life to 7th July.

World: 558,995,701 reported cases and 6,369,701 losses of life.

"Surveillance indicators suggest that, at a national level, COVID-19 activity has increased in several indicators in week 26 of 2022.
The number of acute respiratory infection incidents (suspected outbreaks) increased in England to 504 in week 26, compared to 382 in the previous week."
UK Government
Yes indeedy, COVID numbers continue to rise, and the number of people in hospital is now almost at the level of the last peak in April. English hospital admissions are still highest in those aged over 85, and now highest in the West Midlands.

The COVID Actuaries:
"Hospital admissions with COVID are still rising sharply across England. 7-day average is up 31% week-on-week. All regions seeing fairly consistent growth. Implied R estimate still at around 1.17.
London has now equalled the March peak.
Bed occupancy with COVID is above 12,000."
Yowch.

UK: 22,741,065 reported cases and 180,417 losses of life. 

World: 552,972,953 reported cases and 6,358,508 losses of life.

You are going to have to bear with me a bit, because I'm still writing on my phone and not at home at the moment. Give me a couple of weeks and hopefully we'll be back to normal. 

Latest English hospital admissions are still rising fast - on Wednesday we were up 37% week-on-week, approaching 1,200. 

Bed occupancy with COVID is up by 35% to 8,120. Yowch. 

The experts are beginning to twitch a little at the thought of next Winter - I forsee more jabs this Autumn...

Some English hospital trusts are bringing back a requirement to wear masks. I reported back on 9th June that hospital-acquired illness was rising even faster than community transmission, and I suspect that is still the case. You are far more likely to pass on COVID to elderly sick Gladys in the bed next to the patient you are visiting, than to someone you pass in the supermarket, and Gladys is more likely to die as a result. Hospitals are full of sick and vulnerable people, and people who are interacting with sick and vulnerable people. It's common sense to try to protect them. 

UK GPs are threatening strike action over a new contract that forces them to work Saturdays and evenings.

Just hours after the above story, the BBC was reporting that within a decade around 1/4 of GP positions in England are likely to become vacant.

Well, at the moment you have more chance of being accepted onto UK medical courses if you were born into wealth than any other quality. We actually don't need doctors who can ride a pony. We need doctors who are keen and able - however much wealth their parents earned or inherited. Remove the glass ceiling, support tuition financially and properly invest in our future medics. Or keep dragging them in from countries which are desperately in need of doctors... 

The Zoe app. may have lost it's UK Government funding, but they are still keeping an eye on UK infection rates, and spoiler, its bad news. The ONS random sampling backs that up with more scientific data. 1,829,100 people are estimated to have had COVID in the week ending 23th June. 

It's become apparent that while married Boris Johnson (BJ) was working at the foreign office, he was caught while at work, receiving an oral massage (BJ) from a young lady who went on to get a £100,000 job and later become his new wife. The word is that The Times removed the article due to pressure from within Downing Street. I'll bet. Carrie won't have wanted that one leaked. 

I guess Boris would say to move on, it was a work event and he was only there for 10 minutes.  

The US FDA panel has recommended changing Covid shots to specifically fight omicron this Autumn, and has asked vaccine manufacturers to update vaccines accordingly and begin trials.  

Possibly partly in response to the FDA Panel recommendations, the US Government has signed a fresh contract with Pfizer worth $3.2 billion. 

Omicron BA.5 is now taking over in several areas, including the UK and USA. Sheer volume of infections means although vaccines are still keeping most people out of hospitals, numbers are going up and the death rate is also rising. Past infection is little protection against reinfection from BA.5 and in heavily vaccinated Portugal, hospitals are struggling. 

Monkeypox continues to spread, with over 1000 cases in the UK now. If you have a strange rash, don't go to a sex spa, instead check with your doctor. It is still mainly spreading among people having intimate contact. Sexual partners and households of people infected. 

The World Health Organisation have not yet declared Monkeypox a Public Health Emergency of International Concern, but they are likely to - becauaw once it spreads to local wildlife its incredibly hard to eradicate. Some experts are now asking if we are moving too slowly with this one and failing to use lessons learned from COVID. 

USA Chief Medical Advisor Dr Anthony Fauci has said he's now taking a second course of antiviral Paxlovid, after suffering what's being called "Paxlovid rebound". If you recall, this is where the antiviral doesn't actually help enough for the body to fully beat COVID, so after the course of treatment ends, symptoms return. People generally don't become seriously ill when this occurs, and a second course of antiviral should be enough to do the trick. Mr Fauci is 81. 

Canadian researchers think they’ve found a key clue as to what causes Long COVID. A team of researchers in Ontario focusing on breathing problems have discovered a microscopic abnormality in the way oxygen moves from the lungs to the blood vessels. They have been following 1w hospitalised and 22 non-hospitalised patients for 9 months to see why they arw exhausted and breaghless. That esearch is continuing.  

You more vulnerable people, I may have lost my mum, but I'm never going to forget the rest of you. Those of you who cannot be vaccinated for medical reasons, or anyone who will always be especially vulnerable to COVID - you still matter. You still deserve our protection, and our care. Don't be scared to ask for space, or wear a mask, or whatever makes you feel safer.  

No world numbers because I simply don't have time today. Sorry. Hopefully they will be back next week, but in the meantime you can find them all at Worldometer or John's Hopkins. They are all people... 

Back next Friday, remember to treat yourself and be kind. You deserve it. Give yourself a pat on the back for all that you have achieved over the past week, and don't ever think there was nothing - you have always done something that was difficult for you. Credit yourself. 

Sources: 

https://www.worldometers.info/coronavirus/

https://coronavirus.data.gov.uk/

https://ourworldindata.org/covid-vaccinations

https://www.gov.uk/coronavirus

https://t.co/0lavAOaeYK

https://twitter.com/COVID19actuary/status/1542165358609588235?t=ZiI6KDJwMtXOqbs8OqhHUw&s=19

https://news.upday.com/uk/call-for-autumn-boosters-as-another-covid-wave-hits-britain-see-the-hotspots/

https://www.independent.co.uk/news/health/coronavirus-covid-19-latest-omicron-vaccine-news-b2110061.html

https://twitter.com/Rebeccasmt/status/1542075562293870593?t=poncLatBpXeFOsSUaZXnhg&s=19

https://twitter.com/AdeleGroyer/status/1534817326637502464?t=sf_3iWGgNH6wZbZwqrT3lg&s=19

Doctors

https://twitter.com/i/events/1542095684794474496?t=MnQV2W8DFK-JjCoPvOTnHQ&s=09

https://twitter.com/BBCHughPym/status/1542393232713203715?t=Yg_L2eCEkXj7m4pnerYpRw&s=19

https://inews.co.uk/news/science/covid-case-surging-300000-day-warning-autumn-wave-worse-1713005

https://news.yahoo.com/pfizer-signs-3-2-billion-210047641.html

https://www.cnbc.com/2022/06/28/fda-panel-recommends-changing-covid-shots-to-fight-omicron-this-fall-.html

https://twitter.com/DrEricDing/status/1541418780210995200?t=OG8d4mhZqmXJt9GCMIidgg&s=09

And more BA.5

https://twitter.com/DrEricDing/status/1542115126215598080?t=Uf12XbvKfO9vaDNZLYAyUw&s=19

https://news.sky.com/story/monkeypox-cases-in-the-uk-rise-to-more-than-1000-latest-figures-show-12641999

https://twitter.com/zeynep/status/1542150260918816772?t=fj7zYrnXhV-8Q7E8i29ntA&s=19

https://twitter.com/T_Inglesby/status/1542220342072049666?t=fM4ViM46_DLQid4ZedV1WQ&s=19

https://twitter.com/i/events/1541846548845367302?t=f0RzC3LcVLBVRXXr1XTjeA&s=09

https://www.dnaindia.com/health/report-massive-breakthrough-as-cancer-disappears-in-every-patient-in-drug-trial-dostarlimab-2958614

So... COVID cases are rising still in all 4 UK nations - we are up around 23% week on week according to random sampling (so it's pretty accurate). The latest ONS figures suggest that it the week ending 18th June, 1.7m people across the UK had COVID.

Hospitalisations have a slight rise, the unfortunate North East, and people aged over 85, still struggling the most.

The World Health Organisation convened a special meeting yesterday to decide if the Monkeypox outbreak was a PHEIC - Public Health Emergency of I ternational Concern. No definite answer on that last I looked.
We now have more than 3,200 confirmed cases in at least 44 countries where monkeypox is not usually found among the wild animal population. One person has died.

On Wednesday the UK Health Security Agency declared a National Incident because of Polio.
The UK routinely vaccinated against Polio using live (but inactivated) vaccine until around 2004, when it was changed for an inert (dead) version. Some countries still use live vaccine, which can pass through the person and into their poop still alive - so it is normal to detect it in the UK sewage a few times each year. In this case a live vaccine derived Polio has escaped and linked strains have been detected in samples from different months, so it seems to have passed from person to person.
If you were vaccinated then you are well protected, but we actually have a significant number among us who have not received the vaccination - especially in parts of London.
Polio can be nasty. Check that your kids are up to date with their jabs - it'll be in their red book. If you didn't grow up in the UK, check that you were vaccinated against Polio as a child - and if not, you can contact your doctor to arrange it.

There were also reports on Wednesday of a person contracting Cholera in Spain - that is NOT true. It was a confused message and although it's a very similar condition, it was NOT Cholera. *Phew*

The first court case of someone dying as a result of AstraZeneca vaccination has received a payout. A gentleman from Cumbia died in May 2021, and his fiance has received £120,000. Obviously any sum will never be enough to replace him.

Sperm count drops by about 20% after vaccination and restores to previous levels within around 6 months. No effect on motility or volume. Sprem count often drops with all kinds of illness (your body is busy doing other stuff), including COVID infection, so this wasn't a surprise, but should reassure potential parents (there will still be millions for most people, and you only really need 1).

Moderna have partnered up with the UK Government to build a state-of-the-art manufacturing and research centre in the UK. Moderna's new Omicron-specific vaccine has performed very well in early trials, so this is a very hopeful and progressive move.

Variant watch - worldwide Omicron BA.4 and BA.5 have now taken over as the most common strains. They lead the way in the UK and are quickly taking over in the USA. Thankfully there's still no evidence or suspicion that they are more dangerous or deadly.

A new study has confirmed that while PCR testing is the best way to tell if you have COVID (because it's very sensitive), rapid testing such as lateral flow is the best way to determine if you are actually contagious and breathing out virus (aside from hugging lots of people and waiting a few days).

Trump Of The Day:
I've almost missed Trump. Almost. The January 6th hearing has released lots of documents, including documents proving that the US decided to go for  herd immunity (just like the UK) without knowing that herd immunity was possible (it isn't).

If you have a child under age 10 with a medical condition or allergies then while stocks last you can get free medicalertuk membership and an ID Tag, thanks to sponsorship by the Lions Club. I'll add more details in the comments.

Fertility rates are dropping - and while we often mention Japan when we talk about this, theirs isn't actually the lowest right now. Taiwan is averaging 1.1 live births per female, far far below the 2.1 needed to keep the population at the current level. It is dropping all over Europe and the Western world. Really the only countries where it is above 2.1 are those where infant mortality is very high, life expectancy very low, and there's nothing much else to do ever (no telly, no contraception, no universal education, no money).

A new study published yesterday has worked out how many lives were saved by COVID vaccinations. The figure is 20million. That is a huge number of family and friends who will never know how fortunate they are. Hug your loved ones - let them know you are glad they are with you.

I will write some of this up more thoroughly in a few days time, and I will be back with the next new report next Friday. Have the best weekend you can - and have that treat. You earned it.

Stay Sensible, Play Outdoors, Save The NHS.

Medicalertuk 

MedicAlert IDs, worn on pulse points, can be life-saving in an emergency or an accident for children with medical conditions. For the rest of the time, the peace of mind they provide can give your child the confidence to be more active physically and join in socially. Family members also benefit from knowing that their loved ones are safe. That is why the NHS recommends them.
The Early Start Programme provides free MedicAlert membership until your child’s 10th birthday, along with a free medical ID.
Funded by Lions Clubs, the scheme is currently open for applications. There are limited spaces available based on current funding, so don't delay
https://www.medicalert.org.uk/early-start/

Sources:

https://twitter.com/BBCHughPym/status/1540292380691251201?s=19
Weekly COVID statistics
https://twitter.com/UKHSA/status/1539981805360746497?t=kDZVuCJ54wFVGRPzFzVR5w&s=19

https://news.sky.com/story/covid-infections-rise-in-all-four-uk-nations-as-around-17-million-had-virus-last-week-12639721

NHS hospital stats - monthly
https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-hospit0al-activity/

https://www.reuters.com/business/healthcare-pharmaceuticals/monkeypox-case-count-rises-more-than-3200-globally-who-2022-06-23/
https://twitter.com/WHOEMRO/status/1540002803690737664?t=XIZIqmOKL4wjrQqE32iOBQ&s=19
https://twitter.com/Mahesh_Devnani/status/1540036638763409410?t=drxm_j5ZlC-dSSsCTBAP3Q&s=19
https://www.who.int/news-room/newsletters

Boghuma
https://twitter.com/DrNeilStone/status/1540075585996787718?t=SBfKe4EUEDmgzZJ9Mwo4hg&s=19

Monkeypox updates
https://twitter.com/UKHSA/status/1538857644215214080?t=9Jkr69wgFN4V2paA20vr7Q&s=19

https://twitter.com/michaelmina_lab/status/1537994987706589187?t=XBf4hZe-CuxtoZA6_ivXzA&s=19

WHO Vaccine equity for Africa
https://twitter.com/WHO/status/1539910842807750656?t=6av1c2JBDhqaDFZsrtWdrg&s=19

Monkeypox vaccine UK
https://news.sky.com/story/monkeypox-gay-and-bisexual-men-at-higher-risk-of-exposure-to-be-offered-vaccines-12637989

https://www.bbc.co.uk/news/uk-scotland-61898853

https://twitter.com/UKHSA/status/1539606492386574336?t=ZraYzDdoaN9EBST_TrsSbQ&s=19 https://news.sky.com/story/traces-of-polio-virus-found-in-london-sewage-as-health-officials-declare-national-incident-12638443
https://news.sky.com/story/polio-detection-of-virus-in-london-is-a-major-blow-but-it-has-little-chance-of-spreading-widely-12638525

https://news.yahoo.com/spain-detects-first-local-infection-150135304.html

AstraZeneca death
https://www.bbc.co.uk/news/uk-england-tyne-61885899

Sperm
https://www.news-medical.net/news/20220621/The-effect-of-the-COVID-19-BNT162b2-vaccine-on-semen-parameters-among-semen-donors.aspx
https://onlinelibrary.wiley.com/doi/10.1111/andr.13209

https://t.co/ln5Obu0xKj https://t.co/BUxGUND2zy
https://twitter.com/DHSCgovuk/status/1539496682500628481?t=0eJv6Or3JJRsa6AliPDgNg&s=19

https://twitter.com/DHSCgovuk/status/1539639352992550914?t=dK3fEfjxnY3r7l64a8b0AA&s=19

And this is why https://news.google.com/s/CBIwlZOS7Z0B?sceid=GB:en&sceid=GB:en&r=0&oc=1
"Lasting protection of omicron-specific Covid vaccine could pave way for annual boosters" https://twitter.com/i/events/1539679217230675969?t=XtzcNycvi3T6cQ3UntpC1g&s=09
Moderna's Omicron-specific vaccine performed well in trials

https://twitter.com/Laurie_Garrett/status/1540007730173329414?t=ljDZ3kRqMkT3gAmZOoGYKQ&s=19

https://twitter.com/Laurie_Garrett/status/1539308336188796928?t=WUTbYMROHMd6npVeO4BBBQ&s=19
Never had COVID ? Old news
https://www.bloomberg.com/news/articles/2022-03-30/never-had-covid-you-may-hold-key-to-beating-the-virus#xj4y7vzkg

https://twitter.com/opinion/status/1539844737443762181?t=XGHB7vVQP4FXvpibh7tpoA&s=19

https://twitter.com/Laurie_Garrett/status/1539968277329354752?t=3EFpd9868JjY7jtk8frWDw&s=19

https://news.sky.com/story/covid-19-jab-saved-20-million-lives-in-its-first-year-study-suggests-12639430
https://news.sky.com/story/covid-19-jab-saved-20-million-lives-in-its-first-year-study-suggests-12639430

Important news for people with MS.
https://twitter.com/florian_krammer/status/1540008771145109505?t=0Eb09m1QrrKl05jDQsun5w&s=19

COVID-19 Coronavirus UK and World News Update 21st June 2022

UK COVID Statistics according to Medriva: 

Today:
Cases: 22,525,358 (+16,430)
Losses of Life: 179,706 (+105)
Yesterday:
Cases: 22,508,928 (+36,425)
Losses of Life: 179,601 (+64)
(Includes weekend backlog - I'm guessing cases on Monday and losses of life on Tuesday)

UK Gov Dashboard:
Total  losses of life with COVID listed as a cause on the Death Certificate up to June 10th: 196,977

Rep. Of Ireland: 1,578,284 cases and 7,409 losses of life up to yesterday, 20th June. 

World: 545,221,827 reported cases and 6,342,385 losses of life.

Sorry I'm late - I had to take the kitten for her jabs! 

“There is now a burning imperative to forge an Army capable of fighting alongside our allies and defeating Russia in battle... We are the generation that must prepare the Army to fight in Europe once again.”
General Sir Patrick Sanders, new head of the British Army. Not actually saying we are going to go to war against Russia, thankfully, but clearly expressing the fact he believes there may be some potential.

Over 125 million COVID-19 vaccines have now been administered in England alone. If you have been invited for any and not yet had them, you will always be able to book in or go to a walk-in centre (if you are over 18) - it isn't too late.

COVID-19 Coronavirus UK and World News Update Friday 17th June 2022

UK COVID Statistics:

Total Cases 

England 18,908,381

Wales 875,497

Scotland 2,449,840

Northern Ireland 713,294

Lost their life within 28 days of a positive test:

England 156,186

Wales 7,517

Scotland 12,389

Northern Ireland 3,445

Admitted to hospital with COVID in the 7 days to Friday 10th June: 4,780

In hospital on Monday 13th June: 5,918

Rep. Of Ireland: 1,578,284 cases and 7,409 losses of life (not yet reported today).

World: 543,316,589 reported cases and 6,338,474 losses of life.

The ONS UK Random sampling (week ending 11/12 June) shows an increase, and it's big - cases are up 43% from last week.

"The latest data from our COVID19 Infection Survey show infection rates increased in all four UK countries, likely due to continued growth of Omicron BA.4 and BA.5 variants."

(These are the variants which have battered South Africa and they are more transmissible than any others to date.)

"COVID19 infection rates increased in all English regions, except for the North East where the trend was uncertain."

Infections have increased across all age groups.

Hospitalisations are still highest in the North East (the North East has maintained a high level of hospital admissions pretty much throughout the last year, so they've suffered enough, they really don't need any more).

"COVID19 hospital admission rates increased in all age groups, remaining highest in those aged 85 years and over."

It isn't all such bad news. If you want reassurance about how well vaccinations are working at preventing severe COVID:

"Our COVID19 insights interaction tool shows infection levels are at similar levels to the Alpha wave peak in January 2021. However, during this time hospitalisations were 6 times higher and deaths involving COVID19 were over 32 times higher."

The Silent Brother is a brand new release from author Simon Van Der Velde, who sent me a copy for review. I'm glad he did, because it's been an excellent read, and actually a book which has stayed with me, as it has a depth and relevance I couldn't have seen coming, and actually a lighter ending which doesn't leave you feeling demoralised. 

Subtitled as a Literary Thriller, The Silent Brother is a life story for one fictional person, Tommy, and by the end of the book we've grown up with him, and really do know him incredibly well. 

We begin with 5 year old Tommy living with his alcohol-loving Mum and her boyfriend, Daryl. Daryl is a hard man for any child to live with, aggressive, jealous, violent and a heavy drinker. I feel that he's possibly very young to be raising children and it's not where he wants to be. 

Simon absolutely nails my childhood in the 70's. Looking back now, it really was rough, so I was surprised to discover that actually The Silent Brother was set in the late 80's/early 90's. His account hit so many buttons, I'd never be able to explain it in a book review. I'm a 50 year old woman who has spent the last 3 weeks revisiting my childhood and teenage years, and the relationships I had with the people around me. 
The scene with his brother Benjy hiding at the back of a cupboard, in the space between the back board and the wall, I've been there. The fear of your adults, and the crap TV. The acceptance of physical punishment being "a good hiding", as if any "good" could ever come of it. I was hurled back 40 years to places I'd forgotten existed, and I closed the book being grateful I'd always chosen the less destructive path, glad for what I have and also a little sad, as I remember the not-so-great times. It's a sad jolt back to Earth to think that 20 years later time had stood still, and to realise that for some now, it's still just the same. Anyway, I digress...

Tommy becomes involved in crime early on in life, and in the book, and you can clearly see that he is a product of the events that occurred in his life, the people around him, and chance timing. What you realise is just how easily someone's life path can change. A single brief exchange can alter everything.