Calgarypuck Forums - The Unofficial Calgary Flames Fan Community

Go Back   Calgarypuck Forums - The Unofficial Calgary Flames Fan Community > Event Forums > COVID-19 Forum
Ivrnet

Reply
 
Thread Tools Search this Thread
Old 08-31-2020, 10:54 AM   #1
Azure
Had an idea!
 
Azure's Avatar
 
Join Date: Oct 2005
Exp:
Default Your Coronavirus Test Is Positive. Maybe It Shouldn’t Be.

If this turns out to be in anyway even remotely true, the riots that we are seeing now will pale in comparison to what will happen.

Heads better roll.

Quote:
The most widely used diagnostic test for the new coronavirus, called a PCR test, provides a simple yes-no answer to the question of whether a patient is infected.

But similar PCR tests for other viruses do offer some sense of how contagious an infected patient may be: The results may include a rough estimate of the amount of virus in the patient’s body.

“We’ve been using one type of data for everything, and that is just plus or minus — that’s all,” Dr. Mina said. “We’re using that for clinical diagnostics, for public health, for policy decision-making.”

But yes-no isn’t good enough, he added. It’s the amount of virus that should dictate the infected patient’s next steps. “It’s really irresponsible, I think, to forgo the recognition that this is a quantitative issue,” Dr. Mina said.

The PCR test amplifies genetic matter from the virus in cycles; the fewer cycles required, the greater the amount of virus, or viral load, in the sample. The greater the viral load, the more likely the patient is to be contagious.

This number of amplification cycles needed to find the virus, called the cycle threshold, is never included in the results sent to doctors and coronavirus patients, although it could tell them how infectious the patients are.

In three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, up to 90 percent of people testing positive carried barely any virus, a review by The Times found.

On Thursday, the United States recorded 45,604 new coronavirus cases, according to a database maintained by The Times. If the rates of contagiousness in Massachusetts and New York were to apply nationwide, then perhaps only 4,500 of those people may actually need to isolate and submit to contact tracing.

One solution would be to adjust the cycle threshold used now to decide that a patient is infected. Most tests set the limit at 40, a few at 37. This means that you are positive for the coronavirus if the test process required up to 40 cycles, or 37, to detect the virus.

Tests with thresholds so high may detect not just live virus but also genetic fragments, leftovers from infection that pose no particular risk — akin to finding a hair in a room long after a person has left, Dr. Mina said.

Any test with a cycle threshold above 35 is too sensitive, agreed Juliet Morrison, a virologist at the University of California, Riverside. “I’m shocked that people would think that 40 could represent a positive,” she said.

A more reasonable cutoff would be 30 to 35, she added. Dr. Mina said he would set the figure at 30, or even less. Those changes would mean the amount of genetic material in a patient’s sample would have to be 100-fold to 1,000-fold that of the current standard for the test to return a positive result — at least, one worth acting on.
https://www.nytimes.com/2020/08/29/h...s-testing.html
Azure is offline   Reply With Quote
Old 08-31-2020, 11:17 AM   #2
pseudoreality
Scoring Winger
 
pseudoreality's Avatar
 
Join Date: Jul 2012
Exp:
Default

I don't think anyone claimed the test was perfect. People could have low viral counts at the beginning, end, or even throughout the infection. People with low viral counts could still be contagious, even if it is reduced. People can also shed dead virus for a long time after an infection. However, my understanding from chatting with people running the PCR tests is the viral load estimates have a significant amount of uncertainty with them and not really useful. They talk a little about "signal strength", but really, it is an on/off thing and that's why it is reported that way.
pseudoreality is offline   Reply With Quote
The Following 6 Users Say Thank You to pseudoreality For This Useful Post:
Old 08-31-2020, 11:32 AM   #3
Azure
Had an idea!
 
Azure's Avatar
 
Join Date: Oct 2005
Exp:
Default

Quote:
Originally Posted by pseudoreality View Post
I don't think anyone claimed the test was perfect. People could have low viral counts at the beginning, end, or even throughout the infection. People with low viral counts could still be contagious, even if it is reduced. People can also shed dead virus for a long time after an infection. However, my understanding from chatting with people running the PCR tests is the viral load estimates have a significant amount of uncertainty with them and not really useful. They talk a little about "signal strength", but really, it is an on/off thing and that's why it is reported that way.
The results of the test are presented as the complete truth insofar as that they are binding to the individual. Positive? Isolate. Negative? Good to go. The government is going so far as to fine people now depending on the results of the 'test.'

You are not allowed to go back and retest. Your test results do not say that at a threshold of 30 the test was negative, but at 40 it was positive.

If a threshold of 40 is being used, but research shows that 90% of the people that tested positive at that threshold did not have a viral load that would be considered contagious, heads better roll.

The fact that this isn't getting massive airtime is unreal.
Azure is offline   Reply With Quote
Old 08-31-2020, 11:44 AM   #4
PepsiFree
Participant
Participant
 
PepsiFree's Avatar
 
Join Date: Jul 2015
Exp:
Default

The idea that heads should roll or that the reaction to this should make the current riots pale in comparison is sensationalist hogwash. We all know nothing about this has been perfect, but how could it be?

Some of these studies have just come out this month, and you're trying to retroactively place blame on any number of people and organizations for reactions months ago? That seems very silly to me.

I said a month or two ago that learning about this virus will continue for months and possibly years. It will be a long time before we fully understand what we should and should not have done, what could of helped, and what didn't. Expecting anything else doesn't make much sense, especially looking in retrospect.
PepsiFree is offline   Reply With Quote
The Following 14 Users Say Thank You to PepsiFree For This Useful Post:
Old 08-31-2020, 11:48 AM   #5
DeluxeMoustache
 
DeluxeMoustache's Avatar
 
Join Date: Mar 2010
Exp:
Default

nm

Last edited by DeluxeMoustache; 08-31-2020 at 11:58 AM.
DeluxeMoustache is offline   Reply With Quote
Old 08-31-2020, 11:48 AM   #6
opendoor
#1 Goaltender
 
Join Date: Apr 2007
Exp:
Default

Who cares? It's not like there have been massive numbers of positive tests forcing huge swaths of the population to isolate. Compared to the societal and economic costs of shutdowns and continued social distancing for the entire populace, the effects of a tiny percentage of the population who tested positive having to isolate for a couple of weeks is an insignificant drop in the ocean.

There have been 13K cases in Alberta; you think that because 11-12K people in a population of 4.4 million may not have been as infectious as previously thought and perhaps might not have needed to isolate, there should be riots and heads should roll? Get a grip.

Never mind the fact that that's hardly definitive proof of anything. If 90% of cases (which is probably something like 97-98% of infections given that confirmed cases are only a proportion of those who are actually infected) aren't infectious, how is it spreading so quickly? How does 1/4 of New York City's population become infected over a period of a few months if less than 1 in 20 infected people are capable of spreading it? With an estimated R0 of 3+ in New York in the late winter and early spring, that would mean that once you take out the 19 out of 20 who apparently aren't infectious, the average infectious person spread it to 60 people. That seems exceptionally improbable.
opendoor is offline   Reply With Quote
The Following 2 Users Say Thank You to opendoor For This Useful Post:
Old 08-31-2020, 12:11 PM   #7
NuclearFart
First Line Centre
 
NuclearFart's Avatar
 
Join Date: Mar 2006
Exp:
Default

Wow naive overreaction. Vitually nothing in medicine is black or white, heck even death has the occasional shades of gray. Almost everything about the practice of medicine is about probabilities, so this is certainly not unique to COVID. This is the entire basis of test sensitivity and specificity, and the context of disease prevalence.

Regardless, a low viral count certainly does not mean clinically irrevelevant. If you catch the infection early enough, obviously the titers will be low. This is actually ideal from a practical standpoint because then we know to legitimately isolate the patient before their peak transmission point.
NuclearFart is offline   Reply With Quote
The Following User Says Thank You to NuclearFart For This Useful Post:
Old 08-31-2020, 12:24 PM   #8
pseudoreality
Scoring Winger
 
pseudoreality's Avatar
 
Join Date: Jul 2012
Exp:
Default

Quote:
Originally Posted by Azure View Post
The results of the test are presented as the complete truth insofar as that they are binding to the individual. Positive? Isolate. Negative? Good to go. The government is going so far as to fine people now depending on the results of the 'test.'

You are not allowed to go back and retest. Your test results do not say that at a threshold of 30 the test was negative, but at 40 it was positive.

If a threshold of 40 is being used, but research shows that 90% of the people that tested positive at that threshold did not have a viral load that would be considered contagious, heads better roll.

The fact that this isn't getting massive airtime is unreal.
Where exactly is that the practice? I don't believe that is mainstream. Many people have had several tests and are not limited to one test. Also, no one has ever said a negative test means good to go. It just means they didn't detect it at that point. It could be early on in the infection and not picked up yet or you could contract it later. Physical distancing and increased sanitation practices are still universally recommended. This is the messaging that most public health agencies around the world are giving.
pseudoreality is offline   Reply With Quote
Old 08-31-2020, 12:27 PM   #9
blankall
Ate 100 Treadmills
 
blankall's Avatar
 
Join Date: Mar 2006
Exp:
Default

I just don't see how this is a big issue. We've known all along that many asymptomatic people with low viral counts may not be contagious to others. Having those people isolate for 2 weeks is an acceptable precaution, as there's no way to be sure who is and who is not contagious.

Of all the major restrictions that have occurred due to Covid, having those with the actual virus, who may or may not have enough virus to transmit to others, isolate seems like a tiny issue.
blankall is offline   Reply With Quote
The Following User Says Thank You to blankall For This Useful Post:
Old 08-31-2020, 01:08 PM   #10
Azure
Had an idea!
 
Azure's Avatar
 
Join Date: Oct 2005
Exp:
Default

Quote:
Originally Posted by blankall View Post
I just don't see how this is a big issue. We've known all along that many asymptomatic people with low viral counts may not be contagious to others. Having those people isolate for 2 weeks is an acceptable precaution, as there's no way to be sure who is and who is not contagious.

Of all the major restrictions that have occurred due to Covid, having those with the actual virus, who may or may not have enough virus to transmit to others, isolate seems like a tiny issue.
You don't think the shutdowns weren't massively influenced by what the testing was saying?

No need to test unless you have symptoms, but we'll go ahead and shut down the entire economy anyway just to make sure.

Either way, school is starting in a few weeks. We'll see how everyone reacts when students all start testing positive. Maybe the 'test', how it is conducted and what it actually means will become more important then.
Azure is offline   Reply With Quote
Old 08-31-2020, 01:13 PM   #11
Azure
Had an idea!
 
Azure's Avatar
 
Join Date: Oct 2005
Exp:
Default

Quote:
Originally Posted by pseudoreality View Post
Where exactly is that the practice? I don't believe that is mainstream. Many people have had several tests and are not limited to one test. Also, no one has ever said a negative test means good to go. It just means they didn't detect it at that point. It could be early on in the infection and not picked up yet or you could contract it later. Physical distancing and increased sanitation practices are still universally recommended. This is the messaging that most public health agencies around the world are giving.
Uhh, what? If you go get tested and your test comes back negative, there is no contact tracing done. It doesn't matter if you're sick or not.

Obviously people who are sick should isolate (as they should from any sickness really).

If you go get tested and the test comes back positive, contact tracing is done. Again, doesn't actually matter if you are sick or not.

All I'm saying is that the 'test' has massively influenced how the world reacted. Shutdowns were literally enacted to protect against the asymptomatic people walking among us who could infect everyone without even knowing they were sick.

Now we're learning that the test was conducted in a way where the results can EASILY construe false positives.

This is not a 'oh we don't understand the virus' problem. This is a 'oh we used the wrong settings and got results that have a high likelihood of not being accurate' problem. Oh, and those results have helped dictate government policies around shutdowns.
Azure is offline   Reply With Quote
Old 08-31-2020, 01:15 PM   #12
blankall
Ate 100 Treadmills
 
blankall's Avatar
 
Join Date: Mar 2006
Exp:
Default

Quote:
Originally Posted by Azure View Post
You don't think the shutdowns weren't massively influenced by what the testing was saying?

No need to test unless you have symptoms, but we'll go ahead and shut down the entire economy anyway just to make sure.

Either way, school is starting in a few weeks. We'll see how everyone reacts when students all start testing positive. Maybe the 'test', how it is conducted and what it actually means will become more important then.
Once again, we all knew that most positive cases were asymptomatic and that most asymptomatic people probably didn't transmit to others. None of this is new info.

For the record, I'm a relatively anti-shutdown person. In that I was for opening up earlier than we did, and also for "flattening the curve", as opposed to the large groups of people who seem to think it's possible to stop all infections.

I do agree with you that data has been manipulated since day #1 to support a political outcome. I just don't see this study as new data.
blankall is offline   Reply With Quote
The Following User Says Thank You to blankall For This Useful Post:
V
Old 08-31-2020, 01:18 PM   #13
Azure
Had an idea!
 
Azure's Avatar
 
Join Date: Oct 2005
Exp:
Default

Quote:
Originally Posted by blankall View Post
Once again, we all knew that most positive cases were asymptomatic and that most asymptomatic people probably didn't transmit to others. None of this is new info.

For the record, I'm a relatively anti-shutdown person. In that I was for opening up earlier than we did, and also for "flattening the curve", as opposed to the large groups of people who seem to think it's possible to stop all infections.

I do agree with you that data has been manipulated since day #1 to support a political outcome. I just don't see this study as new data.
I'm sorry, but government policy is not following along with this.

I do not really have a problem with isolating if you're sick, testing after a week if you've been listed as a contact, etc. It is what it is.

My issue is with the mandatory shutdowns that have been drawn out to the point where we have spent $300 billion, but many small businesses are still going to fail because they simply can't sustain what is happening.

What are those shutdowns based on? What the data is showing is not lining up with what the government is doing.

Also, testing has not gotten more efficient for the general public. Big corporations on the other hand are doing it with ease (see the NHL). I just don't understand that.

The NHL clearly believes that their test is accurate. It can also be carried out on a bigger scale, and is probably cheaper.

I agree that testing and better contact tracing is the key to getting out of this. I just don't see that happening.

Last edited by Azure; 08-31-2020 at 01:20 PM.
Azure is offline   Reply With Quote
Old 08-31-2020, 01:40 PM   #14
GGG
Franchise Player
 
GGG's Avatar
 
Join Date: Aug 2008
Exp:
Default

Quote:
Originally Posted by Azure View Post
I'm sorry, but government policy is not following along with this.

I do not really have a problem with isolating if you're sick, testing after a week if you've been listed as a contact, etc. It is what it is.

My issue is with the mandatory shutdowns that have been drawn out to the point where we have spent $300 billion, but many small businesses are still going to fail because they simply can't sustain what is happening.

What are those shutdowns based on? What the data is showing is not lining up with what the government is doing.

Also, testing has not gotten more efficient for the general public. Big corporations on the other hand are doing it with ease (see the NHL). I just don't understand that.

The NHL clearly believes that their test is accurate. It can also be carried out on a bigger scale, and is probably cheaper.

I agree that testing and better contact tracing is the key to getting out of this. I just don't see that happening.
I don’t believe that shutdowns were ever based on test results. Shutdowns were based on Italy and New York hospitals being overwhelmed if nothing was done to stop the virus. As far as return to work and reopening I don’t think that absolute numbers ever mattered rate of change in the positive or negative direction has been what the key piece of data was.

If you change testing thresholds all of these jurisdictions would just change policy thresholds for restrictions to match.

The other thing with a high number of cycles being used is you catch probable cases early. The PCR test is designed to be sensitive and have low false negatives. If you reduce the sensitivity of the test but still have a 48hr turnaround on test results you increase risk.

If you are going for the decreased sensitivity style test you need something you spit on and get a positive or negative that you can do everyday. With a test like that you could have a 10% false negative rate and it wouldn’t be a big deal. More focus could be placed on developing this type of test.
GGG is offline   Reply With Quote
The Following 8 Users Say Thank You to GGG For This Useful Post:
Old 08-31-2020, 04:03 PM   #15
Azure
Had an idea!
 
Azure's Avatar
 
Join Date: Oct 2005
Exp:
Default

Quote:
Originally Posted by GGG View Post
I don’t believe that shutdowns were ever based on test results. Shutdowns were based on Italy and New York hospitals being overwhelmed if nothing was done to stop the virus. As far as return to work and reopening I don’t think that absolute numbers ever mattered rate of change in the positive or negative direction has been what the key piece of data was.

If you change testing thresholds all of these jurisdictions would just change policy thresholds for restrictions to match.

The other thing with a high number of cycles being used is you catch probable cases early. The PCR test is designed to be sensitive and have low false negatives. If you reduce the sensitivity of the test but still have a 48hr turnaround on test results you increase risk.

If you are going for the decreased sensitivity style test you need something you spit on and get a positive or negative that you can do everyday. With a test like that you could have a 10% false negative rate and it wouldn’t be a big deal. More focus could be placed on developing this type of test.
The argument is that a threshold of 40 gives you positives that shouldn't even exist. In other words, its not fair to simply say it needed to be like that to make sure all cases are caught when those cases were not actually creating a problem.

But I agree, perhaps that test still being used on a daily basis is the problem. We are blowing up people's lives because we still can't perform testing any better than we could on day 1.

If this whole pandemic could have been controlled by telling people who were sick to stay home, it would have been simpler. However the whole asymptomatic angle created a problem where any random person could be a carrier, or was a carrier, and therefore everyone needs to stay home.
Azure is offline   Reply With Quote
Old 09-01-2020, 08:24 AM   #16
Cali Panthers Fan
Franchise Player
 
Cali Panthers Fan's Avatar
 
Join Date: Feb 2013
Location: Boca Raton, FL
Exp:
Default

Ugh...

False positives are not dangerous to others. False negatives are. How do you not understand this?

If you selectively ask a few people who test positive to isolate for a couple weeks to ensure they do not spread a possible infection to others, the restrictions on society are minimal as a whole. Is that not what you want? Would you rather mass lockdowns again?

And again, you cannot simply say "if you're sick, stay home" because we know that asymptomatic transmission has occurred in anywhere from 20-45% of the known cases (studies vary on the estimations). What testing does is catch those asymptomatic cases before they can spread it and cause a massive increase in the R0. Catching those cases, even if they are few in number, keeps this from becoming an out of control situation like we saw in Florida earlier. Do you want 12000 cases a day? No? Then you test and you assume someone could be infectious if they test positive.

We are certainly not "blowing up people's lives" as you claim. It's a momentary inconvenience to stay home for a couple weeks after testing positive. It's akin to the slight inconvenience of wearing a mask when around others. Of course that isn't 100% effective to manage all cases, nor will it mean that everyone who wears a mask could be infectious, but considering how virulent this infection is, and how rampant spread can be without these measures, would you not want to implement the simplest and most cost-effective measures to manage the spread while keeping the economy open?

Testing isn't perfect, but it's never been that way. Every single test has a certain amount of false positive and false negative to go along with the true positive and true negative. Your gripe is that the false positives are too high, which is debatable, since the timing of the test matters most and tests done early in the virus incubation period may catch it before they become infectious to others. Fine, maybe a test could be more sensitive, and I'll grant you that point. But we are in triage mode and you're trying to manage giant populations. You need to do what is cost-effective and sufficient to catch enough positive cases to prevent further spread. If you set the threshold at a less sensitive level, you risk an increase in the false negatives, those who are claimed to be virus free when they are actually infected and could be dangerous to others.

In these situations, you want a test that is overly sensitive to ensure that you have as few false negatives as possible. Again, the harm to the individual is minimal and the benefit to society at large is great as the economy can stay open and kids CAN go to school.

I guess I'm not sure what your beef really is other than you believe that the government guidelines are overtly oppressive. If that's your point then you need to prove definitively that there are real damages from having an individual isolate after a positive test. No anecdotes. I want to see real data please.
__________________
Quote:
Originally Posted by ResAlien View Post
If we can't fall in love with replaceable bottom 6 players then the terrorists have won.
Cali Panthers Fan is offline   Reply With Quote
The Following User Says Thank You to Cali Panthers Fan For This Useful Post:
Old 09-01-2020, 08:57 AM   #17
81MC
First Line Centre
 
Join Date: Aug 2017
Exp:
Default

reminder: there are plenty of jobs where if you don’t show up, you don’t get paid. And they assumes you don’t ultimately lose your job, because there’s ‘no work’ when you get back.

Sure, you may be lucky enough to have paid sick leave and real job security. But that doesn’t apply to everyone. If you need two weeks off because you have a cold, then a month later another two weeks off because a family member tests positive, they could absolutely cause long-term financial hardships.
__________________
Next thing you know, they’ll take my thoughts away.
81MC is offline   Reply With Quote
Old 09-01-2020, 09:04 AM   #18
Codes
Powerplay Quarterback
 
Codes's Avatar
 
Join Date: Jun 2010
Location: Winnipeg
Exp:
Default

I wholeheartedly disagree with this premise. Reverse-Transcription Real-Time PCR is extrememely sensitive and specific. In the diagnostic world for a lot of these tests, a result of 37-39 would be flagged as suspicious and be repeated, tested by other methods, and in some cases, additional samples would be requested. However, with the sample load as high as it is, the easiest and safest response is to consider it positive and order the individual to quarantine.

What this article fails to consider is of those people whose tests were considered to be in the "weak positive/suspicious" range, how many went on to develop the disease. As NuclearFart mentioned, asymtomatic carriage is not the only factor at play; you may have caught the individual during the early stages of infection. And by doing so, you have mitigated this risk of additional infection.

This virus is extremely contagious, and we have a responsiblity to everyone around us to self-isolate even if we think we have the virus. The winter season is coming, and SARS-CoV-2 will hit hard. Combine that with seasonal flu, and we could be in for a tough time.

As far as I'm concerned, this article has done a disservice to all public health organisations, and will only add fuel to the fire for the skeptics and deniers. Uggh, the more I think about this, the more angry I get.
__________________

Last edited by Codes; 09-01-2020 at 09:29 AM.
Codes is offline   Reply With Quote
The Following 6 Users Say Thank You to Codes For This Useful Post:
Old 09-01-2020, 09:35 AM   #19
Azure
Had an idea!
 
Azure's Avatar
 
Join Date: Oct 2005
Exp:
Default

Quote:
Originally Posted by Codes View Post
I wholeheartedly disagree with this premise. Reverse-Transcription Real-Time PCR is extrememely sensitive and specific. In the diagnostic world for a lot of these tests, a result of 37-39 would be flagged as suspicious and be repeated, tested by other methods, and in some cases, additional samples would be requested. However, with the sample load as high as it is, the easiest and safest response is to consider it positive and order the individual to quarantine.

This virus is extremely contagious, and we have a responsiblity to everyone around us to self-isolate even if we think we have the virus. The winter season is coming, and SARS-CoV-2 will hit hard. Combine that with seasonal flu, and we could be in for a tough time.

As far as I'm considered, this article has done a disservice to all public health organisations, and will only add fuel to the fire for the skeptics and deniers.
As far as I'm concerned the fact that we are 4 months into this and still don't have a daily way to test people on an efficient scale is more than enough fuel for everyone. At the same time the trusty old government and our great public health organizations, who are telling everyone to isolate and stay at home is literally being one upped by professional sports organizations who have developed the exact test the government can't figure out in less time than it has taken for the government to decide that masks are important.

At the same time, people lives are being ruined, and there is no plan in place to get people back to work in a way where we can avoid issues with this 'extremely contagious' virus.

Nada, nothing.

Now on top of this, we are now being told that the testing methods being used aren't exactly conclusive. It doesn't matter if you think they are too sensitive or not sensitive or whatever, there is enough evidence to say that the results are not conclusive enough given the policies that have been created. And if you think testing, and the results being provided don't help dictate public policy (shutdowns, isolation, mandatory stay orders, etc, etc) I have a bridge to sell you.

So please, don't tell me about the 'disservice' we are doing to public health organizations. Had the public health organizations told everyone to wear masks 3 months ago we wouldn't be here.

If we are going to ruin people's lives, blow up the economy, and basically wreck everything, we should be going on more than 'well we can't afford to have a false negative.'
Azure is offline   Reply With Quote
Old 09-01-2020, 10:29 AM   #20
peter12
Franchise Player
 
peter12's Avatar
 
Join Date: Jul 2002
Exp:
Default

Looking backwards at the shutdowns, I see we made a necessary calculation based on what we knew at the time, but it is something that we can never - going forward - do again. That's it.
peter12 is offline   Reply With Quote
Reply

Thread Tools Search this Thread
Search this Thread:

Advanced Search

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Forum Jump


All times are GMT -6. The time now is 04:42 AM.

Calgary Flames
2019-20




Powered by vBulletin® Version 3.8.4
Copyright ©2000 - 2020, Jelsoft Enterprises Ltd.
Copyright Calgarypuck 2016