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[Draft 2] - Isolation and Quarantine Facilities

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Simone Republic
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[Draft 2] - Isolation and Quarantine Facilities

Postby Simone Republic » Fri Nov 15, 2024 2:28 am

Motivation

Replacement for 389.

Repeal of GA389 (in turn continuing from a repeal from Kaschovia):
viewtopic.php?f=9&t=558202

Kasch/Tin's replacement:
viewtopic.php?f=9&t=536607

Legality

Note that this is also bound by GA#53, and the subsequent [2017] GAS 11 ruling that you cannot pass a resolution to encourage something and then have a subsequent resolution that prohibits it. Since GA#53 encourages home/hospital quarantine, I have interpreted this to mean that quarantine facilities cannot be set up except as a last resort and that quarantine cannot last indefinitely (because of the encouragement clause in GA#53).

Personal notes

I have been quarantined before and I find it unpleasant, and I believe the costs of quarantine sometimes outweigh the benefits (mental health issues for those isolated etc., vs potential life savings)

Do people get tired of quarantines?

There's a realistic issue (Tin actually raised this) - do people get tired of quarantines? Also segregating large portions of the population are not necessarily practicable, especially if a significant part of the population of a WA state are infected by the same disease at the same time - Covid-19 being the prime example (plus flus, potentially H5N1). The effects of school closures on education scores is becoming apparent.

Draft 2

The World Assembly (WA),

Affirming relevant GARs, including 53 (epidemic response), 97 (quality healthcare), 320 (disease control), 518 (disease vectors), and 566 (investigations);

Desiring a delicate balance between the rights of the quarantined, those at high risk from potential serious illnesses, the impact of extensive isolation on quality of life, and health outcomes for wider communities;

The WA hereby enacts as follows:

  1. Definitions. In this resolution:
    1. "Confinement" means the strict quarantine of individuals at specific locations designated by a WA state (other than at hospitals or their own usual residences), specifically to prevent the spread of quarantinable diseases.
    2. "EPARC" means the Epidemic and Pandemic Alert and Response Center.
    3. "State" refers to WA member states as well as competent authorities of that state, and "individual" refer to sapient individuals in a state.
  2. Quarantinable disease.
    1. A disease is "quarantinable" only if EPARC deems it to be (i) highly contagious; (ii) communicable through mere tangential or casual contact; and (iii) can result in highly detrimental outcomes for a significant portion of individuals exposed to the said disease.
    2. EPARC may define whether a disease is "quarantinable" differently in each state or in sub-national divisions in that state based on local factors, such as if a disease is endemic, the vaccination or treatment options available, the prevailing mortality rate, comorbidities or the prevalence of disease vectors.
    3. Diseases that can only be transmitted through sexual contact, or the transmission of body tissues (such as blood transfusion) cannot be deemed "quarantinable".
  3. Isolation measures.
    1. If a WA state detects an outbreak of a disease classified as "quarantinable" in that state, a WA state must be able to show clear and convincing evidence that adopting isolation measures is necessary to contain the spread of the said disease, and that the benefits to the wider community in that state outweigh the burden placed on isolated individuals. Mandatory treatment (including involuntary hospitalization) shall only be imposed if justified by the same standard of proof.
    2. Isolation measures shall be proportional to the severity of the outbreak. The use of social distancing, home isolation, and other less intrusive measures are to be prioritized. Confinement may only be imposed on an individual if a WA state can show clear and convincing evidence of sufficient severity and urgency, or if an individual cannot be otherwise isolated such as due to special medical needs, a lack of hospital capacity, or homelessness.
    3. The imposition of any isolation measures is subject to due process of law. Each state is required to impose safeguards to ensure that confinement is only imposed on a strictly necessary basis, and kept to such minimum time as deemed necessary by EPARC, taking into account a balance between public health and the interest and well-being of individuals under isolation.
  4. Confinement facilities. If a confinement order is imposed on an individual, a facility for confinement shall have in place protocols to:
    1. Provide reasonable levels of comfort, hygiene, safety, and the supply of basic necessities for anyone held in such a facility;
    2. Provide reasonable amenities such as Internet access for remote learning or remote work;
    3. Avoid separation of families, and to provide reasonable levels of care for children, infants, or individuals with physical disabilities or other special needs;
    4. Prevent cross-infections in a facility;
    5. Prevent facility staff from exposure to the said disease;
    6. Provide transit to and from a facility in a hygienic manner;
    7. Preserve the privacy and dignity of those held in such facilities;
    8. Provide (if available) ongoing treatment for that disease, and, to the best extent possible, general medical care for individuals confined.
  5. EPARC assistance.
    1. EPARC is to render sufficient support to any WA state to comply with this resolution, either at the request of a WA state, or at EPARC’s discretion if it deems such intervention necessary in the interest of the wellbeing of other WA states.
    2. EPARC is responsible for enforcement and interpretation of this resolution.
  6. Interpretation. An individual subject to isolation or quarantine is deemed part of a "protected class" and holding an "immutable characteristic". Terms in the singular include the plural and vice versa.


Co-author: Kaschovia

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Last edited by Simone Republic on Mon Feb 03, 2025 6:32 am, edited 41 times in total.
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Postby Bananaistan » Fri Nov 15, 2024 5:09 am

"Bananaistan is opposed to WA internment camps for people with colds and flu."
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Postby Torregal » Fri Nov 15, 2024 6:50 am

Taking from the real-world example you mentioned: given that Section 1 permits a WA state to define whether a disease is quarantinable, what would stop a state under this framework from declaring an incurable transmissible disease like HIV as such, and indefinitely confining individuals who are HIV+? Especially if that state were, say, hostile to groups disproportionately likely to be HIV+? Is there any external check on a state's ability to contort itself around these eligibility criteria?

And in such a scenario, what would prevent such a state from declaring that providing quarantine accommodations that it's simply not possible to "[p]rovide reasonable levels of comfort, hygiene, safety, and the supply of basic necessities for anyone held in such a facility," nor preserve their privacy and dignity?

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Postby Tinhampton » Fri Nov 15, 2024 1:30 pm

I actually forgot to contribute to your pre-forum draft, sorry :P

I don't feel comfortable with the mandatory testing requirement in Article 2. Not even PR China during peak COVID-19 was doing mandatory population-wide testing.

What are "significant positive health outcomes?" It is possible to feel much, much better in the course of recovering from a disease... while still having that disease.
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Postby Simone Republic » Fri Nov 15, 2024 7:00 pm

Torregal wrote:Taking from the real-world example you mentioned: given that Section 1 permits a WA state to define whether a disease is quarantinable, what would stop a state under this framework from declaring an incurable transmissible disease like HIV as such, and indefinitely confining individuals who are HIV+? Especially if that state were, say, hostile to groups disproportionately likely to be HIV+? Is there any external check on a state's ability to contort itself around these eligibility criteria?

And in such a scenario, what would prevent such a state from declaring that providing quarantine accommodations that it's simply not possible to "[p]rovide reasonable levels of comfort, hygiene, safety, and the supply of basic necessities for anyone held in such a facility," nor preserve their privacy and dignity?


Any comments are helpful. I am really trying to go around the issue of HIV without going down the path of naming actual diseases. Most countries name specific diseases for reporting, and only a very small number of diseases for mandatory quarantine (or treatment) - usually extremely serious stuff like cholera, anthrax, legionnaire's disease, the plague, tuberculosis (that's the big one that's airborne) - I think all of them are sufficiently serious that they require intensive care treatment anyway

https://medlineplus.gov/ency/article/001929.htm
https://www.gov.uk/guidance/notifiable- ... eport-them

Tinhampton wrote:
What are "significant positive health outcomes?" It is possible to feel much, much better in the course of recovering from a disease... while still having that disease.


Work around on the fact that some diseases are inactive but may still be in a person's body.... I am trying to do more research on that. Basically leaning towards doing mandatory isolation rather than mandating quarantine - few places did actual quarantine during Covid, Mainland China plus Australia being the exceptions

Tinhampton wrote:I don't feel comfortable with the mandatory testing requirement in Article 2. Not even PR China during peak COVID-19 was doing mandatory population-wide testing.


That came in via the last draft.

Bananaistan wrote:"Bananaistan is opposed to WA internment camps for people with colds and flu."


Trying to think of how to word around the fact that paratyphoid fever (say) or the bubonic plague would require isolation, but regular fever would not, without specifying paratyphoid fever in the actual resolution. Anyway internment camps would be in conflict with GA#53.
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Postby The Overmind » Fri Nov 15, 2024 8:35 pm

Simone Republic wrote:
Bananaistan wrote:"Bananaistan is opposed to WA internment camps for people with colds and flu."


Trying to think of how to word around the fact that paratyphoid fever (say) or the bubonic plague would require isolation, but regular fever would not, without specifying paratyphoid fever in the actual resolution.

Incidentally, with respect to "(iv) lack viable vaccines that can at least significantly reduce the probability of detrimental outcomes," the presence or absence of a viable (or effective) vaccine for something should not be a part of the determination of whether or not quarantine is necessary. I think you need to tighten up the definition in clause 1 overall, but this specific exception doesn't make sense. Vaccines are, by their nature, only effective for a portion of the population, and can often only mitigate, not stop, the spread of illness. This is not to say that they are not vital to minimizing loss of life, potentially preventing dangerous sequelae, slowing the incubation of new strains, epidemiological management, and maximizing disability-adjusted life years in the face of potentially life-altering illnesses, but they do not stop the spread of particularly harrowing diseases, and, thus, quarantine still serves a vital role even when effective vaccines exist.
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Postby Simone Republic » Sun Nov 17, 2024 12:29 am

Pre-draft

Pre-draft

The World Assembly (WA),

Noting relevant resolutions in force, including GARs 53, 320, 492 and 518;

Noting that quarantines are not necessarily practicable, especially if a significant part of the population of a WA state are infected by the same disease at the same time;

Believing that some rules to protect the rights of those suffering from quarantinable infectious diseases is necessary;

The WA enacts as follows:

  1. Quarantinable disease” means diseases defined by a WA state or EPARC that: (i) are communicable through mere casual contact, (ii) are capable of wide transmission across a WA state, (iii) can result in highly detrimental outcomes for anyone infected; and (iv) lack viable vaccines that can at least significantly reduce the probability of detrimental outcomes.
  2. Testing. If EPARC declares that a major outbreak of a quarantinable disease is in progress in a WA state (or a part thereof), that WA state shall, to the best of its capability, regularly test all individuals in that state (or part thereof) for that disease.
  3. Quarantine facilities. The relevant WA state shall arrange for appropriate quarantine facilities for anyone infected with that disease. Such facilities shall have in place protocols to:
    1. Provide reasonable levels of comfort, hygiene, safety, and the supply of basic necessities for anyone held in such a facility, to the best extent possible;
    2. Prevent cross-infections in such facilities;
    3. Provide transit to and from such facilities in a hygienic manner;
    4. Preserve, where possible, the privacy and dignity of those held in such facilities;
    5. Provide (if available) ongoing treatment for that disease, and, to the best extent possible, treatment for other existing conditions of those held in such facilities.
  4. Community isolation. Isolation in the community, such as for any infected to isolate at their own homes, is an acceptable alternative to quarantine if:
    1. The WA state is unable to fully provide for quarantine facilities due to time or capability constraints; or
    2. The individual(s) infected have their own facilities capable of mimicking conditions at a quarantine facility and can self-administer any treatment available.
  5. Prevention. Diseases that can only be transmitted solely through sexual or other intimate contact between individuals cannot be deemed by a WA state or EPARC to be a quarantinable disease.
  6. Exit from isolation facilities. The relevant WA state shall have reasonable protocols in place, subject to due process, whereby individuals held in quarantine facilities are released as soon as possible, provided that they have achieved significant positive health outcomes, taking into account a balance between public health and the interest of individuals under quarantine to regain their liberties.
  7. EPARC. “EPARC” refers to the Epidemic and Pandemic Alert and Response Center. EPARC is to render sufficient support to any WA state to fulfill the requirements of this resolution, either at the request of a WA state, or at EPARC’s discretion if EPARC deems such intervention absolutely necessary in the interest of the collective wellbeing of other WA states. EPARC is responsible for implementing clauses (2) to (5) in all territories directly under the jurisdiction of the WA, including the WA Headquarters.
  8. Interpretation. This resolution does not cover port health, including the entry or exit of anyone infected with a quarantinable disease to or from a WA state. Terms not defined herein (such as “casual contact”) shall be defined by the relevant WA state or EPARC. Decisions by EPARC take precedence over decisions made by individual WA states.


The Overmind wrote:
Simone Republic wrote:
Trying to think of how to word around the fact that paratyphoid fever (say) or the bubonic plague would require isolation, but regular fever would not, without specifying paratyphoid fever in the actual resolution.

Incidentally, with respect to "(iv) lack viable vaccines that can at least significantly reduce the probability of detrimental outcomes," the presence or absence of a viable (or effective) vaccine for something should not be a part of the determination of whether or not quarantine is necessary. I think you need to tighten up the definition in clause 1 overall, but this specific exception doesn't make sense. Vaccines are, by their nature, only effective for a portion of the population, and can often only mitigate, not stop, the spread of illness. This is not to say that they are not vital to minimizing loss of life, potentially preventing dangerous sequelae, slowing the incubation of new strains, epidemiological management, and maximizing disability-adjusted life years in the face of potentially life-altering illnesses, but they do not stop the spread of particularly harrowing diseases, and, thus, quarantine still serves a vital role even when effective vaccines exist.


The vaccine issue I can get my head around, because Covid vaccines don't prevent spreading either, and I have comorbities myself.

The quarantine issue I have is that GA#53 encourages home and hospital care, and the repeal would trigger the Gensec ruling on this exact issue (the fact that GA#389 does quarantine differently from GA#53) (edit: 2017gas11)

viewtopic.php?p=32663234#p32663234
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Postby Simone Republic » Tue Dec 17, 2024 12:50 am

Bump for additional feedback. I find this a tricky one since I am not very good at health-related issues.

https://constitutioncenter.org/blog/con ... -situation
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Postby Cessarea » Tue Dec 17, 2024 6:31 am

The Cessarean Protocol for foreign affairs - in all of its monolithic glory - rests behind the desk designated for the nation's delegation. Small mechanical entities of all shapes and sizes swarm its body, welding the metal and replacing some seemingly destroyed circuits. The orb above, shining in a faint yellow light, emits from itself jagged voices, partially in disharmony with one another:

"A-apologies-es-es for our current state. We are re-recovering from a particularly infuriating encounter with some delegations from this bo-bo-body. Without further digressions, the Protocol has previously analysed this proposal - 01-IQF - and has decided to share its analysis." The orb's colour shifts to a neutral white, as it prepares to continue its commentary:

"Minor violation of Efficiency and Necessity Prerogative: article 1, 'b', 'iv', in conjunction with would mandate that any disease with an available, effective vaccination method be immediately excluded from the list of 'quarantinable diseases'. The mere existence of such, however, does not imply that it will effectively eradicate the disease it is designed to combat in a short period of time. Quarantines or other measures in the way of restricting certain freedoms may be necessary during the vaccination process."

"Major violation of Efficiency and Necessity Prerogative: article 5 seeks to establish a committee and give it a reasonable mission, yet it fails to establish its proper objectives when acting in a member-nation, as well as the source of funding for its operations. Shall EPARC render technical and medical support? Shall it aid in the construction and maintenance of facilities? Shall it hand out monetary aid only? Such questions must be superficially answered."

The orb of light shifts in hue once more, settling for a deep red. "For now, the Protocol rejects this proposal for material incongruence, hoping to see our concerns addressed in the future."
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Postby Torregal » Tue Dec 17, 2024 6:47 am

I think I could ultimately support this if there were some oversight mechanism to prevent or check the weaponization of otherwise-legitimate quarantine authority against undesirable groups (i.e. the real-world HIV example), as well as external review of the conditions quarantined individuals are being held in.

In a similar vein, I think some of the feedback you’ve gotten about 1(b)(iv) is worthwhile. Again, I may be harping a little too much on the real-world comparator here, but it’s what I know: while there isn’t an effective, widely-available vaccine for HIV, there certainly are individual and public health interventions render it untransmittable at a individual level (modern antivirals and widespread adoption of pre-exposure prophylaxis in susceptible populations). I’d love to see a little more nuance to address that kind of scenario.

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Postby Simone Republic » Tue Jan 14, 2025 5:58 pm

Draft 1
The World Assembly (WA),

Affirming relevant GARs, including 53, 91, 320, 492, 518, and 566;

Desiring a delicate balance between the rights of the quarantined, those at risk potential serious illnesses, the impact of extensive isolation on quality of life, and health outcomes for the wider community;

The WA hereby enacts as follows:

  1. Definitions. In this resolution:
    1. "Quarantine" means the confinement of inhabitants of a WA state to a specific location to prevent the spread of quarantinable diseases. This excludes confinement to that inhabitant's own residence or in hospitals.
    2. "Quarantinable disease" means diseases defined by a WA state or EPARC that: (i) are communicable through mere casual contact, (ii) are capable of wide transmission across a WA state, (iii) can result in highly detrimental outcomes for anyone infected; and (iv) lack viable vaccines that can at least significantly reduce the probability of detrimental outcomes.
  2. Quarantine facilities. Each WA state is required to consider home isolation, or hospitalization if medically necessary, as a priority over quarantines. If quarantine is implemented, quarantine facilities shall have in place protocols to:
    1. Provide reasonable levels of comfort, hygiene, safety, and the supply of basic necessities for anyone held in such a facility;
    2. Avoid separation of families, and to provide reasonable levels of care for children, infants, or individuals with physical disabilities or other special needs;
    3. Prevent cross-infections in such facilities;
    4. Provide transit to and from such facilities in a hygienic manner;
    5. Preserve, where possible, the privacy and dignity of those held in such facilities;
    6. Provide (if available) ongoing treatment for that disease, and, to the best extent possible, treatment for other existing conditions of those held in such facilities.
  3. Prevention. Diseases that can only be transmitted solely through sexual or other intimate contact between individuals cannot be deemed by a WA state or EPARC to be a quarantinable disease.
  4. Exit from isolation facilities. The relevant WA state shall have reasonable protocols in place, subject to due process, whereby individuals held in quarantine facilities are released as soon as possible, provided that they have achieved significant positive health outcomes, taking into account a balance between public health and the interest of individuals under quarantine to regain their liberties.
  5. EPARC. “EPARC” refers to the Epidemic and Pandemic Alert and Response Center. EPARC is to render sufficient support to any WA state to fulfill the requirements of this resolution, either at the request of a WA state, or at EPARC’s discretion if EPARC deems such intervention absolutely necessary in the interest of the collective wellbeing of other WA states. EPARC is responsible for implementing clauses (2) to (5) in all territories directly under the jurisdiction of the WA, including the WA Headquarters.
  6. Interpretation. Anyone subject to isolation or quarantine is part of a "protected class" and is holding an "immutable characteristic" for the purpose of WA laws. This resolution does not cover matters related to the entry or exit of anyone infected with a quarantinable disease to or from a WA state or stay-at-home orders. Terms not defined herein shall be defined by the relevant WA state or EPARC. Decisions by EPARC take precedence over decisions made by individual WA states.
[/list]


Co-authors: pending, Kaschovia

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Cessarea wrote:The Cessarean Protocol for foreign affairs - in all of its monolithic glory - rests behind the desk designated for the nation's delegation. Small mechanical entities of all shapes and sizes swarm its body, welding the metal and replacing some seemingly destroyed circuits. The orb above, shining in a faint yellow light, emits from itself jagged voices, partially in disharmony with one another:

"A-apologies-es-es for our current state. We are re-recovering from a particularly infuriating encounter with some delegations from this bo-bo-body. Without further digressions, the Protocol has previously analysed this proposal - 01-IQF - and has decided to share its analysis." The orb's colour shifts to a neutral white, as it prepares to continue its commentary:


(IC)

"Most encounters with delegations from this body tend to be infuriating. We hear that a lot here. Especially when other delegations deal with this delegation."

Cessarea wrote:"Minor violation of Efficiency and Necessity Prerogative: article 1, 'b', 'iv', in conjunction with would mandate that any disease with an available, effective vaccination method be immediately excluded from the list of 'quarantinable diseases'. The mere existence of such, however, does not imply that it will effectively eradicate the disease it is designed to combat in a short period of time. Quarantines or other measures in the way of restricting certain freedoms may be necessary during the vaccination process."


(IC)

"Bears are solitary animals, so imposing quarantine just because a bear is sick with something is generally bizarre."

"Also, koalas aren't bears – they're marsupials. So the fact that they get a lot of chlymydia is not generally my problem."

(OOC)

I've tilted the "restrictions in certain freedoms" towards a very individual state-specific approach. So basically the rights of those quarantined to receive benefits (such as education, mental health support, etc.) are guaranteed but quarantine itself is being used only as a last resort.

Cessarea wrote: "Major violation of Efficiency and Necessity Prerogative: article 5 seeks to establish a committee and give it a reasonable mission, yet it fails to establish its proper objectives when acting in a member-nation, as well as the source of funding for its operations. Shall EPARC render technical and medical support? Shall it aid in the construction and maintenance of facilities? Shall it hand out monetary aid only? Such questions must be superficially answered."


(OOC)

They are covered in some past resolutions, I'd extend the preamble (which I rarely do) to elaborate.

I made a major change which is that only EPARC can declare diseases as quarantinable if requested by a WA state (so roughly in consultation with the WHO in real life), and left it to individual states to decide if they want to go with full scale quarantine (the China model) or voluntary isolation (US during Covid) or compulsory isolation (UK, with some changes). Note that US still requires quarantine for say cholera or the plague, so civil rights don't totally apply here.
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Postby The Overmind » Tue Jan 14, 2025 8:40 pm

Support in principle, and mostly as written pending feedback from other colleagues.
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Postby Simone Republic » Thu Jan 16, 2025 6:58 am

Tinhampton wrote:I actually forgot to contribute to your pre-forum draft, sorry :P

I don't feel comfortable with the mandatory testing requirement in Article 2. Not even PR China during peak COVID-19 was doing mandatory population-wide testing.

What are "significant positive health outcomes?" It is possible to feel much, much better in the course of recovering from a disease... while still having that disease.


I changed the draft to "minimize" the time spent in quarantine and dropped the testing part, largely for space reasons. (I have a suspicion that an eventual repeal/replace of GA53 - which precedes Covid - would make sense).

Note that my draft is far tighter in terms of the legal standard of proof required for quarantine compared to Kasch/your draft from June 2023.

The Overmind wrote:Support in principle, and mostly as written pending feedback from other colleagues.


Please do take a closer look. I tilt much more to "individual liberty" than "medical necessity" since I've lived through Covid-related quarantines before and lean towards the liberty end. But I do think that at least before widespread vaccination, Covid probably meets the "clear and convincing evidence" basis.
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Postby Cessarea » Thu Jan 16, 2025 7:23 am

"02-IQF is appreciated and analysed." The Protocol announced, followed by brief moments of thought. Then, its light shifting from white to a neon green: "Cessarea's concerns have been addressed, we are satisfied with the current text. We would only suggest that article 7 changes "individuals" to "an individual" so as to remain grammatically coherent with the rest of the sentence. We would also suggest changing the first instance of 'is deemed' to 'is considered as being' so as to avoid repetition. The Protocol sees no other material incongruences, and hereby approves 02-IQF."
Last edited by Cessarea on Sun Jan 19, 2025 5:45 am, edited 1 time in total.
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Postby Simone Republic » Thu Jan 23, 2025 12:09 am

Bump for further feedback.
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