COVID Here comes COVID-19 version BA.2, BA.4, BA.5,...

[Astronuc]

I've lost track of the variant evolution. However, Omicron descendant, KP.3.1.1 is apparently dominant in the US. I've heard that a number of public officials developed Covid during the last month.

KP.3.1.1, of the Omicron family, is now the predominant SARS-CoV-2 variant circulating in the United States, having overtaken its parent linage KP.3 and previous KP.2 variants. KP.3.1.1 is the only major variant increasing in proportion nationally.

https://www.cdc.gov/ncird/whats-new/kp-3-1-1-is-the-predominant-variant.html

I just received the latest booster from Moderna (my 5th booster); my wife and one also got the same booster. My initial vaccine and subsequent boosters have been Pfizer/BioNTech. I had no significant reaction, only soreness near the injection site. My son also got the same Moderna vaccine, and he did feel some fatigue and discomfort; he had skipped the previous booster, which I received last October.

We all had Covid in January. My wife and I took Paxlovid for 5 days, while my son did not (according to current protocols). My wife and I had mild symptoms, similar to having an allergy or mild cold. My son, who had the booster about the same time I did, had symptoms of a strong cold, including coughing, fever and fatigue. After my wife and I finished the Paxlovid, the symptoms did become somewhat stronger with a so-called post-Paxlovid rebound. I think Paxlovid should be used for 7 days rather than 5 days.

We now get Covid and influenza vaccines at the same time, usually in October, but this year in September. I will probably get the vaccines for RSV, pneumococcal bacteria and shingles soon.

We generally wear N95 masks when entering public spaces, e.g., supermarket or shops. We seldom eat in restaurants preferring to get take-out.

 

[Laroxe]

Yep! KP 3-1-1 appears to be the new kid on the block and is becoming the new dominant variant. Its getting increasingly difficult to make sense of what gives these variants a selective advantage, I know that its suggested to have a shorter incubation period, but all the Omicron variants seem to share this and the difference doesn't seem that significant and despite the claims of increased antibody resistance, we all make quite a number of different antibodies and the variants are likely to only really reduce the effectiveness of a few. The current information on the UK data dashboard suggests a small increase in the number of cases (4.3% over the last 7 days) while deaths have fallen by 20.9% and hospital admissions by 6.6%, though there is a delay before the number of cases affect the other numbers.

This does sort of call into question the need to take precautions against infection, continued exposure to the virus would facilitate the maintenance of high levels of more variant specific antibodies. We are still playing catchup with the vaccines, by the time a new vaccine is ready there is often a new variant, luckily the vaccines still work, the effect of the observed genetic changes in the viruses doesn't seem terribly significant. However, we do know that to prevent the development of symptoms after exposure requires very high antibody levels, levels that even when achieved are short-lived, so increased exposure might be useful.

Unfortunately, we simply can't make adequate risk assessments based on cost benefit analysis, particularly for people considered to be at high risk. At the moment, it would be a brave Dr. that would advise a patient considered to be at high risk to dispense with all their precautions. It still seems to be the case that vaccination is by far the most effective protection, its interesting that in the UK Paxlovid appears to be used far less frequently, but you wouldn't know this by looking at any effect on the mortality rates.

I know that there is the possibility that the new DNA vaccine from Novavax will provide a more persistent antibody response, and there are new inhaled vaccine boosters in trials that increase local tissue defences in the upper Resp. Tract, the usual point of viral entry. The trouble is that now it is increasingly difficult to collect the data needed to assess treatments and new vaccines, so progress has slowed considerably and these things are important in the preparations for the next pandemic. The results of the increased monitoring of novel pathogens has resulted in even more alarmist reporting, which might in fact be misleading.

 

[OmCheeto]

An interesting conversation with Dr. Fauci was published a few days ago.

Dr. Anthony Fauci Shares Insights on His Career and Leadership of the NIAID
Published September 16, 2024
...
Neil S. Greenspan, MD, PhD;
This gets into the next question, which is — and I know you’ve been asked this by other interviewers, but I think it’s important to address how precisely to think about the effectiveness of the mRNA vaccines in limiting transmission, because people often talk about it in absolute terms that it either does or doesn’t, and I want to know if you would agree that — my take would be that even if it isn’t 100% able to prevent transmission, that doesn’t mean it’s not benefiting us by reducing the probability of transmission, or the scale of transmission.

A. Fauci;
No, I’m with you on that, because it doesn’t do it to the 90% or even 80% or 70%. It does have some impact on transmission, number one. However, that impact is short lived. So, if you start off with the ancestral strain that we made the vaccine against. In that trial, it likely had a reasonably good effect on transmission, not 93%, but reasonably good.

What we learned from experience, and you know the people who criticize the scientists and criticize the public health officials say, “You told us it was going to protect.”

We made an assumption, that protection would remain at a high level, and it didn’t. It was lower than we wanted to begin with, and it didn’t stay very long. What stayed long was the protection against severe disease leading to hospitalizations and death. That was reasonably durable, not measured in many years, but durable beyond a few months; whereas the protection against infection was lower than that against severe disease and was much less durable. But in answer to your question, that doesn’t mean there was no protection against infection. If you could get a little bit of mileage out of that, it would be worth it. So long as you don’t — now that we know what the results are — you don’t say it definitely is going to protect you against infection. It’s not. I’m a classic example of that. I’ve been vaccinated 6 times with the primary series, followed by a bunch of boosts. I’ve been infected 3 times.

So not only does vaccine (not fully protect), but hybrid immunity with vaccine plus infection didn’t protect me against getting infected. Three and a half weeks ago I had a very mild infection, but I still got infected. Now, given my age, if I didn’t have hybrid immunity, I might have died from the infection.

I find it interesting that the original vaccine had an efficacy of 95% and yet the average death rate for the last two years is 1/7th that of the average of the first two years (64,000 vs 420,000). I'm curious of the vaccination status of all those people that died.
(google google google)
And there we have it. Per Our World in Data, unvaccinated people are 4.7 times more likely to die than fully vaccinated people. (May 7, 2022 - April 1, 2023, all ages)

ps. Here's an updated graph of my dreadfully old 'trend in deaths' I posted in 'Random Thoughts' the other day. It looks as though if things don't improve, Covid will be the number two killer around the middle of next month. I left in the 2020 as it still amazes me how we went from 20 deaths per day to 2000 deaths per day in just 3½ weeks. Note that the 2020 plot dates do not match the x-axis but started on March 9th.

 

[OmCheeto]

Weekly deaths report is out at the CDC.
Not really much of a change from last week, trend-wise.
Now tied for the longest surge.
Makes me think I should get serious about getting the latest booster.

 

[Laroxe]

Making sense of the data we have can be confusing, there are lots of different variables that effect how it can be interpreted. You say that the original vaccine had a 95% efficiency, I don't think that is what Fauci said, they were discussing the effectiveness of the vaccine on preventing transmission, and he commented that in the early days of vaccination against the original Covid variant it did have quite a good effect. The problem was that this effect didn't last long and rapidly disappeared with the new variants. In many places the first available vaccination doses were given to particular groups particularly those at high risk, these people are often already restricted in their social contacts, this really complicates the usefulness of the early data. Still, our world data is an excellent resource and often provides explanations of how the data can be used. I didn't see the part about the vaccinated being more likely to die, but I've seen similar claims, they do provide some guidance on the date which addresses this issue at:
https://ourworldindata.org/covid-deaths-by-vaccination

It does seem that a lot of commentators try to use the raw data on the numbers who die, but if you have a very large population that are vaccinated vs a small number of unvaccinated, the raw data tells you very little. Generally, when you look at the effect of the introduction of the vaccines on deaths, there is a very clear and dramatic reduction at the population level something which becomes even more obvious if we look at the effect on the elderly who are at greater risk. I have to say I'm not keen on the graphs you used, I wasn't aware that any of the causes of death were occurring at a steady rate and could be plotted as a straight line over time.

 

[OmCheeto]

Making sense of the data we have can be confusing, there are lots of different variables that effect how it can be interpreted. You say that the original vaccine had a 95% efficiency, I don't think that is what Fauci said, they were discussing the effectiveness of the vaccine on preventing transmission, and he commented that in the early days of vaccination against the original Covid variant it did have quite a good effect.

First off, I have a feeling we are going to end up in complete agreement on nearly everything, but will be talking past each other due to things like your expertise in medicine and my having never even taken a basic biology course.

My '95% efficacy' comment was from one of the original trials reported back in 2000 by the NEJM.

The problem was that this effect didn't last long and rapidly disappeared with the new variants.

agreed

In many places the first available vaccination doses were given to particular groups particularly those at high risk,

agreed

these people are often already restricted in their social contacts, this really complicates the usefulness of the early data.

agreed

Still, our world data is an excellent resource and often provides explanations of how the data can be used. I didn't see the part about the vaccinated being more likely to die

[bolding mine]​

agreed. Though I seem to sense that you implied that I said that, which is where we are going to have to disagree.

, but I've seen similar claims, they do provide some guidance on the date which addresses this issue at:
https://ourworldindata.org/covid-deaths-by-vaccination

It does seem that a lot of commentators try to use the raw data on the numbers who die, but if you have a very large population that are vaccinated vs a small number of unvaccinated, the raw data tells you very little. Generally, when you look at the effect of the introduction of the vaccines on deaths, there is a very clear and dramatic reduction at the population level something which becomes even more obvious if we look at the effect on the elderly who are at greater risk.

agreed

I have to say I'm not keen on the graphs you used, I wasn't aware that any of the causes of death were occurring at a steady rate and could be plotted as a straight line over time.

It's the simplest of maths. Take all the people who die in a year from a certain cause and divide by 365.
Beings that I consider most people are both mathematically and medically functionally illiterate, I draw a picture to explain what I'm trying to convey, as that's generally how I best understand things.

From my graph, I can see that currently, covid is killing the same number of people as diabetes.

So then, the question I now have is:

Given that the 'Our World in Data' data shows that people who are not vaccinated are ≈5 times more likely to die than vaccinated people, does my 64,000 average deaths indicate that....

5 out of 6 deaths are because of vaccine hesitancy, and hence 64,000/6 * 5 = 53,000 deaths were avoidable?

This is a question more for maths types, as I'm a low grade recreational mathematician.

 

[Laroxe]

First off, I have a feeling we are going to end up in complete agreement on nearly everything, but will be talking past each other due to things like your expertise in medicine and my having never even taken a basic biology course.

My '95% efficacy' comment was from one of the original trials reported back in 2000 by the NEJM.

View attachment 351425




agreed

agreed

agreed

[bolding mine]​

agreed. Though I seem to sense that you implied that I said that, which is where we are going to have to disagree.

agreed

It's the simplest of maths. Take all the people who die in a year from a certain cause and divide by 365.
Beings that I consider most people are both mathematically and medically functionally illiterate, I draw a picture to explain what I'm trying to convey, as that's generally how I best understand things.

From my graph, I can see that currently, covid is killing the same number of people as diabetes.

So then, the question I now have is:

Given that the 'Our World in Data' data shows that people who are not vaccinated are ≈5 times more likely to die than vaccinated people, does my 64,000 average deaths indicate that....

5 out of 6 deaths are because of vaccine hesitancy, and hence 64,000/6 * 5 = 53,000 deaths were avoidable?

This is a question more for maths types, as I'm a low grade recreational mathematician.

First, my apologies if I misunderstood what you were saying about the effectiveness of vaccinations on mortality.

I assume your estimate of 64,000 deaths is based on the average monthly excess mortality in the US, if it isn't my 2nd set of apologies, but that's what I was looking at. While excess deaths may not provide an accurate number that can be attributed to Covid19, it's thought to represent a better estimate of the effects of the pandemic. In fact in the US in 2020 there were some 470,000 excess deaths (deaths in excess of the previous 5-year averages) while only 352,000 of these identified Covid as the primary cause of death.

I don't think we can talk about vaccine hesitancy as a cause of death, but that does lead us into another issue, particularly if we try to compare different causes. The fact is that deaths in people with Covid19 are often associated with multiple pathologies, and your example of diabetes is a good one. You mention that Covid kills as many people as diabetes,but diabetes in itself, these days is not the real cause of the associated deaths, it is the fact that it increases the risk of death from heart/arterial disease, kidney disease, various infections, various cancers etc. In fact, diabetes is a major risk factor in deaths from Covid19, Covid19 also increasing the risk of death from heart disease. Overall, the strongest associated risk from Covid19 is old age, this effect being an important factor in how effective vaccination is in inducing an immune response.

However, your overall assessment of the effectiveness does seem to be consistent with the data though with some important caveats. Once the vaccine became available because of both policy and education, those at greatest risk had a particularly high rate of vaccination, I would suggest that the demographics of the people who refuse vaccination is likely to be very different from the population averages. There is the added problem in that the virus itself changes which can have a direct impact on vaccine effectiveness and overall mortality, as does the improved care available and the availability of antivirals has an important effect on mortality.

I think we have to consider a lot of the information that has been used to produce many of the figures as essentially unreliable. The original figures reflected the early variants of the virus which we now know were much more likely to lead to serious disease, this was reflected in the mortality data. Over time, the virus appears to have become less virulent, even when we consider the potential changes to vaccine effectiveness. I'm left wondering how useful the various estimates actually were, it now appears that there were so many variables unknown or unconsidered. Weare now of course in a quite different situation in which the longer term effects of Covid19 as a cause of death in people of all ages.Its unlikely that there are many people that have avoided contact with the virus, so vaccination now has a much more nuanced effect, and yet excess deaths in the EU continues at levels around 5% above the expected level. While some of this can be attributed to the effects of Covid19 on healthcare, the reduction in monitoring and data collection is effectively preventing explaining the rest.

 

[Astronuc]

And yet another variant, XEC

New COVID-19 XEC variant circulating just before fall
https://medicalxpress.com/news/2024-09-covid-xec-variant-circulating-fall.html

The new variant has sprouted from the omicron variant that developed in late 2021. Although XEC is new, Francois Balloux, director of the Genetics Institute at University College London, told the BBC that he would be surprised if it became the dominant variant throughout winter.

Centers for Disease Control and Prevention researchers indicate that the vaccine and booster shots should protect against the new variant. Here is what we know about the XEC variant and what you can do to stay healthy.

https://www.cdc.gov/covid/php/variants/index.html
https://covid.cdc.gov/covid-data-tracker/#datatracker-home


https://www.latimes.com/california/...hreat-for-winter-as-doctors-urge-vaccinations

XEC, which was first detected in Germany, is gaining traction in Western Europe, said Dr. Elizabeth Hudson, regional chief of infectious diseases at Kaiser Permanente Southern California. Like virtually all coronavirus strains that have emerged in the past few years, it’s a member of the sprawling Omicron family — and a hybrid between two previously documented subvariants, KP.3 and KS.1.1.

 

[Rive]

And yet another variant, XEC

Here (Hungary) the last available vaccine was still against XBB, but validity of stock ran out at the end of last month.
Right now we have no available vaccine at all.
I foresee lot of 'fun' in the coming months

 

[berkeman]

In the US, the government has just now authorized each household to order 4 free COVID test kits (this has happened in the past, but this is a new round of availability/shipments):

https://abc7news.com/americans-can-again-order-4-free-at-home-covid-tests-from-federal-g/15358833/

 

[Tom.G]

Here is the link to order tests:
https://special.usps.com/testkits

And from todays Los Angeles Times newspaper, a link to finding a local source of Testing Sites here in the US:
https://testinglocator.cdc.gov

And some general information about Covid and the Tests:
https://www.fda.gov/medical-devices...al-devices/home-otc-covid-19-diagnostic-tests

Cheers,
Tom

 

[Laroxe]

Here (Hungary) the last available vaccine was still against XBB, but validity of stock ran out at the end of last month.
Right now we have no available vaccine at all.
I foresee lot of 'fun' in the coming months

Its not quite the problem you think it is, all of the vaccines continue to offer significant protection against the new variants, which is just as well as we are continually playing catch up with the new monovalent vaccines. By the time a new vaccine specific to the circulating variant is deployed, there is often a new variant in circulation. Luckily, it does seem that the new monovalent vaccines do have some advantages even against the newer variants, not used in the formulations available. It's not really the case that we have no vaccine available, even the original vaccine offers protection, it's just that the newer vaccines are marginally more effective. The fact that the majority of the population has had some exposure to the virus also helps, while antibody levels tend to fall quickly some parts of our immune response are far more enduring.
It's a bit of a shame that the latest vaccinations that use different technologies take far longer to evaluate, its hoped that Novavax, which has just become available, might lead to a more enduring effect, but I haven't seen any confirmation of this. There are others that might also offer much more significant advantages in terms of ease of handling, production, administration and immune responses offering improved cost-effectiveness.

 

[Laroxe]

And I dare say high time. Both covid and the flu have always been a threat for those with obesity and related life style induced co morbidities.

I think we need to be careful about any association of blame with risk. While lifestyle choices can be important in health they are often used in a highly selective way, based on poor quality evidence and without context. Remember that the most significant risk factor for both Covid and flu is age, with many of the other risk factors being strongly associated with age. Simply living a life, puts us at risk and evolution has predisposed us to be willing to or desire to take risks, fun fairs are in many ways based on this. When we are critical of others behaviours, we are assuming our choices are better, It's what politicians do to justify control.
Its been known for some time, and well before Covid19 appeared that Obesity has a direct effect on a persons willingness to seek care and the standard of the care they are likely to receive.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381543/

 

[pinball1970]

Reports of "surges" of XEC in the UK papers.

You drill down to the UKHSA surveillance reports and the language is more measured.

https://www.gov.uk/government/stati...vid-19-surveillance-report-10-october-week-41

 

[Astronuc]

A side effect, or consequence, of vaccines and isolation, or social distancing, may be the extinction of some strains of Influenza viruses.

October 17, 20249:30 AM ET - The flu shot is different this year, thanks to COVID
https://www.npr.org/sections/shots-...1-5155104/flu-shot-vaccine-b-yamagata-extinct

This year’s flu shot will be missing a strain of influenza it’s protected against for more than a decade.

That’s because there have been no confirmed flu cases caused by the Influenza B/Yamagata lineage since spring 2020. And the Food and Drug Administration decided this year that the strain now poses little to no threat to human health.

Scientists have concluded that widespread physical distancing and masking practiced during the early days of COVID-19 appear to have pushed B/Yamagata into oblivion.

From June 3, 2021 - Certain Strains Of Flu May Have Gone Extinct Because Of Pandemic Safety Measures

. . . every year when they get a flu shot that it protects against three or four different strains of flu. There's H1N1, which they'll know from the 2009 pandemic. There's H3N2. And there are two components that protect against influenza B viruses - B/Victoria and B/Yamagata.

It appears that a strain of Inlfuenza B may have become extinct.

 

[OmCheeto]

Wasn't sure which of the 5 bazillion Covid threads to resurrect, but I chose this one, just because.
Anyways, I've decided to go public with my OCD finding that weekly flu deaths exceeded covid deaths for the first time since the Covid pandemic started.
Latest week nowcast death counts:
covid = 1150
flu = 1535

Not to say the flu strains are worse than covid. The seasonality of the flu is still keeping it in the basement as far as total annual deaths go.

But, hmmm...., on a log scale, I may have to scratch my head some more on further predictions.

 

[Tom.G]

Thanks for the thread resurrection @OmCheeto, it needed a shot-in-the-arm.

 

[BillTre]

shot-in-the-arm

re-immunization

 

[pinball1970]

It’s great that you got both shots! The updated Omicron booster does offer some protection against newer BA.xxxxxx variants, though effectiveness may vary depending on mutations. As for future boosters, it’s likely we’ll see an approach similar to flu shots, where vaccines are updated annually to target the most prevalent strains. With how fast variants emerge, periodic boosters may become the norm. Will be interesting to see how vaccine strategies evolve!

The community on PF said the same thing in 2021, bring Covid to season flu levels via the vaccine and the fact that everyone at some point will get Covid. So a mixture of vaccine and natural immunity- in that order!

 

[Laroxe]

I thought this was interesting and discusses a number of important issues, the main findings are discussed in the conclusion if you want to save time.
Generally, it's true all the vaccines offer some protection, they all stimulate the production of a number of antibodies and so far there is no evidence of any variant evading them all. The high level of previous exposure, either with vaccines or by infection, provides a background in which serious disease is far less common. It's still the case that the age of the recipient is important, antibody levels fall quickly, and the virus hasn't settled into any predictable pattern of infections.
The vaccines targeting the new variants do appear to offer some advantages, but the new vaccines are always playing catchup to the appearance of new variants. As developments have slowed, we still haven't seen any data about the vaccines based on newer technologies and as funding has been reduced many manufacturers have been discontinuing developments.

https://www.sciencedirect.com/science/article/pii/S0163445324001117?via=ihub#sec0070

 

[Astronuc]

Now we are up to the X's.
https://time.com/7300451/new-covid-19-variant-xfg/

XFG is spreading most widely in Southeast Asia, although cases have been reported in 38 countries. In the U.K., it accounts for 30% of COVID-19 infections, and in the U.S., 14% of confirmed cases are XFG, according to the U.S. Centers for Disease Control and Prevention (CDC). (These data are likely incomplete: the CDC notes that since less data are being reported, the variant trackers are not precise.)

Persistent little buggers.

XFG is still in the Omicron family. It derives from the JN.1 Omicron group, which is the target of the latest COVID-19 vaccine. XFG is a combination of two other variants that have recombined: LF.7 and LP.8.1.2.

It is growing globally. Samples of XFG sent to the global database of genetic virus sequences jumped from 7% of all COVID-19 samples in May 2025 to nearly 23% a few weeks later, according to WHO. Compared to the variant NB.1.8.1—which is currently dominant in many countries, including in the U.S.—XFG contains nine additional mutations in the spike protein.

Vaccines seem to work against it​

Scientists are currently studying how well people are protected against severe disease from XFG. Researchers conducted lab studies using human cells and a "pseudovirus" stand-in for XFG, as well as animal studies, and found slightly lower immune responses to XFG.

XFG has another name! Stratus.
https://theconversation.com/xfg-cou...riant-heres-what-to-know-about-stratus-260499

This new subvariant is known as XFG (nicknamed “Stratus”) and the World Health Organization (WHO) designated it a “variant under monitoring” in late June. XFG is a subvariant of Omicron, of which there are now more than 1,000.

A “variant under monitoring” signifies a variant or subvariant which needs prioritised attention and monitoring due to characteristics that may pose an additional threat compared to other circulating variants.

XFG was one of seven variants under monitoring as of June 25. The most recent addition before XFG was NB.1.8.1 (nicknamed “Nimbus”), which the WHO declared a variant under monitoring on May 23.

Both nimbus and stratus are types of clouds.

Nimbus is currently the dominant subvariant worldwide – but Stratus is edging closer. So what do you need to know about Stratus, or XFG?

I like XFG better. The 'stratoshere' will never the same.

What happened to cumulonimbus?

https://www.who.int/docs/default-source/coronaviruse/25062025_xfg_ire.pdf?sfvrsn=fab54cd7_1

 

[OmCheeto]

One interesting tidbit I calculated a few days ago was that it will take the flu 35 years to kill as many people as Covid did over the last 5 1/2 years.

This is based on the flu killing an average of 35,000 people per year, and my current sum of 1.24 million Covid deaths.
The source of these numbers is the US CDC, so these numbers are for the U.S. only.

 

[Astronuc]

COVID cases are high in Texas, California, Oregon, Nevada, New Mexico and other states in the West and South Central part of the country.
https://thehill.com/homenews/nexsta...-is-spiking-again-especially-in-these-states/

(NEXSTAR) – The U.S. is seeing a late summer surge in COVID-19 cases, tracking from the Centers for Disease Control and Prevention shows.

The spike is particularly pronounced in one region of the country, which includes Arkansas, Louisiana, New Mexico, Oklahoma and Texas, where about 15% of COVID tests reported to the CDC are turning up positive.

But practically the entire Western country isn’t far behind. A dozen more states west of the Mississippi reported test positivity rates about 10% last week.

Edit/update: https://www.buzzfeed.com/jillianwilson/covid-surge-west-center-states

“We are seeing cases increase here in Houston, and in Texas, and if we look at the data that is available from [the Centers for Disease Control and Prevention], it certainly seems like the South Central US — Texas, New Mexico, Oklahoma, Arkansas, Louisiana — are seeing some of the higher test positivity rates in the in the country,” said Dr. S. Wesley Long, the medical director of diagnostic microbiology at Houston Methodist Hospital.

Seems to be spreading in major transportation hubs and high population density areas.

 

[OmCheeto]

Covid death rates have been rising exponentially for the last 8 weeks, with a doubling time of 5 weeks.
The latest number is ≈ 530 deaths per week. [reference]

Not sure if this is because of a new strain, or carelessness. The CDC posted a couple of days ago that childhood flu deaths have nearly doubled within the last few years, most likely due to lower and lower number of people vaccinating their children. [reference]

note: As usual, the graphs are of my own doing.