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REPORTABLE
IN THE SUPREME COURT OF INDIA
CIVIL APPELLATE JURISDICTION
CIVIL APPEAL NO. 4049 OF 2020
(arising out of SLP (C) No. 15293/2020 Diary No.
19638 of 2020)
DR. AKB SADBHAVANA MISSION
SCHOOL OF HOMEO PHARMACY ...APPELLANT(S)
VERSUS
THE SECRETARY,
MINISTRY OF AYUSH & ORS. ...RESPONDENT(S)
J U D G M E N T
ASHOK BHUSHAN, J.
The application seeking permission to file
special leave petition is allowed.
Leave granted.
2. This appeal has been filed by the appellant
Dr. AKB Sadbhavana Mission School of Homeo Pharmacy
aggrieved by the part of Division Bench judgment of
Kerala High Court dated 21.08.2020 passed in Writ
Petition (C) No.9459 of 2020. The appellant, who was
not party in the writ petition feeling aggrieved by
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certain directions issued by the High Court have come
up in this appeal.
3. We need to notice the contents and prayers of the
writ petition filed in the Kerala High Court by
respondent No.4 (proforma respondent). The writ
petition was filed by respondent No.4, an Advocate
praying for writ of Mandamus or for any other writ or
order directing the Secretary, Department of AYUSH,
Government Secretariat, Trivandrum to ensure that the
Homeopathic practitioners are immediately allowed to
perform in accordance with the Exhibit-P1
notification (Guidelines dated 06.03.2020 issued by
Secretary, Department of AYUSH (Ministry of Ayurveda,
Yoga & Naturopathy, Unani, Siddha, Sowa-Rigpa and
Homeopathy) (AYUSH, New Delhi).
4. The petitioner’s case in the writ petition is
that petitioner is an ardent admirer of the
Homeopathic medicine system, which system of medicine
in India is controlled and regulated by the Ministry
of AYUSH. The petitioner pleaded that to control the
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spread of Coronavirus (COVID-19), notification dated
06.03.2020 was issued by the Secretary, Ministry of
AYUSH to the Chief Secretaries of all States in which
notification, it was pointed out that interventions
under AYUSH systems have been varyingly used for
making an effective public health response in similar
situations faced in many States/Union Territories
earlier. The petitioner’s grievance was that State
of Kerala and the Secretary, Department of AYUSH,
Government Secretariat, Trivandrum did not take steps
to implement the advisory dated 06.03.2020 whereas
many other State Governments have taken steps much
earlier. The petitioner pleaded that Homeopathic
system would have been absolutely able to control the
spread of COVID-19 through its immunity boosting
medicines. Petitioner further stated in the writ
petition that if the Homeopathic medicines had been
distributed earlier in highly affected pockets and
particularly to those under isolation and quarantine,
the explosive situation had not happened, which has
happened in the State of Kerala. The only prayer
made in the writ petition are to the following
effect:-
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(i) To issue a Writ of Mandamus or any
other Writ or Order directing the
third respondent to ensure that the
Homeopathic practitioners are
immediately allowed to perform in
accordance with the Exhibit P-1
notification.
(ii) To grant such other reliefs as this
Honourable Court deems fit and
proper in the facts and
circumstances of the case.
5. The Division Bench of the High Court disposed of
the writ petition by judgment dated 21.08.2020. The
High Court in its judgment has extracted advisory
dated 06.03.2020 of the Government of India, Ministry
of AYUSH, the Government Order dated 08.04.2020 and
21.04.2020 issued by Government of Kerala and after
noticing the aforesaid, the High Court disposed of
the writ petition. In paragraphs 13 and 14 of the
judgment, the High Court has stated as follows:-
“13. It is the case of the petitioner that
Exhibit-P1 has not been implemented by the
State of Kerala, whereas it is the
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submission of learned Senior Government
Pleader that Government has approved the
action plan of Homeo Department for giving
Homeo medicines as prophylactic. However,
the target population was not intended to
include COVID-19 patients or their
contacts or those people, under
quarantine. Advisory of the Ministry of
AYUSH is being followed by the Government
and tablets are given free of cost to
those persons as immunity boosters. As per
the State Medical Protocol, COVID-19
affected persons should not be treated by
anybody other than the Government and
those authorised by the Government. As per
the medical protocol of the Government,
doctors practising in AYUSH medicines are
not supposed to prescribe any medicines,
stating that it is curative for COVID-19
disease. However, as per the advisory,
there is nothing prohibiting the qualified
medical AYUSH practitioners to prescribe
immunity booster mixture or tablets, as
suggested by the Ministry of AYUSH,
Government of India, New Delhi. When the
Central as well as State Governments have
approved prescription of certain mixtures
and tablets, as immunity boosters,
qualified medical practitioners in AYUSH
can also prescribe the same, but only as
immunity boosters.
14. We also make it clear that if any
qualified doctor practising AYUSH
medicine, makes any advertisement or
prescribes any drugs or medicines, as a
cure for COVID-19 disease, except those
specifically mentioned in Annexure-I
advisory to Exhibit-P1 D.O. letter dated
6.3.2020, it is open for the respondents
to take appropriate action under the
provisions of the Disaster Management Act,
2005, and the orders of the Governments,
both Central as well as the State, issued
from time-to-time. Only those tablets or
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mixtures shall be given as immunity
booster and not as cure for COVID-19.
AYUSH medical practitioners are further
directed not to violate the Government
Order dated 6.3.2020. In this regard,
Medical/Police Departments are also
directed to monitor the action of AYUSH
medical practitioners.
Writ petition is disposed of accordingly.”
6. The appellant, who was not party to the writ
petition, has filed this appeal and the reasons given
for filing this appeal by the appellant as stated in
paragraph 4 of the application seeking permission to
file special leave petition, are as follows:-
“4. It is respectfully submitted that the
Hon'ble High Court had not issued any
notice either to Ministry of AYUSH,
Government of India or to Homoeopathy
doctors or its organisation before passing
the impugned order. Homoeopathy Doctors
are treating all patients who come for
treatment. As is well known, most of the
Covid-19 patients, are asymptomatic and
therefore such blanket orders will cause
grave prejudice to the Homoeopathy
doctors, who treat the patients. The
direction to take action under the
Disaster Management Act is very harsh and
the said order has been passed without
hearing the doctors, who are affected by
such orders. The Writ Petition has been
filed by a lawyer, who is an ardent
follower of homoeopathy medicine. The
prayer was to implement the direction
passed by AYUSH on 06.03.2020. The Hon'ble
High Court unfortunately went beyond the
pleadings and made observations which will
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affect the profession of Homoeopathy
doctors. It is pertinent to mention here
that many of the State Governments have
been prescribing Homoeopathy medicines as
an immunity booster. Even the Health
Minister, Government of Kerala had given a
press statement that Homoeopathy medicines
are very good for prevention of Covid-19.
In the State of Gujarat, the Government
itself had prescribed the homoeopathy
medicines for its citizens.”
7. The appellant is aggrieved by the directions of
the High Court contained in paragraph 14 only. The
High Court in its judgment dated 21.08.2020 itself
has extracted the G.O. dated 21.04.2020 of the
Government of Kerala where Government of Kerala was
pleased to approve the action plan outlining the
Homeopathy Strategies for prevention and management
of COVID-19 in Kerala. It is now useful to refer to
the G.O. dated 21.04.2020, which has been quoted in
the impugned judgment, which is to the following
effect:-
“GOVERNMENT OF KERALA
Abstract
AYUSH Dept. – COVID-19 - Action Plan
outlining the Homeopathy Strategies for
Prevention, and Management of COVID-19 in
Kerala – Approved - Orders issued.
------------------------------------------
AYUSH(B) DEPARTMENT
8
G.O.(Rt)No.161/2020/AYUSH
Dated,
Thiruvananthapuram,
21/04/2020
------------------------------------------
Read:- 1. Letter No. DHTVM/2606/2019-P2
dtd. 13.04.2020 of the Director
of Homeopathy.
ORDER
In the circumstances explained by the
Director of Homeopathy vide letter read
above, Government are pleased to approve
the Action Plan outlining the Homeopathy
Strategies for prevention and management
of COVID-19 in Kerala as appended to this
order.
(By order of the Governor)
Bhooshan V.,”
8. We have heard Shri Venkita Subramoniam, learned
counsel for the appellant and Shri Tushar Mehta,
learned Solicitor General of India for the
respondent.
9. An affidavit has been filed on behalf of
Ministry of AYUSH to which rejoinder has also been
filed. The appellant being aggrieved only with
directions in paragraph 14 and no relief having been
claimed by the appellant against the State of Kerala,
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we have not issued notice to respondent Nos. 2 and 3
and we proceeded to decide this appeal after hearing
the learned counsel for the petitioner as well as
learned Solicitor General of India for the
respondent.
10. Learned counsel for the appellant contends that
the directions issued by the Division Bench of Kerala
High Court in paragraph 14 to take actions against
Homeopathic doctors, who prescribe any drug as a cure
for COVID-19 disease should be proceeded with under
the provisions of Disaster Management Act, 2005 was
uncalled for and beyond the scope of the writ
petition. Learned counsel submits that even the
Government of India advisory dated 06.03.2020
permitted COVID-19 like illness to be managed by
AYUSH systems. The advisory itself permits
Homeopathy to be used as preventive, prophylactic,
symptom management of COVID-19 like illnesses and add
on interventions to the conventional care. The High
Court has erred in confining right of Homeopathic
medical practitioners to prescribe only as immunity
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booster, which direction is not in accord to the
Guidelines dated 06.03.2020.
11. Learned counsel for the appellant submits that
guidelines for Homeopathic practitioners for COVID-19
has been issued by Government of India, Ministry of
AYUSH, which clearly permits medical practitioners,
which permission from local health authorities and
Medical Superintendent of the hospital to prescribe
medicines for COVID-19. When the guidelines issued
specifically permits treatment of COVID-19 patients,
the High Court erred in observing that Homeopathy
practitioners can only prescribe medicines as
immunity booster. It is submitted that the direction
issued by the High Court in paragraph 14 has made
vulnerable the Homeopathic practitioners from being
proceeded with under Disaster Management Act, 2005
and actions by police and other medical staff, which
is demoralising the practitioners of Homeopathy.
12. Shri Tushar Mehta, learned Solicitor General of
India appearing for Ministry of AYUSH, Government of
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India has submitted that Government of India keeping
in view the unprecedented and unforeseen precarious
situation caused by COVID-19, the Ministry of AYUSH
decided to augment and strengthen the COVID -19
medical response of the country by using the
traditional healthcare system of the country, which
includes AYUSH Organisation, Homeopathic practices as
well as Unani practices. Learned Solicitor General
of India has referred to advisory dated 06.03.2020,
which covers the field and he has also referred to
the guidelines issued by Government of India. Shri
Mehta has referred to the affidavit filed on behalf
of Ministry of AYUSH. He submits that Homeopathy
practitioners are permitted by the Ministry of AYUSH
to prescribe medicines as (i) preventive and
prophylactic; (ii) symptom management of COVID-19;
(iii) add on interventions to the conventional care.
13. We have considered the submissions of the learned
counsel for the parties and have perused the records.
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14. The advisory dated 06.03.2020 issued by the
Ministry of AYUSH has been relied by the learned
counsel for the appellant as well as learned
Solicitor General and was also extensively extracted
by the High Court in its judgment. The advisory
dated 06.03.2020 contains the object of AYUSH
systems. It is useful to extract following (relevant
of Homeopathic only), which is part of advisory dated
06.03.2020:-
“i. Preventive and prophylactic:
xxxxxxxxxxxxxx
Homoeopathy:
Arsenicum album 30, daily once in empty
stomach for three days. The dose should be
repeated after one month by following the
same schedule till Coronavirus infections
prevalent in the community.
In one of the studies Arsenic album as one
of the constituents in a formulation
affected HT29 cells and human macrophages.
Also, it showed SNF-KB hyperactivity
(reduced expression of reporter gene GFP
in transfected HT29 cells), tTNF-a release
in macrophages. More over, Arsenic album
is a common prescription in the cases of
respiratory infections in day to day
practice.
ii. Symptom management of COVID-19 like
illnesses
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xxxxxxxxxxxxxx
Homoeopathy
Various medicines which found to be
effective in treating flu like illness are
Arsenicum album, Btyonia alba, Rhus toxico
dendron, Belladonna Gelsemium Eupatorium
perfoliatum. All these medicines should be
taken in consultation with qualified
physicians of respective AYUSH systems.
iii. Add on Interventions to the
conventional care
xxxxxxxxxxxxxx
Homoeopathy
Medicine mentioned Symptom management of
COVlD-19 like illnesses under subhead
Homoeopathy can also be given as add on to
conventional care.
All these medicines should be taken in
consultation with qualified physicians of
respective AYUSH systems.
15. The above clearly indicate that Ministry of AYUSH
specifically permits use of Homeopathy for following
three ways:-
(i) Preventive and prophylactic;
(ii) Symptom management of COVID-19 like illness;
(iii) Add on interventions to the conventional
care.
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16. We may further notice the specific averments made
by Ministry of AYUSH in its affidavit dated
23.11.2020 regarding what is permitted to the
Homeopathy Medical Practitioner as per Ministry of
AYUSH. Paragraph 16 of the affidavit sworn on behalf
of the Ministry of AYUSH is as follows:-
“16. In addition to the above, it is
respectfully reiterated that Ministry of
AYUSH has clearly permitted the
homeopathic medical practitioners to
prescribe the chugs, as mentioned in the
guidelines, as an add-on drug to the
conventional treatment for patients who
have been tested Covid positive and are
undergoing conventional treatment.
Thus in the respectful submission of
the answering respondent, prescription of
the medication prescribed by the Ministry
of AYUSH to Covid positive patients as an
add-on treatment is permitted, and
therefore, any contention to the contrary
stating that homeopathic medical
practitioner cannot prescribe any
treatment to Covid-19 positive patients,
even as an add-on to conventional
treatment is liable to be rejected. It is
stated that the only embargo is that the
said Medicines should not be administered
or advertised as a cure but should be
administered as preventive
measure/immunity booster or as an add-on
to the conventional treatment.”
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17. It is clear from the advisory dated 06.03.2020
and the specific stand taken by the Ministry of AYUSH
as contained in paragraph 16 extracted above that
Homeopathic medical practitioners are not only
confined to prescribe Homeopathic medicines only as
immunity booster. The following observations in
paragraph 13 by the High Court does not correctly
comprehend the guidelines dated 06.03.2020:-
“13. ……………………………………When the Central as
well as State Governments have approved
prescription of certain mixtures and
tablets, as immunity boosters, qualified
medical practitioners in AYUSH can also
prescribe the same, but only as immunity
boosters.”
18. The High Court in the impugned judgment has
emphasised that if any qualified doctor practising
AYUSH medicine, makes any advertisement or prescribes
any drugs or medicines, as a cure for COVID-19
disease, except as prescribed in letter dated
6.3.2020, it is open to the authorities to take
appropriate action under the provisions of the
Disaster Management Act, 2005. Insofar as
advertisement by Homeopathic practitioners is
concerned, i.e., clearly prohibited by the
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regulations framed in Section 33 read with Section 24
of Homeopathy Central Council Act, 1973 namely the
Homeopathic Practitioners (Professional Conduct,
Etiquette and Code of Ethics) Regulations, 1982. The
Regulation 6 prohibits advertisement for solicitation
of patients personally or advertisement in the
newspaper by the Homeopathic practitioners.
Regulation 6 is to the following effect:-
“6. (1) Advertising
Solicitation of patients directly or
indirectly by a practitioner of
Homoeopathy either personally or by
advertisement in the newspapers, by
placards or by the distribution of
circular cards or handbills is unethical.
A practitioner of Homoeopathy shall not
make use of, or permit others to make use
of, him or his name as a subject of any
form or manner of advertising or publicity
through lay channels which shall be of
such a character as to invite attention to
him or to his professional position or
skill or as would ordinarily result in his
self-aggrandisement provided that a
practitioner of Homoeopathy is permitted
formal announcement in press about the
following matters, namely :-
(i) the starting of his practice;
(ii) change of the type of practice;
(iii) change of address;
(iv) temporary absence from duty;.
(v) resumption of practice
(vi) succeeding to another's practice.
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(2) He shall further not advertise himself
directly or indirectly through price lists
or publicity materials of manufacturing
firms or traders with whom he may be
connected in any capacity, nor shall he
publish cases, operations or letters of
thanks from patients in non-professional
newspapers or journals provided it shall
be permissible for him to publish his name
in connection with a prospectus or a
director's or a technical expert's
report.”
19. When statutory regulations itself prohibit
advertisement, there is no occasion for Homeopathic
medical practitioners to advertise that they are
competent to cure COVID-19 disease. When the
Scientists of entire world are engaged in research to
find out proper medicine/vaccine for COVID-19, there
is no occasion for making any observation as
contained in paragraph 14 with regard to Homeopathic
medical practitioners. The homeopathy does not cure
the disease, but it cures the patients.
20. We have already noticed that the writ petition,
which was filed in the Kerala High Court only with a
limited relief for issuing direction to respondent to
implement the advisory dated 06.03.2020 issued by
Ministry of AYUSH, there was no occasion for High
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Court to make observations and issue direction as it
has been made in paragraph 14.
21. We, however, make it clear that what is
permissible for Homeopathic medical practitioner in
reference to COVID-19 symptomatic and asymptomatic
patients is already regulated by the said advisory
and guidelines. The Government of India, Ministry of
AYUSH has also brought on record the guidelines
issued subsequent to 06.03.2020 for Homeopathy
medical practitioners for COVID-19, where Homeopathic
approach to COVID-19 has been elaborately dealt with.
The said guidelines, which has been issued after
04.04.2020 has been brought on the record as Annexure
C by the Ministry of AYUSH. The guidelines contained
following under the heading “Homeopathic approach”-
“Homoeopathic Approach
It is advised that before taking up for
homoeopathic medicines for prophylaxis,
Amelioration and mitigation, physician
must acquaint himself of above sections.
In case of epidemics or pandemics, first
approach is to follow preventive measures
and educate people about general measures
and to provide such interventions which
will keep their immunity enhanced.
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Homeopathy therefore recommends issuing of
public notice for Genus epidemics
identified by the designated experts for
immunity enhancement and practitioners may
suggest the same to the people and as per
the Advisory issued by Ministry of
AYUSH(6).
Second approach is to provide homoeopathic
symptomatic mitigation to affected
persons. Homoeopathic medicines are also
useful in the treatment of communicable
diseases like Influenza Like Illness(7)
(8), dengue(9), acute encephalitis
syndrome(10). Several studies are also
published which shows the immune
modulatory potential of homoeopathic
medicines in preclinical studies (11) (12)
(13) (14) (15) (16). These medicines can
be prescribed in an integrated manner or
standalone depending on the severity on a
case to case
Therapeutic Aid
As a system with wholistic approach
medicine were selected based on the
presenting signs and symptoms of each
patients (17) (18) (19) (20). The
medicines given here are suggestive based
on their use and studies in the past in
diseases of similar presentation like
COVID-19 (21) (22) (23). Patients of
COVID-19 are to be treated with adjuvant
Homoeopathic medicines with the permission
from local health authorities and Medical
Superintendent of the Hospital.
Homoeopathic doctors must follow all
preventive measures (using PPEs) as are
required for dealing with COVID 19
patients.
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The remedies according to different stages
of disease are given below:
Mild Disease (Symptomatic Amelioration and
Mitigation Approach):
Medicines like Aconite napellus, Arsenicum
album, Bryonia alba, Gelsemium
sempervirens, Rhus tox. Eupatorium
perfoliatum, Ipecacaucunha, Belladonna,
Camphora, may be used depending upon the
symptoms similarities.
Severe disease but not in critical
condition:
It is defined by following criteria
(Dyspnoea, respiratory frequency ≥ 30/min,
blood oxygen saturation (SpO2) ≤ 93%,
PaO2/FiO2 ratio < 300, and/or lung
infiltrates > 50% within 24 to 48 hours)/)
Suggested medicines are as adjuvant to
Standard Management guidelines in the
hospital setting only with the
approval of authorities and
willingness of the patient/guardian.
The prescription is to be given only
by institutionally qualified
practitioner.
Medicines like Phosphorus,
Chelidonium, Veratrum Viride, Iodum,
Camphora, Cinchona officinalis,
Lycopodium, Ars. iod., Antim ars.,
Stannum met, Carbo veg., can be
prescribed on symptomatic indication.
Posology
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The medicine selected for each patient is
tailored to person specific, taking into
consideration, his/her mental make-up,
physical symptoms, and characteristic
particulars etc. In case of long term
illness, besides the above mentioned
factors, age, occupation, previous
illnesses and life circumstance unique to
that individual irrespective of the
disease which he/she is suffering from,
are also taken into consideration; thus
the dictum “Homoeopathy treats the patient
but not the disease”.
After the appropriate medicine is
selected, it is essential to decide the
requisite potency, dose and repetition
which is imperative for optimum response
and faster recovery in each case.
Different types of potencies such as
decimal or centesimal potencies can be
employed for treatment as are required for
acute diseases. However, selection of
potency of the remedy is dependent on
various factors like susceptibility of the
patient (high or low), type of disease
(acute/chronic), seat/ nature and
intensity of the disease, stage and
duration of the disease and also the
previous treatment of the disease(24).”
22. The above guidelines make it clear that
Homeopathy has been envisaged by the Ministry as the
therapeutic aid.
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23. The above guidelines refer to Homeopathy
medicines as medicines for prophylaxis, Amelioration
and mitigation. The guidelines, however,
specifically provides that “the prescription has to
be given only by institutionally qualified
practitioners”. The High Court in its impugned
judgment has not fully comprehended the guidelines
dated 06.03.2020 and taking a restricted view of the
guidelines and have made observations for taking
appropriate actions against the Homeopathic medical
practitioners, which cannot be approved. The High
Court, however, is right in its observation that no
medical practitioner can claim that it can cure
COVID-19. There is no such claim in other therapy
including allopathy. The High Court is right in
observing that no claim for cure can be made in
Homeopathy. The Homeopathy is contemplated to be
used in preventing and mitigating COVID-19 as is
reflected by the advisory and guidelines issued by
the Ministry of AYUSH as noticed above.
24. We, thus, observe that directions issued by the
High Court in paragraph 14 of the judgment need to be
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modified to the extent as indicated above. It goes
without saying that Homeopathic medical practitioners
have to follow the advisory dated 06.03.2020 issued
by AYUSH Ministry as well as guidelines for
Homeopathic medical practitioners for COVID-19 issued
by Government of India, Ministry of AYUSH, as noted
above. The Civil Appeal is disposed of accordingly.
The interlocutory applications filed seeking
permission for impleadment is rejected.
......................J.
( ASHOK BHUSHAN )
......................J.
( R. SUBHASH REDDY )
......................J.
( M.R. SHAH )
New Delhi,
December 15, 2020.
