The "substantial" nature is questionable. See, for example, the correction issued by the Mississippi Department of Health: https://msdh.ms.gov/msdhsite/_static

The "substantial" nature is questionable. See, for example, the correction issued by the Mississippi Department of Health: https://msdh.ms.gov/msdhsite/_static/resources/15400.pdf https://msdh.ms.gov/msdhsite/_static/resources/15400.pdf