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Coronavirus Those who ignore history are doomed to repeat it

#461 User is offline   y66 

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Posted 2020-April-25, 07:53

Damien Cave at NYT: Vanquish the Virus? Australia and New Zealand Aim to Show the Way

Quote

It all started with scientists. In Australia, as soon as China released the genetic code for the coronavirus in early January, pathologists in public health laboratories started sharing plans for tests. In every state and territory, they jumped ahead of politicians.

“It meant we could have a test up and running quickly that was reasonably comparable everywhere,” Dr. Collignon said.

The government then opened the budgetary floodgates to support suffering workers and add health care capacity. When infections started climbing, many of the labs and hospitals hired second and third rounds of scientists to help.

That collaboration set the tone. Many of the state and local task forces spurred on by Mr. Morrison’s early action have stayed in constant contact, drawing in academics who independently started to model the virus’s spread. Their findings, hashed out by email, text or group calls, have been funneled up to national decision makers.

The newly formed national cabinet has delivered a surprising level of consensus for a country with a loose federal system subject to high levels of discord among state premiers, whose roles and powers resemble those of American governors.

In late March, for example, Mr. Morrison announced an agreement to severely tighten restrictions, banning international travel and telling all Australians not working in essential services to stay home. Though there was some divergence, mostly over schools, state leaders expressed bipartisan support and have held the line even as case numbers plummeted.

In New Zealand, public health experts pushed for an even bolder move.

Dr. Michael Baker, a physician and professor at the University of Otago in Wellington, became a prominent voice outside the government pushing for elimination of the virus, not just its suppression.

He argued that New Zealand, an island nation with a limited number of cases, should think of the virus more like measles than influenza — something that should be made to disappear, with rare exceptions.

“The modelers said we had to go into lockdown for two months to have a high probability of eliminating it entirely,” he said. “You have to wait until the numbers are very low so you have the ability to stamp out an outbreak if it occurs.”

Worrying that the virus would spread too rapidly, Dr. Baker said he was racked with anxiety in the first few weeks after the initial case appeared in New Zealand. “We were on a knife’s edge,” he said. “Would we commit?”

Ms. Ardern announced on March 23 that the country would aim for elimination. Critics questioned whether it was possible, noting that there might be too many asymptomatic cases to guarantee elimination.

Dr. Baker responded by citing Taiwan, which has contained the outbreak to a point where socially distanced normal life has returned on a densely packed set of islands with over 23 million people.

“It’s a matter to get all the systems working,” Dr. Baker said. “The borders, the contact tracing, the testing, the surveillance.”

Quote

“This is certainly distinct from the United States,” said Dr. Peter Collignon, a physician and professor of microbiology at the Australian National University who has worked for the World Health Organization. 

If you lose all hope, you can always find it again -- Richard Ford in The Sportswriter
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#462 User is offline   Winstonm 

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Posted 2020-April-25, 10:04

View Posty66, on 2020-April-25, 07:53, said:



Quote

“This is certainly distinct from the United States,” said Dr. Peter Collignon, a physician and professor of microbiology at the Australian National University

Yippie-Ky-A says tough-guy U.S.

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#463 User is offline   Winstonm 

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Posted 2020-April-25, 10:15

View Postpescetom, on 2020-April-23, 15:44, said:

This isn't something really new, medics in Italy commented on it a month ago.
The massive inflammation caused by the virus impact lungs directly but also blood, abnormal pressure and clotting can complicate pneumonia and also cause death in other ways.


I'm not sure if this increase in strokes in middle-aged and asymptomatic people is widely known, at least not in the U.S.

Quote

Now for the first time, three large U.S. medical centers are preparing to publish data on the stroke phenomenon. The numbers are small, only a few dozen per location, but they provide new insights into what the virus does to our bodies.

"Injustice anywhere is a threat to justice everywhere."
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#464 User is offline   FelicityR 

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Posted 2020-April-25, 11:08

View PostWinstonm, on 2020-April-25, 10:15, said:

I'm not sure if this increase in strokes in middle-aged and asymptomatic people is widely known, at least not in the U.S.




Surprisingly, inflammation of the sinuses (sinusitis) can lead to a stroke for many younger people. And whilst coronavirus doesn't directly cause sinus problems - as far as I am aware - given that the pathogen is air-based, it's probable it is contributing to strokes in a similar way. Even general inflammation in the body can lead to strokes, and we are now aware that younger healthy patients have been subject to cytokine storms as a result of contracting covid-19.
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#465 User is offline   Winstonm 

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Posted 2020-April-25, 12:22

View PostFelicityR, on 2020-April-25, 11:08, said:

Surprisingly, inflammation of the sinuses (sinusitis) can lead to a stroke for many younger people. And whilst coronavirus doesn't directly cause sinus problems - as far as I am aware - given that the pathogen is air-based, it's probable it is contributing to strokes in a similar way. Even general inflammation in the body can lead to strokes, and we are now aware that younger healthy patients have been subject to cytokine storms as a result of contracting covid-19.


In the article a surgeon is said to have observed multiple clot formation in the brain as he was removing a larger one.


Quote

As Oxley, an interventional neurologist, began the procedure to remove the clot, he observed something he had never seen before. On the monitors, the brain typically shows up as a tangle of black squiggles — “like a can of spaghetti,” he said — that provide a map of blood vessels. A clot shows up as a blank spot. As he used a needlelike device to pull out the clot, he saw new clots forming in real-time around it.

“This is crazy,” he remembers telling his boss.


The thrust of these articles is that Covid-19 affects multiple organs and is not simply a respiratory virus.

https://www.washingt...3571_story.html

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#466 User is offline   FelicityR 

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Posted 2020-April-26, 15:03

I'm surprised - well, I haven't been able to find any journalist who has speculated thus - on whether Boris Johnson's own personal experience with being ill with coronavirus, including hospital treatment and prolonged recuperation, will effect how he now views the UK's own covid-19 epidemic. The Sunday online papers just basically indicated he will be back at the helm soon, and it's been confirmed that he is already back at 10 Downing Street as I write.

There was a feeling amongst many people in the UK that without Mr Johnson the government went into the doldrums, repeating basic diktats that the public must obey during the lockdown. The Conservatives, despite their daily briefings with Cabinet figures, seemed rudderless without Johnson.

However, I wonder if what has happened to him will change the course of the future policies of controlling this epidemic. Yes, he will still have senior politicians and scientists to advise him, and Boris Johnson has always been a bullish character, but I have a gut feeling that he's now going to err on the side of caution, having experienced the epidemic on the front line himself.

There's an undercurrent of feeling in this country that if we can't get the country back on its feet quickly, both the general public and the financial sector will suffer enormously. Already there has been a human cost beyond coronavirus with many hospital appointments and treatments for ill patients, including those with cancer, cancelled.

I have spoken to quite a few people over the past few weeks, and many of the younger ones are worried about debt, (un)employment, rising costs, etc. in a country where people have taken on large debts already to maintain a reasonable standard of living.

The fallout from what happens next could be far worse than what has happened in the previous three months. It will take time to restart all aspects of society, I feel, and despite the best efforts of the Boris Johnson and the government, whatever they decide, it's going to a long road of recovery for many people probably for many years to come.
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#467 User is offline   PeterAlan 

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Posted 2020-April-26, 21:06

View PostFelicityR, on 2020-April-26, 15:03, said:

I'm surprised - well, I haven't been able to find any journalist who has speculated thus - on whether Boris Johnson's own personal experience with being ill with coronavirus, including hospital treatment and prolonged recuperation, will effect how he now views the UK's own covid-19 epidemic.

Andrew Rawnsley wrote this piece on Sunday for The Observer's / Guardian's website (and presumably the print edition). I expect there will be others to be found.
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#468 User is offline   FelicityR 

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Posted 2020-April-26, 21:46

View PostPeterAlan, on 2020-April-26, 21:06, said:

Andrew Rawnsley wrote this piece on Sunday for The Observer's / Guardian's website (and presumably the print edition). I expect there will be others to be found.


Thank you, Peter. I read the Guardian (amongst others) online but completely missed this :( (How? Goodness only knows.)
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#469 User is online   Cyberyeti 

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Posted 2020-April-27, 02:32

I wonder what people make of this article, I've not come across the source before this, but it adds a perspective I haven't seen so far:

https://thebulwark.c...Z8msT4Weg7jg0uQ
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#470 User is offline   hrothgar 

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Posted 2020-April-27, 05:15

View PostCyberyeti, on 2020-April-27, 02:32, said:

I wonder what people make of this article, I've not come across the source before this, but it adds a perspective I haven't seen so far:

https://thebulwark.c...Z8msT4Weg7jg0uQ


I think that it is well considered

I think that there is a lot of wishful thinking going on
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#471 User is offline   FelicityR 

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Posted 2020-April-27, 05:35

View PostCyberyeti, on 2020-April-27, 02:32, said:

I wonder what people make of this article, I've not come across the source before this, but it adds a perspective I haven't seen so far:

https://thebulwark.c...Z8msT4Weg7jg0uQ


Yes, it is a very considered piece of journalism. Not scaremongering but stating the facts. However, I have a feeling once the lockdown is over for most life has to go on. Pockets of coronavirus out there or not.

The Dalai Lama said something along the lines of "Choose to be an optimist. It feels better." Did people stop flying due to 9/11? For a short time after they did, but gradually with all the safeguards now at the airports they came back.

I know coronavirus is different. But there will be safeguards in place initially. Every country will have to adapt: that's saying the obvious. Two World Wars didn't extinguish the human spirit. People will suffer due to coronavirus even after the lockdown is lifted, and perhaps for years after, that's a fact. But it's happening all around the world.

This is a time for world leaders to be united to get the world back on its feet. If the politics of jealousy, envy, division and hate get in the way then we have no hope. Let's hope it's a new beginning, not the beginning of the end.
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#472 User is offline   cherdano 

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Posted 2020-April-27, 06:39

The problem is - if enough of the normal life resumes to bring R back to, say, 1.5 then it will only be a matter of time unless the health system gets overwhelmed and we get new records of daily recorded deaths again, and there is no choice but to implement another lockdown. The main difference will be that a larger share of the public won't support the second lockdown.

I think the only viable strategy is
  • continue the lockdown as long as is politically feasible, to bring the number of currently infectious people down to a low number, and then
  • do EVERYTHING that helps bring down R in period after that:
    • Test test test, espcially those who would come in contact with many people in their life: any form of carers (doctors, nursers, carehome workers, homecare workers), grocery workers, hair dressers once hair salons are set to reopen, bus drivers, police officers, ...
    • do EVERY form of contact tracing - app-based (but PLEASE follow the apple/google model with minimal privacy invasions - more people signing up is more important than giving government more control, even if you don't care at all about the civil liberties implications; meanwhile, do ANYTHING that can entice people to sign up for them, e.g. by giving preferential access to testing), traditional test-and-contact-tracing
    • require/strongly advise mask-wearing by the general public in any public setting
    • offer publicly administered quarantine setting for anyone who thinks they are infectious and doesn't want to transmit it to the rest of their household

  • gradually reopen things as long as the data makes clear we keep R at or below 1.


E.g. say you think mask-wearing reduces the transmission probability only by 10%? Well, I think that's great news, it means just this comparatively unobtrusive measure brings us roughly 1/9th of the way from R = 2.6 to R = 1. Or, you think it won't help because the general public won't wear them properly? Ok, then let's spend BILLIONS on an education campaign on how to use them (helping newspapers stay afloat as a side effect can only be a good thing). A contact-tracing app for which only 40% sign up won't do much, as roughly only 0.4*0.4 = 16% of all transmissions will be caught (when both sides are using the app)? Well, 16% still helps!

Any 10% reduction of R is currently done via an enormous self-harm to the economy. Replacing that with an expensive and annoying public health intervention affecting everyone is a GREAT tradeoff.
The easiest way to count losers is to line up the people who talk about loser count, and count them. -Kieran Dyke
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#473 User is offline   kenberg 

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Posted 2020-April-27, 07:05

View PostCyberyeti, on 2020-April-27, 02:32, said:

I wonder what people make of this article, I've not come across the source before this, but it adds a perspective I haven't seen so far:

https://thebulwark.c...Z8msT4Weg7jg0uQ


The article's point: The government might/will ease restrictions, but people will still be cautions. I have thought exactly that for some time.


Yesterday we had a Zoom session with grandkids in Oregon. Not long ago we planned to fly out there for a visit, that plan has been indefinitely postponed. And we will use our judgment on this long after government restrictions are softened.

My younger daughter owns and runs a boarding kennel for dogs (and the occasional cat etc). There are various reasons to board a dog, but often it is because the owner is travelling. I would love to think that her business will soon return to normal but realism suggests otherwise.

These are personal items, but I think that the effect of many such personal choices is what the article was getting at . Across the nation/world, individuals are going to be making choices and it will have a substantial long term economic effect. The government can tell us not to attend large gatherings and can pretty much enforce the rule. When the government ends the prohibition many people will still opt for caution.

This all seems obvious to me. Of course my choices, being 81, might well differ from the choices of someone who is 30. But there are a fair number of us oldies, and even youngies might be cautious.
Ken
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#474 User is online   Cyberyeti 

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Posted 2020-April-27, 07:13

View Postkenberg, on 2020-April-27, 07:05, said:

Of course my choices, being 81, might well differ from the choices of someone who is 30. But there are a fair number of us oldies, and even youngies might be cautious.


I'm 55. The case that really concerns me is the one of the Romanian woman in Italy that's tested positive continuously for 8 weeks so far. I have colds that can last a year. My immune system has handled viruses strangely ever since I got virally induced ME. Being infectious and completely locked down for a long period is something I really don't want to contemplate.
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#475 User is offline   FelicityR 

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Posted 2020-April-27, 08:59

View Postcherdano, on 2020-April-27, 06:39, said:

I think the only viable strategy is...


...for this government to put some concrete proposals forward, as you have done cherdano. Well done. It's the procrastinating and keeping us all in the dark that is now making things worse. Even if they have to move the goalposts as things develop, it's better to have something on the table than nothing at all.

What could well happen is that the lockdown will be slowly eroded by civil disobedience if people cannot see a way forward. Giving the general public a specific road map will inspire confidence. Trotting out the same tired excuses and explanations is beginning to grate. Treating us all as if we are part of a 'Nanny State' is both insulting and unproductive. Most people will take responsibility for their actions: it's only the minority out there who are ruining it for the majority.

It's about time the Police and the Courts concentrated their efforts on fining heavily those idiots who disobey the covid-19 lockdown rules wholesale. Paltry fines and verbal warnings are just not effective. We all have enough time to take on board the restrictions that are in place. They are in place for a very good reason. Those that want to disobey them should be held to account.
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#476 User is online   Cyberyeti 

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Posted 2020-April-27, 09:08

View PostFelicityR, on 2020-April-27, 08:59, said:

...for this government to put some concrete proposals forward, as you have done cherdano. Well done. It's the procrastinating and keeping us all in the dark that is now making things worse. Even if they have to move the goalposts as things develop, it's better to have something on the table than nothing at all.



This has been a problem with British politics for a while. It has been seen as more of a crime to change your mind than to carry on with the wrong plan. Corbyn always criticised a U-turn, even when it ultimately came up with the right idea.
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#477 User is offline   pescetom 

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Posted 2020-April-27, 12:39

Today's statistics in Italy: positive 105813 (+1.6%), dead 26977 (+1.2%), no longer infected 66624 (+2.5%). Intensive care 1956 (-3%). Fatality rate 20.3%.
So back at least for a day to significant growth in positives, but intensive care continues to empty.

Yesterday the PM announced the measures for phase 2, inevitably controversial. Those of us who would settle for being able to go for a run or a ride are content, those who hoped to go to the seaside or to open their shop are not. Incredibly for Italy, the church did not get its way. Bridge wasn't even discussed.
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#478 User is offline   johnu 

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Posted 2020-April-27, 14:29

View PostCyberyeti, on 2020-April-27, 07:13, said:

I'm 55. The case that really concerns me is the one of the Romanian woman in Italy that's tested positive continuously for 8 weeks so far. I have colds that can last a year. My immune system has handled viruses strangely ever since I got virally induced ME. Being infectious and completely locked down for a long period is something I really don't want to contemplate.

What is unknown about COVID-19 is frightening. Many of the Wuhan survivors are retesting positive after testing negative, and some are like your example who continue to test positive. Is there a problem with the tests that in some circumstances the wrong result is returned. Are the people who are still testing positive actually infected and capable of spreading the virus, are survivors getting reinfected, or are survivors not getting rid of absolutely 100% of the virus and then the virus regains strength and reinfects them???
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#479 User is offline   y66 

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Posted 2020-April-27, 16:48

James Paton at Bloomberg (April 27, 2020, 11:52 AM EDT)

https://www.bloomber...y?sref=UHfKDqx7

Quote

A vaccine to halt the coronavirus pandemic could be available as early as this year for vulnerable groups such as health-care workers, even faster than initially thought, according to a key group at the heart of the global development effort.

The Coalition for Epidemic Preparedness Innovations, which is funding nine different coronavirus vaccine projects, has previously suggested a shot could be ready within 12 to 18 months, an already ambitious target. That assessment didn’t account for the possibility of companies working closely together to accelerate the process, faster enrollment in human trials and other factors, according to Richard Hatchett, the head of the Oslo-based organization.

“These are all things we are looking at now as potential opportunities to perhaps deliver vaccines even faster than the 12 to 18 months we were discussing,” he said on a call Monday.

As the number of coronavirus infections globally nears 3 million, the pressure is growing to come up with therapies and vaccines to combat the contagion. Dozens of companies around the world are pursuing a vaccine, among them Sanofi, Johnson & Johnson and Moderna Inc.

A University of Oxford team led by Sarah Gilbert, a professor of vaccinology, has begun trials of a potential vaccine and aims to get efficacy results as soon as September. Manufacturing is already underway.

Caution Urged

Some experts have called for caution, noting that most vaccines go through years of tests before they hit the market, and that 12 to 18 months would be extraordinarily fast. The coronavirus shots moving most rapidly are made with new technologies that have never proven useful in humans.

Hatchett said he doesn’t want to overpromise, but several vaccines backed by CEPI may enter a second phase of testing as soon as late spring or this summer. That means the first could become available in 2020 if they prove to be safe and effective, probably on an emergency-use basis. In that scenario, they might be accessible only to certain at-risk populations before being deployed more widely.

Developers are mindful of examples in the past where rapid vaccine development “unfortunately led to bad outcomes,” he said. “We take it with the utmost seriousness. We cannot cut corners. It’s absolutely critical that we ensure safety and efficacy.”

With experimental vaccines progressing, governments and health groups are turning to the challenge of producing enough doses to meet global demand and ensuring that shots are distributed equitably. The coalition wants to set up manufacturing in every region of the world and has been talking with other groups including Gavi, the Vaccine Alliance, which helps developing countries finance and distribute vaccines.

“Given the economic disruption that is caused by the pandemic and the global interconnectedness of the economy, if we don’t address the pandemic everywhere, we will still be at risk,” Hatchett said.

Global Coordination

The head of Sanofi, Paul Hudson, raised questions last week about Europe’s ability to manufacture enough doses and said the U.S. may be in a position to vaccinate first, thanks to the Biomedical Advanced Research and Development Authority, a government agency that backs vaccine development.

“We should really have a global perspective and make sure we don’t end up limiting the access because it’s produced in certain countries,” Erna Solberg, Norway’s prime minister, said on the call with CEPI’s head.

CEPI has secured commitments for about half of the $2 billion it estimates will be needed to develop the vaccines, and it may invest in 15 or more programs, Hatchett said.

The coalition is partnering with companies including Moderna and Inovio Pharmaceuticals Inc., along with institutions such as Oxford and the University of Queensland in Australia.


Note: The Coalition for Epidemic Preparedness Innovations was founded by the Wellcome Trust and by the Bill and Melinda Gates Foundation.
If you lose all hope, you can always find it again -- Richard Ford in The Sportswriter
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#480 User is offline   FelicityR 

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Posted 2020-April-28, 00:39

View Postjohnu, on 2020-April-27, 14:29, said:

What is unknown about COVID-19 is frightening. Many of the Wuhan survivors are retesting positive after testing negative, and some are like your example who continue to test positive. Is there a problem with the tests that in some circumstances the wrong result is returned. Are the people who are still testing positive actually infected and capable of spreading the virus, are survivors getting reinfected, or are survivors not getting rid of absolutely 100% of the virus and then the virus regains strength and reinfects them???


I read a case yesterday of a woman who still tested positive after 55 days. Though I haven't read of any of the re-tested positives displaying a new set of symptoms - please correct me if you have read otherwise. We still do not understand covid-19 and how the virus undergoes change within the body. Given that some of the tests have been faulty - as you said - that could be the reason. I'm not surprised though. The word 'lingering' does crop up regularly within the health service. It does make some sense as general winter flu can go for months, especially in older people. They go through the worst of the symptoms for a couple of weeks but the milder symptoms stay with them for a few months, sometimes until the warmer weather.

Winter flu is a virus, too. Maybe covid-19 lingers in some patients in the same way. The body cannot fight it off entirely but it is controlled as the body has now produced enough antibodies to keep the virus in check.
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