Coronavirus Tidbits #179 2/13/21

Announcements:

First, there is now a Resources Page here for the most commonly asked questions I'm getting.

Happy to continue to answer your questions/concerns as best I can, so don't be shy about that.

New posts:

Bans On Mask Mandates To Protect Against Covid Endanger Students With Disabilities

https://www.forbes.com/sites/judystone/2022/02/06/bans-on-mask-mandates-to-protect-against-covid-endanger-students-with-disabilities/?sh=67b5d02d6d2f

 

News 

Omicron news:

A coronavirus variant once helped the global pork industry. Could one protect us?

A killer pig virus vanished when a tamer mutant evolved—a provocative, but not perfect, parallel with Omicron

Science 4 FEB 2022 BYJON COHEN

Long before COVID-19 became a household word—in 1946, to be precise—veterinary researchers at Purdue University reported that something invading the guts of young pigs was causing diarrhea, vomiting, and weight loss, ultimately killing most of them. The scientists did not know the cause of the sickness, which devastated U.S. pig farms, but they could trigger the disease by feeding ground-up bits of a sick pig’s guts to healthy piglets. This pig farmers’ nightmare, in time, proved to be a coronavirus, which was named transmissible gastroenteritis virus (TGEV).

To this day, TGEV has never harmed a human, and its relationship to SARS-CoV-2, the driver of COVID-19, is distant. But after spreading around the world through the 1970s, TGEV took a strange turn: The disease it caused basically vanished when a TGEV variant that was even more transmissible, but less harmful, essentially immunized pigs against the original virus. “The very best coronavirus vaccine was done by nature,” says Stanley Perlman, a veteran coronavirus researcher at the University of Iowa.

TGEV’s fate was unraveled years ago, but it has recently had some researchers wondering whether the latest SARS-CoV-2 variant of concern, Omicron, might produce a similar plot twist in the ongoing human pandemic. Omicron is causing far too much severe disease and death to celebrate it as a savior—last week, it had a higher daily death toll in the United States than the Delta variant at its peak. But some suspect it, too, will turn out to be a “natural vaccine” against more pathogenic strains.

https://www.science.org/content/article/coronavirus-variant-once-helped-global-pork-industry-could-one-protect-us

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Previous COVID infection may confer 56% protection against reinfection

A study in Qatar estimates that previous COVID-19 infection imparts 56% protection against future symptomatic infection caused by the highly transmissible Omicron variant, down from about 90% for other SARS-CoV-2 strains.

The study, published yesterday in the New England Journal of Medicine (NEJM), was led by researchers at Weill Cornell Medicine–Qatar in Doha.

The team extracted data on COVID-19 testing, vaccination, clinical infections, outcomes, and demographics from national databases amid the Omicron surge.

The median interval between initial COVID-19 infection and polymerase chain reaction (PCR) testing of 5,696 positive cases and 10,673 negative controls was 279 days for analysis of the Alpha variant, 285 days for the Beta variant, 254 days for the Delta variant, and 314 days for Omicron.

Estimated effectiveness of a previous infection in preventing reinfection was 90.2% against Alpha, 85.7% against Beta, 92.0% against Delta, and 56.0% against Omicron. Sensitivity analyses that excluded vaccinated patients confirmed the results.

Among reinfected patients, one patient with the Alpha variant became severely ill, as did two each with Beta and Omicron, but no patients with Delta did so. No reinfection was critical or fatal. Estimated effectiveness against severe, critical, or fatal COVID-19 was 69.4% for Alpha, 88.0% for Beta, 100% with Delta, and 87.8% with Omicron.

"We found that the effectiveness of previous infection in preventing reinfection with the alpha, beta, and delta variants of SARS-CoV-2 was robust (at approximately 90%), findings that confirmed earlier estimates," the researchers concluded.

"Such protection against reinfection with the omicron variant was lower (approximately 60%) but still considerable," they added. "In addition, the protection of previous infection against hospitalization or death caused by reinfection appeared to be robust, regardless of variant."
Feb 9 NEJM research letter

https://www.cidrap.umn.edu/news-perspective/2022/02/news-scan-feb-10-2022

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Monoclonal Antibody Retains Activity Against Omicron's BA.2 Sub-Variant

California-based Vir Biotechnology, Inc. recently announced preclinical data suggest that sotrovimab, an anti-SARS-CoV-2 monoclonal antibody, retains neutralizing activity against the BA.2 subvariant of Omicron.

https://www.precisionvaccinations.com/2022/02/10/monoclonal-antibody-retains-activity-against-omicrons-ba2-sub-variant

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Other

New conditions common 1 to 5 months after positive COVID test

A cohort study of Americans tested for SARS-CoV-2 infection shows that new-onset shortness of breath, heart rhythm abnormalities, and type 2 diabetes were more common 31 to 150 days after testing positive for COVID-19 than among those with negative results.

The research was published today in JAMA Network Open.

A team led by Centers for Disease Control and Prevention (CDC) researchers examined new signs and symptoms among 144,768 nonhospitalized and 23,933 hospitalized people 20 years and older with a positive COVID-19 test, and 1,227,510 nonhospitalized people with a negative test. Among the 338,024 people younger than 20 years, 25,327 nonhospitalized and 1,338 hospitalized people tested positive, and 260,660 nonhospitalized and 50,699 hospitalized patients had a negative test result.

The team followed the cohorts for 150 days after they were tested for COVID-19.

This, however, was the first population-based characterization of these conditions in the United States, they said.

https://www.cidrap.umn.edu/news-perspective/2022/02/new-conditions-common-1-5-months-after-positive-covid-test

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Diagnostics:

still an incredible, negligent last of testing.

Drugs and Vaccines:

First study to show waning effectiveness of third dose of mRNA vaccines

A nationwide study from the U.S. Centers for Disease Control and Prevention (CDC) is the first to show that immunity against severe COVID-19 disease begins to wane four months after receipt of the third dose of an mRNA vaccine (Pfizer or Moderna). Waning immunity was observed during both the Delta and Omicron variant waves in similar fashion to how mRNA vaccine effectiveness wanes after a second dose. Although protection decreased with time, a third dose was still highly effective at preventing severe illness with COVID-19.

https://medicalxpress.com/news/2022-02-waning-effectiveness-dose-mrna-vaccines.html?

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Exercise post-vaccine bumps up antibodies, new study finds

Researchers at Iowa State University found 90 minutes of mild- to moderate-intensity exercise directly after a flu or COVID-19 vaccine may provide an extra immune boost.

https://medicalxpress.com/news/2022-02-post-vaccine-antibodies.html?

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WHO efforts to bring vaccine manufacturing to Africa is being undermined by pharma, reveals The BMJ

The World Health Organization (WHO) is supporting African companies to make a COVID vaccine. But today, in an article co-published with German newspaper Die Welt, The BMJ can reveal that a foundation representing vaccine maker BioNtech has been accused of seeking to undermine this initiative.

https://medicalxpress.com/news/2022-02-efforts-vaccine-africa-undermined-pharma.html?

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COVID lifesavers molnupiravir, Paxlovid now wait for patients

Supplies of the eagerly awaited oral COVID-19 antiviral prescription medications are slowly arriving at US pharmacies, but despite strong evidence that they can help reduce symptoms and prevent severe illness, federal data and experts suggest that many patients don't know about them or don't want to take them.

Two oral COVID-19 antiviral medications, molnupiravir (Merck) and Paxlovid (nirmatrelvir and ritonavir, Pfizer), have been proven to be safe, effective, and convenient treatments to take at home.

However, patients have to surmount several hurdles to get them—including recognizing that they have symptoms of COVID-19, getting a COVID-19 test, having a positive test, securing a doctor's appointment, getting a prescription, and finding a pharmacy with a supply—and they have to do all of this quickly. Antivirals need to be started within the first 5 days of COVID-19 symptom onset in order to produce a benefit.

https://www.cidrap.umn.edu/news-perspective/2022/02/eagerly-awaited-covid-lifesavers-molnupiravir-paxlovid-now-wait-patients

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Who Actually Receives Monoclonal Antibody Treatment?

New research co-authored by researchers from Harvard T.H. Chan School of Public Health found seniors over age 65 at the highest risk for severe COVID-19 have often been the least likely to receive innovative monoclonal antibody (mAbs) treatments.

among Medicare beneficiaries who weren't hospitalized or who didn't pass away within seven days of their diagnosis, only 7.2% received mAb therapy.

The likelihood of receiving mAbs was higher among those with fewer chronic conditions—23.2% of those with no chronic conditions received mAbs, versus 6.3%, 6.0%, and 4.7% of those with 1-3, 4-5, and 6 or more chronic conditions, respectively.

In addition, there were significant differences among states.

https://www.precisionvaccinations.com/who-actually-receives-monoclonal-antibody-treatment

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FDA Authorizes New Monoclonal Antibody Bebtelovimab for COVID-19 that Retains Activity Against Omicron Variant

The EUA for bebtelovimab is for the treatment of mild to moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kilograms, which is about 88 pounds) with a positive COVID-19 test, and who are at high risk for progression to severe COVID-19, including hospitalization or death, and for whom alternative COVID-19 treatment options approved or authorized by the FDA are not accessible or clinically appropriate.

Bebtelovimab is not authorized for patients who are hospitalized due to COVID-19 or require oxygen therapy due to COVID-19. Treatment with bebtelovimab has not been studied in patients hospitalized due to COVID-19. Monoclonal antibodies, such as bebtelovimab, may be associated with worse clinical outcomes when administered to hospitalized patients with COVID-19 requiring high flow oxygen or mechanical ventilation.

https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-new-monoclonal-antibody-treatment-covid-19-retains

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J&J pauses production of its COVID vaccine despite persistent need

Johnson & Johnson’s easy-to-deliver COVID-19 shot is the vaccine of choice for much of the developing world.

Yet the U.S. company, which has already fallen far behind on its deliveries to poorer countries, late last year quietly shut down the only plant making usable batches of the vaccine, according to people familiar with the decision.

The facility, in the Dutch city of Leiden, has instead been making an experimental but potentially more profitable vaccine to protect against an unrelated virus.

The halt is temporary — the Leiden plant is expected to start churning out the COVID vaccine again after a pause of a few months — and it is not clear whether it has had an impact on vaccine supplies yet, thanks to stockpiles.

But over the next several months, the interruption has the potential to reduce the supply of Johnson & Johnson’s COVID vaccine by a few hundred million doses, according to one of the people familiar with the decision. Other facilities have been hired to produce the vaccine but either are not up and running yet or have not received regulatory approval to send what they are making to be bottled.

https://www.nytimes.com/2022/02/08/business/jj-pauses-production-of-its-covid-vaccine-despite-the-persistent-need.html

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COVID-19 Vaccinated Women Deliver Infants With Protective Antibodies

A peer-reviewed study from Massachusetts General Hospital (MGH) published on February 7, 2022, found that most infants born to COVID-vaccinated mothers had persistent anti-S antibodies at six months, compared with infants born to mothers with a SARS-CoV-2 virus infection.

This study included individuals vaccinated with two doses of an mRNA vaccine or infected at 20 to 32 weeks' gestation when the transfer of antibodies through a women's placenta has shown to be at its peak.

After two months, 98% of the infants (48 of 49) born to vaccinated mothers had detectable protective Immunoglobulin G (IgG) levels, the most common antibody found in the blood.

At six months, the researchers looked at 28 infants born to vaccinated mothers and found that 57% (16 of 28) still had detectable IgG.

That was compared with just 8% (1 of 12) born to infected mothers.

"While it's still unclear just how high the titer needs to be to completely protect an infant from COVID, we know anti-spike IgG levels correlate with protection from serious illness," says Andrea Edlow, MD, MSc, a Maternal-Fetal Medicine specialist at MGH, Director of the Edlow Lab in the Vincent Center for Reproductive Biology and co-senior author of the publication published in The JAMA Network.

"The durability of the antibody response here shows vaccination not only provides lasting protection for mothers but also antibodies that persist in a majority of infants to at least six months of age."

https://www.precisionvaccinations.com/2022/02/08/covid-19-vaccinated-women-deliver-infants-protective-antibodies

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COVID-19 vaccine for kids under 5 delayed as Pfizer extends trial

In a sudden turnabout, Pfizer and BioNTech today announced they were delaying the application process for an emergency use authorization (EUA) for their vaccine for children ages 6 months to 4 years old, and gathering more information on two and three doses of the vaccine.

The announcement comes just days before the Food and Drug Administration (FDA) was set to consider the application, and a day after the Centers for Disease Control and Prevention (CDC) had told pediatric vaccine providers to ready themselves for a Feb 21 delivery date of the mRNA vaccine.

"As part of its rolling submission, the company recently notified the agency of additional findings from its ongoing clinical trial," the FDA said in a statement. "Based on the agency's preliminary assessment, and to allow more time to evaluate additional data, we believe additional information regarding the ongoing evaluation of a third dose should be considered as part of our decision-making for potential authorization.”

In December, Pfizer released data on two 3-microgram doses of the Pfizer-BioNTech vaccine in children 6 months to 4 years. In children 2 years and older, the reduced doses did not elicit a significant immune response, and the company suggested a third dose may be needed.

Today in a statement Pfizer said an ongoing study of a third dose of vaccine administered 2 months after the primary series is "advancing at a rapid pace," and the companies will wait for the three-dose data, which they expect to have by early April, before applying for the EUA.

https://www.cidrap.umn.edu/news-perspective/2022/02/covid-19-vaccine-kids-under-5-delayed-pfizer-extends-trial

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Devices:

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Epidemiology/Infection control:

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https://twitter.com/rubin_allergy/status/1491105352469053441?s=20&t=eZ5nw-fbpavaUFzMBI_YvQ

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Tips, general reading for public:

Tatiana Prowell (@tmprowell) and others have tips for newly infected and/or exposed, below. See also https://cleanaircrew.org/someone-in-my-home-has-covid-how-do-we-isolate-safely/

1/ The first thing to say is that if someone has #COVID19 symptoms (#Omicron most common: nasal congestion/runny nose, scratchy sore throat, fever, & aches), you have to assume they have it. You may not have a test (urgent cares are still open & do) or they may still be neg.

2/ You, as the person exposed to the one with symptoms, have to assume that you both do & don’t have #Omicron too. Wait, what?  I mean: assume you could infect others now & take care to avoid exposing them, BUT don’t assume it’s too late for you to avoid getting it.

3/ Especially in households with #vaccinated (& #boosted) family members, I have seen people manage to limit #Omicron to the first person who was infected. This #CovidVariant is incredibly contagious, but It CAN be done. Don’t give up on the idea!

4/ If you have N95/KN95/KF94 masks, get in them immediately. If you have only 1, put the sick person in it for source control. If you have >1 but not enough for all put the sick one & the highest risk (older, #immunocompromised) people in them. Then get outside, & leave door open.

5/ Fresh air is a friend & shared air is an enemy. The more you can ventilate your , now & until this is over, the better. You want the concentration of #omicron in air as low as possible. This decreases odds of infection & may make you less sick if you do get infected.

6/ Plan to bundle up if you’re in a  climate, because you’re going to need to leave doors & windows open enough for air exchange, esp for next 5d or so, & a cross draft. If you have a fresh HVAC filter, change it. If a hardware place is open, get a MERV13 HVAC filter. (Amazon has too.)

7/ Run the fan on your thermostat on high. Filter that #Omicron ! If you need supplies of any kind, please do curbside pickup or same-day delivery or drive-thru. No one exposed should be indoors in public, & def not the one with symptoms, to prevent further spread.

8/ If you don’t have any N95/KN95/KN94 masks, please see if a nearby friend or neighbor has unused ones you can have & order them replacements. The nonprofit @projectn95  (http://projectn95.org) is a great place to get them. Your backup plan for right now is a surgical mask.

9/ A surgical mask (ASTM level 3, 3-ply is best) has good filtration but usually not good fit. There are often gaps. Knot ear loops where they join the mask & then tuck to improve the mask fit. Here’s a short video demo: https://youtu.be/GzTAZDsNBe0. Put a cloth mask over the surg mask.

10/ Now it’s time to create the space where the infected person or people will isolate for 10d to let #Omicron run its course. This prior  of mine covers what is helpful to have in there & other things to consider.

11/ This whole scenario assumes that things are going ok with the person who has #Omicron. How do you know if they are ok? As I mentioned before, if you have a pulse oximeter (O2 sat monitor)-the thing drs put on your fingertip to measure O2-use it. See guide in .

12/ If you don’t have a pulse oximeter, many pharmacies carry them. They are over the counter. Ask the pharmacist if you don’t see them. You can order them online from many places too. Get one highly rated by many people. They need not be expensive. $15 gets a very good one.

13/ Some of your devices (smart watches, fitness trackers) can detect heart rate (60-100 normal for adults) & less reliably O2 levels. If you have them & they read low O2 levels, def do call a dr or seek care. Video calls are helpful to check on the sick as well.

14/ If the person w/ #Omicron is high-risk (especially #immunocompromised, organ or bone marrow transplant, active #cancer#pregnant#diabetes, older, etc), they should contact a dr even if they seem ok. There are outpatient treatments that sig risk of being hospitalized.

15/ These include monoclonal antibodies (some brands no longer work vs #Omicron, but 1 called sotrovimab remains effective). It is given IV as a single dose. There are also two types of pills taken for 5d at home. All are in short supply at the moment. https://google.com/amp/s/abcnews.go.com/amp/Health/omicron-treatments-monoclonal-antibodies-work-variant/story%3fid=81893922….

16/ All of these things to treat outpatients w/ #Omicron, the monoclonal antibody sotrovimab, as well as the pills (Paxlovid: https://google.com/amp/s/www.nytimes.com/2021/12/22/health/pfizer-covid-pill-fda-paxlovid.amp.html…) & (molnupiravir: https://google.com/amp/s/www.nytimes.com/2021/12/23/health/covid-pill-merck.amp.html…) are new, so they are being reserved for higher-risk folks while supply increases. [Paxlovid is better imho] 17/ If you are not the sick person, but one of the exposed, & you can walk-up/drive-up (NOT indoors & ONLY in a !) to #GetVaccinated, do it. If age 16+ & 6+ mos post dose 2 of vaccine (or 2+ post J&J), go #GetBoosted now! The booster protects w/in a wk! 19/ If you are high-risk #immunocompromised or #immunosuppressed, we know that #vaccineswork less well in many of you. While you should still #GetVaccinated & #GetBoostedan injection (Evusheld) can decrease your risk of #COVID19. It’s given every 6 mos. ~ ~ ~

Also #Remdesivir might be available as an outpatient for high-risk- (1.6%) in the remdesivir group and 21 of 252 (8.3%) hosp or death in placebo https://www.nejm.org/doi/full/10.1056/NEJMoa2116846 I suggest contacting the local health department +/- hospital to see where any of these drugs might be available. There are very limited supplies.

Politics:

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https://twitter.com/threadreaderapp/status/1492530133101694982?s=20&t=DNYxrl4ZOlFG-thVNcPf6Q

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Georgia Senate bill would put limits on fundraising by challengers

https://www.ajc.com/politics/georgia-senate-bill-would-put-limits-on-fundraising-by-challengers/YU3I27QAVRDALIA7QSTN5LBOWM/

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Nearly 30% of Biden’s nominees to the federal bench have been public defenders, 24% have been civil rights lawyers and 8% labor attorneys. By the end of his first year, Biden had won confirmation of 40 judges, the most since President Ronald Reagan. Of those, 80% are women and 53% are people of color, according to the White House.

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https://twitter.com/TelegraphWorld/status/1491765261439021064?s=20&t=zOhuaVvCYvvLqSJkB1WJPQ

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Although some say they have a wonton disregard for safety....

Especially their controversial “stop and bisque” program....

They are but sometimes when aggravated they become vichyssoise.

Marjorie Taylor Greene is planning the next soup d’état.

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https://twitter.com/LanceUSA70/status/1490802378655760386?s=20&t=DNYxrl4ZOlFG-thVNcPf6Q

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Feel good du jour:

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https://twitter.com/msnaydani/status/1491109258603433987?s=20&t=zOhuaVvCYvvLqSJkB1WJPQ

Comic relief:

https://twitter.com/WUTangKids/status/1492183686049107968?s=20&t=DNYxrl4ZOlFG-thVNcPf6Q

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https://twitter.com/buitengebieden_/status/1489679357836673028?s=20&t=eZ5nw-fbpavaUFzMBI_YvQ

Perspective/Poem

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Specifically, I focused on leprosy and the idea that those infected had to be isolated, even after there was a known cure, and sterilized or have their children taken by the state. 2/

The chronically ill were objects of sympathy but not autonomous human beings in their writings. They were to be treated with kindness but acknowledged as obstacles to progress. 3/

I knew that these threads continued, unexplored, in our profession. But the pandemic has made them painfully clear. "We are tired of covid" is the refrain. "Stay home if you are chronically ill." Wearing a mask has become too much to ask. 4/

These calls came loud and clear from some sectors of our government early on. I remember the lieutenant governor of Texas suggesting grandparents would be willing to die for the greater good. 5/

And now I see my colleagues saying that there is "no evidence" (aka evidence that they choose to listen to) that masks in schools work. Despite good ecological data. Despite data that schools that mask are more likely to stay open. 6/

They imply that those that can't get vaccinated had their chance. They say that those who remain risk after vaccine should stay home. In other words, you are an obstacle. Isolate. 7/

To wave your arms to so many and say, you are in the way, it smacks of the colonies. It smacks of eugenics. 8/8

I think something we get wrong about the past is we think villains knew they were villains. People who believe in their cause are much more dangerous. I have no doubt that the #urgencyofnormal crowd and their media supporters are true believers. 9/

Those who touted eugenics policies likewise thought they were doing the right thing, even performing a kindness towards the "unfit" by taking the decisions out of their incapable hands. 10/

None of us can know how history will see us, but to me, this seems a new slogan for an old policy. Lives can be saved if we mask and make vaccines more available, and trust me if I vaccinate a dozen people a week there is a loy more we could do. 11/

What is your inconvenience to someone else's life? These things are not equal unless some lives matter less to you. 12/12

One more thing: so many want to "go back to normal." "Normal" gave us the pandemic and so much unequal suffering. "Normal" will do the same again, over and over. I don't want to go back. I'd love for us to learn something from history--for once--and do better. 13/end

Bits of beauty:

 


 

 

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