Florida implements my renal dialysis-inspired COVID care idea (sort of)

Since all that hospitals are generally doing for COVID-19 patients is providing supportive care (i.e., not treatment) and, in fact, patients can do just as well at home with an oxygen bottle (nytimes), it seemed like an obvious idea to look for a way to handle COVID-19 patients somewhere other than a hospital. If nothing else, this would prevent the COVID-19 patients from infecting workers and patients within the hospital. If we could build renal dialysis capacity, why not COVID-19 treatment centers? is my idea from April 2, 2020:

On the one hand, the U.S. health care system is kind of lame. It consumes a ton of money. New York State spends $88 billion per year on its Department of Health, $4,400/year for every resident, mostly just for people on welfare in New York; Mexico spends about $1,100/year across all citizens, including those with jobs. The U.S. health care system delivers feeble results. Life expectancy in Mexico is 77 versus 78 in the U.S. Despite this prodigious spending, New York has completely failed to protect its residents from something that isn’t truly new.

On the other hand, the U.S. managed to build enough renal dialysis capacity to keep 468,000 Americans with failed kidneys alive. This is a complex procedure that requires expensive machines, and one that did not exist on a commercial basis until the 1960s.

Of course, one issue is that we had decades to build up all of this renal dialysis capability while we have only about one more month to build COVID-19 treatment capacity. But once we have built it, can we sail through the inevitable next wave or two of COVID-19?

(Looks like I can take credit for predicting “the inevitable next wave or two of COVID-19” (the U.S. is officially in Wave #3? BBC).)

If renal dialysis can be delivered in a strip mall, why not COVID-19 care? Florida has taken a step in the direction that I suggested nearly 1.5 years ago. From https://floridahealthcovid19.gov/monoclonal-antibody-therapy/ :

Note that the locations are not hospitals. They’re not empty strip mall shops or big box stores as I’d expected, but rather parks and libraries (i.e., existing state-owned facilities). But maybe this is because these are the state-run operations rather than private sector. (Also, as far as I have seen, South Florida isn’t in the Zombie Apocalypse retail vacancy situation that Boston is.)

Also, I wonder if the 9-5 hours support my analogy between the Vietnam War and our War on COVID-19. We were in a fight where the fate of democracy all around the world was at stake… but the upper-middle class back home kept playing tennis and golf and President Johnson and Congress kept larding on social welfare programs without considering the cost. Right now we’re in an unprecedented emergency. Our best and brightest technocrats are using advanced technology and trillions of dollars against an enemy that has already killed more Americans than all wars combined… but we will fight the enemy from 9-5. (I don’t think this is completely fair because the Florida state government has treated COVID-19 as a respiratory virus to be managed like the flu, not as an entirely new phenomenon nor as something that can be vanquished by government action.)

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Nation’s leading Shutdown Karens complain that schools were shut down

This is kind of fascinating… the New York Times, which was a principal cheerleader for lockdowns, now complains about American public schools having been shut for roughly one year… “The School Kids Are Not Alright” (NYT, August 22):

One of the most distressing aspects of the Covid pandemic has been seeing governors and state education officials abdicate responsibility for managing the worst disruption of public schooling in modern history and leaving the heavy lifting to the localities. Virtually every school in the nation closed in March 2020, replacing face-to-face schooling with thrown-together online education or programs that used a disruptive scheduling process to combine the two. Only a small portion of the student body returned to fully opened schools the following fall. The resulting learning setbacks range from grave for all groups of students to catastrophic for poor children.

From the start, elected officials seemed more concerned about reopening bars and restaurants than safely reopening schools that hold the futures of more than 50 million children in their hands.

Could this be the new definition of chutzpah? (replacing the former “that quality enshrined in a man who, having killed his mother and father, throws himself on the mercy of the court because he is an orphan.”)

The rest of the editorial is about new ways for President Biden to force every American schoolchild to wear masks for 7 hours per day. Having bravely confronted the Taliban, Uncle Joe will now turn his post-nap attention to K-12ers who are wearing chin diapers, under-nose masks, or running wild:

President Biden took the right approach on Wednesday when he announced that his Education Department would use its broad authority to deter the states from barring universal masking in classrooms.

How much difference will this make? See “The Science of Masking Kids at School Remains Uncertain” (New York, August 2021):

At the end of May, the Centers for Disease Control and Prevention published a notable, yet mostly ignored, large-scale study of COVID transmission in American schools. A few major news outlets covered its release by briefly reiterating the study’s summary: that masking then-unvaccinated teachers and improving ventilation with more fresh air were associated with a lower incidence of the virus in schools. Those are common-sense measures, and the fact that they seem to work is reassuring but not surprising. Other findings of equal importance in the study, however, were absent from the summary and not widely reported. These findings cast doubt on the impact of many of the most common mitigation measures in American schools. Distancing, hybrid models, classroom barriers, HEPA filters, and, most notably, requiring student masking were each found to not have a statistically significant benefit. In other words, these measures could not be said to be effective.

In the realm of science and public-health policy outside the U.S., the implications of these particular findings are not exactly controversial. Many of America’s peer nations around the world — including the U.K., Ireland, all of Scandinavia, France, the Netherlands, Switzerland, and Italy — have exempted kids, with varying age cutoffs, from wearing masks in classrooms.

(As with physics, e.g., Katherine Clerk Maxwell‘s equations, the predictions from coronascience will be different depending on the country in which the experiment is conducted.)

Another interesting media phenomenon is cheering for school districts that defy governors’ orders to reopen fully. See “How three school districts are defying state restrictions on mask mandates” (CNN) for example:

The debate over masks in schools has reared its head once again with the new academic year, and a handful of states have taken steps to restrict local officials’ ability to implement their own masking requirements, either through the governor’s office or state legislatures.

These restrictions — made despite guidance from the US Centers for Disease Control and Prevention recommending masks for everyone in schools regardless of vaccination status — have prompted showdowns between state officials and some local school districts, who say they’re trying to protect their communities, particularly students who are ineligible for vaccines.

Perhaps most prominently, several Florida school districts have decided to impose mask mandates, defying an executive order by Gov. Ron DeSantis that forbids such requirements and threatens to take away school funding if school districts don’t allow students to opt-out.

But some school districts have taken more methodical approaches, carefully circumventing state restrictions on mask requirements through careful legal maneuvering or apparent loopholes.

The school bureaucrats’ motives are noble. They want to protect their communities and especially the children. The nobility of their motive is one reason that a governor’s order cannot apply to them.

What if, in April 2020, a school district in a rural area of a state had said “we’re reopening our school in defiance of the governor’s shutdown order because we are trying to protect our children’s future and ensure that they have enough education to thrive. We aren’t suffering from a plague the way folks in the big city who ride the subway to their Tinder dates are”? Would the same journalists have praised such defiance?

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Internment camps for the unvaccinated?

Nobody loved my previous modest proposal: Euthanize the unvaccinated?

Here’s another idea for keeping the righteous safe from those who deny #Science… internment camps for the unvaccinated. Korematsu v. United States affirmed FDR’s decision to send Japanese-Americans into camps. World War II was a bad situation, but Japanese-Americans were a minor and speculative threat. Nonetheless, the Supreme Court held that the Constitution did not apply #BecauseEmergency.

Consider that COVID-19, at least according to our media, has already killed far more Americans than died in World War II (and the death of an 82-year-old with diabetes and cancer is actually more tragic than the death of a healthy 18-year-old soldier). So the emergency is far more severe right now than whatever we had concerning us in 1942 when Roosevelt issued Executive Order 9066. This is certainly no time to let purported Constitutional rights interfere with public health.

We are also informed that the unvaccinated are 99.2 percent responsible for spreading coronaplague and for COVID-19 deaths. The unvaccinated are a clear and present danger to themselves and others.

Isn’t the logical next step placing the unvaccinated into internment camps for their own protection? “Imperfect Vaccination Can Enhance the Transmission of Highly Virulent Pathogens” (PLOS, 2015):

Could some vaccines drive the evolution of more virulent pathogens? Conventional wisdom is that natural selection will remove highly lethal pathogens if host death greatly reduces transmission. Vaccines that keep hosts alive but still allow transmission could thus allow very virulent strains to circulate in a population. Here we show experimentally that immunization of chickens against Marek’s disease virus enhances the fitness of more virulent strains, making it possible for hyperpathogenic strains to transmit. Immunity elicited by direct vaccination or by maternal vaccination prolongs host survival but does not prevent infection, viral replication or transmission, thus extending the infectious periods of strains otherwise too lethal to persist. Our data show that anti-disease vaccines that do not prevent transmission can create conditions that promote the emergence of pathogen strains that cause more severe disease in unvaccinated hosts.

The only way to keep the unvaccinated safe from the super-COVID that we’re breeding by vaccinating those who were never at significant risk (with an imperfect vaccine) is to place the unvaccinated into camps where they can be isolated from the vaccinated population.

Readers: What do you think of this idea? And could Andrew Cuomo be repurposed to run one of the camps? He has experience ordering the infected into nursing homes. (But if he hadn’t done that, the hospital situation could have been worse; see Our hero’s hospital is full (but not with patients who should be there).) Maybe Cuomo could be tasked with rounding up the unvaccinated and ordering them into the Protection Camps. If that’s too big a task for one person, Cuomo could be in charge of outreach to young unvaccinated women.

Loosely related… a fixer-upper in Bodie, California, in the same dry Eastern Sierra environment as Manzanar.

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COVID-19 is sure to kill you, but life insurance rates haven’t changed

I’m preparing to teach a class at Florida Atlantic University and one of my talking points will be “look at insurance rates if you want to understand the risk of data loss.” In other words, a risk cannot be unquantifiable if there are insurance companies willing to sell coverage for that risk.

Then it occurred to me that we could calibrate our level of coronapanic to what insurance companies are doing. The media informs us that life expectancy has plummeted in the United States. Healthy young people are being felled by the mighty Delta variant and it is urgent for them to get vaccinated (so that the headline can read “Healthy young vaccinated person killed by COVID-19″? See “Nearly 60% of hospitalized COVID-19 patients in Israel fully vaccinated”).

Insurance companies do have a health screening procedure for their larger policies, e.g., trying to exclude those with heart conditions, morbid obesity, etc. If COVID-19 is a significant risk for those the insurance companies consider “healthy” then rates have surely gone up, right?

“Has COVID-19 made life insurance more expensive? These researchers say they have the answer” (MarketWatch, December 2020):

The coronavirus pandemic has produced grim numbers that keep rising, like case counts, hospitalization rates and deaths.

But there’s [one] that hasn’t increased this year: the cost of life insurance.

“We find limited evidence that life insurance companies increased premiums or decreased policy offerings due to COVID-19,” researchers said Monday in a study analyzing more than 800,000 life insurance-policy quotes from almost 100 companies between 2014 and October 2020.

University of Kentucky and Illinois State University economists did discover fewer policies being extended to the oldest of potential policyholders, above age 75. But even then, the cost of those premiums did not noticeably increase.

How are we able to sustain our high level of panic if the insurance companies aren’t adjusting their rates?

Related:

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Incentives and Coronapanic

In response to Recycle Chinese and Soviet anti-landlord propaganda to bolster support for Rochelle Walensky’s rent moratorium order?, Mitch wrote:

So getting vaccinated and slowing the spread increases one’s chance of having to pay rent. The incentives are not well aligned.

(The government says nobody has to pay rent in an area where COVID-19 transmission is occurring (90 percent of current renters covered). And they say that getting the vaccine will stop transmission (except that it doesn’t, according to the same government). Thus, it would be financially irrational for a community of renters to get vaccinated.)

“New Rule Raises Question: Who’ll Pay for All the Covid Tests?” (NYT) also raises a question of how people will respond to economic incentives:

Among the employers taking a different approach is Rhodes College in Tennessee: It will require unvaccinated students without a medical or religious exemption to pay a $1,500 fee per semester to cover the costs associated with a weekly coronavirus testing program.

To avoid paying $3,000 per year, in other words, an unvaccinated student need only get some card stock to feed into a laser printer and create his/her/zir/their own vaccination record. HIPAA would prevent the school from calling whatever “healthcare professional or clinic site” is written down on the record, right? In any case, on my CDC card, the clinic site information does not contain the full city/state nor any contact info. A college would have to be very motivated indeed to try to determine whether a vaccination card is genuine. The vaxyes service checks the lot number against the date of administration, but presumably this would also check out fine if the student copied the information from a virtuous friend who actually got the shots:

An initial review to ensure a match personal identification and vaccine card, vaccine dates make sense, lot numbers, and possible fraud markers.

If colleges want the unvirtuous to admit their thoughtcrime and unreasonable resistance to government pressure, wouldn’t it be smarter to offer the testing at no charge? Then the only incentive to forge a vaccine card would be avoiding the inconvenience and discomfort of weekly testing, not $3,000 in cash on top of that.

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Never say never: Maskachusetts back in masks

Back in April, when we told friends and neighbors in Massachusetts about the decision to follow the reverse underground railroad to freedom (see Relocation to Florida for a family with school-age children), they scoffed at the idea that Florida was a more reliable source of Freedom of Assembly, freedom for children to exercise without masks, in-person education, etc. COVID-19 was finished, vanquished by wise leadership and vaccines. They confidently predicated that, after the 15-month state of emergency officially ended on June 15, 2021, the residents of Massachusetts would never again be ordered to wear masks, to refrain from gathering, to keep children at home, etc.

From our former town:

Effective on 12:01 a.m. August 20, 2021, face coverings are required for all individuals aged two years
and above in all indoor public spaces, or private spaces open to the public…

(the schools, of course, decided months ago that children would be ordered to wear masks, even those children whose parents elect to experiment on them with an emergency authorized vaccine dosage calibrated for adults; this may be moot for urban schools, which closed down for nearly a year during the 2020-2021 coronapanic)

It is currently illegal to be indoors in Provincetown without a mask: “Provincetown Approves Indoor Mask Mandate To Stem Spread” (a bandana is okay when meeting new friends from Grindr!). The situation is similar out across the water: “Three Martha’s Vineyard towns issue mask mandate” (Boston Herald, August 17). How about staying home in the suburbs? Belmont went back into masks on August 9.

Keep in mind that the typical peak period for respiratory viruses in New England is still 3-6 months in the future. The above are the restrictions for the ordinarily flu/cold-free summer (and last summer was more or less COVID-free as well).

The “curve,” according to The Google:

The Leaderboard of the #Science-following Righteous:

(Florida, of course, has a much uglier curve right now, in what seems to be a pattern going forward of high COVID during the peak summer months. But the fact that the government hasn’t caved in to Karens’ demands for muscular orders and restrictions is confidence-inspiring. Unlike most other states, Florida does not pretend that governors’ orders and bandanas are a magic solution for preventing viruses from killing humans. The current COVID-19 wave in Florida is a good stress test for the residents’ and government’s commitment to children, education, freedom, and the Constitution.)

For lockdown state children, from Disney+, Goofy in How to Stay At Home, Episode 1 of which is “How to Wear a Mask”:

Related:

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Karenhood in Massachusetts measured quantitatively

After 40+ years of sitting at a computer and typing, my back is in no shape for packing and moving to the Florida Free State. A friend’s 16-year-old soccer star and some of his teammates have been essential to our sorting/discarding/packing process. The muscle turned out to have a quantitative measurement of Karenhood in Massachusetts. Neighbors in his suburban town called the police on 19 separate occasions after observing the high school soccer team practicing (outdoors) without strict mask discipline. (There were more than 19 individual calls to the police. In fact, during one practice 5 different Mask Samaritans called the police.)

The most dramatic COVID-19 team response was five town officials converging on the soccer field. Two coaches, two people from the public health department, and a police officer.

Very loosely related, from Coronavirus Rescue Team (May 13, 2020):

(I told the above story to a woman who lives in Concord, Maskachusetts, center of the BLM movement, at least to judge by the prevalence of lawn signs. “I was walking with my sister in a wide-open field with nobody around,” she said. “A car stopped and the driver yelled at us for not wearing masks.”)

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Where did India end up in the COVID Olympics?

Four months ago, India was the subject of media attention due to a wave of coronavirus infection. Nearly all of the journalists whipped up hysteria by citing absolute numbers of infections and/or deaths in India, not adjusting for the population size. From Coronaplague in India proves Dr. Jeff Goldblum’s theories? (April 14):

In other words, India has suffered more from COVID-19 than a country in which 100 percent of the population died of COVID-19, just as long as that country had only 13 million people.

How bad are things in what TIME and the Guardian say is the worst-plagued country on Earth? The country has suffered 125 COVID-19-tagged deaths per million inhabitants (ranking). That compares to 2,530 per million here in Massachusetts (states ranked; note that this is per 100,000 so multiply by 10). Maybe they will be getting worse, though. If things get 20X as bad as they’ve been in India, the situation will be about as bad as it is right now in Massachusetts.

Readers: What’s your best guess as to how events unfold in India? My guess is based on regression to the mean. India was an outlier (125 deaths per million). When the dust settles, India will be somewhere in the middle (right now the worldwide average is about 375 deaths per million; 3 million deaths in a population of 8 billion). Perhaps we’d have to adjust for the fact that the median age in India is roughly 27, slightly younger than the world median (around 30).

It has been four months. We know that the science is settled. Is it fair to say that “the dust has settled” right now in India? (i.e., that they’re at least between waves of coronavirus infection) If so, how accurate was my prediction of “slightly less than the worldwide average because of India’s slightly younger-than-average population”? We can use Statista’s COVID-19 deaths by country (the most thoroughly masked and shut nations at the top, #BecauseScience) as an authoritative source for India’s death rate (about 314/million). We can take the total deaths on the WHO dashboard (4.33 million) and divide by the number on the Census Bureau’s population clock (7.78 billion) to get the worldwide death rate: 556/million. In other words, after all of the media hysteria it turns out that India has a lower death rate from/with COVID-19 than the world average. What if we compare to the U.S. states? Maskachusetts is at 2,630 per million (a lot of U.S. stats are per 100,000 so we need to multiply by 10), a rate that is 8X higher than India’s.

Let’s also look at predictions from readers…

disevad, who lives in India, said “My intuition is that its going to subside in next 3 weeks or so”.

[i.e., that the peak of “cases” would be roughly May 6, 2021. When was the peak? Our World In Data says… May 6, 2021 (414,118 cases). How about deaths? The peak was around May 17; see Google data below]

RS said, “I wonder if after the panic dies down and wearing masks continues to be something that people in CA and MA do for the rest of their lives it will take on a similar flavor. Wearing a mask during flu season (which will be renamed Corona season as you note) is a sign that they are making healthy choices, and a much easier choice than losing the 20-30 pounds that they gained during lockdown.” To see if this prediction is correct we have to wait until the winter to see if the masks sprout, but we can check right now to see if our neighbors are still fat.

Viking said, “By the time it is obvious India is past the peak, say daily deaths are down to 650/day, I expect 200 to 300 cumulative deaths per million. So 8 to 12% of Maskachusetts rate.” [The above numbers work out to 12%!]

Related:

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How can city vaccination requirements be enforced without RFID chips in residents’ necks?

Cities are casting out heretics (i.e., those who haven’t accepted a non-FDA-approved COVID-19 vaccine). See “San Francisco to require vaccine proof at indoor venues” (AP):

Worried that the highly contagious delta variant of the coronavirus could derail San Francisco’s economic rebound, Mayor London Breed announced Thursday that the city will require proof of full vaccination at indoor restaurants, bars, gyms and entertainment venues to help keep businesses open.

“This is to protect kids, is to protect those who can’t get vaccinated, is to make sure that we don’t go backwards, is to make sure that I never have to get up in front of you and say, ‘I’m sorry, I know we just reopened and now the city is closed again because we are seeing too many people die,’ ” Breed said.

The mandate will be more stringent than the one announced by New York City Mayor Bill De Blasio last week. San Francisco will require proof of full COVID-19 vaccination for all customers and staff, while New York mandated proof of at least one dose for indoor activities.

Loyal readers will recall that, earlier in coronapanic, I advocated for RFID chips in the necks of anyone who lives in or visits the U.S. This would enable quarantine-enforcement and contact-tracing via door frame scanners. See RFID chips in the necks of college students and #Science proves that I was right (about the need for RFID chips in humans for COVID-19 surveillance), for example. Combined with a central health care database, as in the UK or Israel, it would be possible to confine heretics and infidels to their homes via simple computer programming.

The government has had 1.5 years to plan, but apparently that wasn’t sufficient to develop a durable proof of vaccination card that would fit in a wallet. And, in any case, if an event has thousands of people coming through the doors, how would checking all of these cards be practical? Consider that someone who got injected in a foreign country might be coming through and will be presenting a card in a language that the people at the door can’t read. Also, shouldn’t those checking for heretics be sure to match the name of the vaccination record and the name on a photo ID? How does that work given that (1) IDs are not required for vaccination, and (2) the undocumented may not have ID documents, but are still entitled to full participation in U.S. civic life.

Separately, woudn’t it be fun to build the door scanner that would check the RFID chip, look up vaccine status in the national database, and light up a huge red blinking “HERETIC” sign while sounding submarine movie buzzers and alarms?

[The above should not be read as an opinion on the vaccine requirement policies. I mean only to question how the requirements can be enforced, as a practical matter, without automation and, therefore, some quick way to scan a human and determine vaccine status.]

Related:

  • On the subject of adult politicians, such as Mayor Breed, saying that they’re acting to protect children… “Deaths from COVID ‘incredibly rare’ among children” (Nature, July 2021): A comprehensive analysis of hospital admissions and reported deaths across England suggests that COVID-19 carries a lower risk of dying or requiring intensive care among children and young people than was previously thought. In a series of preprints published on medRxiv, a team of researchers picked through all hospital admissions and deaths reported for people younger than 18 in England. The studies found that COVID-19 caused 25 deaths in that age group between March 2020 and February 2021. About half of those deaths were in individuals with an underlying complex disability with high health-care needs, such as tube feeding or assistance with breathing. [For comparison, about 50 children, 16 and under, die annually from traffic accidents in the UK (source) because the nation has not adopted my speed limit idea.]
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Now that we have real leadership from the White House, are Americans better at fighting the COVID War?

We were informed by the media that a principal reason the U.S. was unequal to the task of fighting the COVID War was poor leadership from the White House. Donald Trump was anti-science and refused to believe that shutdowns and masks for the general public would have a significant impact on the coronavirus. See “Inside Trump’s Failure: The Rush to Abandon Leadership Role on the Virus” (NYT, July 2020), for example.

The roots of the nation’s current inability to control the pandemic can be traced to mid-April, when the White House embraced overly rosy projections to proclaim victory and move on.

Donald Trump has been gone for 7 months now. President Biden is providing fantastic science-guided leadership from the White House. Are Americans responding to this improvement by behaving better? The CDC recommends indoor masking, for example. Have you seen more people wearing masks indoors this month compared to in early January 2021? More people washing hands and using sanitizer? Fewer gatherings? In your direct experience, are more people or fewer people traveling (and therefore spreading variant COVID!) compared to when the hated dictator was in power? (data point: our hotel in Niagara Falls said that they’d been 100 percent full for months)

One place that was following the science, in our recent travels, was the Cleveland Museum of Natural History. Masks are required in an outdoor garden/zoo, in order to protect the animals from contracting plague. Masks are, of course, required indoors, so that child visitors are protected.

The scientists at the museum want to remind you that when non-natives move into a country, the natives will have a tough time affording “food or other resources”, that the non-natives may bring disease, and that, once the non-natives arrive, the natives may stop reproducing.

What about at the art museum next door, where the median age of a visitor is probably 40 years older than at the natural history museum? Masks are optional, indoors and out.

Overall, our experience has been that, despite great leadership from the White House, Americans are not #FollowingTheLeader. Unless the vaccination rate is near 100 percent, mask usage indoors doesn’t match the old CDC’s recommendation that only the vaccinated can shed the hijab. Signs and practices certainly do not line up with the CDC’s latest guidance that everyone, including the vaccinated, should wear a mask indoors. From a McDonald’s near the Syracuse, NY airport, August 3:

The sign regarding the “newly released” science was already out of date and none of the customers inside was wearing a mask.

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