Covid-19 Watch: Politics

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com1

Introduction

Over the past week I have watched increasing infighting and politicisation both over the Covid-19 pandemic and the response. In the UK Dominic Cummings, a senior advisor to Boris Johnson, became the story when he flagrantly disobeyed lockdown orders, though he, and the government, claim he did not. The Tanzanian president denies the epidemic, the South African emergence from lockdown is fraught, and there was a political attack on Professor Glenda Gray, President of the South African Medical Research Council (SAMRC) and a member of the Ministerial Advisory Council (MAC).

I write these communiques from a well-appointed shed in the garden of my home in Norwich, UK. My sanity is helped as spring is well advanced and I can leave the door open and revel in bird song. The robin sits just outside on the hawthorn bush and looks at me quizzically. My youth spent in church brings to mind:

“Behold the fowls of the air: for they sow not, neither do they reap, nor gather into barns; yet your heavenly Father feedeth them.” Matthew 6:25-34, King James Version.

The suburban wildlife does not care about the pandemic. In fact, the hedgehog said, “Pandemic, what pandemic”.2 This week has seen the changes in the countries with the worst entrenched epidemics (Table 1). The US leads the field followed by Brazil, Russia and the UK. Spain and Italy are relegated to fifth and sixth.

The Numbers

At 8 am on 27th May 2020 the JHU Coronavirus Resource Centre recorded 5,594,175 global infections.3 Absolute numbers are in Table 1. Russia and Brazil were added last week, this week I am simplifying the table by changing the dates to report cases every two weeks.

Table 1: Global and National Cumulative Numbers of Confirmed Covid-19 Cases (alphabetical order)4
Date Global cases China France Italy Russia Brazil South Africa Spain UK USA
15 Feb 69,000 68,400 12 3 2 0 0 2 9 43
4 Mar 93,000 80,480 288 3,100 3 4 0 222 86 149
18 Mar 201,500 81,100 9,100 35,700 147 372 116 13,900 2,600 7,800
1 Apr 861,000 82,400 57,000 110,600 2,777 6,836 1,400 104,100 29,900 213,400
15 Apr 1,982,552 83,351 131,682 162,488 24,490 28,280 2,415 174,060 94,845 609,422
29 Apr 3,117,756 83,940 169,053 201,505 99,399 79,685 4,996 232,128 162,350 1,012,583
13 May 4,262,799 84,018 178,349 221,216 232,243 180,000* 11,350 228,030 227,741 1,369,964
20 May 4,900,155 84,063 180,933 226,699 299,941 271,885 17,200 232,037 250,138 1,528,566
27 May 5,594,175 84,103 182,847 230,555 362,342 291,222 24,264 236,259 266,599 1,681,418

*estimate

At the beginning of an epidemic actual cases provide the best, and often, the only data. As it evolves, other information becomes important and valuable. It is hard to compare absolute numbers in China with its population of 1.439 billion, with the United States’ 331 million people, or South Africa’s 59 million people. To make useful comparisons we need to look at rates.

Table 2: Covid-19 Deaths and Cases per million (alphabetical order)5
China France Italy Russia South Korea South Africa Spain UK USA
Deaths per million (19 May) 3.33 421.07 529.64 18.84 Error* Error* 593.04* 523.33 275.8
Total cases per million (20 May) 58.4 2,189 3,736 1,991 25 277 4,953 3,629 4,557
Deaths per million (26 May) 3.33 424.27 544.04 25.15 5.21 8.32 574.31 555.19 299.79
Total cases per million (25 or 26 May) 58.4 2,225 3,806 2,421 216 398 5,034 3,847 4,964

*misread these data last week

There is not much to report on the numbers this week. A fear is they (and the increases) have become normalised. We watch the mounting toll with a sense of helplessness, and even a growing indifference, unless of course Covid-19 touches people we know.

The antibody test will tell who has been infected and recovered. This is increasingly important for knowing where we are in the pandemic and allowing individuals to adapt behaviour. However, the development, certification and marketing of these tests is complex. They will be a gold mine for the developers, especially if they are bought by governments. The Telegraph, a British paper reported:

“the Department of Health is in negotiations with the Swiss healthcare company Roche to buy millions of the company’s kits.

Mologic, a Bedfordshire company that produces pregnancy tests, was granted £1 million by the Government to develop the coronavirus test.

SureScreen, a Derby firm, has created a finger-prick test which they say takes 10 minutes to return a result and is 98 per cent accurate. The tests are reportedly being used by private companies in a number of European countries”.6

We have to hope that the FDA in the USA, NICE in the UK, or the Medicines Control Council in South Africa will ensure we get accurate and affordable tests. They need to be available globally.

The Politics

South Africa

Scientific freedom and academic integrity came under attack over the past week. The president of the Medical Research Council (MRC) Glenda Gray commented that she and fellow clinicians were seeing children with malnutrition at Chris Hani Baragwanath academic Hospital. “We have not seen malnutrition for decades so we are seeing it for the first time in the hospital”.7 This resulted in a reprimand from Zweli Mkize the South African Minister of Health who said: “The statement made by Prof Gray is at the least devoid of the truth. Having read the article, I have been taken aback by the obvious inaccuracies it contains which have, in my view, caused unnecessary sensationalism and doubt on the work and effort of government in dealing with Covid-19.”8 His top civil servant, the Acting Director General, called the chair of the MRC to complain about Gray’s allegations and request her conduct be investigated.9

Academics and many others rallied behind Prof Gray. On 26 May the MRC announced they would not investigate Gray as she had not breached any policies. This is symptomatic of the inability of politicians to accept any criticism. It is reminiscent of the Mbeki response to the AIDS epidemic in 2000. Surely if ever there were a time to stand together it is now.

We know that has been an increase in malnutrition among children. This will continue, and get very much worse, as the economic turmoil, massive increases in unemployment, and general uncertainty regarding the pandemic persists.

England

The UK is a divided nation, it seems there are also deep divisions in England alone. The uproar over the movements of Dominic Cummings, the Prime Minister’s adviser, during the lockdown resulted in his extensive press conference on 25 May.

Cummings drove his ill wife and child from London to Durham and back during the height of the lockdown. This is where his parents and extended family live, and he argued it was the only way he and his wife could obtain childcare. He compounded this offence by being seen visiting a local beauty spot before returning to London. The press was persistent, but Johnson has indicated, thus far, he intends to take no further action. The already somewhat strained willingness of the public to trust the government and continue to follow distancing regulations is threatened. Various police forces have confirmed this attitude.10

Thailand

Thai Medical News reports that some leaders have been downplaying the seriousness of the coronavirus epidemic.11 According to an article ‘certain high levels authorities requested that any mention of the airborne nature of the virus and all footage of the event be deleted’. Global News in Canada retained footage. It is posted on YouTube. The important segment is from minute 38 to minute 40. I cannot comment on the Thai website’s reliability, but I do believe the Global News so here are the words of the WHO director general. ‘Corona is airborne. It is more contagious… it has more potency, virulence’.

Elsewhere

In Brazil President Bolsonaro continues to flout the Health Ministry’s physical distancing guidelines and is unwilling to take Covid-19 seriously. On the other side of the world the Tanzanian President’s denial of the coronavirus is a cause of great concern. Perhaps we should take comfort from the fact he called for three days of national prayers and has said they were answered.12


Guest Contribution: Complexity by Simon Dalby13

As the COVID-19 pandemic spreads around the world so too do attempts to respond. The policy discussions about how to deal with the disease, and the economic shocks that such attempts have set in motion, are proliferating even faster than the virus itself in many places.

Two things are especially noteworthy in all this.

First, what is being emphasized in most of this discussion is the interconnectedness of humans, nature and our social and economic arrangements. The speed of the spread of the virus, and the complicated routes it has taken, revealed by attempts at contact tracing those who get sick, make clear just how complicated links are between people and their surroundings. The disease has also revealed numerous weaknesses in contemporary economic arrangements; the dependence of urban dwellers on long supply chains is now very clear. And now as the Northern Hemisphere starts hurricane, typhoon and cyclone season, the disruptions from more severe weather events add to the difficulties. Storms have already hammered the Philippines, India and Bangladesh, while tornadoes and floods add to pandemic woes in the US.

Ironically some scientists have suggested that cyclone Amphan, which recently hit Kolkata, might have been made worse by the economic shut down in India. Clear skies, due to the absence of pollution over the Bay of Bengal, may have allowed more sunshine than usual to heat the already warm waters there, making the storm more severe. The clear implication is that we can no longer assume an external environment separate to humanity; the rich and powerful parts of humanity are remaking the planetary system quite dramatically by the sheer scale of industrial and economic actions.

This goes too for the origins of zoonotic diseases like the corona viruses. While ever further penetrations of human activity into forests and wildernesses offer opportunities for viruses to jump from animals to humans, so too do industrial farming arrangements where massive numbers of food animals are concentrated. Understanding the increasingly artificial nature of this situation, of the earth being remade by the rich and powerful among us humans, both in terms of the destruction of remaining relatively “natural” spaces, and the construction of huge industrial systems, is key to careful thinking about the context within which policy responses to both COVID-19, and the economic disruptions of the present, have to be undertaken.

Second is that the pandemic is loosening the policy consensus on the appropriate roles for government in economic and social life in many places. Conventional assumptions about who needs to do what where are being challenged. The pandemic response has emphasized the role for governments in shaping economic activities; in many places the priority given to “the market” has been shoved aside as disease control became the priority. But clumsily shutting down key parts of the retail and consumer part of the economy, has highlighted the vulnerability of poorly paid workers to economic disruptions, as well as the plight of small businesses dependent on continuous consumption of their products. Some larger corporations, and airlines and hotels at the heart of the tourism industry in particular, are in financial trouble too. This is a very brittle system leaving huge numbers of people vulnerable.

Crucially, in the last few months rising concerns about climate change have begun to penetrate into economic and financial circles. Larry Fink, the CEO of Blackwell, one of the key international investment management companies, has been arguing for some time now that sustainability has to be priority number one for corporations. McKinsey’s business management consultants seem to have come to the same conclusion recently. In late May an Economist magazine editorial used language reminiscent of that used by many climate change activists to insist that the response to the pandemic needed to be one that took the opportunity to reshape economies away from a reliance on fossil fuels. Carbon pricing, and building electric infrastructure are seen as crucial to flattening the climate curve. This new emphasis on thinking about humanity as part of a rapidly changing ecosphere just might be the silver lining in the dark clouds of pandemic chaos.

But there is nothing certain in these times. The attempts by fossil fuel corporations, hit hard by the price fluctuations in early 2020, to get bailouts, and in the case of the Trump administration a whole scale demolition of safety and emissions standards to facilitate further fracking and gas consumption, suggest a major political fight is in the offing. If attempts to rebuild cities and our economies on ecologically sensible lines are to be successful, then thinking through how ecology and economy can be made to operate together, without using massive amounts of fossil fuels, or making us all vulnerable to species jumping zoonotic diseases, has to be a key part of the policy deliberations, and all our political efforts in coming months.


Conclusion

There are few winners in the Covid-19 epidemic. Undoubtedly some medical companies and drug money manufacturers will do well. Perhaps in the long term we will see a change in how we treat our environment, in which case we will all be winners. Possibly the wealthy will realise that ‘enough’ is less than they have. The major losers are the poor and the weak. One group of people who need special consideration are those avoiding hospitals out of fear. This is not confined to the developing world, the numbers attending accident and emergency departments in the UK have decreased significantly since the epidemic began.

It is hard to arrive at conclusions in this week’s communiqué. Perhaps the most significant point is that patience is wearing thin and leadership is fraying. With lockdown being eased, it will be essential to scrutinise the number of cases and see, if in seriously affected countries like Spain, Italy and the United Kingdom, they remain low or rebound. If they rise again then the consequences will be bleak.

The next communiqué will have a guest writer covering Russia and Eastern Europe.

References

Mark Heywood, MAVERICK CITIZEN, Malnutrition, health services and democracy: The responsibility to speak out, 26 May 2020 https://www.dailymaverick.co.za/article/2020-05-26-malnutrition-health-services-and-democracy-the-responsibility-to-speak-out/

Atul Gawande, Amid the Coronavirus Crisis a Regimen for Re-entry, The New Yorker, 13th May 2020

The Independent SAGE Report, COVID-19: what are the options for the UK? Recommendations for government based on an open and transparent examination of the scientific evidence, Report
Submitted to The UK Government and the People of Great Britain & Northern Ireland by Sir David King, former Chief Scientific Adviser, UK Government, Chair of Independent SAGE. http://www.independentSAGE.org

Thank you to everyone reading, reposting and providing comments. For those who are interested in the economics of COVID-19, join the group “Economics of COVID-19” LinkedIn group. What I write is public domain, share, forward and disseminate. My contact: awhiteside@balsillieschool.ca


  1. Red text indicates figures or information will change. Bold text indicates a key point.
  2. I don’t believe the hedgehog is conversing with me, that would be silly – he does not understand epidemiology.
  3. https://coronavirus.jhu.edu/map.html
  4. These data are from the JHUM website. The countries are chosen because of their epidemics.
  5. Sources: Deaths http://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/
    Case per million ourworldindata.org/grapher/total-confirmed-cases-of-covid-19-per-million-people
  6. https://www.telegraph.co.uk/news/2020/05/26/coronavirus-test-antibody-uk-covid-19-superdrug-buy/
  7. https://city-press.news24.com/Voices/full-statement-prof-glenda-grays-public-attack-of-government-based-on-inaccurate-information-mkhize-20200521
  8. https://city-press.news24.com/Voices/full-statement-prof-glenda-grays-public-attack-of-government-based-on-inaccurate-information-mkhize-20200521
  9. Mark Heywood, MAVERICK CITIZEN, Malnutrition, health services and democracy: The responsibility to speak out, 26 May 2020 https://www.dailymaverick.co.za/article/2020-05-26-malnutrition-health-services-and-democracy-the-responsibility-to-speak-out/
  10. This raised so many questions – including why did his wife not drive?
  11. https://www.thailandmedical.news/news/breaking-news-world-health-organization%E2%80%99s-chief-says-coronavirus-is-airborne-but-many-concealing-this-including-media-from-us,-china-and-europe
  12. https://time.com/5841441/tanzania-coronavirus-defeated-prayer/
  13. Simon Dalby is a Professor of Geography and Environmental Studies at Wilfrid Laurier University. His published research deals with climate change, environmental security and geopolitics. He was educated at Trinity College Dublin, the University of Victoria and holds a Ph.D. from Simon Fraser University.

Covid-19 Watch: The ‘Leader Board’ Changes

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com1

Introduction

The Covid-19-driven lockdowns have led to a range of reactions, from acceptance to seeing it as an assault on liberty. The responses depend on many things: national and regional politics; family situations; resources; resilience; and, of course, the severity of the regulations. The rules are being eased in most countries, but the manner and speed varies greatly. In this blog I will focus on lockdowns, the effect they have, are going to have, and how we might get out of them.

This week has seen significant changes in the countries with the worst epidemics (Table 1). South Korea is being dropped from my table, they had 10,000 confirmed cases in early April and took over a month to add a further 1,000. There are outbreaks but it no longer needs to be discussed, other than as a success. Brazil is the replacement country; it now ranks third in the world.
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Covid-19 Watch: Reproduction Rates, Graphs and Face Masks

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com1

Introduction

When writing I use quotations, aphorisms, and occasionally lines of poetry. Leonard Courtney (1832 – 1918), a British politician and president of the Royal Statistical Society said, ‘the price of peace is eternal vigilance’. Our watchword must be ‘the price of epidemic control is eternal vigilance.’2 The Covid-19 pandemic is entering a new phase. That is not to suggest it is under control or that the battle is over. Far from it. In some countries cases and deaths continue to climb, in others the control is precarious. We need to monitor, and be ready to act.

This week has been especially fascinating with interesting new developments. There is more evidence the virus reached Europe before the end of 2019. In addition to the case in France, a choir in Bradford (UK) reported a cluster of illness in early January. It began with the partner of a man who returned from business in Wuhan on 17 or 18 December.3 Korea was a poster child for epidemic control but in the last week has seen a small number of new cases.

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Covid-19 Continues

For the past two months I have not written my usual personal blog for my website. There is a reason for this, the Covid-19 pandemic. Covid-19 is the greatest global challenge I have seen. It could be outstripped by a climate catastrophe, but for now it is all consuming. Given the work I have done on HIV and AIDS I am supposed to know a bit about pandemic diseases. It is worth remembering that like AIDS, Covid-19 is a retrovirus that transferred across the species barrier into humans. AIDS was recognised as a new disease in 1981. There were scares with SARS, Ebola, Zika and MERS, but none developed into a major pandemic.

In four short months Covid-19 has claimed over 250,000 lives and infected more than 3,500,000 million people. I began posting a weekly communique on Covid-19 to share what we know and need to know. This replaced the personal monthly blog I have written for more than 10 years. You have, along with several other hundred people, signed up for the communique and now you are getting this additional piece, so please feel free to delete it.

I originally wrote the monthly offering because I had something to say and share. It was just two sides of an A4 sheet when printed, and the reason was to keep the price of postage down.

“Ah ha”, I hear, “But it is on the website and sent electronically, so what is this postage business?”

Well, several of my elderly relatives are either self-confessed luddites or just lack technological skills, and don’t have email, so it was printed and posted to them. Yes, in an envelope with stamps on.

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Covid-19 Watch: Science and Social Impact

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com1

Introduction

‘The times they are a-changin’’ as Bob Dylan sang in 1964.2 Much is happening and some of it is good. The numbers in Europe’s worst affected countries are stable or declining. Some countries are tentatively starting the process of emerging from lockdown. The feared increases in Africa are still to materialise, the USA with the world’s worst epidemic is experiencing waves with a slight downward trend. That is the good news. On the debit side some leaderships have lost it and economic and social impacts are emerging. They are worse than we dreamed. I have key, usually short, readings at the end.

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Covid-19 Watch: Lockdowns and Economics

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com1 and Dr Steven Forsythe, Deputy Director of Economics and Costing, Avenir Health

Introduction

After I began posting I promised to invite guest contributions. It is with great pleasure (and some relief) that this post focuses on the economics of Covid-19, written by friend and colleague Dr Steven Forsythe. Please, readers, feel free to suggest what you want covered in greater depth. The world is stirring as countries tentatively start the process of emerging from lockdown. This is a key topic for next week.2 I am adding three key, usually short, readings per week at the end of the blog.

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Covid-19 Watch: Politics, Public Health and Economics

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com1

Introduction

On 22nd April, the day this commentary is released, I was supposed to be at the Heidelberg Institute for Global Health (IGH).2 On the 4th March I published the first Covid-19 commentary, and I went to see the nurse at my health service. Because the IGH is attached to a hospital, longer term guests must be immunised against everything! To my relief instead of giving me shots, the nurse took an armful of blood for antibody tests. We will see what I actually need. Also on that day the Johns Hopkins University (JHU) website reported 95,100 Covid-19 cases globally; 262 in Germany; and 86 in the United Kingdom. Today the figures are global cases 2,565,258, Germany 148,453 and the UK 130,184.

I should reiterate the limitations of these posts. Most examples are drawn from countries and health systems I know best. These are the UK, South Africa, Canada, and Eswatini. This epidemic is, without doubt, the greatest challenge to humankind I have seen. The mantra is: ‘we will get through it’. But society is changing and will be fundamentally different. It could be better! I have 30 years’ experience, much working on the social, political, economic, and psychological causes and consequences of HIV and AIDS. Covid-19 is new. There is a lot we don’t know, and we are developing responses as the epidemic spreads. I read widely and listen to key lectures and webinars. Despite that it is easy to feel overwhelmed by the amount being written and published. There is also a problem of ‘fake’ news and unreviewed papers.

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Covid-19 Watch: The Epidemic Curve starts to change

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com1 – note: this blog includes an Appendix written for parents “Supporting Children During Lockdown”.

Introduction

On the weekend of 11th April Boris Johnson, the British Prime Minister, was released from St Thomas’ Hospital in London recovering from Covid-19. He was hospitalised for a week, including three days in intensive care. To his credit he has not returned to work but will spend time recuperating. In a brief video message, he recognised that the National Health Service (NHS) saved his life and took the opportunity to name some of the carers. He specifically ‘called out’ nurses from New Zealand and Portugal. Hopefully this will give rise to renewed respect and additional funding for the NHS, and a realisation as to how dependent the nation is on migrant health workers.

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Covid-19 Watch: The Complexity of Data

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com1

Introduction

Many of us have time on our hands at the moment. This is illustrated in unexpected ways: a clear-out resulting in a table of toys at the front of a house with a notice ‘FREE’; the distance we have walked on Sunday, an unbelievable – for me – 11 kilometres; and the recipe books being dusted off. I read a great deal normally and have just finished Erik Larson’s ‘The Splendid and the Vile: A Saga of Churchill, Family and Defiance During the Blitz’. It covers the period from Churchill’s appointment as Prime Minister on 10th May 1940, when Nazi forces over-ran Europe, to the end of 1941.2 There are similarities between that period and where we are now: a sense of dread, a formidable and heartless enemy, and the need for good science and unity. This is not, as many journalists have implied: ‘the blitz spirit’, which has been parodied, most notably in Private Eye.3 It is rather a sense of helplessness.
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Covid-19 Watch: The Curve Steepens

Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com

Red text indicates figures or information will change. Bold text indicates a key point.

Introduction

I believe there are, at last, signs of hope in some of the data. My sense of optimism is, of course, helped by the weather and the advancing spring in Norwich. Mornings begin with a wonderful dawn chorus, quite unlike South Africa’s raucous hadedas. In the UK the chorus is begun by a robin, joined by blackbirds and many other species. In addition, the garden is full of daffodils, sadly just past their peak.

“I wandered lonely as a Cloud
That floats on high o’er vales and Hills,
When all at once I saw a crowd,
A host, of golden Daffodils;
Beside the Lake, beneath the trees,
Fluttering and dancing in the breeze.” – William Wordsworth

On 4th March, the Johns Hopkins website reported 93,000 Covid cases, mostly in China. A week later, on 11th March, there were nearly 120,000 cases. China still had the largest number but only a slight increase. By Wednesday 18th March there were 201,530 cases. On 25th March there were 423,121. On the morning of 1st April there were 860,793 cases. The global doubling time is a little less than a week. There are excellent websites tracking the epidemic.1

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