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I'm a Doctor Who Has C0VlD-19. AMA

Iwokeup

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What are your thoughts on kids going to back to school?
What @Vigilante said.

Also there's this:

34065

TL;DR

No (none, nada, zilch, zippo) transmission from kids to others, verified by DNA sequencing of the virus that each child/adult was infected with.
 
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For those that know me, I'm a part-time ER doctor turned entrepreneur. I was recently diagnosed with C0VlD-19 and wanted to help dispel any rumors about the illness, etc.

Quick background

- Middle aged, absolutely no health issues (like really. None)
- Never smoker, drink only 1-2 glasses of wine (or good whiskey!) a month. No drugs
- Workout 2x day (lift and cardio) - #75Hard routine, for those curious.
- Part time ER doctor still because I follow @Vigilante's advice to draw from the employee cup for as long as possible.
- Work in Texas and have seen literally hundreds of C0VlD-19 POSITIVE patients over the pandemic course.

[And yes, we are admitting a LOT of C0VlD-19 patients because they are sick. Recently admitted a 30 yo Paramedic who was sitting 70% on room air(!)]

- Not a Mask Karen/Nazi when not in the hospital. In fact, this is my motto outside of the hospital:

View attachment 34054
.
.
.
.
This is an update I shared with a colleague today:

I tested POSITIVE via nasal PCR for C0VlD-19. I'm doing well now. Managed to knock out a great w/o this morning (db presses, pull-ups, curls) but it was rough for a while.

HPI: Have worked every weekend in June and first weekend in July in the ERs. At least 5-10 C0VlD-19+ pts/12 hour shift. Using PPE when in room, face mask at workstation.
- Last work shift was 7/5.
- Sx onset 7/7 as follows: Fevers, arthralgia, myalgia. Dry cough.
- Sats on 7/9 down to 92%/RA. Add'l sx incl. nausea, loose stools and abdominal pain. Tachycardia.
- Started HCQ +Azithro+Zn on 7/9.
- Significant overall improvement.
- Nasal swab test 7/10
- Result POSITIVE yesterday (7/14).
- URI sx until 7/14 + fatigue.
- Absolutely asymptomatic today. Checked QTC with an EKG back in Mar and nl s no findings.
- Still taking med regimen.
- Sats have been 97-98 since 7/10


AMA. Will respond when time allows.

Thank you for posting this! It's super helpful.

So, in your medical opinion, masks don't really help to reduce transmission (in terms of asymptomatic people wearing them)?

Have you seen a lot of children with it? I have a 5-year-old with very severe asthma induced by viral infections like colds, and I also have a 7-week-old baby. Is it really risky to their lives if I send my 5-year-old to kindergarten?

Since HCQ is so politicized and the claim is that it doesn't work, can the general population still request a prescription of it if diagnosed with COVID?
 

Jon L

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And what are your thoughts on kids wearing masks for up to eight hours per day… Specifically elementary school age kids?
Kids will be inclined to take their masks off. To reduce the probability of that happening, we should require that parents duct tape masks to their kids' faces each morning, starting a month before the first day of school. That way, they will be used to wearing masks once school starts.

My 5th grader would have no issue with this. In fact, I think she'd look forward to doing her part to prevent the rampant spread of the virus among elementary age kids.
 

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Correct. Normal for most people is 97-100% on "room air," aka your normal atmosphere at sea level.

92% is enough to admit most folks who don't have underlying disease.

How accurate are the finger tip pulse oximeters? Are you tested using a different kind? I have one and I regularly get 90-92 on it. I am living at 9500 ft elevation though. When I take a bunch of really deep breaths I can get it to 96 maybe.
 
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Jon L

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What @Vigilante said.

Also there's this:

View attachment 34065

TL;DR

No (none, nada, zilch, zippo) transmission from kids to others, verified by DNA sequencing of the virus that each child/adult was infected with.
I don't know a ton about viruses, but C0VlD-19 seems like an odd one...how many other viruses behave this way?
 

Simon Angel

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How accurate are the finger tip pulse oximeters? Are you tested using a different kind? I have one and I regularly get 90-92 on it. I am living at 9500 ft elevation though. When I take a bunch of really deep breaths I can get it to 96 maybe.

I'm pretty sure that altitude is the reason for your lower oxygen levels. I think that's good for you, though, because your body is already used to lower than normal levels.

People with anemia were considered a high risk group (or at least speculated) since with anemia your body also gets hypoxic (low oxygen in blood), yet it turned out that it wasn't the case.
 

Jon L

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I'm pretty sure that altitude is the reason for your lower oxygen levels. I think that's good for you, though, because your body is already used to lower than normal levels.

People with anemia were considered a high risk group (or at least speculated) since with anemia your body also gets hypoxic (low oxygen in blood), yet it turned out that it wasn't the case.
Here's a study to back that up:
Says that a 40 year old at sea level might have 97% reading, but at 5000 feet, that same person would show 90%, even though they're perfectly healthy. (scroll down to the bottom of the page)
 
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srodrigo

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from:
https://www.nbcnews.com/health/health-news/cdc-says-C0VlD-19-cases-u-s-may-be-10-n1232134

"'Our best estimate right now is that for every case that's reported, there actually are 10 other infections,' Dr. Robert Redfield, director of the CDC, said on a call with reporters Thursday. "
Right.

Which would put the fatality rate @ 0.004% or 4 in 1,000.

For comparison, your risk of dying from a lightning strike in your life is estimated to be 1 in 3,000.

Thanks. I'm not good at maths, but if infections are 10x than reported (in which case they should update their own data), then the death rate gets divided by 10. So, from the CDC data:

TOTAL CASES: 3,416,428
TOTAL DEATHS: 135,991


135,991 / (3,416,428 * 10) = 0.004 = 0.4%

which AFAIK is still around 3 times higher than the 0.13% flu death rate.
 

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How and when do you see this ending?
 

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Thanks. I'm not good at maths, but if infections are 10x than reported (in which case they should update their own data), then the death rate gets divided by 10. So, from the CDC data:

TOTAL CASES: 3,416,428
TOTAL DEATHS: 135,991

135,991 / (3,416,428 * 10) = 0.004 = 0.4%


which AFAIK is still around 3 times higher than the 0.13% flu death rate.

You are correct, it is 0.4%. From the data I have seen the estimated IFR (infection fatality rate) is 0.15%. Typical flu is reported around 0.06%, but obviously varies year to year based on the strain. So covid is between 2-3x more deadly than flu.

Do not confuse IFR with case fatality rate (CFR). CFR is deaths per positive tests, but based on antibody studies it is believed that there are 10x the number of infections than positive tests. Most people simply never get tested because they do not get that sick or choose not to get tested even if they feel significantly ill. Anyone saying 4% fatality is talking CFR not IFR, but CFR isn’t a good measure of impact because it can fluctuate widely depending on how many people that got sick also got tested.
 
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Thanks. I'm not good at maths, but if infections are 10x than reported (in which case they should update their own data), then the death rate gets divided by 10. So, from the CDC data:

TOTAL CASES: 3,416,428
TOTAL DEATHS: 135,991

135,991 / (3,416,428 * 10) = 0.004 = 0.4%


which AFAIK is still around 3 times higher than the 0.13% flu death rate.
also a number to think about: how many people have the flu and never report it? do we have 10x the amount of cases in flus?

also, immunity... if the virus is a new thing, then nobody has any immunity to it, which means we'll all get it the first round, and then later on will be less likely to get it (if we get immune to it)
 

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Does getting your temperature checked before being allowed into certain buildings do anything at all? I'm assuming it's just a fake measure to make people think they are safer.

Edited to add that the radar temp guns that are used around here were shown to be inaccurate.
 
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Kak

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Are lockdowns counter-intuitive?

Meaning... They slow our progress out of this mess...

What is better for "the greater good" lockdowns or recoveries?
 
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Lyinx

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Are lockdowns counter-intuitive?

Meaning... They slow our progress out of this mess...

What is better for "the greater good" lockdowns or recoveries?
That my friend, is the multi-billion dollar question :)
 

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You are correct, it is 0.4%. From the data I have seen the estimated IFR (infection fatality rate) is 0.15%. Typical flu is reported around 0.06%, but obviously varies year to year based on the strain. So covid is between 2-3x more deadly than flu.

Do not confuse IFR with case fatality rate (CFR). CFR is deaths per positive tests, but based on antibody studies it is believed that there are 10x the number of infections than positive tests. Most people simply never get tested because they do not get that sick or choose not to get tested even if they feel significantly ill. Anyone saying 4% fatality is talking CFR not IFR, but CFR isn’t a good measure of impact because it can fluctuate widely depending on how many people that got sick also got tested.

Thanks for clarifying. I just did some maths out of curiosity as I was surprised that covid would be less deadly than the flu. The IFR makes more sense though, as you pointed out. I'm not into this medical terms, so good to get some explanations :)

also a number to think about: how many people have the flu and never report it? do we have 10x the amount of cases in flus?

also, immunity... if the virus is a new thing, then nobody has any immunity to it, which means we'll all get it the first round, and then later on will be less likely to get it (if we get immune to it)

There might be a higher flu IFR as well (I have no idea whether it's 10x or different though).

About immunity... I've read that immunity to covid might last for just a few months, so it might be similar to the flu in that regard. I wonder whether someone actually knows for sure yet, as this is still a brand new virus.
 

Lyinx

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About immunity... I've read that immunity to covid might last for just a few months, so it might be similar to the flu in that regard. I wonder whether someone actually knows for sure yet, as this is still a brand new virus.
I've heard all kinds of theories on immunity, so far I can best go from local community response:
100's of folks got it at one time, very few died, and now it's gone for a month or two with only a few late-bloomers that got bad cases still being in recovery (2 cases that I know of, both probably 8 weeks in, looking towards recovery shortly but not 100% out of the woods yet)
 
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Iwokeup

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Thank you for posting this! It's super helpful.

So, in your medical opinion, masks don't really help to reduce transmission (in terms of asymptomatic people wearing them)?
No, they really don't work.

Here's a lengthy article going through the science of it.

Have you seen a lot of children with it? I have a 5-year-old with very severe asthma induced by viral infections like colds, and I also have a 7-week-old baby. Is it really risky to their lives if I send my 5-year-old to kindergarten?
I've seen some children with it. Do kids get it? Yes, but in far smaller proportion to everyone over 20 and certainly everyone over 40. They also do FAR better than every other group in just about every category.

Caveats: kids like yours with severe underlying respiratory illness should be cautious. As you know, asthma is an inflammatory condition and COVID seems to induce an inflammatory response in the lower respiratory tract.

Since HCQ is so politicized and the claim is that it doesn't work, can the general population still request a prescription of it if diagnosed with COVID?
Depends. State by state regulations vary. Where I work, no, you'd have to figure some workaround.
 

Iwokeup

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@biophase
Here's a study to back that up:
Says that a 40 year old at sea level might have 97% reading, but at 5000 feet, that same person would show 90%, even though they're perfectly healthy. (scroll down to the bottom of the page)
I love Rebel EM.

Here's a very nice graphic that lays it out for you by altitude:

34081
Source
 

Iwokeup

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Thanks. I'm not good at maths, but if infections are 10x than reported (in which case they should update their own data), then the death rate gets divided by 10. So, from the CDC data:

TOTAL CASES: 3,416,428
TOTAL DEATHS: 135,991

135,991 / (3,416,428 * 10) = 0.004 = 0.4%


which AFAIK is still around 3 times higher than the 0.13% flu death rate.
Thanks for catching that. Yes. Not 0.004% but rather 0.4%.
 
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Iwokeup

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How and when do you see this ending?
Maybe next spring? Honestly, it's going to take time and in my opinion is going to become endemic and something that we deal with for years to come.

In epidemiology, an infection is said to be endemic in a population when that infection is constantly maintained at a baseline level in a geographic area without external inputs. For example, chickenpox is endemic in the UK, but malaria is not.
 

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You are correct, it is 0.4%. From the data I have seen the estimated IFR (infection fatality rate) is 0.15%. Typical flu is reported around 0.06%, but obviously varies year to year based on the strain. So covid is between 2-3x more deadly than flu.

Do not confuse IFR with case fatality rate (CFR). CFR is deaths per positive tests, but based on antibody studies it is believed that there are 10x the number of infections than positive tests. Most people simply never get tested because they do not get that sick or choose not to get tested even if they feel significantly ill. Anyone saying 4% fatality is talking CFR not IFR, but CFR isn’t a good measure of impact because it can fluctuate widely depending on how many people that got sick also got tested.
Great post, @GIlman. Glad to see another physician chiming in here.
 

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Does getting your temperature checked before being allowed into certain buildings do anything at all? I'm assuming it's just a fake measure to make people think they are safer.

Edited to add that the radar temp guns that are used around here were shown to be inaccurate.
It's definitely screening out people more likely to be ill w/COVID but it won't catch asymptomatic carriers.

For example, in that Icelandic study noted above, the people who were both more likely to be infected because of:

1. Travel patterns (to/from high risk areas) and
2. Symptomatic (including fevers),

13% were found to be COVID - positive

On the other hand, in the general population among those self-reporting as symptomatic, only 0.6% and 0.8% were found to have COVID.

What does that mean in practical terms? For everyone who reported feeling symptomatic, it would take screening ~(S.W.A.G.) hundreds of symptomatic people before you found one positive case (or possibly positive since your'e only screening by temperature).

> Plus those things suck in terms of accuracy.
> Plus temperatures vary wildly throughout the day and illness course.
> Plus how many symptomatic people are going to go into buildings these days? (some, b/c "humans")
> Plus I can't tell you how many "I've got a fever" s I've seen with temps at a rock stable 97.5. FFS.

So even more S.W.A.G-Y estimation? Likely screening thousands before you found one positive COVID carrier.

In medicine we call that kind of test completely worthless.
.
.
.

So somewhat more effective than the TSA Kabuki Theater we're all subjected to. :bored:
 
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Jon L

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on face masks: I thought that the point of wearing a mask wasn't to prevent the wearer from getting Covid, but to catch some of the particles they exhale, in case they have covid themselves. This, so they say, reduces the chance of spreading the virus to people in their vicinity. I also thought there were studies that showed this was effective in the case of this virus. (The theory being that if you reduce, even by a little bit, the how many people an infected person infects, you can greatly reduce the overall spread of the disease) No?
 

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Are lockdowns counter-intuitive?

Meaning... They slow our progress out of this mess...

What is better for "the greater good" lockdowns or recoveries?
Yes. Remember, the lockdowns were only ever to mitigate the risk of overwhelming hospital capacity. Remember those days? LOL
 

Iwokeup

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One thing re: immunity. Very few viruses convey lifelong immunity. Think about it, not even chickenpox gives lifelong immunity anymore.

I'm not very bullish on a vaccine, plus I refuse to be a guinea pig.
 
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Iwokeup

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on face masks: I thought that the point of wearing a mask wasn't to prevent the wearer from getting Covid, but to catch some of the particles they exhale, in case they have covid themselves. This, so they say, reduces the chance of spreading the virus to people in their vicinity. I also thought there were studies that showed this was effective in the case of this virus. (The theory being that if you reduce, even by a little bit, the how many people an infected person infects, you can greatly reduce the overall spread of the disease) No?

Couple of thoughts:
  • The size of the COVID virus is 12 microns (millionth's of a meter).
From the above article:

Filtering Capacity: The filters in masks do not act as sieves by trapping particles greater than a specific size while allowing smaller particles to pass through. 18 Instead the dynamics of aerosolized particles and their molecular attraction to filter fibres are such that at a certain range of sizes both large and small particles will penetrate through a face mask. 18Accordingly, it should be no surprise that a study of eight brands of face masks found that they did not filter out 20-100% of particles varying in size from 0.1 to 4.0 microns. 21 Another investigation showed penetration ranges from 5-100% when masks were challenged with relatively large 1.0 micron particles. 29 A further study found that masks were incapable of filtering out 80-85% of particles varying in size from 0.3 to 2.0 microns. 30 A 2008 investigation identified the poor filtering performance of dental masks. 27 It should be concluded from these and similar studies that the filter material of face masks does not retain or filter out viruses or other submicron particles. 11,31 When this understanding is combined with the poor fit of masks, it is readily appreciated that neither the filter performance nor the facial fit characteristics of face masks qualify them as being devices which protect against respiratory infections. 27 Despite this determination the performance of masks against certain criteria has been used to justify their effectiveness.2 Accordingly, it is appropriate to review the limitations of these performance standards.

Performance Standards: Face masks are not subject to any regulations. 11The USA Federal Food and Drug Administration (FDA) classifies face masks as Class II devices. To obtain the necessary approval to sell masks all that a manufacturer need do is satisfy the FDA that any new device is substantially the same as any mask currently available for sale. 21 As ironically noted by the Occupational Health and Safety Agency for Healthcare in BC, “There is no specific requirement to prove that the existing masks are effective and there is no standard test or set of data required supporting the assertion of equivalence. Nor does the FDA conduct or sponsor testing of surgical masks.” 21 Although the FDA recommends two filter efficiency tests; particulate filtration efficiency (PFE) and bacterial filtration efficiency (BFE) it does not stipulate a minimum level of filter performance for these tests. 27The PFE test is a basis for comparing the efficiency of face masks when exposed to aerosol particle sizes between 0.1 and 5.0 microns. The test does not assess the effectiveness of a mask in preventing the ingress of potentially harmful particles nor can it be used to characterize the protective nature of a mask. 32 The BFE test is a measure of a mask’s ability to provide protection from large particles expelled by the wearer. It does not provide an assessment of a mask’s ability to protect the wearer. 17Although these tests are conducted under the auspices of the American Society of Testing and Materials (ASTM) and often produce filtration efficiencies in the range of 95-98 %, they are not a measure of a masks ability to protect against respiratory pathogens. Failure to appreciate the limitations of these tests combined with a reliance on the high filtration efficiencies reported by the manufacturers has, according to Healthcare in BC, “created an environment in which health care workers think they are more protected than they actually are.” 21 For dental personnel the protection sought is mainly from treatment induced aerosols.

The Inadequacies
Between 2004 and 2016 at least a dozen research or review articles have been published on the inadequacies of face masks. 5,6,11,17,19,20,21,25,26,27,28,31 All agree that the poor facial fit and limited filtration characteristics of face masks make them unable to prevent the wearer inhaling airborne particles. In their well-referenced 2011 article on respiratory protection for healthcare workers, Drs. Harriman and Brosseau conclude that, “facemasks will not protect against the inhalation of aerosols.” 11 Following their 2015 literature review, Dr. Zhou and colleagues stated, “There is a lack of substantiated evidence to support claims that facemasks protect either patient or surgeon from infectious contamination.” 25 In the same year Dr. R. MacIntyre noted that randomized controlled trials of facemasks failed to prove their efficacy. 5 In August 2016 responding to a question on the protection from facemasks the Canadian Centre for Occupational Health and Safety replied:

  • The filter material of surgical masks does not retain or filter out submicron particles;
  • Surgical masks are not designed to eliminate air leakage around the edges;
  • Surgical masks do not protect the wearer from inhaling small particles that can remain airborne for long periods of time. 31
In 2015, Dr. Leonie Walker, Principal Researcher of the New Zealand Nurses Organization succinctly described- within a historical context – the inadequacies of facemasks, “Health care workers have long relied heavily on surgical masks to provide protection against influenza and other infections. Yet there are no convincing scientific data that support the effectiveness of masks for respiratory protection. The masks we use are not designed for such purposes, and when tested, they have proved to vary widely in filtration capability, allowing penetration of aerosol particles ranging from four to 90%.” 35

Face masks do not satisfy the criteria for effectiveness as described by Drs. Landefeld and Shojania in their NEJM article, “The Tension between Needing to Improve Care and Knowing How to Do It. 10 The authors declare that, “…recommending or mandating the widespread adoption of interventions to improve quality or safety requires rigorous testing to determine whether, how, and where the intervention is effective…” They stress the critical nature of this concept because, “…a number of widely promulgated interventions are likely to be wholly ineffective, even if they do not harm patients.” 10 A significant inadequacy of face masks is that they were mandated as an intervention based on an assumption rather than on appropriate testing.

So basically, in theory they work. In practice? Not so much.
 

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Couple of thoughts:
  • The size of the COVID virus is 12 microns (millionth's of a meter).
From the above article:



So basically, in theory they work. In practice? Not so much.


QGHIxGS.gif
 

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Right.

Which would put the fatality rate @ 0.004% or 4 in 1,000.

For comparison, your risk of dying from a lightning strike in your life is estimated to be 1 in 3,000.

For clarity's sake, the odds of becoming a lightning victim in the U.S. in any one year is 1 in 700,000. (quote from the article, that's the risk of dying) You quoted the odds of being hit by lightning. Still, the point's valid.

How serious it is for asthamtics (adults or kids separately)?
 
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robjohn

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Hi Dr. You mentioned that if you made it thought the next 48 hours, you would be fine. How are you feeling? Hope you’re doing better.

Say that you lived with an elder family member who moved out when you became ill. This family member has all the dangerous preconditions such diabetes, heart condition and hypertension.

At what point would you feel safe for him/her to return and live with you again? In other words, at what point would you be considered noncontagious? Is it a certain time period after initial symptoms? Is it a lack of symptoms? Is it a negative test? Thank you
 

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