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2 employees at long-term care homes test positive for COVID-19, N.S. reaches triple digits

Nova Scotia has seen its largest jump in cases of COVID-19 in a single day as the number of cases reached triple digits.

On Saturday, the provincial government announced it has detected an additional 20 cases, bringing the total number of cases in Nova Scotia to 110.

Two of the new cases are employees at long-term care facilities.

One works at the R.K. MacDonald Nursing Home in Antigonish, N.S., while the other is an employee at Lewis Hall, a private retirement community in Dartmouth.

All residents and staff at the facilities have been notified, with the province’s health officials continuing to investigate and work with the facilities’ administrators.

Although no residents or other staff are showing symptoms, some are now in self-isolation as a precautionary measure while close contacts are being tested.

Nova Scotia says there are no cases of COVID-19 among residents of long-term care facilities at this time.

“The weekend is here and we need to be more vigilant than ever. We can’t let our guard down,” said Premier Stephen McNeil in a press release.

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“Only go out if necessary and obey the physical distancing rules. And stay connected with your loved ones and neighbours. We will all get through this together.”

The 20 new cases have been directed to self-isolate at home for 14 days.

Officials are currently working to identify people who may have come in close contact with the newly confirmed cases.

As of Saturday, the province said it could not yet confirm community spread as they continue to investigate several cases.

Cases in the province range from under the age of 10 to mid-70s. Three people are currently in hospital while four people have recovered and their cases are now considered resolved.

Dr. Robert Strang, the province’s chief medical officer of health, said in a press release that an increase in cases is expected as travellers continue to return to Nova Scotia.

“We’re three weeks into our response and I know this is hard for everyone. Please continue to be part of flattening the curve by following public health advice and direction.”

As of Saturday, there have been 4,031 negative tests in Nova Scotia and there are confirmed cases in all parts of the province.

Questions about COVID-19? Here are some things you need to know:

Health officials caution against all international travel. Returning travellers are legally obligated to self-isolate for 14 days, beginning March 26, in case they develop symptoms and to prevent spreading the virus to others. Some provinces and territories have also implemented additional recommendations or enforcement measures to ensure those returning to the area self-isolate.

Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

For full COVID-19 coverage from Global News, click here.

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Coronavirus: Service New Brunswick locations to be closed temporarily

Service New Brunswick locations will be closed until Wednesday, April 1, when select service centres will reopen by appointment only, according to the province.

“Service New Brunswick had taken precautions to limit the number of customers allowed into its centres at one time and promoted social distancing among customers and employees,” said Service New Brunswick in a statement released on Saturday.

However, it was determined by the province that more was needed to keep customers and employees safe during the pandemic.

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On April 1, Service New Brunswick said it will be able to process essential transactions by appointment only in nine of its locations, which include Campbellton, Bathurst and Miramichi.

To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out.

For full COVID-19 coverage from Global News, click here.

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France faces tough weeks ahead in its fight against the coronavirus, PM warns

PARIS — The next two weeks will be the toughest yet in the fight against the coronavirus in France, Prime Minister Edouard Philippe warned on Saturday as his government raced to add intensive care beds and source protective gear.

The outbreak initially took hold in eastern France, where hospitals have become overwhelmed, and has been spreading west. Doctors in the greater Paris region have said their intensive care units will be full by the end of the weekend.

COMMENTARY: How Switzerland ended up with the second-highest coronavirus infection rate in the world

“We are fighting a battle that will take time,” Philippe said at a news conference. “The first two weeks of April will be harder than the two we have just lived through.”

To free up intensive care beds in worst-hit areas, the army and emergency workers were this weekend stepping up the transfer of patients to less-affected regions, using a military helicopter and a specially adapted train.

By Saturday, the coronavirus had claimed 2,314 lives in France, with more than 37,575 confirmed cases, according to official figures.

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The government tally only accounts for those dying in hospital but authorities say they will be able to compile data on deaths in retirement homes from next week, which is likely to result in a marked increase in registered fatalities.

Veran said the government had ordered more than 1 billion face masks, most from China, to build up supplies, with the country using some 40 million every week during the crisis.

Hospitals have scrambled to add intensive car beds and cancelled non-essential operations. There were now 10,000 intensive care beds nationwide, double the capacity when the outbreak began, and another 4,500 were targeted, Veran said.

But doctors warned beds alone were insufficient.

“We lack manpower,” Djillali Annane, head of intensive care at the Raymond Poincare hospital on the edge of Paris, told BFM TV.

Medical students are being drafted in to help ease the staffing crunch.

A decision would be taken in a week on a further extension of an unprecedented lockdown beyond April 15, the prime minister said. People in France can only leave their homes to buy groceries, go to work if essential or seek medical care.

“We will only be able to see the first signs of what impact the lockdown has had towards the end of next week,” Arnaud Fontanet of the Institut Pasteur told the same news conference.

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No More Than 10 People in One Place, Trump Said. But Why?

“The most important thing was if one person in the household became infected, the whole household self-quarantined for 14 days because that stops 100 percent of the transmission outside of the household,” Dr. Birx said, without offering more detail about how they reached the number 10.

One study from researchers at Imperial College London predicted that without action to stem the spread, the virus could cause more than two million deaths in the United States. It suggested that the most effective way to avert that outcome was to limit interactions between people for a period of time.

But there is no standard or scientific definition of what a mass gathering of people is, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. And scientists who have studied the 1918 Spanish flu pandemic and more recent outbreaks have not found strong evidence that restricting mass gatherings alone is effective in controlling an outbreak, Dr. Osterholm said.

In addition to the size of a gathering, public health experts may consider factors such as the density of people in one place when making recommendations on social distancing, Dr. Osterholm said.

Events where people congregate in a small space may increase the opportunity for person-to-person transmission of the virus. Gatherings that last for longer periods of time, such as rallies, concerts or conferences, may also increase the opportunities for transmission compared with brief encounters that may occur at a pharmacy or a grocery store. That is why the context of the gathering may be more important than the actual number of people in some situations.

“What is proper social distancing for a major metropolitan city with sustained community acquired transmission is going to be different from a sleepy farming community,” Ms. Hills said. “You wouldn’t want to just one-size things.”

The prevalence of a pathogen in the community is another important factor to consider. If a pathogen is extremely widespread, then it makes sense to limit gatherings to much smaller numbers, Dr. Osterholm said.

“If 20 percent of the population is infected, you can have one meeting with 10 people in it and pretty well assume that there will be someone there who can transmit the virus,” Dr. Osterholm said. Because of a lack of testing, it is not yet clear what portion of the population is infected with the coronavirus.

Does that mean it’s safe to have up to 10 people in your home for a dinner party, a book club meeting or some other small gathering?

The safest thing to do for the moment would be to cancel such plans, or perhaps shift them to videoconferencing.

And for those who go forward with guests, it is important to consider whether anyone in the household or among the invited guests may be elderly or have underlying health conditions. Research suggests that individuals in these categories are more likely to catch an infection, and they may develop more severe disease if they get sick.

Family-style meals and open buffets should be avoided in any case.

“You might want to have one person in charge of dishing out all of the plates, rather than each person going in and interacting with the food,” Ms. Hills said.

And if you or one of your guests develops a fever or cough or simply feels fatigued, it is best to err on the side of caution and cancel plans, Ms. Hills said. “Everything can be rescheduled.”

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Trial of Coronavirus Vaccine Made by Moderna Begins in Seattle

Moderna uses genetic material — messenger RNA — to make vaccines, and the company has nine others in various stages of development, including several for viruses that cause respiratory illnesses. But no vaccine made with this technology has yet reached the market.

The infectious disease institute has been working with Moderna because the RNA approach can produce vaccine very quickly, said Dr. Barney Graham, the deputy director of the institute’s Vaccine Research Center.

He said the researchers at the vaccine center were focused on pandemic preparedness.

“The goal here is to be ready for all the virus families that can infect humans,” he said.

As bad as this epidemic is, Dr. Graham said, in one way it is lucky that a coronavirus caused it, because the researchers were at least partly ready for it. If another type of virus had caused the outbreak, it could have taken months longer to create a potential vaccine.

Other companies, using different approaches, are also trying to manufacture coronavirus vaccines. Moderna is the first to reach a clinical trial.

The trial will enroll 45 healthy adults ages 18 to 55. Each will receive two shots, 28 days apart. Moderna calls the vaccine mRNA-1273.

Three different doses will be tested — each in 15 people — and the participants will be studied to determine whether the vaccine is safe and whether it stimulates the immune system to make antibodies that can stop the virus from replicating and prevent the illness it causes.

Four participants were vaccinated on Monday, and four more are to get shots on Tuesday. Then there will be a pause to monitor them, before more participants receive injections, Dr. Graham said.

The participants will be followed for a year, but Stéphane Bancel, the chief executive of Moderna, said in an interview that safety data would be available a few weeks after the injections were given. If the vaccine then appears safe, he said, Moderna will ask the Food and Drug Administration for permission to move ahead to the next phase of testing even before the first stage is finished.

The second round of testing, to measure efficacy as well as to verify safety, will include many more participants.

Moderna, with headquarters in Cambridge, Mass., and a manufacturing plant in nearby Norwood, is already buying new equipment so that it will able to produce millions of doses. Mr. Bancel acknowledged that the company was taking a risk, because neither safety nor efficacy has been proved yet.

“Humans are suffering and time is of the essence,” he said. “Every day matters. We have taken these decisions to take the risk, because we believe it is the right thing to do.”

The company’s stock price jumped in February in response to news reports about the vaccine. And on Monday, Moderna’s stock rose more than 24 percent, rising $5.19 to close at $26.49.

Work on the vaccine started in January, as soon as Chinese scientists posted the genetic sequence of the new coronavirus on the internet. Researchers at Moderna and the National Institute of Allergy and Infectious Diseases identified part of the sequence that codes for a spike-like protein on the surface of the virus that attaches to human cells, helping the virus to invade them.

A nonprofit group, the Coalition for Epidemic Preparedness Innovations, helped pay to manufacture the vaccine for the trial.

That spike sequence is the basis for the vaccine. Moderna does not need the virus itself to produce its vaccine: The company synthesizes the stretch of RNA required for the vaccine and embeds it in a lipid nanoparticle.

By Feb. 24, Moderna had a batch of vaccine ready to ship to the infectious diseases institute, for use in the trial. On March 4, the Food and Drug Administration gave permission for the trial to begin.

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Pence Pledges High-Speed Coronavirus Testing From 2,000 Labs This Week

“The sites will roll out progressively over the week,” Admiral Giroir said. “This is not make believe, it is not fantasy. We will start shipping gear and deploying officers Monday and Tuesday.”

Mr. Pence said that more than 10 states had already set up their own drive-through test sites. But some have had waiting times several hours long and had to turn people away.

Admiral Giroir said the first priority in testing would be given to health care workers, first responders and people who are particularly vulnerable, including those over 65 with symptoms and others with underlying conditions that weaken their immune systems. Regions with high numbers of cases will get first priority for the testing centers, he added.

Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, and Admiral Giroir, whom Alex M. Azar II, the health and human services secretary, last week put in charge of coordinating testing efforts across federal agencies, appealed to the public not to seek testing unless symptoms and a real need were present.

Dr. Birx warned that as testing increases — Admiral Giroir described a regimen that “can test many tens of thousands to hundreds of thousands of individuals per week and maybe even more” — there will be a spike in the number of reported cases.

The shortage of tests and the long delay in starting to correct the problem have left doctors and patients frustrated and frightened, and experts say the lag in identifying cases helped hide the spread of the virus and slowed efforts to stop it.

Dr. Osterholm said that testing would play an important role in determining whether efforts to control the virus were working.

When schools are shut down, restaurants and bars are closed and Broadway has gone dark, how will authorities know when it is time to let things get back to normal? he asked.

“We need a trigger to turn things on, and a trigger to turn them off,” he said. “You need testing for that.”

In an email, Dr. Thomas R. Frieden, the former head of the Centers for Disease Control and Prevention said, “Testing is not a panacea.”

He warned that demands for widespread testing could even do harm. In areas where the virus is spreading, he said, people with mild or no symptoms “will take up the time, protective equipment, and lab materials of health facilities,” possibly becoming infected in the process.

Dr. Frieden added, “Testing is crucially important to find when the virus is spreading, control outbreaks in health facilities, care for people with pneumonia, and understand the virus better.”

But he emphasized that it’s important to understand the limits of testing.

“Whether the people with symptoms are positive or not, they must isolate themselves, especially from medically vulnerable people: the test could be falsely negative, or could become positive the next day. Furthermore, in a communitywide outbreak, there’s no way public health workers will be able to identify and track contacts of all people who test positive.”

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Coronavirus Is Very Different From the Spanish Flu of 1918. Here’s How.

In 1918, it was impossible to test people with mild symptoms so they could self-quarantine. And it was nearly impossible to do contact tracing because the flu seemed to infect — and panic — entire cities and communities all at once. Moreover, there was little protective equipment for health care workers, and the supportive care with respirators that can be provided to people very ill with coronavirus did not exist.

With a case fatality rate of at least 2.5 percent, the 1918 flu was far more deadly than ordinary flu, and it was so infectious that it spread widely, which meant the number of deaths soared.

Researchers believe the 1918 flu spared older people because they had some immunity to it. They theorize that decades earlier there had been a version of that virus, one that was not as lethal and spread like an ordinary flu. The older people living in 1918 would have been exposed to that less lethal flu and developed antibodies. As for children, most viral illnesses — measles, chickenpox — are more deadly in young adults, which may explain why the youngest were spared in the 1918 epidemic.

Regardless of the reason, it was a disaster for life expectancy, which plummeted. In 1917, life expectancy in the United States was 51 years. It was the same in 1919. But in 1918, it was just 39 years.

The new coronavirus tends to kill older people and those with underlying medical conditions, and it does not seem to kill children. All of which means it will have far less effect, if any, on life expectancy.

As for the coronavirus case fatality rate, it is not yet known, but the latest data from South Korea, with 7,478 confirmed infections, show a rate significantly higher than the seasonal flu. After testing 100,000 people for the virus, the country appears to have a case fatality rate of .65 percent. (Though the data is evolving as researchers in other countries track cases.)

What the current situation does have in common with 1918, though, is the tenor of public concern.

Among the first places the 1918 flu arrived in the United States was Fort Devens, near Boston. So many young soldiers were sick, and so many were dying, that the Surgeon General sent four of the nation’s leading doctors to investigate.

One of them, Dr. William Vaughan, later recalled: “Hundreds of stalwart young men in the uniform of their country, coming into the wards of the hospital in groups of ten or more. They are placed on the cots until every bed is full, yet others crowd in. Their faces soon wear a bluish cast; a distressing cough brings up the blood stained sputum. In the morning the dead bodies are stacked about the morgue like cord wood.”

Accounts like these scared Americans deeply.

On Oct. 3, 1918, Philadelphia closed all schools, churches, theaters, pool halls and other gathering places. Undertakers were overwhelmed — some funeral homes increased their prices sixfold and some even made the bereaved bury their own dead.

In Tucson, Ariz., the board of health forbade people to venture out in public without a mask. In Albuquerque, where schools and theaters were closed, a local newspaper wrote, “the ghost of fear walked everywhere.”

Similar actions are being taken today. Seattle has closed some public schools. The South by Southwest festival in Austin, Tex., has been canceled. Apple asked employees to work from home. More than 2,700 people are under some sort of quarantine in New York City. And some Costco stores are having trouble keeping bottled water in stock.

But so far this year, the annual epidemic of seasonal flu in the United States is proving much more devastating than the coronavirus.

The Centers for Disease Control and Prevention reports that there have been at least 34 million infected with flu this season, 350,000 hospitalizations and 20,000 deaths. So far, coronavirus has killed 27 people in the United States.

For the economy, the effects of the 1918 flu, despite factory closings and social disruptions, were hard to disentangle from the profound ones of World War I. The world was not as interconnected as it is today, and by the summer of 1919, the pandemic had ended.

Coronavirus is already having significant impacts on the stock market and other aspects of the economy, but the long-term consequences remain to be seen.

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In the Eye of the Coronavirus Testing Storm: Robert Redfield of the C.D.C.

“Certainly this administration has been cited repeatedly for appointing people to important positions who did not have the relevant expertise,” said Chris Beyrer, an epidemiology professor at Johns Hopkins who has collaborated on research with Dr. Redfield over the years. “But you wouldn’t say that about Bob Redfield. He’s a very seasoned public health person, and he certainly has led significant scale programs.”

On Friday morning, as criticism of testing problems ballooned, the Department of Health and Human Services announced that Adm. Brett Giroir, the assistant secretary for health, would oversee and ramp up efforts by the C.D.C., the Food and Drug Administration, state and local public health authorities, and private laboratories to expand testing. Mr. Trump also tweeted criticism of the C.D.C., saying, “For decades, the @CDCgov looked at, and studied, its testing system, but did nothing about it,” and said that President Barack Obama had made the problem worse.

As the virus has spread across the country, Dr. Redfield has spent hours on the phone with Dr. Fauci, a longtime friend, as well as elected officials and state and local public health leaders, often deep into the night. And he has worked quietly, associates say, to preserve the morale of the C.D.C.’s 11,000 employees, including almost 700 who are in the field helping states and cities respond.

A conservative Republican, Dr. Redfield in less busy times attends Catholic Mass daily, walking the short distance from his home in Baltimore to the Cathedral of Mary Our Queen. Now, he splits his time between the C.D.C. headquarters in Atlanta, where he and his wife rent an apartment close to the campus, and Washington, where these days he is relentlessly summoned for meetings and hearings.

Dr. Redfield went through college and medical school at Georgetown University on full Army scholarships after his father, a scientist who worked on RNA at the National Institutes of Health, died young. He spent the first two decades of his career as an infectious disease specialist at the Walter Reed Army Institute for Research, focusing on AIDS research at a time when the disease was still poorly understood and spreading fast.

In the mid-1980s, he was at the center of a different testing controversy — about how extensively the military should test its members for AIDS and how it should use the test results it had compiled. Dr. Redfield advocated for widespread testing and tracking as the best way to prevent the infection’s spread, while others argued it was a way for the military to flush out or otherwise discriminate against gay members. Later, he was the subject of a military investigation after colleagues suspected that he overstated the therapeutic effects of an experimental AIDS vaccine; the investigation led to a correction in some published data, but no evidence of misconduct was found.

He retired from the Army in 1996 to co-found the Institute of Human Virology at the University of Maryland School of Medicine, where the goal is to discover and distribute treatments for chronic viral and immune disorders, especially H.I.V. When Dr. Redfield left the institute, his co-founder, Dr. Robert C. Gallo, called him a major force in establishing programs to confront the H.I.V. and hepatitis C epidemics in Baltimore and around the state.

He is credited with helping the institute increase its patient base to 6,000 in Baltimore and Washington, D.C., and to more than 1.3 million in Africa and the Caribbean, where he also helped with the medical response in Haiti after the 2010 earthquake. He formed close relationships with patients, and kept photos of some who died of AIDS in his early days at Walter Reed in his office for years.

In his first two years leading the C.D.C., Dr. Redfield helped persuade Mr. Trump to take on the ambitious goal of ending transmission of H.I.V. in the country by 2030, through expanded efforts to prevent infections and treat those with the virus. And he has been a vocal champion of efforts to address opioid addiction and overdose, even sharing with the nation that one of his own sons had nearly died of an overdose and that the family struggled to find him treatment.

Dr. Redfield’s initial compensation at the C.D.C. caused an embarrassing controversy shortly after he took office. After earning about $650,000 a year at the University of Maryland, he was hired at an annual salary of $375,000, substantially higher than his predecessors and his boss, the secretary of health and human services, Alex M. Azar II.

The exceptional pay was granted under a federal provision that the Department of Health and Human Services can use to pay an official more than the approved government rate if the person provides a specific scientific need that otherwise cannot be filled. The department said this was a rare chance to hire a leading virologist.

But Dr. Redfield had actually sought the job for years. After Senator Patty Murray, Democrat of Washington, questioned the use of this exemption to pay him such a high rate, Dr. Redfield agreed to lower his salary to $209,700.

As the coronavirus crisis has grown, he has relied on the expertise of others in the sprawling agency, many of whom have been there for decades, including Dr. Anne Schuchat, the principal deputy director, and Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Disease, who has led frequent briefings for the news media.

Unlike his predecessor, Dr. Tom Frieden, a dynamic public speaker well versed in Washington political culture, Dr. Redfield has at times come across as a deer in the headlights, including during last week’s hearings. Some have questioned whether his strict adherence to rules and a chain-of-command approach, after decades in the military, may have impeded the rollout of national testing while other countries ramped up much faster.

Dr. Redfield has repeatedly said that the role of the C.D.C. is to provide testing to state and local health departments, which are supposed to do surveillance testing to gauge the extent of community spread, rather than to private-sector labs that provide on-demand testing of patients for hospitals and doctors’ offices.

But during a crisis, the C.D.C.’s role takes on more urgency — and speed becomes crucial. The agency is charged with developing a diagnostic test that is then reviewed by the Food and Drug Administration. Once the C.D.C. tests are approved, the agency manufactures them for its network of public health labs. At the same time, the tests are generally copied by commercial labs for use on patients around the country.

For coronavirus, the C.D.C.’s initial test kit was returned by numerous state public health offices, who said it was not working properly.

Dr. Redfield has still not explained what was wrong with the test kits. Numerous times, he has referred to the issue as a “manufacturing problem” that occurred when the contractors started scaling up to produce them en masse. But others involved in the matter say the problem was at the source – C.D.C. and that the agency waited too long to alert the rest of the public health community to the issue.

He has privately expressed frustration at the slow, bureaucratic process of permitting commercial and academic institutions to make their own tests — in which the F.D.A. plays a large role. But his public explanation, that the C.D.C. is not responsible for ramping up widespread commercial testing, has not been greeted sympathetically.

“I still don’t quite know why we are not taking the test that the rest of the world is using rather than making our own,” Senator Bill Cassidy, Republican of Louisiana, told reporters on a conference call on Thursday. “If there is ever a time to cut through red tape, now is the time to cut through red tape. I am not sure the extent the C.D.C. is doing that.”

Dr. Redfield is hesitant to make bold statements or requests — when Representative Ro Khanna, Democrat of California, asked in a hearing how much money he thought necessary to modernize and bulk up the nation’s public health infrastructure, he demurred, saying, “I’d have to get back to you.”

Some of Dr. Redfield’s supporters see his understated approach as an asset.

“My impression is that he is happy to have other people take credit even when he’s been behind the scenes doing a lot of work,” said John Auerbach, the president and chief executive of Trust for America’s Health, who has known Dr. Redfield for years.

Representative Tom Cole, Republican of Oklahoma, who has gotten to know Dr. Redfield since he took the helm at the C.D.C., called him “by any stretch a really admirable human being.”

“Clearly there is going to be a post-mortem of what happened on the testing front,” Mr. Cole said. “If anybody has a criticism, that is probably the biggest criticism. And where there are legitimate questions, that doesn’t mean that Dr. Redfield failed — but something went wrong.”

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