TECHINT A New Pneumonia Epidemic is on the Way

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Maha health dept ramps up med infra after pneumonia outbreak in China (INDIA)

Nov 30, 2023

PMC health department on Friday issued a letter to hospital superintendents, zonal medical officers and ward medical officers directing them to ensure medical infrastructure and systems are fully functional


Following reports of mysterious pneumonia outbreak in China, the civic health department in Pune is overhauling its medical infrastructure after the state health department released advisory on Wednesday to local bodies to monitor influenza-like illness (ILI) and severe acute respiratory illness (SARI) and reviewing preparedness to tackle such illnesses.

The Pune Municipal Corporation (PMC) health department on Thursday issued a letter to hospital superintendents, zonal medical officers (ZMO) and ward medical officers (WMO) directing them to ensure Covid-19 infrastructure and systems are fully functional.


They have been further asked to start surveillance and monitor SARI and ILI cases reported in the city, said the official. As per the advisory, all districts have been asked to conduct a thorough examination of Covid infrastructure, including beds, oxygen plant cylinders, ventilators, and other critical systems that are fully functional.

Hospitals are instructed to send samples of ILI/SARI patients to RT-PCR labs for testing and some samples for genomic sequencing at the National Institute of Virology, Pune.

Dr Suryakant Devkar, assistant health officer of PMC, said, “We have issued a letter to all ward offices and hospitals to start monitoring all influenza cases. These cases will be tested for influenza viruses like H3N2, H1N1 and Covid-19. The samples of pneumonia patients will be sent for testing and samples of severe patients will be sent to NIV for genomic sequencing. Currently, the influenza situation in the city is under control.”

Dr Devkar said that information, education and communication (IEC) activities for influenza illness and Covid-19 have been started in the city.

“The health staff working in municipal hospitals have been asked to follow hygiene and start using a face mask, PPE kits and sanitisers as per the requirement,” he said.

District civic surgeon Dr Nagnath Yempalay said around 100 beds have been made ready at the Aundh District Hospital to handle any untoward spike in cases.

“The entire setup is ready with trained staff, oxygen plant and medicines. We have an adequate stock of medicines which will last for the next six months. We can increase the bed capacity to 300 beds if required. We are closely monitoring pneumonia and flu cases,” he said.

Dr Pratapsinh Sarnikar, joint director of health services, said there is no need to panic as currently there is no danger of the new mysterious pneumonia to Maharashtra.

The department has been cautious following the Covid pandemic.

“The public health department and private doctors should be cautious and prevent any unlikely outbreak of influenza cases,” he said.

Pneumonia outbreak in China: How Indian states are preparing​


Last week, the Centre had asked all states and Union Territories to review hospital preparedness.


In view of the mysterious pneumonia outbreak in China, several states in India are overhauling their medical infrastructure.

China has been seeing a spike in cases of respiratory illnesses among children, forcing the closure of schools in the northern part of the country. On Sunday, China's National Health Commission spokesperson Mi Feng had said that the surge in acute respiratory illnesses was linked to the simultaneous circulation of several kinds of pathogens, most prominently influenza.

The spike became a global issue after the World Health Organization prodded China for more information about the outbreak.


Last week, the Centre had asked all states and Union Territories to review hospital preparedness, saying that the health ministry is closely monitoring the rise of respiratory illness cases in China among children.

As a matter of abundant caution, also because of the ongoing influenza and winter season, the ministry had asked the states to check their hospital preparedness measures such as hospital beds, drugs and vaccines for influenza, medical oxygen, antibiotics, PPE etc.

Pneumonia outbreak in China: Here's what states are doing about it.​



Tamil Nadu​



Tamil Nadu health minister Ma. Subramanian on Wednesday said that the state's public health department is very carefully investigating the fevers that occur in children.

“Pneumonia fever has been detected in China. It has been found to affect children more. In this regard, the public health department is very carefully investigating the fevers that occur in children. The new type of fever has not been detected anywhere in Tamil Nadu,” Subramanian said, according to ANI.

He added that fever camps are being held every week to detect the ongoing rainy season outbreaks. "This will be held every Saturday for another 5 weeks," the minister said.

Dr Selvavinayagam, director of Tamil Nadu Public Health and Preventive Medicine, told the news agency that there have been no significant cases detected as of now in the state and that there was no need to be alarmed.

“We have already established the surveillance part, where we will be requesting all the institutions to report to us on the IHIP (Integrated Health Information Portal) portal... With regard to infrastructure, our team is capable of expanding the required infrastructure at any time...” he said.

Gujarat​


Gujarat health minister Rushikesh Patel said that the state government and the Central government are ready for any kind of emergency which may arise due to the surge in respiratory illness cases in China.

He said that the state has re-examined the oxygen availability and bed preparations made during the period of the Covid-19 pandemic in Gujarat.

“Union health minister Mansukh Mandaviya and ICMR are keeping a close watch on this and have also issued an advisory on this,” Patel told ANI. "We have re-examined the oxygen availability and bed preparations made during the COVID period in Gujarat. Arrangements have also been made to create a separate ward for such cases."

He added that there has been no news of any casualties from China, but still, the Gujarat and Central governments have made their preparation.

Karnataka​

In Karnataka, state health minister Dinesh Gundu Rao also said that there was no need to panic about the illness, but added that hospitals in the state are prepared for any kind of emergency.

“I told officers to look into all that. We also received guidelines from the Government of India. We have now told all our hospitals to be prepared - to just check the preparations, do some mock drills, see the availability of oxygen, beds, PPE kits and keep a lookout. Right now there is nothing to panic about, there is no such situation,” he told ANI.

Rao further added that the state will wait for further guidelines from the Government of India. "But we are keeping our hospitals prepared and letting people know about the situation," the minister added.

Rajasthan​

The medical and health department in Rajasthan has advised its staff to remain alert and form rapid response teams following a rise in cases of respiratory diseases in northern China.

In an advisory, the health department has asked officials concerned to prepare an action plan for the prevention and treatment of the disease, according to PTI.

Additional chief secretary of the department, Shubhra Singh, while addressing officials through video conference on Tuesday, said the situation is “not worrisome at present”.

She, however, cautioned that the medical staff should work with full vigilance for surveillance and prevention of infectious diseases across the state.

Singh also directed officials to prepare an action plan in three days for the prevention and treatment of this disease. She further asked them to appoint a nodal officer at the district and medical college levels and to form rapid response teams at the division and district level, according to PTI.

Uttarakhand​



In Uttarakhand, the state government has sounded an alert, directing officials to step up surveillance in the state, according to ANI.

Notably, three districts in the state – Chamoli, Uttarkashi and Pithoragarh – share land borders with China.

The state has directed officials to keep a close vigilance on people suffering through the symptoms of the 'Severe Acute Respiratory Illness' on community level.

"All the district officers and chief medical officers of the state are been directed to make adequate arrangements for isolation beds/wards, oxygen beds, ICU beds, ventilators, and oxygen cylinders for the treatment of pneumonia and influenza flu patients in their respective districts", read an official statement issued by the Health Secretary, according to ANI.

It added: “All the hospitals across districts are directed to ensure the staff availability as well as stock of required medicines in all the hospitals across districts.”


 

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Denmark reports Mycoplasma pneumonia epidemic​


Denmark's Statens Serum Institute (SSI) today said Mycoplasma pneumoniae infections have reached the epidemic level, with an increase that began in the summer but has risen significantly over the past 5 weeks, according to a statement translated and posted by Avian Flu Diary, an infectious disease news blog.

Last week, the Netherlands reported a striking rise in pneumonia in children and young people since August, according to a government surveillance report flagged by FluTrackers, an infectious disease news message board.

The notices of rising pneumonia activity in some European countries come against the backdrop of reports of overwhelmed pediatric hospitals and clinics in China due to a mix of respiratory viruses, including Mycoplasma pneumonia, commonly known as "walking pneumonia." The surge in respiratory infections in China raised fears that a novel pathogen was behind the rise.

In Denmark, Mycoplasma pneumonia activity is rising across the country, with 541 cases reported last week, triple that of the middle of October. SSI said epidemics occur about every 4 years, with incidence highest in the fall and early winter. Chinese clinicians, quoted in media reports, have said that, before COVID, the country experienced Mycoplasma pneumonia outbreaks every 3 to 7 years.

Taiwan prepares for possible surge​

Elsewhere, Taiwanese officials today said Mycoplasma pneumonia is circulating at low levels, but given the surge in northern China they are taking steps to increase production and imports of azithromycin, the main drug used to treat the infection, its Central News Agency reported.

Currently, Mycoplasma pneumonia cases make up less than 1% of flulike illnesses diagnosed at Taiwan's hospitals over the past month.

 

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GARii33WoAA1y8b


@TR_123456 @Test7 @Yasar @Zafer @Ryder @Rodeo @Rooxbar @Gary @Nilgiri @OPTIMUS @TheInsider @Heartbang @MADDOG @Anmdt @Bürküt @Cabatli_TR @Kaan Azman @Kartal1 @Saithan @Sanchez

Attention please! A new global epidemic is about to begin. Everyone should take the necessary precautions, people!
 

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Ah! Just in time for the American presidential elections! That oughta keep the orange bastard out (!)

Jokes aside, there's definitely something yucky floating out there and I got it. Managed to take swift action and doing OK, but its a nuisance nonetheless. Take care of yourselves.

(Oh and the US election isn't the only election to watch in 2024. Notable candidates include Taiwan, EU parliament, South Korea, Pakistan, Russia, Iran, Mexico, El Salvador, Algeria, Tunisia, and Venezuela.)
 

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Upsurge of respiratory illnesses among children-Northern China​


Description of the Situation​

Since mid-October 2023, the World Health Organization (WHO) has been monitoring data from Chinese surveillance systems that have been showing an increase in respiratory illness in children in northern China.
At a press conference on 13 November 2023, China’s National Health Commission reported on a nationwide increase in the incidence of respiratory diseases, predominantly affecting children. Chinese authorities attributed this increase to lifting of COVID-19 restrictions and the arrival of the cold season, and due to circulating known pathogens such as influenza, Mycoplasma pneumoniae, respiratory syncytial virus (RSV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Mycoplasma pneumonia and RSV are known to affect children more than adults.
On 22 November 2023, WHO identified media and ProMED reports about clusters of undiagnosed pneumonia in children's hospitals in Beijing, Liaoning and other places in China. Through the International Health Regulations mechanism, WHO made an official request to China to provide additional epidemiologic and clinical information, as well as laboratory results from these reported cases and data about recent trends in circulating respiratory pathogens. A key purpose was to identify whether there have been “clusters of undiagnosed pneumonia” in Beijing and Liaoning as referred to in media reports, and if so whether these were separate events, or part of the known general increase in respiratory illnesses in the community. WHO further reached out through clinical networks for additional information.
On 23 November, WHO held a teleconference with Chinese health authorities from the Chinese Center for Disease Control and Prevention and the Beijing Children’s Hospital, facilitated by the National Health Commission and the National Administration of Disease Control and Prevention, in which the requested data were provided, indicating an increase in outpatient consultations and hospital admissions of children due to Mycoplasma pneumoniae pneumonia since May, and RSV, adenovirus and influenza virus since October. Some of these increases are earlier in the season than historically experienced, but not unexpected given the lifting of COVID-19 restrictions, as similarly experienced in other countries. No changes in the disease presentation were reported by the Chinese health authorities. Chinese authorities advised that there has been no detection of any unusual or novel pathogens or unusual clinical presentations, including in Beijing and Liaoning, but only the aforementioned general increase in respiratory illnesses due to multiple known pathogens. They further stated that the rise in respiratory illness has not resulted in patient loads exceeding hospital capacities.
The Chinese authorities advised that, since mid-October, enhanced outpatient and inpatient surveillance has been implemented for respiratory illnesses covering a broad spectrum of viruses and bacteria, including, for the first time, Mycoplasma pneumoniae. This complements existing respiratory surveillance mechanisms and may have contributed to the observed increase in detection and reporting of respiratory illness in children.

Public Health Response​

Since mid-October, in addition to enhancing disease surveillance in health care facilities and community settings, Chinese authorities have stressed the need to strengthen the capacity of the health system to manage patients. China has systems in place to capture information on trends in influenza, influenza-like illness (ILI), RSV and SARS-CoV-2, pneumonia and other severe acute respiratory infections (SARI), and reports influenza detections to platforms such as the Global Influenza Surveillance and Response System (GISRS). GISRS is led by WHO and used for the international virological and epidemiological surveillance of human influenza.
WHO is closely monitoring the situation and is in close contact with national authorities in China. WHO will continue to provide updates as warranted.

WHO Risk Assessment​

In the current outbreak of respiratory illness, the reported symptoms are common to several respiratory diseases and, as of now, at the present time, Chinese surveillance and hospital systems report that the clinical manifestations are caused by known pathogens in circulation. Mycoplasma pneumoniae is a common respiratory pathogen and a common cause of paediatric pneumonia, and is readily treated with antibiotics.
China has an influenza-like illness (ILI) and severe acute respiratory infections (SARI) sentinel surveillance system. Since mid-October, China has implemented enhanced surveillance systems for respiratory illness covering a broad spectrum of respiratory viruses and bacteria, including Mycoplasma pneumoniae.
There is limited detailed information available to fully characterize the overall risk of these reported cases of respiratory illness in children. However, due to the arrival of the winter season, the increasing trend in respiratory illnesses is expected; co-circulation of respiratory viruses may increase burden on health care facilities.
According to surveillance data reported to WHO’s FluNet and published by the National Influenza Centre in China, ILI was above usual levels for this time of year and increasing in the northern provinces. Influenza detections were predominantly A(H3N2) and B/Victoria lineage viruses.

WHO Advice​

Based on the available information, WHO recommends that people in China follow measures to reduce the risk of respiratory illness, which include recommended vaccines against influenza, COVID-19 and other respiratory pathogens as appropriate; keeping distance from people who are ill; staying home when ill; getting tested and medical care as needed; wearing masks as appropriate; ensuring good ventilation; and practicing regular handwashing.
WHO does not recommend any specific measures for travellers to China. In general, persons should avoid travel while experiencing symptoms suggestive of respiratory illness, if possible; in case of symptoms during or after travel, travellers are encouraged to seek medical attention and share travel history with their health care provider.
WHO advises against the application of any travel or trade restrictions based on the current information available on this event.
 

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Forget the ‘tripledemic.’ The U.S. is headed for a ‘syndemic’ this winter—and experts warn we’re not prepared​


COVID will likely reach levels in December not yet seen this year, combining with surges of flu, RSV, and other pathogens for a winter not so different from last year’s “tripledemic,” experts say.

Raj Rajnarayanan, assistant dean of research and associate professor at the New York Institute of Technology campus in Jonesboro, Ark., told Fortune that the U.S. is a “sitting duck” in the face of a “syndemic” winter.

It’s a term he prefers to “tripledemic,” as it acknowledges the impact of more than three pathogens on the healthcare system, and the need for policies to address the phenomenon, in addition to medical interventions.

“Strained hospital capacities, workforce exhaustion, burnout, a lack of effective therapeutic tools, poor communication, a lack of compliance [with COVID precautions], a lack of continuity planning, and the pervasive influence of social determinants of health” only make the nation’s delicate health infrastructure more fragile, he said.

COVID wastewater levels are “high” and again headed upwards, on track to surpass their 2023 peak, which occurred in September, according to wastewater data posted by the U.S. Centers for Disease Control and Prevention. COVID hospitalizations are up 10% week over week, according to the most recent data made available. And deaths, while not rising, are not receding, either.

Jay Weiland—a top COVID forecaster cited by leading public health experts like Dr. Eric Topol—told Fortune he has “little doubt” that this winter’s COVID wave will be the highest the country has seen since last winter, when Omicron spawn XBB.1.5, or “Kraken,” sent cases rocketing skyward yet again.

There’s a “reasonable chance” it surpasses last year’s wave, he added—but little chance it competes with the initial Omicron peak of the 2021–22 winter, when U.S. infections hit an all-time high.

Meanwhile, U.S. rates of hospitalization from RSV and flu are also on the rise, and outpatient visits for respiratory illnesses are abnormally high, according to CDC data.

“Last year really showed what happens when we go a few years without seeing our normal viral trends,” Dr. Karen Acker, pediatric infectious diseases specialist at New York–Presbyterian Komansky Children’s Hospital, told Fortune on Friday.

It's a nod to the “immunity debt” theory, according to which infections from other pathogens spike after pandemic precautions are abandoned. Some blame the potential phenomenon for last year’s relatively severe winter respiratory disease season, which challenged hospital capacity in many locations.

“It may take some time for viral levels and the immunity dynamic to level out,” she added. “This may be another bad year.”

Flu surging, RSV ‘near peak’​

But not all experts agree. It's "premature to say it's going to be a bad year here," Dr. Michael Osterholm—director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP)—recently told Fortune. While pathogens like flu and RSV peaked earlier than usual during last year's so called "tripledemic," the severity of the season "wasn't beyond usual." What's more, low hospital bed capacity and staff levels were under-appreciated factors that contributed to the crisis, making it look worse than it was, he said.

Encouragingly, while U.S. rates of hospitalization from COVID, RSV, and flu combined are on the rise, they remain below levels seen this time of year during the past two years. Still, they’re significantly higher than those seen in the two winters prior to the COVID-19 pandemic.

RSV hospitalizations are the highest they’ve been since 2020, with the exception of last winter. And flu hospitalizations are the highest they’ve been at this time of year since 2017, when they were identical—also with the exception of last year.

CDC Director Dr. Mandy Cohen on Thursday said U.S. flu season, while so far typical, is “accelerating fast,” and that RSV levels are “near peak,” in testimony before the House Energy and Commerce Subcommittee on Oversight and Investigations.

Multiple experts told Fortune that this winter’s respiratory season should more closely resemble pre-pandemic years than last year’s, though it may take several years for typical seasonal viral patterns to reestablish.

It may take a year or two before winter viral seasons return to normal, Osterholm recently told Fortune. Amesh Adalja, an infectious disease specialist and senior scholar at the Johns Hopkins Center for Health Security, told Fortune he expects a more standard season this year, “with the exception that COVID-19 will remain a major force that impacts hospitalizations and death numbers.”

Adalja expects the usual mix of COVID, flu, rhinovirus, metapneumovirus, RSV, adenovirus, and seasonal coronavirus, with most of the latter presenting as common colds.

It’s possible, but uncertain, that the U.S. sees a surge in cases of mycoplasma pneumoniae, an atypical bacteria that can cause lung infection, experts say. Such a surge is reportedly occurring in China among youth, in addition to the Netherlands, Denmark, France, and Ireland.

Dr. Stuart Ray, vice chair of medicine for data integrity and analytics at Johns Hopkins’ Department of Medicine, doesn’t have “strong sense that this will be a particularly bad” respiratory season, he told Fortune. “But it’s awfully hard to predict the future when it comes to respiratory pathogens, as we’ve learned in recent years."

A recent U.K. case of a strain of swine flu new to humans “illustrates the uncertainties we always face on this topic,” Ray said. Officials with the World Health Organization on Friday said the sickened individual, who has recovered, lives close to pigs but had no contact with them, and that “limited human-to-human transmission may have played a role,” though there is “no definitive evidence.”

While Ray doesn’t see the particular strain of swine flu posing a larger threat to humans this winter, “something like that is always looming as a possibility,” he said.

COVID a continued wild card​

Of the three main winter respiratory pathogens—COVID, flu, and RSV—COVID remains the greatest threat this season, Cohen told Congress on Thursday. It’s “still the respiratory virus putting the most number of folks in the hospital and taking lives,” she said.

Experts are eyeing variant “Pirola,” BA.2.86, and its descendants, like JN.1, in particular, saying their fast rate of spread could heightened an anticipated winter surge.

Already, BA.2.86 and its descendants are thought to be behind around 9% of COVID cases in the U.S.—ranking third in the race for viral supremacy and lagging “Eris,” EG.5, by only a few percentage points, according to CDC data released this past week.

The BA.2.86 viral family also represents about 9% of sequences reported globally over the past month, with levels doubling each week for the past four weeks, according to a recent report from the World Health Organization. Last week it upgraded BA.2.86 and descendants to a variant of interest of global proportions—second only to the category of variant of concern. And the CDC released a statement on the variant, saying it expects BA.2.86 and descendants to continue to grow in the U.S., and singling out JN.1 as a variant with particular potential to take off.

While BA.2.86 and descendants aren’t thought to cause more severe disease than other Omicron variants, according to the WHO, a greater-than-expected surge in cases would still pressure an already fragile U.S. health care system, experts say.

‘Immunity debt’ one of several theories​

While some experts point to the immunity debt theory as the driver behind wonky post-pandemic viral seasons, some experts say other theories should be considered. Among them: that COVID suppresses the immune system—at least temporarily, and at least in some—making them more susceptible to other infections.

Another: that being infected with both COVID and another pathogen at the same time makes the other pathogen, like RSV, more severe.

One additional: viral interference, in which competitive viruses like COVID “cancel out” other viruses for a period of time. Such a phenomenon appears to have happened during the H1N1 bird flu pandemic of 2009, during which other strains of flu and RSV “disappeared” for a time, as Osterholm points out.

Rajnarayanan points to a recent article in the British Medical Journal, the findings of which suggest that COVID contributed to last year’s surge of RSV cases “through the large buildup of COVID-19 infected children and the potential long-term adverse effects of COVID-19 on the immune and respiratory system.”

“Immunity debt is one hypothesis,” Ryan Gregory, a biology professor at the University of Guelph in Ontario, Canada, told Fortune. But “the consequences of getting the answer wrong requires us to test all available explanations and not to be content with making assumptions because an explanation sounds plausible.”

Regardless of how we got here, increased exposure to viruses after a period of decreased exposure—to pay the so-called immunity debt—isn’t helping anyone, Gregory contends.

“There is no circumstance in which more viruses circulating is a good thing,” he said.



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Mycoplasma Pneumonia Fatality Rate Is Lower Than COVID-19


Jakarta, December 6 2023


Pediatrician at Cipto Mangunkusumo Hospital, Dr. Nastiti Kaswandani emphasized that the fatality rate and severity due to Mycoplasma pneumoniae bacteria is lower than the fatality rate due to COVID-19.

"When compared with COVID-19, the severity and mortality (death) due to Mycoplasma pneumoniae tends to be lower, only 0.5 to 2 percent, even for those with comorbidities," said Dr. Nastiti.

Because of this, pneumonia caused by mycoplasma bacteria is often referred to as walking pneumonia. This name is because the symptoms tend to be mild so patients do not need to be hospitalized and can simply undergo outpatient treatment.

"The child's clinical condition is good enough so that he can still carry out activities as usual, so most of the cases can be done outpatiently, the medication is given orally, and the child can recover on his own," he explained.

On the same occasion, Lung Specialist Doctor at Persahabatan Hospital, Prof. Erlina Burhan said that pneumonia caused by mycoplasma bacteria is actually not a new disease. The bacteria that cause acute inflammation in the lungs have been discovered for a long time, even since the 1930s.

However, recently it has become a concern and concern for the world because the Mycoplasma pneumoniae bacteria is thought to have caused an increase in pneumonia cases in North China and Europe, the majority of which attack children.

Prof. Erlina said that because it is not a new disease, treatment for Mycoplasma pneumoniae is not difficult to find because it can be found at the Community Health Center and can be obtained using BPJS.

"Therefore, people do not need to panic because this disease has been found in Indonesia for a long time," he said.

Prof. Erlina said that the most important thing now is to implement clean and healthy living behavior (PHBS). According to him, this is the main key to preventing this disease.

Apart from that, according to Prof Erlina, people also need to follow health procedures as recommended by WHO and the Indonesian Lung Doctors Association (PDPI) to reduce the risk of respiratory disease.

These recommendations include vaccinating especially children, keeping your distance from sick people, not traveling when sick, going to the doctor and getting treatment if needed, wearing a mask, ensuring good quality ventilation and washing your hands regularly.

"We must be alert and apply PHBS and not panic," he said.

Head of the Communications and Public Services Bureau
Dr. Siti Nadia Tarmizi, M. Epid


 

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