Running the Numbers on Coronavirus in America

Health care workers in protective suits, Wuhan China. Photo credit: China Daily / Reuters

By DJ Rippert

Sprichst du panik? Liz Specht is an biologist and engineer. She is currently the Associate Director of Science and Technology at The Good Food Institute. On Friday Dr. Specht (who holds a Ph.D. from UCSD) posted a long series of tweets regarding the spread of Coronavirus and the limitations of America’s healthcare system. You can read her tweets here.

Dr. Specht is vitally concerned about COVID-19 and the supply of hospital beds and protective masks in the U.S. She calculates that by May 8 all the hospital beds in the U.S. will be filled. That’s just over two months from now. She further believes that America’s low inventory of N-95 and surgical masks required for healthcare workers will only make matters worse. As those tending to COVID19 patients get sick we may run out of healthcare workers as well as hospital beds.

This may differentially impact Virginia. As Bacon’s Rebellion guest commentator James C Sherlock noted, Virginia has a shortage of docs and nurses. In addition, experience in Italy shows that up to 10% of cases which tested positive required mechanical ventilators as part of the treatment. Whether Virginia’s very questionable COPN practices have held down the number of hospital beds and / or mechanical ventilators is an open question. Meanwhile, as Jim Bacon notes, our state government’s reaction to COVID-19 is somewhere between “just trust us” and “what, me worry?”

Very important note — Dr. Specht is a trained biologist who certainly holds some strong opinions as to the public health severity of COVID-19 in the United States. However, she is not an epidemiologist. Other equally expert people, including some epidemiologists, do not share her pessimism. The crux of Specht’s argument is that the number of Coronavirus cases will double every six days. I have no idea whether Dr. Specht will be proven right or wrong on that count. I do know that if she is right, Virginia is in a world of trouble.

The essential math. In the 24th (!) tweet in her chain Dr. Specht writes, “I’m an engineer. This is what my mind does all day: I run back-of the-envelope calculations to try to estimate order-of-magnitude impacts.” I frequently find myself doing the same thing. Let’s look at Dr. Specht’s math.

  1. On March 6 there were approximately 250 confirmed cases of  COVID-19 in the US.
  2. America’s lack of test kits means that there are far more cases than have been detected to date. Specht uses an 8X multiplier to get 2,000 actual cases as of March 6.
  3. Using epidemiological methods and models, Specht sees the number of cases doubling every six days. Confirmed cases may appear to rise even faster as more test kits are rolled out.
  4. This exponential progression calculates one million U.S. cases by the end of April, two million by May 5, four million by May 11, etc.
  5. The virus will continue to expand exponentially until it has infected more than 1% of the “susceptible population” at which time it may slow. Specht never defines “susceptible population,” but I assume all Americans are susceptible.  That generates 3.3 million infections before the spread even slows.
  6. Using Italy as a guide, 10% of those infected will require hospitalization. That leaves us with a need for 330,000 hospital beds before the presumed pandemic even slows.
  7. America has about one million hospital beds; 65% are typically in use at any given time. That means 350,000 open beds although the “regular flu” this time of year might push utilization above 65%.
  8. Even if every open hospital bed in the U.S. is suitable for the isolation of patients with infectious diseases, the hospitals will be full by May 8th.
  9. As the hospitals fill, the demand for doctors and nurses will also increase. This brings up the question of protective masks for health care workers.
  10. There are 18 million healthcare workers in the U.S.. The U.S. has a “stockpile” of 12 million N-95 masks and 30 million surgical masks.
  11. Once the virus starts to spread in earnest, every working health care worker will need a mask. Using the conservative assumption of one third of health care workers treating patients each day and the more conservative assumption of using one mask per day the supply of masks will run out in two days. (Note: I cannot follow Dr. Specht’s math here: 42M masks / 6m health care workers on a given day = seven days of supply, not two.)
  12. Almost all masks used in the U.S. are manufactured overseas, mostly in China. Even the raw materials for masks come from outside the U.S., mostly from China.

Margin of error. Dr Specht allows that her estimates may be wrong. She writes, “Importantly, I cannot stress this enough: even if I’m wrong – even VERY wrong – about core assumptions like % of severe cases or current case #, it only changes the timeline by days or weeks. This is how exponential growth in an immunologically naïve population works.”

Earth to Ralph Northam … Governor Ralph Northam’s message to Virginians can be summarized as “don’t worry, we’re ready.” This lacks credibility and should be seen as completely unacceptable. When biologists like Dr. Specht put forth harrowing numbers like those in her tweet stream Virginians need more than “trust me” from our already credibility-challenged governor.

Correction: The article originally misidentified Dr Specht as an epidemiologist. That is incorrect. While Specht is reported to hold a Ph.D. in biology she is not described as an epidemiologist.

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38 responses to “Running the Numbers on Coronavirus in America”

  1. Peter Galuszka Avatar
    Peter Galuszka

    Ripper. Where is trump in this? You diss nirtham but give the donald a pass.

    1. djrippert Avatar

      Our blog’s tagline – “Reinventing Virginia for the 21st Century” I’d love to write more about national and international news but I don’t because I think it would be “off topic” for this blog.

      If Specht is even close to being right this will be Trump’s Waterloo. America has a plan to expand hospitals (especially military hospitals) very rapidly in case of war. Those hospitals should be getting expanded now.

  2. CrazyJD Avatar

    >>Sprichst du panik? Liz Specht is an epidemiologist and engineer.

    DJ, Did you bother to look up anything about Specht? Whatever else she is or is not, her own Twitter feed says she is NOT an epidemiologist.

    It seems like you have not done your due diligence in checking out stuff that is sketchy at best, particularly in the current situation. Would it be just a wild guess to say it looks, feels, and sounds like total speculation?

    1. djrippert Avatar

      “Liz Specht, a PhD in biology …”

      OK, I somehow dreamed up epidemiologist. Been reading too many articles today I guess. In the interests of accuracy I will change epidemiologist to biologist.

      Regardless, her theory is mathematical. I guess you can argue the doubling every 6 days but after that … it’s just numbers.

      Today, New York state declared an emergency.

      Italy locked down the Milan region. The lockdown came as “surged to 5,883 with 233 deaths, and on the day Nicola Zingaretti, the leader of one of the two major government parties, announced he had contracted the illness.”

      I wonder how many cases there will be in the Milan area six days from now. Specht would say a bit over 11,000. What’s your estimate?

  3. Steve Haner Avatar
    Steve Haner

    Assuming you were the governor, and knew that the problem was truly dire, would you go before the cameras and say the problem is truly dire? Many of you hearing this will die? Not sure spreading panic is a good idea.

    1. djrippert Avatar

      Gov Cuomo today declared a state of emergency saying, “I’m not urging calm, I’m urging reality.” This freed up $30M to combat the disease.

      Three cases were confirmed in Maryland yesterday. Is there any chance that Virginia will be spared?

      Our state government is not DOING anything is my guess. Hospitals should be getting expanded now. If that were happening it would be in the news. If elective surgery and other elective medical procedures were halted in Virginia it would be in the news now. Specht’s main point is that cases double every six days. What’s Northam waiting for? To get to 100 cases before he acts? That will be 3,200 a month later. The time to act is now. Tap the “Rainy Day Fund” and start work.

      Finally, only in Virginia could anyone believe that panic can only be spread by the rhetorical incontinence spewing from our governor’s mouth. If Northam doesn’t acknowledge a problem Virginians will stay calm? Why? Because Coonman T Blackface is such a reliable, credible fountain of wisdom that all the national and international press can be ignored by Virginians pending confirmation from him? You’ve got to be kidding me. Nobody takes anything Northam says (or doesn’t say) seriously. Only actions count. Time to act.

      Our state government should be getting ahead of this now rather than playing “needles in a haystack” with a ridiculous number of pending bills.

    2. djrippert Avatar

      Also … Northam has no problem spending billions of dollars of other people’s money because most scientists tell him that global warming will destroy the world. Why wouldn’t he act when scientists tell him this will be bad?

  4. LarrytheG Avatar

    As they say, not my first rodeo but I’ll be danged if I can remember this much folderol for prior outbreaks.

    I take it seriously but wonder why this one seems so much more serious.

    1. djrippert Avatar

      That is the crux of the debate. How contagious is this disease? It didn’t happen like that with SARS in 2002 – 2004. It didn’t happen with H1N1 in 2009. Maybe this Coronavirus will go the same way.

      I don’t subscribe to the Wall Street Journal so I can only read the headline. From today … “Scientists quietly see a best-case scenario of tens of thousands of deaths; 10 million over two years is the worst case.”

      A worst case of 10M deaths with a 1% fatality rate (my guess) means 1 billion people get the disease. In Italy 10% of those who get the disease are being hospitalized. That’s 100M people in hospitals. With Virginia at 8.5M and the world at 7B that puts 121,428 Virginians in hospital beds. At 3 weeks in hospital per admission (I’m guessing) that would be 2,549,988 hospital bed days. If the cases come in evenly over two years (something Dr Specht does not believe will happen) we would need 3,493 beds for Coronavirus over the next two years.

      It looks like Virginia has 17,000 or so staffed hospital beds. That’s 5,950 open beds at any given point in time assuming a 35% vacancy rate.

      But what percent of beds would work for infectious disease cases?
      How exponential will the growth of cases be?
      Do we have enough health care workers?

      The term “tens of thousands” on the low side of the estimate is pretty ambiguous. Let’s say 50,000. That’s 1/2 of 1% of the worst case of 10 million deaths. Everything gets divided by 20. That’s 17 hospital beds per day over two years in Virginia needed for Coronavirus patients.

      I feel like somebody ought to look at Northam and ask, “Are you feeling lucky punk? In all this confusion I can’t say whether 50,000 or 10 million people will die. So, are you feeling lucky?”

      If Virginia really has a plan what harm would come from outlining that plan?

      Maybe you trust Ralph Northam’s honesty enough to believe him when he says no more than “we are prepared”. I don’t. He lost the assumption of credibility with me over how he handled the blackface / klan robes / Coonman story.

      If he has a plan he should show it.

  5. CrazyJD Avatar

    Well, I’ll be dipped in dung. Larry and I completely agree on something. Way to go, Larry.

    1. LarrytheG Avatar

      must be something going around……… 😉

    2. djrippert Avatar

      I would have been much happier to hear Northam say “We don’t think this will be a major outbreak and we’ll handle it like another bad flu season or like we handled SARS”

      At times like these I think there is a premium for politicians’ being transparent.

      On a very selfish note, I was a lot richer three weeks ago than I am today based on the stock market turmoil over the Coronavirus. I’m hoping this turns out to be no big deal, believe me. I’ve rolled out of equities and into cash for that part of my portfolio. But that cash is very idle. I’d like to get it back into the market but I won’t do that while New York declares a state of emergency and Milan locks down.

      If Dr Northam thinks this is no big deal then that is what he should say.

      1. LarrytheG Avatar

        Is it the GOvt’s responsibility to mitigate the impact to the “markets”?

        This is going to savage the markets, no question, but not sure if it will lead to a recession rather than a downturn and rebound.

        Someone must know something most of us don’t – given the continual
        “alarm” we are seeing from govt officials.. do we know all we should know?

        1. djrippert Avatar

          My point on the markets was only that I have no reason to be an alarmist. Quite the contrary – I’d love to wake up and hear this was all a big misunderstanding.

  6. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    I have no way to assess the COVID19 risks in Virginia.

    But surely the shortage, and undue urban concentration, of health care facilities (including outpatient care and doctors) in Virginia by reason of its health care cartel system will put Virginia at a great handicap vis-a-vis Maryland, thus hobbling Virginia’s ability t0 deal effectively with COVID19, its spread, prevention and care, as compared to Maryland’s inbuilt ability to deal with any COVID19 challenges it may have to meet and overcome.

    1. djrippert Avatar

      Excellent point. These outbreaks seem to occur in “clusters”. There’s no guarantee that a “cluster” will occur where there are a lot of hospital beds. So, sick people from Harrisonburg, for example, get shipped to UVA Hospital in Charlottesville? I wonder how loving of their fellow man the members of the Charlottesville City Council would be under that scenario.

      For example, how is King County’s plan to buy a motel for Coronavirus treatment going in the minds of those who live near that motel?

      1. LarrytheG Avatar

        see, that’s a “thing” about “brotherly love”……….. 😉

      2. LarrytheG Avatar

        Apparently Trump supporters think this is a Dem/liberal made up “scheme”, virtue signaling and all that ?

  7. LarrytheG Avatar

    50 million died in 1918 from the Spanish Flu

    1. djrippert Avatar

      Yes, in a world with a population of 1.8B. One of those who died was the great uncle I never met. Now it’s 7.7B. That works out to 214 million dead today. I get about 236,000 dead Virginians today at that rate. However, there are a lot, a lot, a lot of differences between then and now. Far fewer people would die today from the Spanish Flu. I read a book called The Great Influenza a few years ago. Fascinating. However, I do like the government’s warning against spitting as a good pandemic control.

  8. I don’t know if Dr. Specht’s numbers will prove to be accurate or not, but her underlying point about the geometric rate of increase of infection of a virus like COVID-19 is something that should sober us all. It may be a worst-case scenario, but we need to consider worst-case scenarios. We don’t necessarily need to freak out, assuming that the worst-case scenario is the most likely scenario, but we do need to know if how well prepared we are to handle the worst case should it materialize.

    I’m not as alarmed as Don. The reports I’ve read suggest that the spread of the virus in China has peaked. Also, I think the mortality rate is higher in China than it will prove to be in other countries because COVID-19 is a respiratory ailment, and those at greatest risk are those who already have respiratory ailments. China has the worst air pollution in the planet (except possibly India), and many are at elevated risk for that reason alone. Also, I heard the figure that half the male population in the Wuhan region are smokers, another respiratory risk. So, let’s be cautious about extrapolating from China to the U.S.

    And let’s not freak out.

    That said, the figure Don cites about the 10% hospitalization rate in Italy is pretty scary, and it goes straight to the point about hospital capacity. Also, we have seen in Washington state that nursing homes — concentrated clusters of elderly people, many of whom are at elevated risk — are vulnerable. We don’t have to theorize about this. We know that nursing homes pose special challenges. What is in the Governor’s “plan” to address the special vulnerabilities of nursing home populations in Virginia?

    A delicate balance must be struck. Northam is right to urge calm. Panic engenders counter-productive behaviors. At the same time, he needs to assure us that precautions will be taken — and tell us what they are and under what circumstances they will be invoked — when the virus reaches Virginia. (It probably already has, and we don’t know it.) Comparing the examples of Taiwan and China, we have learned that a well-informed populace can better combat the spread of the disease than a populace kept in the dark.

  9. djrippert Avatar

    As for the spread of the virus peaking in China … if the Chinese government is talking they are lying – about anything and everything. Unsurprisingly, some say they are lying about getting control of the Coronavirus situation:

    Keep your eyes on Italy. At least you can believe what you hear.

    Yesterday two British Airways baggage handlers at Heathrow Airport tested positive for COVID19. Did they get it from touching luggage? Who knows?

    I am not alarmed about the Coronavirus. I haven’t changed a single thing I do on a daily basis. If I had to guess, I’d guess it will look overblown by July. But just like Global Warming I have to ask myself, “What if it really is a brewing fiasco?” How much should we be doing right now “just in case”? But most of all – shouldn’t we expect the people we elect to have contingency plans and to explain those plans to the citizenry?

    Don’t forget that the boy who cried wolf was eventually eaten by a wolf. Or at least his sheep were eaten by a wolf.

  10. Jim Loving Avatar
    Jim Loving

    Here are numbers I saw posted (tweeted) from The American Hospital Association:

    American Hospital Association “Best Guess Epidemiology” for #codiv19 over next 2 months:

    96,000,000 infections
    4,800,000 hospitalizations
    1,900,000 ICU admissions
    480,000 deaths

    vs flu in 2019:

    35,500,000 infections
    490,600 hospitalizations
    49,000 ICU admissions
    34,200 deaths


  11. johnrandolphofroanoke Avatar

    The schools have no plan whatsoever. Trust me kids love to share everything. Student desks are germ factories. I tried reaching out to the superintendent and the school board up in Loudoun County. I was sent links to some websites. This reminds me a great book that bears relevant lessons to this potentially serious crisis. “At Dawn We Slept” by Gordon Prange.

    1. LarrytheG Avatar

      agree about the “mucus” factories but for some reason, this virus does not affect kids like others have – though it may well be possible that they could be “carriers”.

  12. LarrytheG Avatar

    Part of the problem is the “news cycle”. Even though there is a lot going on in the US and the World – the media tend to “cycle” the major stories over and over and if there is not some other disaster like a plane crash or other significant event – they just keep cycling the current “news”.

    This is all media – not left or right. Most all newspapers do it – as well as broadcast media though left and right tend to have different perspectives.

    If some major “news” comes along, I’m betting the emphasis on coronavirus will fade a bit. If there remains a dearth of other news, we’re going have it coming out of our ears..

  13. Two(2) cases in Fairfax Co. this morning.
    Soldier in Ft Belvoir and 80-woman from Fairfax or Quantico per WTOP radio. Both had been visiting overseas for various reasons. Not to mention several DC cases found yesterday.
    My wife and I were surprised it has taken so long to have a first case here.

    The lady went on the Nile, get it? Da Nile.

    1. Excellent article. John Nichols, the pathology expert quoted in the article, may or may not be correct in his analysis. But he highlights a critical dimension of the COVID-19 crisis that I have seen unexplored elsewhere: What conditions of temperature, humidity and sunlight does in thrive in, and what conditions destroy it?

      “Three things the virus does not like: 1. Sunlight, 2. Temperature, and 3. Humidity,” Nicholls said in response to a question about when he thinks confirmed cases will peak.

      “Sunlight will cut the virus’ ability to grow in half so the half-life will be 2.5 minutes and in the dark it’s about 13 to 20 [minutes],” Nicholls said. “Sunlight is really good at killing viruses.”

      “The virus can remain intact at 4 degrees (39 degrees Fahrenheit) or 10 degrees (50 F) for a longer period of time,” Nicholls said, referring to Celsius measurements, according to the transcript. “But at 30 degrees (86 degrees F) then you get inactivation. And high humidity — the virus doesn’t like it either,” he added, the transcript of the call showed.

      However, Nicholls also said that he doesn’t consider SARS or MERS, a Middle Eastern novel virus that spread in 2012, to be an accurate comparison for this year’s outbreak. Rather, the novel coronavirus most closely relates to a severe case of the common cold.

      1. LarrytheG Avatar

        here’s one of the top spreaders of disease:

        and here’s what needs to be done (different hand/foot versions)

      2. djrippert Avatar

        Unexplored elsewhere? Isn’t this what Trump has been saying …

        My challenge is that there are 75 confirmed cases in Australia where it has been summer for months.

  14. LarrytheG Avatar

    Well, at least he has scientific background .. I was afraid all these un- credentialed climate bloggers were going to also claim another worldwide conspiracy among scientists to lie to us so they could then invest at the bottom of the stock market and make huge money.

    Never can tell, those climate scientists are a despicable bunch!

  15. djrippert Avatar

    Bernie Sanders on coronavirus … “Sanders’s campaign did not return earlier MarketWatch requests for comment on his plan for addressing infectious-disease outbreaks.”

    Joe Biden on coronavirus … “While Biden has not released a formal plan to address infectious-disease prevention and response, he called Trump “the worst possible person to lead our country through a global health challenge”

    Like it or not Donald Trump is the only candidate credibly running for President who has made a clear statement about how we should handle the coronavirus – basically, let it run its course and watch it die out like SARS and H1N1.

    Shouldn’t Biden and Sanders be forced to say what they would specifically be doing about the coronavirus if they were president right now?

  16. sherlockj Avatar

    From Virginia’s Commissioner of Health on Friday:
    Department of Health
    PO BOX 2448 RICHMOND, VA 23218
    COVID-19 Update
    March 6, 2020
    TTY 7-1-1 OR 1-800-828-1120
    The Coronavirus Disease 2019 (COVID-19) outbreak continues to rapidly evolve. As of March 5, 2020, the World Health Organization reports more than 95,000 cases globally, and the Centers for Disease Control and Prevention (CDC) reports 99 presumptive or confirmed cases in 13 U.S. states. Three states have reported community spread (California, Washington, and Oregon). There are no cases in Virginia. For most of the American public, who are unlikely to be exposed to this virus at this time, CDC considers the immediate health risk from COVID-19 to be low.
    As we all prepare for COVID-19 in Virginia, please be aware of several major, recent developments:
    1. On March 4, CDC revised its recommendations about how to identify a suspect case or a Patient Under Investigation (PUI) for COVID-19. Clinicians should use their judgment based on the local epidemiology of COVID-19 and the patient’s signs and symptoms to determine whether a patient should be tested for COVID-19. Most COVID-19 patients have developed fever and/or symptoms of acute lower respiratory illness (e.g., cough, difficulty breathing). Influenza is still widespread in Virginia. Clinicians are strongly encouraged to test for influenza and other causes of respiratory illness before testing for COVID-19. Epidemiologic factors to help guide testing decisions include: any persons, including healthcare workers, who have had either close contact with a laboratory-confirmed COVID-19 patient or a history of travel from an affected geographic area within 14 days of symptom onset.
    2. Virginia’s Department of General Services, Division of Consolidated Laboratory Services (DCLS) began testing for COVID-19 on February 29. At this point, DCLS has received a very small number of test kits from CDC, and thus has a very limited capacity for testing. Until private labs are able to provide testing and DCLS receives additional test kits, we must use clinical and epidemiologic criteria to identify patients most likely to be infected. These interim criteria are summarized in the VDH Interim Guidance for COVID-19 Testing on the VDH website. Instructions for public health testing are on the DCLS website.
    3. Virginia’s local health departments do not provide primary care and thus are not equipped to clinically evaluate patients or collect specimens for COVID-19. If there are barriers in your practice to testing your patients for COVID-19, please call the director of your local health department to discuss your concerns.

    4. Private laboratories will begin COVID-19 testing in the near future. Please check with your laboratory partners for testing availability.
    5. COVID-19 is a reportable condition in Virginia. Healthcare providers are legally required to report all suspected cases (i.e., PUI) and confirmed cases to the local health department immediately. Laboratory directors are required to submit the initial specimen to DCLS within seven days of identification per these regulations. Healthcare providers are encouraged to report cases using our online electronic reporting tool whenever possible.
    6. To allay fears, it’s important that Virginia has a coordinated message for announcing the first COVID-19 case in Virginia. If you receive a positive laboratory diagnosis from a private lab for the first case of COVID-19, immediately call the director of your local health department to discuss how this will be coordinated.
    7. CDC recently updated guidance for travelers arriving in the United States from countries with widespread ongoing community transmission (i.e., those with a Level 3 – Travel Health Notice, which currently includes China, Iran, Italy, and South Korea). These travelers are being advised to stay home and avoid contact with others for 14 days from the time that the person departed the area. They should not go to work or school and should avoid public transportation and activities. Travelers from countries with a Level 2– Travel Health Notice (currently Japan) are advised to stay home to the extent possible and limit public activities for 14 days after leaving the affected area. More details are available on the VDH website (see Travelers tab).
    Please continue to visit CDC’s COVID-19 website and VDH’s COVID-19 website for the most current information or contact your local health department if you have questions.
    We thank you for your assistance in helping to prepare for and respond to COVID-19. Sincerely,
    M. Norman Oliver, MD, MA State Health Commissioner

    1. djrippert Avatar

      Very informative but not very action oriented. I’d expect something more along the lines of … (examples)

      If any area of Virginia reaches more that 100 confirmed cases of coronavirus the schools in that area will be shut down and classes will continue via remote learning.

      If 250 confirmed cases are found in Virginia medics from the Virginia National Guard will be called to duty.

      If 400 confirmed cases are found in Virginia mobile field hospitals from the Virginia National guard will be brought into operation.

      That’s a contingency plan.

      What we get instead is …

      “3. Virginia’s local health departments do not provide primary care and thus are not equipped to clinically evaluate patients or collect specimens for COVID-19. If there are barriers in your practice to testing your patients for COVID-19, please call the director of your local health department to discuss your concerns.”

      What? If a doctor finds barriers to testing for COVID-19 they should call the director of the local health departments because “local health departments do not provide primary care and thus are not equipped to clinically evaluate patients or collect specimens for COVID-19. If there are barriers in your practice to testing your patients for COVID-19”

      So … call the people who can’t do anything to help?

  17. Philip Finn Avatar
    Philip Finn

    I think the “math problem” concerning masks is about the use of the word “day” which, to a healthcare worker, is actually q “shift” of 8 hours. This presumes (correctly, I think) patients requiring 24-hour care. Thus, 24 hours is three “days”
    At that rubric, the masks would indeed be gone in two 24-hour periods.

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