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Cross-posted to The Next Hurrah (with slight modification).

Regular TNH contributor  and Daily Kos irregular Plutonium Page has summarized one of a series of stories in Nature fictionalizing the flu pandemic of the winter of 2006. Interestingly, the well-respected magazine chose the form of a 'blog' to get the word out. Remember, THIS IS FICTION.

26 December 2005 It's an emergency -- official

    President George Bush has just addressed the press in the East Room of the White House. Here's the transcript: "At this hour, the World Health Organization has declared a full-scale pandemic influenza alert, with person-to-person spread lasting more than two weeks in Cambodia and Vietnam. During previous influenza pandemics in the United States, large numbers of people were ill, sought medical care, were hospitalized and died. On my orders, the Department of Homeland Security and the Department of Health and Human Services have today implemented the nation's draft Pandemic Influenza Response and Preparedness Plan. It will serve as our road map, on how we as a nation, and as a member of the global health community, respond to the pandemic. We are ready. Thank you, and may God bless America."

    Ready, my ass! I've reported on avian flu for almost a decade. The first thing I did on hearing Bush's address was to get on my cellphone to my husband, Jonathan. I told him to pack some bags and get ready to take the kids to my mother's house in Florida. "Remember all that stuff I told you about how a bird flu pandemic might hit the United States? Well, I think it's about to happen."

A review of the technique is here from the blog WorldChanging:
The current (26 May 2005) issue of Nature focuses on avian flu and the possibility of a pandemic. They've chosen to illustrate how a flu pandemic might play out with a future scenario in the form of a blog. While WorldChanging has written before about both the hype and reality of a possible pandemic, the Nature piece is worth reading -- especially as an example of how scenarios and blogs as narrative vehicles continue to trickle up through traditional media.

In the meantime, the following is not fiction (as we traditionally define it, anyway):

    What Is Really Going On In China?

    We don't yet know.  But read this collection of links.  Here is the most worrying excerpt:

    Reports coming out of Qinghai suggest H5N1 infections in humans and birds are out of control, with birds distributing H5N1 to the north and west, while people are being cremated and told to keep quiet.

    Reports from Chinese language papers detail over 200 suspected infections in over two dozen locations in Qinghai Province.  In the most affected 18 regions, there are 121 deaths, generating a case fatality rate above 60%.

    Even if only a small fraction of the deaths are H5N1 linked, the cases would move the bird flu pandemic stage from 5 to the final stage 6, representing sustained human-to-human transmission of H5N1.

    The high case fatality rate suggests the H5N1 in Qinghai has achieved efficient human transmission while retaining a high case fatality rate.  If confirmed, these data would have major pandemic preparedness implications.  These cases began almost a month ago and are now spreading via people who have previously entered the high risk area.

In one sense, a less virulent death rate, coupled with increased infectivity would be the worst combination. China also claims to be developing a vaccine, which, along with everything else we read, is impossible to objectively verify.

For more Q&A on bird flu see the New Yorker. One example:

How does SARS fit into this story? For a while, it inspired something like panic, and yet the concern seems to have died down.      

    When SARS emerged, nobody knew what caused it or how deadly it would be. Officials monitoring the first reports assumed it was a flu pandemic--and they were actually relieved to find out that it was not. But the fear is not hard to understand: some people were afraid that sars would be as deadly as H.I.V. was when it first began to spread, in the nineteen-eighties, but also as easy to contract as the flu. It turned out to be a new virus--a distant cousin to the common-cold virus--and it is neither very easy to get nor, usually, deadly. But new diseases with no known causes or cures are always frightening.

Unfortunately, there'll be more to come on this. The Nature issue is very thorough, and worth an entire read.

WHO is trying to do the right thing. See (or rather, listen to) All Things Considered:

All Things Considered, May 27, 2005 · International law requires nations to report outbreaks of only three diseases: cholera, plague and yellow fever. That's changing under sweeping new regulations approved this week that require nations to tell the World Health Organization about any outbreak with the potential to spread across borders.

And, finally, some more: U.S. Criticized Over Bird Flu Plans.

What are individuals expected to do about bird flu? not much, other than consider calling your local health department or hospital and ask them if they are considering plans for a potential pandemic next fall. If the feds won't do it, your local health department might have to consider such things as quarantine plans, school closures, stockpiling of medicines (like tamiflu) for health care workers, identification of emergency shelters (like high schools) to be converted to clinics, etc. No need to panic, but a reminder or two to the Mayor or Selectmen (or whatever your local government provides) may help get the ball rolling. it may help, even if this turns out to be just an ordinary flu year.

And as a reminder, Effect Measure has put together a web resource list for your education.

Originally posted to Greg Dworkin on Sun May 29, 2005 at 12:01 PM PDT.

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Comment Preferences

  •  DemfromCT (none)
    Forget vampires! That's scary stuff.

    Thrice is he armed who hath his quarrel just. -- Sherlock Holmes

    by Carnacki on Sun May 29, 2005 at 12:11:56 PM PDT

    •  you're telling me (none)
      my oldest is planning on spending fall semester in Beijing.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun May 29, 2005 at 12:30:38 PM PDT

      [ Parent ]

      •  have him read current issue of Nature (none)

        Telling him "no" might backfire.  Instead, just get the current copy of Nature and leave it around and see if he reads it.  If he doesn't on his own, suggest he do so:  "Since you're planning to go to China I figured you should read this first..."

        Reading it might be enough for him to come to his own conclusions and put off the trip.  If he doesn't, you can always pull the pre-emptive parental No laterif the news seems to warrant it.  Key question: if China goes hot, and travel is shut down, how's he going to get back into the USA...?

        As for Tamiflu, it may very well be confiscated when he goes in or while he's there.  Think of a border guard who sees it as his ticket to survival.  

  •  Human to Human Transmission (none)
    I tried following the links to get more information on human to human transmission in China, but nothing really panned out.  This is a key issue.  Do you have a link that reports on it?  

    Dobson help us if there actually is human to human transmission with a 60% mortality rate.  In a given year 30% of the U.S. population comes down with influenza.  If 60% of those died, we're talking more than 50 million deaths in the U.S. alone.

    The rapture indeed.

    This aggression will not stand, man

    by kaleidescope on Sun May 29, 2005 at 02:41:29 PM PDT

    •  there is suspicion of human to human transmission (none)
      in sporadic cases from Vietnam, but China is not easy to get reliable info on. This link explains that sustained human-to-human transmission would make this a pandemic [and this is currently NOT confirmed]... that's the worry.

      The expectation is that the death rate would drop for a pandemic... if you kill all the messengers, who is left to deliver the message?

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun May 29, 2005 at 03:14:58 PM PDT

      [ Parent ]

      •  Thanks (none)
        Killing the messenger still works for a pathogen so long as the messenger dies after passing on the message.  That's why HIV and rabies are able to sustain such high mortality rates -- the messengers are contagious for quite a while before they die.  The fourteenth century (presumably) bubonic plague killed a quarter of the population of Europe in a few short years.

        This aggression will not stand, man

        by kaleidescope on Sun May 29, 2005 at 06:08:14 PM PDT

        [ Parent ]

        •  Here are some (less than firm) sources (none)
          The fourteenth century (presumably) bubonic plague killed a quarter of the population of Europe in a few short years.

          But of course the 'kill-the-messenger-stop-the-transmission" paradigm does not work where the real source of the infection is another associated species where the same virus is a non-fatal pandemic. That was the case with bubonic plague, and rats, and flees.  But there do seem to be enough examples of the ability of some flu forms to combine high mortality with easy transmission to cause epidemiologists to come down with serious cases the cold sweats when they see reports like this. They think that they are too plausible and too dangerous not to be followed up with haste.

          An English language source for these reports,  really just Chinese language blogs, is this article from four days ago in New Scientist "Claims of human bird flu cases in China denied" which starts out

          19:28 26 May 2005 news service Debora MacKenzie

          Chinese officials have denied media reports that H5N1 bird flu has killed more than a 100 people in the west of the country.

          A web-based Chinese-language news service called Boxun (Abundant News), which allows correspondents to freely post information on its site, reported on 25 May that 121 people in 18 villages in the sparsely-settled western province of Qinghai have died of bird flu, and more are ill. Some 1300 people, have been isolated, it reports.

          If someone here reads Chinese they can check out via

          "Snowy Owl" blogs here on with what he/she says is a translation of a Boxun article and precedes it with this comment

          Reading this the possibility that this is a ploy to bring attention to the region crossed my mind. Just a thought.

          The posting is rough in translation and starts out

          Answered: " unable to verify Qinghai avian flu epidemic situation" (May 26, 2005

          Answered: The related news about Qinghai avian flu epidemic situation is blocked, according to the news writer, therefore the is unable to verify.

          Merely using telephone interview won't be able to obtain the concrete information, some mainland China media also disclosed very little information. The only way is to do the on-the-spot investigation. The recent information obtained by nine young people who spent few days and did some observations around Qilian County. Because we would like to have thorough fact on Qinghai's avian flu, we went to the area to do actual interview by acting as tourists. We could have had some pictures and materials but the police had confiscated our two cameras, so we have to use the writing to transmit messages, please understand.

          Only if you have been to the locality to understand that how the shocking impoverish China can be, anybody who has the conscience can cry for this. Many helpless, constrained anger, as primitive society's barren, the prosperous traveling is insulated from these people. Perhaps the avian flu can bring to many people's vital interests so it has caught people's attention. Will anyone pay attention to native's survival? ( [. . . .]

          If you want to know the truth about Qinghai, the poor Qinghai, the constrained Qinghai, don't look at the official media, only those who has connection with Qinghai people, or actually go to Qinghai to obtain the actual information. Don't think that you may obtain any confirmed information with the official medias. That is extremely stupid.

          Don't think that the epidemic situation has not exploded or proliferated to assume there is no people decease and the reports are not true. If you do not believe, please visit Qinghai, talk to the local people, those who are not controlled or warned by the government official. They can tell you the whole truth.

          We are able to provide Qinghai avian flu information as it, because we are not able to obtain more news at this time. We have to gather funding to obtain more information, because information requires on-the-spot verification. Please pay attention to Qinghai. Thank you the fair reports of, since the domestic platform deleted all of our messages.

          The nine young people's who published the Qinghai avian flu information (Boxum News free press zone) (

          "Snowy Owl" also posts this same message here on but without the "ploy to bring attention" comment and ends the article there like this

          Issued the Qinghai birds and beasts flu information nine 年青人 _ (abundant news freely sends manuscript area to send manuscript)

          (This for hits the engraving plate, the original text website: Http://


          Snowy Owl
          "Serenity is not freedom from the storm, but peace amid the storm".

          There is plenty of room for doubt in such a report, and yet the image it paints of a blogosphere able to give a quick international audience to even a censored "domestic platform" of the Internet gives us a glimpse at what may be the future. If there is any real message here it is that we can't know for sure just looking at the blogosphere -- this is a real world thing.

  •  Give son (none)
    Some Tamiflu to take with him, and some surgical masks.
    Our country is dicking around on this and we are going to run out of time. This is not IF, it's WHEN.

    War is not an adventure. It is a disease. It is like typhus. - Antoine De Saint-Exupery

    by Margot on Sun May 29, 2005 at 03:11:12 PM PDT

    •  You need more than regular surgical masks. (none)
      Those won't prevent viruses from getting through.  You need a mask with a filter that catches stuff a small as a virus.  Don't bet your life to a mere surgical mask.

      It is a very mixed blessing to be brought back from the dead.

      by Steven D on Sun May 29, 2005 at 03:13:08 PM PDT

      [ Parent ]

      •  tamiflu, handwashing, and luck... (none)
        as they say in the real estate biz: location, location, location...

        "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

        by Greg Dworkin on Sun May 29, 2005 at 03:16:14 PM PDT

        [ Parent ]

      •  You're right (none)
        I know better than this. I was thinking of all the photos of people there wearing surgical masks, but in the past I have had to be fitted for a mask that would filter out TB and other things, so I know you are right.

        War is not an adventure. It is a disease. It is like typhus. - Antoine De Saint-Exupery

        by Margot on Sun May 29, 2005 at 05:10:36 PM PDT

        [ Parent ]

      •  however... (none)

        Surgical masks will prevent you inhaling droplets from a nearby person's cough.  And will also contain or at least slow down droplets from your own coughs.  

        Key question: when a droplet lodges in the mask, and the water content of it evaporates, can the remaining virus particles be inhaled? or would they be trapped in whatever other solid material remained after the droplet has evaporated?  

        •  maybe the best thing about a mask (none)
          is that it gets you not to touch your face as much. I haven't found any data, but travelers tell me the mmasks are ubiquitous in Asia.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun May 29, 2005 at 07:29:04 PM PDT

          [ Parent ]

  •  Recommended (none)
    It distresses me that the only place I hear about these stories is liberal blogs.  Never in the msm/sclm.

    It is a very mixed blessing to be brought back from the dead.

    by Steven D on Sun May 29, 2005 at 03:11:21 PM PDT

    •  that's because there's no link to 9/11 (none)
      or bioterror, so it doesn't count.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Sun May 29, 2005 at 03:17:04 PM PDT

      [ Parent ]

      •  Another aspect that worries me (none)
        Quarantine laws and implementation plans.  They vary widely from state-to-state.  State health departments and state law enforcement agencies have sole authority and responsibility, according to the US Constitution, for managing outbreaks of infectious diseases and other public health emergencies within their borders.  The Federal Government may only step in when it judges that state actions are not effective in preventing disease spread beyond their borders.  At that point, the Feds can do pretty much whatever they want to.

        Regardless, many state quarantine measures, on paper at least, are more draconian than even Martial Law.    If we do experience a serious outbreak of Asian Bird Flu in the US, governmental response is likely to make the Patriot Act seem like the permissive good old days.  And don't for a minute think that the Bushies won't milk all possible political advantages out of the situation.

        •  ain't that a depressing thought (none)
          a pandemic that requires govt. action... and a govt. you can't trust.

          "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

          by Greg Dworkin on Sun May 29, 2005 at 07:13:20 PM PDT

          [ Parent ]

        •  the problem is (none)
          that to do a proper quarantine, you pretty much need to impose martial law anyhow.

          I understand your concerns about BushCo but what troubles me about it is that they might end up implementing tough measures to oppress people---but screw it up so that it wouldn't be an effective quarantine anyhow. God knows they manage to screw  
          everything else up.

  •  preparedness measures (4.00)
    Ideally you want to self-quarantine yourself & family/housemates for the first month following detection of the first case in your area.  

    See also Scientific American (March 2005 issue) about this: the best way to stop a pandemic in its tracks is for everyone to stay home (self-quarantine) for the first couple of weeks it's in their area.  

    What you need to do to prepare isn't much different than what's needed for your local natural disasters (storms, floods, earthquakes, etc.).

    Consider also the possibilty that routine breakdowns in utilities and services could take longer than usual to fix, in the event the power company, water/sewer department, and private contractors (plumbers etc.) are short-staffed during the crisis.  

    For example an otherwise "normal" localized power outage that would ordinarily be fixed same or next day, might take a few days to fix, during which time food stored in your fridge might go bad.  

    Have two weeks' to a month's worth of food on hand.  Include foods that don't need refrigeration and can be cooked under emergency conditions such as over an outdoor bonfire.  

    Have two weeks' to a month's worth of clean water on hand (same reason: in case there's a plumbing or public water supply problem that can't be fixed in the normal amount of time).  You can store water in half-gallon or 2-liter juice or soda bottles that have been washed and rinsed thoroughly.  Add a couple of drops of plain chlorine bleach (not scented bleach or bleach/detergent blends) to each container to keep the water sanitary.

    Have some cash on hand to meet emergency expenses for two weeks to a month.  Get the cash before there is any sign of a flu crisis.  If you don't particularly like or trust your bank, move your accounts to a local credit union, preferably one that's small enough that they know their customers by name: do this now, well ahead of the crisis.  If you're in tight economic conditions, put aside a little cash every week, whatever you can spare.

    Keep your gas tank full.  You're going to buy the gas anyway, you may as well get in the habit of filling up when you're at 1/2 or 3/4 of a tank, rather than waiting until you're at 1/4 or less.

    Public transit is a potential hazard, if you're riding during peak hours under crowded conditions.  See about changing your work hours so you start and leave earlier or later than normal to avoid crowds.  Otherwise you might have to consider going to work earlier and coming home later, even if it means wasting time at both ends.  

    Plan to do re-supply shopping during either the early morning or late night hours when the stores are least crowded.  Do a couple of test runs now so you know the hours of your local grocery stores etc.  Consider the possibility that some or most stores may reduce their hours if they are short-staffed.

    Buy appropriate facemasks now.  Assume one mask per day in normal usage, or as per the instructions on the package.  What you want are masks that are rated to stop the transmission of germs.  You might also want to buy a box of disposable surgical gloves, to wear when in public places.

    Germs hang out on surfaces, and H5N1 is known to be highly persistent.  The most notorious surfaces for germs are doorknobs, telephone receivers (especially payphones), countertops, desktops, and light switches.  Also be concerned with public drinking fountains, vending machines, public bathrooms, anything that the general public handles.  Don't get paranoid, just be aware and prudent.  

    Improve your hand-washing habits starting now.  Wash your hands before you go to the toilet as well as after (before, because you don't want germs from your hands getting on/in sensitive areas of your body that aren't exposed to sunlight).  Wash your hands before handling food or eating.  Wash your hands before touching your face or blowing your nose.  Wash your hands after blowing your nose (to prevent spreading germs to others).  Wash your hands when you get home from work each day.  

    Accordingly, buy more soap than normal, keep track of how much you use, and plan to have a month's worth at home.  

    Also buy a couple of bottles of "Purell" or similar alcohol-based hand sanitizing lotion.  Keep a small bottle with you when you're out of the house in case you need to wash your hands but can't otherwise (i.e. public bathroom out of soap).  

    Also more detergent and bleach than normal.  Under some conditions it might be prudent to change from "work clothes" to "at-home clothes" at the end of each day, and have a good scrub or even a shower before putting your "at-home clothes" on.  

    If you use public laundromats or communal washing machines, consider they may be a risk factor (warm, humid air; other users' infected clothing; etc.).  If you can't afford to buy a standard size washing machine, consider a "compact washer," decent ones cost about $250. and can be ordered online.  Otherwise, practice at washing your clothes by hand in the sink or tub, and drying them on an outdoor or indoor clothes line, or drying rack (about $25).  Note, never hang clothes near a heater: major fire hazard.  A small fan can provide enough air circulation to dry clothes overnight indoors.

    Depending on your job, look into the option of telecommuting (working from home), and start taking steps to make that happen (e.g. start with one day a week, increase to two, talk to your supervisor about going to full telecommute mode when the flu hits your area.

    If you work in retail or otherwise have to deal with the public, insist on your right to wear facemask and surgical gloves.   If your workplace is unionized, talk to your union representaties about this issue now, and give them the facts they will need to make the case.  

    Consider buying one or two courses of Tamiflu for each member of your household.  If you plan to do this, do it now, because during a crisis it may not be possible.  Get a prescription and buy it from a reputable local pharmacy; do not order via online pharmacies as there are plenty of fake / counterfeit pills going around.  

    Talk to your friends and family about forming a mutual financial support network in the event that one or more of you has to leave a job for flu safety reasons.  Organize this in advance, including the rules that govern how much money each person should keep on hand to contribute if it becomes necessary, what conditions justify someone quitting a job to stay safe, how you'll decide to allocate resources, and so on.  Have those discussions well ahead of a crisis, and write down your agreements and have everyone sign the document.  

    Talk to your city government about its preparedness plans.  Talk to your city council member, your local director of public health, and/or other officials as needed.  Write to your local officials.  Keep a moderate tone when you write.  

    If you travel by air during the holidays, consider alternatives, and make those plans now.  The most prudent thing to do is to hold family gatherings at times other than the usual calendar holidays.  Travel during off-peak seasons when planes are not crowded; tickets are also cheaper during those times.  

    If you have to fly on a crowded plane, wear an appropriate face mask and surgical gloves.  When someone coughs or sneezes, germs can travel up to seven rows ahead of them.  When you book your tickets, tell the booking agent you're planning to wear a mask, and ask if there are any security issues (i.e. people in face masks in airports).  Bring a couple of extra sets of masks and gloves with you in your carry-ons when you fly.  When you board the aircraft, politely ask the flight attendant to make a safety announcement to ask people to cover their mouths with a tissue if they have to cough or sneeze.  If you're seated next to someone who appears to be ill, ask to be moved further back in the airplane.  

    That was supposed to be a short list.  Hmm.  Most of this stuff is basically minor inconvenience, and it could save your life.  Just take reasonable steps, and put up with the inconveniences.  The risks of wasted time and money in the event this turns out to be a false alarm, are a heck of a lot less than the risk to your life if this is anywhere near as serious as it appears.

    •  very useful (none)
      even if all isn't followed, some are prudent for any emergencies.

      FEMA keeps a running preparedness list for natural disasters, as well.

      "Politics is the art of looking for trouble, finding it everywhere, diagnosing it incorrectly and applying the wrong remedies." - Groucho Marx

      by Greg Dworkin on Mon May 30, 2005 at 05:32:59 AM PDT

      [ Parent ]

    •  I read somewhere (none)
      that there have already been cases of avian flu in the U.S. I suppose in people who have been visiting Asia, but I don't have any details.

      Plainly there is something going on in China, but their government doesn't want to talk about it. I guess they have learned nothing from dealing with SARS.

      The scary thing about all this is not knowing what is going on. If there is a human-to-human transmission happening, there is no way that the Chinese government will be able to keep covering this up. But if they don't let anybody know what is happening, it will be too late to be able to do much about it.  Not that it's easy to do much about it anyhow.

    •  This is such an eminently practical (none)
      And doable list that I put it on my blog, with a link back to this comment so you would get credit for coming up with it. I hope you don't mind, I'm not trying to steal it or violate any copyrights. If you do mind I will take it off, or only leave a part of it and make people come here to see it.

      I've been doing a bit of a series about the H5N1 virus lately, and I thought that I may have sufficiently alarmed people enough that practical suggestions would be welcome. :-D

      The entry in my blog, in case you want to check it out or suggest a different way to give you credit or something:

      •  it's OK (none)

        Thanks!  No problems with copyright, copyleft, or copy-in-the-middle:-).  

        The most important thing in planning for any potential natural or civil emergency is to use good sense, be prepared in advance, practice your emergency routines so you can do them without a lot of fuss, and keep a cool head so you can help others.

        By the way, if the flu hits hard, there will be an unstoppable public demand for single-payer universal health care.  

        •  Thanks (none)
          for letting me use it! It may be useful to my few readers.

          You know I was thinking that myself about the universal health care. I had a big discussion with some folks about that. I was on the side that we should have it BEFORE a pandemic hit, because people would be more likely to go to the doctor sooner and it would help slow the spread of the flu. But all they could come up with was problems with universal care, not how we could make things better. It was frustrating. They just didn't seem to think it mattered, and assumed the health department would take care of it.

          I can imagine it now, the health department taking months to get in gear and becoming overwhelmed, while if we had universal health care they would have a working system that took care of everyone already in place. People wouldn't be trying to "tough it out" because they couldn't pay for health care, and so wouldn't be spreading the flu all over.

          Short sighted people...

  •  Once Again, Thanks (none)
    Looks like we really know nothing about what's happening in Qinghai, at least as far as human to human transmission is concerned.  If a pandemic is starting there, it would be tragic since, as the first boxun quote says, Qinghai is one of the poorest places on the planet, with a large Tibetan population.  On the other hand, it's sparsely populated and isolated, which might slow global transmission and give some time to begin to deal.  Reliable information is key.  Let's hope the Chinese government really learned its lesson with the SARS incident.

    This aggression will not stand, man

    by kaleidescope on Mon May 30, 2005 at 07:33:15 AM PDT

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