What you should know about coronavirus variants, according to a virologist

covid vaccine development
(Author not pictured) Epidemiologists predict that within a year current vaccines could need to be updated to better handle new variants.

  • Dr. Paulo Verardi is an associate professor of virology and vaccinology at the University of Connecticut.
  • He says people should be aware of the currently identified five COVID-19 variants.
  • Assume these variants will continue to evolve and adapt, stay vigilant, and get vaccinated.
  • See more stories on Insider’s business page.

Spring has sprung, and there is a sense of relief in the air. After one year of lockdowns and social distancing, more than 171 million COVID-19 vaccine doses have been administered in the US and about 19.4% of the population is fully vaccinated. But there is something else in the air: ominous SARS-CoV-2 variants.

I am a virologist and vaccinologist, which means that I spend my days studying viruses and designing and testing vaccine strategies against viral diseases. In the case of SARS-CoV-2, this work has taken on greater urgency. We humans are in a race to become immune against this cagey virus, whose ability to mutate and adapt seems to be a step ahead of our capacity to gain herd immunity. Because of the variants that are emerging, it could be a race to the wire.

Five variants to watch

RNA viruses like SARS-CoV-2 constantly mutate as they make more copies of themselves. Most of these mutations end up being disadvantageous to the virus and therefore disappear through natural selection.

Occasionally, though, they offer a benefit to the mutated or so-called genetic-variant virus. An example would be a mutation that improves the ability of the virus to attach more tightly to human cells, thus enhancing viral replication. Another would be a mutation that allows the virus to spread more easily from person to person, thus increasing transmissibility.

None of this is surprising for a virus that is a fresh arrival in the human population and still adapting to humans as hosts. While viruses don’t think, they are governed by the same evolutionary drive that all organisms are – their first order of business is to perpetuate themselves.

These mutations have resulted in several new SARS-CoV-2 variants, leading to outbreak clusters, and in some cases, global spread. They are broadly classified as variants of interest, concern or high consequence.

Currently there are five variants of concern circulating in the US: the B.1.1.7, which originated in the UK; the B.1.351., of South African origin; the P.1., first seen in Brazil; and the B.1.427 and B.1.429, both originating in California.

Each of these variants has a number of mutations, and some of these are key mutations in critical regions of the viral genome. Because the spike protein is required for the virus to attach to human cells, it carries a number of these key mutations. In addition, antibodies that neutralize the virus typically bind to the spike protein, thus making the spike sequence or protein a key component of COVID-19 vaccines.

India and California have recently detected “double mutant” variants that, although not yet classified, have gained international interest. They have one key mutation in the spike protein similar to one found in the Brazilian and South African variants, and another already found in the B.1.427 and B.1.429 California variants. As of today, no variant has been classified as of high consequence, although the concern is that this could change as new variants emerge and we learn more about the variants already circulating.

More transmission and worse disease

These variants are worrisome for several reasons. First, the SARS-CoV-2 variants of concern generally spread from person to person at least 20% to 50% more easily. This allows them to infect more people and to spread more quickly and widely, eventually becoming the predominant strain.

For example, the B.1.1.7 UK variant that was first detected in the US in December 2020 is now the prevalent circulating strain in the US, accounting for an estimated 27.2% of all cases by mid-March. Likewise, the P.1 variant first detected in travelers from Brazil in January is now wreaking havoc in Brazil, where it is causing a collapse of the health care system and led to at least 60,000 deaths in the month of March.

Second, SARS-CoV-2 variants of concern can also lead to more severe disease and increased hospitalizations and deaths. In other words, they may have enhanced virulence. Indeed, a recent study in England suggests that the B.1.1.7 variant causes more severe illness and mortality.

Another concern is that these new variants can escape the immunity elicited by natural infection or our current vaccination efforts. For example, antibodies from people who recovered after infection or who have received a vaccine may not be able to bind as efficiently to a new variant virus, resulting in reduced neutralization of that variant virus. This could lead to reinfections and lower the effectiveness of current monoclonal antibody treatments and vaccines.

Researchers are intensely investigating whether there will be reduced vaccine efficacy against these variants. While most vaccines seem to remain effective against the UK variant, one recent study showed that the AstraZeneca vaccine lacks efficacy in preventing mild to moderate COVID-19 due to the B.1.351 South African variant.

On the other hand, Pfizer recently announced data from a subset of volunteers in South Africa that supports high efficacy of its mRNA vaccine against the B.1.351 variant. Other encouraging news is that T-cell immune responses elicited by natural SARS-CoV-2 infection or mRNA vaccination recognize all three UK, South Africa, and Brazil variants. This suggests that even with reduced neutralizing antibody activity, T-cell responses stimulated by vaccination or natural infection will provide a degree of protection against such variants.

Stay vigilant, and get vaccinated

What does this all mean? While current vaccines may not prevent mild symptomatic COVID-19 caused by these variants, they will likely prevent moderate and severe disease, and in particular hospitalizations and deaths. That is the good news.

However, it is imperative to assume that current SARS-CoV-2 variants will likely continue to evolve and adapt. In a recent survey of 77 epidemiologists from 28 countries, the majority believed that within a year current vaccines could need to be updated to better handle new variants, and that low vaccine coverage will likely facilitate the emergence of such variants.

What do we need to do? We need to keep doing what we have been doing: using masks, avoiding poorly ventilated areas, and practicing social distancing techniques to slow transmission and avert further waves driven by these new variants. We also need to vaccinate as many people in as many places and as soon as possible to reduce the number of cases and the likelihood for the virus to generate new variants and escape mutants. And for that, it is vital that public health officials, governments, and nongovernmental organizations address vaccine hesitancy and equity both locally and globally.

Paulo Verardi, associate professor of virology and vaccinology, University of Connecticut

The Conversation
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How NY Gov. Cuomo’s ‘apologies’ fail to recognize that power imbalances are at the root of sexual harassment

andrew cuomo
New York state Gov. Andrew Cuomo.

  • Andrew Cuomo has issued denials, defenses, and apologies in response to misconduct accusations.
  • His “I never intended” responses miss the point – that power is at the heart of sexual harassment.
  • Ending sexual harassment will require a critical rethinking of the distribution of workplace power.
  • See more stories on Insider’s business page.

In recent weeks, multiple women have reported demeaning and sexualized workplace behavior by New York Gov. Andrew Cuomo. In response, Cuomo has issued a combination of denials, defenses, and apologies.

Much of the public analysis of his statements has focused on the adequacy of these apologies – whether he took sufficient responsibility or expressed sufficient remorse.

Apologies deserve attention. They can help right wrongs and heal relationships.

Yet in the focus on apologies, an opportunity is missed to learn something about power. Power, after all, is at the heart of sexual harassment.

‘Unwanted imposition’

As Catharine MacKinnon, the architect of modern sexual harassment law, has argued, sexual misconduct at work can be defined as “the unwanted imposition of sexual requirements in the context of a relationship of unequal power.”

If responses like Cuomo’s are viewed through a power-informed lens, different patterns emerge. In my own study of over 200 such statements, I found many references to the accused’s own long careers, to their many professional accomplishments, and to their excellent reputations. In short, when challenged, the men in my study (and all but three were men) did what came naturally: They reached for their power.

This pattern is connected to another theme that I discovered in the statements I studied: repetition of explanations and defenses centered on the accused person’s own subjective intent and perceptions.

It’s me being funny. I’m not trying to sexually harass people,” for example, or “I come from a very different culture,” or “I remember trying to kiss [her] as part of what I thought was a consensual seduction ritual.”

However, the accused’s intentions, thoughts, or beliefs – so central in the statements I studied – are only peripheral under sexual harassment law.

Not a joke

Under Title VII of the Civil Rights Act of 1964, the main federal law that covers workplace discrimination and harassment, an employee may sue her employer when she has experienced severe or pervasive workplace harassment.

Severity and pervasiveness are judged subjectively, from the harassed person’s point of view, and objectively, in the view of a theoretical “reasonable person.” The law also requires that the conduct be unwelcomed by the harassed person.

Though different courts have interpreted these requirements differently around the edges, sexual harassment cases do not turn on whether the harasser thought his conduct was a joke, or culturally acceptable, or ritualized seduction.

Instead, the law’s subjectivity and “welcomeness” requirements ask a superior – like Cuomo – to evaluate his own conduct from his subordinate’s point of view. Superiors who want to avoid committing harassment to begin with (before anything gets to a judge, jury, or media story) need to step outside their own perspective.

This requires empathy. And the more power that a person wields in the workplace, the more difficult it may be to step outside one’s own position and consider the circumstances from another person’s perspective.

‘I never intended’

Here’s where Cuomo’s responses are revealing.

In his first official statement, released on Feb. 28, 2021, out of 18 “I” statements, over half were versions of “I never intended,” “I was being playful,” or “I do, on occasion, tease people.”

Cuomo followed suit in his press conference on March 3, repeating over and over variations on the “I never intended” or “I never knew” or “I didn’t mean it that way” theme.

These statements suggest that, over his long career, Cuomo did not pay attention to the effects of his words and actions on his subordinates, and that the power of his position may have reinforced his heedlessness.

The US Equal Employment Opportunity Commission warns about just this type of scenario in its list of harassment risk factors: “High value employees may perceive themselves as exempt from workplace rules or immune from consequences of their misconduct.” Workplaces with significant power imbalances, too, make the risk factor list.

If the movement sparked by #MeToo focuses only on taking down individual bad actors, it will leave intact the workplace structures that enable and protect the powerful – and that produce statements like Cuomo’s. Ending sexual harassment requires a critical rethinking of workplace power, whether it flows from ownership of a company, management of an office, supervision of a shop floor, or the office of the governor.

Charlotte Alexander, associate professor of law and analytics, Georgia State University

The Conversation
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3 signs that your manager or boss may be a narcissist

boss employee angry annoyed boss bored unhappy office work jobs
Narcissists can pretend they care about other people, but they’re really only interested in their own gain.

  • Narcissistic people often consider themselves to be the most important person in the room.
  • Managers or bosses who are narcissistic are likely to put their own interests ahead of everyone else.
  • These types of managers often make people feel unsafe to take risks or express themselves openly.
  • See more stories on Insider’s business page.

Relationships at work matter greatly to our well-being, and perhaps no work relationship affects us more strongly than the one we have with our manager. In fact, people who leave their job frequently report that their manager is their most important reason for doing so.

Managers’ narcissistic tendencies are often a key issue that troubles their relationship with their employees. Although narcissists tend to make a good first impression, their true nature unfolds over time and reveals that they care above all about themselves, not about others.

Our recent studies show that narcissistic managers are poorly equipped to develop good, sustainable relationships with others because their selfish behavior and disregard for others erodes what is the basis of all good relationships – trust.

My fellow researchers and I therefore wondered: Could some narcissistic managers develop the ability to camouflage their lack of concern for others and make others trust them by creating the impression that they care?

How do narcissistic managers erode others’ trust in them?

Narcissistic individuals display a range of self-centered characteristics, including selfishness, entitlement, arrogance, and the exploition of people for personal gain. They consider themselves as more important, talented, and attractive than others, but they are also insecure about themselves and have a strong need to be admired. Narcissists thus simultaneously crave other people’s reaffirmation and validation of their inflated self-image, and feel entitled to attention and admiration.

This duality of craving and feeling entitled to admiration leads narcissistic individuals to consider themselves born to be leaders and to feel entitled to leadership positions, positions in which they may be seen and admired.

Unfortunately, we tend to interpret a narcissistic individual’s overconfidence as a signal that they are, in fact, competent and that they would make a good leader. So narcissists’ aspiration for leadership positions combined with the good first impressions that they make can cause them to rise in hierarchies, which results in narcissistic traits being relatively common among managers.

Although narcissistic individuals may make a good impression initially, they can be ill-suited to leadership positions, because effective leadership requires developing collaborative, reciprocal, trusting relationships with others. Instead, as our research consistently finds, narcissistic managers are considered less trustworthy by those who work for them. This is because developing trust requires integrity and caring about others, neither of which come natural to narcissistic individuals.

In fact, narcissistic managers are likely to put their own interests ahead of those of others and may even step on others when doing so is needed to achieve personal gain. Consequently, as our studies confirmed, a narcissistic, untrustworthy manager will make people feel unsafe to take risks, make mistakes, and express themselves openly.

Is it easy to spot a narcissist?

Because the effects of narcissistic leaders are likely to come out and their true nature may be revealed over time, it is tempting to think that we could easily detect a narcissistic manager. If this is the case, we may simply – through selection tests in organizational recruitments, for example – try to detect them and ensure that they’re not selected for leadership positions.

Such efforts certainly hold merit, as narcissistic individuals are typically not shy about admitting that they want to be admired or even that they overlook the interests of others. Indeed, in general, narcissists do not present themselves as agreeable or modest. However, narcissists are not incompetent and they have the capability to learn that they may be even more effective in attaining their selfish goals if they present themselves in a socially acceptable way or, in other words, if they camouflage their lack of care and fly under the radar.

A consistent finding in our studies is that some narcissistic managers engage in techniques to manage the impression that others have of them – they actively seek to behave in ways that makes them appear sincere to others. Moreover, our findings indicate that these impression-management techniques can be successful: employees perceive highly narcissistic managers that try to make themselves appear sincere as more trustworthy than their highly narcissistic counterparts who do not engage in this impression management behaviour and, because of this, their employees feel safer to express themselves openly. In a nutshell, they can fake that they care and be successful in doing so.

What might this fake caring look like?

When someone behaves in a way that seems caring, it can be difficult to tell whether or not they are faking it. Fortunately, there may be some signs. In general, the fact that narcissistic individuals need to learn how to give others the impression that they care, means that they cannot rely on spontaneous behaviour and responses. This means that their seemingly sincere behaviour is likely to appear awkward or scripted. For example:

  • Someone who is truly caring is likely to spontaneously ask you how you are doing, and is likely to be aware of what is going on in your life. In contrast, a person who does not really care is less likely to ask you spontaneously. Instead, it could be that they only ever ask how you are after you have just asked them. It could simply be that your question reminded them to express caring about you in return. Moreover, they may be unlikely to ask follow-up questions after having shown their superficially caring behaviour. After all, they are not truly interested in you.
  • Someone who is truly caring is likely to listen and be more empathic. In contrast, if you find yourself telling a story about your own experience and the experience suddenly appears to be about them, their seemingly empathic response to your story might be only an opportunity for them to tell a story about themselves. Similarly, it is possible that their reaction to your story is not empathic at all, remains superficial, and only sticks to the facts.
  • At the same time, however, if they only let you talk and never share or relate to what you are saying, it may well be that they have made you believe that they are interested in you but that they do not actually care. Someone who is caring and trustworthy is likely to express trust in you as well – for example, by sharing about their own life – because trustworthy people are likely to see relationships as a two-way street.

Most people have a natural inclination to trust others who show signs of caring, so we are vulnerable to the assumption that narcissists have good intentions, especially those narcissists who engage in extra effort to appear sincere. Some awareness of this effect and the ways in which we might recognize fake caring is helpful to protect well-intentioned people from being exploited and manipulated.

Melvyn R.W. Hamstra, assistant professor in leadership and organizational behavior, IÉSEG School of Management

This article is republished from The Conversation under a Creative Commons license. Read the original article.

The Conversation
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If you’re experiencing Zoom burnout, try audio-only meetings to help boost productivity and imagination

Zoom Fatigue
When we have Zoom fatigue from too much screen time, we tend to remember less information.

  • Zoom fatigue is more than eye strain from screen time – it hurts our productivity and job performance.
  • Over video, we work harder to send and receive nonverbal cues, and this can become exhausting.
  • Try audio-only meetings instead to stimulate the imagination and help prevent mental overload.
  • See more stories on Insider’s business page.

Just as other brand names make their way into the dictionary, Zoom has now become a daily verb and a noun. We Zoom each other, we say “Let’s have a Zoom,” and we get Zoom fatigue. Now there’s Zoom burnout as well – a phrase that encompasses a lot more than the eye strain of too much screen time.

Emerging research shows we get less done and we may end up unnecessarily replicating communication in our personal and working lives. A new study highlights the causes of this fatigue and how to deal with it.

Too much Zooming can become mentally demanding. There’s a lot of evidence that when people are mentally tired, they tend to act less efficiently. Sustained performance on a mentally demanding task decreases over time.

Also, when we’re fatigued, our working memory performs less well. We become forgetful, our listening quality degrades, and recording Zoom meetings for later viewing simply creates more energy sapping screen time.

The online meetings designed to get things done could be the very things harming our productivity, just at a time when margins are particularly tight and businesses are financially on the edge. And there’s some evidence that using audio only might be more productive than an overload of screen meetings.

Zoom fatigue

The new study highlights the psychological impact of spending hours each day on a range of video calling platforms. The study found people often reach “nonverbal overload” with too much eye contact. This means we need to work harder to send and receive all those nonverbal signals that are lost when many of us are just a head filling the screen.

In face-to-face meetings, another study points out, nonverbal communication flows naturally and “we are rarely consciously attending to our own gestures and other nonverbal cues.” This is one of the reasons many people can’t wait to get back to face-to-face. For others, Zooming is fine until the fatigue kicks in, then an unease arises.

This is where the good old phone meeting could come in. The same study describes “a wonderful illusion that occurs during phone calls.” We’re no longer weighed down with nonverbal overload or eye contact meltdown. We may even stretch, move around the room, even make a cup of tea as we speak.

We tend to imagine we are getting 100% of the others’ attention on a phone call. The researchers conclude that “only a minority of calls require staring at another person’s face to successfully communicate.”

Give up Zoom?

Many experts are now calling for fewer Zoom meetings.

Yet, evidence for seriously considering meeting over the phone comes from other academic work that goes back a lot further. Early studies comparing TV radio, newspapers, and computer screens identified newspapers as enabling significantly highest recall of facts. Computer screens surprisingly performed closer to newspapers and better than TV and radio. So, one up for the screens? The problem is we tend to remember less when we have screen fatigue.

In contrast, a lot of research confirms how radio stimulates the imagination. “I prefer radio to TV because the pictures are clearer,” goes the old saying. Whether with the phone, radio, or podcasts, our active imagination is more engaged actively listening than when we passively view. And we can become very passive when we’re screen exhausted.

Some neuroscience research has confirmed that when our imaginations are active they can become more emotionally stimulated. Scientists have interpreted this as an indicator that the audio content requires active imagination on the part of the listener.

One further piece of research becomes critical here, suggesting that imagination runs hand in hand with motivation. According to this view, imagination can make us more goal directed, more likely to get things done. Zoom fatigue can have the opposite effect. The imaginative process inherent in the audio call increases the likelihood that we’ll make good on our intentions.

If this is true – and there needs to be more research in the problem – it will certainly be time to become more conscious of when and how often we meet on Zoom, for how long and for what purpose.

Try holding some of your work meetings by phone. It might seem strange at first and take a bit of getting used to, but you might just find your meetings are more productive and satisfying. Your imagination might kick into gear and re-fire your motivation. I’m not saying banish all the Zooming, just re-balance your use of audio and screen.

Paul Levy, senior researcher in innovation management, University of Brighton.

The Conversation
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COVID-19 lockdowns may be preventing kids’ immune systems from maturing, according to an immunologist

Children playing outside
Outdoor activities are crucial to help reduce the risks of allergic diseases in young children.

  • Current isolation policies will negatively impact young children’s immune systems’ ability to self-regulate.
  • When people are less exposed to the natural environment, there’s potential for an increase in allergic diseases.
  • Children in lockdown for over a year now are at risk for developing allergies, asthma, and autoimmune issues.
  • Visit the Business section of Insider for more stories.

“Eat dirt!” is a phrase I remember well. It was in the title of an article published by Harvard University environmental health professor, Dr. Scott T. Weiss, and it captured my attention while I was learning about an immunological concept known as the “hygiene hypothesis.”

The core of the idea is that we live in a microbial world: an environment full of bacteria, parasites, viruses, and fungi. And that our interactions with these microbes after birth are extremely important to educate our immune systems to function properly. When we are born, our immune systems are still maturing.

I like the way researchers led by microbiologist Sally F. Bloomfield expressed it in their study:

“The immune system is a learning device, and at birth it resembles a computer with hardware and software but few data. Additional data must be supplied during the first years of life, through contact with microorganisms from other humans and the natural environment.”

The immune system has many potent mechanisms for killing pathogens. It needs to be carefully regulated to ensure it can eliminate dangerous microbes from the body without causing excessive harm to our own tissues. The interactions we have with our environment early in life are essential for our immune systems to learn to differentiate between safe and dangerous disease-causing microbes.

Our bodies are covered inside and out with microorganisms that, under normal circumstances, happily cohabitate with us and promote a healthy immune system. If infants, toddlers, and young children are not sufficiently exposed to the microbial world around them, their ability to properly regulate their own immune systems can be compromised.

To return to the computer analogy, the data that gets uploaded into the software is incomplete. This lack of data can cause the immune system to struggle to differentiate between what is truly dangerous and should be eliminated, and what is not dangerous and should not be responded to. In plain terms, this scenario can promote allergies, asthma, and autoimmune diseases.

Concrete jungles

Scientists are moving away from using the term “hygiene hypothesis” because it could be misinterpreted as meaning that hygiene is not good for a developing immune system. This is not true, nor should anybody advocate for actually eating dirt to gain exposure to microbes. Moderation and targeted hygiene would be best.

Specifically, we need to practice proper hygiene in the context of trying to prevent infectious diseases, but still allow our immune systems to interact with safe and essential microbes. Many middle-income countries have seen an epidemic of allergic diseases over the past several decades. This is, in part, due to increased urbanization which is akin to living in “concrete jungles” with reduced exposure to the natural environment.

Societies have also adopted behaviors that limit exposure to microbes. The overuse of antibiotics exacerbates the problem by non-discriminately eliminating good microbes along with bad ones.

Bloomfield and her team of microbiology researchers came to some important conclusions in their study:

“Evidence suggests a combination of strategies, including … increased social exposure through sport, other outdoor activities, less time spent indoors … may help … reduce risks of allergic disease. Preventive efforts must focus on early life.”

Now think about government-led responses to COVID-19, which was declared a pandemic by the World Health Organization on March 11, 2020. The lockdown and restriction policies that have been enacted to help prevent the spread of COVID-19 contradict the recommendations to ensure proper immunological development in children.

Data suggest that SARS-CoV-2 does not represent a greater danger to children than the annual flu. Yet social interactions of children have been severely limited, including removing them from schools. Most of their extracurricular activities have been canceled and they have been discouraged from leaving their homes. Even the air they breathe is often filtered by masks and there is prevalent use of hand sanitizer.

Compromised immunological development

In short, most COVID-19 policies have maximized the potential for children to develop dysregulated immune systems. As a viral immunologist, I was not overly concerned about this in the early stages of the pandemic when “temporary” measures were put in place to “flatten the curve.”

However, there is cause for concern one year later, after many places in Canada and other countries have spent months in lockdowns or with very limited social contact and activities to prevent the spread of COVID-19.

The youngest among us have had their immunological development compromised for one year and growing. The more immature the immune system is, the more prone it will be to becoming dysregulated during the pandemic.

For example, the problem would likely be more prevalent in infants than toddlers. Although the human immune system is largely mature by approximately age six, some important components are still developing into adolescence. As such, the only people who can be certain that current isolation policies will have no negative impact on their immune system’s ability to self-regulate are adults.

An unfortunate and underappreciated long-term legacy of this pandemic will likely be a cluster of “pandemic youth” that grow up to suffer higher than average rates of allergies, asthma, and autoimmune diseases. This will hold true for children in all countries that enacted isolation policies.

Interestingly, it has been noted that the new messenger RNA-based COVID-19 vaccines that are packaged inside liposome nanoparticles might be contraindicated for some individuals with a propensity towards severe allergic responses. Ironically, we may be setting up many of our youth to develop hypersensitivities to this vaccine technology when they are older.

Raising children during the pandemic has largely occurred in isolated/sanitized environments that are unprecedented in extent and duration. These kids are at greater risk of developing hypersensitivities and autoimmune diseases than anyone before them. The immune systems of children are not designed to develop in isolation from the microbial world, so let’s consider letting children be children again.

Byram W. Bridle, associate professor of viral immunology, department of pathobiology, University of Guelph

The Conversation
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Black Americans have legitimate reasons to be skeptical of getting the COVID-19 vaccine – a bioethicist explains why

covid vaccine
It’s important to learn the painful medical histories of Black people to help combat their trust in the medical system.

  • Black Americans are being hospitalized and dying from COVID-19 at higher rates than white Americans, says bioethicist Esther Jones.
  • Still, many Black people are skeptical about receiving the vaccine due to distrust of the American medical system. 
  • Jones says healthcare workers and policymakers can help close racial health gap by understanding the source of this skepticism. 
  • Visit the Business section of Insider for more stories.

Black Americans have been the least inclined of any racial or ethnic group to say they’d get vaccinated against the coronavirus. The proportion of Black people who said they’ll probably or definitely take the shot has risen over time – but even by mid-January, with two COVID-19 vaccines authorized for emergency use in the US, only 35% of Black survey respondents said they’d get it as soon as they could, or already had gotten the shot.

At the same time, the COVID-19 pandemic has disproportionately harmed Black, Indigenous and other people of color in comparison to white members of American society. With Black Americans being hospitalized at rates 2.9 times higher than white Americans and dying from COVID-19 at rates 1.9 times higher, you might assume that Black people would be lining up at breakneck speed to receive the vaccine as soon as it’s available to them.

But the Black community has reasons for distrust – even beyond what might be attributed to the mixed messaging of the nation’s COVID-19 response. And it’s not a simple or sole matter of miseducation. I’m a medical humanist and bioethicist who studies history, ethics, and literature to understand racial and gender health disparities. My research explores the history of unethical and abusive treatment Black Americans have experienced at the hands of the medical establishment. Based on past experience, Black people have many legitimate reasons to be in no hurry to get the vaccination.

A troubling track record

The American medical establishment has a long history of unethical treatment of Black research subjects. Medical ethicist Harriet A. Washington details some of the most egregious examples in her book “Medical Apartheid.” There’s the now notorious Tuskegee syphilis experiment, in which the government misled Black male patients to believe they were receiving treatment for syphilis when, in fact, they were not. That study went on for a total of 40 years, continuing even after a cure for syphilis was developed in the 1940s.

Perhaps less widely known are the unethical and unjustified experiments J. Marion Sims performed on enslaved women in 1800s US that helped earn him the nickname the “father of modern gynecology.” Sims performed experimental vesicovaginal fistula surgery on enslaved women without anesthesia or even the basic standard of care typical for the time.

Sims experimented on Anarcha, a 17-year-old slave, over 30 times. His decision not to give anesthesia was based on the racist assumption that Black people experience less pain than their white peers – a belief that persists among medical professionals today. Historian Deirdre Cooper Owens elaborates on this case and many other ways Black women’s bodies have been used as guinea pigs in her book “Medical Bondage.”

Cases of medical malfeasance and malevolence have persisted, even after the establishment of the Nuremburg code, a set of medical ethical principles developed after World War II and subsequent trials for crimes against humanity.

In 1951, doctors harvested cervical cancer cells from a Black woman named Henrietta Lacks without her permission. Researchers went on to use them to create the first immortal cell culture and subjected her descendants to ongoing study for years without informed consent. Investigative journalist Rebecca Skloot details the cascade of ethical violations in her book “The Immortal Life of Henrietta Lacks.” Despite heightened awareness after the book’s publication, the ethical violations continued when a group of scientists mapped the HeLa genome without her family’s knowledge or consent.

Advances in genomics are still being used to resuscitate theories of racial “science.” For example, a now-debunked 2007 study purported to isolate a so-called “warrior gene” in Maori Indigenous men and argued they are genetically “hard-wired” for violence. Scientists and news outlets in the US jumped on board, suggesting there’s a genetic predisposition for Black and Latino males to engage in gang activity.

Legal scholar Dorothy E. Roberts explains in her book “Fatal Invention” how incidents like this one perpetuate the harm of race-based science. Using biological data and flawed reasoning tainted by racial stereotyping reinforces racist beliefs about Black people. Such logic focuses on purely biological factors and ignores the social and systemic factors that produce negative and inequitable health outcomes.

While there is now an ample body of scholarly research that reveals these truths about racism in the medical establishment, Black Americans need only to gather around the kitchen table with a few friends and family to share and hear personally experienced stories of medical malfeasance.

Present day persistence of racism in healthcare

Even though their experiences at the hands of researchers like J. Marion Sims were central to advances in modern gynecology, today Black women have not benefited from these advances to the same degree as white women. Black women still suffer worse outcomes and more deaths from gynecologic cancers and have worse health and more deaths affiliated with childbearing, just to name two.

When tennis star Serena Williams gave birth, she saw firsthand how Black women are disbelieved by the medical establishment. She might have died from postpartum blood clots if she hadn’t advocated for herself in the face of dismissive medical professionals.

Black people are acutely aware of this history of racism in the medical establishment, and the ways it persists today on both an individual and a collective level. Stereotypes about Black patients, whether the result of explicit or implicit bias, continue to affect the care they receive and their medical outcomes. Again and again, when surveyed, Black Americans report that medical providers don’t believe them, won’t prescribe necessary treatments, including pain medication, and blame them for their health problems.

And the association between racism and increased disease cases and deaths has held true during the COVID-19 pandemic.

Overcoming these challenges

Ongoing trust issues around the COVID-19 vaccines are just the latest indication of racial health disparities in the US.

Still, there are ways to begin to close the COVID-19 racial health and mortality gap. Vaccinations for Black people may otherwise continue to lag in proportion to population size.

Esther Jones, associate professor of English, affiliate with Africana studies and women’s & gender studies, Clark University

 

The Conversation
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How tech-based design solutions can help stop the spread of COVID-19, according to an architect

elevator button coronavirus
In some quarantine hotels, staff help guests by pressing the elevator buttons.

  • Mengbi Li is a lecturer in built environment architecture at Victoria University in Melbourne, Australia. 
  • She says the design or redesign of existing infrastructure can help people overcome COVID health challenges.
  • One redesign option is to make high-touch public spaces, like elevator buttons and toilets, motion-sensitive and touch-free.
  • Visit the Business section of Insider for more stories.

The coronavirus has been escaping with distressing frequency from quarantine hotels, threatening serious outbreaks. To make things worse, multiple variants of the virus, possibly more infectious and deadly, have recently been detected. This accentuates the need for robust hotel quarantine, especially in countries like Australia that have controlled community transmission.

While the hotel quarantine system has received wide attention, relatively few people have had the opportunity to experience and observe it first hand. Even fewer have been able to compare with other regions handling similar challenges. I happen to have needed to travel overseas and thus experienced quarantine in several places over the past months.

Based on my experience as an academic in architecture, I share some thoughts and observations here on how the design or redesign of buildings, infrastructure, and cities can help people overcome the health challenges created by COVID-19.

Our buildings and cities were not designed to handle such extraordinary situations as this pandemic. One consequence is their design has often made the need to touch surfaces unavoidable.

Take elevators, for example

Some of the most frequently touched surfaces in buildings are the buttons in lifts. In some buildings in China, plastic wrap is used to cover the buttons and a sticker showing the time and date of last disinfection is attached nearby. Other buildings provide tissues for people to use as disposable finger covers.

In quarantine hotels, this procedure is even more carefully managed. Staff help guests by pressing the button. This small touch area needs frequent cleaning, which calls for extra human resources.

At Baiyunshan airport in Guangzhou, I used an elevator with touch-free buttons. The keypad had infrared sensors installed next to the usual button. With just a wave of their finger over the touch-free button, users can select their destination.

Another mode free of physical screens features numbers displayed in a front-projected holographic display. A sensor detects the movement of pressing a button in the air to activate the lift.

This technology is not out of our reach. In response to the pandemic, authorities in Melbourne and Sydney have trialed touch-free buttons using infrared technology at pedestrian crossings.

One concern about touch-free buttons is the challenge they present to the visually impaired. Currently, a push-button is placed next to the infrared sensor. An alternative for people who need assistance would be to use gesture or voice commands. Other concerns include reliability and vandal-proofing.

Another sensitive touch spot is the toilet. The airport toilets I visited in Australia, China, and Singapore are equipped with touch-free features to activate the flush, tap, soap dispenser, and hand dryer. However, the doors and locks cannot function without touch. Touch-free sensors or foot pedals would probably help.

Alternatively, new materials or coatings like antimicrobial polymers could be applied in areas where touch is unavoidable. Of course, care must be taken to ensure the antiviral potency is both reliable and people-friendly.

Design solutions don’t have to be high-tech

Interestingly, touch-free public spaces do not always rely on advanced materials or sophisticated technology. In a Melbourne quarantine hotel, I noticed several bollards with foot pedals being used as hand sanitizer dispensers. These are designed to function mechanically and require no power connections.

Instead of a simple stainless steel bollard, this dispenser could be further reimagined as an artistic sculpture integrating the building’s signage at the entrance. Elsewhere, this design could be incorporated into litter bins along the streets.

Usually, for architectural design, circulation patterns are analysed to see how people reach each space and establish the relationships between different areas. For safety purposes, exits are checked to ensure people can evacuate in a timely way. To prepare for future pandemics, these studies could add analysis of touch points in both pandemic and non-pandemic periods.

The shared challenge posed by the pandemic has prompted some innovative ideas. For example, physical reminders to keep a social distance have variously involved using carpet tiles, mowed or trimmed landscape patterns, furniture arrangements, temporary structures, and pavements or stickers.

Other solutions involve applying modular construction from well-equipped containers to create emergency hospitals or mobile testing stations.

From touch-free public spaces to designing for social distance and modular construction, there are still many ways the design or redesign of our buildings and cities can help to protect the public. Good design is particularly important to protect those in high-risk environments, such as workers and senior citizens in health care and aged care.

As necessity is the mother of invention, there is nothing like a period of stress to stimulate creativity, industry, and innovation.

The Conversation
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I’m a doctor who was on the WHO’s COVID-19 mission to China. Here’s what we learned about the virus’ origins.

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The shuttered Huanan Seafood Wholesale Market in Wuhan, China, January 21, 2020.

As I write, I am in hotel quarantine in Sydney, after returning from Wuhan, China. There, I was the Australian representative on the international World Health Organization’s (WHO) investigation into the origins of the SARS-CoV-2 virus.

Much has been said of the politics surrounding the mission to investigate the viral origins of COVID-19. So it’s easy to forget that behind these investigations are real people.

As part of the mission, we met the man who, on December 8, 2019, was the first confirmed COVID-19 case; he’s since recovered. We met the husband of a doctor who died of COVID-19 and left behind a young child. We met the doctors who worked in the Wuhan hospitals treating those early COVID-19 cases, and learned what happened to them and their colleagues. We witnessed the impact of COVID-19 on many individuals and communities, affected so early in the pandemic, when we didn’t know much about the virus, how it spreads, how to treat COVID-19, or its impacts.

We talked to our Chinese counterparts – scientists, epidemiologists, doctors – over the four weeks the WHO mission was in China. We were in meetings with them for up to 15 hours a day, so we became colleagues, even friends. This allowed us to build respect and trust in a way you couldn’t necessarily do via Zoom or email.

This is what we learned about the origins of SARS-CoV-2.

The virus was most likely of animal origin

wuhan huanan market
A cyclist rides in front of the closed Huanan market in Wuhan, China on February 9, 2021.

It was in Wuhan, in central China, that the virus, now called SARS-CoV-2, emerged in December 2019, unleashing the greatest infectious disease outbreak since the 1918-19 influenza pandemic.

Our investigations concluded the virus was most likely of animal origin. It probably crossed over to humans from bats, via an as-yet-unknown intermediary animal, at an unknown location. Such “zoonotic” diseases have triggered pandemics before. But we are still working to confirm the exact chain of events that led to the current pandemic. Sampling of bats in Hubei province and wildlife across China has revealed no SARS-CoV-2 to date.

We visited the now-closed Wuhan wet market which, in the early days of the pandemic, was blamed as the source of the virus. Some stalls at the market sold “domesticated” wildlife products. These are animals raised for food, such as bamboo rats, civets, and ferret badgers. There is also evidence some domesticated wildlife may be susceptible to SARS-CoV-2. However, none of the animal products sampled after the market’s closure tested positive for SARS-CoV-2.

We also know not all of those first 174 early COVID-19 cases visited the market, including the man who was diagnosed in December 2019 with the earliest onset date.

However, when we visited the closed market, it’s easy to see how an infection might have spread there. When it was open, there would have been around 10,000 people visiting a day, in close proximity, with poor ventilation and drainage.

There’s also genetic evidence generated during the mission for a transmission cluster there. Viral sequences from several of the market cases were identical, suggesting a transmission cluster. However, there was some diversity in other viral sequences, implying other unknown or unsampled chains of transmission.

A summary of modelling studies of the time to the most recent common ancestor of SARS-CoV-2 sequences estimated the start of the pandemic between mid-November and early December. There are also publications suggesting SARS-CoV-2 circulation in various countries earlier than the first case in Wuhan, although these require confirmation.

The market in Wuhan, in the end, was more of an amplifying event rather than necessarily a true ground zero. So we need to look elsewhere for the viral origins.

Did frozen or refrigerated food play a role?

frozen food coronavirus china
A woman looks at frozen food in a supermarket in Beijing, China, August 13, 2020.

Then there was the “cold chain” hypothesis. This is the idea the virus might have originated from elsewhere via the farming, catching, processing, transporting, refrigeration, or freezing of food. Was that food ice cream, fish, wildlife meat? We don’t know. It’s unproven that this triggered the origin of the virus itself. But to what extent did it contribute to its spread? Again, we don’t know.

Several “cold chain” products present in the Wuhan market were not tested for the virus. Environmental sampling in the market showed viral surface contamination. This may indicate the introduction of SARS-CoV-2 through infected people, or contaminated animal products and “cold chain” products. Investigation of “cold chain” products and virus survival at low temperatures is still underway.

It’s extremely unlikely that the virus escaped from a lab

wuhan institute of virology
The Wuhan Institute of Virology, pictured on April 17, 2020.

The most politically sensitive option we looked at was the virus escaping from a laboratory. We concluded this was extremely unlikely.

We visited the Wuhan Institute of Virology, which is an impressive research facility, and looks to be run well, with due regard to staff health.

We spoke to the scientists there. We heard that scientists’ blood samples, which are routinely taken and stored, were tested for signs they had been infected. No evidence of antibodies to the coronavirus was found. We looked at their biosecurity audits. No evidence.

We looked at the closest virus to SARS-CoV-2 they were working on – the virus RaTG13 – which had been detected in caves in southern China where some miners had died seven years previously.

But all the scientists had was a genetic sequence for this virus. They hadn’t managed to grow it in culture. While viruses certainly do escape from laboratories, this is rare. So, we concluded it was extremely unlikely this had happened in Wuhan.

A team of more than 30 experts 

WHO wuhan
Members of the World Health Organization’s team investigating the origins of the coronavirus pandemic at a press conference in Wuhan, China, on February 9, 2021.

When I say “we,” the mission was a joint exercise between the WHO and the Chinese health commission. In all, there were 17 Chinese and 10 international experts, plus seven other experts and support staff from various agencies. We looked at the clinical epidemiology (how COVID-19 spread among people), the molecular epidemiology (the genetic makeup of the virus and its spread), and the role of animals and the environment.

The clinical epidemiology group alone looked at China’s records of 76,000 episodes from more than 200 institutions of anything that could have resembled COVID-19 – such as influenza-like illnesses, pneumonia, and other respiratory illnesses. They found no clear evidence of substantial circulation of COVID-19 in Wuhan during the latter part of 2019 before the first case.

What’s next?

Our mission to China was only phase one. We are due to publish our official report in the coming weeks. Investigators will also look further afield for data, to investigate evidence the virus was circulating in Europe, for instance, earlier in 2019. Investigators will continue to test wildlife and other animals in the region for signs of the virus. And we’ll continue to learn from our experiences to improve how we investigate the next pandemic.

Irrespective of the origins of the virus, individual people with the disease are at the beginning of the epidemiology data points, sequences, and numbers. The long-term physical and psychological effects – the tragedy and anxiety – will be felt in Wuhan, and elsewhere, for decades to come.

The Conversation
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Despite trillions in coronavirus aid, many US families are still struggling to pay for basic necessities like food and rent

Supermarket queue
Research show that the first round of pandemic aid barely helped many families in need.

  • Americans are still financially struggling during the pandemic despite aid from the government.
  • A new study suggests further government aid is needed on a larger scale to help tens of millions of families.
  • Low-income Black and Latino households may need more than others.
  • Visit the Business section of Insider for more stories.

As Congress prepares another injection of COVID-19 aid for businesses and individuals, there’s been debate about whether it’s necessary on top of the US$3.5 trillion spent so far.

President Joe Biden had initially hoped to get bipartisan support for his $1.9 trillion proposal, but the only counteroffer from Republicans was a $600 billion bill, with many in the GOP suggesting more money wasn’t needed. And some economists have expressed concern that giving Americans too much right now could overheat the economy.

We are public opinion scholars at the Harvard T.H. Chan School of Public Health. In cooperation with our partners at the Robert Wood Johnson Foundation and National Public Radio, we conducted a survey in July and August of last year to try to understand how the first round of aid had affected American families in need. What we found shocked us then and feels relevant now as the government negotiates its next steps.

Despite trillions of dollars in government assistance, about two-thirds of families that suffered job losses or reduced wages during the pandemic still reported facing serious financial hardship.

Many people were struggling – and still are – just to pay for basic necessities, like food and rent.

The first round of pandemic aid

Congress passed most of the initial relief in March, including direct payments to qualifying families, expanded unemployment benefits and loans to small businesses that turned into grants if they kept workers on their payroll.

By July 1, when we began our survey, most Americans entitled to a direct check should have received it, and unemployed adults were still receiving supplemental aid of $600 a week on top of state benefits.

We wanted to understand the financial burdens experienced by American families that were economically harmed by the coronavirus pandemic. And we wanted to see whether the government aid was helping the people who needed it most.

Using a nationally representative, randomized survey design, we contacted 3,454 adults and asked them about the financial problems facing their households. We focused on the 46% who said they or other adults in their household either lost a job, had to close a business, were furloughed, or had their wages or hours reduced since the start of the coronavirus pandemic. We published our findings in the economic affairs journal Challenge in January.

Serious financial problems

While it seems like a no-brainer that Americans weren’t ready for the unexpected employment disruptions caused by the COVID-19 pandemic, it was surprising to us that federal aid and charitable assistance seemed to be doing so little to support the people it was intended to help.

We found that the aid didn’t put much of a dent in the financial problems faced by families earning less than $100,000, whether because relief was delayed or wasn’t spent, the amount wasn’t adequate or the funds never made it to the intended recipients.

Among households with employment or wage losses during the pandemic, 87% of those earning less than $30,000 a year and 68% of those earning $30,000 to $99,999 told us they were still facing serious financial problems. And more than half of households in these income brackets reported they had already used up all or most of their savings – or they didn’t have savings to begin with. That share jumped to over three-quarters for people with incomes under $30,000.

Savings take years or decades to accumulate, so it’s likely these households are in even worse trouble now. What’s more, significantly less aid has been provided from the federal government since we conducted our survey.

The Conversation

Many Americans still need a lifeboat

Our findings suggest there is a definite need for further government aid on a large scale for tens of millions of families.

A useful way to think about this is how the government provides relief after a natural disaster. In disasters, cash payments are often sent directly to those in need, like lifeboats launched to rescue people at risk of drowning.

And in fact, the pandemic has been an economic disaster for some – particularly low-income and Black and Latino households – more than others. They still need a lifeboat to get them through the storm.

Mary G. Findling, research associate at the Harvard T.H. Chan School of Public Health, Harvard University; John M. Benson, senior research scientist at the Harvard T.H. Chan School of Public Health, Harvard University, and Robert J. Blendon, Richard L. Menschel Professor of Public Health and professor of health policy and political analysis, emeritus, Harvard University

The Conversation
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One in 3 COVID survivors may suffer from symptoms even after recovery. Researchers don’t yet know how long it could last.

fatigue tired
People with lingering symptoms may experience brain fog, pain, or debilitating fatigue.

  • About one in three people retain symptoms after recovering from COVID-19, says scientist Stephanie LaVergne.
  • Patients with both severe and mild cases are susceptible to lingering symptoms.
  • Researchers are still trying to determine why some symptoms remain and how long they will persist.
  • Visit the Business section of Insider for more stories.

A few months ago, a young athletic guy came into my clinic where I’m an infectious disease physician and COVID-19 immunology researcher. He felt tired all the time, and, importantly to him, was having difficulty mountain biking. Three months earlier, he had tested positive for COVID-19. He is the kind of person you might expect to have a few days of mild symptoms before recovering fully. But when he walked into my clinic, he was still experiencing symptoms of COVID-19 and he could not mountain bike at the level he was able to before.

Tens of millions of Americans have been infected with and survived COVID-19. Thankfully, many survivors get back to normal health within two weeks of getting sick, but for some COVID-19 survivors – including my patient – symptoms can persist for months. These survivors are sometimes dubbed long-haulers, and the disease process is termed “long COVID” or post-acute COVID-19 syndrome. A long-hauler is anyone who has continued symptoms after an initial bout of COVID-19.

Numerous studies over the past few months have shown that about one in three people with COVID-19 will have symptoms that last longer than the typical two weeks. These symptoms affect not only people who were very sick and hospitalized with COVID-19, but also those with milder cases.

Long COVID is similar to COVID-19

Many long-haulers experience the same symptoms they had during their initial fight with COVID-19, such as fatigue, cognitive impairment (or brain fog), difficulty breathing, headaches, difficulty exercising, depression, sleep difficulty and loss of the sense of taste or smell. In my experience, patients’ symptoms seem to be less severe than when they were initially sick.

Some long-haulers develop new symptoms as well. These can vary widely person to person, and there are reports of everything from hair loss to rapid heart rates to anxiety.

Despite persistent symptoms, SARS-CoV-2 – the virus itself – is not detectable in most long-haulers. And without an active infection, they can’t spread the virus to others.

Who are the long-haulers?

Patients who were hospitalized for COVID-19 are the most likely to have persistent long-term symptoms.

In a study published in July 2020, Italian researchers followed 147 patients who had been hospitalized for COVID-19 and found that 87% still had symptoms 60 days after they were discharged from the hospital. A more recent study, published in January, found that 76% of hospitalized COVID-19 patients in Wuhan, China, were still experiencing symptoms six months after first getting sick.

This Wuhan study was particularly interesting because the researchers used objective measures to evaluate the people reporting lingering symptoms. People in the study were still reporting persistent breathing problems six months after getting sick. When researchers performed CT scans to look at the patients’ lungs, many of the scans showed splotches called ground-glass opacities. These likely represent inflammation where SARS-CoV-2 had caused viral pneumonia. Additionally, the people in this study who had severe COVID-19 could not walk as fast as those whose illnesses were less severe – these lung problems reduced how much oxygen was moving from their lungs into their bloodstream. And remember, this was all measured six months after infection.

Other researchers have found similar objective health effects. One study found evidence of ongoing viral pneumonia three months after patients left the hospital. Another study of 100 German COVID-19 patients found that 60% had heart inflammation two to three months after initial infection. These German patients were relatively young and healthy – the average age was 49, and many had not needed hospitalization when they had COVID-19.

The sickest COVID-19 patients are not the only ones to suffer from long COVID. Patients who had a milder initial case that didn’t result in hospitalization can also have persistent symptoms.

According to a recent survey done by the Centers for Disease Control and Prevention, 35% of nonhospitalized patients who had mild COVID-19 cases did not return to baseline health 14 to 21 days after their symptoms started. And this wasn’t just in older people or people with underlying health conditions. Twenty percent of previously healthy 18-to-34-year-olds had ongoing symptoms. Overall, research shows as many as one-third of individuals who had COVID-19 and weren’t hospitalized will still be experiencing symptoms up to three months later.

To put these numbers in context, only 10% of people who get the flu are still sick after 14 days.

Long-term symptoms, long-term effects

The medical community still does not know just how long these symptoms will persist or why they occur.

According to recent research that has yet to be peer-reviewed, many long-haulers cannot return to work or do normal activities because of brain fog, pain, or debilitating fatigue. Before my patient got sick, he would bike up a mountain in our Colorado town almost every day. It took him four months to recover to the point where he could climb it again.

SARS-CoV-2 hurts people in more ways than the medical community originally recognized. At Colorado State University, my colleagues and I are studying long-haulers and exploring whether immune system imbalances play a part in their disease process. Our team and many others are diligently working to identify long-haulers, to better understand why symptoms persist and, importantly, to figure out how the medical community can help.

Stephanie LaVergne, research scientist, Colorado State University

The Conversation
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