Those Outside of The Statistics: They Died from "Common Pneumonia"?



Author: FANGGONG Yiliu, LI Shiyun, XIN Na, Intern MA Kexin; Editor: SONG Wei (Caijing)

Translator: Anonymous, COVID-19 Reardings

Caijing interviewed over ten families, for most of them, all family members were infected. They carried their critically ill elderly and the pregnant woman, going from hospital to hospital, their loved ones’ lives hanging by a thread.

fever patients
January 31, fever patients lining up for IV at a hospital in Wuchang, Wuhan

January 26, 2020, Liu Mei received an invoice of cremation. Her mother-in-law, a 73 year old woman, stopped breathing at home. She was rushed to the hospital and died after rescuing efforts had failed.

Liu Mei told reporters from Caijing, her mother-in-law started to show symptoms similar to COVID-19 on January 21. Checkup at Wuhan No.4 Hospital showed that her lungs were highly infected. She was taken to multiple hospitals but never admitted. She could only self-isolate at home, until she was critically ill.

Liu Mei’s family never saw her mother-in-law again after she was taken by an ambulance. All they got was an invoice of cremation, showing her cause of death: viral pneumonia. According to the family, the death of the mother-in-law was not included in the number of COVID-19 deaths, because up to her death, she was never hospitalized nor confirmed diagnosed, she could only be treated as one of those unfortunate that died from “common pneumonia”.

The old lady passed away so suddenly, there was no decent undertaking of her body, no farewell from the family. Until now her ashes were still at the funeral home.

The story of Liu Mei’s family is not alone. From the investigations of Caijing reporters, though the number of patients in fever clinics of designated hospitals is slightly lower than what it was before the lock down of the city on January 23, even with expanding designated hospitals for the third time, the difficulty of finding a hospital bed is still not completely resolved. While the numbers of confirmed diagnosed and suspected cases keep rising, there are still many people who are outside of the statistics, their lives hanging by a thread.

A department director from a designated hospital told Caijing, these past two days there were about 120 fever patients in the fever clinic each day, 80 of them had lung infections, but only five of them could eventually be admitted in the hospital.

“We could only let the remaining 75 patients go home. There’s nothing they could do, there’s nothing we could do.” The director told Caijing reporters.

This director said, generally, when both lungs show ground glass opacity, the patient can basically be counted as a suspected case, but only hospitalized patients are actually counted as suspected, and only then are they qualified for the nucleic acid test. At least 80% of the patients that are tested with nucleic acid test kits will be confirmed diagnosed, then they will be transferred to other designated hospitals.

From what Caijing has learned, that hospital had at least five deaths of suspected cases that were never confirmed diagnosed, so they were not included in the confirmed case death number. This means that the numbers people are seeing right now, the confirmed cases and deaths, do not reflect the whole picture of the situation.

hospital situations
Current situation of all designated COVID-19 hospitals, repeatedly verified by Caijing reporters and volunteers

Based on the current investigation, there were two main ways for patients to be admitted. First is to queue up by the community: after the implementation of the Wuhan community shunting policy on January 24, patients need to be admitted to the hospital with a hospitalization notice – patients first go to the community to submit CT scan and blood lab reports, the community reports to the street, and then they may be assigned a hospital bed based on the severity of the illness and the availability of designated hospital beds. Second, go to a designated hospital that has nucleic acid test kits, get the result in 48 hours, after a positive diagnosis they can not be rejected by the hospital.

It is not easy to follow these two paths, and each one may be endless waiting. But for the severely ill, every minute can be a torment of life and death.

Caijing interviewed over ten families, for most of them, all family members were infected. They carried their critically ill elderly and the pregnant woman, going from hospital to hospital. “The hospital told us we could only try to save ourselves.” Many patients’ family told Caijing, their loved ones’ lives were hanging by a thread.

Till 24PM January 31, 2020, there were cumulatively 7153 confirmed cases in Hubei, 3215 of which were from Wuhan.

There was a sentence on the Twitter page of the WHO: Remember, these are not numbers, but real people. Unfortunately, there are still some people who are not included, and their life and death stories are outside the statistics.

The Difficult Path to Life

Father kept saying, he didn’t die 70 years ago on the battlefield, but he could die now from the mismanagement of medical resources.

“The doctor said clearly, my dad had the novel coronavirus, but there was no test kit so they couldn’t confirm.” Sun Chen told Caijing.

Sun Chen said, January 26, his father suddenly coughed up blood during self isolation at home. He immediately took his father to Tongji Hospital. The test result showed that his lungs were moderately to severely infected. Unfortunately this CT report did not help his father to be hospitalized, because they didn’t go through the complete diagnostic process.

The hospital told Sun Chen’s father to isolate at home and take medicines, but Sun Chen realized, the cases around me were all severe, I had to get my father a hospital bed.

What does a hospital bed mean? Without it, Li Kaimeng from Han Yang had to watch his father breathe with difficulty through the night at home, until he breathed out his last breath. His father was a veteran who later worked at the government, the pillar of his family. After the unfortunate death of his father, it took the funeral house over ten hours to get there. They were busy too, they needed to take multiple bodies at a time.

A Wuhan railroad worker Chen Li’s grandma, due to the lack of hospital beds, sat in Han Kou hospital outpatient waiting area for three days, eventually couldn’t make it and died after failed rescue attempts. Grandma did not go through the diagnostic process either, so she also was not included in the numbers.

A doctor told Caijing, there’s no specific medicine for COVID-19. For moderate and mild condition patients, it does not make much difference to be hospitalized or not. But for patients with severe conditions, it makes a big difference. For those patients who have been isolated at home but are in a crumbling state, being admitted to a hospital is their last hope.

“The doctor told both my dad and I to try to get in a hospital, especially my dad, he can’t wait any longer, his life is at risk.” Du Hongli’s father hadn’t been able to eat or talk since January 27.

Wuhan Liyuan Hospital’s test result showed that Du Hongli’s father had severe ground glass lesions in his lungs, obvious lung spots, and blood oxygen levels of only 90, indicating that the patient had severe hypoxia symptoms.

Du Hongli tried everything to get into a hospital, taking his father along. On January 27 he registered in his community, there has been no reply. His own lungs were infected too, and he has a low fever. He borrowed a van from a friend, driving his father from hospital to hospital.

Wuhan 672 Hospital has over 300 beds, but they won’t admit anyone without a hospitalization notice. The newly opened Wuhan Union Hospital Hanyang Campus has 700 beds, but they told Du Hongli the same thing, you need to wait.

On January 28, Du Hongli rushed to the Trusted Investigations Office of the district government and received the same response, no beds. He asked the Health Commission and the other party replied that there was no solution and he could only wait. Because there was no way to coordinate patients across regions, they could only wait for admission to the corresponding hospital in the region.

Du Hongli’s father had served in the army for 15 years, been on the battlefield in the Korean War, and been a close guard for two senior generals. Du Hongli told Caijing reporters that the whole family had now been infected, and his symptoms of dizziness and chest tightness were getting worse and worse. He didn’t know how long he could hold on with his father.

Du Hongli's father had served in the army for 15 years

His father kept saying, he didn’t die 70 years ago on the battlefield, but he could die now from the mismanagement of medical resources. “Everyday you only see two kinds of cars in front of the hospital, ambulances and cars from funeral homes, you only feel hopeless and helpless.”

It’s difficult for his father to move. Everyday Du Hongli took his father to the outpatient department of Union Hospital Hanyang Campus to get shots, and slept in the hotel next to the hospital. Or he would go to Tongji Hospital and Union Hospital in the morning, to wait in line for a test strip, yet everyday Union Hospital only gave out 100 test strips, they were usually gone when they arrived. By the time this article was published, his father was still not hospitalized, because they still hadn’t had the opportunity to go through the entire diagnostic process.

Wuhan resident Ms. Wang told Caijing, her mother had gone into a shock twice at home. Her mother had been getting medication and shots from the community before Chinese New Year. January 23, her mother felt particularly uncomfortable, so she rode a bike with her father to Hankou Hospital, waited in line for 12 hours and finally got CT scans. The results showed bilateral infection in the lungs.

Ms. Wang said, at that time there was no I.V. available in the hospital, even Oseltamivir for the flu was in short supply, they could only prescribe her a dosage amount for children. After that her mother had to self isolate at home, relying on an oxygen inhaler at home. “One time my mom went into a shock, my dad cried while hugging my mom, thinking she was gone.”

Before this, this old couple held the “don’t trouble others when you can handle it yourself” attitude. But with these two back to back incidents, they had to call their daughter.

However at that moment, Ms. Wang and her husband were both infected, she had to take care of her husband who was in high fever, while both of her own lungs were showing ground glass opacity. Roads were blocked, she couldn’t reach her parents. She called the ambulance for her parents, but there were close to 500 callers ahead of her. “At that time the ambulance call center told me, people who called two days ago were still not taken to the hospitals, there’s not much hope.”

Holding on until about three or four o’clock that afternoon, the two elders were exhausted, but still struggled to ride bikes to the hospital.

Ms. Wang continued to call the “mayor’s hotline”. The next day, she got a response, “you need to report to your community, then the community will report to the street, then the street will contact the command center. If there’s a bed available, the command center will contact the hospital to arrange for you guys.”

Professor Yao Lan, deputy director of the China Basic Medical Security Research Center of Huazhong University of Science and Technology, told Caijing reporters that promoting the lower level health care system and implementing true hierarchical diagnosis and treatment is an effective measure to avoid overcrowding at hospitals and preventing cross infection.

But to patients in severe conditions, every minute is a torment between life and death. They don’t know how long it takes for the community to report. “We’ve been reporting to the community all the time, they said there’s nothing they can do, saying they are reporting, when is this gonna come to an end?” Ms. Wang said.

During that time, they had called every number they could find, contacted everyone that could help, she even called the police, the police gave her a number, she called, the other end said she had to contact the community.

January 29, Ms. Wang felt that her parents couldn’t make it much longer. She called for the ambulance again. The call center said that they could only send an ambulance if they had already had a hospital bed arranged.

Ms. Wang remembered something she saw online, about there being 700 added beds at Union Hospital West Campus. so she persuaded the call center to send an ambulance and take her parents to Union Hospital West Campus. It was 9 pm when they arrived. The ambulance crew said, “There are a lot of people at the hospital, patients are lying down outside the ER, and there’s no emergency equipment, you might not get your turn even if you wait in line.”

About the 700 beds, it was said that because there was a shortage in protective suits for doctors, they couldn’t make them all available. “Because if you make them available, doctors will get infected too without protective equipment.”

The ambulance crew asked Ms. Wang to quickly choose a second hospital, she begged them to take her parents to Wuchang Hospital. She brought her quilt and hand warmer to the hospital to meet her parents. That was the first time she saw her parents since January 20.

Their faces were white, her father’s temperature was over 39°C, he couldn’t even stand up straight. Her mother was lying down in the ambulance breathing in the oxygen. There was no bed available, the hospital couldn’t take them. The ambulance crew was rushing them, they had spent three hours on this family already.

At this point, her mother made a decision. She held her hands together in namaste and told the crew, “if I am going to die, I want to die at home, I am not leaving my home anymore, there’s no hope, please take me home.” The crew asked Ms. Wang to sign a document, took her mother back inside the ambulance and closed the door.

Watching the ambulance leave, Ms. Wang couldn’t hold it any more. She crouched down, sat on the quilt, and bawled.

The Long Intake Process

A doctor at a designated hospital in Wuhan said that the hospital admitted 600 critically ill patients, but none were confirmed. “Not enough test kits, but we don’t understand why there’s not enough either.”

Caijing reporters learned that there are currently two main ways for patients to be admitted. One is to queue up at the community, patients first need to submit lung CT scans and blood lab reports, then the community reports to the street, and then they may be assigned a bed at a designated hospital based on the severity of the condition. The other way is to go to a designated hospital that has nucleic acid test kits, get the result in 48 hours, after a positive result they cannot be rejected by the hospital.

January 24, Wuhan command center for COVID-19 announced that fever residents need to be screened according to their conditions. Community is the pressure valve of this epidemic. In Wuhan, if an individual has a high body temperature, he/she needs to report to the local community volunteer, then community association, then community health service center, at that point patients with mild conditions are to observe at home or go to hospitals by themselves, patients with severe conditions shall be taken by the ambulance to designated fever clinics.

As a social worker for a community on Wuhan Huaqiao Street, Wang Mu had been working non-stop for eight days ever since the day before Chinese New Year. Everyday he and his workmate would track fever residents’ conditions. Before 4pm, Wang Mu needed to submit lists of patients, including a separate list for severely ill fever patients. The lists would be uploaded to the street then district, after evaluation, the community would get a notice about “which patient could go to which hospital at what time”.

Caijing reporters acquired the reporting standards as follows:

Fever patient: (1) Fever over 37.5°C; (2) cough; (3) lack of strength.

Suspected Patient: (1) CT scans show bilateral ground glass developments; (2) white cell abnormality in blood lab report; (3) meet the fever patient requirements.

Severe condition patient: (1) Low blood oxygen saturation; (2) difficulty breathing; (3) has chronic pre-existing conditions; (4) older, relatively weak; (5) meet fever and suspected patient requirements.

However, in reality, many patient family members told Caijing, even if both the community and hospital suggested that the patient be hospitalized immediately, there was no guarantee that the patient could get a hospital bed.

Infectious disease quarantine requirements made medical resources extremely tight. A hospital with previously over 1000 beds, after setting up isolation rooms, can have less than 1/3 beds available.

A doctor from a designated hospital told Caijing, in the hospital he is working for, there are many patients waiting in line with hospitalization notices but still can’t be admitted due to lack of beds.

The leader from the community where Wang Mu worked told Caijing, on January 30 alone, he had over 100 phone records. From the other end of the line you would suddenly hear people crying or screaming. “I can only try my best to comfort them, stay in a good mood everyday will help your immune system then your health will get better”.

The other path, patients waiting in line at a designated hospital for confirmed diagnoses, takes forever too.

Liu Mei said, after her mother-in-law passed away, her eldest and younger brothers and her husband were also infected. Their condition got worse and they needed to be hospitalized. They went to Tongji Hospital on February 1 to queue up for the nucleic acid test strip, and were told that there were only 10 test strips a day.

Until the publication of this article, there are only 10 hospitals that can perform nucleic acid tests. They are: Wuhan Jinyintan Hospital, Wuhan Pulmonary Hospital, Tongji Hospital Affiliated to Central China University of Science and Technology, Union Hospital Affiliated to Central China University of Science and Technology, Hubei Provincial People’s Hospital, Wuhan University Zhongnan Hospital, Wuhan First Hospital, Wuhan Central Hospital, Wuhan Third Hospital, and Wuhan Center for Disease Control and Prevention.

A doctor from a designated hospital told Caijing, his hospital took in 600 patients in severe conditions, but none of them were confirmed diagnosed. “No enough test kits, but we don’t understand why there are not enough test kits either.”

What kind of patients can get the test kits? Doctors from Wuhan No.3 Hospital said, after hospital examination, if the doctor thinks the patient needs to be hospitalized, the patient will be admitted and tested.

An employee from Zhongnan Hospital said, “applying for a nucleic acid test requires that a doctor make a report about a suspected case, but only in an urgent situation will a doctor write such a report.”

What is “an urgent situation”? Caijing asked many places, and there was no clear answer.

Many patients and doctors are confused, (1) Wuhan Health Commission claimed on January 27 that in principle they can test almost 2000 samples everyday, but why are there never enough nucleic acid test kits? (2) Even after testing a confirmed diagnosed report cannot be provided right away.

Doctors from Wuhan No.1 hospital said, testing takes a whole day. “You test today, tomorrow you will have a rough result, “ but the problem is that the No.1 Hospital can’t issue a confirmed diagnosis report, and the designated hospitals won’t admit a patient without the report.

When reporters asked which institutions could issue a confirmed diagnosis report, the doctor said: “I’m not sure about this either, maybe Tongji and Union can. Patients’ conditions are getting worse and worse, it’s also because there is no bed without this diagnosis report.”

As to who will be counted in suspected numbers, doctors’ criteria include “low fever, cough, CT scan results”. The above mentioned doctor said he would report to his department, but he didn’t know what would happen to those numbers afterwards. A director from another designated hospital told Caijing reporters, only admitted severely ill patients would be counted as suspected cases, with further diagnosis and treatment.

On January 30, a designated hospital in Wuhan started to report suspected cases that needed to be tested, all the way from the department to the hospital to the district then to the city. A doctor from the hospital indicated that if a patient dies before he or she is confirmed diagnosed, they won’t be included in the number of confirmed case deaths, they can only be counted as “died from lung infection”.

“In my department, death rate is much higher than discharge rate. At the same time, many discharged patients should not be counted as fully cured, they needed to be observed for a long time”, the above doctor said.

This means that there are many patients who are outside of the confirmed diagnosis process and the statistics, they can only try to survive on their own.

Resident Li Li told Caijing, through the help from the community staff, her father was finally able to get into Wuhan Eighth Hospital, but the Eighth Hospital is not a designated hospital, it was previously a specialized anorectal hospital.

The hospital diagnosis said that her father’s lungs were badly infected and necrotic, and the oxygen support had reached the maximum limit. He needed to be transferred to a designated hospital as soon as possible, but because the Eighth Hospital did not have test kits, the patient could not be confirmed diagnosed, and they couldn’t transfer him without the confirmed diagnosis.

“The Eighth Hospital has reported the situation for days and there’s zero reply,” Li Li said, she called the ambulance, their answer was that she had to go to the designated hospital via the community, but the Eighth Hospital was arranged exactly by the community and with a lot of effort.

The story of her father was stuck in a painful endless loop with no end.

By the time of the article’s publication, the reporters had called every designated hospital. All seven hospitals that connected all indicated “currently we don’t have any hospital beds available”.

Who Can Get In?

“If possible, gather all the patients with mild conditions, isolate them and give them treatment, it will be more effective for controlling the epidemic”.

In the eyes of countless family members of patients, the rapidly constructed Huoshenshan Hospital and Leishenshan Hospital are their only hope.

Caijing reporters learned that on February 3, the 1,000-bed Huoshenshan Hospital must be completed as planned, but the specific opening requires the coordination between property, electricity, medical equipment and so on. At present, most hospitals interviewed by Caijing reporters have not yet received notifications of patient transfer.

The few days waiting for Huoshenshan and Leishenshan Hospitals to open are critical moments between life and death for some critically ill patients. Caijing reporters learn that even with a confirmed diagnosis and community hospitalization notice, it still may not be possible to be admitted to a hospital as quickly as possible.

Both Hoshenshan and Leishenshan Hospitals add up to 2,000 beds, which is not enough for two days of new cases in Hubei Province.

Asking for help on Weibo became many people’s last resort. A family member of a pregnant woman from Wuhan Jiangxia District told Caijing, she was eight months pregnant, her most recent test result showed that both her lungs were highly infected.

Fever clinics don’t take pregnant women, there’s no fetal monitoring at outpatient departments, and hospitals for women don’t take fever patients. A few days after family members posted on Weibo, on January 31 they got the attention of the local community and government. They were taken by a community car to multiple hospitals, and finally on Feb 1 the woman was admitted to Wuhan University People’s Hospital East Campus.

This was good news to the family, but for other families this news gave them mixed feelings. “So now, whoever screams the loudest gets to live?” A patient family member said to Caijing reporters.

The person that can get a hospital bed is called “the lucky one”. Six people were sick in Liu Xiaoqing’s family, only three were hospitalized, “more like you need to find someone, a connection”.

Liu Xiaoiqing’s family possibly got infected in a family gathering. On January 18, it was still said that “the virus won’t transfer from one person to another”, so they went out and had a New Year’s Eve dinner. Not long after that one by one her family started to get fevers, from her parents, an aunt, to her 90 year old grandma, to her other aunt and uncle. January 21, her mother went for CT scans, showing viral infection in both lungs.

After that her mother was in a high fever for four days, almost passing out, “we contacted a lot of people, finally found out about Hankou Hospital, there was one bed available and she got in.”

January 28, her grandma started to get sick. Running between Hannan Hospital and Union Hospital West Campus, still couldn’t be admitted. Grandma waited all day at the outpatient center, finally got a shot, but “immediately started to shake like epilepsy, couldn’t walk or talk normally”, doctors let her stay to get some oxygen, but grandma still had difficulty breathing after she went home.

Her father also had difficulty breathing after the shot and used an inhaler. Liu Xiaoqing posted her situation on Weibo. The next day morning at 7 am, she woke up and received some useful information, and got her dad in ICU.

Her dad said, others might think this is not fair since they finally got hospitalized by posting on Weibo, “but life is more important”. Later, she deleted the post.

January 29 at 4 am, Chen Xiaowei from Wuhan Jianghan District dragged herself to the hospital to wait in line, finally got the test strip at Union Hospital. February 1 she got the test result, positive, but when she and her family went to the community for a hospitalization notice, they saw that there were people at the service point, but they just would not open the door. So they called the police.

Police didn’t show up, it was the street office that helped them find a solution. Chen Xiaowei said that afternoon the street office found a bed at Union Hospital for her. “Finally saved”, she said.

That night, when Chen Xiaowei and her husband arrived at Union Hospital West Campus, they were told they needed to go to Redcross Hospital. Until we published this article, they were still in the observation room in Redcross Hospital, waiting for a bed.

Professor Yao Lan, deputy director of the Security Center of Huazhong University of Science and Technology, said she saw that Macau had requisitioned a hotel relatively far from the crowd as a centralized management area for people with a history of contact in Hubei. She suggested that similar measures could be taken in Hubei and other regions to effectively control suspected cases.

Dr. Shen Jun, chief assistant of the emergency center of Zhongnan Hospital and director of emergency surgery, told Caijing reporters that all patients that Zhongnan Hospital has taken in are in serious condition, “patients with very unstable vital signs (patients with poor oxygenation, fast heart rate, fast breathing rate, and respiratory distress syndrome)”. There is a shortage of beds, and those suspected or mild cases are isolated at home.

Dr. Shen Jun's Zhongnan Hospital team successfully saved a severly ill patient with ECMO, the first in the province

It is said that there are almost no empty beds in the hospital, the emergency department is also used to treat patients with viral lung infection, ER observation rooms are also full. “Basically whenever there is a vacant bed, one person from the observation room goes in.”

Dr. Shen Jun said, (current) management of the beds can’t satisfy the needs from the communities. “For example, some patients are taken to the hospital by their family, they are very sick, if there’s a space in the observation room, they can stay there, I can’t let them go back to wait in line and wait for the community report to arrange for them. Or that I don’t take him, and instead take someone with mild conditions reported from the community, that’s definitely not possible.”

About the test kits, he said Zhongnan Hospital’s fever clinic can do the test, and it takes about two hours to get the result. But there’s a limit in test kits, they are only given to patients showing viral infection in lung CT scans.

Dr. Shen Jun suggested that, if possible, gather the mild condition patients, centralize the isolation and treatment, so that the epidemic can be effectively controlled. He also suggested that patients isolating at home take two kinds of medicine, the antiviral and the antiinfective, and if the fever is over 38.5°C to reduce the temperature. “So far there’s no special medicine for this, don’t follow the Internet and take whatever people say that may work. Hospitalization is to provide supportive care for severe condition patients, if you can make it through this period, it will be over, that’s all.”

Dr. Shen Jun and Dr. Hu Ming from Wuhan Pulmonary Hospital ICU were all sweaty after the surgery

The last two days he received a 45 year old patient, a family of five, both parents had died from COVID-19, the son was also infected. The patient’s condition was very serious. They used high-flow oxygen inhalation and non-invasive mask ventilation, but her blood oxygen saturation was still only 50%. Finally, she had to be anesthetized and intubated with ECMO (extracorporeal membrane oxygenation).

“Before we did the anesthesia for intubation, she watched us prepare, her tears kept falling, that fear breaks your heart,” Dr. Shen Jun said that there were many situations like this. “We doctors are all determined to do our best to save all the patients”.

Sun Chen, who has been waiting for the nucleic acid test strip with her father, does not allow herself to cry or succumb to insomnia any more. She knows she has to continue to urge the community, look for a hospital, and cook for her parents. Too many things to do, she can’t fail. She expects Huoshenshan and Leishenshan Hospitals to be built soon. “Must get in. This is our last hope.”

(In the text, Liu Mei, Sun Chen, Li Kaimeng, Chen Li, Liu Xiaoqing, Li Li, and Wang Mu are aliases. Intern Zhang Fan and volunteer Geng Peng also contributed to this article.)

The original article was removed from its source and all major news portals in China the next day it was published. The good news was, four days after its publication, on February 5, the authorities released a new version of the diagnostic criteria for COVID-19, which included a “clinically diagnosed case” category for patients diagnosed with CT scans instead of nucleic acid tests in Hubei province. At the same time, fangcang (field) hospitals converted from large public spaces such as gyms and conference centers started to accept mild condition patients, just as the article had suggested at the end. – COVID-19 Readings

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