Corona fevers and the madness of models

by Daphna Whitmore

A third of the world is under lockdown and a clear assessment of this measure to curb the spread of COVID-19 is urgently needed. 

With any high-stakes decisions it has to be asked what are we dealing with here? Are the measures warranted? Will they achieve their aim? Could they cause more harm than good?

We still do not know precisely how deadly the virus is. In early January reports started coming out of China that a new virus was killing 15% of those infected. It is now thought to be more likely 1% and may be as low as 0.05%.

Nor is there evidence that a lockdown of an entire country is effective. It has never been done before, let alone encompassing one-third of the world. Why was this extremely destructive action taken? There was abundant evidence that some countries were not being overwhelmed by the virus. Countries such as South Korea, Singapore, Taiwan and Vietnam have not shut down their economies. Their eateries are open and they carry on with a mostly normal life.

New Zealand’s aim of eradication is probably unachievable. It would take a closed border and strict quarantine for any arrivals indefinitely. It would also rely on a highly effective vaccine being made which would then have to be made mandatory. None of these are realistic options.

China battled to keep the infection contained but the virus had probably spread before it was discovered.   Confirmed cases soon appeared in Thailand, then Japan, South Korea, the United States and Britain. By the end of January there were hundreds of cases in Iran and then Italy. There were daily reports of a mounting death toll and hospitals that were at breaking point in Italy. 

On March 16 the Imperial College of Medicine in Britain published a report which projected that the US would have over two million deaths and up to half a million in Britain from the virus.  On March 26 in an updated report they estimated that “in the absence of interventions, COVID-19 would have resulted in seven billion infections and 40 million deaths globally this year.”

They were predicting that left unchecked nearly the entire population of the world would be infected.

The report’s lead author, Neil Ferguson, said that  stringent lockdown measures, if kept in place for a long time, could reduce the death toll to 20,000 or fewer in Britain.  He stressed that social distancing measures and intermittent lockdowns would still be needed for up to 18 months to prevent a catastrophe as transmission will quickly rebound if interventions are relaxed.

It was not the first time the Imperial College had used a worse-case scenario modeling. In 2009 they had forecast that billions would be infected with swine flu and there would be millions of fatalities. The swine flu ended up with a relatively low fatality rate of 0.02%.

Following the dire predictions of the Imperial College the slogan ‘Flatten the Curve’ went out around  the world. Flattening the curve was vital to minimise, or better still prevent, a sudden shock to the healthcare system which could lead to increased deaths due to lack of ventilators as happened in Wuhan and Italy.  The Imperial model played a key role in Britain’s coronavirus strategy and influenced many other countries. 

In New Zealand similar modelling was done and in a report to the Ministry of Health on March 24th a worse case scenario was set out:

It was plausible that 3.32 million New Zealanders would be expected to get symptomatic illness; 146,000 would be sick enough to require hospital admission; 36,600 would be sick enough to require critical care (in an ICU); and 27,600 would be expected to die. This death toll would far exceed the death toll for NZ from World War One (18,000 deaths) and from the 1918 influenza pandemic (9000 deaths). Not considered here also are all the deaths from people who don’t receive normal care (eg, for heart attacks) due to re-orientation of the health system to deal with COVID-19.

Following this report the government moved to shut down all non-essential businesses and ordered the population, apart from essential workers, to stay at home. The government had basically ordered the working class to go on an open-ended general strike! It would last at least four weeks and may continue longer and be repeated.

Destruction in the wake of the lockdown

Thousands of jobs and livelihoods were gone overnight. Study plans, sports and cultural events were turned upside down. The government would soften the blow they said by writing an open cheque.  People have been encouraged to ‘dob in’ anyone they see not toeing the line 100%, with the police being deployed to enforce the lockdown conditions.

Let’s be clear, this is not the Black Death or Ebola, both of which killed around 50% of people infected.

The lockdown has not only wiped out a huge piece of the economy, it has also swept away civil liberties. We may only venture out to the supermarket or around the neighbourhood for exercise. We are not permitted to go to the beach. There is to be no walking with friends in a park. There can be no funerals, and the only visits to hospitals are when loved ones are dying.  Planned operations have been cancelled, the public hospitals are mostly empty and private hospitals are closed. People’s other health needs have been put on hold. All contraception clinics were closed and are only just starting to be allowed to see a few clients now. Building sites lie idle and the construction industry says it will contract by a third. The print media has been decimated. Does anyone imagine tourism will bounce back with uncertainty around flights even when the lockdown ends?

A state of civil emergency was called to legally enforce the lockdown, with the belief that this would save tens of thousands of lives. 

A lot was riding on the model being reliable. 

The lockdown was launched like a war effort that required everyone to be on board or force would be applied. There was the appearance of consensus on the presumptions of the model. To question the model, or to suggest measures that did not include a total lockdown was called reckless and cruel. 

Questions must be asked

When Simon Thornley, a well-respected medical doctor and epidemiologist, questioned the approach in an opinion piece the media’s favourite science commentator, Souixsie Wiles, tweeted that people should ignore his column and said he had no experience in infectious diseases. It was patently untrue and she was taken to task about this by public health professor Grant Schofield. He too was facing criticism for raising concerns about the approach being taken.

Some world class scientists and physicians were asking serious questions. One of the first was John Ioannidis, a very highly regarded professor of medicine and epidemiology at Stanford University. He sounded alarm bells:

We lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.

If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe. 

Ioannidis argued that estimates of the death rate were wildly variable:

That huge range [1% to 0.05%] markedly affects how severe the pandemic is and what should be done. A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational. It’s like an elephant being attacked by a house cat. Frustrated and trying to avoid the cat, the elephant accidentally jumps off a cliff and dies.

We know that COVID is spread through droplet infection. These are large molecules that are too heavy to float in the air and spread far, so they drop to the ground. They tend to be transmitted person-to-person within a meter or so, or through touching surfaces then touching the face. In February the WHO looked at the epidemic in China and concluded that COVID-19 does not spread as easily as initially thought. They said that casual contacts had a 1–5% chance of catching the virus but the majority of cases were transmissions in the home. 

Biophysicist Michael Levitt, who won the Nobel prize for chemistry in 2013 for the development of multiscale models for complex chemical systems, was looking at COVID early on. He noticed the rate of infection of the virus in the Hubei province increased by 30% each day:

That is a scary statistic. I am not an influenza expert but I can analyze numbers and that is exponential growth. At this rate, the entire world should have been infected within 90 days.

But then he saw the trend change. 

On February 1, Hubei had 1,800 new cases each day and within six days this number reached 4,700, but then on February 7 the number of new infections began to decline and did not stop. A week later, the same happened with the number of deaths. This dramatic change in the curve marked the median point and enabled better prediction of when the pandemic will end. Based on that, I concluded that the situation in all of China will improve within two weeks.

He was proved correct. As cases and deaths in China rapidly subsided news media reports were showing more frightening images of overcrowded hospitals and deaths in Italy. 

The Italian case

It is easy for numbers to be misleading. For a start Italy records all deaths where the virus is present as a COVID death. So an elderly man who dies from a heart attack and also has a positive test for COVID will be recorded as part of the pandemic figures.

The Oxford Centre for Evidence Based Medicine says estimates of Italy’s case fatality rate of 8% were calculated using the confirmed cases. They believe the real fatality rate could in fact be closer to 0.06%, which is similar to Ioannis’ lower estimate. 

It is a mistake to extrapolate out and assume the rest of the world will have the same experience as Italy.  Italy has very high rates of respiratory deaths compared to other countries. As of 2 April COVID deaths in Italy are around 13,000. This is similar to their annual influenza deaths and much less than 2017 when there was a particularly bad flu season and 25,000 people died. Furthermore, Italy adopted a lockdown first of the northern regions then throughout the entire country. Given that transmission occurs mostly at home, closing schools and confining people to spending all day at home is likely to spread the infection to the vulnerable older family members.

Northern Italy also has one of the oldest populations and the worst air quality in Europe, which may be a cause for high rates of respiratory infections. Prof Walter Ricciardi, scientific adviser to Italy’s minister of health, pointed out that age is a confounding factor, noting that the median age of patients in Italy’s hospitals is 67 while in China it is 46. 

There was also the narrative that doctors in Italy were having to make the terrible choice of who to put on ventilators and denying the elderly a chance to live. No doubt more ventilators were needed, but even with sufficient ventilators, many elderly people with multiple illnesses would be unlikely to be admitted to an ICU because their chances of surviving, even with intensive treatments, are close to zero. 

Coronaviruses are very widespread. The common cold, which tens of millions of people catch every year, are coronaviruses. They are harmless for most people but can kill the elderly. Some coronaviruses can cause more severe illnesses such as SARS 1, with a death rate of around 10% of those infected, and Middle East respiratory syndrome (MERS), which has a death rate of around 35%. 

Almost as common as coronaviruses are influenza viruses. Around a billion people every year have seasonal influenza and around 3 to 5 million are severe cases, resulting in 290,000 to 650,000 deaths.

What if this coronavirus is not very different to others? That was something John Ioannidis considered: 

Could the Covid-19 case fatality rate be that low? No, some say, pointing to the high rate in elderly people. However, even some so-called mild or common-cold-type coronaviruses that have been known for decades can have case fatality rates as high as 8% when they infect elderly people in nursing homes. In fact, such “mild” coronaviruses infect tens of millions of people every year, and account for 3% to 11% of those hospitalized in the U.S. with lower respiratory infections each winter.

These “mild” coronaviruses may be implicated in several thousands of deaths every year worldwide, though the vast majority of them are not documented with precise testing. Instead, they are lost as noise among 60 million deaths from various causes every year.

With a deadly pandemic excess death should be apparent in the overall death rates. Despite COVID spreading throughout Europe overall death rates this year are no higher than other years; in fact they are slightly lower. The exception is Italy, where the death rate is notably higher.

Professor Sucharit Bhakdi, Emeritus Professor of the Johannes-Gutenberg-University in Mainz and longtime director of the Institute for Medical Microbiology, wrote  an open letter to Angela Merkel questioning the basis for a lockdown. He noted:

A number of coronaviruses have been circulating for a long time – largely unnoticed by the media.  If it should turn out that the COVID-19 virus should not be ascribed a significantly higher risk potential than the already circulating corona viruses, all countermeasures would obviously become unnecessary.

The internationally recognized International Journal of Antimicrobial Agents will soon publish a paper that addresses exactly this question. Preliminary results of the study can already be seen today and lead to the conclusion that the new virus is NOT different from traditional corona viruses in terms of dangerousness. The authors express this in the title of their paper “SARS-CoV-2: Fear versus Data”.

The death rate of a disease cannot be accurately calculated until the true number of infections is known, including those without symptoms. Wide surveillance testing would need to be done to determine the real incidence and the true death rate.

It is also possible that large sections of the population have had COVID and recovered from it without symptoms. The Wall Street Journal on March 24 wrote that if the number of infections double roughly every three days, then from 1 January to 9 March as many as six million people in the US would already have been infected. That would make the death rate 0.01%, which is one-tenth of the flu mortality rate of 0.1%. 

We won’t know until antibody serology – which tests for previous infection – of a large sample of the population is done. Antibody blood tests should soon be available and will be an invaluable tool. 

The Imperial College’s report did not take account of the social or economic costs of a lockdown. Never before had such a lockdown happened. There was no way of knowing if it would even work. We now face a very sharp economic recession with permanently lost jobs, long before a vaccine is ready or natural immunity takes hold.

Furthermore, given the fear was that the health system would be swamped then, surely, every effort should have been made to get ventilators and to hire staff. 

Professor Peter Goetzsche, who was a pioneer and leading figure in the movement for evidence-based medicine, is another critic of lockdowns. He says the draconian measures are not warranted although “(i)solation and keeping a distance of 2m to other people is very good advice because the virus spreads in large droplets and it does not have wings”.

Economic suicide vs effective methods

Rather than kill the economy, the government could adopt the methods of countries that are doing well. Places such as South Korea, Taiwan, Vietnam and Singapore have limited the spread and the number of deaths without shutting down their economies.

A Cochrane meta-analysis in 2011 of studies looking at how to reduce respiratory infections found that virus spread can be prevented by hygienic measures such as handwashing and wearing masks.

In Taiwan they acted early, screened arrivals, quarantined, carry out stringent handwashing, distributed hand sanitiser, masks and thermometers. In South Korea they adopted strict quarantine of cases and did a lot of testing and contact tracing. In Vietnam they developed fast tests, strict quarantine and also restricted travel from regions with outbreaks of COVID. Notably, the Vietnamese government paid for accommodation for people in quarantine and provided food and medical attention during these 14 days. Singapore took a multi-faceted approach to containment. It included tracking and tracing contacts of patients with confirmed cases and clinician discretion in ordering tests. Singapore has not closed its schools and that is because there are so few cases among young people.

Labour has enjoyed the backing of National over the lockdown. Jacinda Ardern has been praised for being strong and decisive. Leading public health figures like Dr Michael Baker and Dr Peter Gluckman were outspoken in calling for the lockdown and no doubt this put pressure on the government to go for the lockdown position. 

They have also relied heavily on mathematical modelling and backed an extreme measure before having sufficient facts. Models are only as good as the assumptions on which they are based. Prof Sucharit Bhakdi, in his open letter to Merkel, questions whether the projections make a distinction between symptom-free infected people and actual, sick patients – i.e. people who develop symptoms?

The decision to lockdown the country was made without adequate information. Getting out of this mess will be much harder than rushing off the cliff was. The lockdown should be lifted and the type of stringent measures that have worked in Asia applied here. The sooner the better because the cure is already worse than the disease.

See also: Coronavirus – we need to learn from Darwin

17 comments

  1. It could be that this not an example of the irrationality of capitalism but rather that the capitalist class saw the honest concern of doctors and epidemiologists as an opportunity to crush and demoralize the working class, attack civil liberties, close borders, and restart the economy with government loans (our money) and a much lower wage structure, and reap huge profits.

    • I don’t think the capitalist class would do that because it is rather suicidal. I do think capitalist governments have not had good advice. My view is that stupidity is more common than conspiracy.

  2. I’m not at all convinced by this article. The ordinary flu does not overwhelm our “just in time” stripped bare for profit health care system in New York, yet New York is being overwhelmed. This is a new infection so people have no immunity and there are no treatments unlike the flu.

    I do agree that we don’t know the real death rate unless the entire population is tested. We do know that there are high death rates in Italy and New York. In most of Europe and the US this is just getting started.

    There is also increasing evidence that this disease is air borne and catching before symptoms manifest themselves or perhaps from people who never get sick. There is the case in Seattle where apparently healthy people got together for choral practice and 80% got sick immediately thereafter and two died. They had all used hand sanitizer and avoided hugs and handshaking. Also, the idea is that children are carriers even if they experience mild or no infections so they could infect their teachers and patents and grandparents.

    Staying home does not increase the chance of catching bugs from family members. Family members virtually always catch infections from each other even when people go to work or attend school. But germs spreading in offices is extremely common.

    It doesn’t mean our capitalist countries are doing well. The US is doing horribly relying solely on shutdown and not taking other measures that could save lives and lessen the length and extent of shut down. Testing is still not widely available even if one has symptoms. If we could test everyone with symptoms or even better, the entire population, we could impose quarantines and selective shutdowns like China did in Wulan without having to shut down the whole country. We should be mass producing on an emergency basis the masks, ventilators and protective equipment that we need. Our nurses and doctors are right now risking their lives. We can mobilize production for imperialist war, but not for this pandemic. Grocery workers and delivery workers who are also on the front lines are going on wild cat strikes in the US demanding they be protected with masks and receive hazard and sick pay.

    We should be putting massive resources into finding safe and effective treatments and safe and vaccines, rather than rely on the free market and Big Pharma.

    Homeless people need private places to shelter such as the empty hotel rooms rather than the congregate shelters that are incubators of infection.

    Finally, rather than multi trillion dollar bailouts for major corporations and the wealthy, we should hold working people harmless, providing a holiday from rent, mortgage and utilities and the income needed to survive while off work. And for the US we need to demand impruved Medicare for all so no one will be denied the care they need or go bankrupt for lack of adequate health insurance.

    • Ann the flu does overwhelm the hospitals, and most years there are reports of stressed and worn out medics. One billion people get seasonal influenza most years. Sometimes the vaccine is a mismatch and is not effective.

      We do need to keep looking at what is working. Italy had a lockdown from early on in the first affected areas.
      The virus is not airborne, it is spread by droplet infection. This is not measles or TB, if it was we’d see tens of thousands of airport workers infected.

      I agree with your points about the need for testing, housing the homeless etc. This episode is highlighting many things in society.

  3. Could you please clarify the numbers around Italy as the article first says deaths for Covid-19 are not higher than for for example the flu in other years, but later on it says that the number of deaths in Italy is significantly higher this year.

    • The total number of deaths is for all causes. They are higher in Italy than other years. The total influenza deaths for 2018-2020 are not published yet as far as I can see. So it could well be that COVID is the cause of the increase, or maybe a combination of a bad flu season plus COVID, we won’t know until those figures are published. Influenza deaths in Italy from 2013-2017 were 68k.

  4. What is working? Taiwan, despite its close contact with China, has had great success with travel restrictions, movement tracking by phone, and the mass supply of masks, with no lockdown. But Taiwan is not allowed to attend WHO meetings, so we do not hear much about this. It’s also worth noting that NZ’s large Chinese community doesn’t seem to be the source of the outbreaks here; Chinese practices such as mask wearing and less physical contact in cold season obviously work.
    At some point people will start to remember that the longevity of their vulnerable loved ones is, in normal times, highly dependent on their income, employment status, and the national GDP.

  5. Thanks for that Daphne, I’ve a few points to make about this. The International Journal of Antimicrobial Agents report dates from March 2nd. A time when total deaths in France number just 3 and Italy just 52. It doesn’t inspire much confidence in me.

    Your point about the 13,000 deaths in Italy up to April 3rd being similar to their average annual deaths due to influenza is meaningless to me. The 13,000 deaths are form over a 30 day period, it remains to be seen what sort of a death toll will be arrived at by next February.

    The virus only spreads through mucus, but the mucus can be tiny, tiny droplets. Covid 19 isn’t strictly airborne I agree, but recent studies show that in an enclosed space, with still cool air, tiny droplets can stay afloat after a sneeze or cough for up to 3 hours. These tiny microscopic droplets can make their way deep into a persons lungs and work their way into their host. A bit of a breeze from an air conditioning system can help to disperse the droplets so they stick to a surface and deteriorate. Likewise, open air situations are way safer than indoors.

  6. Thanks for this, again Redline are brave enough to break the consensus. You do have to ask if the cure is worse than the disease. You also have to ask how many “emergency” powers and surveillance measures will remain in place after all this over. One only has to look to the moves put in place to keep us “safe” after 9/11, none of which were rescinded. If you go back further in history for another example, passports were introduced by many countries in World War 1 as a “temporary” measure.

  7. Thanks for this Daphna and Redline.
    Absolutely crucial to be rigorously questioning in this time of what is more ( especially under capitalist governments) a pandemic of propaganda ( eg rampant manipulation of statistics) and unbelievable fear based mass acquiescence (including so called “left”commentary) to creeping fascism, than the actual realities of the virus of which of course there ARE concrete material risks that need to be responded to proportionately and effectively. The response to any dissent or questioning, eg the “heresy” of comparing Cv to other flu, be it “seasonal” or “outbreaks” is increasingly not only the target of govt censorship ( eg Herald censorship of Simon Thornley’s article) but worse, policed online and in neighbourhoods, by virtue signalling bourgoisie.
    The work of Redline has never been as important as now.

    • Thanks Ketana. There is clearly a lot of panic about the pandemic, which cannot help to actually lessen the deaths or sort the health problems facing society. It is bizarre that modelling has become such a dominant tool in the decision-making. I’m also struck by the fact that this lockout of workers is not the action of the capitalists but their governments. Most western parliaments are not made up of workers or capitalists but technocrats and they don’t have much of a grasp of production because it’s not something they have been involved in.

  8. I won’t engage with your interesting analysis of scientific evidence, but relate anecdotes from my own extended family. I have a cousin on my mother’s side and a second cousin on my father’s, both have/had sons in China during the crisis. You don’t examine why the enormous drop in numbers of deaths and infections occurred in China but their stories give an insight into that.

    One nephew had followed his Chinese wife to her small home village, 3 hours by bus from Wuhan. She had taken their infant daughter to visit her parents at Xmas, and he joined them for their daughter’s first birthday at the end of January. The plan was to return to NZ immediately after that. But they became locked in, unable to move away from the village. Fortunately the village was self sufficient for food and no-one had covid-19 while all the surrounding villages were infected. The government enforced the lockdown by setting up roadblocks everywhere (probably manned by the military) so there was no travel from or to villages except for the govt food trucks which did not enter the healthy village. When the infections dropped, restrictions continued but lighter – some travel between villages so they could shop at other villages which had shops. No official transport to places outside the area but travel by car allowed. My nephew was able to get a car ride from a cousin of his wife’s from another village. He had the necessary papers and was driven to an airport and caught a flight to NZ. He landed here a few days ago. His wife waits for her documentation to be processed thru NZ channels. The driver had to return to his village

    The other nephew works for an international company and is living in a city of about 13 million with his wife and child. There has been only one death from covid-19 there but nevertheless, strict monitoring of movement is in place. When he leaves his apartment to shop for food at the small grocery shop around the corner, his temperature is tested before he can enter. Also, his id card is photographed. That is because if any shoppers become sick, all those who shopped the same day can be tracked down and tested. My cousin and I agreed that the surveillance in amazingly protective.

    I hope our govt accepts the Chinese safety equipment on offer.

  9. I would note that some people, for example Amazon workers, are using this time to organize more strenuously, and if the U.S. population wasn’t so brain-dead people could spend their time at home LEARNING and ORGANIZING! Unlike Daphna, I am thankful to live in a state where COVID-19 has been taken seriously, a state with the oldest population of all 50 states. The head of our CDC, Dr Nirav Shah, a man who says that Maine is the most welcoming place he has ever lived, seems grounded and sensible, and while he has so far refused to project statistics — as he points out, too little is known — he believes that staying at home is the best thing that people can do to protect themselves.

    Ironically, the first cases in Maine were at a wealthy retirement community called Oceanside in Falmouth, filled with people who have money to fly and cruise around the world. Though no specifics have been given due to privacy issues, of the nine people who have died so far in Maine my guess is that some of them resided at Oceanside.

  10. The questions around data and modelling are complex and important, and I realise that there are many unanswered questions. But from what I have read so far, I think that this piece makes some fundamental errors.

    The focus throughout is on the mortality rate. It may well be that this is quite low, but it does not really matter. What matters is the reproduction number. Studies from China – as far as I can tell these represent the most solid data sets at this point in time – estimate the reproduction number as between 1.4 and 3.9. Most likely we are looking at a situation of exponential increase – all the available data sets I have seen back this up.

    The claim about China ‘suddenly’ experiencing a massive drop in case fatalities is very misleading – this is a result of stringent lockdown measures. See, for example:

    “There is already some evidence that staying at home, and maintaining a safe distance from others, can slow the spread and stop this domino effect. Research looking at infections in Wuhan showed that the introduction of large-scale control measures saw the reproduction number in the city fall from 2.35 to almost one. When a reproduction number reaches one, the number of cases will stop rising as effectively each infected person is passing it on to just one other person.”

    (Source: https://www.bbc.com/future/article/20200324-covid-19-how-social-distancing-can-beat-coronavirus?ocid=fbfut&fbclid=IwAR21BADTrZ6f6byCZl4w7ehxtv67ujAehD5eM9BkYy7xw4on4bvDn1280LM)

    There are many reasons to be wary and critical of the politics and motivations around the lockdown measures: we should be wary and critical of increasing survellaince powers given to police, and of course we need to advocate for the rights of beneficiaries and workers against the bail outs of corporates, etc etc.

    But we need to support the lockdown and the elimination strategy. The mathematical models informing this decision are based on what appears to me sound and rigorous scientific studies.

  11. If anyone would like to read a truly scientific piece, I would suggest this article:

    http://www.informationclearinghouse.info/55017.htm

    Our utter brokenness, especially those of European descent who live in white-supremacist societies such as the U.S. and New Zealand, has everything to do with the spread of SARS Co-V2 (which is the cause of COVID-19). Interestingly, the strain in the U.S. is the same as the one in Europe, WHICH IS NOT THE SAME AS THE STRAIN IN CHINA. One country on the planet has possession of all five strains of coronavirus and that is the United States. Please take the time and effort to read Dr Quijano’s excellent essay.

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