Coronavirus: One-on-one with Scott Gottlieb


Hello Paul Scheck listers. This is Dan Diamond and welcome to our special pulse. Check series on the corona virus outbreak. Today I'm talking with Scott Golly but the former head of the food and Drug Administration. Who's been one of the influential figures advising the trump administration on its corona virus response from the outside? Dr Gotlib began warning on the corona virus outbreak in January as the virus spread and one the rest of China before most Americans had even realized the potential threat now. He Dispenses Policy Prescriptions and commentary on twitter MTV while guiding officials behind the scenes. You'll hear our conversation in a moment but first the whole politico newsroom is engaged in our coverage of the corona virus could find that coverage are politico nightly newsletter as well as in the political pulse newsletter that author every morning with Adam Cameron. Now here's my conversation with Dr Scott. Golly so we had talked about doing this person. But you're not in DC. That's right MENA KEG it. Is that the new normal just waiting this out in Connecticut for the next few months while. I'm not sure I'm going to be here the whole time. I'm obviously trying to spend as much time at home in time with my family as well. I don't want to leave them if I can avoid it. But I'LL BE DOWN IN WASHINGTON I've been back and forth a little bit already meetings down in Washington and I think if there's something important that I need to be down there for I'll be heading down. Are you taking steps to protect yourself when you're traveling in the middle of this outbreak? Yeah the last time I flew was Two weeks ago And I was pretty careful. Last two board cleaned my seat You know didn't take anything from the flight attendant Which I think is a mode of transmission nine. You Know Simple. Things used a lot of pure. Al obviously is a lot of things you can do to mitigate your risk. I I believe that a lot. More transfer for this virus is probably through shared services and contaminate services. And that's not to say that there isn't a respiratory transmission. There is but My theory and I haven't been able to get anyone to say. I'm right or wrong on his A lot of colleges but if you perhaps compared this to flew in terms of the transmission of flu whereas flu might be more transmission from respiratory droplets. I suspect that there might be more. Transmission on a relative basis of corona virus through shared services and contaminate services. Otherwise it doesn't it's not easily explained how you can get situations like the conference you had an in in. Massachusetts where single infected individual at biogen conference was able to infect. I believe around seventy people It's not plausible. That a single individual would be in close enough proximity to seventy people at a single conference to transmit something through respiratory droplets in any sort of reasonable setting or reasonable interactions. And so that's certainly suggests that there was some surface got contaminated whether it was a utensil used to share it to to get food or something like that that became a source of the infection and in fact the emerging data shows that the viruses sticky at hangs around surfaces when there are images of the Chinese brain disinfectants in the streets I initially looked at that and Scott it a little bit. Admittedly I thought it was for show. I thought that they were doing that to send a message to the local population that they were taking every possible step now. In retrospect I think that the Chinese might have been onto something and then you might seem more Spraying disinfectants in In shared spaces here in the United States as well in cities like New York where the viruses become epidemic. I do think surfaces are form of transmission. And so I'll I'll pause here The upshot of that is what it means for consumers is that you know the whole idea of cleaning your hands not touching your face wiping down shared services. If you run a business organization I think that could have a big impact here. Debbie burkes on the White House task force certain General Durham Adams and others have also tried to hammer home that point of of shared surfaces. You mentioned New York City and as we speak there's a tragedy unfolding in the big apple. Corona virus cases are surging hospitals already or straining to manage the load. The video and stories are horrifying. I know you were warning. The New York City would be hard hit. Did you expect it? This soon in all Kendra expected it sooner. I was talking privately and a little bit publicly about elmhurst being very worried about her queens having practice there for a number of years and knowing the the population there It's that that's one of the public hospitals elmhurst Queens right and that that hospital has been very hard hit and what was perplexing me in in February. Was that there. I was talking to doctors in Elmhurst and there was no There was no reporting that there were cases showing up that could be consistent with corona virus because I thought that the the initial indication that we had spread in the United States would be a cluster of people showing up with an unexplained respiratory illness. Atypical Pneumonia Air Ds Type Picture Respiratory Distress Syndrome. It at a single hospital that it would take two or three people showing up at a single hospital and being on the critical care ward and in doctors would say this is. Something's going on. They would send off the samples to CDC and we would discover that corona virus circling. That's how I thought that this would unfold out the first stages this would unfold and I felt that elmhurst was very vulnerable city because of the flows of immigrants from areas that were affected particularly China so I thought that that city would be that area would be seated early and it. Wasn't you know it. I was checking with some of the physicians. I knew there and they weren't seeing that they weren't Explained that and now it's exploded and exploded very quickly And so what it suggests. There's different ways. You can postulate what what happened but what it suggests is that there were probably multiple seeds in the New York area that all were sparks that lit fires that burned simultaneously and they all exploded all at once into bonfires. As opposed to a single introduction that formed large cluster Because if you have this much spread right now If it was a single cluster. That was expanding you would have. You should've discovered that. Cluster at an earlier stage but if you had multiple clusters while expanding simultaneously and they all exploded at the same time that might explain the level of spread. You have right now without the sort of early indication that you would've thought would've materialized that stands in contrast to Seattle Seattle appears to be More of a single cluster. Now there's been multiple introductions based on the sequencing work that we've looked at the Trevor Bedford's done out of the Hutch. He's done outstanding work through this whole this whole crisis but the the vast majority of the cases in Seattle seemed to be related to a single cluster and so it was one introduction that then led to thousands of cases. And that's why Seattle you discovered earlier. Perhaps because you were discovering that that expanding cluster through off enough sparks into the hospital to be discoverable earlier as opposed to a lot of clusters all growing simultaneously until they all got big enough to throw off their individual sparks. You mentioned Trevor Bedford. That's scientist who did some of the tracking of the genome in Seattle and has posted that on on twitter. Right New York City. It's close to your heart studied. There you work there. You changed your twitter background to look like that famous. I love New York bumper sticker. How're you doing with this emotionally? I think I'm Grappling with the same things. Everyone else's looking at this This is an unfolding tragedy in New York. It's hard to watch. I know the people at Mount Sinai Well I know a lot of doctors at other parts of the city. I talked to them. in here what's happening and This is Like nothing any anybody's ever seen before who's practicing medicine. Who's alive today? And they're they're overwhelmed. They're overworked. They're personally scared for their own health and safety. They have to go home to families every night. You know that's hard it's it's scary And I think that they are. You know the emotional part of this is that they're grappling with a situation where they're very worried that they're not going to provide the level of care that they feel. They ought to be to everyone pretty soon. That they're gonNA have to make hard choices. And even if they're not making explicit choices that just not gonna be able to care for everyone in time from that people need care in order to both save lives and help ensure people have good outcomes here. I am does not an easy way to mitigate that because what you'd want to be doing right now is pouring massive resources into New York and supporting these hospitals in these doctors as what they didn't China very successfully they poured resources into the WHO Bay province and Wuhan literally bring thousands of doctors into that province to support the local healthcare infrastructure. We don't have that luxury. We don't have that luxury because we don't have the same top down control controls. China does but we also going to have multiple cities that get pressed even if we don't have epidemics of this portion of the parts of the United States and we may I'm hopeful we won't but we may we are still going to have enough parts of the United States. That are pressed. That is gonna be hard to pull resources out of other population centres. Pour THEM INTO NEW YORK Yes the best healthcare system I think in the country. But we're going to see it in about a week. Be maxed out and then after that. You'RE GONNA start to see people being put in the makeshift hospitals In Java's convention Elsewhere and if this continues the way the governor's modeling. Those are going to get maxed out soon too and I'll just close by saying you can't move people to Southern Connecticut Long Island New Jersey. The outlying hospitals are also going to be maxed out. This is really a an issue affecting the tri-state area. Not just not just New York City so the hospitals you might transfer to Are also going to be at the brink. I talked to doctors at Stanford Hospital where I used to practice medicine as well now built a second. Icu and the hospital. Pretty much maxed out right now in. It's still it's still early innings. Remember even this peaks even if the epidemic peaked in two weeks in New York City. Which is the optimistic. End of the governor's projections. You won't have a peak in hospitalizations till at least two to four weeks. After that in Bay province they implemented the lock down the number of cases Accruing each day in peak for another six weeks and then hospitalizations peak for another four weeks after that. Now that's that's a long time frame will probably be in a shorter timeframe but hospitalizations will peak Week weeks after the number of cases peak right because of the lack exactly again booth when people are infected and then when they need hospitalization and then when they're on the ventilators for weeks at a time Seattle got slammed. Now New York City is getting hit. Hard where are you watching doctor as the next cities that this could become a catastrophe? Well let me give you the optimistic vision. And then I'll give you the pessimistic vision. The optimistic vision is that right now. The case numbers are growing rapidly because of an artifact of testing that we have a backlog of testing the people who are being tested. And who are in that backlog right now. People who presented the hospital six more likely to be positive. So the positivity rates very high once we work off the backlog and start testing in the community the actual rate of growth will decline that New York City actually will peak in two weeks. Hospitalization rates seem to be slowing down And other cities acted quickly enough with their mitigation tactics to avert At an outcome on order of New York City and certainly San Francisco appears to have done that They appear to be on a better trajectory than other parts of the country and they acted early with the mitigation steps. That's the optimistic vision. That vision has this whole epidemic peaking sometime in May be mid April rather than late April. The more pessimistic view would be that New York peaks later This really does end up being a disaster in the city. I don't believe that's going to be the case. I think that is probably on the shorter end of the of the curve in terms of when L. peak the shorter end of those two to three weeks and then the longer end of it and allow those models. Don't Bake in the mitigation steps that we took in New York City while not very fast Act acted aggressively and a reasonable timeframe certainly relative to what China did but the pessimistic vision would have multiple cities in the United States seated simultaneously but behind New York. And there's fires now burning there that are going to become epidemic some of which will be on the same proportion as New York If you look at what's the data right now in China no no province had more than fifteen hundred cases outside the who province and as you know those provinces of big in the United States right. Now there's nine cities that have more than fifteen hundred cases to date and so the risk is that other cities become epidemic. The ones. I'm worried about. I'd be very worried about New Orleans. They were very slow to act in Louisiana. I'd be very worried about cities in Florida like Dade County. They were slow to act cases a building. There I'd be very worried about Texas where they've given authority to local officials to make decisions and we've seen slower decisions and not a lot of testing. It's it's a little bit odd that Texas only has the number of cases that it does so Dallas is building cases. I'd be worried about Dallas. I'd be worried about any city with a mass transit system where a lot of people use mass transit because of the shared services. So if that's your concern you have to worry about cities like Chicago and perhaps Boston both which earlier to act with tough mitigation steps but notwithstanding that they've cities similar to New York. So you have to worry about a city with a mass transit system because of what we've learned about the transmissibility of this unshared surfaces so those are the ones put top of my list. I'd also add Atlanta to that list. Atlanta looks very hot right now. DETROIT. You'd probably put on that list as well and You know parts of California Seattle out of the woods. I think Seattle might have caught a break. Notwithstanding the fact that they were slow to act and take tough measures they might have caught a break. Insofar as maybe this is just one large cluster rather than simultaneous clusters in California. Los Angeles looks very hot. But the local officials in the state officials there have been fairly aggressive and implemented. They mitigation steps earlier in the course of the epidemic relatives certainly to China and Italy. You just listed off a number of major American cities where the virus could hit hard and to your point in ways worse than in China. Just simple question yes or no in two weeks will the. Us have the worst corona virus outbreak in the world. I think I think by this Friday the. Us May have the worst current virus outbreak in the world in absolute terms on a per capita basis. I'm hoping we don't Eclipse Italy Italy. As I believe around seventy thousand cases right now I could be off on that and Population of around sixty million on a per capita basis in the United States. That would be in the hundreds of thousands of cases. I believe we'll get into the hundreds of thousands of cases here in the United States. Hopefully the low hundreds of thousands of cases. I don't believe we'll get into the millions but you know by this Friday. We could have one hundred thousand cases in the United States Or B B approaching that number. We'll have some days with some big totals coming up in the next next week Or Two as New York reaches its peak number of cases and then the question is what happens in other cities you started writing in tweeting about corona virus back in January and February. There's op-ed you did in the Wall Street Journal with Lou Borio Act. Now to prevent an American epidemic the date on that was January twenty eighth some trump appointees around that time told me that you were alarmist for attention that you didn't know what you were talking about. Unfortunately you did. What did you see back then that prompted at your flurry of warnings? Well I was talking to a lot of biologists from all around the world not just the United States but Some folks in Australia and other parts of the world Hong Kong that? We're very concerned about the The nature of this pathogen and I'd written a piece in the Washington Post early in the back of my first tweet on this there was January. Second it was just the nature of the pathogen that it appeared to be based on the early reports much more contagious than SARS. Less less deadly than SARS a lot. Less than Lehman SARS but much much more contagious than SARS. As though it had the features of a pathogen that as I said was saying at the time Sort of had that The perfect storm if you will had that perfect balance in terms of being lethal enough to be very very virulent very threatening but transmissible enough that it could race around the world We always knew that there'd be one day be a pathogen that occupies that middle space because a lot of Moore's and SARS were very lethal but not very contagious and other things. That are very contagious. Aren't very lethal. And so will you worry about as a pathogen that that fills that middle ground between being transmissible but being lethal and this seemed to be that perfect pathogen in terms of its its characteristics. And that's what worried me. The most the president has said that it was impossible to prepare for this. But you seem to be prepared. You were writing and warning on it. Why were you more aggressive than the White House on this? Well I wasn't more aggressive right. I was on the outside Ah pining on this as opposed to being inside being able to affect trade policy I was very worried about it. That's the bottom line and I think that there's going to be a lot of time spent for decades and decades. They'll be writing about this one hundred years to look back at. You know what we could have done and should have done the things that we could have done. It should have done in January and February wrote about in January and February. Now I'm focused on what we should be doing now to help both. Come down from this epidemic as well as prepare for the summer and the fall to make sure this doesn't happen again and there's a different toolbox that we need and some steps. We need to be taking right now to make sure that when this epidemic does reach its apex start decline. We can move towards away from population based mitigation towards more case based interventions where we intervene to target the disease itself rather than intervene at target entire population. And there's a toolbox that we're GONNA need a fall to prevent outbreaks from happening again and certainly prevent another epidemic and it doesn't include a vaccine because I think we need to. We need to figure out what life's GonNa be like for the next year or two without a vaccine because we're not gonNA have it and so that's what we need to be focused on right now we can prepare in March for May We didn't fully prepare January for March. That's hindsight You know what would we needed to do? There's some things we could have done clearly in January and February. That would put us in better shape than we are in right now but we'd into him. We need to work with the platform that we have. So if you're trying to plan ahead for the months to come power you spending your time. Are you on the phone? With policy makers scientists were you coordinating relief efforts. Like take me through your day. In this moment we're spending time talking to members of Capitol Hill On a bipartisan basis. And spending a lot of time trying to formulate Ideas in in a practical fashion that can be implemented into policies so not just not just position papers and white papers but actually trying to give specs on what could be in legislation. What could be policy some of this? I put on twitter. I tweeted out in installments. Some guidances I put should be issued to bring the academic labs and clinical labs into the testing game in February and some of it. I put into papers and got a pay coming out with mark. Mcclellan diagnostic testing and how to build out a sentinel surveillance dark mark. Mcclellan the former FDA COMMISSIONER. So when you tweet these guidances out. Do you think that that leads to train? Do know that people are looking at your your twitter feed and using that for policy. I hope people looking at it. I mean you know the the social media that putting out on my platform is getting. You know it's it's getting hit. It's getting re tweeted. And so I do. I do think it's getting circulating. People are seeing it how much I don't know But I get calls on it. I I get calls from people who are in a position to implement some of these measures asking me for more details. That's what I've spending a lotta time. Trying to provide. People might focus right now. Is I think we need a much different screening capacity in the fall? I think we'll have the tools to do that and we need to build it into some of the legislation. That's going to be coming out. We need a very robust sentinel surveillance system. We need to have appointed care diagnostic and very liberal testing in the doctor's offices and we need to have logical testing to look at the background rates of immunity in the population. That's going to inform policy making. It's also going to provide an early trip wire to identify spread in the United States. And when it happens in small clusters before becoming epidemic and that gives you the opportunity to use case based events where you go in you identify the individuals you quarantine them you quarantine their close contacts as opposed to having to put in place. The population base mitigation steps. That we're doing now. Which are blunt instruments? You do that when you've lost control of an epidemic. We don't want to lose control this. We can't afford to let this happen again. We can barely afford for. What's going on right? Now and the human carnage is going to be heart wrenching but this cannot happen again and so if we have another large outbreak pedantic in the fall if we can't get back to some semblance of normal life because this pathogen is circulating and people are fearful about going out going to work. This country is going to be in a difficult spot. We don't need to be there we can. We can have a toolbox that I think committee that but we absolutely need to be planning right now. What those tools are getting them in place. We have a head start. We have the time to do it. And it also is going to involve a therapeutic. I think that there's a real possibility that we can have an antiviral that can help treat. People who get infected. In high risk of a bad outcome might rescue them if they if they've already developed really severe symptoms but if you introduce an antiviral earlier in the course of disease like you use antivirals influ for someone who's at high risk of having a bad outcome that can help mitigate the potential for a bad outcome. I think we can. Couple that with a therapeutic antibody. Recombinant antibodies a number of companies working on this including regenerate who I work with when I was at FDA on developing that he bullet treatment that could be could be successful here in developing an antibody that could target the virus. And you can use that as a prophylaxis in your healthcare workers and people who nursing home patients. Chemotherapy patients people at high risk of of a bad outcome. You basically give them a monthly injection or maybe every month and injection of an antibody that's serves as prophylaxis to help them from getting infected in the first place and that's how the antibody drug that Regina undeveloped for Ebola works and it was successful. It was it was beneficial. It's been eclipsed by a vaccine but but it was a good bridge to vaccine and that's what you want here. You want an antibiotic therapy again by that. Could BE A Bridge to a vaccine will get a vaccine. We just aren't going to have it in time for the next cycle. You said you're spending your days. Talking to members of Congress talking to scientists planning ahead offering policy guidance on twitter my colleague Cerro Vermont. I wrote a story where we called you. The shadow corona virus's. Are you refuse to talk to us for that story? I've got you in front of a microphone. So let me ask you now. Is that a fair term. I don't think so I you know the people who are working. This problem in the White House are dealing with a much broader range of issues. Hey Hopping in here to say Dr. GOTTLIEB's recording dropped out so the remainder of our conversation is with a backup recording. I don't think so I you know the people who are working this problem in the White House are dealing with a much broader range of issues than I am Including all the logistical issues. Of How do you get a ninety five masks in ventilators into New York? And how do you make sure the supply chain doesn't break down? I mean my my Work is narrowly focused I'm trying to think about August. I'm trying to think about the fall. I'm trying to think about this summer. I'm trying to think about what happens. When the epidemic passes as there's a lot of good people focused on the immediate crisis. I'm trying to think a little bit about the future. About when this immediate crisis passes how do we transition away from these population base measures towards more case based interventions and then? How do we build a toolbox in the fall that prevents large outbreaks happening again? And makes this a livable pathogen? You know this this is GonNa be with us. This is a fearsome pathogen. This will probably spread to South America as they go into their winter. There does appear to be a seasonality to this and then it could come back again and we're going to have to contemplate travel restrictions and South American nations coming up this summer We're going to be contemplating all these things. But this could come back again in the fall and in the winter and become a seasonal pathogen until we can bank with vaccine and so the question becomes. How do we make sure that this could exist in the background? And we can have a normal life and life's never going to be perfectly the same. This has changed. This has altered the course of history and the world. This has changed American Life and global life. We're going to have more cleaning of shared services we're going to have restrictions on how many people crowded elevator. Uber's and airplanes are going to be advertising the deep cleaning. We're GONNA see more ultraviolet light in indoor settings we're GONNA see copper used on shared services. There's things that are going to change just like after nine eleven and I'm not meaning to compare this to nine eleven but after nine eleven there was security features. That never went away. We we didn't have. Tsa before nine eleven. We didn't take our shoes off in the airport. So certain things are going to stay with us. But with the right toolbox with the right Surveillance techniques and perhaps some therapeutics in our metareum. This can become a pathogen. That circulates that on a daily basis. People don't worry as much about they. They changed their habits. They used parral. They wash their hands more There's things that they do differently but you don't. You can get back to normal life with some additional vigilance and that and that's what we that's what we need to strive for. And I think that we're going to get there but we just need to be focused on that strategy. That's what I'm trying to think through given that there are so many threats. That's only to be tackled. Is it realistic that we would go back to work? In two weeks. Like president trump has signaled. He blinked America to do what happens if if the economy opens back up around Easter. Look I think what policy makers policy makers are are Trying to find is some identifiable measure progress that could be related to the American people in a way that people can create expectations around that. That's what that's what everyone wants to people on Capitol Hill. I believe that's what the president wants. I think we need that. I think we need a way to speak to the American people about what what progress is what will it look like when we're turning the corner and then what can we gradually reintroduce into our lives. I don't think anyone believes that. This is an on and off switch. I think people understand. This is going to be a gradual evolution. Certainly my conversations with people. I think that they understand that but I think what we need to give. The American people is something to measure progress by. And if you can't back into an approximate date about when things are going to start to transition you need to back into our Identifiable goal posts that people can see by turning on their TV so it needs to be something. You can't tell people Here's a model and you know we're GonNa know when the data you know gets to a point with model starts to change people don't know your model. You need to say well when we reached the apex and you see new cases declining or when you see hospitalizations falling off that means this and that means we can. We can probably start to think about this and so it needs to be something that people can measure themselves for themselves and say I'm trying to think that through as well what that looks like and what that gradual evolution is China did a very good job at this You know. In retrospect China did a lot of things right even though they got to a slow they got off to a slow start but they did a lot of things right after that There's GonNa be consequences for some of the things they did. Some of them were two Jacobean. But in terms of restarting their economy they gradually took their foot off the brake of population-based mitigation and gradually introduced case based interventions I in the outlying regions of of the WHO providence and then gradually and who province. I think we'll we'll have a similar situation here where we can gradually take take off some of the most onerous things in parts of the country. We broken transmission with a virus isn't circulating anymore or circling a low level and in substitute in other things to help. Make sure it doesn't flare up again and it's GonNa be a gradual evolution. So if if you think that this is GonNa peak sometime in mid to late April. Probably MORE LIKELY LATE. April but maybe mid April. If you believe the optimistic scenario so we'll be coming down the epidemic curve. This is a bell curve so the time to get to the peak. It's it's similar to the time to get down from the peak but as you're coming down that curve on the back end you can start contemplating some of these things and so we'll be coming down that curve. Hopefully in May and into June and hopefully transmission breaks off in June and July and August are relatively quiescent. And so as we're coming down at curving getting into the summer we can start to contemplate especially in parts of the country. We can have evidence that there isn't transmission taking place contemplating lifting some of these some of these population-based restrictions. That are in place right. Now you do need in order to do that. You do need to have good surveillance. You need to know where the viruses circulating where it isn't circulating so you need to get really good surveillance in place. I believe I believe. We'll have the be robust screening. We'll be able to screen hundreds of thousands of cases a day as we scale this up. The only limitation on very very robust screening on that magnitude isn't going to be the diagnostic capability of the labs. It's GONNA be literally the supply chain supporting the diagnostic capabilities. So things like the pipe pets and the cotton swabs agents all the low commodity components of testing other things that are probably going to put an upper limit. On how many tests we can do a day as As tragic as that sounds like it's hard to believe we're going to be limited and how many tests we can do day because we're not going to have a little plastic parts to put samples in last question you ran the FDA. Is it hard to be on the outside? Rather the inside for this crisis and is it possible you'd go back inside It's terribly hard to be on the outside And not supporting my former colleagues and doing and participating. The things that I know can can help improve the outcome and as far as the role. I'M GONNA play. We'll see I mean right now. You know I'm engaged wearing my policy at the American Enterprise Institute and talking to members of the administration and members of Congress helping to give them support. Give them ideas draft things where it's helpful? Put it out on twitter on on on white papers. Everything I'm saying on the inside I'm saying on the outside. So if you WanNa know what I'm telling policy makers if you follow me on twitter it's I'm basically saying the same things so I'm pretty I try to be pretty consistent students about making sure that I'm putting out publicly what I'm saying privately. That's one of the most effective twitter plugs I've ever heard Dr Godly. Well you get back to fighting the corona virus with your platforms. Thanks so much for joining politico pulse check. Thanks a lot thanks. I mean that's our show for today. My thanks Scott Gottlieb for taking time out of his packed schedule to join us at politico. Our producer is anti reese. Jenny comment is our senior producer. Irene Noguchi is our executive producer. You can find political pulse. Check my going to your favorite podcast APP. Searching for our title you can help us by leaving review rating on the show. That's a signal helps new listeners. Discover PULSE CHECK Tim. Thanks for listening. And we'll be back with you again next week

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