$5, 15-Minute Coronavirus Test: Travel Game-Changer?

Filed Under: Travel

Airline stocks jumped this past Thursday with news of a new coronavirus test that costs just $5 and takes just 15 minutes to produce results. While this is an exciting development in general, is there any reason to be excited about this as it impacts travel?

Basics of Abbott’s new coronavirus test

Abbott Laboratories this week received emergency use authorization from the Food & Drug Administration for a new coronavirus test that’s unlike any other. The test costs just $5 and produces results in 15 minutes.

The U.S. has already reached a deal to purchase 150 million of these tests for $750 million, which comes out to just $5 per test. The tests should start being available in September, and by October there should be 50 million of them available per month.

Much like a traditional PCR test, this test involves a nasal swab. While it needs to be administered by a health professional, there’s no special equipment needed to read the results, so it’s kind of like a pregnancy test, in that sense.

How accurate is the test?

  • It has a sensitivity of 97.1% (meaning that it produces positive results when there should be positive results); in other words, expect 2.9% false negatives
  • It has a specificity of 98.5% (meaning that it produces negative results when there should be negative results); in other words, expect 1.5% false positives

Is this great news for the travel industry?

There are lots of logistical challenges to travel nowadays, in particular, if looking to travel internationally. For travel to return on a widespread basis (without a vaccine) we need testing to be more readily available, cheaper, and with faster results.

Limited supplies of $200 tests where many people receive results in over a week aren’t terribly useful for restarting the travel industry.

Airline stocks shot up with news of this new test, and some even called it a game-changer for the travel industry. I’m not sure I share the optimism.

Yes, Abbott’s new test is great for fighting coronavirus in general. This is an easy, fast, and affordable testing option. Perhaps what’s good for us in general right now is also good for the travel industry.

However, it sure seems to me that this test is almost explicitly not useful for travel. Rather this seems ideal for testing a large number of people who may have been exposed to coronavirus. For example, if someone in a nursing home tested positive for coronavirus, something like this could be a game-changer.

However, is the same true for travel? I don’t think so, due to two major issues.

Supplies are far too limited

The US government is purchasing 150 million tests, and Abbott can produce 50 million of these per month. While those sound like big numbers, in reality, they’re not.

In terms of prioritizing, it’s hard to think that airlines will somehow get first dibs at these kinds of tests. It’s neither practical nor responsible for that to be the case. These tests are ultimately most useful for situations where people may have been exposed to someone with coronavirus, rather than just testing asymptomatic people for discretionary travel.

Pre-coronavirus we saw over 60 million travelers per month in the US, while right now we’re seeing somewhere around 20 million travelers per month. Regardless of how you slice it, it seems unlikely the airline industry would be able to get its hands on enough tests anytime in the near future for this to be useful.

I suppose if production could be ramped up to hundreds of millions per month this might be possible, but that still seems to be a way off.

The false-positive rate is problematic for travel

As mentioned above, the tests produce 1.5% false positives, and 2.9% false negatives. That’s not bad at all when you consider how quick and cheap this test is, but keep in mind that this would mean there are people on every flight with false positives.

Have a flight to Europe with 300 people on it? There will on average be several people with false positives. They’re probably traveling with friends and family members, so you’re potentially looking at over a dozen people who either tested positive, or who may have been exposed.

How would that be handled? Would they be retested? If they retest negative, would that be sufficient? Would they not be able to travel and immediately go into a 14-day quarantine?

Not only would this cause panic, but the logistics would be a nightmare.

Bottom line

Abbott’s new test is great for airlines in the sense that it’s the type of testing that could contribute towards coronavirus being more under control, and lowering the infection.

The airline industry would indeed benefit from coronavirus being more under control. However, specific to the airline industry, I don’t personally see this being a game-changer.

Not only would it be irresponsible to use this kind of (limited) testing for travel anytime soon, but a 2.9% false-positive rate would also be problematic here.

What do you think — could this quick and cheap testing help travel, or is it unlikely?

(Tip of the hat to View from the Wing)

Comments
  1. Ben, you’ve got your false positive and false negative rates the wrong way around. 97.1% sensitivity means 2.9% false negative rate.
    But the actual number of false negatives depends on the pre-test probability of the person / population taking the test.

  2. Whoops, my apologies. I think post is updated correctly now, but please let me know if that’s not the case. It’s still early on a Sunday, so… :p

  3. The false negative rate is much more concerning than the false positive rate. A false positive means someone may need a second test or, worst case, be unnecessarily prevented from flying. A false negative allows an infected passenger on an airplane, and, at that rate, could pose an high risk of infection on a given flight.

  4. The problem even with the PCR test is, that false negative results are much more likely at a very early stage of infections (roughly the first 4 days). This is also why some countries are not using PCR tests to determine immigration and quarantine requirements. So I guess for the Abbot test it would be crucial to produce reliable results at this early stage (anywhere 97.1% would be excellent at this stage of the infection).

  5. “ worst case, be unnecessarily prevented from flying”

    So what happens when someone on a non refundable ticket is prevented from flying due to a false positive Covid-19 test – do they get full refunds from the airlines?

    The test is a game changer, but not for the reasons posited in the post. Testing individuals before flights, cruises, etc can’t practically sort out all people with Covid before those events. However, what rapid tests do allow is for the entire population to drastically reduce spread. Going to a party? Take a rapid test. Population wide, false negatives/positives are not that material in this situation as this spread is reduced. All that needs to happen for travel and other parts of the economy to come back is the reduction of spread to more manageable levels – rapid tests are a key piece of that.

  6. I can see a lot of positives about the test, but not in the context of travel.
    I mean. You test at the airport, you’re negative, you board, get off in Ibiza and have a holiday. When you get to the airport for your flight back, you’re positive. What then?

  7. It seems like most commenters and the writer (and likely most of the public) are fixated on needing 100% sensitivity and specificity.
    If you are not willing to live with the inherent risks, then don’t travel until COVID is wiped out, as even a vaccine is not 100% effective. Nothing in this world is 100%.

  8. The test is not a home test. It most be administered by a healthcare professional and the cost of the kit to US government may be $5 but there is still cost of labor and logistics. In US, public sector labs account for less than 10% of capacity. Almost all of that is at county labs or state health facilities. Private labs expect to make money. As with so many things at the moment, this is a political story with very little new science. Best estimate is cost is about 50 percent of current PCR tests, turnaround all in is 3-9 hours (you will need an appointment) and false positive rates 1-2%, which is not trivial. The new test is welcome and a step forward. But an incremental one. The scenario described above is fantasy.

  9. Mike- Exactly, which is why testing for the purposes of air travel itself doesn’t really make sense. You can test for entry into a foreign country, but in terms of flying back to your own country, a test isn’t likely going to prevent you from traveling back. Masking is the best approach to air travel until Covid becomes a much less prevalent threat. Rapid testing is much more useful in settings like conferences, conventions, concerts, weddings, hospital, education, offices, health care, etc – and frankly it can have a much bigger impact on those settings.

  10. Unlike other posts where I’ve disagreed vehemently with Gary, this time my response is largely positive with caveats

    Overall
    We are finally seeing light at the end of the tunnel
    This test in conjunction with others like Yale’s saliva test or Rutgers innovative test will be the way forward
    Fir instance, my group will soon do 10,000 Tests per day, and we hope to do 30,000 per day by January

    Home testing that can be collected without a medical professional is critical, as we don’t have enough healthcare workers to do millions of swabs per day
    The holy grail will be a pregnancy-like home based test That is collected by patient and returns a result that day at home

    Travel will be prioritized last, as it should be
    We need to do these tests weekly or biweekly for
    – schools
    – hospitals, clinics, nursing homes
    – Offices/workplaces
    – basically everywhere

    This will get our economy up and running again

    The major hurdle to these tests will be supply. Each test comes out promising hundreds of millions of tests. After a few weeks there is a shortage. For instance we ramped up from 200/day to 2500/day. Only to get stuck at 650 now due to shortages of swabs

    In addition be VERY wary of these sensitivity and specificity data
    Abbots ID NOW rapid test had similar claims. But in practice the test is much less reliable than initially thought

    The major hurdle to testing at airports will be waiting
    Where do you put thousands of people to wait for their test result?
    Even a 5-10 minute wait takes time. What do you do with the people who were around a positive test?

    As always, Gary’s hope for a quick timeline to herd immunity is profoundly optimistic
    NY, CA, FL are nowhere near herd immunity.
    The rest of the nation is even further away
    We will get herd immunity when a vaccine is widely available, if people take it
    Hopefully in 12-18 months

    Lastly;
    FlyingDr has it right

    Almost everyone here is using sensitivity and specificity incorrectly, and using them to mean something they don’t. (For instance One cannot do the math that Gary tried to do using only sensitivity and specificity data, even tough I know many other news articles are doing the same thing)

    Google “Positive and Negative Predictive Value of a test” for more information

  11. I think you’re looking at this the wrong way around. Instead of worrying about the cases on planes and in airports with false negatives, it’s more about the 97% that have the right result to reduce the numbers travelling with COVID significantly. This has huge advantages to make travelling safer – reducing spread within airports/airplanes and from one country to another.

  12. So, where are you going to go anyway, there are no concerts, no festivals, no big weddings. No conferences no big business meetings to attend, Disney world with limited capacity and a sorry aspect of normalcy, go on vacations where all the people is feeling sorry for the past tourist bonanza and remembering with sadness how the world used to be?. The world will come back and it will be pleasant to travel again….but is not the time yet.

  13. This is an antigen test.

    Virtually all airlines and countries require a PCR test.

    All the rest is noise.

  14. Tests like that have been around for a while for other viruses like influenza and hasn’t performed so well. You really need a high prevalence to minimize errors. I am suspicious that the performance data will be reproductible in a real life setting, especially in a predominantly asymptomatique population

  15. “There will on average be several people with false positives.” This is not correct because it assumes that 100% people who attempt to board a plane are ‘positive’ and the test missed several of them. In really there are very few ‘positive’ people who even attempt to board to begin with and the test will most like catch them. If you test 10 people with a test that is 97% accurate then it’s accurate enough to catch all 10.

  16. A 97.1% sensitivity rate is very good medically speaking. A 2.9% false negative could be seen as a problem, but nothing in life is 100%. Yes, someone with early stage COVID 19, could test negative and be allowed on a flight, but compared with what? There will always be those undetectable cases that sneak by the screening measures. And I will wager that those numbers exceed a 2.9% false negative, especially if we are trying to open up travel again. A widely available test that is 97.1% effective will greatly improve our surveillance for travel. This will have to be accompanied by continued mask wearing of course.

  17. This is insane. What if you get a false positive and you’re traveling to a hospital to see a dying loved one with days left to live? What if you get a false positive on your honeymoon? Yesterday, the New York Times reported that up to 90% of PCR tests are likely picking up the “viral debris” of people who’ve already fought off SARS-CoV-2 and are no longer infectious. If you are “positive” due to viral debris (like a hair left in the bathroom after a shower), but no longer infectious and no longer symptomatic, why shouldn’t you be able to travel? We need to stop upending life for a mild respiratory virus. Enough is enough.

  18. While the test is great, you should consider the skewed distribution here. Assuming that at any given time the fraction of actual infected individuals (i.e. those infected who have not recovered yet) ranges between 0.1 or less (Europe, Asia) and 0.5 (US) then a false positive rate of 1.5% means that 14 out of 15 positives (Europe, Asia) or 3 out of 4 (US) are actually *not infected*.
    So basically, for a random sample of the population (for example, travelers) the vast majority of positive results are wrong. Would you use such a test? As Ben notes it may cause more trouble than it may help. The test is obviously useful in cases where there is a suspicion for infection (exposure, symptoms) since this population is much less skewed in terms of the likelihood of being infected. But I am not sure how good this is for travel.

  19. Ben, this is not how sensitivity and specificity (S/S) work, although they are commonly misinterpreted this way. Sensitivity is the chance a test will correctly identify a positive case (in this case, someone has nCoV) and specificity is the chance a test will do the same with a negative case. How is this different than positive predictive value (PPV) and negative predictive value (NPV)? Because with S/S, you made the measurement against people who you already know have or don’t have the condition. It does not take into account the prevalence (pre-test probability) of the condition. Why do manufacturers only quote S/S? Well, if the prevalence of a condition is not known, you cannot calculate the PPV and NPV. More importantly, it is way easier to determine S/S because you simply take test cases that you know have the condition through some other testing method, and you see what your new diagnostic test shows against that same test subject.

    With the Abbott test, you can see what a huge impact prevalence has on PPV/NPV: Given a sensitivity of 0.971 and specificity of 0.985, let’s assign a prevalence of 0.01. This means we’re taking a guess that one percent of the people, say in the airport getting on a flight, are truly infected with coronavirus. You can use this online calculator: http://vassarstats.net/clin2.html and see that the positive predictive value is only 40% and the chance of a false positive is 60%! There is a 2.5% chance for any one person’s test to be positive. On the other hand, the negative predictive value in this case is 99.97%. This is the impact of prevalence or pre-test probability on PPV/NPV.

    So what good is this test you say? If a test is negative, you’re almost completely assured that the traveler is safe to fly. If the test is positive, you could just require testing with PCR, which has a much higher sensitivity. Sure, the person will be delayed a few days. We as a society have to decide if this is worth restoring confidence to travelers and perhaps eliminating transmission through air travel.

  20. @Stats
    Your math is correct.
    But at the same time, if this is applied to air travel, a plane with 300 people departing from the US in your example would have 1-2 people actually infected, who would be correctly identified by the test most of the time (in over 92 of 100 flights).
    The test would also falsely identify 4-5 additional travelers as positive, who are in fact negative.
    If you assume 1 travel companion on average, this would leave around 280-285 people on their way to the destination, safely, because the positives were removed.

    If positives are retested, the numbers may be further improved.

    Not so bad imho.

    I agree with Lucky that the availability of a sufficient number of tests will be the biggest concern.

  21. This post is a core example of why Gary and Lucky should stick to travel writing not medical diagnostics or public health.

    1) This is an antigen test – all current travel country specific travel testing requirements for for PCR or molecular tests. No sign of that changing

    2) Article whines about false positive rates and what happens if you receive one. From a public health standpoint false negatives are a much bigger problem. Get a false positive: stay home and treat like a real positive. Get a false negative: you are running around spreading the virus.

    3) Tests will never be 100% accurate. Stop pretending like they will be. If these specificity and sensitivity rates are true – they are pretty good.

    4) From a public health standpoint: enabling travel should not be a priority for mass testing capabilities. Far more impactful areas to focus on: education, healthcare, government, military, frontline retail workers, etc…

    5) Big risk that people start seeing easy testing as a panacea, and stop doing the things that mitigate the spread of the virus. “Oh, I got a negative test, don’t need to wear a mask now.

    Vaccines and therapeutics is what opens travel

  22. “While it needs to be administered by a health professional”…

    Aye, there’s the rub. If Abbot can produce 50 Million tests a month, where do we get the “health professionals” to administer over 16 Million tests a day? Especially if the intention is to do the test in an airport….?

  23. The sensitivity and specificity of Antigen tests are against the PCR test. The PCR test has sensitivity of 50-70% and specificity of 99+%, so the actual sensitivity and specificity of Antigen tests are lower than these #. A positive test of Ag test is considered positive, but a negative one is not reliable enough. Even when you test negative with any test, it is safer to have the person quarantined for 14 days.

  24. Here’s my anecdotal experience with COVID-19 testing. My BIL, a musician, became exposed to the virus while playing with his band on Bourbon Street during the Mardi Gras last February. After returning home to Florida, he tested negative twice with full blown symptoms. Eventually, he collapsed and was transported to a trauma center where he finally tested positive and was put on a ventilator and died ten days later. His wife, my sister, had symptoms, after her husband was hospitalized and tested negative twice but went into isolation on the advice of her doctor on the chance that she was positive. Three months later she was full of antibodies. I tested positive with no symptoms after returning from Milan in February and today, I also have antibodies. Different doctors have told me and my sister that it’s rare for a false positive but there seem to be plenty of false negatives. I wouldn’t necessarily be worried about a false positive before a flight nor would I necessarily feel safe among a group of people on a flight who have all tested negative in the current COVID-19 environment in the US.

    As for the rapid tests being available for air travelers, I’m sure they will be given first to medical personnel and schools, rightly so.

  25. As long this is still a pandemic there is going to be no change to leisure travel. If I am a family or 4, I will not spend hundreds or thousands of dollars to go on vacation and risk being found positive at the airport and lose all the money I spent on my trip. This will only work for business people to go back to meetings & by the looks of it, the overwhelming majority of business travel will never return now that people, especially older folks are used to doing online meetings daily. The fact is that until there’s a vaccine and countries stop this nonsense travel ban ideology, no test or trace method will truly bring any real change to the travel industry

  26. @Robert Hanson

    “Aye, there’s the rub. If Abbot can produce 50 Million tests a month, where do we get the “health professionals” to administer over 16 Million tests a day? Especially if the intention is to do the test in an airport….?”

    I think you mean 1.6 mil/day. But when I read “it needs to be administered by a health professional,” I thought along the same lines as you. Even IF airlines could get their hands on all the tests, how would you distribute that among airports? A lot more thought needs to go into this project if airlines/airports were involved in the equation.

  27. The current way we’re testing is bonkers. Glad to see coverage of this is expanding recently and that regulators are getting behind other strategies. Antigen tests are the way forward. Governments should be chucking billions at this – it could change the course of the deepening economic crisis we’re entering.

    If you want a primer on this I highly recommend viewing this video by Medcram: https://www.youtube.com/watch?v=h7Sv_pS8MgQ (also generally great scientific coverage of the medical/therapeutic side of the pandemic)

    Good NY Times article on this just recently published too: https://www.nytimes.com/2020/08/29/health/coronavirus-testing.html

  28. All this for a virus with a 99.8 percent survival rate, only 6% of deaths have zero underlying conditions, and most were of very advanced age to begin with. We’ve all lost our minds.

  29. @Bob doll! We have not lost our minds…. the masses have ;-). I am not surprised that the majority of people on here are dying for a vaccine…based upon the history of commenters over the years.

    I think this is a step in the right direction, and should not be shot down by the naysayers and the people who tend to live in a negative space. There is no 100%. If so afraid then theses folks should stay home and vacation on their front lawn!

    A few airports and airlines are trying and we should see this as a major positive.

  30. It would be really helpful if the term “Health Professional” was actually quantified.

    It’s a nasal swab. That’s all. A reasonably intelligent person could be certified competent to take a nasal swab in a half-day of training at the most. They are not doctors, they just need to know where to swab and how to prevent contamination of the sample and cross-contamination between victims (er, patients).

    For “centuries” we only allowed MD’s to inject vaccines. Now every pharmacist can legally perform injections (at least in Canada) and experience has shown no negative effects thus freeing MD’s for more important work.

    I hope that this is the beginning of more products that can be administered in a reasonable time while travelling. There is always a small risk which can be minimized by social distancing, washing hands, sterilizing surfaces and, possibly, by wearing a mask properly. This test will reduce the inherent danger by significant magnitudes provided we do not relax on the basic guiding principles.

  31. The literature that comes with the Abbott test says something to the effect that the >97% specificity and sensitivity values are based on testing people with a certain number of days *after showing symptoms* (I think it was 4 to 7). The million dollar question is what are the s/s values for people with no symptoms. As someone mentioned above, it’s likely to be much harder to detect the virus in someone who is positive but symptom-free, so the false negative rate is likely to be higher for asymptomatic individuals. If it’s a lot higher, the test will be pretty much useless for the most important function it could serve: determining whether a symptom-free individual should have contact with others. If someone has symptoms, contact with others should be avoided to begin with.

    And then there’s the problems that the s/s values are likely different for different populations. In normal times, this has to be thoroughly studied before a test is approved. By all means, I’m in favor of trying the test out as widely as possible – but we need to keep in mind that there’s a good chance it won’t work as well as hoped. And that has it’s own risks: a much higher rate of false negatives for some groups would make the test *worse* than useless because people will trust the negative result and spread the virus to more people than if they hadn’t taken the test.

  32. Well the simple math if the infection rate if tested people is close to 5% and the false negative is 2.9% and we have 20 million positive that mean 30000 flying daily infected. Now we take in consideration that here people are randomly tested not ones with symptoms so infection rate should be Lower but I think we could still have over 20000 people are flying while sick

  33. @bob doll and @jordan

    Totally agree with you guys. I can’t believe the fear I see in some people these days. Over a very minor threat in comparison to all the things in this world that can kill us. And a threat that’s highly concentrated amongst the elderly. It’s sad.

    Everyone here loves to travel. Presumably they take some risks while on their journeys. Swimming in the ocean, eating new and unusual foods cooked on the side of the road in some third world country, going out at night in strange new cities, interacting with other cultures, riding a tuk tuk racing through traffic in Bangkok during a rainy season thunderstorm. We drank in bars with people from all over the world we never met before and will never meet again. We shared a spliff with newly made friends in Holland. We visited and hugged our loved ones and friends. All without paying a thought to any sort of social distancing. “Living” is what we called it. Life is risk.

    We were so willing to accept these travel bans. Some of us beg for them to continue. Saying they won’t travel until their safety and everyone else’s from this virus can be totally assured. I suspect I’m not the only one here who found great joy in travel. Don’t forget what you’re giving up. Life is not safe. Risks are the essence of life.

    We so willingly gave up so much so quickly. We inflicted a global economic depression on ourselves. We’ve dramatically negatively impacted the lives of everyone on this planet with our lockdowns and travel bans and shutdowns of events. Hundreds of millions being driven into poverty around the world. They will lose years from their lives. The stress of the economic situation alone will take years from peoples lives. Not to mention the suicides, alcoholism, drug addiction, depression. The toll on the quantity and quality of human lives will be massive. Much of it will go unrecognized as it plays out over the coming years and decades.

    And the reward for this massive individual and collective sacrifice? We’ll slow the spread of a virus that is no serious threat to the vast majority of the population. Yes some people will die from this virus, but this reaction and the widespread harm it is causing to the mental, physical and financial health of everyone else is completely unwarranted.

    Is this the plan for every new virus with a less than one percent infection fatality rate that comes along now? Everyone here, on one MILE at a time, should certainly hope not. There will be more viruses. New strains of flu, coronaviruses. They emerge regularly. It’s part of living on this planet.

    If this is to be our reaction, burn those miles as fast as you can as soon as you can. Say goodbye to flying around the world in 1st class sipping krug. Say goodbye to mass air travel in general. It will be a thing of the past in the “new normal” we are constantly being conditioned to accept. Maybe we can tell our grandkids stories about the olden days of travel through a plastic bubble so we don’t catch covid-79.

    Don’t accept this as normal. Please don’t ever accept the current state of the world as anything that deserves to be called normal. Humans are social animals. Mass gatherings are normal. Close interaction with other human beings is Normal. Travel is Normal. Touch is Normal. Being comfortable sitting next to a stranger or walking through a crowded street is normal.

    Your life, the quality of it, is important. Every bit as important as the quantity. And every bit as important as anyone else’s life. Try not to spread this or any other disease of course. Reasonable precautions are alwsys a good idea. Don’t feel some obligation to lock yourself away from the world just to make sure you have as little chance as possible of catching or spreading this disease. Get back to travel as quickly as you can, if that is something that you find joy in. Live! Take risks!

    For the record I work in the hospitality industry. I’ve seen some commenters on here expressing the sentiment that they don’t want to endanger the employees of hotels/airlines/restaurants etc. It is very unlikely you will kill us with this virus. You may destroy our livelihoods if you don’t start traveling again though. And soon. We need your business and we need it now. I feel terrible for the people in the hospitality industry who work in less fortunate areas of the world. So please travel if you can and as soon as you can. We need your business. In many nations they need it literally to survive.

  34. Dominion republic are carrying out rapid PCR tests funded by their government We are taking advantage In 3 weeks if our flights do not get cancelled again.

  35. I see this as way to cumbersome to administer-assuming airlines are going to test people before they board. As it is airlines struggle with the boarding process to ensure ontime departures. And as stated in the many comments above issues with false positives and in general with positive results. I can see meltdowns now when people aren’t allowed to board and have not the financial resources or time to go self quarantine before traveling home.

  36. It’s killed 848k worldwide and we’re closing in 25.4M. Probably many more due to unreporting in Brasil and India. 31% of deaths are people 55 and over. I’m sure that’s a huge part of the travel community.

    This is a step to help build confidence. But let’s accept there is risk with everything we do in this world. Nothing is 100%. No vaccine is 100% & because we have 20% naysayers out there who won’t get it, won’t be able to afford it, etc.

    So let’s applaud ABT and all the other firms out there working to get us back to normality in 2021 and get things moving in 2020.

    I know I want to get back to traveling….

  37. The test is just a start. Then what happens after. Let’s say you test positive and you are in another country. It’s complicated. They won’t want to pay for your illness because you are not their citizen but it’s risky to send you home…

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