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COVID-19 Risk Topics Blog

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BETA Healthcare Group is committed to keeping its members informed on topics related to the COVID-19 outbreak and to help our healthcare facility members during this unprecedented time. We have formed an internal COVID-19 Task Force dedicated to answering our members' questions and providing information and resources.

This page is your source for risk considerations related to COVID-19, links to helpful resources across various healthcare settings and situations, and links to BETA group purchasing/supplier information. The Risk Blog information provided below is general guidance and provided for informational purposes only. The commentary is current at this time, but circumstances are changing rapidly. For the most up-to-date information, please consult primary sources or check with your BETA contact.

For risk or underwriting concerns specific to your organization around COVID-19, please contact us at riskmgmt@betahg.com.

On September 17, 2020, Governor Gavin Newsom signed Senate Bill 1159. This bill creates a retroactive presumption of compensability related to COVID-19 for your employees and codifies the Executive Order (EO) previously issued on 05/06/2020. The primary tenets of the EO remain in place. This includes the diagnosis/positive test requirement, 14-day exposure period from when the employee last worked outside of their home, retroactive to cover the entire pandemic; and the requirement that any emergency COVID-19 related sick leave benefits be exhausted prior to the provision of Temporary Disability benefits. There are additional employer requirements that an organization must comply with.

A copy of the bill can be found here.

See BETA Healthcare Group’s member communication about SB 1159 here.

BETA’s workers’ compensation team is here to assist you through this difficult time. Please feel free to reach out to us with any questions.  Your claims examiners, assistants and the entire management team is available to assist in any way possible.

If you have any questions, please contact:

Jamie Goff

Sr. Director of WC Claims

(916) 266-5249

The U.S. Department of Labor has adopted revised enforcement policies for Coronavirus and issued a memorandum to provide updated interim guidance to Compliance Safety and Health Officers (CSHOs) for enforcing the requirements of 29 CFR Part 1904 with respect to the recording of occupational illnesses, specifically cases of COVID-19. On May 26, 2020, the previous memorandum on this topic[1]was rescinded, and this new memorandum was put into effect. It will remain in effect until further notice. This guidance is intended to be time-limited to the current COVID-19 public health crisis. Check OSHA's webpage at www.osha.gov/coronavirus for updates.
Under OSHA's recordkeeping requirements, COVID-19 is a recordable illness, and employers are responsible for recording cases of COVID-19, if:
The case is a confirmed case of COVID-19, as defined by the Centers for Disease Control and Prevention (CDC);[2]
The case is work-related as defined by 29 CFR § 1904.5;[3] and
The case involves one or more of the general recording criteria set forth in 29 CFR § 1904.7.[4]
See the full memo at:
https://www.osha.gov/memos/2020-05-19/revised-enforcement-guidance-recording-cases-coronavirus-disease-2019-covid-19

In response to COVID-19, many patients’ surgeries were postponed due to the pandemic. Safely resuming patients’ needed surgeries and minimizing COVID-19 risk is top of mind for healthcare facilities and preparation is key. The American College of Surgeons (ACS), the American Society of Anesthesiologists (ASA), the Association of periOperative Registered Nurses (AORN) and the American Hospital Association (AHA) issued a joint statement outlining key principles and considerations to guide healthcare organizations in assessing their facility readiness and ability to resume elective surgeries. Facility readiness for resuming these procedures will vary by geographic location depending on local COVID-19 activity and response resources.

Highlights of the statement include:

  • Implement a policy for testing staff and patients for COVID-19, accounting for accuracy and availability of testing and a response when a staff member or patient tests positive.
  • Form a committee – including surgery, anesthesiology and nursing leadership – to develop a surgery prioritization policy, which factors in previously canceled and postponed cases, and allot block time for priority cases, such as cancer and living donor organ transplants.
  • Adopt COVID-19-informed policies for the five phases of surgical care, from preoperative to post-discharge care planning.
  • Collect and assess COVID-19 related data that will be used to frequently re-evaluate and reassess policies and procedures.
  • Create and implement a physical distancing policy for staff, patients and visitors in non-restricted areas in anticipation of a second wave of COVID-19 activity.

See the full Joint Statement: https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/joint-statement-on-elective-surgery-after-covid-19-pandemic

Additional guidance from the American Society of PeriAnesthesia Nurses (ASPAN):

The Centers for Disease Control (CDC) has issued updated guidance based on currently available information about COVID-19 and the current situation in the U.S. (which includes community transmission, infections identified in healthcare personnel, and shortages of PPE). The guidance is applicable to all healthcare settings and is focused on reducing facility risk, isolating symptomatic patients as soon as possible, and protecting healthcare personnel providing key recommendations for:

  • Minimizing chances for exposure
  • Adhering to standard and transmission-based precautions
  • Implementing environmental infection control

See the Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Fcontrol-recommendations.html

How long does the virus remain on surfaces?

On May 22, 2020, the Centers for Disease Control and Prevention (CDC) updated its guidance regarding surfaces:

Though the primary way the virus spreads is through close contact from person-to-person, it's possible to be infected from touching a surface or object that has the coronavirus on it and then touching the mouth, nose or possibly eyes. But this isn’t thought to be the main way the virus spreads. We are still learning more about how this virus spreads.

The primary route of COVID-19 infection isn't by touching contaminated surfaces but through the respiratory system. People should focus on wearing masks and social distancing and less on sanitizing surfaces.

For additional information from the CDC on how COVID-19 spreads, see:

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

The CDC has published a set of guidelines on how to clean and disinfect surfaces. "Current evidence suggests that SARS-CoV-2 may remain viable for hours to days on surfaces made from a variety of materials," the agency still says in their guidelines. "Cleaning of visibly dirty surfaces followed by disinfection is a best practice measure for prevention of COVID-19 and other viral respiratory illnesses in households and community settings."

See CDC guidance for cleaning and disinfection of community facilities:

https://www.cdc.gov/coronavirus/2019-ncov/community/organizations/cleaning-disinfection.html

Both the U.S. Department of Health and Human Services (HHS) and the World Health Organization (WHO) studies have shown that COVID-19 can exist on different types of surfaces anywhere from less than 24 hours to two to three days depending on various factors including temperature, humidity, ventilation, and the amount of virus deposited. COVID-19 on surfaces can be easily cleaned with common household disinfectants that will kill the virus and healthcare organizations can make decisions about their cleaning and disinfecting protocols for examination rooms and other treatment areas.

 

How long does an examination room need to remain vacant after being occupied by a patient with confirmed or suspected COVID-19?

Centers for Disease Control (4/23/20):

Although spread of SARS-CoV-2 (COVID-19) is believed to be primarily via respiratory droplets, the contribution of small respirable particles to close proximity transmission is currently uncertain. Airborne transmission from person-to-person over long distances is unlikely.

The amount of time that the air inside an examination room remains potentially infectious is not known and may depend on a number of factors including:

  • The size of the room
  • The number of air changes per hour
  • How long the patient was in the room
  • If the patient was coughing or sneezing
  • If an aerosol-generating procedure was performed

Facilities will need to consider these factors when deciding when the vacated room can be entered by someone who is not wearing PPE.

For a patient who was not coughing or sneezing, did not undergo an aerosol-generating procedure, and occupied the room for a short period of time (e.g., a few minutes), any risk to health care personnel (HCP) and subsequent patients likely dissipates over a matter of minutes.

However, for a patient who was coughing and remained in the room for a longer period of time or underwent an aerosol-generating procedure, the risk period is likely longer. For these higher risk scenarios, it is reasonable to apply a similar time period as that used for pathogens spread by the airborne route (e.g., measles, tuberculosis) and to restrict HCP and patients without PPE from entering the room until sufficient time has elapsed for enough air changes to remove potentially infectious particles.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-faq.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Finfection-prevention-control-faq.html

The CDC also offers guidance on clearance rates under differing ventilation conditions.

Are there recommendations for implementing environmental infection control?

In addition to ensuring sufficient time for enough air changes to remove potentially infectious particles, healthcare personnel should clean and disinfect environmental surfaces and shared equipment before the room is used for another patient. According to the Centers for Disease Control (CDC), certain actions should be taken:

  • Dedicated medical equipment should be used when caring for patients with known or suspected SARS-CoV-2 (COVID-19).  All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions and facility policies.
  • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
  • Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for COVID-19 in healthcare settings, including those patient-care areas in which aerosol generating procedures are performed.  Refer to the list on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against COVID-19.
  • Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine procedures.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html#infection_control

Additional information about recommended practices for terminal cleaning of rooms and PPE to be worn by environmental services personnel is available in the Healthcare Infection Prevention and Control FAQs for COVID-19

In response to the rapidly evolving COVID-19 pandemic, the Centers for Medicare and Medicaid (CMS) is allowing all Medicare-enrolled ambulatory surgery centers (ASCs) to enroll as hospitals to provide inpatient and outpatient hospital services as ASCs can play a large role in helping hospitals optimize patient flows. ASCs can currently take advantage of temporarily waived or relaxed regulations that allow them to temporarily close, enroll as a hospital or contract with a hospital to provide services.

The Accreditation Association for Ambulatory Health Care, Inc. (AAAHC) issued a press release outlining the steps for working with hospitals in the face of the COVID-19 pandemic and has a recorded webinar available with guidance for ASCs to understand their options and support efforts to increase hospital capacity:

When deciding the scope of service, AAAHC recommends identifying the needs of state and local hospitals, then examining the internal capacity necessary to meet their needs. It is important to determine if there are additional supplies or staffing requirements as well. ASCs should then put agreements or contracts in place which include the scope of service and the level of acuity, and then create clinical policies to fulfill these responsibilities.

Key roles will include the charge nurse, infection control professional and the primary liaisons for notifications. The charge nurse will be responsible for coordinating 24/7 staffing, scheduling, supply management and more, while the infection control professional will develop hospital wide programs and plans around infection, including cross-infection prevention, and train and monitor the staff to adhere to these policies. The primary liaisons will communicate with state and local officials to ensure consistency and accuracy of messaging.

Many questions are arising about Personal Protective Equipment (PPE) particularly around how to use it, the differences between types of masks, fit testing, reuse, making masks, and shortages in the face of the COVID-19 pandemic. BETA has assembled some information and resources to help guide you during this time.

What is the difference between a surgical mask and an N95 Respirator?

  1. Surgical masks are used to protect against fluid exposures such as large droplets and sprays. The mask is generally loose fitting and does not require a fit test prior to use. The mask is discarded after each patient encounter and a new one is used.

The N95 Respirator provides a filter of up to 95% of airborne particles (large and small droplets). The N95 is tight-fitting and requires a fit test to be performed to determine the appropriate size/fit. Each time an N95 is used, a seal check must be performed to ensure minimal leakage around the edges. To understand the differences between the two mask types, there is a flyer titled “Understanding the Difference” available for placement in nursing stations from the Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/niosh/npptl/pdfs/UnderstandDifferenceInfographic-508.pdf

Many questions are arising about Personal Protective Equipment (PPE) particularly around how to use it, the differences between types of masks, fit testing, reuse, making masks, and shortages in the face of the COVID-19 pandemic. BETA has assembled some information and resources to help guide you during this time.

Can I reuse an N95 respirator mask?

Yes, you can reuse an N95 respirator mask if you can decontaminate the mask for 72 hours before using it again and the mask has not sustained any damage (including it if no longer forms to the face with an effective seal) according to the CDC:

  • Give each healthcare worker five (5) masks and five (5) breathable paper bags. Per the CDC and NIOSH: “The healthcare worker will wear one respirator each day and store it in a breathable paper bag at the end of each shift.” If the organization does not have enough masks to provide each healthcare worker with five N95 respirator masks, then filtering facepiece respirators (FFR) decontamination is necessary. Refer to the CDC article titled “Decontamination and Reuse of Filtering Facepiece Respirators” for more information on decontamination at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html

Regarding KN-95 masks, the FDA has issued guidance that they should not be reused: https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-surgical-masks-and-face-masks

Many questions are arising about Personal Protective Equipment (PPE) particularly around how to use it, the differences between types of masks, fit testing, reuse, making masks, and shortages in the face of the COVID-19 pandemic. BETA has assembled some information and resources to help guide you during this time.

We have expired N95 masks. Can we still use them?

Masks manufactured between 2003 and 2013 have exceeded their designated shelf life. The CDC and NIOSH has issued guidance in their article titled “Release of Stockpiled N95 Filtering Facepiece Respirators Beyond the Manufacturer-Designated Shelf Life: Considerations for the COVID-19 Response.” In addition, NIOSH conducted a study and found that the following masks have performed in accordance to NIOSH standards:

  • 3M 1860
  • 3M 1870
  • 3M 8210
  • 3M 9010
  • 3M 8000
  • Gerson 1730
  • Medline/Alpha Protech NON27501
  • Moldex 1512
  • Moldex 2201

According to the CDC, provided that the masks have been stored according to the manufacturer’s recommended storage directions, these masks will perform correctly. All expired and non-expired masks should be evaluated before use taking these steps:

  • Visually inspect the N95 to determine if its integrity has been compromised
  • Check all components such as straps, nose bridge, and nose foam to ensure they did not degrade
  • If the integrity of any part of the respirator is compromised (and a seal check cannot be performed) do not use and discard the respirator
  • Upon donning a mask, always immediately perform a seal check with any FFR mask

While the CDC and NIOSH understand the current challenges with PPE they suggest that you refer to the webpage titled “Strategies for Optimizing the Supply of N95 Respirators” at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/respirators-strategy/index.html

Many questions are arising about Personal Protective Equipment (PPE) particularly how to use it, the differences between types of masks, fit testing, reuse, making masks and shortages in the face of the COVID-19 pandemic. BETA has assembled some information and resources to help guide you during this time.

Can I make a mask?

Yes, a respirator mask can be made using a 3D printer. According to engineer Rory Larson at Maker Mask, he is offering the first medically approved Computer Aided Design (CAD) for a 3D printed mask. The mask is called Maker Mask and is a respirator mask available to the government and the public free-of-charge via an open-source model. The Seattle Children’s Hospital is now using the mask after testing for fit, breathability, and comfort. The 3D printing design is provided free of charge and will enable organizations such as government, universities, community colleges and any organization with a 3D printer to produce a respirator mask. The 3D production cost is about $2.00 to $3.00 per unit. For more information on how to get the design visit www.makermask.com. You can also view a demonstration at https://youtu.be/MgBNaB5LTh4. The CDC also has a webpage titled “FAQs on 3D Printing of Medical Devices, Accessories, Components, and Parts During the COVID-19 Pandemic” for more information and guidance on efficacy of use. https://www.fda.gov/medical-devices/3d-printing-medical-devices/faqs-3d-printing-medical-devices-accessories-components-and-parts-during-covid-19-pandemic

Emergency Paid Sick Leave and Emergency Family and Medical Leave Expansion under Families First Coronavirus Response Act (FFCRA)

The U.S. Department of Labor (DOL) has issued temporary regulations implementing the emergency paid sick leave and FMLA expansion provisions of FFCRA. You can read the DOL’s FAQs – including FAQ # 56 on the exemption for hospitals and other health care employers – at https://www.dol.gov/agencies/whd/pandemic/ffcra-questions. Information about the COVID-19-Related Tax Credits for Required Paid Leave can be found here: https://www.irs.gov/newsroom/covid-19-related-tax-credits-for-required-paid-leave-provided-by-small-and-midsize-businesses-faqs. Additional resources and commentary are being published by the California Hospital Association (CHA), the Society for Human Resource Management (SHRM), and the State of California Department of Industrial Relations (DIR).

In the wake of the COVID-19 outbreak, facilities and physician are offering visits and providing consultation via Telehealth. Telehealth specifically applies to video interactions and the interchange of data via Facetime, Skype, Zoom, etc. It does not apply to strictly telephonic (audio only) conversations or consultations. In audio-only situations, providers are dispensing medical advice, not Telehealth as it is defined in California. Important to consider from a risk perspective is – where is the provider located and where is the patient located. If they are not in California, reach out to your BETA Risk Manager or Underwriter for information and guidance.

Physicians are moving from the ED to inpatient settings as well as retired physicians are coming out of retirement to volunteer during this COVID-19 situation. For volunteering physicians, is their license active? Do they plan to assist for more than 5 days? If planning to volunteer for more than 5 days, contact your broker or BETA to ensure that medical malpractice coverage is extended (coverage is available for up to 30 days due to the state of emergency and can be added on a case-by-case basis).

Facilities are moving to share space (and sometimes resources) during this unprecedented COVID-19 situation. If a facility is considering such an arrangement, key risk considerations revolve around how much is going to be shared? It is just the space itself?  Are personnel going to be shared? Is the space to house COVID-19 patients or are there other patients too? Who is staffing and how are they trained? Reach out to your BETA Risk Manager for information and guidance specific to your particular situation.

COVID-19 Resource Links: Protecting Patients and Your Workforce

AAFP: Checklist to Prepare Physician Offices for COVID-19

https://www.aafp.org/dam/AAFP/documents/patient_care/public_health/COVID-19%20Office%20Prep%20Checklist.pdf

American College of Obstetricians and Gynecologists: Practice Advisory - COVID-19

                  https://bit.ly/2DApa5E

American Academy of Pediatrics: Management of Infants Born to Mothers with COVID-19

                   https://bit.ly/3ibz64R

American Society for Healthcare Risk Management (ASHRM) Resources Page

https://www.ashrm.org/resources-novel-coronavirus-covid-19

ASA: Joint Statement: Roadmap for Resuming Elective Surgeries (COVID-19)

                  https://bit.ly/2YUTEIm

CA.gov: CA Surgeon General's Playbook: Stress Relief During COVID-19 (PDF)

                https://bit.ly/3fwtEZC

CA.gov: Resources for Emotional Support and Wellbeing

        https://bit.ly/35h3Iww

CA Announcement: Guidance Related to Non-Discrimination in Medical Treatment for Novel Coronavirus (COVID-19)

https://bit.ly/3dNVOP6

California Department of Health Care Services - Suicide Prevention: Provider Letter with Tools and Resources

                  https://bit.ly/3fNk3NU

Cal OSHA: Interim Guidance for Protecting Healthcare Workers from Exposure to Coronavirus Disease (COVID-19)

https://www.dir.ca.gov/dosh/coronavirus/COVID-19-Interim-Guide-for-Hospital-Workers.html

CDC: COVID-19 Cleaning and Disinfection for Non-Emergency Transport Vehicles

                   https://bit.ly/3bhEwIz

CDC: COVID-19 Communication Resources

https://www.cdc.gov/coronavirus/2019-ncov/communication/index.html

CDC: COVID-19 Conserving and Extending Respirators for Nonhealthcare Sectors

                  https://bit.ly/3eu8qLn

CDC: COVID-19 Resources for Clinics and Healthcare Facilities

https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/index.html

CDC: Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 (Interim Guidance)

https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/hcp-return-work.html

CDC: How COVID-19 Spreads

                  https://bit.ly/2HlA7tW

CDC: How to Fit and Remove a Disposable Respirator

https://www.cdc.gov/niosh/docs/2010-133/pdfs/2010-133.pdf

CDC: Keeping the Workplace Safe (PDF)

https://www.cdc.gov/coronavirus/2019-ncov/downloads/workplace-school-and-home-guidance.pdf

CDC: Updated Infection Control Guidance for Healthcare Settings

                 https://bit.ly/3btWmIt

CDC: U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with COVID-19

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

CHA: Coronavirus Response: One-Stop Shop for Guidance, Updates, Info

https://www.calhospital.org/coronavirus

CMA: COVID-19 Frequently Asked Questions and Resources

https://www.cmadocs.org/covid-19/faq

CMA: COVID-19 Physician Volunteer Form

https://docs.google.com/forms/d/e/1FAIpQLScEe87iBRFYyI62AUamy1a0TQ0Cjv42PlBqzXwxmFEaqmGyEw/viewform

         CMQCC and CPQCC: COVID-19 Resources for Maternal and Infant Health

                   https://caperinatalprograms.org/

         CMA: COVID-19 Telehealth Toolkit for Medical Practices

https://bit.ly/2xCAPhW

ECRI: COVID-19 Resource Center for Healthcare

                    https://bit.ly/33PucVv

EEOC: What You Should Know About the ADA, the Rehabilitation Act and COVID-19

https://www.eeoc.gov/wysk/what-you-should-know-about-covid-19-and-ada-rehabilitation-act-and-other-eeo-laws

FDA: Updated Guidance on N95, KN-95 Respirators, Surgical Masks and Face Masks

                   https://bit.ly/2MSuWRz

Federal OSHA: COVID-19 Resources

https://www.osha.gov/SLTC/covid-19/

Federal OSHA: Ten Steps All Workplaces Can Take to Reduce Risk of Exposure to Coronavirus (Poster available in 12 languages)

                  https://www.osha.gov/pls/publications/publication.html

Federal OSHA: COVID-19 Respirator Use - Wearing and Removing a Respirator (Video)

                  https://www.youtube.com/watch?v=oU4stQgCtV8

Federal OSHA: Respiratory Fit Testing (Video)

https://www.osha.gov/video/respiratory_protection/fittesting.html

Federal OSHA: Recording Workplace Exposures to COVID-19

https://www.osha.gov/SLTC/covid-19/standards.html

National Association for Homecare and Hospice Resources

https://www.nahc.org/resources-services/coronavirus-resources/

Relias COVID-19 Training Resources and Publications

https://www.relias.com/topic/coronavirus

SHRM: Coronavirus and COVID-19 Resources (Communicating with Employees, FMLA, more)

https://bit.ly/2QIYKCL

The Joint Commission COVID-19 Guidance and Resources

https://www.jointcommission.org/covid-19/

University of Washington COVID 19 Policies and Protocols Resource Site

                https://covid-19.uwmedicine.org/Pages/default.aspx

University of Washington Top 10 Things Hospital IT Departments Can Do in Response to COVID-19

https://www.beckershospitalreview.com/healthcare-information-technology/uw-medicine-top-10-things-hospital-it-departments-can-do-in-response-to-covid-19.html

COVID-19 Workers’ Comp Compensability Info and Resources

Care for the Caregiver Webinar (Replay)

Crisis Standards of Care Webinar (Replay)

Archived Webinars

  • Click here to view archived COVID-19 relevant webinars.

Pearls of Positivity

BETA Healthcare Group celebrates its members who are experiencing "Pearls of Positivity" in the face of the COVID-19 outbreak. The first spotlight is on Torrance Memorial Medical Center and the heroes sign outside their facility.

Resources

Contact Us

If you have questions related to COVID-19, please contact us at riskmgmt@betahg.com.

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