Organised ‘overkill’: China shows off rapid lockdown system after latest outbreak

BEIJING (Reuters) – Days after a 17-year-old girl tested positive for COVID-19 in a remote part of western China last week, health authorities said they had tested over 4.7 million people in the region.

FILE PHOTO: Chinese Foreign Ministry spokesman Wang Wenbin speaks during a news conference in Beijing, China July 27, 2020. REUTERS/Tingshu Wang

China’s strict formula of immediate lockdowns and mass testing even at the first signs of infection has been vital to its success in controlling the disease, allowing its economy to quickly recover from the crisis, officials say.

The highly orchestrated strategy – described as “overkill” even by its own proponents – is unique among major economies at a time when Europe and the United States are facing a massive surge of new cases and often chaotic policies.

At the time the girl was diagnosed, the Kashgar region of Xinjiang had reported no new cases for almost 70 days.

“China has taken the most comprehensive, strictest and most thorough control and prevention measures since the COVID-19 pandemic started,” foreign ministry spokesman Wang Wenbin said on Wednesday.

“The facts show China’s measures are effective.”

Key to the programme are factors unique to China, including the Communist Party’s tight grip on all aspects of society.

Authorities have unimpeded access to personal information as part of an expansive surveillance network, which has played a major role in tracing infections.

The government has also quickly enlisted the help of businesses, which are churning out tens of millions of test kits, and tightly controls their pricing and distribution, issues which have severely set back efforts to contain the disease in other countries.

China has reported just 2,382 cases since June. By contrast, Germany and France are set to follow Italy and Spain back into partial lockdowns, as Europe reported a record 230,000 cases in one day earlier this week, while U.S. cases are set to hit 9 million soon.

MASS TESTINGS

In August, Beijing ordered all major hospitals in the country to offer testing, and said there should be one urban testing base constructed for every million residents, with the capacity to scale up to 30,000 tests a day in a local outbreak.

Regions are also required to share resources, in sharp contrast to the early days of the outbreak, when several cities were accused of stealing equipment from each other.

The system, like all Chinese Communist blueprints, is highly structured around specific targets; testing teams should be able to complete a campaign within seven days.

Earlier this month, almost 11 million test results were delivered in around five days in the eastern port city of Qingdao. In Wuhan, the initial epicentre of the pandemic, over 9 million samples were taken over 10 days in May.

The mass testings are mandatory. Some are held in outdoor sporting venues and city parks, with hundreds of people lining up.

PUTTING PEOPLE AT EASE

Epidemiologists have called into question the efficacy of the mass testing events, noting some patients require multiple tests over time

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FBI warns ransomware assault threatens US health care system

BOSTON (AP) — Federal agencies warned that cybercriminals could unleash a wave of data-scrambling extortion attempts against the U.S. health care system, an effort that, if successful, could paralyze hospital information systems just as nationwide cases of COVID-19 are spiking.

In a joint alert Wednesday, the FBI and two federal agencies said they had credible information of “an increased and imminent cybercrime threat” to U.S. hospitals and health care providers. The alert said malicious groups are targeting the sector with attacks aiming for “data theft and disruption of healthcare services.”

The impact of the expected attack wave is difficult to assess.


It involves a particular strain of ransomware, which scrambles a target’s data into gibberish until they pay up. Previous such attacks on health care facilities have impeded care and, in one case in Germany, led to the death of a patient, but such consequences are still rare.

The federal warning itself could help stave off the worst consequences, either by leading hospitals to take additional precautions or by expanding efforts to knock down the systems cybercriminals use to launch such attacks.

The offensive coincides with the U.S. presidential election, although there is no immediate indication the cybercriminals involved are motivated by anything but profit. The federal alert was co-authored by the Department of Homeland Security and the Department of Health and Human Services.

Independent security experts say the ransomware, called Ryuk, has already impacted at least five U.S. hospitals this week and could potentially affect hundreds more. Four health care institutions have been reported hit by ransomware so far this week, three belonging to the St. Lawrence Health System in upstate New York and the Sky Lakes Medical Center in Klamath Falls, Oregon.

Sky Lakes acknowledged the ransomware attack in an online statement, saying it had no evidence that patient information was compromised. It said emergency and urgent care “remain available.”

The St. Lawrence system also acknowledged a Tuesday ransomware attack, noting in a statement released Thursday that no patient or employee data appeared to have been accessed or compromised. Matthew Denner, the emergency services director for St. Lawrence County, told the Adirondack Daily Enterprise that the hospital owner instructed the county to divert ambulances from two of the affected hospitals for a few hours Tuesday. The company did not return requests for comment on that report.

Alex Holden, CEO of Hold Security, which has been closely tracking Ryuk for more than a year, said the attack could be unprecedented in magnitude for the U.S. In a statement, Charles Carmakal, chief technical officer of the security firm Mandiant, said the cyberthreat could be the “most significant” the country has ever seen.

The U.S. has seen a plague of ransomware over the past 18 months or so, with major cities from Baltimore to Atlanta hit and local governments and schools walloped especially hard.

In September, a ransomware attack hobbled all 250 U.S. facilities of the hospital chain Universal Health Services, forcing doctors and nurses to rely on paper and pencil

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FBI warns ransomware assault threatens US healthcare system

BOSTON (AP) — Federal agencies warned that cybercriminals are unleashing a wave of data-scrambling extortion attempts against the U.S. healthcare system designed to lock up hospital information systems, which could hurt patient care just as nationwide cases of COVID-19 are spiking.

In a joint alert Wednesday, the FBI and two federal agencies warned that they had “credible information of an increased and imminent cybercrime threat to U.S. hospitals and healthcare providers.” The alert said malicious groups are targeting the sector with attacks that produce “data theft and disruption of healthcare services.”

The cyberattacks involve ransomware, which scrambles data into gibberish that can only be unlocked with software keys provided once targets pay up. Independent security experts say it has already hobbled at least five U.S. hospitals this week, and could potentially impact hundreds more.

The offensive by a Russian-speaking criminal gang coincides with the U.S. presidential election, although there is no immediate indication they were motivated by anything but profit. “We are experiencing the most significant cyber security threat we’ve ever seen in the United States,” Charles Carmakal, chief technical officer of the cybersecurity firm Mandiant, said in a statement.

Alex Holden, CEO of Hold Security, which has been closely tracking the ransomware in question for more than a year, agreed that the unfolding offensive is unprecedented in magnitude for the U.S. given its timing in the heat of a contentions presidential election and the worst global pandemic in a century.

The federal alert was co-authored by the Department of Homeland Security and the Department of Health and Human Services.


The cybercriminals launching the attacks use a strain of ransomware known as Ryuk, which is seeded through a network of zombie computers called Trickbot that Microsoft began trying to counter earlier in October. U.S. Cyber Command has also reportedly taken action against Trickbot. While Microsoft has had considerable success knocking its command-and-control servers offline through legal action, analysts say criminals have still been finding ways to spread Ryuk.

The U.S. has seen a plague of ransomware over the past 18 months or so, with major cities from Baltimore to Atlanta hit and local governments and schools hit especially hard.

In September, a ransomware attack hobbled all 250 U.S. facilities of the hospital chain Universal Health Services, forcing doctors and nurses to rely on paper and pencil for record-keeping and slowing lab work. Employees described chaotic conditions impeding patient care, including mounting emergency room waits and the failure of wireless vital-signs monitoring equipment.

Also in September, the first known fatality related to ransomware occurred in Duesseldorf, Germany, when an IT system failure forced a critically ill patient to be routed to a hospital in another city.

Holden said he alerted federal law enforcement Friday after monitoring infection attempts at a number of hospitals, some of which may have beaten back infections. The FBI did not immediately respond to a request for comment.

He said the group was demanding ransoms well above $10 million per target and that criminals involved on the

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COVID rising in southwest Va.; health system issues warning

RICHMOND, Va. (AP) — Southwest Virginia is seeing a sustained, troubling increase in cases of COVID-19 driven partly by small family gatherings, the governor and top health officials said Wednesday, as one area health system issued a stark warning that its resources were being stretched thin.

“To be quite frank, today our region is in a really bad place in this pandemic,” said Jamie Swift, the chief infection prevention officer for Ballad Health, which serves southwest Virginia, as well as adjacent parts of Tennessee, North Carolina and Kentucky.

Gov. Ralph Northam said at a news conference in Richmond that Virginia overall is among just a handful of U.S. states not reporting large increases in COVID-19 cases. But the seven-day testing percent positivity rate in the region’s westernmost localities is about twice the rate of the rest of the state’s 5.1 % and has been increasing for 15 days, Northam said.

“I strongly urge everyone in the southwest — look at these numbers and step up your precautions,” Northam said.


The governor said there were no immediate plans to introduce new regional restrictions to reduce the spread of the virus, but he said such a move was a possibility if the numbers keep trending up.

Northam and Secretary of Health and Human Resources Dr. Daniel Carey said gatherings of extended family members not living in the same household were contributing to the spread. Virginia has so far reported nearly 177,000 cases of COVID-19 and just over 3,600 deaths since the start of the pandemic, according to health department data.

Dr. Karen Shelton, the director of a health department district that includes much of southwest Virginia, wrote in an email that other factors contributing to what she called a “surge” in cases included: outbreaks at churches, inconsistent mask wearing, in-person schooling, social gatherings of friends and coworkers, and relatively fewer people telecommuting due to less broadband access.

Shelton also said a surge in cases in neighboring Tennessee was contributing.

“Tennessee has fewer regulations and has had events, social gatherings, and sports. Friday night football has continued with fans gathering closely in stands without masks,” she wrote.

Swift, Ballad’s infection prevention officer, said at a news conference that it was “past time” for the area to change its behaviors.

The health system said it had seen a 43% increase in the cases across its region over the past week, 88.5% of its ICU beds were full, and it had 181 team members in quarantine or isolation.

“At this rate, we’re only going to be able to care for COVID-19 patients,” said Ballad’s Chief Operating Officer Eric Deaton.

Dane Poe, the administrator of Lee County, located in the furthest southwest tip of Virginia, said the county has been lucky so far to not have more than a few dozen cases requiring hospitalization. The county’s only hospital closed in 2013.

Still, having to be prepared for the additional hospital trips has further strained the six already-strapped volunteer agencies in the country that provide ambulance services,

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DentaQuest Partnership and 120 Industry Leaders Create New Framework For More Sustainable Oral Health System

Three Domain Framework is the future of dentistry

Boston, Oct. 26, 2020 (GLOBE NEWSWIRE) — Even as the COVID-19 pandemic exacerbates the nation’s broken oral health care system, it has created an opportunity for the industry to move toward a new, more sustainable model centered around the patient, primary care and prevention. The DentaQuest Partnership for Oral Health Advancement released a report today — based on the work of the Community Oral Health Transformation Initiative learning community — that establishes a primary care-like structure for oral health care delivery, facilitates value-based payment models and enables patients to invest in their own oral health.

120 of the industry’s most prominent organizations and leaders contributed to the development of the Three Domain Framework, which lays out a clear path for providers and practices to expand access to care, improve health outcomes and reduce the cost burdens associated with poor quality of life due to oral disease.

The framework gives patients and dental and medical providers the freedom to collaborate on treatment plans that work best for a given situation within the context of overall health. And it emphasizes patient and provider safety while addressing critical gaps in both patients’ access to care and providers’ financial viability.  

“Oral health is directly linked to overall health, but our current system doesn’t reflect that reality,” said Dr. Sean Boynes, vice president of health improvement for the DentaQuest Partnership for Oral Health Advancement. “And COVID-19 has shined a bright spotlight on this flaw. The Three Domain Framework outlines a new approach for oral health — one that focuses on prevention and healthy outcomes, facilitates value-based payment models, and will help address deep disparities in care and access. We are grateful to the many contributors who are working together to put our oral health system on a new and better path. This is the future of dentistry.”

The three domains can be adopted in any order, meaning the care team can determine where to begin. Providers can safely begin shifting their models of dentistry by starting in a domain that supports their unique needs and those of their patients. 

Domain One: Advancements in Teledentistry

The pandemic has increased interest in and utilization of teledentistry, but widespread adoption requires defining new treatment codes and rethinking the flow of care for a variety of dental visits. Domain One focuses on the identification, development and adoption of telehealth strategies and builds an accessible evidence-based virtual delivery approach specific to oral health that can enhance disease prevention and whole-person health.

Domain Two: Prioritization of Minimally Invasive Care

The pandemic also sparked interest in Minimally Invasive Care (MIC), as providers sought treatment methods, like sealants and silver diamine fluoride, that limit aerosols and the spread of COVID-19. MIC can reverse or slow early disease stages using a program of anticipatory guidance and collaborative decision-making with patients. Domain Two prioritizes the use of MIC for oral health management and maintenance.

Domain Three: Integration and Personalization of Oral Care Delivery

Domain Three

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Health Insurance Companies Working the System

Health Insurance Companies Working the System

PR Newswire

HUNTINGTON BEACH, Calif., Oct. 24, 2020

HUNTINGTON BEACH, Calif., Oct. 24, 2020 /PRNewswire/ — Many Californians are familiar with health insurance companies like Anthem Blue Cross, Blue Shield, Healthnet, Cigna or Aetna. We pay them a premium each month and expect that when we have a claim, they would do their part and cover us by paying our physicians and medical facilities. Although these are large companies, with many subscribers, COAST Surgery Center discovers that when they pay out their claims, they pay peanuts. How do they get away with that? Coast Surgery Center reveals their inside secret.

Coast Surgery Center (PRNewsfoto/Coast Surgery Center)
Coast Surgery Center (PRNewsfoto/Coast Surgery Center)

Since California law allows health insurers 40 days to accept or deny a claim, then allows them to notify patients every additional 30 days if they need more time, this allows for a loophole with no real deadline. So these insurers create a special department, which some call PPR (Pre-payment Plan Review), to intentionally delay payments by sending out general denial letters.  These letters provide auto-generated reasons like “incorrectly billed, missing signatures, missing documentation, or missing medical records,” in order to buy them time. They would give patients, doctors, and facilities the run-around and give excuses that may not even be relevant to the claim.

These large insurance companies pay lobbyists to help create laws that allow them loopholes to be able to get away with cheating their customers. Customers then purchase insurance policies that don’t even cover them when they need it. When customers get frustrated and demand the insurance to pay or want to ring the alarm, the insurance company then pays, but pays Medicare rate, instead of paying the Usual Customary Reasonable (UCR) or (RC) rates as they really should be. So medical providers and facilities get nearly nothing. This doesn’t make any sense when insurance premiums increase annually, and coverage keep decreasing.

California tax payers including patients, doctors, and facilities fund the Department of Insurance and the Department of Managed Healthcare (DMHC) so that they can ensure consumers of their healthcare rights and to protect consumers from being cheated. Yet these departments have either turned a blind eye towards these insurance companies or are not aware of their tactics. These Departments should be protecting consumers and investigate these insurance payout processes because they are working the system and using the loophole to scam customers of millions of dollars in premiums and paying out next to nothing or not at all. So instead of protecting the health insurance companies and letting them work the system, the Dept of Insurance and DMHC should be protecting patients.

If you are a patient, doctor or facility that have received notices from your insurance company or from a Pre-payment Plan Review department and have been struggling to get your claims paid, call COAST Surgery Center at 855-263-9968 and share with us your struggles.

Cision
Cision

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PM admits failings as England’s Covid contact-tracing system hits new low

Boris Johnson and his chief scientific adviser have admitted to failings in England’s £12bn test-and-trace system as contact-tracing fell to a new low and waiting times for test results soared to almost double the target.



a group of people walking down a street next to a car: Photograph: Adrian Dennis/AFP/Getty Images


© Provided by The Guardian
Photograph: Adrian Dennis/AFP/Getty Images

Under pressure to explain new figures showing less than 60% of close contacts being reached, while test turnaround times rose to nearly 48 hours, the prime minister said: “I share people’s frustrations and I understand totally why we do need to see faster turnaround times and we need to improve it.”

The system, designed to contain outbreaks by ensuring anyone exposed to the virus self-isolates, was helping “a bit”, Johnson added. “The thing depends on people self-isolating and breaking the transmission. It is helping a bit already to break the transmission. About 1m contacts have been reached. But there is more that it can do if everybody complies once they are contacted by NHS Test and Trace.”



a person riding on the back of a car: Workers at a drive-in Covid testing centre. In the week ending 14 October, 59.6% of close contacts were reached by test and trace.


© Photograph: Adrian Dennis/AFP/Getty Images
Workers at a drive-in Covid testing centre. In the week ending 14 October, 59.6% of close contacts were reached by test and trace.

Alongside him at a Downing Street press conference, Sir Patrick Vallance said problems with test and trace were in part inevitable as coronavirus cases rose in the second wave – but also a result of the system’s operation. They were “diminishing its effectiveness”, he said.

Another expert said test and trace was “struggling to make any difference to the pandemic”.

In the week ending 14 October, 59.6% of close contacts were reached, down from the previous week’s figure of 62.6%, which was the lowest since the test-and-trace operation was launched at the end of May.

Sage said in May that at least 80% of contacts must be reached for the system, described as “world-beating” by the government, to be effective. Documents published last week show Sage considers its success to be “marginal”.

In fact the true proportion of contacts of Covid patients reached is lower still: the latest report reveals 101,494 people tested positive but only 96,521 were transferred to the contact-tracing system, of whom just over 80% were reached and asked to provide information about their contacts. That means, overall, only 46% of close contacts were reached.

The latest performance statistics, published on Thursday, also showed Boris Johnson is further from delivering on his pledge that the results of all in-person tests will be returned within 24 hours.

The median time taken to receive a test result at regional sites rose to 45 hours, from 28 the previous week. Local test site result times increased to 47 hours from 29, and mobile test units rose to 41 hours from 26.

Vallance told a Downing Street press conference on Thursday: “It’s really important to concentrate on numbers of contacts [and] isolation as quickly as you can and getting things back as quickly as you can, ideally to get the whole process done within 48 hours. And it’s very clear there’s room

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What We Know So Far about How COVID Affects the Nervous System

Many of the symptoms experienced by people infected with SARS-CoV-2 involve the nervous system. Patients complain of headaches, muscle and joint pain, fatigue and “brain fog,” or loss of taste and smell—all of which can last from weeks to months after infection. In severe cases, COVID-19 can also lead to encephalitis or stroke. The virus has undeniable neurological effects. But the way it actually affects nerve cells still remains a bit of a mystery. Can immune system activation alone produce symptoms? Or does the novel coronavirus directly attack the nervous system?

Some studies—including a recent preprint paper examining mouse and human brain tissue—show evidence that SARS-CoV-2 can get into nerve cells and the brain. The question remains as to whether it does so routinely or only in the most severe cases. Once the immune system kicks into overdrive, the effects can be far-ranging, even leading immune cells to invade the brain, where they can wreak havoc.

Some neurological symptoms are far less serious yet seem, if anything, more perplexing. One symptom—or set of symptoms—that illustrates this puzzle and has gained increasing attention is an imprecise diagnosis called “brain fog.” Even after their main symptoms have abated, it is not uncommon for COVID-19 patients to experience memory loss, confusion and other mental fuzziness. What underlies these experiences is still unclear, although they may also stem from the body-wide inflammation that can go along with COVID-19. Many people, however, develop fatigue and brain fog that lasts for months even after a mild case that does not spur the immune system to rage out of control.

Another widespread symptom called anosmia, or loss of smell, might also originate from changes that happen without nerves themselves getting infected. Olfactory neurons, the cells that transmit odors to the brain, lack the primary docking site, or receptor, for SARS-CoV-2, and they do not seem to get infected. Researchers are still investigating how loss of smell might result from an interaction between the virus and another receptor on the olfactory neurons or from its contact with nonnerve cells that line the nose.

Experts say the virus need not make it inside neurons to cause some of the mysterious neurological symptoms now emerging from the disease. Many pain-related effects could arise from an attack on sensory neurons, the nerves that extend from the spinal cord throughout the body to gather information from the external environment or internal bodily processes. Researchers are now making headway in understanding how SARS-CoV-2 could hijack pain-sensing neurons, called nociceptors, to produce some of COVID-19’s hallmark symptoms.

Neuroscientist Theodore Price, who studies pain at the University of Texas at Dallas, took note of the symptoms reported in the early literature and cited by patients of his wife, a nurse practitioner who sees people with COVID remotely. Those symptoms include sore throat, headaches, body-wide muscle pain and severe cough. (The cough is triggered in part by sensory nerve cells in the lungs.)

Curiously, some patients report a loss of a particular sensation called chemethesis, which

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New Survey Reveals Physicians Support a Hybrid Health Care System

New Survey Reveals Physicians Support a Hybrid Health Care System

PR Newswire

BOSTON, Oct. 22, 2020

The Physicians Foundation Releases New Survey on the Future of the Health Care System

BOSTON, Oct. 22, 2020 /PRNewswire/ — The Physicians Foundation, a national nonprofit advancing the work of practicing physicians to support the delivery of high-quality patient care, today released the results of a national survey of 1,270 physicians on the future of the health care system. When asked to rank their preferences for the future direction of the U.S. health care system, physicians ranked a two-tiered system featuring a single payer option plus private pay as the best direction. As part of the same question, physicians overwhelmingly ranked a government funded and administered single payer/Medicare for All system lowest among four potential options. The survey, COVID-19 And The Future Of The Health Care System, is the third in the Foundation’s three-part series, 2020 Survey of America’s Physicians, examining how COVID-19 is affecting and is perceived by the nation’s physicians.

The Physicians Foundation Logo (PRNewsfoto/The Physicians Foundation)
The Physicians Foundation Logo (PRNewsfoto/The Physicians Foundation)

The survey also asked physicians to rank a series of policy steps that would ensure access to high-quality, cost-efficient care. Physicians overwhelmingly indicated that efforts to “simplify/streamline prior authorization for medical services and prescriptions” was the most important thing that could be done to ensure access to care. Reimbursing physicians for providing telemedicine services and simplifying access to integrated mental health services each were tied as the next most popular choices.

“As we’ve seen from our data over the past few months, COVID-19 has had a tremendous impact on physicians. We know that burnout continues to grow as a result of frustration with the pandemic and our current health care system, and you see that in this survey’s results,” said Gary Price, MD, president of The Physicians Foundation. “Physicians are fed up with being unable to practice medicine the way they were trained to do so. They are tired of fighting insurers and PBMs to get patients the treatments they need, and they want change. They want to be able to offer the services patients need and want.”

Direction of the Health Care System

While physicians’ overall preference is for a hybrid approach, their opinions on other options for organizing our system yielded significant insights. Most surprisingly, maintaining or improving the current Affordable Care Act (ACA) influenced program did not initially rank high, with only 19% selecting this as number one on the one to four scale. Instead, 30% of physicians (the second highest percentage) chose moving to a market-driven system with Health Savings Accounts (HSAs) and catastrophic policies as number one. It wasn’t until the next levels (two to four) were added that improving the current ACA system became more highly ranked (49%) than transitioning to a market-driven/HSA model (45%). The survey found significant polarity in support for HSAs: thirty percent of physicians rated it a number one, but 42% also rated it a four.

Support for a

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Irish COVID-19 ‘test and trace’ system overwhelmed by case surge

DUBLIN (Reuters) – Ireland’s system for tracing contacts of COVID-19 cases has been overwhelmed by a surge in cases forcing the health service in recent days to advise infected individuals to identify their own close contacts and tell them to get tested, officials said.

The government earlier this year hired hundreds of people to quickly contact those who test positive, identify people they had close contact with in the preceding days, and tell those people to self-isolate and get tested.

But a surge in infections that has almost tripled the five-day case average in Ireland since the start of October to just under 1,200 per day, meant there were no longer enough officials to make the necessary calls, the Health Service Executive said in an emailed statement on Wednesday.

“We have seen unprecedented demand on the contact tracing centres with the exponential growth in the number of cases and over the week we simply couldn’t get to everyone,” Niamh O’Beirne, national lead for testing and tracing, told RTE radio.

Most of those who were informed of infections on Friday, Saturday and Sunday will be asked to identify and contact their own close contacts and advise them to self-isolate and ask their doctors about arranging a free test, she said.

The Health Service Executive, which plans to add up to 800 people to its current staff of 400 contact tracers, said the normal system resumed for those informed of infections on Monday.

As a result of the surge in cases, Ireland on Monday imposed some of Europe’s toughest COVID-19 constraints, shutting non-essential retail outlets, closing restaurants and limiting non-essential travel.

Ireland on Tuesday had the 13th highest rate among the 31 countries monitored by the European Centre for Disease Prevention and Control, with 253 cases per 100,000 over the past 14 days.

(Reporting by Conor Humphries; Editing by Catherine Evans)

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