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Testing Strategy for Coronavirus (COVID-19) in High-Density Critical Infrastructure Workplaces after a COVID-19 Case Is Identified




Workers in critical infrastructure sectors may be permitted to work if asymptomatic after potential exposure to a confirmed case of coronavirus disease 2019 (COVID-19), provided that worker infection prevention recommendations and controls are implemented. Outbreaks of illness among workers in food-producing facilities and surrounding communities have raised unique questions that identified the need for testing for COVID-19 to supplement existing guidance. This document presents different testing strategy options for exposed co-workers when public health organizations and employers determine testing is needed to help support existing disease control measures. Such strategies can aid in identifying infectious individuals with the goal of reducing transmission of SARS-CoV-2 in the workplace. These strategies augment and do not replace existing guidance.

SARS-CoV-2, the virus that causes COVID-19, is primarily spread from person to person through respiratory droplets. Workers in high-density settings in which workers are in the workplace for long time periods (e.g., for 8-12 hours per shift), and have prolonged close contact (within 6 feet for 15 minutes or more) with coworkers may be at increased risk for exposure to SARS-CoV-2. A close contact is defined in existing Public Health Recommendations for Community-Related Exposure. Other distinctive factors that may increase risk for transmission among these workers include: sharing transportation such as ride-share vans or shuttle vehicles, car-pools, and public transportation; frequent contact with fellow workers in community settings in areas where there is ongoing community transmission; and shared or congregate housing such as dormitories. Workers include, but are not limited to, all employees, contractors, and others who perform work at the facility or worksite. Early experience from COVID-19 outbreaks in a variety of settings suggests that when symptomatic workers with COVID-19 are identified, there are often asymptomatic or pre-symptomatic workers with SARS-CoV-2 present at the workplace. Testing is important to identify such individuals, as they may not know they are infected. SARS-CoV-2 transmission from asymptomatic or pre-symptomatic persons can result in additional cases and potentially outbreaks of COVID-19. Implementing screening for symptoms of COVID-19, testing, and contact tracingpdf icon may be used to detect infected workers earlier and exclude them from the workplace, thus preventing disease transmission and subsequent outbreaks.[13]

Critical infrastructure employers have an obligation to manage the continuation of work in a way that best protects the health of their workers and the general public. Appropriate workplace protections, such as engineering and administrative controls, for those present in the workplace should remain in place. Examples of these controls can be found in existing guidance for Meat and Poultry Processing Workers and Employers, and for Manufacturing Workers and Employers and other critical infrastructure guidancepdf iconexternal icon. Screening1 workers and others entering the workplace for symptoms of COVID-19 and body temperature is a critical component of preventing transmission and protecting workers. Workplaces should review and follow existing guidance. Workers who are symptomatic upon arrival at work, or who become sick during the day, should immediately be separated from others. They should be sent to their home or a health care facility, as appropriate, and referred for further evaluation and testing in consultation with the state, territorial, or local health departments or through occupational health providers.

After a COVID-19 case is identified, testing strategies of exposed co-workers may be considered to help prevent disease spread, to identify the scope and magnitude of SARS-CoV-2 infection, and to inform additional prevention and control efforts that might be needed.

Viral (nucleic acid or antigen) testing should be used to diagnose acute infection.

Two kinds of tests are available for COVID-19: (1) viral tests to detect current infections, and (2) antibody tests to identify previous infections. CDC provides an overview of categories of people for SARS-CoV-2 testing with viral tests (i.e., nucleic acid or antigen tests). Viral testing can be used to inform actions necessary to keep SARS-CoV-2 out of the workplace, detect COVID-19 cases quickly, and stop transmission. Testing practices should aim for rapid turnaround times in order to facilitate effective action. Viral testing detects infection at the time the sample is collected; very early infection at the time of sample collection or exposure (e.g., workplace or community) after sample collection can result in undetected infection. Testing at different points in time, also referred to as serial testing, may be more likely to detect acute infection among workers with repeat exposures than testing done at a single point in time.

At the current time, antibody test results should not be used to diagnose someone with an active SARS-CoV-2 infection. Refer to the CDC website for additional information regarding testing for COVID-19 and specimen collection.

Considerations for use of a testing strategy for COVID-19 infection:

  1. A testing strategy should only be implemented if results will lead to specific actions.
    • When a confirmed case of COVID-19 is identified, interviewing and testing potentially exposed co-workers should occur as soon as possible to reduce the risk of further workplace transmission.
  2. A comprehensive approach to reducing transmission is recommended. Positive test results indicate the need for exclusion from work and isolation at home.
    • When workers are living in close quarters, such as people who share a small apartment, or people who live in the same household with large or extended families with ongoing risk of close contact exposures to COVID-19, alternative housing may be considered.
    • Decisions about whether workers with COVID-19 should be directed to alternate housing sites should be made in coordination with local or state public health authorities. Discontinuation of isolation for persons with COVID-19 and work exclusions may follow either a symptom-based strategy or test-based strategy in consultation with a healthcare provider.
  3. A risk-based approach to testing co-workers of a person with confirmed COVID-19 may be applied. Such an approach should take into consideration the likelihood of exposure, which is affected by the characteristics of the workplace and the results of contact investigations (see Figurepdf icon). Examining facility and operations work records, conducting walk-throughs, and employee interviews may aid in categorizing co-workers into the three tiers of testing priority. Prioritization should be done quickly so that testing of co-workers is not delayed. Additionally, if ongoing screening for symptomatic workers or contact tracing identifies additional workers who test positive, the algorithm outlined below should be applied to their contactspdf icon.
    • Tier 1 is the highest priority for testing of exposed co-workers. Because individuals with COVID-19 may be infectious prior to symptom onset [2,4], contact tracing and baseline testing should include co-workers who were exposed to a worker with confirmed COVID-19, beginning 2 days before the individual with COVID-19 became symptomatic (or, for asymptomatic workers, 2 days prior to specimen collection) until the time of isolation. Exposure includes:
      1. Those who are identified as close contacts through case investigation and contact tracingpdf icon evaluating proximity and length of contact of co-workers with the individual with COVID-19. If the decision is made to test all co-workers in the same area on the same shift, then contact tracing can just focus on other potential close contacts, for example those who specifically mention eating lunch together, coworkers who carpool, or reside in the same home.
      2. Co-workers who work during the same shift or overlapping shifts, in the same area, for example on the same line and same room, as one or more of the workers with COVID-19 based on the employer’s assessment of risk in the workplace, such as the layout and size of the room, the design and implementation of engineering controls, adherence to administrative controls2, and movement of workers within the area.
    • Tier 2 is the next highest priority tier for testing. Tier 2 includes workers on the same shift, but in a different area of the facility or operation who may have had an exposure to a worker with confirmed COVID-19. Testing may be extended to workers in Tier 2 based on results from contact tracing or based on the employer’s assessment of risk in the workplace. If additional COVID-19 cases are identified, then reassessment of the tier and testing would be indicated. Some facilities and workplaces may simultaneously implement Tier 1 and Tier 2 testing. This would include testing all exposed workers on the same shift as the worker(s) with confirmed COVID-19, regardless of area of the facility.
    • Tier 3 includes workers not in Tiers 1 or 2. Tier 3 includes workers who shared a common space (e.g. a rest room, break room) and therefore exposure to worker(s) with confirmed COVID-19 cannot be definitively ruled out. Tier 3 also includes workers who generally work a different shift than the worker(s) with confirmed COVID-19 but exposure cannot be excluded based on the potential for overlap in work time from back-to-back shifts. Testing may be extended to workers in Tier 3 based on contact tracing or on the employer’s concern about overall risk of COVID-19 in the workplace. Some facilities and workplaces may elect to include testing of co-workers in Tier 3 from the outset. For example, high rates of COVID-19 transmission in the surrounding community may prompt employers to test more broadly. Note that if test results from Tier 1 or Tier 2 testing indicate infection among workers in multiple areas of the facility, including some cases among workers who worked on multiple shifts, then testing may need to be expanded accordingly.
  4. Implementation of testing strategies can supplement measures to reduce transmission in the workplace, provided other protections are in place to protect worker health while keeping the workplace open. If employers elect to conduct facility-wide testing, multiple asymptomatic workers with SARS-CoV-2 infection may be identified. Employers should have a plan for meeting staffing needs while these persons are out of the workplace per COVID-19 Critical Infrastructure Sector Response Planning. Of note, CDC’s critical infrastructure guidance provides exceptions to current home quarantine practices after an exposure to COVID-19. Current guidance advises that employers may permit workers who have had an exposure to COVID-19, but who do not have symptoms, to continue to work, provided they adhere to additional safety precautions, such as measuring the employee’s temperature and assessing for symptoms of COVID-19 before each work shift (“pre-screening”), asking the employee to self-monitor for symptoms during their work shift, and asking the employee to wear a cloth face covering while they are in the workplace. A testing strategy should enhance existing disease prevention measures by augmenting ability to detect infection among asymptomatic or pre-symptomatic workers. For all these strategies, waiting for test results prior to returning to work is preferred to keep infected workers out of the workplace.
    • Workers in Tier 1, who have close contact with or exposure to a co-worker with confirmed COVID-19 should be tested and quarantined as soon as possible to reduce the risk of further workplace transmission. Workers should follow existing guidance regarding self-monitoring by checking their temperature twice daily and watching for symptoms. Strategies with differing levels of risk of workplace transmission may be considered for exposed but asymptomatic critical infrastructure workers in Tier 1 to return to work with appropriate workplace protections. Strategies involving serial testing (e.g., testing at baseline and Day 3 vs. testing only at baseline) are more likely to identify infected workers than testing at a single point in time. In selecting a strategy, employers should consider which strategy appropriately balances maintaining operations with worker safety. Strategy 3 should only be considered during critical staffing shortages.
      • Strategy 1: The strategy is for exposed workers in Tier 1 to follow existing recommendations regarding exclusion from work. These workers are excluded from work and quarantined for 14 days, based upon the incubation period, even if their baseline test results are negative. This strategy reliably excludes workers who are exposed and may become infected, limiting infection of others in the workplace.
      • Strategy 2: The strategy is a test-based option for returning to work earlier than 14 days after an exposure for workers in Tier 1. This includes baseline testing and serial testing (i.e. re-testing) every 3 days until there are no more new cases detected in the Tier 1 cohort. Individual workers in Tier 1 who remain asymptomatic and have negative tests at baseline and Day 3 can return to work and should continue to be tested every 3 days after returning to work until there are no more new cases in the worker cohort. With this strategy some workers who are infected and return to work may begin to shed virus after Day 3. Infection in these workers could be missed without serial testing resulting in potential workplace transmission. Workers who test positive or become symptomatic during quarantine or after returning from work should be excluded from the workplace, as discussed above.
      • Strategy 3: During critical staffing shortages, another strategy to facilitate early return to work is to allow asymptomatic workers in Tier 1 to return to work after a baseline test is obtained. Under this strategy, it is recommended that return to work would follow a negative test result, but could occur while results were pending, provided other protections are in place. In this case, this worker cohort should continue to be tested every 3 days after returning to work until there are no more new cases. Workers who test positive or become symptomatic should be excluded from the workplace, as discussed above.
    • Workers in Tier 2 and Tier 3: Screening for symptoms should continue for workers in Tiers 2 and 3. Baseline testing may be considered for these workers based on the employer’s assessment of exposure risk in the workplace or a positive symptom screen. They can continue to work provided they remain asymptomatic and, if tested, their test is negative.
  5. Which organizations perform the testing may vary among jurisdictions and may include the public health department, an employee health clinic, a healthcare provider engaged by the employer, or local health care facilities.
    • Symptom screening, testing, and contact tracing must be carried out in a way that protects confidentiality and privacy, to the extent possible, and is consistent with applicable laws and regulations. To prevent stigma and discrimination in the workplace, make employee health screenings as private as possible. Follow guidance from the Equal Employment Opportunity Commissionexternal icon regarding confidentiality of medical records from health checks.
      Symptom screening upon entry to the workplace should be designed so that the screening process is conducted in as private a manner as possible, without a worker’s personal information being overheard or communicated inappropriately at any time. Because OSHA’s Access to Employee Exposure and Medical Records standard (29 CFR § 1910.1020external icon) requires that covered employers retain medical records for the duration of employment plus 30 years, consider the burdens and benefits of documenting individually identifiable results of entry screenings. Healthcare providers that are covered entitiesexternal icon under the Health Insurance Portability and Accountability Act (HIPAA) must abide by HIPAA rules. Due to the “direct threatexternal icon” posed by COVID-19 to co-workers, healthcare providers who test workers for COVID-19 as described in this guidance should notify employers of tested workers’ fitness for duty, workplace restrictions (e.g., restrictions on ability to enter the worksite, limitation to telework, etc.), and the need for contact tracing of other workers deemed to be in close contact, even if this might allow employers to surmise that employees might have COVID-19. However, providers should not share employees’ test results or diagnoses with employers without employees’ permission, even though at entry screening, employers may ask all employees who will be physically entering the workplace if they have COVID-19external icon, or symptoms associated with COVID-19, or ask if they have been tested for SARS-CoV-2.
    • Providers should report and explain test results to workers and notify the state, territorial, tribal, or local health department of cases in a timely fashion. When employers become aware of cases, the Recording and Reporting Occupational Injuries and Illnesses standard (29 CFR part 1904external icon), may require certain employers to keep a record of serious work related injuries and illnessesexternal icon including work related COVID-19external icon.
    • Contact tracing, whether performed by a health department or a healthcare provider engaged by the employer, should be carried out in a way that protects the confidentiality and privacy of an employee with COVID-19, or a SARS-CoV-2 positive test, to the degree possible.
  6. Ensure that sick leave policies are flexible and consistent with public health guidance and that employees are aware of and understand these policies. Maintain flexible policies that permit employees to stay home to care for a sick family member or take care of children due to school and childcare closures. Additional flexibilities might include giving advances on future sick leave and allowing employees to donate sick leave to each other. Employers that do not currently offer sick leave to some or all of their employees should consider drafting non-punitive “emergency sick leave” policies.


1Employers should evaluate the burdens and benefits of recording workers’ temperatures or asking them to complete written questionnaires.  These types of written products can become records that must be retained for the duration of the workers’ employment plus 30 years. See OSHA’s Access to Employee Exposure and Medical Records standard (29 CFR § 1910.1020).

2At this time, differential determination of close contact for those using fabric face coverings is not recommended per CDC guidancepdf icon.


  1. Treibel, T.A., et al., COVID-19: PCR screening of asymptomatic health-care workers at London hospital. The Lancet, 2020. 395(10237): p. 1608-1610.
  2. Dora, A.V., et al., Universal and Serial Laboratory Testing for SARS-CoV-2 at a Long-Term Care Skilled Nursing Facility for Veterans – Los Angeles, California, 2020. MMWR Morb Mortal Wkly Rep, 2020. 69(21): p. 651-655.
  3. Moriarty, L.F., et al., Public Health Responses to COVID-19 Outbreaks on Cruise Ships – Worldwide, February-March 2020. MMWR Morb Mortal Wkly Rep, 2020. 69(12): p. 347-352.
  4. He, X., et al., Temporal dynamics in viral shedding and transmissibility of COVID-19. Nat Med, 2020.

Note:  This document is intended to provide guidance on the appropriate use of testing and does not dictate the determination of payment decisions or insurance coverage of such testing, except as may be otherwise referenced (or prescribed) by another entity or federal or state agency.



Singapore Organizations Adopt AI, ML Amid COVID-19 Induced Uncertainties




Amid the COVID-19 pandemic, Singapore businesses are turning to artificial intelligence (AI) and machine learning (ML) to manage consumer credit risk and deal with economic uncertainties, according to a new research by information services company Experian.

Experian, which surveyed 3,000 consumers and 900 executives working in retail banking, e-commerce, consumer technology and telecommunications, found that COVID-19 has accelerated adoption of digital solutions.

Singapore organizations in particular are embracing AI and ML at a much faster pace than their international peers, with 78% of organizations already using AI to cope with today’s marketplace unpredictability while 79% are leveraging ML. These are higher than the global figure of 69%.

S&P Global Ratings estimates that Asia Pacific (APAC) financial institutions will be hit with US$1.4 trillion in additional nonperforming assets and additional credit costs of about US$440 million as risks associated with COVID-19 and market volatility take hold.

Against this backdrop, 25% of Singapore-based respondents are planning to use on-demand cloud-based decisioning applications, policy rules (25%) and automated decision management (24%) to help them effectively determine which consumers can be safely given extended credit. Over the next 12 months, 69% will be allocating resources towards building their analytics capabilities to assess customer creditworthiness, the survey found.

Online shopping and e-commerce on the rise

Singaporean businesses’ willingness to invest in and adopt digital solutions comes at a time when consumers are demanding better digital-first experiences. A research conducted in June by market research consultancy Blackbox and survey firm Toluna found that while consumers spent more online during the pandemic, about four in ten Singaporeans said they were not satisfied with their e-commerce experience, noting that delivery costs, product prices and delivery time could be better improved.

That being said, global marketing research firm Nielsen expects the penetration of users venturing into e-commerce to continue to rise. Nielsen’s COVID-19 dipstick in March 2020 found that 69% of Singaporean people surveyed who bought household goods online for the first time during COVID-19 will do so again in the next 12 months.

Similarly, Standard Chartered, which polled 12,000 consumers across 12 markets in August 2020, found that, amid COVID-19, Singaporean consumers that prefer online purchases to in-person card or cash payments increased to 50%, up from 35% before the pandemic.

Changing spending habits

Globally, the COVID-19 crisis and its ramifications have disrupted markets and deteriorated the health and economic welfare of consumers. In Singapore, 23% of respondents still face challenges in paying credit card bills, while 20% are encountering difficulties paying their utility bills, the Experian research found. This has prompted many consumers to rethink their spending habits, shifting to essentials and cutting back on most discretionary categories.

In Singapore, consumers are taking steps to manage these financial challenges by reducing their expenditure on non-essentials (22%), saving more (22%), and starting a personal budget (17%), the study found.

According to the Standard Chartered survey, consumers in the city-state are spending about 15-52% more on groceries, digital devices and healthcare, but spend less on clothes, experiences and travel or holidays.

Almost eight in ten respondents in Singapore said they would like to be better at managing their finances, and six in ten said the pandemic has made them more likely to track their spending. Most of the respondents are either user or interested in using budgeting as well as finance tracking tools.

Jeremy Soo, head of consumer banking at DBS Bank, told Fintech News Singapore in September, that, amid COVID-19, people were starting financial planning earlier. Since the bank launched its new digital financial planning tool, NAV Planner, back in April, over one million customers had used it, Soo said.

Featured Image: Pexels

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Nitric oxide as a potential treatment for the SARS-CoV-2 coronavirus




nitric oxide coronavirus

Researchers explore the potential antiviral effects of nitric oxide against the coronavirus responsible for the COVID-19 pandemic.

As the world continues to grapple with the COVID-19 pandemic caused by the SARS-CoV-2 coronavirus, scientists all over the world are racing to find a safe and effective vaccine or treatment. The speed and severity of the SARS-CoV-2 coronavirus’s spread around the world has placed an urgent need for an effective therapy. Unfortunately, to date, there are still no effective therapies for preventing an infection with the virus infection or for treating COVID-19.

Nitric oxide (NO) is a naturally occurring compound that is also produced in the body known to have a wide range of antimicrobial activity against bacteria, fungi, and viruses among other things. Previously, nitric oxide has been shown as an effective agent against SARS-CoV (the coronavirus responsible for the 2003 epidemic of severe acute respiratory syndrome – SARS) in lab cell studies and in a small clinical trial involving inhalation of the compound. During the SARS outbreak, nitric oxide was given as an inhaled gas to treat SARS patients with success, particularly because of nitric oxide’s ability to decrease lung inflammation in these patients. The success seen in previous studies with nitric oxide against the SARS coronavirus suggests the potential for similar success against SARS-CoV-2.

In a recent study published in Redox Biology, scientists in Sweden explored nitric oxide’s potential as a treatment against the coronavirus in laboratory cell studies. The scientists specifically focused on examining the antiviral effects nitric oxide had on cells infected with SARS-CoV-2. They found that nitric oxide inhibited the replication of SARS-CoV-2 in infected cells in a dose dependent manner, proving that nitric oxide possesses antiviral effects on the novel SARS-CoV-2 coronavirus, in a manner likely similar to its antiviral effects against SARS-CoV. The scientists also identified a potential target – SARS-CoV-2 main protease – for future therapeutic developments, including nitric oxide.

While this present study highlights the antiviral potential of nitric oxide on the SARS-CoV-2 coronavirus, there is much more research to be investigated and studied before any recommendations on the clinical use of nitric oxide in patients diagnosed with COVID-19 can be made. The researchers’ next steps are to study whether the antiviral benefits of nitric oxide as seen in this present study are the same when it is inhaled as a gas.

Written by Maggie Leung, PharmD


Akaberi, D., Krambrich, J., Ling, J., Luni, C., Hedenstierna, G., Järhult, J. D., . . . Lundkvist, Å. (2020). Mitigation of the replication of SARS-CoV-2 by nitric oxide in vitro. Redox Biology, 37, 101734. doi:10.1016/j.redox.2020.101734

Nitric oxide a possible treatment for COVID-19. (2020, October 2). Retrieved from

Image by visuals3Dde from Pixabay 


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Air Travel High: TSA Screens 1 Million For First Time Since March




Passengers enter a checkpoint at O’Hare International Airport on Monday. The TSA reports it screened over 1 million passengers on Sunday, the highest number since the coronavirus crisis began. Scott Olson/Getty Images hide caption

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Scott Olson/Getty Images

How’s this for an October surprise? Despite a significant rise in COVID-19 cases in many parts of the country, it appears that more people are flying on commercial jetliners than at any time over the last seven months.

More than one million people were screened by the Transportation Security Administration at airport security checkpoints Sunday. It’s the first time the TSA’s daily traveler count has topped the one million mark since March 16.

And this wasn’t just a one-day surge in air travel. The TSA’s daily throughput figure has topped 900,000 eight times already this month, and the TSA reports that the 6.1 million people passing through U.S. airport checkpoints between Oct. 12 and Oct. 18 was the greatest weekly traveler volume measured since the start of the pandemic.

But experts say there is a lot of pent-up demand for air travel and it’s important to note that despite the modest increase, the number of people flying is still down more than 60% from the 2.6 million who flew on the same October Sunday last year.

Still, it’s a bit of good news at a time the nation’s airlines are burning through tens of millions of dollars a day and reporting huge financial losses due to the coronavirus pandemic. Delta and United both reported last week that they lost billions in the third quarter, as fewer people than expected dared to get onto airplanes in July, August and September. American and Southwest report their third-quarter results later this week, but are also expected to show billions in losses after many would be passengers canceled summer travel plans or drove to their destinations instead of flying.

The industry group Airlines for America says airlines are in desperate need for additional federal coronavirus relief, as they are collectively losing $5 billion a month.

Last year and into January and February of this year, airlines were setting passenger volume records. The TSA reported screening between 2.5 and 2.7 million people on the busiest travel days, which are usually Fridays and Sundays. But as the coronavirus outbreak spiked last March, companies halted business travel and millions canceled vacations and weekend getaways.

By mid-April, the number of travelers passing through security checkpoints plummeted to under 100,000, a decline of 96%. Other than the days after the terrorist attacks on Sept. 11, 2001, the group Airlines for America says there hadn’t been that few people flying since the dawn of the jet airplane age in the 1950s.

There were short-lived upticks in air travel demand in early summer, especially around the Memorial Day and Fourth of July holiday weekends. But the number of COVID-19 cases spiked after each holiday, especially in parts of the country that rushed to reopen bars, restaurants and other gathering places. Lingering concerns about spreading the viral illness dampened demand for air travel during the later summer months.

As welcome as this month’s surprising rise in air travel is, there is still a lot of uncertainty over whether the trend will continue, especially heading into the Thanksgiving and Christmas holiday season, which is usually a busy air travel period.

Most airlines have significantly reduced their schedules as demand remains weak, and some have suspended service to smaller cities. In late September, bookings for travel in November were just a fraction of last year’s level, according to the airline data firm OAG.

And with what appears to be a new wave of COVID-19 cases surging, especially in the Midwest, several states are setting records for the daily number of infections being reported. Public health officials in many states are urging residents to stay home to celebrate the holidays in small family groups.

“COVID-19 has changed the way we work, live, and play, and will now change how we plan to celebrate the holidays,” said Illinois Public Health Director Dr. Ngozi Ezike, who added that “the safest way to celebrate is with members of your household and connecting with others virtually.”


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