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2018年我国城镇新增就业1361万人

Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 2015年1-11月顺德家具出口达69.8亿元 (Published 14 August 2020) Cite this as: BMJ 2020;370:m3181

Read our latest coverage of the coronavirus outbreak

  1. Shamil Haroon, clinical lecturer in primary care1,
  2. Joht Singh Chandan, academic clinical fellow in public health12,
  3. John Middleton, president3,
  4. Kar Keung Cheng, professor of public health and primary care1
  1. 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  2. 2Warwick Medical School, University of Warwick, Coventry, UK
  3. 3Association of Schools of Public Health in the European Region (ASPHER)
  1. Correspondence to: S Haroon s.haroon{at}bham.ac.uk

楼市调整产业地产迎发展 资本布局智慧产业园区

The UK is one of the countries most severely affected by covid-19. Recent outbreaks in English towns such as Oldham, probably involving transmission within large multigenerational households, show the importance of getting the right public health measures in place now to prevent more widespread surges in infections.1

Current test and trace policies have mainly focused on preventing spread in care homes, hospitals, and in the community.2 However, contact within households is thought to be responsible for roughly 70% of SARS-CoV-2 transmission when widespread community control measures are in place.3 In Wuhan, the reproduction number (R) dropped from 3.54 to 1.18 after lockdown and cordon sanitaire. But the epidemic was only brought under complete control when Fangcang (field) hospitals were introduced to isolate cases outside the home, with R dropping to 0.51 after two weeks.4

Current UK guidance advises household contacts to isolate within the same home as the index case for 14 days.5 They make up the majority of contacts for infected individuals and are likely to remain exposed to the infected household member during this period of isolation.6 Despite guidance advising household members to socially distance, contacts are likely to interact repeatedly—during mealtimes, for example—and to share facilities such as bathrooms.

We know that transmission is more likely to occur indoors than outdoors.7 The cumulative risk to household contacts from an infected person is likely to be substantial during peak viral shedding. In one study in New York State, 38% of household contacts tested positive for SARS-Cov-2, and similar secondary infection rates have been reported in China.89 Transmission may be even higher among household contacts of essential workers, who are at greater risk of being infected than the general population.10

Household members who are older, have underlying medical conditions, or share a bed or vehicle with the index case are the most susceptible.91112 Children seem to be at lower risk of being infected.13 However, their stool samples and nasopharyngeal swabs can remain positive for SARS-CoV-2 for more than two weeks after symptom resolution,14 although their role in transmission remains to be established.

Governments should consider new public health measures to prevent household transmission as we prepare for a potential second wave. Household quarantine is likely to remain an important pandemic control measure, and government support for people quarantined at home is conspicuously absent in the UK: this position has been challenged by independent experts.15

Effective isolation

Effective isolation of index cases from household members could reduce secondary infections.12 Wearing masks within quarantined households may help, particularly if used by the index case as soon as infection is suspected.16 The World Health Organization recommends that infected people and unavoidable close contacts, particularly those in vulnerable groups, should wear medical masks, but Public Health England does not currently recommend this. Other measures that should be considered (and evaluated) include clear advice on enhanced personal hygiene; cleaning and disinfecting shared toilets and other common spaces, door handles, and touch points; and staggering mealtimes.

People who are unable to self-isolate safely at home could be accommodated in special isolation facilities such as hotels and hostels, an approach adopted by some other countries, including Italy, Finland, and Lithuania.17 In China, field hospitals were created to manage and strictly isolate patients with mild-to-moderate covid-19.18 Nightingale hospitals in the UK could be similarly repurposed to support isolation of infected people with mild-to-moderate disease. As medical and nursing care needs are mostly modest, the cost would be relatively low. However, such a system depends on access to rapid testing for anyone with symptoms or possible exposure so that infection can be confirmed and isolation started before transmission occurs. It would also require public trust that isolation in these facilities would be voluntary, safe, and supportive.

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最佳歌曲:
昨天,中国一次控制爆破让19栋楼在10秒钟之内被夷平。
Investigators have arrested one youth and one 18-year-old in connection to the July 9th shooting.
"The average salary level of employees grew by about 6.3 percent year on year in the first three quarters of last year, while China's annual GDP growth stood at 6.7 percent in 2016, both slowing from a year earlier," Jin added.
这部20世纪70年代黑色幽默犯罪电影的主角,是诈骗高手欧文·罗森菲尔德和他的情妇西德尼·普鲁塞尔,他们被一名联邦调查局(FBI)干员抓获,然后被迫欺骗腐败的政治家。二人继续与干员、政治家目标以及自己的家人周旋,最终达成豁免协议,得以不受任何刑事指控就脱离苦海。

However, its alumni are the most mobile internationally, with 85 per cent of the class of 2014 having worked abroad.
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Potus v Korus
康涅狄格州斯托宁顿(STONINGTON, CONN.)
这种增长为中国电影业未来的发展奠定了坚实的基础。

Footnotes

  • 一边需求广泛一边有利可图 群租房困局待破题
  • adj. 最初的,原始的,有独创性的,原版的

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It's lightweight and rolls up easily for travel.
6. "How I Met Your Mother" (3.0 million)
“尽管我本质上是一名工程师和分析人员,但迄今为止我所做过的最重要的决定都与此无关,它们永远是基于直觉,”他去年在曾就读MBA的杜克大学(Duke University)对一名采访者表示。
Umbrellas for dogs are having a moment. They’re cute and funny, but also practical.

习近平:国企一定要改革,抱残守缺不行

References

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