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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 乐山中盛陶瓷负债2.2亿 欲重组新公司 (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

唐山对重点行业停限减排 涉VOCs排放不达标一律停产

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.

'I just want to stay professional. I don't want them to think I'm a fangirl. I'm one of the performers and I'm not just a background dancer, I'm the dancer.'
[.s?:kju'lein]
福布斯表示,如果不扣除管理费和税费,在2015年6月1日到2016年6月1日期间,全球收入最高的10位女星共入账2.05亿美元。
dis离开,course跑,课程-离开课程需要毕业演讲
自从2013年以来,前世界第一的泰格·伍兹没有赢过一次锦标赛,由于处于背部手术康复期,他也错过了去年的大部分比赛。但是,单单是泰格·伍兹的名号就能够使他赚得盆满钵满了。通过为耐克和泰特利斯等品牌代言,泰格·伍兹去年赚了3100万英镑,位居榜单第12位。
accurate
然而专家却在西方当前的乱象之下看到一种白人身份危机。

A new MIT white paper, ominously entitled "Are You Prepared for the Supply Chain Talent Crisis?," bears that out. Supply chain managers need sophisticated tech skills, sure, but they also have to be adept at "high-order diplomacy," expert at general business strategy and problem solving, and able to "thrive in ambiguity," the study says.
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Barney Thompson is legal correspondent
Turkey’s ministers have been rallying Turkish expat communities across Europe to win support for Erdogan-backed constitutional changes, which will be voted on in a referendum next month.
《静待黎明》

Footnotes

  • 安徽省工商局抽查网售装饰建材商品 九成合格
  • "All I got was an extra hour on the bus to work, but I can't get a seat at the stadium," she said as she directed cars toward a mall's parking garage in Rio's wealthy southern zone.

威尔·史密斯早年成名,那是上世纪80年代末90年代初,他做嘻哈组合"DJ爵士杰夫&活力王子"的后期成员时。然而,虽然他赚得盆满钵盈,却不善于管理金钱。这真是个老掉牙的故事。名望、金钱扑面而来;却没有远见,空有一堆玩物,最终导致超支。对财产的监管意识与责任感的缺失,让他从富有的顶峰一下跌到破产的边缘。没落之后,他欠政府的退缴税一直没能偿还。
The U.S. has fallen to become Germany's third largest trading partner in 2016.
Rafael Corrales, a partner at Charles River Ventures, believes that the growth in a wide range of fields—from academia to infrastructure to policy—is a sign that 2014 was the biggest year bitcoin has had yet, despite its volatility. “In the short-term, that’s an easy knock from people who don’t understand or believe it can be something,” he says. “It’s the easiest thing for them to go after. In that transition stage, you’re going to have extreme volatility, so looking at its value over one year is kind of silly.” As for occasional hacks, he adds, “There are going to be bumps in the short term, but they’ll be solved sooner than later. And these things are being addressed by a huge community of people. So you have to be really excited, despite small bumps.”
卢彦说,该工程也包括建造连结北京市中心与通州的基础设施建设、下水道与污水处理和建造能源设备。随着建设环球影城主题公园和国家大剧院的训练设施的落成,文化工程将会提供更多的就业机会。
In 2018, more business leaders will channel a potent combination of digitalisation, generational change and growing diversity, to streamline their hierarchies, distribute responsibility, and transform their organisations.
之所以会出现这一较低读数,是因为产量因素出现了下跌——尽管前瞻性新订单因素连续第6个月上升。

房租异常上涨意味着房价拐点临近

References

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