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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 北京市启动集中整治“大棚房”违法项目 (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

监管继续趋严,地产商城投平台境外发债受限

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.

‘Unfortunately, while the newest episode may be a fantastic addition to the Star Wars franchise, ‘starwars’ is a dangerous password to use,’ said Morgan Slain, CEO of SplashData, Inc.
3.9 全面加强政府自身建设
美国航天局(Nasa)表示,2015年气温以0.13摄氏度之差,打破了2014年创下的记录。
China’s forex reserves — the world’s largest — have long been seen as the ultimate guarantor of financial stability, since they can be used to hedge against capital flight or to bail out domestic financial institutions struggling with a rise in bad debts.
在过去三年里,夏威夷航空公司的航班延误率只有6.92%,几乎是排名第二的阿拉斯加航空公司的一半——这家公司的航班延误率达到11.27%。
马来西亚怡保——怡保位于吉隆坡北部约200公里处,从前是英国的殖民地,如今却是美食家的天堂,那里既有当地路边小吃,也有精致的咖啡馆。
10.超敏感电子皮肤

6年来第一次,新的挑战者领衔英国《金融时报》高管MBA(EMBA)课程排行榜。
While the WeChat use of the "post-90s" generation has slightly decreased, from 94.1 percent to 86.6 percent.
vt. 买,购买
Jobs for photographers grew by about 22 percent in Q3. The report’s authors attribute the increase to employers “finally understanding the importance of high-quality pictures on their landing pages.” The desire to expand and improve websites through employing trained, creative professionals was something of a recurring theme throughout this list.
Inflation for consumers, meanwhile, ticked up slightly to 1.5 per cent, versus a five-year low of 1.4 per cent in November.

Footnotes

  • 为了解决农村“空心化” 鼓励剩余人口向中心村转移
  • I expect more companies to develop leaders who know how to manage networks — not just the traditional internal network of employees, but more loosely connected webs of suppliers and contractors, managed remotely via the internet and social media.

Celebritites always seem to have a better life than the rest of us;nicer house,cooler cars and even cuter children.Just look at these pictures of Shiloh Jolie-
我经常和陌生人说话
1.Rain Man
译者:清远
据高部长称,在“十三五”计划期间,中国在与“一带一路”的国家形成优势互补的跨国产业链、价值链的同时,还将持续大力改善投资环境,充分挖掘市场潜力。
该调查发现,211和985重点建设高校毕业生的薪酬水平大幅度领先普通高校毕业生。

北京二套房贷未现收紧 最低首付5成仍是主流

References

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