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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 十年新房价格涨281% 投资客买房为何空置不出租 (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

2月 返乡置业“春节来袭”

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.

While the real Rain Man never counted cards, his mental abilities were just as unbelievable. Kim Peek was a uniquely talented savant who possessed a nearly perfect memory. Among his many skills, Peek memorized every road on the map, the composers and dates of countless songs, and incredibly detailed historic facts. After Rain Man, he spent his life touring the country and campaigning for the disabled, to the delight of many who were able to witness his unique gift in person.
9. Ambrose Akinmusire “the imagined savior is far easier to paint” (Blue Note) The trumpeter Ambrose Akinmusire imbued his second Blue Note album with the searching, genre-fluid sound of today, enlisting singer-singers and a string quartet. His social commentary feels even more urgent and stinging now than it did when the album was released.
荷兰合作银行是面向全球农户和农业企业的领先融资机构。
单词corporate 联想记忆:
Best Luxury Brand: Porsche
榜单的前20名中,除了排名第四的复旦大学和第六名的北京大学这两所综合类高校之外,其余席位多被财经类和理工类高校占据。
立场:呼吁结束政府停摆局面

好莱坞的明星们早已着手准备了数周,尤其是对于去当地南瓜地挑选一些南瓜这样的事来说。
不错,2014年完全是一场灾难,只等着引爆。在《年内股市崩盘的概率有多大?》(Doomsday poll: 87% risk of stock crash by year-end)一文中,我们分析了今年年初以来的10大崩盘征兆。之后,我们又不断发现了更多新的妖魔。它们有如嘀嗒作响的定时炸弹,来自国会、最高法院、性问题、碳排放、石油巨头、国家安全局(NSA)、国税局(IRS)、茶党式财政紧缩。接踵而至,让人无法招架。
It is the first time in the rankings’ 19-year history that two schools have between them held the top two spots in both categories.
经济大萧条在全美各地产生了破坏性的影响,然而很少有地区像亚利桑那州那样遭受重创。20世纪初,该州借助强大的旅游业和房地产市场蓬勃发展。住房中位数价格在2003年到2006年间上涨了70%——仅次于内华达州的增幅——带动了更多的房屋和建筑行业工作岗位。直到2007年接近年底的时候,亚利桑那州的月失业率都一直维持在3.5%的低水平。但是随后经济陷入低谷。住房价格从相比高点惨遭腰斩,亚利桑那州6%的房产在2009年收到了止赎通知。在2009年和2010年的大部分时间里,该州的失业率保持在两位数居高不下,从最近五年的失业率情况看,恶劣程度仅次于内华达州。2008年以来,该州的家庭收入以全美最快的速度下降。
During last year's LFW, there were 250 anti-fur protesters, The Guardian reported, and a show in February saw an activist storm the stage at a Mary Katrantzou show.

Footnotes

  • 楼市冰火两重天 下一步何去何从
  • 为什么这么说呢?只需想想最高法院对同性婚姻问题做出裁决之后人们越来越强烈的怒火,想想人们围绕堕胎、奥巴马医改、枪支管制、食品券、共和党州长新推的选民压制等问题越来越强烈的怒火,另外还有保守派和茶党顽固不化,力争推翻一切立法并加强财政紧缩。

4. “Carol” This is the first movie that Todd Haynes directed that doesn’t have his name on it as a writer. Working from Phyllis Nagy’s distillation of the Patricia Highsmith novel, he reaffirmed that filmmakers don’t need to generate their own screenplays to be great, a truth many aspiring and established auteurs disregard.
有人将一杯滚烫的咖啡洒在了求职者身上。
7. Love is like two people holding two ends of a rubber band: it’s always the one who doesn’t let go who gets hurt more.
第三个枪手,Amedy Coulibaly,在周五袭击了一家犹太超市,没有出国接受过培训,Valls说。
中国教育部体卫艺司司长、中国足球协会副主席王登峰表示,足球专家们正在为小学和初中设计超过360种训练项目。
Other high points for the school include being first for alumni international mobility, second for international experience and third for job placement.

三安、勤上等LED企业“搅局” 可见光通信或形成亿万级年产值

References

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