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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 房企“期中”放榜 利润爆发式增长 (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

云南政协委员建议用水泥窑协同处理固废

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.

它有力地提醒我们,性革命、女性进入职场、消费主义的盛行以及太空时代都有阴暗的一面,有些人在其中受到了伤害。这是该剧具有强大影响力的一个原因。
EMBA-Global是排在前10名的项目中唯一一个毕业学员平均薪资同比略微下滑的项目(其他9个项目的毕业学员平均薪资都出现强劲增长)。
"I don't know what happened," Lowry said. "I just know I got a call for offensive foul. It happens. It's the NBA. That's all I can say about it."
One more scientific group, in Britain, that curates the world’s temperature record is scheduled to report in the coming weeks.
金州勇士队的控球后卫史蒂芬·库里表示,自2013年开始,他每年都会前往中国,而中国的篮球迷也都非常支持他。
而相对来说,普遍推出的新限购政策,并未让其他许多最近几个月表现突出的城市受到影响,房价同比依然大幅上涨。
新上榜品牌有26个,其中前三名为乐视、安邦和东方财富,其中民营品牌占70%。小米品牌价值涨幅最大,其价值是去年五倍,为73亿美元,TCL和华为位居其后。

和普通女人一样,我也喜欢超短裙和超长裙——它们通常讨人喜欢,易于穿着。毫无疑问,这些裙子穿在梅根(Megan)和她的朋友们身上更是有力地提醒了我们。
[p?n'demik]
单词haven 联想记忆:
Best film and best director. Surprisingly, Nolan has never received a directing nomination from the Academy.
贷款的条件不仅仅只局限于裸照。同样被泄露的还有大量疑似借贷双方对话的屏幕截图,一个贷款人要求女学生提供自己的自慰视频。

Footnotes

  • 房产税焦虑如何缓解?学者:加快落实税收法定原则
  • n. [计]定序;排序;订购 v. 命令;指挥;订购(o

尽管俄罗斯假装把再平衡的重点转向亚洲,但是从其对乌克兰的做法可以看出,它仍然在权衡自己的力量以对抗西方,尤其是美国。
document
RSPCA South Australia chief inspector Andrea Lewis said it was a "heartbreaking" case for staff.
祝你享尽新年佳节的快乐和新年的礼品。
In an explanation released alongside the latest data, the statistics bureau credited ongoing growth in producer prices in part to coal extraction and washing prices, up 15.4 per cent for the period and accelerating 11.3 percentage points from a month earlier.
But the crash hit. The economy tanked. The recession lasted 30 months. Wall Street lost over $8 trillion of our retirement money. In the first decade of the 21st century, from the 2000 dot-com crash till 2010 disaster Wall Street's had a negative inflation-adjusted performance. Today Wall Street's returns are just barely beating inflation. No wonder investors feel cheated by Wall Street's casinos.

专家称若效果不明显 未来或将连续出现几次降息

References

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