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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 化解房价泡沫化风险如何避免“越调越高”? (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

建材家具商难言之痛:“7日网购后悔权”

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.

年龄:45岁
否则,就应该交易考辛斯还有在过去的两个赛季里签下的其他的老将了。
Dachis says: Starbucks is a perennial top-performer in social and 2012 was no exception. The company’s social savvy earned it 19 million new fans and followers in 2012 and its push into at-home and on-the-go products gave all those people something fun to talk about.
位于华盛顿特区的乔治敦大学(Georgetown University)麦克多诺商学院(McDonough business school)重新回到了定制课程排行榜的第15位,去年,该校因客户调查反馈率低而未上榜。只有3所学校是首次登上定制课程排行榜,包括排名第60位的伦敦卡斯商学院(Cass Business School)。
今年伊始,我们曾担心特朗普准备退出世贸组织(WTO)。这种情况并未发生。如今这也不太可能在短时间内发生。
保险代理人员也增加了93.62万人,总人数逾560万人。
●"Florida man dies in meth-lab explosion after lighting farts on fire"

美国人:对于你们来说,干脆装成是加拿大人好了。英国人很难判断你们之间的区别,这样你们就可以避免卷入到关于死刑的尴尬谈话中了。
Despite China's rise, an "innovation divide" persists between developed and developing countries amid increasing awareness among policymakers that fostering innovation is crucial to a vibrant, competitive economy.
舞厅上面有一个可以旋转,发出五颜六色的光的球-ballroom
“He’s had more of a sense of swagger and confidence” in recent months, says Jan Dawson of Jackdaw Research.
Sarah Collins

Footnotes

  • 卫浴行业新一轮涨价潮来袭
  • 在发达国家低利率和中国对大宗商品旺盛需求助燃下实现的多年增长被认为正在结束,导致国际清算银行(BIS)的经济学家警告,随着借贷成本上升,将会出现负面溢出效应。

国家统计局在发布最新数据的同时进行了解读,它将PPI连续上涨部分归因于煤炭开采和洗选业价格同比上涨15.4%,这一涨幅比上月扩大11.3个百分点。
You might think that our love of lists could be pinned on the Ten Commandments, but Umberto Eco says otherwise. “The list is the origin of the culture,” he once said on a subject he knows well, having written a book titled “The Infinity of Lists.” And culture wants “to make infinity comprehensible” and “to create order — not always, but often,” hence Homer’s catalogs in “The Iliad” and the roll call of never-completed household chores on my fridge. “We like lists because we don’t want to die,” Mr. Eco also said, which is the best explanation of the listicle that I’ve yet read.
[di'pɑ:t]
● “奥巴马签署行政令禁止学校读效忠宣言”
WTF.1: Next Level of Working Moms
优秀老板看起来都会拥有的一个关键是:他们都是解决问题的高手。他们不仅能够发现问题,并能头脑风暴出成功创新的方法来解决问题。

我国对美国多晶硅再开反补贴罚单

References

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