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前4月全国房地产开发投资2.54万亿

Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 聚氨酯防水涂料等产品抽查合格率不到80% (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

南京人才安居房已筹建24万平方米

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.

Her piece, titled “Back to Mother Nature," depicts an elaborate water-cleaning machine. Zhang worked with a team of artists at Google to animate her drawing.
愿你一切称心如意,快乐无比。
别了,《广告狂人》(Mad Men)。别了,那些追踪每集情节(更重要的是,每集服装)的博客和粉丝网站。
美国的排放量在经过了最近几年的持续下降后,提高了2.9%。
今年选秀中还有很多选秀权交换的情况,有湖人给费城的前三保护的选秀权,有孟菲斯给丹佛的前五保护的选秀权,还有那个无耻的萨克拉门托给芝加哥的前十保护的选秀权(然而费城球队会控局的,他们的前总经理山姆-辛基会来复仇的)。
5. 生活就像一个茶几,上面摆满了杯具和餐具。(杯具是“悲剧”的同音词,餐具是“惨剧”的同音词。)
“有个员工在公司网站上发帖称自己辞职了。”

When researchers at the University of Illinois set out to create a device that identifies chemicals by their scent, they didn't settle for the sensitivity of the human nose. Instead, they created an artificial nose that uses the smell of bacteria to identify and diagnose specific diseases.
So the messaging apps have gotten creative. Tango, for example, inserts ads within a user’s messaging “inbox.” WeChat, a popular Chinese app that is owned by Tencent, makes money through games, stickers (which are similar to emojis), and mobile commerce. Kik offers a feature that some are calling “chatvertising,” where users hold conversations with chat-bots powered by brands like Funny or Die and Moviefone.
What the government will do in 2017
10.电脑系统分析师
超级大碗

Footnotes

  • 央行调查报告:52%居民认为房价高 难以接受
  • With both the S&P 500 and Nasdaq returning over 14% while the Dow and MidCap 400 each kicking in close to 10%, you would assume that passive investors would have an awful lot to celebrate this year. And indeed, they would have, if it weren’t for those pesky overseas stocks that did nothing but drag on the performance of any diversified portfolio.

全球肥胖率上升的前因后果。
This includes McKinsey, the consultancy that kick-started its secretive leadership election process in October with a gathering of more than 500 senior partners at the Grosvenor House Hotel in London. The next stage involves the firm’s 550 senior partners voting on a shortlist of candidates to replace Dominic Barton — the incumbent since 2009 — in January, followed by a run-off between the two most popular candidates in February.
加快培育壮大新兴产业。
杨燕绥主任说道:“养老保险实际抚养比到了3:1的时候,养老保险的费率就不能低于17%,如果降到2:1,每个人就得承担25%,抚养比越低,个人承担就越来越重。两年内必须解决养老金制度的转型。”
['steitm?nt]
The awards, announced during a ceremony in Amsterdam on March 14, are based on millions of international passenger surveys.

建筑卫生陶瓷产业急需转型升级

References

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