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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 精装修“失宠”透视楼市变局 (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

最新房价出炉 楼市现重要信号 看你家是涨是跌?

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.

他做出了不从事企业战略工作的战略性转变,尽管他自己的学校曾经建议他别从事教育方面的职业,虽然他担任过私人教师。
在《星球大战:原力觉醒》后,迪士尼影业和卢卡斯影业承诺每年冬天推出一部星球大战系列电影,都将围绕原来的主题展开。
"Everywhere I go business owners are seeing an increase in demand," said Gus Faucher, senior economist at PNC Financial Services. "Businesses will have to raise wages to attract or maintain workers."
New construction will provide luxury options for renters with deep pockets, mostly in the boroughs outside Manhattan. In Brooklyn, 6,527 new rental units are expected to hit the rental market next year, nearly twice the 3,802 units anticipated for Manhattan, according to Citi Habitats.
1、死侍
And this year, the Nobel Prize has defied the convention of celebrating big by presenting the biggest prizes to discoveries on the smallest scales.
“Even if you have made your peace with a Fed rate rise there are other reasons to be nervous,” said David Hauner, head of emerging markets at Bank of America Merrill Lynch, who points to falling oil prices and the slowdown in China to illustrate why market volatility measured by the CBOE’s Vix index, a barometer of investor sentiment, has been elevated since August.

eccentric
2年前中国股市突破6000点,而2010年股市能否重拾失地呢?当初中国股市行情十分被看好,但今天,如果你问同样的问题,有的人会拿全球经济说事儿——因为全球经济仍旧步履艰难。
The awards returned Ms. Lawrence, a winner last year for Russell's 'Silver Linings Playbook,' to the stage for an acceptance speech-something she said was no easier a year later.
卓越雇主排名:7
?Women fall for him because he's exciting to be around and this plays a much larger part in a relationship than most think. It's the key to a great first date. Even the femme fatales assigned to kill Bond fall for him. But studies show this isn't surprising at all. 007's character has frequently been accused of being sexist. This is probably true -- and only serves to make him that much more attractive to the ladies.

Footnotes

  • 家居品牌假日促销常态化 商家不敢再玩“假促销”
  • 7、Bad body language habits

Although Facebook is blocked in China, Tencent has linked WeChat to Facebook, which means that users outside of China can use the service in conjunction with the world's most popular social network. That is a boon for WeChat in Southeast Asian countries like Indonesia, Thailand and the Philippines, which have large numbers of Facebook users. Tencent has offered WeChat in languages for all three markets.
Obama won the second to put himself back in the race. Although he also won the third, foreign policy is not a major concern for voters and it is unlikely to result in any major poll swings.
愿你一切称心如意,快乐无比。
3、美酒佳人。 邦德走到哪里喝到哪里,美酒的确能帮他俘获佳人。喜欢喝一杯的人最容易在第一次约会时就抱得美人归。
This one's just like looking in the mirror, mainly because Derrick Rose was in high school just six years ago in 2006.
[is't?bli?t]

中国首个绿色建材基金正式运营

References

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