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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 建材行业如何化解品牌难题 (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

智装18融合高端沙龙本月18日在京举行

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.

一位伦敦软件神童的“硅谷梦”成真,雅虎(Yahoo)斥资近3000万美元收购了他制作的新闻应用。
Other high points for the school include being first for alumni international mobility, second for international experience and third for job placement.
几家与韩国有关系的机构已经感受到了北京方面对萨德计划的怒火。上个月,由于乐天(Lotte)出让土地用于部署萨德平台,中国官方新闻机构新华社(Xinhua)向乐天发出了强硬警告。乐天是韩国最大的企业之一。
Paddington 2
联合国世界知识产权组织(WIPO)、英士国际商学院和美国康奈尔大学联合发布的年度报告显示,全球第二大经济体正在赶追创新领域那些传统的领先者。目前,第一集团主要是由瑞士、瑞典、英国和美国引领。
New York's inactivity begs two questions. Does Jackson have the energy needed to undo the damage he's created during his tenure?
5) I’ve Got Your Back: We’ve all made big mistakes. In those times, step in with a reassurance: “I’m not judging you. You’re going to get through this. You’re not alone. We’ll figure this out together. It’s going to be OK.”

该剧因为爱情戏份太多,对周莹奋斗的故事描写太少而受到批评,其豆瓣评分为7.2分。
Such borrowing is predicated in part on the assumption that by decontextualizing a style you also strip it of any possible negative implications: military, dynastic, what have you. It becomes an aesthetic form that exists on its own terms, as opposed to one that symbolizes all sorts of complicated societal or political convulsions.
SIZE: 5,003 square feet total
China Mobile, supply chain rumors are emerging about Apple’s next significant product releases. Digitimes reports that according to “sources from the upstream supply chain, ” Apple is planning to release a 5-inch iPhone 6 “phablet” this coming May and a large tablet in October.
复仇史诗电影《荒野猎人》获评剧情类最佳影片。小李子和导演伊纳里图一同上台领奖。

Footnotes

  • 工业4.0之下,会出现百亿级的家居企业吗?
  • 《法律与秩序:特殊受害者》(Law & Order: SVU):NBC频道的这部电视剧上一季中的危机仿佛是从肥皂剧中搬来,发生了各种大事,奥利维亚(Olivia,玛莉丝卡·哈吉塔[(Mariska Hargitay]饰)经历了许多危险——喜欢跟踪的变态强奸犯,折磨人的婚外恋,新生婴儿,现在这一切终于平息下来。在今年的第16季中,侦探们回到了重要的性犯罪上,其中一集的灵感来自雷·赖斯(Ray Rice),讲述的是从监控录像中看到一个著名体育广播员殴打自己的妻子。

他还贴出了一张自己看着一群种族多元化儿童的图片。
欧盟正明确表现出,它希望利用美国在贸易上领导力的空缺来敲定新的贸易协议。欧盟在拉丁美洲与南方共同市场(Mercosur)的谈判时断时续,已经进行了10多年。但欧盟和阿根廷等南方共同市场的关键成员国正推动在今年年底前达成一项协议。这将成为一项重要声明,正好杵在美国的后院内。
4. HHhH
Foreign robot makers sold 103,191 robots to China in 2017, up 71.9% from a year earlier.
只有两个人知道奥斯卡奖获奖名单,他们负责审计整个流程,这两个人就是PwC公司的税务顾问玛莎?瑞兹和会计师布莱恩?卡利南。
Two days ago here in Brazil, we were shocked when we spent some time with some children living on the streets. And this is what one child told us: "I wish I was rich and if I were, I would give all the street children food, clothes, medicine, shelter and love and affection." 在巴西,我被2天前见到的情景震惊了,那时我和当地的小孩在玩耍,其中一个小孩说:“我希望我能富裕起来,然后我会给这个街道所有的小孩饭吃,给他们衣服穿,医疗,住房和爱”。

南京二手房交易量三连降 挂牌价持续走高

References

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