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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 定制家具或将成为下一个竞争点 (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

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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.

More than 27,000 vacancies are offered by over 120 central departments and their affiliated public institutions in the 2017 civil servant recruitment drive. The number of vacancies is about the same as 2016.
She only learnt to walk five months ago, but 'Baby Beyoncé' is already strutting her stuff on stage at pageants.
室内环境:这栋房屋在1848年前后建成,上次翻修是在2008年。房屋前门上方有一扇气窗,侧灯的红色玻璃上蚀刻有叶形花纹。屋内一楼有一间带有顶冠装饰板条和两座壁炉的大客厅,其中的一座壁炉给这间正式的餐厅区供暖。客厅外是一间家庭娱乐室,内有凸起的护壁板、一个带有水槽的吧台和另一处餐厅区。那扇法式双开门通往一处铺着石板的露台。有些房间可观赏小纳拉甘西特湾的景观。
My fellow trainer, Sylvia Guinan, made me aware of these rules that a husband has laid out for his wife to follow during the 2014 World Cup.
With all its eccentric beats and bubblegum, Number 1 Angel feels like the purest distillation of the U.K. star's pop brilliance, whether she's working with up-and-coming rapper Cupcakke on "Lipgloss" or collaborating with M? on "3AM (Pull Up)."
The image of a smooth-talking, chain-smoking and sexist James Bond may be a thing of the past as the latest 007 novel gives him a politically-correct makeover.
But what about the tens of thousands of Irish fans? They're out of control.

[?'s?u?ieit]
沪深300指数(CSI 300)包含了沪深两市交易的300支主要A股,其于2016年交易首日下跌7%,根据新推行的市场熔断机制,意味着当日股市交易已结束。
3. Flying Horse
Since April 2007, the value of the top 100 brands has increased by 106 per cent. That compares with a 61 per cent rise in the S&P 500 and growth of 21 per cent in the MSCI world index over the same period.
The Suicide Squad is scheduled for an August 5th 2016 release.

Footnotes

  • 发改委:城乡基础设施的互联互通贯穿城镇化各个阶段
  • A series of explosions on Aug. 12 that originated in a warehouse illegally storing hazardous chemicals in the port city of Tianjin killed 173 people, injured hundreds and left behind post-apocalyptic scenes of destruction. The blasts raised serious questions about the lax enforcement of safety regulations during China's rapid industrialization.

And second, while perceptions haven't changed much, the reality has: Making sure stuff gets where it needs to go, as cheaply and efficiently as possible, has evolved into a high-tech, high-stakes game that calls for a scarce combination of "hard" and "soft" skills.
美国就业市场笼罩着重重阴云──特别是遭遇增税、减支双重打击的可能性,即“财政悬崖”。[qh]
课程安排:每隔一个周末在芝加哥上课,共计大约18门课程,包括4门选修课。学员在芝加哥住校学习3周,在香港和伦敦分别学习1周。
拥抱世界
The companies that have tried — and so far failed — to create a sustained ETF boom in Asia say the need for wholesale reform suggests the market will be defined by a protracted effort to convince both the regulators and customers to redraw the scenery.
根据中国海关的数据,10月铁矿石进口量较上月环比下降12.3%,同比下降4.9%,而煤炭进口环比下降21.4%,同比下降30.7%。

投资不过山海关?东北民企如何跨跨越“三座大山”

References

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