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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 持续扩张 绿色家居市场规模今年将达694.4亿 (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

发改委:商品房待售面积已经连续10个月下降

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.

Economists say that both the residential and commercial markets in Hong Kong will be hurt by the same factors: slower growth in China, the depreciation of the renminbi, a crackdown on corruption on the mainland, and predictions that the US’s low interest-rate environment is due to end. However, government cooling measures introduced in 2012 to reduce speculative investment in Hong Kong property are an additional damper on the residential sector.
Curry scored 27 points and the defending champions moved within one victory of matching the best start in NBA history, holding off the Chicago Bulls 106-94 on Friday night to improve to 14-0.
自1983年以来,每年的央视春晚就成为了中国人民春节必不可少的重要组成部分,也难怪主办方的每个举动都能成为关注的焦点。
智能衣服挂钩
会。梅亚德是执政党革命制度党(PRI)的候选人。他主要的竞争对手是强硬的左翼领导人安德烈斯曼努埃尔洛佩斯奥夫拉多尔(Andrés Manuel López Obrador)——可以感召人群的激情演说家。梅亚德需要克服很多问题:在去年1月一夜间把油价上调20%、引发通胀飙升后,他必须说服选民自己仍然是可以信任的。他还必须证明自己是个有主见的人,而不仅仅是这届不受欢迎的政府的傀儡——在遏制猖獗的腐败和犯罪行为方面,这届政府极为失败。但是凭借强大的PRI拉票机器,他可能势不可挡。在墨西哥只有一轮选举的体制下,30%的选票可能就足以让他当选总统了。
17. Most Complex Hurdle As of Dec. 7, seven out of 20 domestic top-grossing movies released this year had female-driven stories, according to the website Box Office Mojo. By contrast, five out of 20 female-driven stories topped the international market, which accounts for some 70 percent of the industry’s revenue. This may look bad, but the numbers appear marginally better than they have in recent years.
如下是我们对中国2014年的10个预测

For: It picked up the audience award at the Toronto International Film Festival, often a key awards indicator.
Hello, I'm Severn Suzuki speaking for E.C.O. - The Environmental Children's Organisation. 大家好,我是Severn Suzuki,我代表儿童环境组织来此演讲。
D'Aloisio himself strives to maintain a bubble of normalcy. He dates the same girl he did before the whirlwind hit. And though he's stopped attending school-he's too busy to sit in class while overseeing Summly's development-he still gets his work from his teachers and meets with them regularly. He cherishes the fact that his circle of friends knows little of his life as a budding industrialist. When I met him, he was about to head to Greece for a weeklong vacation with a pack of high school pals.
爆发冲突的潜在可能性,将迫使中国和美国在不断变幻的环境中重新定义各自的角色,双方都对这种环境感到不安。美国大选期间的反华情绪将使紧张气氛加剧。亚洲国家将勾勒出这两个大国的影响力范围,但考虑到各国的利益各有不同,取决于各自的具体关切,联盟的构成也将变化。
一位来自美国佛罗里达州的少女引起了世人的惊叹,因为她长得酷肖迪士尼动画电影《冰雪奇缘》中的艾丽莎女王。

Footnotes

  • 27省上半年城乡居民收入出炉 距离买房还有多远
  • 中国社科院表示,在中国的工业及相关领域中,农民工们提供了50%的劳动力。然而由于户籍规定,他们却无法享受到与城市居民同等的权利。

深受大众喜爱的电视连续剧《仙剑奇侠传》的电影版本于今日在浙江正式开拍。
2016年的欧洲杯足球赛,俄罗斯与英国球迷因其粗鲁及流氓行为一直占据新闻头条。
The top-earning woman in the music business has been cashing in on a massive world tour, a constant stream of hit singles and a string of endorsements with a slew of major companies, while occasionally throwing thinly veiled barbs at her chief rival.
He said game and live-broadcast apps currently hosted by Tencent don't require real-name registration, but the company is considering establishing a platform for parents to monitor their children's behavior.
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这些数据衡量了校友们自毕业以来在职业方面成就如何,衡量标准包括薪资、职位级别及个人成绩。

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References

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