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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 电商法要来了,门业老板怕了吗? (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

家居卖场巨资打造4A景区 望带动人气

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.

单词productive 联想记忆:
普华永道中国内地及香港市场负责人林怡仲表示,市场的波动导致了新股审批的节奏的加紧,从而维持资本市场的稳定。
spoon
除了作品被展示在谷歌主页,张天羽还获得了3万美元的大学奖学金。她所在的学校也将获得5万美元的谷歌教育科技拨款。谷歌还以她的名义向慈善机构捐赠了2万美元,用于给孟加拉的学校提供净水。
We will improve mechanisms that give incentives and allow for and address mistakes so as to support those who are dedicated to their work and stand behind those who live up to their responsibilities. Every one of us in government must take an active approach to our work and have the courage to tackle the toughest problems, we must work closely with the people, using concrete action to make progress in development, and using genuine hard work to realize a bright future.
Neumann, Silbermann and Sharp are three of 66 billionaires under 40 years old, a record for the Forbes list.
巴西

据Mic上周报道,脸书表情包分享群组已经成为一个新兴的大学传统,全国各地的学生们用截图和配字互开玩笑,与对手学校互怼。
伊法斯夫拉腾以英国独立党(U.K. Independence Party)为例,它的官方平台力主脱欧,但是面向选民的宣传中又强调移民对经济与文化的影响,她说这是一种混合了务实与民粹的论调。
It is the first biography to win the prize, although Mr Greenspan’s autobiography, The Age of Turbulence, was shortlisted in 2007, the year before the financial crisis raised serious questions about the central banker’s legacy.
McDonough School of Business at Georgetown University in Washington DC returns to the custom ranking in 15th place after dropping out last year because of a low survey response rate from clients. Only three schools enter the custom ranking for the first time, including London’s Cass Business School in 60th place.
斜着头,怒目,像受到惊吓的狗狗那样

Footnotes

  • 楼市新政出台半月 开发商涨价倾向明显但未实施
  • 故事发生在《海底总动员》第一部结束的一年后,多莉展开了一场全新的海底冒险:寻找自己的父母。在这部史诗巨制中,多莉沿加利福尼亚海岸的冒险之旅,得到了尼莫和马林的鼎力相助。 故事中也将迎来一批全新的角色。

骑行背带
Here are four memorable designs from the year, including commentary from some of the artists who helped shape the looks.
[k?'min]
Consumer Electronics Show
7成以上受访者表示,实现自我价值是创业的最大动机。
《财富》美国500强公司苹果(Apple))已宣布,将从现金中拿出300亿美元用于股票回购。这个消息让投资者很高兴:股价暴涨,甚至在消息发布一周后,这只股票相对于标准普尔指数在这7天上涨了12%。苹果有一项规模更大、总额高达1300亿美元的资本回报计划,将一直延续到2015年,而这些回购就是这项计划的一部分。

北京11月首套房贷款平均利率5.47%

References

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