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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 个人房贷突破20万亿,26家上市银行上半年发力涉房贷款 (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

二季度房价将回稳 房地产投资仍“拖后腿”

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.

根据中国海关总署(General Administration of Customs)发布的数据,12月份以美元计的出口额同比减少6.1%至2094.2亿美元。这一跌幅比经济学家预期的中数多了2.1个百分点,也大于11月份修正后1.6%的跌幅(修正前该数字为增长0.1%)。
Taylor Swift, 'Reputation'
The theory describes Type B individuals as a contrast to those of Type A. Type B personality, by definition, are noted to live at lower stress levels. They typically work steadily, and may enjoy achievement, although they have a greater tendency to disregard physical or mental stress when they do not achieve.
['debju]
可穿戴设备通常分为三大类:像健身追踪器这样的复杂设备;像智能手表这样的智能配件(由于它们可以运行第三方应用);还有像谷歌眼镜这样完全自主、可以直接联网的智能可穿戴设备。
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.
6.不是故事的结局不够好,而是我们对故事要求太多。

其中,由于IT/互联网/通讯/电子行业迅猛发展,吸纳了近三成的2016年应届毕业生。
For the full year, profits rose 3.3 per cent, the slowest growth since at least 2008, when Chinese manufacturers were slammed by the global financial crisis.
The 8,000 volunteers who will welcome international visitors to London 2012 have been issued with a 66-page instruction manual, covering everything from foreign etiquette to uniform care and advice on dealing with journalists. But what of the visitors themselves? Could they not do with a manual outlining the customs, manners and practicalities of the islands they are visiting? We hereby present a simple guide to UK etiquette for the 2012 Olympics.
The ranking is based on data collected from two surveys: one of the participating business schools and the other of alumni who graduated three years ago — the class of 2013.
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Footnotes

  • 新三板LED方阵再添新军 3公司股票挂牌获批
  • "Protections that promote equality and diversity should not be conditional on someone's sexual orientation," he wrote. "For too long, too many people have had to hide that part of their identity in the workplace."

伞上的链子可以系在狗狗的项圈或背带上。
Two arrests have been made in connection to the shooting death of 14-year-old Lecent Ross, police said Thursday.
The joint Sino-American programme delivered by the Hong Kong University of Science and Technology and Kellogg School of Management has returned to the top of the Financial Times ranking of the best 100 MBAs for senior executives.
她说早在去年12月份,她第一次看这部电影的时候,就注意到了自己和电影中的女主角长得十分相似,当时她觉得十分诡异。
His strategic shift away from corporate strategy was in spite of the fact that his own school had deterred him from making a career in education, even though he had worked as a private tutor.
Company: BooginHead

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References

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