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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: “五一”期间短租房价格上涨3-5成 (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

2015年红木家具产业之变:市场重新洗牌明显

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.

他称:“有色钻石的市场门槛设置得非常高,因为它们实在太稀有了。”
●"Man shoots off his own penis taking selfies with gun"
6. Data scientist
Meanwhile, in an unfortunate red carpet faux pas, Pink and Shakira both showed up in the same Balmain dress.
An Obama tweet, published in August after racial violence rocked Charlottesville, Virginia was the second most-shared this year, according to Twitter, with more than 1.7 million retweets.
n. 潜力,潜能一位新浪微博网友写道:“不敢相信这么多医生都在论文中造假。病人还能相信他们可以帮人治病吗?”

Did you have to worry about these little things when you were my age? 在您那个年代,您曾经担心过我们现在担心的事吗?
In response to the incident, Jiedaibao made an announcement on its Sina Weibo on Dec. 1, stressing that the use of nude pictures as collateral for loans constitutes a private deal between users, which the company cannot regulate.
Losing my future is not like losing an election or a few points on the stock market. I am here to speak for all generations to come. 失去未来不像落选选举或者股市浮动那么简单,我来到这里是为了将来所有的世代而演讲。
他认为,地方政府通过卖地、强拆来追求GDP代价太大,早晚要还。“我愿意用一个政协委员的身份非常严肃地提出问题,我们是不是可以不要那么重视GDP?我们是不是可以选择减缓经济发展的速度?”
感恩节当天,沃尔玛、塔吉特(Target)和Kmart等美国大型零售商都开门营业,以便借假日购物旺季大赚一笔。今年,沃尔玛开始营业的时间甚至比去年早了两个小时。但好市多拒绝加入“黑色星期五狂欢”,感恩节并没有开门营业。首席执行官克雷格杰利内克认为,给员工放一天假比提高公司利润更加重要。

Footnotes

  • 瓷板幕墙将逐步取代石材幕墙
  • 而或许更引人关注的问题是,雅虎究竟为何决定拿出3,000万美元来收购一款手机应用呢?诚然,Summly的文本精炼能力与新战略下的雅虎对移动设备的侧重不谋而合。伴随着以11亿美元对轻博客的收购,以及广受好评的新款天气应用的推出,Summly软件的加入见证了雅虎占领智能手机领域的坚定决心,以及为爱使手机的年轻消费者提供优质服务的不懈努力。

James Bond Themes Honorable Mention: "We Have All The Time in the World" by Louis Armstrong
科森重塑了卡瑞尔的鼻子,把它变成鹰钩鼻。他还把卡瑞尔的发际线往后刮了一点,留出更多额头。
"The Hunger Games" star ranks first on the 2012 edition of AskMen.com's "Top 99 Most Desirable Women" list. The poll, which collected more than 2.4 million votes, asked the website's readers to choose their favorite female celebrities based on their looks, personality, talent and other desirable characteristics.
?在纽约的交通基础设施遭受巨大的打击。许多城市的地铁隧道被淹没。
其中,国产动作片《战狼2》位居榜首,成了中国史上收入最高的影片,门票销售狂揽56.8亿元。
法国当局十二月发表声明,他们已经取缔了十几个向人们发布去伊拉克和叙利亚作战的网络。

家具销售将有标准格式 解决商家“耍花枪”问题

References

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