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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 百安居陷“多事之秋”:多门店罢工 (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.

All those totals are higher than a year ago, with the largest growth being in market value (up 13% year-over-year). These firms employ 90 million people worldwide.
在过去的二十年里,几起校园中毒事件引发了群众对学生心理发展及帮助的争论和关注。
根据胡润研究院日前发布的《2016中国女富豪榜》,现年75岁的房地产开发企业富华国际集团创始人陈丽华凭借总共505亿元的资本净值成为中国女首富。
Inflation for consumers, meanwhile, ticked up slightly to 1.5 per cent, versus a five-year low of 1.4 per cent in November.
New Year time is here. I hope you have a wonderful New Year. May every day hold happy hours for you.新年来临,祝新年快乐,愿你时时刻刻幸福欢乐!
这也是精算师高居美国最佳工作榜首的原因之一。这是求职网站CareerCast.com最新调查结果,调查报告于周二发布。生物医学工程师排名第二位,2012年高居榜首的软件工程师如今排名第三。排名垫底的工作包括现役军人、伐木工人和报社记者。
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4.Thank you so much! I just love it! – Because telling someone that their gift sucked would make me look like an insensitive jerk。
据中国与全球化研究中心秘书长苗绿表示,因为中国正大力参与全球合作,因此中国正试图吸引更多具有国际背景的学生。
最近雇主已经加大招聘力度。劳工部数据显示,10月份新增就业岗位17.1万个,今年以来平均每个月增加15.7万个。这个速度高于去年,并且是2006年以来最强劲的就业增长。[qh]
Consumer Electronics Show
For decades, the language of white identity has only existed in the context of white supremacy. When that became taboo, it left white identity politics without a vocabulary.

Footnotes

  • 二线城市是2016年楼市主攻阵营
  • ?Bond is by no means a comedian but he knows the power of a well-timed one liner. Women are attracted to funny men because humor is a sign of intelligence. You can even predict how many women a man has slept with by how funny he is.

“If you were going to be betting, you would bet its going to be warmer than 2015,” said Mr Karl.
3.The End of the One-Child Policy
另一名来自美国的毕业生写道,来自世界各地的知识的丰富性和深度为课程带来了巨大的价值,他补充称,“鉴于这里汇聚着众多的文化和经验,有关贿赂的课堂道德讨论不像典型的美国学校那样枯燥。”
萨姆·史密斯是一个风格多变的男人,他可以在奥蒂斯·雷丁、艾瑞莎·弗兰克林和雷·查尔斯以及像艾米·怀恩豪斯和阿黛尔这样的现代偶像的风格中随意转换。
It's been confirmed that Hu Ge who took the leading role of "Li Xiaoyao" will join the cast of the film, while the name of female lead has not yet been revealed.
It came as no surprise that the likes of Emily Ratajkowski, Adriana Lima, Lily Donaldson and Petra Nemcova turned out to be the red carpet rulers on day one of the 70th Cannes Film Festival.

上周二手成交大涨34% 上海“325”行情重现

References

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