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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 敲诈勒索北京租客 三名“二房东”获刑 (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

50余城先后出台人才引进政策 部分城市房价上涨明显

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.

“这部电影讲述的是在荒野中求生存、适应自然以及人文精神的胜利,更重要的主题是信任。”
Chinese Cultural Relics is a new journal that translates Chinese-language articles, originally published in the journal Wenwu, into English. The discovery of the 1,700-year-old cemetery was included in its inaugural issue.
8月,为了捍卫中国在全球经济中的制造业中心的地位,央行引导人民币作出数十年来最大幅的贬值。稍后,在国际货币基金组织(International Monetary Fund)把人民币纳入全球储备货币之后,人民币进一步贬值。这一现象可能反映了资本外流。
游戏平台:Xbox One、Xbox 360、PS4、PS3 、PC
时间:2011-02-16 编辑:beck
单词flimsy 联想记忆:
Finding the skill sets and attitudes that support the culture of the brand you want to promote will foster innovation and enhance your reputation. Include folks from outside the company for the people you rely on. That will start a free marketing chain reaction that can build confidence and revenue.

I am here to speak on behalf of the starving children around the world whose cries go unheard. 我演讲是为了世界所有忍受饥饿的儿童,而他们的哭泣却无人听见。
A report from the ministry showed that employers recruited 5.2 million workers through public employment service agencies in the first quarter, dropping 229,000, or 4.5 percent, from the previous year.
The fastest growing start-ups tend to be global in their outlook. The immigration restrictions already imposed by President Trump in the US and those under consideration as part of the UK’s separation from the EU are likely to be a hindrance in the coming year for hiring.
About 200 million migrants, half of whom are women, sent $445 billion to their families in Asia, Latin America and Africa in 2016, the International Fund for Agricultural Development (IFAD) said last Wednesday.
1.Bladeless Fans

Footnotes

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仪征博物馆的工作人员告诉每日邮报电子报,这件青铜器是在西汉(公元前206年–公元8年)贵族墓中发现的。
“这不是可持续的增长,因为它们并未被租出去,当地市场的喊价者们并不会购买。”
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.
什么温度的葡萄酒最好喝(图)
该项目曾在2006年荣获亚军,并在2008年斩获冠军头衔。
源于:last(adj 最后的)

房产中介股市抢客源 房地产去投资化成为趋势

References

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