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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 瓷砖石材新品夺眼球 (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

中国发布人权白皮书:人均消费支出40年增18倍

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.

和过去几年相比,2013年信心受到动摇的时候少了,但市场依然很容易受到影响。OppenheimerFunds的首席经济学家韦布曼(Jerry Webman)表示,虽然2013年的信心要强于以往,但全球各地也不都是这样。
ordering
“Thutmose III was one of the most important pharaohs in Egypt’s New Kingdom and is credited with establishing the Egyptian imperial province in Canaan,” said Gabriel Barkay, the co-founder and director of the Temple Mount Sifting Project.
夏洛特·艾玛·艾奇逊《1号天使》
时间:2011-03-28 编辑:beck
3.视频编辑:增长了19.2%
优秀的老板知道公司或客户需求和他/她的员工需求之间一定存有一个平衡度。优秀的老板都喜欢倾听员工的心声和同他们交流可能存在的一些问题,因为他们知道员工快乐工作效率才会更高。

As fall arrived and school began, D'Aloisio felt immense pressure to deliver for his backers. He needed to whip his algorithm into better shape, so he contracted a team of Israeli coders who specialize in natural language processing. Searching on Google, he found and hired a retired professor living in Thailand who'd written seminal books on the topic. 'He became our main scientist,' says D'Aloisio. 'He now works at Yahoo! in the Sunnyvale office.'
新兴市场需求减弱使2015年成为全球金融危机爆发以来世界贸易最糟糕的一年,凸显出对于全球经济健康的担忧加深。
My fellow trainer, Sylvia Guinan, made me aware of these rules that a husband has laid out for his wife to follow during the 2014 World Cup.
许多分析师或许会对有关他们低估美联储的说法感到愕然。如今人们在谈论新兴市场资产时,最常提到的两个相关因素就是美联储和中国,以及它们将来造成负面冲击的风险。
作为历史上一种非常敏感的大宗商品,原油价格走势已连续三年保持波澜不惊,其背后的一大支持因素就是美国的页岩油。

Footnotes

  • 小米、三星抢食智能市场 LED智能照明从何入手?
  • Strong reviews, and praise for the performances - particularly from the children at the centre of the story, and Willem Dafoe, who plays the manager of the motel where they live.

6.癌症死亡率
In 1995 Dutch troops serving as UN peacekeepers failed to prevent Bosnian Serb forces murdering 8,000 Muslim men and boys in the town of Srebrenica in eastern Bosnia.
Album of the year: "Chief," Eric Church
通用汽车公司(General Motors)帮助改善了大峡谷州的就业前景。今年3月,这家汽车制造商宣布,计划在凤凰城郊区钱德勒建设该公司的第四座信息技术创新中心。通用汽车预计将雇佣1,000名员工,主要包括为这座新中心效力的软件开发人员、数据库管理员和系统分析师。通用汽车公司首席信息官兰迪?莫特(Randy Mott)在新闻稿中宣布了这个举措,他表示,“大凤凰城地区是出色的枢纽,吸引了新兴技术人才——从大学毕业生到职场专业人士。”
“These kinds of questions are really front and center, even though they’re not necessarily verbalized.”
首先必须了解的一件事是,人格类型与基因无关。这意味着D型人格特征并不是无法改变的。另外,测验也并不意味着测验的结果会决定你的命运。心理学研究表明,任何人格特征都可以改变。

木门业转型迎来新的外贸格局 洗牌潮暗涌

References

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