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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 新城要主动对接中心城区功能疏解 提高综合承载能力 (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

2017年楼市:精准调控下的预期博弈

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.

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想要改善自己的生活,而不只是学业,最好的方法之一就是冥想。每天花上十五分钟,静下心来,集中注意力并充满自信。
3. Feng Shui
Blake Griffin's high school appearance isn't that far off from how he looks today. Just add some hair and some size to his biceps, and you've got Blake Griffin today.
这份排行榜基于对商学院及其2013届毕业生的调查。根据校友职业发展、学校创意生成以及学员和师资多样化对MBA课程进行评比。
警方在屋内查出一柄40口径的Smith & Wesson半自动手枪,目前正在进行弹道测试,检查器是否牵涉其他犯罪活动。
这名法国女星将会和瑞恩·高斯林、迈克尔·法斯宾德、娜塔丽·波特曼共同出演新电影。

沃伦·巴菲特自2014年以来再次排名第二,净资产由去年的608亿美元增加到756亿美元。
Instead it ticked upward slightly to 8.3 per cent.
He Fan, economist at Caixin, said:“This shows that the macro economy has moved further toward stable growth and the economic structure is improving. Future fiscal and monetary policies must be coordinated and large-scale stimulus should be avoided as much as possible.”
过去一年中,亚利桑那州最大的赢家是建筑和休闲/酒店行业,这两个行业共增加了超过1万个就业机会。其他快速增长的行业包括商业服务、金融活动、教育和医疗服务。
1.哥吃的不是面,是寂寞。

Footnotes

  • 元宵节电商大数据:汤圆销量翻25倍
  • During the RoboCup 2500 contestants from 40 countries competed in 15 competitions with various types of computerized soccer robots, healthcare robots, rescue robots and dance robots.

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最近两年你都没有涨薪水
Any decision by China’s policymakers to begin selling down the country’s huge reserves would have a large impact on markets.
The letter mysteriously arrived at the California University of Pennsylvania, in the north-eastern state of Pennsylvania, 10 days ago. Written to Mr Moore, the two-page letter was postmarked 20 February 1958 and signed "love forever Vonnie".
但是在对遗骸进行分析后,研究人员发现这些坟墓被重复利用了多次。有些坟墓中包括有10多个的死者,多次的重复埋葬有待于进一步的研究,研究人员写到。
She then turns back and pecks the man on the cheek, as the crowd erupts in cheers around them.

2016年全球LED工业照明市场达29.32亿美元

References

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