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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 建材网购难撼卖场地位 安装无人管质量难保证 (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

国家质检总局重点关注智能卫浴产品

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.

But closing the deal on RCEP less than a year after Donald Trump pulled the US out of the TPP would be a big win for Beijing.
Fifteen Chinese nationals have been charged with developing a fraud scheme in which they paid imposters to take entrance exams, including the SAT, and gained acceptance to elite American colleges and universities, the US Department of Justice said on Thursday. Conspirators were paid up to $6,000 each time they used counterfeit Chinese passports to trick test administrators into thinking they were the person who would benefit from the test score, a federal grand jury charged.重点单词
The year’s most compelling makeup and hair designs have been almost characters themselves (and are certainly more dynamic than some of those who appear on-screen). But while physical features are obvious right away, they can also give shape and nuance to the performances of those who assume them. Sometimes, a big nose creates a window of understanding.
Nirvana in Fire unexpectedly achieved a tremendous success, rising like a star among the TV dramas in the fall of 2015. Also adapted from an online novel of the same name written by Hai Yan, the adaptation for the first time found its way on the screen in September 2015. Staring Hu Ge and Liu Tao, the series shows a talented military strategist endeavoring to clear his name through continuous fights. The fictional characters and dynasty let the adaptation smartly avoid being criticized for not sticking to historical accuracy. And the drama`s delicate internal settings and impeccable storyline were highly praised by the audiences.
Average age: 33 in Philadelphia, 36 in San Francisco
注册人数:511人
Obama watched the returns on television at his Chicago home. Senior campaign strategist David Axelrod said via email that he was feeling "great."

尽管Facebook在中国被屏蔽,腾讯还是将微信同Facebook连接起来,这意味着中国以外的用户可以同时使用微信和世界上最流行的社交网络。在印尼、泰国和菲律宾等东南亚国家,这对腾讯是有好处的,因为这些国家拥有很多Facebook用户。腾讯针对这三个市场都推出了各自语言版本的微信。
从事房地产业的中国女富豪最多,占23%,金融投资业占18%,制造业占14%。
At a minimum, it is impossible for most people to get to work in the city, which affects the locus of several industries, including finance, advertising, healthcare and the arts. The city's transportation lines, bridges, and tunnels were shut down for nearly two days, and at the latest report, the subways may be down well into next week.
Theresa May, the new British prime minister, earns 143,462 pounds ($186,119) a year. That includes her salary as a member of parliament, which is 74,962 pounds ($97,256) a year.
C罗巨无霸般的收入主要来源于两部分。一部分是他效力于西班牙豪门皇家马德里挣得的令人眼红的3850万英镑的年薪。另一部分来源于他为耐克、豪雅表和营养品公司康宝莱代言带来的总计2200万英镑的代言费。

Footnotes

  • 一线楼市燥热难散:核心原因是新增建设用地少
  • 值得一提的是,优步和特斯拉也未能上榜。“优步和特斯拉都在创新,但用专利数量、成功、全球化和影响力进行衡量,都不足以上榜,”Stembridge说道。“还有,这两家公司在2010-2014年这段时间也没有获得超过100项的专利技术,从而达到该榜单要求。”

designer
And while many Bond girls fade into acting obscurity or fall into second-class flicks after making a 007 splash, Marlohe and her agents at ICM Partners are making sure the actress surrounds herself with top-flight talent as she uses the Bond movie as a launching pad for an international career.
The report shows that social media, and especially WeChat, has become more and more popular in the past year among people over the age of 40.
抵达太阳系深处的人类智慧。
Intel
Yes, even if real GDP growth does not. Speculation over the true GDP growth rate in China, as opposed to the official one, has spawned a cottage industry of specialist economists. The official figures are deceptively stable and serene thanks to suspected “smoothing” by the Chinese authorities, as they bend the figures to fit growth targets. So even if growth does stumble in 2018, the official growth rate is almost certain to come in above the preordained 6.5 per cent.

奢侈品消费能力强 高端家具走俏中国市场

References

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