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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 北京橙色预警36家水泥等行业企业停产 (Published 14 August 2020) Cite this as: BMJ 2020;370:m3181

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  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

沈阳法库潜心打造“中国陶瓷谷” 目标千亿产业集群

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.

以美元值计,11月中国的出口总值同比上升12.3%,比10月的出口总值同比增速6.9%有所提高,高于路透社(Reuters)调查的经济学家给出的预测中值5%。
2013年排名:1
It can free up bartenders so they can make more drinks when it's busy.
The appointment was announced by Steven Ciobo, the Australian minister for trade, tourism and investment, on Feb 21. The Chairman of the China National Tourism Administration, Li Jinzao, was present.
Yao Zhenhua, the chairman of Baoneng Group and the biggest riser since 2015, saw his wealth shoot up 820 percent to $17.2 billion, elevating him to fourth in the overall list.
Talk show host and comedian Ellen DeGeneres will host the Oscars ceremony for a second time.
IT富豪榜排名前十的富豪的平均年龄为45岁,现年52岁的马云是其中年纪最大的一位。

5.高效决策者
会。梅亚德是执政党革命制度党(PRI)的候选人。他主要的竞争对手是强硬的左翼领导人安德烈斯曼努埃尔洛佩斯奥夫拉多尔(Andrés Manuel López Obrador)——可以感召人群的激情演说家。梅亚德需要克服很多问题:在去年1月一夜间把油价上调20%、引发通胀飙升后,他必须说服选民自己仍然是可以信任的。他还必须证明自己是个有主见的人,而不仅仅是这届不受欢迎的政府的傀儡——在遏制猖獗的腐败和犯罪行为方面,这届政府极为失败。但是凭借强大的PRI拉票机器,他可能势不可挡。在墨西哥只有一轮选举的体制下,30%的选票可能就足以让他当选总统了。
adj. 复杂的,复合的,合成的
1985年2月是全球表面温度低于给定月份的20世纪平均值的最后一个月份,这意味着所有年龄在30岁以下的人都没有经历过低于平均温度的月份。最后一个低于20世纪平均温度的年度是1976年。
学员平均年龄:36岁

Footnotes

  • 南康家具电商成绩单出炉 去年交易额52.2亿
  • 彭博(Bloomberg)的调查分析此前预计1月份中国CPI应上升1.9%。

I agreed with Craig and Neil immediately that Ellen is the ideal host for this year’s show. We’re looking forward to an entertaining, engaging and fun show.
习及一些领导人员已经明确指出,中国将会进行可持续发展、内需为依托的经济转型,为此中国可以忍受稍微慢一些的增长速度。于是一些预言家马上就下出结论,认为中国经济会因而立即大幅减速。特别是中国曾经有过这样的先例。在1978到1993年中国领导人进行改革开放,然而在政策施行的最初阶段中国经济曾经遭遇不稳定。
No.4: The 1st Useful Mechanical Pet
同比来看,65个城市的房价同比上涨,5个城市房价同比下跌,
该声明称,EPIC绝不容忍任何人的欺骗或者侵犯版权的行为,不管他的年龄有多大。
今年最令人惊喜的消息还包括油价下跌。经济学家对油价下跌的经济影响也是见仁见智,一方面认为消费者因此节省了不少油钱,一方面则认为这种趋势会影响石油的开采钻探活动。但大家普遍认为这会影响小型车和混合动力车的销量。油价下跌加上车价过高,使得凯迪拉克公司的电动轿跑ELR稳居2014年最不受欢迎的车型“宝座”。11月份,这款售价高达8万美元的电动跑车只卖出了155辆。

地板实行编码 促进企业O2O模式的深度开展

References

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