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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 新华社:加快推进农村危房改造 (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

北京市2019年积分落户于5月22日启动申报

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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Purchase products like magazine racks, shelves, and desk organizers that will keep your supplies and resources in order and close-at-hand. We love the File File, $24.95, at CB2.com (pictured above).
Epic Games在网站Kotaku上发表的一份声明中则指出,提起法律诉讼的原因是罗杰斯在一个YouTube视频的可移除标签上写下了涉及DMCA的反诉内容,这段视频展示并推广了《堡垒之夜》外挂软件。
然而,北方高等商学院毕业生的国际化流动程度最高,2014届毕业生有85%曾在国外工作。
还记得《类人猿行动》吗.这是一部被众人忽略的2016年早些时候的电影,由杰米.多南和斯里安.墨菲担任主演,讲述了对希特勒身边的三把手、党卫队将军莱因哈德.海德里希进行的一次失败暗杀。《行动代号:猿人》也尝试讲述这一故事,杰克.莱诺和奥康奈尔将在片中饰演密谋的士兵,而罗莎曼德.派克和米娅.华希科沃斯卡是他们片中的感情对象,杰森.克拉科则饰演他们的刺杀目标。
"It became an issue about so many things, such as the environment, energy, workplace disasters and the role of big government. It became a lightning rodfor peoples' anxieties," she explained.
London Business School is top of the 2014 FT ranking of European business schools, regaining the position it last held in 2005. LBS pushed the 2013 joint winners HEC Paris and Spain’s IE Business School into second and third places respectively.

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《极盗车神》特别有趣,虽然它未必会使你一直捧腹大笑,但全片都很欢乐。
虽然总统那晚险胜,此次相逢与前两次辩论相比是诚恳且基本上平安无事的,不太可能对选举结果产生多大的影响。
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10. 经济学在害死经济,但就像可卡因成瘾者一样,我们停不下来

Footnotes

  • 家居业海外市场需求下滑 转为依靠内需拉动
  • Yes. Supply outages and geopolitical risk factors will probably persist, alongside output curbs by global producers. But whether prices can maintain levels at $70 or above is dependent on the willingness of Russia to keep backing a Saudi Arabia-led effort to cut production in the face of growing US shale supply. Other participants in the co-ordinated effort also need to sustain strong compliance with the deal, the incentive of which declines as governments reap the rewards of higher prices.

《海底总动员2》将于2016年6月17日上映。
“我首要的使命、首要的责任是忠实于这本书的原始感觉,忠实于伊恩·弗莱明:他的作品、他的世界和他的构想。
40万美元对于他们来说可谓九牛一毛——2015年,希拉里和她的丈夫比尔?克林顿主要通过演讲和版税收入赚得了1060万美元,特朗普也声称自己赚得将近5600万美元。
它还体现在詹巴蒂斯塔·瓦利(Giambattista Valli)最近的秋冬时装秀上,那场时装秀中充满泡泡袖印花长款衬衫和配套裤子,以及低腰直筒女学生连衣裙;还体现在麦丝玛拉(MaxMara)向乔治·巴里斯(George Barris)1962年为玛丽莲·梦露(Marilyn Monroe)拍摄的照片致敬的系列。
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New construction will provide luxury options for renters with deep pockets, mostly in the boroughs outside Manhattan. In Brooklyn, 6,527 new rental units are expected to hit the rental market next year, nearly twice the 3,802 units anticipated for Manhattan, according to Citi Habitats.

限购松绑30城效果调查:仅5城成交量大涨

References

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