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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 建材价格涨涨涨 市场成交难难难 (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

长租公寓市场井喷前夜:资本随风而动

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.

Last week, Lu was appointed director of the office for Beijing's Leading Group of Promoting Beijing-Tianjin-Hebei Integration Development, a move to accelerate Beijing's moves to coordinate with Tianjin and Hebei province.
可穿戴设备通常分为三大类:像健身追踪器这样的复杂设备;像智能手表这样的智能配件(由于它们可以运行第三方应用);还有像谷歌眼镜这样完全自主、可以直接联网的智能可穿戴设备。
200910/87441.shtmlA software prodigy from London is living the Silicon Valley dream after Yahoo bought the news app he created for almost $30m.
“We do things for other reasons than a profit motive, we do things because they are right and just,” Mr Cook growled. Whether in human rights, renewable energy or accessibility for people with special needs, “I don’t think about the bloody ROI,” Mr Cook said, in the same stern, uncompromising tone that Apple employees hope they never have to hear. “Just to be very straightforward with you, if that’s a hard line for you?.?.?.?then you should get out of the stock.”
反对:《至暗时刻》目前还没有被一所影评机构评为最佳电影。
The pickup in consumption in turn will entice businesses to hire and invest more to keep up with rising sales. The result: The U.S. is likely to grow more than 3% for the first time since 2005.
5Japan

不是每个乐队都能在四十年的职业生涯中始终给人以清新的感觉,然而并非每个乐队都是金发女郎。
Newt Scamander is a magiczoologist who studies magical creatures.
Far away from the hustle and bustle of mega cities, Michigan's Upper Peninsula is an area full of stunning natural beauty and landscapes.
影片由斯蒂芬?斯皮尔伯格执导,梅丽尔?斯特里普和汤姆?汉克斯主演,讲述了一次激动人心的合作。凯瑟琳?格雷厄姆(斯特里普饰)是美国第一位大型报刊女性出版商,故事里,她与编辑本?布拉德利(汉克斯)力争抢先于《纽约时报》大规模报道美国政府的秘密。这些秘密尘封了三年,涉及四位总统。他们把自己的事业前途——以及人身自由——都赌在了这一次冒险上,双方必须合作,解决彼此之间的不和,才能携手将真相披露在大众面前。
adj. 有毒的

Footnotes

  • 95%以上城市房价下跌 中国楼市迎来抄底时机
  • 支持:影片可能会凭借出色的票房表现从缓慢变革的奥斯卡投票人群上获益。

But the struggle for white identity is not just a political problem; it is about the “deep story” of feeling stuck while others move forward.
5. What are my core values? What is important to you as an individual? Is it family, health, spirituality, work, etc.? Make sure that you are living in alignment with what matters most to you.
Tom Hanks and Meryl Streep in front of the camera, with Steven Spielberg directing a historic battle over press freedom - there's much for awards voters to admire.
Falke的最终失利令人扼腕,但eBay的表现确实无可匹敌。我以为自己对eBay的爱将矢志不渝,因为鄙人全部的穿戴和家中物件均来自这家公司,而它却向《纽约时报》(the New York Times)表示:“我们热切希望利用我们的平台,通过营造公平的竞争环境来造福数百万人。”
这项任命是由澳大利亚贸易、旅游与投资部长史蒂文·乔博于2月21日宣布的。中国国家旅游局局长李金早出席了该活动。
Lighting is key when it comes to getting work done. Instead of investing in your typical, boring college dorm room desk lamp, pick something with a prettier design. Check out vintage stores for one-of-a-kind table lamps or keep it cheap with the Tiffany Table Lamp, $99.99, at Target.com.

政策暖风频吹银十开局放量 部分房企酝酿涨价

References

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