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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 定制家居受青睐 产业发展仍存局限性 (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

房地产市场分化加剧 一线城市豪宅化趋势明显

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.

中国外汇储备出现史无前例的下跌,已经引发市场担心:如果资本外流持续下去,而央行继续捍卫汇率,外储可能迅速蒸发。多数分析师相信,中国央行将被迫缩减干预力度,以免外汇储备进一步枯竭。
Explaining how he adjusted the novel, he said: 'I think the answer is that in the book I remain true to every one of Bond's things.
一个解释是,在金融业高薪领域工作的男性比例远远超过女性比例。三分之一的男性在私募、风险资本、投资银行或者并购以及对冲基金领域工作,而女性只有19%。
风水学。风水学也是可以帮助我们很好地布置办公桌的好帮手,千万不要把自己的桌子摆在一边靠着墙,背朝着门的方向。
That was true, too, of “Mad Men” on AMC. which in its seventh season has all but exhausted its characters and its 1960s setting, but is still keeping viewers guessing about the end, which won’t air until next year. “The Sopranos” ended ambiguously. “Breaking Bad,” put an end to Walter White. Now, the next television mystery looming ahead centers on Don Draper’s last moments, dead or alive.
Indeed. That's an understated benefit of Philly tanking so hard in recent years: they are so bad it disincentives other clubs from tanking because they'll struggle to be as bad as the Sixers. The Mavericks are in the mix, at least.
《美国谍梦》(The Americans):FX频道的这部电视剧以里根时代为背景,它和剧中两位伪装成美国郊区夫妻的克格勃间谍一样具有欺骗性:第二季表面上看是冷战惊悚剧,实际上是关于爱情、家庭、友谊和猜忌的情节剧。

foundation
[dr?ft]
2Canada
[is't?bli?t]
克普克表示,就1994-95年墨西哥汇率危机而言,三个因素都起了作用,当时美联储开始以25、50甚至75个基点(1994年11月)的加息幅度进入紧缩周期。

Footnotes

  • 房企融资放松?市场误读了发改委
  • 客户通过Twitter 和Faceboo向世界传播“糟糕经历”的能力已经改变了客服世界的生态。尼尔森公司(Nielsen)2012年的一项调查显示,超过一半的客户现在通过社交媒体寻求补救措施;与此同时,在Twitter上提出问题或抱怨后,大约81%的用户提出当天就能获得回应。但在今年秋天,事情变得更加有趣:9月2日,英国航空公司(British Airways)乘客赛义德?哈桑斥资大约1,000美元,购买了几条“推广消息”,猛烈抨击这家航空公司弄丢了他的行李。鉴于有偿社交媒体推广现已成为客户的新武器,从2014年开始,各大航空公司、信用卡公司、银行和其他累犯提供的糟糕透顶的客户服务或将走向终结。无穷无尽的电话等待时间和那些自动化的“电话树”(比如,“英语服务请按1,西班牙语服务请按2,您整整一个下午都需要等候接听请按3”)或许将被扔入历史的垃圾桶。

At least two Harvard professors, however, questioned the decision to withdraw the offers. Alan Dershowitz, an emeritus professor at Harvard Law School, told the Guardian that losing admission to Harvard was a "draconian punishment" for "very bad taste jokes that students were sending to each other".
您只需轻轻一挥将它们放飞,泡沫气球就会自己飘向空中。
在中国,微信还吸引了越来越多的高端用户。腾讯过去在这个群体当中并没有多高的份额。
The questions can seem like a sudden reversal after decades of rising multiculturalism, through the civil rights movement in the United States and the European Union’s opening up of borders.
该学院还在国际课程体验方面排名第二。在最新的毕业生当中,逾五分之四的人有过国外实习经历,逾一半学员有过在另一个国家学习超过一个月的经历。
通常在垃圾桶里东西是没有价值的,不需要任何检查,但Qube试图用“世界上第一个智能垃圾桶”来改变这一现状。Qube声称可以帮助你监控你的垃圾,帮助你利用创新技术回收垃圾。

帝王洁具20亿并购过会 新三板欧神诺“下嫁”上市公司

References

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