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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 央企国企强强联手:华润22.7亿重组昆钢水泥 (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

11月上半月二手房量价回落 政策利好作用有限

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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‘The Good Wife’ Once Will (Josh Charles), Alicia’s illicit love interest, died at the end of Season 5, this sexy CBS courtroom drama seemed as if it might droop and wither, but instead, the sixth season steamed with almost madcap energy, mixing Alicia’s newly fledged political campaign, a war of the roses between Alicia’s new firm and her old one, and the legal travails of Cary, her legal partner. Alicia isn’t quite so good anymore, and that makes “The Good Wife” all the better.
Chinese direct investment in the eurozone was up 37 per cent in 2015, rising to $17.1bn from $12.5bn.
Bernard Baumohl, chief global economist of the Economic Outlook Group, said he is even more optimistic. "The next two years could be the best two we have seen in at least a decade," he said. "There is clearly a lot of evidence the economy is gaining a lot of momentum."
HSBC economist Hongbin Qu said the survey pointed to lost momentum in China's manufacturing sector: He expects Beijing to respond with measures to counteract the slowdown.
“我认为随着社会变得更多元化,未来这个情况会在一定程度上得到改善。不过这需要一定的时间。”
Tiemba scores highly forinternational experience, being delivered half on Tsinghua’s campus in Beijing as well as on Insead’s three campuses in Singapore, France and the UAE.

年龄:44岁
Tsinghua University holds the No. 1 spot in both computer science and engineering. The Chinese institution overtook MIT for the top computer science rank this year.
A total of 61 IPOs were launched on the Shanghai and Shenzhen stock exchanges, down 67 percent on the same period last year. About 28.8 billion yuan (4.3 billion U.S.dollars) was raised, down by 80 percent.
攻读EMBA也有利于升职。一位毕业生表示:“我获得的技能对我的升职至关重要。”五分之一的学员在毕业3年后担任首席执行官、执行董事或董事。学员们在读EMBA前的平均薪资为11.4万美元,毕业5年后增长52%至17.5万美元。
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Footnotes

  • 2014家居销售更注重客户体验
  • 批评人士一直急于指出,库克对新产品开发的参与度不如他前任那样高,而且当他走上舞台介绍新品时,也无法引起同样的兴奋。但库克知道自己的短处,他从健身和时尚界招揽人才,组建了一支新团队,其中包括前博柏利(Burberry)首席执行官安杰拉?阿伦茨(Angela Ahrendts),以及工业设计师马克?纽森(Marc Newson)。

致以最良好的祝福,原你新年快乐幸福。
如果观众还不知道这部影片是以20世纪80年代初为背景,那看一眼安娜的直刘海就知道了。她留着齐肩长发,刘海以外的部分在脸庞四周形成微微弯曲的弧度。这个造型很简单,但对这个女人来说显得很有力量,她丈夫艾贝尔(奥斯卡·伊萨克[Oscar Isaac]饰)经营取暖油生意,不过她的过去更为复杂。
“有个员工在公司网站上发帖称自己辞职了。”
She has also performed on Jimmy Kimmel and The Ellen Show - not bad for someone who hasn't even hit adolescence.
Susan Chan, head of iShares Asia-Pacific at BlackRock, says ETFs are more popular among institutional investors in the region.
As for the worst job of 2013? Newspaper reporter bumped last year's loser, lumberjack, for the ignominious distinction.

木门企业打造家居一体化 “私人定制”应势而生

References

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