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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 家装行业发布发展报告 整装卫浴将大显身手 (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

卫浴行业质量失信企业将“上榜” 国家严把质量安全关

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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沃克排名第六,得益于他演艺生涯中最卖座的影片《速度与激情6》。在因车祸悲剧丧生之前,他已经完成了《速度与激情7》的大部分拍摄工作。据称环球影业(Universal)不会重新拍摄该片,而会对后续拍摄作出相应调整。
com共同,bat打,击-共同打-战斗com bat:共同生活的bat蝙蝠,免不了要combat
大卫评价说:“这唱的太棒了,无可挑剔,简直完美。”
Temperatures had already risen by 0.8C since the industrial revolution and although last year’s 1C rise may not be repeated every year from now on, scientists said 2016 could turn out to be another exceptionally warm year as the El event continues.
adj. 不可否认的,无可辩驳的
出境旅游超过1.2亿人次;

On the subject of #MeToo, she said: 'I just think they're douche bags. They're not champions. I just think they're losers. I don't like them.
第十步 如果以上几条都做不到——就公告天下说你有反社会人格
7. Love is like two people holding two ends of a rubber band: it’s always the one who doesn’t let go who gets hurt more.
在1月10日发表的一条推文中,奥巴马写道:“感谢你们为我做的一切。我最后一个请求和第一个一样。我请求你们不要相信我的而要相信你们自己的创造改变的能力。”
Despite the breakthrough, Jack Ma, chairman of Alibaba Group, said there was no need for human beings to fear machines.

Footnotes

  • 定制家具有望保持18%增速
  • 不过,一些议员已经开始讨论2月末或因联邦借款上限再度引发僵局。达科称,你永远不能指望决策者们不会搬起石头砸自己的脚。

然而,澳大利亚和西班牙学校表现不错。这两个国家分别有3所学校上榜,且排名均有上升。悉尼的麦考瑞大学管理学院(Macquarie Graduate School of Management)是澳大利亚排名最高的学府,排在第49位,而西班牙IE商学院(IE Business School)的排名上升4个位次,排在第8位,这是这所位于马德里的学校自2012年以来首次回到前10名。
May your New Year be filled with special moment, warmth, peace and happiness, the joy of covered ones near, and wishing you all the joys of Christmas and a year of happiness.愿你的新年充满温馨,祥和,与亲人团聚的快乐,祝乐陶陶,新年乐无限。
3.3M公司
We began the year worried that the US was poised to withdraw from the World Trade Organisation. That hasn’t happened. And it’s now unlikely to any time soon.
6.《我爱你,菲利普·莫里斯》
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根治“房闹”须坚持“房住不炒”

References

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