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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: LED行业关注焦点:TPP协定达成对中国经济有何影响? (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

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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.

不要马上接受工作录用
我的核心价值观是什么?作为一个人,对你来说什么是重要的?家庭、健康、信仰、工作还是其他?确保在你的生活中,你追寻了自己最在乎的东西。
飓风厄玛
The company's stats also show that pop diva Whitney Houston's death in February attracted more interest than Kate.
We should stipulate at this point that neither of us have any idea how good this draft is going to be because the college season is barely underway. It sure looks nice, what with all those freshmen stacked up together in the lottery.
1. Bottoms Up Beer System
香港科技大学(Hong Kong University of Science and Technology)和凯洛格管理学院(Kellogg School of Management)合办的中美EMBA项目重新夺回英国《金融时报》100个最佳EMBA项目排行榜的冠军宝座。

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。
n. 城堡
这是悬在全球经济头顶的最大问题,也是最大风险。
马克斯将与她的朋友克洛伊一起,揭开她的同学雷切尔o安布尔神秘失踪背后的真相。游戏具有电影的体验感,配有不拘一格的原声,将当下年轻女孩的焦虑与生死攸关的情境结合了起来,再加上了时光倒流的能力,这一切使得这款游戏脱颖而出。尽管该作品中采用的机制在其他游戏中曾经用过,但由法国开发商制作的美国风格游戏,还是让这种定时操作有耳目一新的感觉。
The top 20 comprises 13 US universities, four British and three others.

Footnotes

  • 木林森江西基地投产19条线 封装霸主照明领域布局提速
  • 艾米卡兹明(Amy Kazmin)

By more than one measure, 2014 is a year the Honda Motor Co. would prefer to forget or to obscure, reflected in a roundabout way by its grand slogan for 2015, “The Year of Honda.”
报告还写道“这一增长进一步依靠视频编辑技术,在第三季度显著增长了19%,因为视频内容已经成为了大多数顾客为中心的网站的首要的吸引和号召行为。通过社交媒体的大量的视频营销也助涨了这一需求。”
该片根据同名童话故事拍摄而成,主要讲述了主人公毛各利的丛林奇遇,他试图在探险中发现自己。他在丛林中遇到很多生物(由众多演员扮演),正是这些生物使他的旅程变得异常艰辛。
“One employee threw a cup of coffee and walked out.”
《拉里·威尔莫夜间秀》(The Nightly Show with Larry Wilmore),Comedy Central,1月19日播出。威尔莫的主题喜剧秀将取代《科尔伯特报告》(The Colbert Report)在夜间11:30播出,这是深夜节目多样化的最新尝试。完全没有压力!
Foss 还指出别人的推荐信有时间标记。如果你一周之内有五个新的赞那样看起来会很可疑,这些赞不像是真心的,好像你在刷好评,让别人说你好。

让利有限 楼市难“翘尾”

References

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