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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 半数以上大房企有望完成全年销售目标 (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

湖南将大力加强硅藻泥建材产业的扶持力度

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.

However, one lawyer, who prefers to remain anonymous, says Teach Firsters’ prior experience and autonomy in a classroom can mean they feel frustrated starting at the bottom of an organisation’s ladder again.
The wealth and depth of knowledge from around the world adds tremendous value to the course, wrote another graduate from the US, adding that “with so many cultures and experiences represented, a classroom ethics discussion about bribery is not your typical boring USA version”.
中国保监会表示“面临复杂多变的市场环境”,上半年实现资金运用收益仅2944.82亿元人民币,下降42.32%。
Usher “Good Kisser” (RCA)
报告指出,2016年中国网民数量增加了4299万人,同比去年增长6.2个百分点,而网民总人数占到了中国总人口的53.2%。
但有些人可能就记住了胡子。
Are the political upheavals of 2016 — Brexit and America’s election of Donald Trump — a triumph of democracy or a threat to it? Democracies must respond to legitimate grievances.

2.管理自己,对他人负责
Of course, these same new forces may also trigger a backlash and a reversion to old command-and-control ways of leading. The politicians who dominate the world stage are, depressingly, mostly cut from the old cloth, and the leadership challenges they face, from Brexit to North Korea, are particularly complex.
Consider:
At a minimum, it is impossible for most people to get to work in the city, which affects the locus of several industries, including finance, advertising, healthcare and the arts. The city's transportation lines, bridges, and tunnels were shut down for nearly two days, and at the latest report, the subways may be down well into next week.
祝新年快乐,并致以良好的祝福。

Footnotes

  • 卫浴商家提升销量的三大“杀手锏”
  • 1. Wal-Mart Stores

Faber laughs at Bernanke's remark that the economy would be strong enough later this year so he could take his foot off the gas, that is begin 'tapering, or scaling back it's stimulative quantitative easing (QE) program later this year.' Yes, laughed.
摩根士丹利的分析师乔纳斯认为,Model X的销量将会更加可观,但不是由于它的燃油经济性,而是它升级后的信息娱乐系统,以及独特的“鹰翼”式后车门。他还表示,如果Model X没有赢得所有的年度车型大奖,他会非常失望。他并不是唯一一个这样想的人。埃隆o穆斯克和其他很多祈祷特斯拉继续保持当前势头的人当然也会这样想。(财富中文网)
Texas was one of the first states to emerge from the recession and it continues to attract companies on the basis of its low tax burden, predictable regulatory environment and skilled labor force. Texas employment is expected to expand 3% annually through 2017, according to Moody’s. (Arizona’s forecasted rate is a microscopic 0.04% better). Texas has attracted a lot of attention from California companies and Governor Rick Perry has not been shy about contrasting the business climates of the two states. California firms EBay and Electronic Arts have both chosen Texas for large expansions in recent years. Austin has been a hotbed of activity this year with Accenture
Wishing you peace, joy and happiness through the coming year.在新年来临之际,祝福你平安、快乐、幸福!
Yang Yansui, director of the School of Public Policy And Management at Tsinghua University, said the four-trillion-pension balance was mostly in personal accounts, while the pay-as-you-go pension system was greatly challenged by dependency ratio.
Inside larger technology companies, female employees will be hoping for signs of change in pay and promotions — but will also be on guard, as a men’s rights backlash brews in some corners of Silicon Valley.

佳兆业集团:生态环境部通报问题不影响东戴河项目后续开发运营

References

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