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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 传统家居卖场转型频现 电商可是唯一出路? (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.

But there's little doubt this was also an 'acqui-hire,' in which the person being bought is just as important as the product. D'Aloisio is now working full time in Yahoo!'s London office, and his youth, his energy and his undeniable it-factor have brought the formerly musty tech giant a much-needed injection of cool. Yahoo! CEO Marissa Mayer -who lends the company some of her own it-factor-praises his 'commitment to excellence in design and simplicity' and says she is 'inspired by the creativity and tenacity Nick brings to his work.'
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正是由于零部件的不断缩小,这些科技设备的运算效率才得以释放,让它火遍全球。
这一次,湖人队处境不错,而且不需要赶着去做什么事,给他们点时间,看看他们到底会怎样。用这样的防守质量他们很难进入季后赛,但是这并不是这个赛季的重点。
The 43-year-old woman was placed on a 12-month good behaviour bond and banned from owning animals.
Its return to the throne came at a cost to London which, after occupying pole position for two years, is trading places with its Asian rival.
Zhang's piece is “so lush and so rich and so full and so complete,” Google Doodle team leader Ryan Germick told the Washington Post. “Every leaf seemed to have life in it.”

中国官方PMI指数从10月份的50.8跌至11月份的50.3,这是3月份以来的最低读数。高于50的读数表示相关产业处于扩张之中。
海莉·威廉姆斯依然是颇有影响力的重要存在,一位不论是低声哼唱还是大声呐喊都能令人信服的歌手。她直言不讳的勇气几乎使你忘记《欢笑过后》记录的是她对这个世界的厌倦。
耶路撒冷小女孩参加“圣殿山筛选项目”考古活动时,发现一古埃及护符。
美联储给当下的新兴市场带来了何种风险?克普克表示,最大的风险之一是,它可能“落在曲线后面”,延误加息太久。相比正确路径,这将导致最终的加息幅度大得出乎意料,最终的利率绝对水平也更高。
至于英格兰嘛?或许最好的事情应该便是在此次比赛中无人会期待有任何事情的发生,而对于英格兰而言,不从小组赛中淘汰掉便是一个褒奖了吧。

Footnotes

  • 山东省明年将开工装配式建筑2200万平方米
  • Institutions may also fail.

The film is shot to mark the tenth anniversary of the television series, first released in 2005.
这名法国女星将会和瑞恩·高斯林、迈克尔·法斯宾德、娜塔丽·波特曼共同出演新电影。
201103/129769.shtmlEveryone tells a white lie on occasion, it’s just a question of why. Some white lies save relationships, some ease a hectic situation, and others buy us time. We all do it, so there is no reason to deny it. As long as we aren’t hurting others or breaking the law, these innocent lies can make life more pleasant. Most of these white lies only stretch aninterpretation of what the truth actually is anyways. Here’s a list of the 10most common white lies and why we tell them.
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单词medal 联想记忆:
SAN JUAN, Puerto Rico (AP) — Puerto Rico’s new governor was sworn in Monday as the U.S. territory prepares for what many believe will be new austerity measures and a renewed push for statehood to haul the island out of a deep economic crisis.

险资牵手长租 助力楼市调控

References

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