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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 摸底十年宅地供应,供地制度面临重大变革 (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.

Richard Waters
开发活动也处于白热化。GitHub网站上的贡献者图标显示,2014年11月,对比特币主码的贡献总量处于2012年春季以来的最高值。此外,就被“分叉”的次数而言,比特币在GitHub上90多万储存库中名列第31位,“分叉”基本是指提议或正在对核心代码进行的改动。换言之,对于开发者来说,比特币风头正劲。比特币公司目前公布的空缺职位的数量,也突显了开发者的兴趣。跟踪该趋势的Bitcoin Pulse称,如今,此类空缺职位数高达105个,接近九月137个的历史最高值。
除了印度,其他金砖国家——巴西,俄罗斯,中国和南非——也削减了对美国政府债券的持有。
7. Big anti-corruptionprograms will be accelerated. We expect to see increased prosecutions,from approximately 140,000 per annum today to more than 200,000 in 2014. Thisaggressive push for integrity and accountability will set the country on astrong new course. Success will become much more about what you know ratherthan who you know.
However, this year it is ranked in eighth place.
国内航空统计公司飞常准发布的最新报告显示,我国主要机场的准点率仍然远未让人满意。
Agents and investment institutions are now flooding the sector, causing additional changes to the platforms in the world's second-largest economy, the report said.

与2013-2014赛季的世界各大足球联赛相比,本届世界杯的场均进球确实更多。荷甲以场均进球3.2个高居欧洲各大联赛之首,德甲则以3.16个紧随其后。上个赛季,其他联赛的场均进球都没有超过2.8个。目前,美国职业足球大联盟的场均进球为2.89个。
Paris is the only Eurozone country in the top 10, and sees a drop of three places, which the report says may be due to falling confidence in the euro.
乔布斯正在展示 iPad 2。2011年3月,旧金山
A few people took advantage of technology:
The leadership changes across the industry will be of particular interest to female consulting professionals, given none of these firms have ever been run by a woman. Consulting firms are vocal proponents of the business case for improved gender diversity at the top of large companies. It will be interesting to see if any of them decide to practice what they preach.

Footnotes

  • 门窗行业发展态势良好 发展势头平稳
  • ● “一艾滋病女子故意传播艾滋病给586名男子,计划在2017年之前传染2000人以上”

读:炸-震动
"He said if he didn't get that package within the next 53 years, he would call to complain," university spokeswoman Christine Kindl told Reuters news agency.
在家里创造一个属于自己的学习空间。如果身边家人都在身边,你就要确保大家都明白你是在里面学习,除非房子着火,他们是不会打扰到你的。
The upshot: The world's largest economy can still function as an oasis in a desert despite the claims of doomsayers that those days are over.
6.摄影记者
She created a whole world around the device -- one populated by humans, a whale in a top hat and dragons.

2016年2月建筑防水行业大事记

References

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