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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 二孩政策全面放开 卫浴行业春天就要来了吗? (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

监管压力下 长租公寓遭遇“至暗时刻”

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.

Dachis says: Zynga struggled to maintain its momentum and diversify its business in 2012. The difficult year was evident in reduced brand discussion and an increase in negativity from product shutdowns that leave the game company with a lot of work to do in 2013.
?Bond is by no means a comedian but he knows the power of a well-timed one liner. Women are attracted to funny men because humor is a sign of intelligence. You can even predict how many women a man has slept with by how funny he is.
首先必须了解的一件事是,人格类型与基因无关。这意味着D型人格特征并不是无法改变的。另外,测验也并不意味着测验的结果会决定你的命运。心理学研究表明,任何人格特征都可以改变。
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坚持依法全面履职。
在10月份的第三场总统大选辩论中,两位总统候选人没教养地拒绝与对方握手问好或道别。
持有40亿美元亚洲相关资产的美国投资机构Cohen & Steers的基金经理梁纬濂(William Leung)认同这一点。他主张,随着价格下跌,投机性投资将被驱逐出市场。他补充称,行业中另类投资热度上升的趋势应当意味着,即便基础资产的价值上涨得更慢,房地产投资信托的价格也会上升。“我们认为,这次调整的幅度将不会太大,”他说。

Management consultancies pride themselves on being expert advisers on “change” — from helping clients integrate after mergers, to keeping them at the cutting edge of new technology. Several of the world’s largest consultancies will have to make use of their own advice in 2018 as they prepare for leadership changes — the first in years — that will have significant ramifications for their workforce.
知名安全机构SplashData近日发布2017年最糟糕密码榜单,统计于今年遭泄露的超过500万个密码。“123456”和“password”(密码)再度居首。
上榜的密码中有几大主题,包括人名和兴趣爱好。
失业率的大幅下降的实际效果将会有所体现
Miranda Lambert “Bathroom Sink” (RCA Nashville)

Footnotes

  • 2017年上半年我国LED球泡灯出口企业TOP10
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Turkey’s ministers have been rallying Turkish expat communities across Europe to win support for Erdogan-backed constitutional changes, which will be voted on in a referendum next month.
The book — published by Basic Books and Oneworld Publications — won out against a strong shortlist dominated by books on technology.
今年第一个月,不论以人民币还是以美元计,中国出口和进口都出现了大于预期的跌幅。
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Issued by the Institute of Social Security Research, Ministry of Human Resources and Social Security, the report shows that the return rate of enterprise employees' pension insurance fund reached 3.1 percent, the highest in seven years.

深圳:经济适用房满足条件可取得完全产权

References

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