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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 广州去年二手楼市以跌势收官 (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.

An escalating war on drugs in the Philippines has led to almost 1,800 deaths under new president Rodrigo Duterte, the country’s police chief has said.
Around the corner from Ross’s home, a group of men sat on the shaded stoop of a townhouse, sipping from beer bottles and listening to music. One man who didn’t want to be named said he knew the arrested youth and young man since they were little kids.
在经历了艰辛的法律诉讼之后,凯莎发表的一切都会给人一种胜利的假象。但这张回归专辑用艺术反映了一位勇士的呐喊,并带来了比所有人期望中更为强大的影响力。
200911/88512.shtmlA love letter to a US college student from the girlfriend who was to become his wife is finally on its way to him - 53 years after it was written in 1958.
The report also found that the top cities in intellectual capital and innovation and technological readiness also achieved high scores in the overall ranking, a clear indication that technologically advanced cities were more likely to earn the title of "cities of opportunity".
The reality turned out to be tougher than he imagined. “I saw it as a two-year opportunity,” says Mr Ravenscroft. “The grinding reality is that it’s a slog.” Moreover, his mentor worked at Lehman Brothers, the bank that collapsed in 2008. “It wasn’t quite as long a mentoring relationship as I’d hoped,” he laughs.
For: The National Board of Review gave it their best film, actor and actress awards.

商务部本月早些时候表示,消费品的零售销售是去年消费的一项关键指标。该销售额同比增长了10.7%,占去年全国66.4%的GDP增长。
当然,它还播放音乐,也有日历,甚至给孩子提供娱乐游戏,但它也可能像别的东西一样会被黑客攻击。
Traditionalists include George Clooney, whose awards – best picture for Argo and best supporting Actor for Syriana – are in his library at home, and Dustin Hoffman, whose two best actor awards – the first for Kramer vs. Kramer in 1980 and the second for Rain Man nine years later, are kept in his study.
想知道2013年的最差工作是哪些吗?报社记者以其令人尴尬的特质,取代伐木工人成为今年的最差工作。
1. Am I taking care of myself? Sometimes we get so wrapped up in taking care of others that we forget to take care of ourselves. It can be so easy to leave ourselves behind.

Footnotes

  • “金九银十”平淡收尾 多轮房贷新政刺激作用有限
  • 他们开始对无保障合同、不稳定的工作时间安排、微薄的工资以及依托优步(Uber)等在线零工经济平台的新形态工作感到忧心忡忡。总部位于巴黎的有影响力的富国俱乐部——经济合作与发展组织(OECD)将于2018年发布《就业战略》,其中可能会更加强调工作的质量和包容性。

On questions 10 and 11, if you circled 0, enter 4; if 1, enter 3; if 2, enter 2; if 3, enter 1; if 4, enter 0.
Mila Kunis just keeps on raking in those sexy titles.
n. 终极,根本,精华
British business schools make up ground on their French counterparts in the revamped Financial Times ranking of masters in management degrees.
In 55th place, University of Edinburgh Business School regains the rank it held two years ago. The school dropped down the tables last year after failing to make it into the Masters in Management ranking. The University of Bradford School of Management recorded its best progression, aided by the school’s first appearance in the ranking of the top 100 Executive MBAs.
“今年榜单有趣的地方之一是,尽管网站都开始实行更严的密码设定政策,位数少的密码仍出现在今年的榜单上。”

降息后房贷利率仍可打9折 业内:折扣可能取消

References

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