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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 杭州已备案长租公寓有16万套 租客入住能否安心? (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

家居卖场的“烦恼”:以旧换新卖得多“赔”得多?

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.

Most observers would think the single-aisle Comac C919’s first flight last May (pictured) is illustrative of this, but while it is a key milestone, it does not represent the whole story about what is happening in the industry. Two other events are much more telling.
这个交易对雷霆有诸多方面的意义:首先,吉布森可以短期内顶替受伤的埃内斯-坎特,而且他带来了季后赛经验、可靠的篮板球保障和坚实的防守——这些可能对阵马刺或火箭的季后赛时都是需要的。
President Barack Obama won re-election to a second term in the White House on Tuesday, television networks projected, beating Republican challenger Mitt Romney after a long and bitter campaign。
排名:第三
谎言10:我以为我早就把邮件发出去了。我真的发过了。说谎原因:如果告诉你我觉得这事不重要,我把这事忘了,就会伤害到我俩的关系了。
该杂志指出:“特朗普的财富与特朗普大厦和距其一英里范围内的八座建筑紧密相关。在该微小市场所发生的一切,对特朗普净资产的影响超过了世界上其他任何事情,而最近,周边房地产市场已经开始陷入挣扎(相对而言)。”
Interviewers made their share of blunders, too.

“That’s the first time we’ve seen that,” said Thomas Karl, director of the US National Oceanic and Atmospheric Administration’s national centres for environmental information.
Men and women rated the strengths of their programme equally.
This year's best midseason trade action happened early:
Newly launched Eleven James is bringing collaborative consumption to men’s watches. With a membership program offering access to a curated collection of high-end watches, Eleven James is extending the membership model that has previously been associated with private jets, luxury cars and vacation homes. Beyond the watches, members are enrolled in a dedicated loyalty program which includes a concierge service, access to partner benefits and unique experiences like watch-themed events. Sounds a little bit like men’s watches meet a Net Jets experience? Founder Randy Brandoff has deep experience in luxury marketing, having previously served as the Senior Vice President and Chief Marketing Officer of Net Jets and the Executive Vice President and Chief Marketing Officer of Marquis Jets. Combining his expertise with a watch industry that’s grown year over year and a business model that’s proven successful in other markets, it looks like Eleven James could be hitting the market at just the right time.
“有个人在Facebook上公开辞职。”

Footnotes

  • 江苏南京、苏州等热点城市房价上涨预期下降
  • Trium is ranked first for the work experience of its alumni before the programme, second for aims achieved and third for international course experience. The programme is second for average salary ($307,003) of alumni three years after graduation, just behind the Kellogg/HKUST programme.

“If hearing that the CEO of Apple is gay can help someone struggling to come to terms with who he or she is, or bring comfort to anyone who feels alone, or inspire people to insist on their equality, then it’s worth the trade-off with my own privacy,” he wrote in Bloomberg Businessweek in October.
There were also shows that didn’t live up to early expectations but still had traction, most notably “The Affair,” on Showtime, which began as a Hamptons film noir and instead turned into a French art film. The crime may not be commensurate with the series’s punishingly slow pace and “Rashomon"-like storytelling, but the series picked up momentum — and suspense — in the final episodes.
然而,克普克认为,美国利率在引发新兴市场危机方面的作用未被充分认识。他提供的证据表明,如果以下三种情况同时出现的话——处于美联储紧缩周期,联邦基金利率高于自然利率(导致实际产出趋近潜在产出的利率),以及美联储将比先前预期更快收紧政策的信号让市场参与者感到惊讶——新兴市场爆发危机的几率会大大增加。
18. 最有趣的道歉(并列)。11月18日,《好莱坞报道者》发表了一份1200多字的道歉,因为它的“奥斯卡女星圆桌会议”没有邀请非白人演员出席。很快,导演亚历克斯·普罗亚斯(Alex Proyas)和狮门公司就为新片《埃及众神战》(Gods of Egypt)中的演员缺乏多样性而道歉。
Winners: Raptors
“这是我们租户运动生死攸关的时刻,”大都会住宅委员会(Metropolitan Council on Housing)的项目总监伊拉娜·迈尔(Ilana Maier)说,“如果我们现在不能大举强化规定,那么这些政策在十年内都发挥不了作用。”

皇明揭铅超标成太阳能光热行业最毒隐患

References

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