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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 涂料企业推广被套“紧箍咒”:新思维才能活出“真自我” (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.

Before long, Russell fell in love with inmate named Phillip Morris. After Morris was released, Russell again escaped prison by calling the clerk's office, impersonating a judge and drastically reducing his own bail. He was caught and escaped two more times to be with Morris, at one point faking his own death. He is now serving a life sentence but admits to finding his film portrayal pretty exciting.
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Prince Miteb bin Abdullah, one of the most senior Saudi royals detained in the kingdom's corruption crackdown, has been released after reaching a settlement deal believed to exceed the equivalent of $1 billion, an official involved in the anti-graft campaign said.
某种程度上,这种借鉴是基于这样的假设:把一种时装风格从它自身的环境中剥离出来,就能同时去除它所有潜在的负面寓意:譬如战争和王朝。它会变成一种独立存在的审美形式,不再象征任何复杂的社会和政治动荡。
单词fatigue 联想记忆:
n. 匙,调羹,匙状物
It makes piggybacks more comfortable.

May the joy of New Year be with you throughout the year.
这位腾讯公司员工说道:“我们希望她的妈妈能出面协助我们一起调查此事。如果用户确实13岁,未经允许花钱,那么我们可以协调退还。”
vt. 帮助,使 ... 容易,促进
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The US president-elect has pledged to abandon trade agreements which could have wide-reaching effects on American imports and exports of commodities if trade agreements are revised.

Footnotes

  • 盘点2015石材行业八大关键词
  • 是否有什么事情我一直放不下?我们不会总是能意识到我们在何时抓住有害但感觉安全熟悉的事情不放手,不论是一份不称心的工作,还是一段不健康的关系或者一种停滞不前的生活方式。看看你是否执着于对你没用的事情,想出小措施来改变和解脱吧。

《患难与共》(Togetherness),HBO,1月11日播出。HBO台的周日晚间喜剧组合中已经有了20出头的纽约女人(《都市女孩》[Girls]第四季第一集将在同一天晚上播出),还有快到30岁的旧金山男同性恋(《寻》[Looking]也在当天开播第二季)。现在又来了30多岁的洛杉矶异性恋者们。这部有点阴郁的半小时喜剧来自杰伊(Jay)和马克·杜普拉斯(Mark Duplass),兄弟俩曾经合拍过《肥大的椅子》(The Puffy Chair)和《纸袋头》(Baghead)等诡异的电影。马克·杜普拉斯和梅兰妮·林斯基(Melanie Lynskey)饰演一对夫妻,和杜普拉斯最好的朋友(史蒂夫·齐西斯[Steve Zissis]饰演)与林斯基的姊妹(阿曼达·皮特[Amanda Peet]饰)合住一栋房子。
我照顾好自己了吗?有时候,我们太过于关心他人从而忘记了去照顾自己。这很容易就把自己遗忘。
巴蒂说道:“纵观亚洲高校前三百名榜单,我们可以看到,现如今,动态、多样化且颇具竞争力的高等教育园区正在亚洲地区逐渐形成,中国则是这个发展过程中极其重要的一部分。”
明星们的私家飞机刚停稳,“老爹身材”一词便在互联网上走红。男性微胖的身材成为潮流,荧幕上不少这样的例子。法新社(AFP)Deborah Cole(黛博拉?科尔)写道:“杰拉尔?德帕迪约(Gerard Depardieu)在《爱之谷》中的形象便是“大汗淋漓、气喘吁吁地打着赤膊”, 华金?菲尼克斯 (Joaquin Phoenix)在 伍迪?艾伦(Woody Allen)的新片《非理性的人》(Irrational Man)中也露出了他那胖胖的肚子。科林?法瑞尔(Colin Farrell)出席《龙虾》(The Lobster)的首映红毯时,看起来如往常一般衣冠楚楚,然而在剧中他却大腹便便。为了给荒诞主义者欧格斯?兰斯莫斯(Yorgos Lanthimos)的黑色喜剧中的孤独主角增肥,法瑞尔大量进食高热量食品,其中包括融化了的冰淇淋。他告诉《好莱坞报道》(Hollywood Reporter),“在早晨10点享用2个芝士汉堡、薯条和可乐可不那么有趣,”他补充道,“不过我喜欢芝士汉堡。”
Strong reviews, and praise for the performances - particularly from the children at the centre of the story, and Willem Dafoe, who plays the manager of the motel where they live.
The report said that technological innovations and balanced development were the keys to building "cities of opportunity".

深圳楼市供给侧革命:商品房供应是去年两倍

References

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