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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 北京公积金新政:违规提取5年禁提禁贷 (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

美涂士:涂料营销,动静之间见方略

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.

但是,当今年12月WTO成员国聚集在布宜诺斯艾利斯召开两年一度的部长级会议时,我们将一尝世界新秩序的味道。一如既往的是,目前尚不清楚WTO此次能否产生一些实质性内容。但真正的考验在于,WTO有史以来第一次不由美国牵头讨论。中国或欧盟会取而代之吗?印度会像过去一样一心阻挠任何协议吗?
从一个孩子的视角,讲述佛罗里达州一家汽车旅馆社区的生活。
Like any college kid, Evan Wray loved using the tiny pictograms known as emoji. But he hated that there was no emoji to express his Fighting Irish pride with fellow University of Notre Dame students. So, alongside co-founder Sean O’Brien, he built a modest business on that disconnect. TextPride, as it was called, licensed images from brands in the sports and entertainment world and sold them as sticker packs. Within a messaging app like Kik, users could buy a packet of stickers for Disney’s Frozen for $1.99, for example.
vt. 把 ...
007电影中,反派人物往往没有自己的主题曲,但是《金枪人》中克里斯多弗·李扮演的暗杀者出场时有一段轻快动人的绝妙曲调,衬托出暗杀者如地狱使者般帅气冷酷。LuLu的演唱完全演绎出这个反派斯卡拉孟加的过人之处。即使这首歌在今天来说欢快得有点可笑,但这也增添了它的魅力。
hospit客人+ality表名词,“状态,性质”→好客
如果你每周的周一到周五没有一天早晨醒来感到一种想要去工作的兴奋,那么这就是一个问题了。那意味着你没有能够享受你的工作并且你的工作正在破坏你的生活质量。如果你每天醒来,恐惧去上班,那么是时候辞掉你的工作了

About 60 per cent have not yet worked and a further 30 per cent have less than two years’ experience.
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.
Other Chinese companies that filed a large number of patents included ZTE, Alibaba, Xiaomi, BYD and Haier, all of which are rapidly expanding into Europe.
Closer to home, fake official data are just as prevalent. The UK’s Office for National Statistics on Tuesday reported that British inflation, measured by its longstanding retail prices index, rose to 4.1 per cent in December. This number is nonsense and the ONS knows it. It tells people the RPI “does not meet the required standard” to be given a quality stamp, yet it has refused since 2012 to take steps to improve the measure and bring it closer to the lower headline measure of 3 per cent.
Whenever I talk to people about the future, I'm struck by their belief that it is knowable. The impression I get is that most people imagine the future like a book ending: already written and readable if you can just steal a quick look at the last few pages. What they find difficult is accepting that the pages aren't written yet. The future hasn't happened, hasn't even been planned--and cannot be known because it doesn't exist.

Footnotes

  • 10月以来调控接踵而至 楼市成交量连续两月下滑
  • Online marketplace Amazon.com Inc made its debut in the 2015 Thomson Reuters Top 100 global innovators list, leaving International Business Machines Corp, the world's largest technology services company, out of the list.

北京某投资公司总经理汪杰表示,金融和地产业高管较高的薪酬反映出我国发展不平衡的问题。
A happy New Year to you.
谷歌的数据还显示,著名流行歌坛天后惠特尼?休斯顿今年二月份去世的消息吸引最多网民关注,风头盖过了凯特王妃。
TWO Americans were awarded the Nobel economics prize yesterday for studies on the matchmaking taking place when doctors are coupled up with hospitals, students with schools and human organs with transplant recipients.
My Sunshine
According to the new report, over the past 20 years India has been the leading user of anti-dumping cases, filing 767, or 15 per cent, of the 4,990 initiated between 1995 and 2015. The US accounted for 570 while the EU registered 480.

家纺“微信门”进入司法程序 富安娜向梦洁家纺索赔200万

References

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