Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 10月房地产信托业务下滑 大资金悄然布局A股 (Published 14 August 2020) Cite this as: BMJ 2020;370:m3181
- Shamil Haroon, clinical lecturer in primary care1,
- Joht Singh Chandan, academic clinical fellow in public health12,
- John Middleton, president3,
- Kar Keung Cheng, professor of public health and primary care1
- 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- 2Warwick Medical School, University of Warwick, Coventry, UK
- 3Association of Schools of Public Health in the European Region (ASPHER)
- Correspondence to: S Haroon
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 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.
其他列入前十的热门搜索项中除了一个以外，都反映了公众对名人的痴迷。青少年热捧的流行小天后麦莉 赛勒斯在热门搜索项中排行第三，紧跟其后排在第四位的是电视明星金 卡戴珊。嘎嘎小姐排在第五位，女演员梅根 福克斯排在第七，前十名的其他几位分别是贾斯汀 比伯、美国偶像和小甜甜布兰妮。排在第六位的iPhone是个例外。
Episodic memory is also known as long-term memory, and the researchers approached the study of exercise in a different manner than previous studies. Other studies examined the impact of aerobic exercise conducted over many months, but this study simply asked participants to lift weights a single time. During the test, half of the participants were asked to use a weight machine before recalling a series of images they were shown at the start of the test. The other half of the participants were also asked to recall the images but without having engaged in any strenuous activity before the recall session. In demonstrating the memory improvement for the participants who engaged in just a single session of weight lifting, the researchers were able to show that improving one's memory through exercise didn't take hours of dedication in the gym. The next time you have the opportunity to lift weights or someone tries to convince you to join the gym you might just want to take him or her up on the offer.
在周二发布的一份研究报告中，行业组织国际金融协会(Institute of International Finance)经济学家罗宾?克普克(Robin Koepke)表示，投资者、新兴市场政策制定者以及美联储自身都忽视了美国利率在引发新兴国家汇率、银行及债务危机方面的作用。
But the declines continued, and now it’s all over, red rover.
LBS tops the ranking of the best 81 business schools in Europe based on the schools’ performance in four of the rankings published by the FT each year: MBA, executive MBA (EMBA), masters in management (MiM) and executive education. (Two schools tied for 80th position with identical scores.)
- 高压式管控 顺德涂料产业寄望“二次生根”
考虑到波士顿咨询集团(Boston Consulting Group)管理合伙人理查德莱塞(Richard Lesser)的第二任期将于10月结束，该公司可能也将引来变化。然而，由于该公司拒绝就其选举流程及领导人最多可以有几个任期置评，莱塞的未来尚不明确。
Since 1983 the annual Spring Festival Gala hosted by China Central Television has always been an important part of the Chinese Lunar New Year celebration - no wonder every move organizers make becomes the center of attention.
The Female Warlord Who Had C.I.A. Connections and Opium Routes
But Moonlight kept pace with it over the course of a marathon four-hour ceremony. Barry Jenkins and Tarell Alvin McCraney won best adapted screenplay, while Mahershala Ali won best supporting actor — the first Oscar for a Muslim American actor.