Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 28城二手房价跌回5年前 房产投资不败神话被打破 (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.
The excitement was triggered by a Reuters story that cited documents about the potential transaction as the source of its information. Samsung actually has made at least one play for BlackBerry BBRY -19.77% before, in 2012. As to this latest rumor, the alleged takeover target was the first to refute that a deal is in the works.
Warm greetings and best wishes for the New Year!致以热烈的祝贺和良好的祝福,新年快乐。
9.We here in the UK want nothing more than to provide you, our guests, with a fantastic experience this summer, combining the best in international sport, brilliant facilities, fantastic entertainment and a cultural legacy that draws on centuries of excellence in art and architecture. If you ended up with four tickets for the wrestling at the ExCel Centre, well, better luck next time.
10. Mail carrier
Science and engineering fields dominate the list of highest-paying college majors, with software engineering, bioscience, and electronic information engineering among the most lucrative majors.
In 2016, China's box-office experienced a shock correction, with growth plummeting to just 3.7 percent from a roaring 48 percent rate in 2015.
- 地方债发行持续升温 哪些机构在大量买进？
Google and Amazon rank second and third respectively.
都不是。1772年,一场空前的危机击中了阿姆斯特丹：一家受人尊敬的荷兰投资银团对不列颠东印度公司(British East India Company)股票的投资变成了一场灾难。
三个泡沫分别是：20世纪90年代初的亚洲泡沫，90年代晚期的互联网泡沫，以及在2008年引起华尔街崩盘的那次泡沫，朱克斯称之为“信贷大泡沫”(Great Big Credit Bubble)。
TV soaps regularly top the TV ratings but the highest trending show of 2012 was the BBC kids' show 'Mike The Knight' that beat US terror drama 'Homeland' and 'Towie.'