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业主电梯“惊魂” 诉物业获赔6000多元

Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 北京月均房租升至近5000元 90后成租房主力 (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.

《法律与秩序:特殊受害者》(Law & Order: SVU):NBC频道的这部电视剧上一季中的危机仿佛是从肥皂剧中搬来,发生了各种大事,奥利维亚(Olivia,玛莉丝卡·哈吉塔[(Mariska Hargitay]饰)经历了许多危险——喜欢跟踪的变态强奸犯,折磨人的婚外恋,新生婴儿,现在这一切终于平息下来。在今年的第16季中,侦探们回到了重要的性犯罪上,其中一集的灵感来自雷·赖斯(Ray Rice),讲述的是从监控录像中看到一个著名体育广播员殴打自己的妻子。
As US ETF assets under management passed the $3tn mark this summer, AUM in the Asia-Pacific industry just managed to creep over $350bn.
Tom Hanks has got a slightly more level head around his. He apparently keeps his best actor awards, one each for Philadelphia and Forrest Gump, on the family trophy shelf alongside football (the English kind) trophies and a World’s Greatest Mom trophy left from a mother’s day past.
During the 40 days of Chunyun period, the inter-city transportation faces great challenges. The demand for tickets far exceeds the supply. Various measures are adopted to alleviate the problem by opening many temporary trains (numbers starting with letter L), extending the working hours of booking office and opening up more booths.
中国仍然是世界经济复苏乏力情况下推动全球增长的重要力量。
这样令人反胃的发现在当地并非第一次。从去年起,位于中越边境的广西警方加强了对走私活动的监察打击力度,并成功突袭七家非法食品加工厂。
n. 疲乏,疲劳,累活

节目23 《直通春晚》①《山路十八弯》(表演者:阿普萨萨)②《我是一只小小鸟》(表演者:许艺娜)③《我爱你中国》(表演者:平安)
中国机器人产业联盟理事长曲道奎称,尽管我国本国供应商在2016年将市场占有率扩至32.7%,去年这一趋势出现反转,其市场占有率降至26.8%。
35岁的阿德里亚娜·利马身着一件凸显身材的白色抹胸式礼服。这位巴西模特选择了简单又时髦的装扮,她把头发扎了起来,戴着一条抢眼的项链,项链上缀满了钻石。
Kendall's earnings more than doubled from 2016's $10 million total, making her the biggest dollar gainer on the ranking.
Spider-Man: Homecoming

Footnotes

  • 俄罗斯进口油漆涂料在家具行业占了90%的份额
  • New residential property prices in China grew faster in October despite a slew of restrictions on purchases,

And a few stopped to change a tire for an elderly French couple.
Fiddle with items, your hair, flick your fingers, rub your leg, pace, rock, and bite your lips.(Well, most of that could just be on the "how to cumberbatch" list)
Wonder Woman
1936年诺贝尔和平奖奖牌在美国巴尔的摩的拍卖会上拍出116万美元高价,这枚奖牌是在南美的一家当铺里被发现的。
中国进口下降在很大程度上源于大宗商品价格走低,而后者反过来又是中国总体需求下降的结果。中国已经多年是铁矿石、煤炭、铜等材料的世界最大消费国。
“也许,小组会多你一个少你一个问题不大,但是,你的不称职就意味着67万人的缺席,你的失语就意味着67万人沉默。”

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References

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