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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 南京去年新房卖了6.2万套 个别板块“一房难求” (Published 14 August 2020) Cite this as: BMJ 2020;370:m3181

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  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.

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The 2014 ranking of 100 programmes for working senior executives is headed by Trium, runby HEC Paris, the London School of Economics and Stern School of Business at New York University. The top five places continue to be dominated by intercontinental EMBAs.
特约专栏作家安东尼·盖尔恩是Paragon欧洲合作伙伴的常务董事。目前位于伦敦。
珍妮·德文表示,“这并不是借口——这是我们经营环境的现实情况。”2012年以来,捷蓝航空公司实施了一系列技术手段,帮助该公司尽快恢复正常,摆脱恶劣天气的影响。她表示,正在使用其他手段来帮助航空公司保证航班准时起降。
Accepting the award, he enthused: 'First off, I want to start off by saying that I'm not really sure how I got this because I've had my album out a few years, but I've got one coming,' before thanking his fans and MTV. Elsewhere, Kendrick Lamar was presented with Best Video, though the rapper was unable to attend the event, instead thanking fans via a video link.
11月,财新-Markit制造业采购经理人指数(PMI)从10月的51%降至50.8%,接近区分扩张和收缩的50%大关。此前,路透社(Reuters)对经济学家进行调查得出的预测中值曾预计,制造业PMI将降至50.9%。

With all its eccentric beats and bubblegum, Number 1 Angel feels like the purest distillation of the U.K. star's pop brilliance, whether she's working with up-and-coming rapper Cupcakke on "Lipgloss" or collaborating with M? on "3AM (Pull Up)."
The EMBA ranking rates the best 100 programmes worldwide for working senior executives. The ranking is based on a survey of business schools as well as their students who graduated in 2012. The data measure how successful alumni have been in their career in terms of salary, seniority and achievements since graduating.
Sectors: out of favour
Will the S&P 500 finish the year above 2,650
About 980 million yuan of illicit assets were recovered, according to the Communist Party of China Central Commission for Discipline Inspection.

Footnotes

  • 多地现业主“弃房断供” 近半弃房者下落不明
  • 当然,格雷泽又从库布里克那借鉴了一些拍摄手法,尤其是外星人在无边际的外太空出生的一幕。他借鉴了尼古拉斯·罗格的《天降财神》,或许在画面的安排上也借鉴了大卫·林奇。但是在科幻情调中,他带给我们当代现实主义的勇气和动力,使我们回想起像肯·罗奇这样的影片制作人的作品,甚至是阿巴斯·基亚罗斯塔米和他的《樱桃的滋味》的开头,一个绝望的男人开着车,绕着德黑兰的流动劳动力市场,拼命的找人来帮他。这些奇妙的外星人题材被打磨的通俗化甚至矫情做作。外星人不解的在电视上看着汤米库珀的一幕已经成为色调悬念的代表作。

天文学家在2016年宣布,LIGO阵列检测到了两个黑洞碰撞所释放出来的引力波,证实了爱因斯坦广义相对论的关键部分。研究人员因这项发现而获得了诺贝尔物理学奖。但是研究人员的发现仍未结束:10月,科学家们监测到了两颗中子星的碰撞,不仅听到了碰撞造成的时空涟漪,而且还用性能强大的望远镜在光学上确认了这一事件。中子星的碰撞被认为是宇宙中所有重金属的来源,包括黄金和白银,LIGO的探测有助于验证有关宇宙化学形成的解释。
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读:炸-震动
The ranking is in part based on how successful alumni have been in their careers, as reflected in the salary data.
You`d love to know the balance of forces that shape and move your ponytail, right? That`s why Joseph Keller, Raymond Goldstein, Patrick Warren and Robin Ball received this igNOMINIOUS prize!
She had recently emerged as the right hand of her father, the former Prime Minister Nawaz Sharif. But corruption charges are clouding her rapid rise.

房贷新政对市场后续影响:楼市回暖走向仍会分化

References

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