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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 修法并不代表“小产权房”能转正 (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

新规范给红木家具销售带上“紧箍咒”

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.

2017年,衡量工业品出厂价格、反映经济活力的主要指标--生产者物价指数(PPI)上涨6.3%,结束了自2012年以来的连续下降态势。2016年PPI下降1.4%。
"The only thing she's got is the woman card," Trump said. "I'd love to see a woman president, but she's the wrong person. She's a disaster."
The people of both countries have the wisdom to properly manage their differences, there is a need and there are also conditions for us to continue to expand our common interests.
exceed
近日,某招聘行业网站发布《2016年应届毕业生就业力调研报告》。报告指出,2016年应届毕业生起薪为4765元,近三成毕业生进入互联网行业,同时互联网行业的平均月薪最高。
“The key thing about Friends is that it’s about people working out how they are going to live their lives — what kind of relationships are they going to have, what kind of job, and the difficulties of settling down,” says Mills to the Daily Mail. “You’re engaged in all those questions about escaping from your family, becoming an adult and working out what you want to be.”And that’s one of the key issues in the youth culture of the 1990s.
然而,她辩称,亚洲ETF流动性较低的问题反映了基金分销体系未能激励中介销售ETF。她说:“我认为没有快速的解决办法,但如果亚洲转向收费模式,会出现起色。”

Tencent, with an estimated value of $44.7 billion, was crowned this year's Most Valuable Chinese brand on a list released by the Hurun Institute on Thursday, marking the second time in a row it came up on top.
课程安排:每隔一个周末在芝加哥上课,共计大约18门课程,包括4门选修课。学员在芝加哥住校学习3周,在香港和伦敦分别学习1周。
n. 辐射,放射线
Also important to EMBA entrepreneurs was the support of their school and alumni network. About three-quarters of entrepreneurs thought that both the school and their alumni network were helpful or very helpful when setting up their company. “Alumni support was key to getting the idea vetted and getting the right contacts needed for the business”, said one.
Puerto Ricans have been hit with dozens of new taxes in the past four years and increases in utility bills as former Gov. Alejandro Garcia Padilla aimed to generate more revenue for a government he said was running out of money. Despite those and other measures, the island’s government has defaulted on millions of dollars’ worth of bond payments and declared a state of emergency at several agencies.

Footnotes

  • 2018广州楼市主基调:平稳
  • 继1958年瑞典世界杯之后,本届世界杯的场均进球数如狂潮般不断刷新。

在36,000位认证网红中,74%是女性,87.8%网红的年龄在17-33岁之间,且89%的人有大学文凭。粉丝也越来越年轻,受教育程度也越来越高,77.8%粉丝的年龄在17-33岁之间,75%的人受过高等教育。
The TV drama is not based on a novel but the story of a real businesswoman Zhou Ying. Born in the Qing Dynasty (1644-1911), Zhou was the richest female entrepreneur in Shaanxi province at that time.
“It was the real 'I have to do this' moment,” he says.
The only things in the way are his staff, Republicans in Congress and the limits of his power. And those are important. Campaign promises of 45 per cent tariffs on Chinese goods have turned into investigations into Beijing’s intellectual property regime.
这位工作人员说道:“她注册时说自己姓韩,也不是像媒体上报道的姓苏。”
Prof Cusumano sees all this as evidence that the company is opening up more, including in allowing developers to customise more of its iOS software.

楼市“寒冬”持续 7月广州成交环比大跌1/3

References

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