Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 2014-2015年全球涂料市场报告 (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.
Below are a number of statements that people often use to describe themselves.
Slow growth around the world won't hurt the U.S. all that much. American exports might flatten out or even dip, but that would be offset by lower imports of petroleum because of sinking oil prices. So the trade deficit is unlikely to get further out of whack.
《倒霉蛋：罗伯特·博斯特的生与死》(Jinx: The Life and Deaths of Robert Durst)，HBO，2月8日播出。《追捕弗雷德曼家族》(Capturing the Friedmans)的导演安德鲁·杰瑞克奇(Andrew Jarecki)执导了这部六集系列纪录片，在片中与博斯特先生通力合作。博斯特出身纽约房地产世家，与数起谋杀事件有关，他的第一任妻子失踪之谜至今未曾解开。
New Year should be a time of banked-up fines, the scent of flowers and wine, good talk, good memories and loyalties renewed. But if all else is lacking - love will do.新年是这样美好的时光：炉火熊熊，花儿芬芳，醇酒飘香，殷殷祝福，美好回忆，恩爱日新。即便没有一切，只要有爱便足矣。
11. 另外26部我喜爱的影片——为什么不呢？其中很多影片本可以跻身我的十佳之列的。《迷失1971》(’71)、《艾米》(Amy)、《失常》(Anomalisa)、《骇客交锋》(Blackhat)、《芝拉克》(Chi-Raq)、《机械姬》(Ex Machina)、《实验者》(Experimenter)、《诉讼》(Gett: The Trial of Viviane Amsalem)、《恐龙当家》(The Good Dinosaur)、《伟人》(The Great Man)、《头脑特工队》(Inside Out)、《奋斗的乔伊》(Joy)、《洛杉矶消逝的风景》(Lost Landscapes of Los Angeles)、《魔力麦克2》(Magic Mike XXL)、《办公室》(Office)、《结果》(Results)、《荒野猎人》(The Revenant)、《西默简介》(Seymour: An Introduction)、《小羊肖恩》(Shaun the Sheep Movie)、《女间谍》(Spy)、《冲出康普顿》(Straight Outta Compton)、《橘色》(Tangerine)、《廷巴克图》(Timbuktu)、《生活残骸》(Trainwreck)、《白色上帝》(White God)及《狼群》(The Wolfpack)。
To Anita Eerland and Rolf Zwaan [THE NETHERLANDS] and Tulio Guadalupe [PERU, RUSSIA, and THE NETHERLANDS] for their study “Leaning to the Left Makes the Eiffel Tower Seem Smaller."
Chinese imports fell 18.8 per cent in October from the same month a year earlier, a slight improvement from the 20.4 per cent year-on-year fall in September. Sharply lower prices of oil and other commodities also helped scythe the bill.
在针对已拥有金融业工作经验的学员开设的金融课程的排行榜上，伦敦商学院(London Business School)重新夺回在2011年至2015年占据的冠军宝座，同时英国剑桥大学(University of Cambridge)佳奇管理学院(Judge Business School)跌回第二名。
This research involves a large longitudinal study of emotion in interactions within married couples.
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.
Frustrated, he invented something that would allow him take a picture of himself: He called it the "extender stick." Since the iPhone really hadn't been invented yet, a small camera was to be attached to one end of the stick. It also had a small mirror in its front so that users could see how they would look in the photograph. He patented the "extender stick" in 1983. The product was mass produced for sale but it was a commercial failure. The quality of the pictures was low. Besides, previous research showed that the women back then were embarrassed by the idea of taking pictures of themselves. The selfie stick was then reinvented by Wayne Fromm in the year 2000, three years before Hiroshi's patent expired. Fromm called his the "quik pod." He believes he is the inventor of today's selfie sticks and has even sued several other selfie stick producers. When asked about Hiroshi's selfie sticks, he said they were "prior art."