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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 北京宇阳泽丽董事长彭松涛:旧房返修市场很大 (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

“新型城镇化”为新型建材发展带来新机遇

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.

有时,它是英语中最可怕的字眼之一。但是当机会在你的职业生涯中出现时,你应该准备好说出这个字眼:Yes。
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此外,排名前列的城市的“成本”、“文化与居民生活”两项指标普遍不高。在满足民众需求、并提供高质量生活方面,中国的“机遇城市”仍然面临挑战。
Losers: Kings
2. Take baby steps.
“How you leave a position can make a lasting impression,” notes OfficeTeam executive director Robert Hosking. That’s for sure. Most (86%) of the HR managers in the survey said that how someone quits a job “affects their future career opportunities.” Word gets around.
Ellen DeGeneres

Peace and love for you at New Year from all your students.
On the a monthly basis prices fell by an average 0.5 per cent.
全国工商联汽车经销商会数据显示,自2014年进口现代中国经销商网络已经缩减了一半。
The refugees have streamed into Greece, Bulgaria, Italy, Spain, Malta and Cyprus during 2015, with a huge majority -- over 800,000 -- arriving by sea in Greece. About 3,600 died or disappeared trying to make the perilous Mediterranean Sea crossing between North Africa and Italy.
《我无法忘记那天晚上和他在一起时发生的事》(‘I Could Not Forget What Happened to Me That Night With Him’)

Footnotes

  • 城市民宿越来越火 重在规范
  • Ah yes, the other reason Sacramento shouldn't tank: Philadelphia has the option to swap picks with them this year. It's actually impossible for the Kings to get the No. 1 pick because of that, and it hurts their chances at a top-three pick overall.

The two extraordinary sex toys will go on display at an upcoming exhibition at the Asian Art Museum of San Francisco in the United States.
I'm going to disagree on one team you mentioned: the Kings. The West is a bit shallow again, and Sacramento is in the mix for a playoff spot. It's not likely or anything, but so long as they are in the mix, they have to pull out almost all the stops to grab it.
店长马克·斯特罗恩说,开发这种设备旨在帮助那些忘记自己锁屏密码的iPhone用户进入被锁在手机上的照片或通讯录。斯特罗恩在香港第一次看到这台设备,他表示,在最一开始大家都对其能否起作用持怀疑态度。但随着时间的推移,这台设备一次又一次的证明了自己。
从2015年至2016年,美国ETF市场增长20%,而亚洲市场仅扩大10%。分析师们表示,从两个角度可以看出亚洲ETF市场的规模不及美国和欧洲:后者的市场规模是亚洲的两倍,ETF管理的资产规模为7160亿美元。
米特卜王子被捕不到一个月即获释,这显示出沙特想要迅速结束这场腐败调查,阿尔瓦利德·本·塔拉尔王子等多名王室成员和亿万富翁在调查中突然被捕。
Immigrant populations in Arkansas, North Carolina and Tennessee have more than tripled since 1990, noted Lee Drutman, a senior fellow at the New America Foundation, in an analysis for Vox. Anxiety over those changes may explain why the Republican Party became so much more focused on limiting immigration over that period — and why white voters in those states overwhelmingly support Mr. Trump.

经济调整市场外迁 家居卖场走出核心城区成破局

References

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