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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 一代钢铁工人变迁沉浮:再没有国企倒不了的想法了 (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

广州:厨房阳台不得租给人居住

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.

And the best gig for 2015? That would be an actuary, the people who specialize in financial risk.
China (mainland and Hong Kong) adds 25 to the list this year, more than any other country, for a total of 207. Three countries debut on the list this year: Mauritius, Slovakia, and Togo.
The issue has also hit Beijing’s efforts to secure market economy status in the WTO, which it claims it will be entitled to automatically on December’s 15th anniversary of it joining. If China obtains that status it could affect the ability of the US and others to bring anti-dumping cases, as it would remove their ability to use prices in third countries for comparison.
n. 隧道,地道
当小李子上台领取奖杯时,制片人哈维·韦恩斯坦兴奋地拍拍他的背,全场观众起立为他喝彩。
Despite an abortive attempt in August to devalue the renminbi — a move that rocked global markets and was quickly abandoned by Beijing — China’s trade-weighted exchange rate was 8.5 per cent stronger in September than a year earlier, making Chinese exports less competitive.
Celebuzz has pulled together some of the best snaps of celebrities who go pumpkin picking.Have a look now in the gallery above, then tell us: Are you ready to celebrate Halloween on Wednesday?

纽约人向专栏提出的问题,不仅取决于他们的个人情况,还取决于当今的重大问题,比如住房成本上升、士绅化、豆腐渣工程。最终,2014年成为了一个一切都在增长的年份,增长的包括房价、租金,以及最重要的——楼盘数量。根据纽约房地产委员会(Real Estate Board of New York)的数据,10月批准建设的单元达到了16700套。
天蓝、地绿、水清的美丽中国
[j?t]
7. 克里斯汀?斯图尔特
Brazil lost that 1950 final, 2-1, to Uruguay, a historic humiliation that still stings Brazilian fans today. Belmonte, 85, hopes he'll get to see his country regain its honor. "I hope Brazil will be able to win this time," he said. "This is our revenge. I want to go see our revenge."

Footnotes

  • 房价企稳信号明显 回升态势或持续至下半年
  • 明年就是这只会说话的萌熊诞生60周年了。为了纪念帕丁顿熊诞生60周年,曾执导2014年口碑和票房都大获成功的电影《帕丁顿熊》的保罗?金回归续集担任导演。在当前这个连儿童娱乐节目都充斥着黑暗和暴力的时代,我们比以往任何时候都需要这种安静地讲述英国普通人生活的片子。这部新电影的情节?事实上,没有太多情节:根据上部电影的结尾,帕丁顿熊现在和温莎花园的布朗一家舒适地生活在一起。他想从一个当地的书商那里给他的姨妈买一本立体书,但发现自己还差几英镑,于是他就穿上了自己的长筒雨靴和粗呢连帽外套,并找到了几份兼职工作——结果却发现这本书在书店被偷了!神秘的破案之旅(其实也没那么严重)就此开始。你在电影中还可以看到关于“橘子酱控”帕丁顿熊的更多笑话。该片将于11月10日在英国上映,11月23日在德国上映,11月30日在柬埔寨和马来西亚上映。(资料来源:欧映嘉纳)

Alice Schwarzer
由于合并后的航空公司通常继续分别公布航班延误统计数据,我们可能需要几年时间,才能看到全新美国航空公司在假日旅行方面表现如何。
Shipments to China cratered by 14.4 per cent year-on-year to Rmb737.5bn in January. That’s from a 4 per cent drop in December, and versus expectations for a 1.8 per cent rise.
急增的整形顾客中很多并不是韩国人,他们来自中国、日本、中东甚至非洲。韩国部长们认为医疗旅游将有助于推动韩国经济发展。
China has recently made majordecisions about its economic future. On November 15, 2013, China announceddramatic new social and economic policies contemplating much greater relianceon market forces than it has in the past and inviting private-sectorparticipation and foreign competition in industries long previously controlledby the central government. It also relaxed its one-child policy, openingthe country and its people to vast new opportunities and inspiring new hopes anddreams.
Heatwaves around the world, including one in India that led to more than 2,000 deaths and another in Iraq that saw the mercury top 50C, helped push temperatures 1C above pre-industrial levels for the first time, US and UK researchers said.

海鑫钢铁几近命悬一线 昔日百亿资金不知去向

References

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