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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 亚什兰上海技术中心新增涂料与建材实验室 (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

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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.

他说:“比如说,如果他们拖延从韩国进口的海关流程并采取对韩国商品的其他报复举措,韩国政府对此将无能为力。”
7、Bad body language habits
7. Political wars guarantee intense volatility through 2014-2016 elections
如果此时打断老师讲课不太合适,你可以快速记下自己的问题,以免忘记,之后再问老师。
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他说,这出乎我意料,但对腾讯走出国门来说这是一个好兆头,特别是因为微信同时结合了WhatsApp和Instagram的特点,所以是一个独特的产品,对于新兴市场消费者来说可能是一个相当不错的东西。
8. Employment futures weak as pensions drain states, municipalities

The best bosses understand that there must be a balance between the company or client’s needs and the needs of his or her employees. The best bosses are willing to listen and talk about any issues an employee may be having because they understand that a happy employee is a more productive employee。
It is reported that Karl Lagerfeld, the artistic director for Chanel, died aged 85 in Paris, leaving the fashion world reeling at the loss of the man.
国有媒体报道称,中国总理李克强表示,2017年中国经济运行好于预期,并预计年度国内生产总值(GDP)增长率为6.9%左右。
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The drama and the original game have a large fan base and enjoy great popularity in China, and even elsewhere in Asia.

Footnotes

  • 广州一二手楼市2月成交量持续走低
  • The report said families back home receive an average of $200 a month, which makes up 60 percent of the household income.Using the steady flow of remittances, families can buy food, get housing, go to school, access healthcare, improve sanitation, or even invest in a business and have some savings, the report said.

报告显示,今年11月11日至15日五天期间,涉及电商平台、电商企业、物流公司、第三方支付机构、消费者等主体的失信案例数量同比增加57.49%。
萨姆·史密斯是一个风格多变的男人,他可以在奥蒂斯·雷丁、艾瑞莎·弗兰克林和雷·查尔斯以及像艾米·怀恩豪斯和阿黛尔这样的现代偶像的风格中随意转换。
“由于这些情况不会一夜间消失,2017年贸易基本没有希望复苏,”里尔宁说。
The annual national civil service exam kicked off last Sunday, and some recent hot topics - such as college graduates starting their own businesses and the Yutu (Jade Rabbit) lunar rover - appeared in the exam questions.
进入前五强的还有桑德拉·布洛克(Sandra Bullock),是我们榜单中仅有的两位女演员之一(另一位是排名第十的詹妮弗·劳伦斯)。布洛克出演了两部电影题材迥异的热门影片:《地心引力》(Gravity)是一部紧张刺激的惊险片,有望使她再次获得奥斯卡提名;而《辣手警花》(The Heat)则是一部票房成绩不俗的喜剧片,全球票房收入达2.3亿美元。
In my anger, I am not blind, and in my fear, I am not afraid to tell the world how I feel. 然而事实却让我很愤怒,但我也很清醒,我虽然害怕,但我敢于告诉世界我真实的感受。

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References

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