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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 苹果将推出智能家居软件操作平台 智能家居概念股强势爆发 (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

江西:创业担保贷款“破千亿” 带动就业389万人次

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.

adj. 有限的,被限制的
Turkey’s ministers have been rallying Turkish expat communities across Europe to win support for Erdogan-backed constitutional changes, which will be voted on in a referendum next month.
The upshot: The world's largest economy can still function as an oasis in a desert despite the claims of doomsayers that those days are over.
As foreign minister, Margot Wallstrom, who broke free from a violent relationship in her 20s, is challenging assumptions in a traditionally male sphere.
Age: 56
Blige将会表演“泥土之界”中的歌曲《Mighty River》,这首获得奥斯卡提名的歌曲是她和Raphael Saadiq以及Taura Stinson共同谱写的。同时,Blige还因出演影片《泥土之界》被提名奥斯卡最佳女配角。她是同时获得奥斯卡提名歌曲和女配角的第一人。
人们揣测的重点在于黑莓健全的知识产权体系。黑莓拥有4.4万项专利,这一数值还在持续增长。比如就在去年10月,该公司就至少获得了27项专利,涉及领域涵盖电话会议界面、触摸屏,以及供智能手机、眼镜、健康腕带等可穿戴设备使用的安全功能等等。安全性仍然是黑莓业务中最大的卖点。只要问问索尼影视部门就知道了,在去年感恩节遭受黑客攻击后,他们“求助”了过时的黑莓才重新启动了通信设备。

触摸屏主要生产商蓝思科技的周群飞以450亿元的资本净值位列榜单第3。
Season\'s greetings and best wishes for the New Year.
All three of the big worldwide financial bubbles that have blow up in the last three decades have 'been fueled by the Fed keeping policy rates below the nominal growth rate of the economy far too long, ' says global strategist Kit Juckes of the French bank Societe Generale.
英国气象办公室哈德莱中心(UK Met Office's Hadley Centre)气候监测与分析的负责人彼得斯托特(Peter Stott)表示,人为造成的气候变化是升温的罪魁祸首,导致世界进入“未知领域”。哈德莱中心发布的研究报告也印证了美国研究人员的分析结果。
Tongzhou was designated as the site of a new administrative center for the municipal government to help relieve the current heavy pressure on public services in downtown Beijing, where the central government is located.

Footnotes

  • 代表委员建言减税降费:完善增值税税制
  • ['traigl]

勉强能。民主党需要再赢得24个席位,这意味着他们需要守住特朗普去年胜选的全部12个民主党选区,并拿下23个在大选中投票支持希拉里克林顿(Hillary Clinton)的共和党选区,另外再添上一两个选区。算起来形势对民主党不利,但从历史先例来看形势有利于民主党。历任总统所在的政党几乎总会在中期选举时丢掉一些众议院席位,有时丢得还挺多,特别是当在位总统的支持率低于50%的时候。看一看2010年的巴拉克奥巴马(Barack Obama)就知道了。
Sylvan Esso “Coffee” (Partisan)
它们的计算方法着重于学校的研究成果和声誉而非特定的本科或研究生课程。这不同于该报在编纂最佳学院排名和最佳研究生院排名时所用的方法。
这位设计师晚年最重要的伙伴之一就是他的伯曼猫邱佩特,拉格菲尔德称它为他唯一的真爱,而且他还曾说过,如果(与动物结婚)合法的话,他会与邱佩特结婚。
支持:该片在威尼斯电影节首映后,获得观众喝彩。
If managers suspect you're looking elsewhere, your LinkedIn profile is often the first place they'll snoop, says Jenny Foss, founder of the career blog JobJenny.com and author of "Ridiculously Awesome Job Search Kit." "It's where a lot of people tend to get busted," she adds。

银行坏账处置加速 “不良”房产拍卖量价齐升

References

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