Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 95%以上城市房价下跌 中国楼市迎来抄底时机 (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.
“What we are seeing right now from China is not only a phenomenon for Brazil, we are seeing the same all over Latin America, declining [Chinese export] volumes into all the markets,” said Antonio Dominguez, managing director for Maersk Line in Brazil, Paraguay, Uruguay and Argentina. “It has been going on for several quarters but is getting more evident as we move into the year .”
One explanation could be that significantly more men than women work in the industry’s best-paying fields. A third of men work in private equity orventure capital, investment banking or mergers and acquisitions, andhedge funds compared with only 19 per cent of women.
2. The new one childplus policy will substantially raise the birth rate, contributing up to 2million new children to the 2014 economy, a 15 percent one-year lift that willonly further boost consumer morale and spirit.
Joakim Noah, meanwhile, proved to be so untradeable that he couldn't even generate a rumor.
Life's ups and downs
他参照美国脱口秀节目主持人的话说：“我一直想和Jay Leno见面，”说这话之前他自己就笑了起来。达拉斯买家俱乐部明星Jared不以为然回应道：“对不起，你又叫什么名字？但观众们似乎意识到了两人之间尴尬的气氛，一位观众开玩笑说：“认为Jared Leto妄想Grinder看着他。”
- 北京多部门打击“租房贷” 专家：中介私自将租赁变为贷款属欺诈
“What Happened, Miss Simone?” (Liz Garbus)
Here, you may be delegates of your governments, business people, organisers, reporters or poiticians - but really you are mothers and fathers, brothers and sister, aunts and uncles - and all of you are somebody's child. 在这里，您可能是您政府商业人士的代表、组织者、记者或政客。但您们也是父亲和母亲、兄弟和姐妹、阿姨和叔叔，你们都会或多或少的为了下一代而活着。
Bank of China posted earnings per share of Rmb0.56, down from Rmb0.61, and a pre-tax dividend per share of Rmb0.175, down from Rmb0.19 last year.
The maker of Post-it notes and Scotch tape authorized a $12 billion stock repurchase program in February, replacing its current $7.5 buyback program. 3M's (MMM, Fortune 500) move followed its announcement late last year that it intends to spend $10 billion on acquisitions and repurchase up to $22 billion of shares over the next four years.
Producing fake data, it appears, is condoned at official levels. Publishing real data lands you up in court. Much more of this and the public will be right to lose trust in official statistics.