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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 个人所得税法修正案草案全文公布 向社会公开征求意见 (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

下半年来23城出台房屋租赁新政 扩房源稳租金成主流

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.

张天羽的作品“非常丰富和完整”,谷歌涂鸦团队领导瑞安·格米克对《华盛顿邮报》表示,“仿佛每片树叶都有生命”。
Deepening reform in major sectors and key links
单词embrace 联想记忆:
如果我们问你“你想要多少月薪?”你应该说随便,或是根据工作责任而定。除非我们逼你,别自己说出一个具体的数。因为那只会让我们在商量上面占上风。
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有关她在片中角色的细节尚未披露。
在《招魂》一举成功后, 埃德·沃伦和罗琳·沃伦夫妇又推出了其续集《招魂2》。 影片讲述了1977年发生在伦敦的一个真实故事——恩菲德招灵事件。

卓越雇主排名:11
单词bent 联想记忆:
在咨询公司Brand Finance的《2017年全球500强》报告中,搜索巨头谷歌超过了iPhone的制造商苹果公司,成为了全世界市值最高的公司。
在"踢脚舞"这集中,我们得以看到伊莱恩·薄伯那难以置信的滑稽舞步。简直难以想象没有她这么带感的放克舞蹈,《宋飞正传》会是什么样子。然而,令人震惊的是,那差点就成了现实。编剧之一斯派克·费雷斯滕知道,制作人拉里·戴维一定会反对这场舞戏,所以他只能等到戴维离开之后。当他的这场舞戏终于获得许可,却又遭到不少同事的强烈反对。
10. Deepika Padukone - $10 million

Footnotes

  • 打造家居产业供应链 互联网与家装是重头戏
  • 9、邦德经历风险无数却总能死里逃生。当然,人物本身是虚构的。有意思的是,研究证明,肌肉男更皮实。实际上,肌肉不发达对男性来说,可能很要命。(可能就是发达的肌肉让他得以活命的吧,我怀疑他会死于心脏病或前列腺癌)。

After months have passed without a culprit in her daughter's murder case, Mildred Hayesmakes a bold move, painting three signs leading into her town with a controversial message directed at William Willoughby, the town's revered chief of police. When his second-in-command Officer Dixon, an immature mother's boy with a penchant for violence, gets involved, the battle between Mildred and Ebbing's law enforcement is only exacerbated.
教育部还表示,公费留学学生的归国率达到了98%。公费留学生一般选择中国急需的专业,包括工程学、纯科学、农业和医学科学等。
《小可爱与拳击手》(Cutie and the Boxer)几乎没有受到观影公众的注意,但好电影名单并非票房大片的罗列。这部达到正片长度的纪录片是扎克利?海因策林(Zachary Heinzerling)的处女作,其影响与感悟同样出色。表面上它只是讲述了一段勉力维持了40年的问题婚姻。然而在表面之下,又惊人地暴露出来的是一段有关竞争(夫妻双方都是艺术家)、怨恨、不情愿的奉献以及持久的爱(这是最让人震惊的)的历史。
这位名叫波比·博伊登的小选美冠军穿着一身黑色的连衣裤,带着鬈曲的假发,非常熟练的跳着扭臀舞,向观众们飞吻。
The judging committee (of one) has spent weeks deciding which members of the Royal family, politicians and celebrities deserve one of these most galling of gongs to mark a grievous breach of protocol or lapse in mannerly judgement over the past year.
《老友记》大部分剧集拍摄之时,手机和Google都还未普及,剧中的服装和道具现在看来也有些过时,但是,剧中的主题却依旧深得现在年轻观众的心。

建材板块集体“中暑”创新低 6月或仍将旺季不旺

References

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