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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 风口上的“众陶联”:颠覆性模式真的能重塑“佛山陶瓷”? (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

精装房时代来临 橱柜市场将迎来哪些新变化

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.

Are the political upheavals of 2016 — Brexit and America’s election of Donald Trump — a triumph of democracy or a threat to it? Democracies must respond to legitimate grievances.
Brazil
丽萨斯通
Helsinki-based developer Remedy Entertainment has blurred the line between Hollywood and games with previous incarnations Max Payne and Alan Wake. Now the studio is combining next-generation visuals with the tension and drama of scripted television. Set in the university town of Riverport, Quantum Break puts players in control of Jack Joyce and Beth Wilder, a pair of ordinary people who are given the extraordinary power to manipulate time after an accident that creates a time rift. Time will randomly break down during the game, which causes disasters in the environment that pause, stutter, rewind and freeze. Fans of Max Payne’s bullet time will see new strategies emerge with gunfights involving time-amplified combat as the player fights against the Monarch Corporation. In addition to the virtual storyline, the game features custom live action storytelling that’s personalized based on the decisions one makes.
['rep?twɑ:]
我知道你们中很多人在公司里曾经找到过自己的前任。但是,这不是放之四海皆准的规律。搞办公室恋情可能会对你产生不好的影响。
2014年、2015年的研发经费增速分别为9.9%和8.9%。研发经费在去年国内生产总值(GDP)中的占比为2.11%,比上年提高0.05个百分点。

[k?mpi'tin]
数据显示,在欧洲外的最受游客欢迎20大目的地中,游客的消费主要用于购物,而非就餐。尽管其中很多是世界著名的美食之都。
迅速崛起的“色情短信”服务商Snapchat与早期的社交媒体巨头Facebook具有令人不可思议的相似性。我们现在都知道扎克伯格早早就投下的赌注获得了多大的成功(更不必说他还彻底击败了卑劣的文克莱沃斯孪生兄弟)。那么,Snapchat能否拥有同样光明的未来?
The Warriors are one of the best teams in NBA history, and you can put their championship run up against any team in NBA history for the best playoff performance ever. But there's also a legitimate question of what this means for the sport. If the best or second-best player of all time stands no chance against this team, what does it mean for the sport's competitiveness? It hasn't been a problem so far, thanks to an extremely wild offseason, but the question remains: what happens to a competitive sports league when it's not truly competitive at the highest level?
vt. 打斗

Footnotes

  • 今年大城市将全面放开放宽落户条件 专家:对楼市有直接影响
  • ‘The Americans’ Set in the Reagan era, this FX series is nearly as deceptive as KGB agents posing as suburban American couple: In its second season, “The Americans” proved to be a drama about love, family, friendship and mistrust disguised as a Cold War thriller.

批评人士一直急于指出,库克对新产品开发的参与度不如他前任那样高,而且当他走上舞台介绍新品时,也无法引起同样的兴奋。但库克知道自己的短处,他从健身和时尚界招揽人才,组建了一支新团队,其中包括前博柏利(Burberry)首席执行官安杰拉?阿伦茨(Angela Ahrendts),以及工业设计师马克?纽森(Marc Newson)。
该榜单囊括了2015年度全球最具影响力、最智慧性感、人气最高、事业最为成功的美丽女性。
Both the film and the television series are adapted from the Taiwan action role-playing game of the same name which was developed by Softstar Entertainment. The game is considered by many as simply one of the best Chinese RPG's ever created.
New construction will provide luxury options for renters with deep pockets, mostly in the boroughs outside Manhattan. In Brooklyn, 6,527 new rental units are expected to hit the rental market next year, nearly twice the 3,802 units anticipated for Manhattan, according to Citi Habitats.
adj. 不合法的,非法的
The new figures come as Mr Duterte fends off criticism at home and abroad over his anti-drugs campaign, which has seen 600,000 potential suspects voluntarily turn themselves in to authorities.

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References

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