Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 国庆归来 建筑钢材价格能否绝地反击 (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.
Do not forget why you're attending these conferences, who you're doing this for -- we are your own children. You are deciding what kind of world we will grow up in. Parents should be able to comfort their children by saying "everyting's going to be alright" , "we're doing the best we can" and "it's not the end of the world". 不要忘记你们为何而来到这里开会，你们为谁做事情？我们是你们的下一代，你们正在决定我们将要在一个什么样的环境中成长，父母需要能够宽慰孩子们，告诉他们“一切都没问题，那不是世界末日，我们正在尽其所能的改变”。
They must understand in their bones that it is illegitimate to make temporary power permanent by rigging elections, suppressing contrary opinions or harassing the opposition.
UK schools account for more than a third of all graduates from the top 50 pre-experience programmes and not only attracted nearly half of all female students but also almost half of all international students. Indeed, 94 per cent of students enrolled in a UK MiF pre-experience programme in 2014 were from overseas. About 85 per cent of these students were from outside the European Economic Area, including 55 per cent of the overall number from mainland China.
Among the 772 movies made in China in 2016, 43 of them reached a box office of over 100 million yuan. Chinese movies harvested an overseas box office of 3.8 billion yuan in 2016 with a yearly increase of over 38%.
The same seven schools continue to dominate the top half of the ranking. AGSM at UNSW Business School of Australia entered the ranking for the first time in eighth position.
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The Great Recession had devastating effects across the U.S. and few places were as hard hit as Arizona. The state was booming on the strength of its tourism and real estate markets during the 2000s. Median home prices jumped 70% between 2003 and 2006—only Nevada had bigger gains—fueling more building and construction jobs. Monthly unemployment was at 3.5% through much of 2007. But then the bottom fell out. Home prices plummeted more than 50% from their peak and 6% Arizona properties received foreclosure filings in 2009. Unemployment stubbornly remained in double-figures for most of 2009 and 2010 and only Nevada lost a higher percentage of jobs over the last five years. Household incomes declined at the fastest rate in the country since 2008.
库克决定通过增加派息和回购股票扩大其现金返还计划，帮助缓和了与维权投资者的关系。目前它总共向股东返还现金940亿美元。最终，库克以足够的坚忍抵挡住挑战，迎来了iPhone又一波增长捷报，以及从乔纳森?艾夫爵士(Sir Jonathan Ive)的设计室诞生的新产品。