Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 进行市场细分 铝合金门窗企业重新规划发展布局 (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.
In truth, slower growth of about 8 per cent could be better for China and for the world. More environmentally sustainable and equitable outcomes would ease popular concerns and higher consumption would ease tensions over global trade.
"Some geniuses in the internet industry created miracles, but that does not tell the whole story," said Chen. "Business has its own rules. Before you start up, you have to know how to produce products, how to sell them, how to manage a company. Those lessons you cannot expect a fresh graduate to know."
6. How to play guitar
Amazon joins the innovators list for the first time for innovations in data centers, devices, electronic methods and systems, according to its latest report.
E-cigarettes first started becoming popular in 2012. They work by heating a nicotine fluid to mimic a real cigarette. Their invention is usually credited to Chinese pharmacist Hon Lik, who reportedly created it after he dreamed that he was drowning in a cloud of vapor. His father had died of lung cancer caused by cigarettes. He himself was an unrepentant smoker who had unsuccessfully tried quitting by using a nicotine patch.
In an industry enthralled to rehashed stories that strike a familiar chord with audiences, give Pixar credit for often trying something new and pushing their viewers into uncharted territories. Coco, directed by Toy Story 3’s Lee Unkrich, has a visual look based around Mexico’s Dia de los Muertos (Day of the Dead). It’s about a young boy named Miguel who idolises legendary guitar player Ernesto de la Cruz and wants to learn how to play as well as he could. So he goes on a transformative odyssey of self-discovery into the realm of the dead to find his long-deceased idol and learn some lessons about the nature of creativity and originality. Whether it can reach the heights of Pixar’s 2015 masterpiece Inside Out remains to be seen, but Coco should surely be a feast for the eyes. Released November 15 in France, November 22 in the US, Croatia and the Philippines, and November 30 in Israel. (Credit: Disney-Pixar)
“It’s fundamentally about ‘who are we?’” said Eric Kaufmann, a professor of politics at Birkbeck College, University of London. “What does it mean to be part of this nation? Is it not ‘our’ nation anymore, ‘our’ meaning the ethnic majority?
2) I Trust Your Judgment: Translation: “You have my permission. I believe in you. Now, go make it happen.” Feels pretty uplifting to hear that, doesn’t it? And I’ll bet you’d do almost anything to please someone who makes you feel that way. Your employees and peers are no different.
The PPI has been negative for 44 consecutive months, reflecting excess supply of housing materials and raw materials, and overcapacity in heavy industry.
会。梅亚德是执政党革命制度党(PRI)的候选人。他主要的竞争对手是强硬的左翼领导人安德烈斯曼努埃尔洛佩斯奥夫拉多尔(Andrés Manuel López Obrador)——可以感召人群的激情演说家。梅亚德需要克服很多问题：在去年1月一夜间把油价上调20%、引发通胀飙升后，他必须说服选民自己仍然是可以信任的。他还必须证明自己是个有主见的人，而不仅仅是这届不受欢迎的政府的傀儡——在遏制猖獗的腐败和犯罪行为方面，这届政府极为失败。但是凭借强大的PRI拉票机器，他可能势不可挡。在墨西哥只有一轮选举的体制下，30%的选票可能就足以让他当选总统了。