Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 小城市“供不应求” 卫浴产品需求大 (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.
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The scientists’ analysis comes only a month after nearly 200 governments struck a new climate agreement in Paris that aims to stop global temperatures from rising more than 2C from pre-industrial levels, and ideally limit warming to 1.5C.
Meanwhile, there are other factors holding back the Asian ETF market that some sceptics fear will hold back development of the retail side.
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For now, most of the activity around bitcoin is monetary in nature, so it makes sense that its critics point to volatility. Though the value of one bitcoin in U.S. dollars has fallen 67% in the past year, its value over the past two years is up 1,879%, according to the market price chart at blockchain.info. So whether it’s a good investment or a bad one is a matter of perspective.
皮耶里在大型消费类产品公司工作过多年，如Stride Rite和科迪斯（Keds）等。所以，这种夫妻店在推出新产品时所遇到的困难令皮耶里感到失望。她解释道：“越创新的产品，因为与主流和‘已知’相悖，因而越难销售。”因此，她在五年前成立了The Grommet，这个信息分享平台会将消费者与发明者的故事和产品联系起来。皮耶里的公司帮助发布的产品包括自制碳酸饮料机Sodastream和智能腕带Fitbit。她一直把惠普公司（HP）CEO梅格惠特曼作为自己的导师，并在哈佛商学院（Harvard Business School）担任入驻企业家。
At the start of the year, the ruling Communist party set a target of 6 per cent growth in trade for this year but total trade has now fallen by just over 8 per cent in the first ten months of 2015 compared with the same period a year earlier.
Simply bend one end of the product around yourself or the back of your seat and bend the other end into a secure position for your head. You can even use the hand to hold your device for movie time.
- 中介委托租房要当心 原合同无转租条款不要租
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?
In the meantime, the sheer total of bitcoin-related startups that launched in 2014 demonstrates bitcoin’s momentum. There is no definitive listing of every single bitcoin startup, but 2014 almost certainly saw the launch of more of them than in any year prior. Data that AngelList sent to Fortune confirms that. In 2011, five bitcoin startups listed themselves on AngelList. In 2012 that number grew to 13. In 2013 it jumped to 193, and last year it exploded to 566. (But not all startups register on AngelList immediately, if at all.) In addition, on January 8 the total number of daily bitcoin transactions hit an all-time high, as Barry Silbert eagerly tweeted.
当时，身为首席执行官的库克也承受着压力，因为苹果除了从iPhone攫取利润之外，缺乏清晰的产品开发方向。维权投资者嗅到了血腥，开始围攻这家公司，打头的是大卫?艾因霍恩(David Einhorn)，接着是卡尔?伊坎(Carl Icahn)，他们游说改变苹果的经营和财务管理方式。伊坎施压要求苹果筹集巨额债务，向股东返还1500亿美元，并敦促苹果发布包括电视机在内的更多产品。