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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 东莞上周八成区域住宅成交不足30套 (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

全球十大年均房价涨幅最高城:沪京位列七八名

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.

Viewers of online live broadcasting can send virtual gifts, which they purchase, to broadcasters. Gifts range from 0.1 yuan to more than 1,000 yuan. A percentage of the money goes to the platform.
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菲律宾参议院一委员会就国内发生的法外处决事件举行了听证会,罗纳德?德拉罗萨(Ronald Dela Rosa)在会上表示,自7月1日杜特尔特就任总统后,有712人在警方缉毒行动中被杀,还有1067起死亡正被作为与毒品相关的自告奋勇者杀人案件在调查中。
Length of program: 19 months
But nearly two-thirds (65 percent) of white evangelical Protestants say they think the storms are evidence of the "end times" as predicted by the Bible.
1.你一夜之间成了领英平台的香饽饽。
某种程度上,这种借鉴是基于这样的假设:把一种时装风格从它自身的环境中剥离出来,就能同时去除它所有潜在的负面寓意:譬如战争和王朝。它会变成一种独立存在的审美形式,不再象征任何复杂的社会和政治动荡。

十年前,斯蒂尔作为一名成功的投资顾问在世界电信展(ITU World)上发言。世界电信展是联合国主导的一项活动,重点是科技在政府中的应用。同一周,加州经历了史上第一次州长罢免选举。斯蒂尔不敢相信,在如此重要的选举中,会出现这种不合时宜的平台故障(三年前才刚刚发生了臭名昭著的佛罗里达州总统选举罢免),所以她决定凭一己之力来解决这个问题。到目前为止,共有169个国家使用了Everyone Counts的电子投票平台,包括波斯尼亚黑塞哥利亚和奥斯卡奖评审委员会。
该研究基于数亿个安全问题的答案以及数百万条恢复账号登录的请求。
Landing a superstar like Cousins for pennies on the dollar won't singlehandedly help the Pelicans carve out a larger slice of the sports landscape in New Orleans, but it's an excellent first step.
而相对来说,普遍推出的新限购政策,并未让其他许多最近几个月表现突出的城市受到影响,房价同比依然大幅上涨。
"When the actual dependency ratio of pension insurance gets down to three to one, the payment cannot be lower than 17 percent. If it drops to two to one ratio, it means that everyone is going to pay 25 percent. The financial burden gets heavier when the dependency ratio gets lower. The restructuring of pension system must be finalized in two years." Yang said.

Footnotes

  • 花钱都买不来的六个瓷砖铺贴经验
  • 当他饰演《活力王子》中"威尔"一角时,前三季的薪水都被制作方扣除了70%!三年之后他才拿到全额工资。碰巧的是,主题曲的第一句就如同是按他的真实经历所写:"这故事就是说/我翻腾的生活/如何大起大落"。只不过在现实中,那个"(他)爱闹事的邻居"是美国国税局。

That possibility was backed up by a list of top-tier cities the statistics bureau began tracking recently
"We will set the exact date and location for our operation in consideration of weather conditions, but it will not be publicised," said Park Sang-Hak, a former defector who has led a series of balloon launches
其他入围者分别是:《失去信号:黑莓离奇崛起与惊人陨落背后不为人知的故事》(Losing the Signal: The Untold Story Behind the Extraordinary Rise and Spectacular Fall of Blackberry),作者杰基麦克尼什(Jacquie Mcnish)和肖恩缠尔科夫(Sean Silcoff)回顾了黑莓是怎样偏离了航向;《数字黄金:比特币背后不为人知的故事》(Digital Gold: The Untold Story of Bitcoin),作者纳塔涅尔波佩尔(Nathaniel Popper)审视了虚拟货币比特币的崛起;《音乐如何变免费:一整代人犯下同样罪行的后果》(How Music Got Free: What Happens When an Entire Generation Commits the Same Crime?),作者斯蒂芬威特(Stephen Witt)介绍了盗版和对等网络共享(P2P)扰乱唱片业的历史;《做不完的事:女人、男人、工作、家庭》(Un滻椀猀栀攀搀 Business: Women Men Work Family),作者安妮-玛丽斯劳特(Anne-Marie Slaughter)在书中讨论了实现性别平衡面临的挑战,以及《行为不端:解读行为经济学》(Misbehaving: The Making of Behavioural Economics),作者理查德泰勒(Richard Thaler)追踪了行为经济学的发展。
And others simply disappeared:
n. 保守派(党),
C罗巨无霸般的收入主要来源于两部分。一部分是他效力于西班牙豪门皇家马德里挣得的令人眼红的3850万英镑的年薪。另一部分来源于他为耐克、豪雅表和营养品公司康宝莱代言带来的总计2200万英镑的代言费。

北京扩大共有产权养老社区试点 将配备社区医院和幼儿园

References

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