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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 人力成本制约 致使酒店服务质量下降 (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

国家政策倾斜基建投资 水泥价格有望进入持续上涨周期

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.

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2、《蝙蝠侠大战超人:正义黎明》
As early as 2008, wearable technology—which can range in anything from measuring your heart rate to curating music based on your mood—has been touted as the next big moment in consumer electronics.
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智能垃圾桶
在北大和清华大学之后,中国内地入选该榜单前20名的院校还有中国科学技术大学,该校位居第15位;复旦大学排名第16位,上海交通大学排名第18位,而浙江大学排名第19。
马克?高恩洛夫(Mark Gongloff)在《赫芬顿邮报》(Huffington Post)上警告说:“一季度美国经济增长的大幅降级揭示了经济体挥之不去的疲弱,暴露了华盛顿执迷于财政紧缩的愚蠢,并给美联储最新的乐观打了一记响亮的耳光。”而随着政治局势的恶化,增长速度还会进一步放缓。

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“许多公司在过去几年中大量裁员,不少团队超负荷运转,为了减轻它们的负担,公司纷纷开始招兵买马,”罗伯特哈夫公司董事会主席兼首席执行官麦克斯?麦斯默尔(Max Messmer)指出。“有些机构是出于眼下的需要才增加人手,但很多企业也是在为2011年有望出现的经济增长做好人才储备。”
这支队伍需要更多的天赋,他们需要大修。对魔术而言,最能吸引天赋到来的方式一直以来都是选秀。
The report shows Cases of dishonesty connected to e-commerce platforms and enterprises, logistics companies, third-party payment platforms and consumers in a five-day period from Nov 11 to 15 increased 57.49% compared to last year.
Several South Korea-linked entities have already felt Beijing’s wrath in response to the Thaad plans. Chinese state news agency Xinhua last month issued a stark warning to Lotte, one of South Korea’s biggest companies, for giving up land on which the Thaad platform will be hosted.

Footnotes

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  • STEP 5: GET RID of most of your friends

Earlier on Tuesday Mr Rutte had issued a call for calm in the dispute with Turkey.
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近期,对中国经济的担忧拖累了全球金融市场,影响了欧元区和其它许多经济体的前景。这种担心是欧洲央行(ECB)预计将在周四启动新一轮经济刺激的原因之一。
政府已经意识到了房地产泡沫的危险性——可能造成国民经济的通货膨胀,甚至可能因为泡沫破灭,最终导致正在复苏的经济脱离正轨。政府已经出台了相关的政策措施,给火爆的房地产市场降降温。在2010年依靠政府出台的政策来调控房价,你认为这有多靠谱?
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统计局:6月CPI同比上涨1.9% 居住类价格同比上涨2.3%

References

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