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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 20天连开三次住房会议:住建部定调精准棚改精准调控 (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

从上市公司中报看房贷和房地产市场走势

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.

攻读EMBA也有利于升职。一位毕业生表示:“我获得的技能对我的升职至关重要。”五分之一的学员在毕业3年后担任首席执行官、执行董事或董事。学员们在读EMBA前的平均薪资为11.4万美元,毕业5年后增长52%至17.5万美元。
但是今年,研究者提出一种新的方法,这种方法可以通过真的细胞制作出有弹性真实的耳朵。这些细胞来自老鼠和奶牛,可以形成胶原凝胶,按任何模具成型。当放入使用3-D打印技术制作的耳朵模型后,一个小时内那些凝胶形成了一只假耳。在移植到对象之前,人造耳朵只需要在营养成分中生长培养几天。
韩国最大的整形医院之一,由权株创立的JK整形手术中心,近期开了一家旅馆来更好地服务顾客。这些顾客每次看病人均花费17675美元。
separate
Explaining the choice, the company cited “societal movements toward gender equality and fluidity, the consumer’s increased comfort with using color as a form of expression, a generation that has less concern about being typecast or judged and an open exchange of digital information that has opened our eyes to different approaches to color usage.”
我们准备今年在香港和内地试行“债券通”,也就是说允许境外资金在境外购买内地的债券,这是第一次。香港是近水楼台先得月。
Average age: 36

Tony Moloney, head of education and skills at National Grid, says the UK utility’s involvement is part of its broader strategy to encourage school students to study Stem subjects — science, technology, engineering and mathematics — and learn more about jobs in his sector.
I hope you have a most happy and prosperous New Year.
5. 格罗斯警告:“庞氏骗局!临界点!信贷超新星!”
死者是一名19岁的女孩,被称为郭玲玲(这可能是化名),据称她未经许可去卫生间后被所谓的导师反复拳打脚踢。验尸报告显示,死亡原因是因为颅骨受伤和脑损伤。
That was in line with last month’s manufacturing PMIs, which showed an uptick in sector activity,

Footnotes

  • 2015上半年陶企总结进行时 行业形势没那么差
  • 据中国互联网络信息中心发布的一份报告显示,截止2016年12月,中国网民数量已经达到了7.31亿人,这一数字差不多相当于整个欧洲的全部人口。

全年城镇新增就业1314万人;
Most of Friends was shot before cellular phones and Google were ubiquitous. The clothes and gadgets seem a bit outdated these days. Despite this, the show’s key elements still hold up remarkably well in the eyes of young viewers.
通过投资深化该国工业结构,从传统沿海城市天津和上海到最近崛起的西部工业城市陕西和四川,从稀有金属开采加工到复杂飞机部件的制造组装,中国正在为该行业添砖加瓦,并向世界展示就其商业航天行业而言最好的时刻尚未到来。
尽管通常每年的十大榜单中至少有四款引擎会在第二年再次上榜,但去年动力强劲的引擎中只有两款仍然出现在2014年榜单上,它们分别是本田雅阁(Accord)动力十足、节能高效的3.5升V6引擎以及奥迪S5所配备的强劲机械增压3.0升V6引擎。
与亨特相反,在《钢琴课》中与亨特联合主演的安娜·帕奎因(Anna Paquin),她的小金人似乎居无定所,游荡在她装袜子的抽屉和放靴子的地板之间。
最后,在EMBA榜单上,若剔除与非欧洲商学院的合办课程,瑞士洛桑国际管理发展学院(IMD)的毕业生的平均薪资为26.1397万美元,远远领先于排名第二的萨伊德商学院和排名第三的西班牙企业商学院。

(两会受权发布)李克强说,对标全面建成小康社会任务,扎实推进脱贫攻坚和乡村振兴

References

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