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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 环保级木地板却无质检报告 (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

东莞家具展成了“捡漏王”

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.

The mega-retailer didn't have a whole lot to complain about in fiscal 2010. Profits were up and, thanks to its sales, the company once again climbed to the top of the Fortune 500. Same-store sales were about flat for the year, but compared with Target's 2.5% decline, flat is good. Most remarkable was Wal-Mart's image overhaul. It helped that former CEO Lee Scott beefed up health care coverage for employees, thought more about the environment and became a public presence. Certain critics will never be placated and fiscal first-quarter results weren't the greatest. But there's no denying Scott left new CEO Mike Duke a company in fighting form.
没戏。这家受到热捧的美国电动车制造商曾经承诺在2018年生产40万辆新款Model 3s。该公司最新的产量目标暗示20万-30万辆。但是电池生产中出现的严重问题意味着一开始就慢了,而且特斯拉的记录不佳。对尚未证明自己离了华尔街不断输入的资金也能活的特斯拉而言,2018年可能会是不成功便成仁的一年。
Newt Scamander is a magiczoologist who studies magical creatures.
Remedy: When we make a major decision such as accepting (or turning down) a job offer, we tend to exercise confirmation bias. If we think we made a good choice, we prioritize information that supports this view and if we fear we’ve made a mistake, we zero in on intel or impressions that reinforce this gut feeling. If you habitually doubt your competence when it comes to making career decisions, the issue is less about the subjective quality of your past choices and more about building confidence in your ability to guide your career in a satisfying direction and exert some degree of control over the outcomes of your choices. Addressing this could involve recalling the circumstances under which you made a particular choice and the priorities you held at the time and noting how they differ from the circumstances and priorities under which you’re evaluating those decisions. It could also involve working with a career coach to identify patterns in your decision-making and to help you bolster areas in which you’d like to increase your confidence – risk taking or negotiation, for example.
This year, the Global 2000 companies hail from 62 countries, up from 46 in our inaugural 2003 ranking. In total, they raked in revenues of $38 trillion and profits of $3 trillion, with assets worth $161 trillion and a market value of $44 trillion.
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Yes. With the US Federal Reserve likely to raise interest rates a few times in 2018, trading is likely to be choppy in emerging markets. Sometimes it may feel a bit like a rerun of the 2013 “taper tantrum”. However, average GDP growth will rise to 5 per cent, up from a forecast 4.7 per cent this year. This will mostly be because Russia and Brazil, which have stumbled, will bounce back.

猪肉价格同比上涨4.8%。猪肉在用来计算CPI的以食品为主的一篮子商品中占有较大权重。
单词statement 联想记忆:
与此同时,前第五届和声明星 Camila Cabello证明了她的独唱生涯正在起飞,因为她的首张单曲《Havana》获得了最佳流行音乐奖。她的胜利意味着Taylor Swift失去了另一个奖项,尽管这对于歌手来说只是众多收获中的一个,但是近期她因为一年的沉寂过后又重新成为焦点。
n. 潜力,潜能尽管英国商学院的排名平均上升了两位,但法国商学院的排名平均下降了一位——法国是商学院数量最多的欧洲国家。里昂商学院(EMLyon Business School)由于跌出MBA榜单之外,整体排名下降了15位,同时北方高等商学院(Edhec Business School)由于未能进入EMBA榜单,整体排名下降了8位。

Footnotes

  • 宁波试水房屋质量交付缺陷险 能否成化纠纷“利器”
  • The manufacturing purchasing managers’ index published by China’s National Bureau of Statistics slipped to 51.6 in October, coming in below a median forecast of 52 from economists surveyed by Reuters and closer to the 50-point line delineating expansion from contraction.

愿你的新年光彩夺目,愿你的新年灿烂辉煌!佳节快乐!
报告指出,2016年中国网民数量增加了4299万人,同比去年增长6.2个百分点,而网民总人数占到了中国总人口的53.2%。
但是,这些进展也指向美国和欧盟在利用此类案件上的巨大差异,欧盟目前正在讨论是否要赋予中国世界贸易组织(WTO)框架下的“市场经济”地位——这一让步会使对中国提起反倾销案变难。
玛丽亚里奥斯
Industry Kitchen的行政主厨布劳略?布耐对《城里城外》杂志表示,这份披萨的灵感来源于纽约的金融区,他将那里称为“堕落的缩影”。
3、消极

外交部举行雄安新区全球推介活动

References

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