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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 家居卖场明码实价受欢迎 发力消除价格不透明 (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

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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.

As he scanned the Internet for knowledge, D'Aloisio decided that what he really needed was a better way to determine, at a glance, what was worth reading. He envisioned a summarization tool that used language theory to give a meaningful synopsis in fewer than 400 characters.
排行榜的最新单曲有Shawn的《There's Nothing Holdin' Me Back》,击败DJ Khaled 的《Wild Thoughts ft. Rihanna》和Ed Sheeran的热播曲目《shape of you》,以及放了播破纪录Addy Yankee & Luis Fonsi的《Despacito》。
如何重置iPod
London, meanwhile, is expected to welcome 18.88 million visitors this year.
在全球,中国将会进一步进行并购和交易。在非洲,1百万中国人在努力获取自然资源。
n. 好客,殷勤,酒店管理
It is not unusual for the documented wealth of China’s richest people to surge suddenly — or even for previously unknown tycoons to burst into prominence — as stock exchange listings and other public investments thrust them into the spotlight.

根据美国影院业主协会的数据显示,2015年全球影院收益达383亿美元创新高,中国贡献了68亿美元的票房收入,较上一年增长了近五成。
其他上榜的明星还有:凯特王妃(排名第八),泰勒·斯威夫特(第12名),金·卡戴珊(第38名),和索菲娅·维加拉(第100名)。
Among dozens of small, technology-focused acquisitions, the $3bn purchase of Beats Electronics, the celebrity-endorsed headphones and music streaming service, stands out as Apple’s largest ever deal. The acquisition still bemuses many Apple analysts, but in Jimmy Iovine and Dr Dre, Beats’ founders, Mr Cook has instantly regained credibility with the music industry after years of neglecting the iTunes download store. If Mr Cook is guilty of missing the rapid growth of subscription services such as Spotify, he has moved swiftly to compensate for it — though for a high price.
n. 莴苣,生菜,纸币
Who was buried here?

Footnotes

  • 遇困后建材家居企业集中突围 行业版图将重新划分
  • This is the 16th edition of the FT global executive MBA ranking.

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报告指出,浙江省的杭州市以及广东省的深圳市通过车辆限制及更好的道路连接等方式,在提升交通状况上取得了最大的进步。
Piano and ballet performance “On My Fingertips And Toes” (Lang Lang and Hou Honglan)
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Henda Ayari

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References

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