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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 35城房价收入比排行出炉 深圳房价收入比第一 (Published 14 August 2020) Cite this as: BMJ 2020;370:m3181

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  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.

Dachis says: 2011 saw a huge bounce for Dominos in brand enthusiasm from their brand relaunch which 2012 just couldn’t match. It’s a shame they can’t redesign their recipes every year.
国考分为笔试和面试两部分。笔试成绩将于1月发布,面试预计在2月或3月举行。
Hurricane Harvey
他说,他和他的女朋友经常通过书信往来,当时他还在上学。他们最后确实结婚了,而且有了4个孩子。
adj. 准确的,精确的
据德国工商总会的统计数据显示,中国于2016年超越美国,首次成为德国的最大贸易市场。
尽管随着租赁成本的上升和失业率的下降,薪酬最终会会上升;商人们将会在招聘劳动力上付出更多的成本而且还有可能由于缺乏员工以增加产量而导致销售量下降的风险。

Literally in the last seconds of the match the Dutch scored its second equalizer. During stoppage time China scored a third goal which won them the Robot World Cup Soccer 2013.
《灾难艺术家》一部分是关于好朋友的电影。一部分是娱乐业的新片,还有一部分是幕后的电影短片。
2010 10-year Treasury yield (year-end): 5.0%
Despite the surge of private wealth in China, the country’s billionaires have not yet cracked the top ranks of global rich lists. Hurun estimates that Mr Wang, China’s richest man and head of the Wanda group, ranks 26th globally.
The ranking is in part based on how successful alumni have been in their careers, as reflected in the salary data.

Footnotes

  • 股市大跌波及楼市 下半年楼市情况并不乐观
  • 最近几年,中国赴韩旅游出现了蓬勃发展,这让韩国的零售商高兴不已,不过也激怒了韩国国内的游客,因为他们发现韩国旅游景点被来访游客淹没。

No. Football punditry is a mug’s game. Better to have the benefit of hindsight. There have been 20 previous World Cups. Of those, Brazil (five titles) and Germany (four), are regular contenders. Home advantage helps, with host nations winning the trophy six times. But next year’s festival of football is being held in Russia, which has the lowest-ranked team in the tournament.
单词effective 联想记忆:
adj. 连续的,继续的,连绵不断的
上个月,中国贸易顺差增至4962亿元人民币,高于去年12月的3821亿元人民币。经济学家曾预计该数据将略高于3890亿元人民币。以美元计,该月中国贸易顺差从去年12月的600.9亿美元增至632.9亿美元,也超过了606亿美元的预期。
5. 《卡罗尔》,导演:托德·海因斯。
Thirty-six Chinese brands have made it onto the list this year. Among them, eight are in the top 100, including the State Grid Corporation of China (36), the Industrial and Commercial Bank of China (ICBC) (40), Tencent (43), China Central Television (CCTV) (62), Haier (76), China Mobile (79), Huawei (81) and Lenovo (90).

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References

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