Covid-19: breaking the chain of household transmissionBMJ 2020; 370 doi: 涂料行业产能过剩，招商工作重心需转移 (Published 14 August 2020) Cite this as: BMJ 2020;370:m3181
- Shamil Haroon, clinical lecturer in primary care1,
- Joht Singh Chandan, academic clinical fellow in public health12,
- John Middleton, president3,
- Kar Keung Cheng, professor of public health and primary care1
- 1Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- 2Warwick Medical School, University of Warwick, Coventry, UK
- 3Association of Schools of Public Health in the European Region (ASPHER)
- Correspondence to: S Haroon
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 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 fear was over downward mobility and cultural changes; the anger was against immigrants and indifferent elites.
While the FT online and full-time MBAs are not strictly comparable because the criteria used to judge them are slightly different, it is interesting to note that IE and Warwick Business School are among six schools to feature in both rankings.
Usually things that go in the trash are of no value and don't need any kind of inspection, but QUBE wants to change that with "the world's first smart trash can." The QUBE claims to help you monitor your trash and help you recycle by using innovative technology.
Experts offer advice for surviving -- and thriving -- in the next year:
Comic skit “You’ve Got Trouble”(Sun Tao, Qin Hailu etc)
Gary Oldman on blistering form as Winston Churchill.
Good luck and great success in the coming New Year.
A study published in the journal "Clinical Psychological Science" in 2012 showcased the power of self-imagination, which showed the technique could help people with impaired memories, as well as individuals with no memory problems. As with other studies of human memory, the scientists asked participants to remember a list of words related to certain personality traits. The participants were then asked to use a specific strategy to help them recall the words. For example, some participants were asked to remember one personality trait by thinking of a second word that rhymed with the trait. Other participants were asked to remember the definition of the trait while others were asked to engage in "self-referential processing" where they would think about the trait in a personal, self-reflective way.
Turkey’s ministers have been rallying Turkish expat communities across Europe to win support for Erdogan-backed constitutional changes, which will be voted on in a referendum next month.
The official prize citation said the two were awarded for "the theory of stable allocations and the practice of market design."
*Guest Actor in a Drama Series: Hank Azaria, “Ray Donovan”
'Winning the Skytrax World's Best Airport Award for the fifth consecutive year is immense encouragement to our 50,000-strong airport community at Changi Airport, every one of whom is passionate about delivering the most memorable airport experience to our passengers', said Lee Seow Hiang, CEO of Changi Airport Group, in a statement.