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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 90后加入“买房大军” 多靠父母出资全家上阵 (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.

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The first drone can be traced back to 1916 when British inventor Archibald Low designed and flew the first unmanned radio-controlled vehicle. The drone was made to counterattack German Zeppelin airships, and it also carried out ground attacks during World War I. It was made with wood and tin, its wings taken from the lower wing of another biplane. Overall, the drone was somewhat unsuccessful because the noise from its engine interfered with its radio. The Sopwith Aircraft Company also tried making a drone in 1916. They placed the radio equipment at the tail so that the engine would not interfere with its signal, but their drone never flew as it was damaged in an accident on the ground. Low would try flying his drone again in 1917 when he flew it in front of some senior military officers. It was launched from the back of a lorry and flew for some time before crashing due to engine failure, almost killing the military officers present.
n. 外表,外貌,出现,出场,露面
Search giant Google has replaced iPhone makers Apple to be the world's most valuable company in the Brand Finance's Global 500 2017 report.
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When Finnish programmer Jerry Jalava had a motorcycle accident in 2008, he faced a double tragedy. First, he lost his finger, an obvious problem for anyone who types for a living. Second, he had to deal with a medical team who thought they were comedians—learning of his profession, one surgeon joked that Jalava should go out and buy a “USB finger drive.”
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Local educational authorities have since revoked Zhengzhou Boqiang New Idea Life Training School's license and launched an investigation into its record. Hauntingly, the school's website remains online, replete with photos of students in camouflage uniforms performing drills and attending what the site labels "wonderful lectures."
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第一架无线电操纵的无人驾驶飞机可追溯到1916年。英国发明家阿奇博尔德·洛设计并试飞了第一架无人遥控飞机。它是为了反攻德国齐柏林飞艇而制作的,在第一次世界大战中参与了对地面攻击的战斗。无人机由木和锡制成,它的机翼用的是其他双翼飞机的较低机翼。总的来说,无人机是有些失败的,因为它的引擎噪音干扰了无线操作。1916年,索普威斯飞松公司也尝试制作无人机,他们将无线电设备放置在无人机的尾部,这样引擎就不会干扰到它的信号。但因一次地面上的意外事故,他们的无人机再未起飞:当洛操作无人机飞到高级军官面前时,他原本计划会在1917年再次试飞无人机。但无人机从卡车的后面发射后,飞了一段时间便因引擎故障而坠毁,差点要了在场的军官的命。

Footnotes

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  • release

在接受《每日电讯报》采访时,玛蒂说:“我再也无法过上平凡人的生活了。因为大家很容易认出我来,甚至当我出去玩或是和朋友吃冰淇淋都能被路人认出来。”
9France
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pandemic
"We have searched for Richard and we have found him. Now it's time to honour him," she said.

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References

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