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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: “六稳”透露调控新信号 (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

部分城市已从“去库存”转入楼市“补库存”阶段

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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Today, the Financial Times reveals the fake gross domestic product data routinely released from many northern Chinese regions. There, solid alternative evidence suggests the authorities have “smoothed” the economic growth figures. They artificially boosted growth figures between 2012 and 2016, masking a real downturn, and last year covered up a genuine recovery.
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Winners: Pelicans
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A disturbing and often bleak analysis of the automated future of work has been named 2015’s business book of the year.

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The Jungle Book will be released worldwide on April 15, 2016.
Several car names were among the top 50, from ‘ferrari’ to ‘mercedes.’
Schools relied on a wide range of technologies to ensure lively interactive delivery of their programmes including virtual classrooms, live sessions and multimedia teaching materials. Alumni were asked to rate delivery as well as indicate how effective online exams were. Results were encouraging. Schools appear to be getting better at online delivery. Every aspect of online delivery was rated higher than it had been in previous years, showing a greater level of satisfaction.
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Footnotes

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  • TextPride changed its name to Swyft Media and launched a platform that pushes emojis and stickers from new brands into messaging apps. Brands pay for the privilege, as they would with a regular ad campaign.

China does not want to see a trade war between the US and China. That would not make our trade fairer and cause loss for the both sides.
9.消防员
人们大多认为,中国的智能手机只会越来越便宜。与此相反,她援引一些研究结果,表明去年中国智能手机的平均售价趋于稳定。同时随着中国用户开始购买品质更好的智能手机,售价实际上已开始走高。
公司:网络投票公司Everyone Counts
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A partnership with IBM to sell iPads and iPhones to big corporate customers is just one example of how Apple is looking beyond its own walls more under Mr Cook, something Jobs had resisted.

宽松货币政策难改楼市走向 去库存仍是关键

References

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