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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 德化陶瓷产业研发节能新技术 无烟柴窑获国家专利 (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

北上广常住人口增速放缓 超大城市谁走了谁还在

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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We also do not want any trade war with others and we have stuck to reform of the yuan's exchange rate formation mechanism to keep it basically stable at reasonable and equilibrium levels.
如果你已经为人父母,我能够理解,这是不太可能的。你会将孩子放在更重要的位置。但是,如果你没有在课堂上展示自己,那么你也就没有做到我们在第一点里讨论的内容。
The people of both countries have the wisdom to properly manage their differences, there is a need and there are also conditions for us to continue to expand our common interests.
Summly的两位员工将迁至雅虎的加利福尼亚州总部,但就目前而言,达洛伊西奥抵挡住了硅谷的诱惑。
When scientists discover how to shrink humans to five inches tall as a solution to overpopulation, Paul (Matt Damon) and his wife Audrey (Kristen Wiig) decide to abandon their stressed lives in order to get small and move to a new downsized community, a choice that triggers life-changing adventures.
Two terrifically entertaining, ensemble-driven, fact-based procedurals about appalling crimes and the institutions — the Roman Catholic Church and Wall Street banks — that allowed corruption to fester. In addition to mustering righteous anger, Mr. McCarthy and Mr. McKay, in very different ways, managed to infuse the routines of modern work (answering phones, typing on keyboards, scrutinizing spreadsheets) with suspense, emotion and moral gravity.

Will the Democrats take back the majority in the midterm election in the US House of Representatives
Lawrence’s 2016 earnings dropped 11.5 percent from her 2015 total of $52 million. Forbes will release its list of the world’s highest-paid actors on Thursday. Last year Robert Downey Jr. topped the list with an estimated $80 million.
He and his girlfriend wrote to each other when he was studying science, he said.They did eventually marry and have four children.
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Footnotes

  • 小微企业普惠性减税力度加大 首季新增减税576亿元
  • The rise of populism, even in countries such as the US and UK where plenty of people are in work, has made politicians realise that the quality of jobs is as important as their quantity.

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然而,英国退欧运动和特朗普崛起中的煽动因素存在相似之处。
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Leadership
利拉詹纳
继续开放

市场总体降温明显 2017年该买房还是该卖房

References

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