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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 2016年第一季度人造板问题频发 (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

国际大厂启动价格战 LED台厂下半年成长待观察

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.

In early December, authorities announced that market circuit breakers would be introduced become effective from January 1 in an effort to limit the volatility seen during the savage, summer sell-off from June. The circuit breakers would see trading in shares, options and futures halted for 15 minutes if they fell by more than 5 per cent. On their first day of use, that first threshold was breached just after the return from the lunchbreak, prompting a 15-minute halt.
她曾为Glitzy Girl、Sally Miller和Purple Pixies等服装公司担任模特,也为《Teen Vogue》《Cosmopolitan》《Elle》和《Seventeen》等杂志拍摄照片。
6.I’m 29. – Because 29 is like 20 years younger than 30.
The booming Internet economy now is playing an increasingly important role in supporting wealth growth in China's IT industry.
Add your scores for 10 to 14 to find out how you score on the Social Inhibition scale.
在完成作业不久之后,孙轶萧就听到外面嘈杂的响声。
6. A brand new human organ has been classified. Researchers have given the nod to the mesentery - an organ that's been hiding in plain sight in our digestive system this whole time. But that's only half the story, because we're still not sure exactly what it does.

单词syndrome 联想记忆:
担忧和愤怒要深刻得多,也更不吸引人。
Don't mistake the lack of a late flurry for an uneventful deadline:
6.头戴式电脑出现
看看这些:

Footnotes

  • 绿色建筑:复合建材唱主角
  • 流行音乐界永远的一号叛逆者夏洛特·艾玛·艾奇逊带着一张出色又令人惊讶的混合专辑回归了。

Ever since the 1994 World Cup, the average scoring has been on a steady downward slope. In 2010 it bottomed out at 2.27, the second lowest average in World Cup history (1990 averaged just 2.20).
However Mr Kwon warned that young people should be cautious when seeking such operations.
人不得不告慰自己,原来如此。
“当她穿着华丽的衣服站在舞台上,她神采奕奕的表情对我来说是无价之宝。”
The circular also stressed zero tolerance for cheating.
7月,中国网络上突然疯传一对情侣在北京一间优衣库的试衣间里做爱的视频。有评论猜测这是优衣库的宣传噱头,但该店否认了这种说法。数人因涉嫌上传及传播该视频而被捕。

2016年家具制造业主营业务收入8559.5亿 产销率98.0%

References

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