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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 材料成本上涨 家具调价成定局 (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

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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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Britney, YOU drive me crazy for appearing on Loose Women smacking gum like it's 1998 as the panel interrogate you.
The 16-year-old surnamed Zhou on April 24 poured pesticide into the water dispenser in the classroom, apparently in an act of revenge against classmates who disturbed the class and affected Zhou's studies, the Chongqing Morning Post said.
10.Fears of Another Tsunami
Vietnamese press claim chicken, sturgeon, fruit and vegetables from China have been undercutting local market prices. While illegal out-of-date produce is creating a black market in China.
这会吓走一些人,这些人不了解你更好。
今年的英国《金融时报》和麦肯锡年度最佳商业图书奖(Financial Times and McKinsey Business Book of the Year Award),颁给了一部描写前美联储(Fed)主席艾伦.格林斯潘(Alan Greenspan)的传记,其内容引人入胜、面面俱到。

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).
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Footnotes

  • 国内六大陶瓷产区生产现状分析
  • 在经过一段漫长而艰辛的竞选活动后,美国当地时间11月6日,美国总统奥巴马战胜了共和党候选人罗姆尼,胜出2012美国总统大选成功连任,将迎来执政白宫的第二个任期。

4.Thank you so much! I just love it! – Because telling someone that their gift sucked would make me look like an insensitive jerk。
其他评论家,如荷兰金融集团荷兰国际集团(ING)国际贸易分析主管拉乌尔?里尔宁(Raoul Leering)担心,即使从短期来看,前景也很暗淡。
The unemployment rate probably won't fall quite as rapidly in 2015, according to economists, especially if more people enter the labor force because jobs are easier to find. Yet another large spate of hiring similar to the gain in 2014 would make the low unemployment rate more believable.
The city offers excitement beyond your expectations, with grand churches, a richly varied number of museums, a growing modern-art scene and streets that come alive with summer festivals.
Will Smith had a very successful career in the late 80s and early 90s as the second half of rap duo DJ Jazzy Jeff and the Fresh Prince. But in spite of his financial success, Smith did not manage his money well. It's a pretty classic tale, really. New fame, lots of money, no future plans, and lots of fancy toys added up to a lot of overspending. This lack of oversight and fiscal irresponsibility landed him on the brink of bankruptcy. He owed the government back taxes that he had not paid.
Martial art “China Youth”(Zhao Wenzhuo and friends)

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References

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