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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 南城发展高峰论坛暨和园品质人居发布会圆满落幕 (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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今年的获奖榜单如下:
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排名:第五
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8Australia
另一名来自美国的毕业生写道,来自世界各地的知识的丰富性和深度为课程带来了巨大的价值,他补充称,“鉴于这里汇聚着众多的文化和经验,有关贿赂的课堂道德讨论不像典型的美国学校那样枯燥。”

Rihanna vs. Rosario Dawson Both stars wore this long satin Dolce & Gabanna dress in different colors.   蕾哈娜和罗莎里奥·道森都穿了这件款式一致颜色不同的D&G
然而,在毕业3年后,担任部门负责人或以上级别职位的女性(59%)显著少于男性(68%)。
"The online Internet anti-corruption bid mostly relies on text, photos and videos and it is easy to be superficial if corrupt officials are only exposed this way."
One of the most discussed potential use cases of the block chain is as a decentralized Uber. Instead of using an app, customers could order a car and pay the driver directly, cutting out the middleman. (Sorry, Travis Kalanick.) The block chain can be utilized for everything from the storage of secure documents (that is, a decentralized Dropbox, too) to “watermarking,” in which a specific coin could contain, say, the deed to your house. “The block chain is going to spawn decades of innovation,” says Ryan Selkis, director of investments at the Digital Currency Group, created by former SecondMarket founder Barry Silbert. “It could lead to things like frictionless share issuance, title transfers, smart contracts. Collectively these things make up the backbone of the economy. If you wanted to create a decentralized Uber, Dropbox, Facebook, you could reinvent the Internet.”
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Footnotes

  • 公积金松绑接棒释压 房价下跌动力趋缓
  • 我是一个封闭的人

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2.室内类比赛项目
It predicts index funds, or those that track commodities indices, to be back in the agricultural market in the second half of 2017, as they look for a hedge against inflation.
This one didn't come easy, though. Toronto fought back from an 18-point deficit and trailed by one late in the game with the ball. But guard Kyle Lowry was called for an offensive foul, and Curry hit two free throws to help seal the win.
经对比,科学家们发现,快跑之后心率变化和整体的跑步速度对记忆结果没有影响,但是穿不穿鞋却有影响。具体地说,脱下鞋慢跑16分钟就能够让“流水记忆”能力提高16%。这一研究结果后被发表在了《知觉与运动技能》一书上。科学家们推断 ,可能是因为不穿鞋跑步的时候,人们需要时刻担心石头或者其他障碍物,这个过程对记忆能力的提高产生了正面的影响。如果你是一个冒险主义者,也许在下次考试或者需要记忆什么重要事项之前可以试着在小区光着脚慢跑试试。
4. Add Color

中国石化长炼打开欧洲涂料原料市场

References

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