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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 北京:簋街周边拟建4处立体停车场 (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

淄博七成陶企恢复生产 日产量下降厂家开始涨价

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.

周二在华盛顿DC倒下的大树把一条街拦住了。
在可预见的未来,我国会见证第三产业的繁荣发展。该报告称,相关专业,包括法律、新闻传播和管理学,预计将扮演更重要的角色。
n. 运动,活动,战役,竞选运动
Negative emotions such as worrying, stress, depression and anger visit type D personalities more often. A small event that is usually overlooked by others can bother a type D a lot and even ruin his mood.
这位腾讯公司员工说道:“我们希望她的妈妈能出面协助我们一起调查此事。如果用户确实13岁,未经允许花钱,那么我们可以协调退还。”
在英国,今年可能是大型咨询公司正式进入法律市场的一年吗?其他的“另类业务结构”——或者说按照“乐购法”(Tesco law)成立的律所——将通过提供固定费用服务、把业务外包给松散的律师网络,或者推出法律聊天机器人提供即时而实惠的建议,而终于立足消费者市场吗?为了普通公民的利益,得有人突破这个领域。
国际机器人联合会主席Junji Tsuda在他的《全球工业机器人市场》报告中指出,在2017年,全球约有38.7万台工业机器人售出,同比增长31%,创造了500亿美元的收入,而中国则是这一强劲增长背后的关键驱动因素之一。

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stress
没有人知道为什么比蒂上台的时候还有一对最佳女演员信封。
n. 沼地,极多,回转 n. 大量,许多 v. 使转,扭
McGowan has also hit out at Meryl Streep, saying that it is 'literally impossible' the actress knew nothing of Weinstein's sexual proclivities until last autumn.

Footnotes

  • LED照明行业并购“新常态” 资本“狂欢”刺激行业洗牌
  • On April 24, Zhou took the pesticide to the Yimin Technician Training School in Rongchang, Chongqing and hid the toxic substance under a desk.

道·哈德森,学院理事会执行官
Overall, St Gallen’s alumni report a 95 per cent satisfaction level, 2 percentage points more than the alumni from London Business School and WHU Beisheim.
Reality Competition Program: “The Voice” (NBC)
2017年,人们指责大型科技公司太过强大、利用自身的规模主宰市场,而且不够关注他们所创造的工具如何被用来做恶。
v. 施压
Scientists confirmed Monday that a skeleton found under a carpark in the English city of Leicester was that of King Richard III, in a bizarre end to a 500-year-old historical mystery.

房地产库存下降 未来投资增速将“冲高回落”

References

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