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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 四川企业8亿元洽购意大利家具名企 (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

深圳:部分城中村住房将纳入保障房体系

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.

与此同时,布拉德福德大学管理学院(Bradford University School of Management)和爱丁堡大学商学院(University of Edinburgh Business School)的排名均上升16位,分别排在第42名和第55名。剑桥大学(University of Cambridge)佳奇管理学院(Judge Business School)的排名上升15位,排在第14名。
The tween is a huge star with three million Instagram followers, whose music videos with the popstar Sia have been viewed more than a billion times on YouTube.
交通运输部科学研究院近日发布的报告显示,北京位居全国十大最拥堵城市排行榜第三,排在济南、哈尔滨之后。
The Journey of Flower
据《北京晚报》报道,最近公布的《凯度中国社交媒体影响报告》显示,由于社交媒体的负面影响,在1990年后出生的中国年轻人中,已有40%的人关闭了社交媒体应用的消息提醒功能。
All told, Ujiri parted with Terrence Ross, Jared Sullinger, and a total of three picks to acquire the two veterans.
上月越南主席张晋创对中国进行国访,会见中国主席习近平。但中越双方并未就跨境贸易达成一致。

Over 10- and 20-year stretches, geographic and asset class diversification have proven beneficial for returns and risk management. Unfortunately, you are not guaranteed to see the benefits of such a strategy during any 12-month period. In an era of 140-character writing and two-minute video, should we be surprised that investors have trouble judging the success of their portfolios over long periods?
'In the next 12 to 24 months, unless any of these bottlenecks are solved, we could see WTI going down to $50 a barrel, to incentivize producers to slow down,' she said
这个夏天,诺埃尔将成为受限制自由球员,考虑到他公认的防守能力、未开发的潜力和乐透秀身份,他期望得到一份慷慨的补偿合同,即使他的职业生涯上场时间还不足5000分钟。
['hedwei]
根据报道,当地法院鉴于周某的年龄及其坦白承认自己的罪行,最终给予了周某一个宽大的判决。

Footnotes

  • 调控加码2月:房价回落 住宅只租不售成趋势
  • In the past six months alone, the Australian-born company fortified its senior executive ranks with high-profile hires from Amazon, PayPal, Google, and Twitter. It brokered a high-profile deal with Magento, the market leader, that promises to bring thousands of new customers to it. And it broke the lease on its new San Francisco office because it is hiring so quickly that it now needs triple the space it originally anticipated.

音乐界收入最高的女明星,她一直以来的赚钱方式是靠大量的世界巡回演唱会,持续不断的热门单曲和一系列主流公司的代言,而且很少露骨地讽刺她的主要竞争对手。
Chris Washington, played by London-born Daniel Kaluuya, is drawn into the sinister underbelly of a small American community.
Only two people know the Oscars winners list and supervise the counting procedures - PwC tax adviser Martha Ruiz and Brian Cullinan an accountant.
The upshot is that Chinese trade looks to have been surprisingly strong last month. We expect exports to continue to perform well in the coming months on the back of strong global demand.
猪肉价格同比上涨4.8%。猪肉在用来计算CPI的以食品为主的一篮子商品中占有较大权重。
在“有工作经验要求”项目排行榜上,伦敦商学院的学生在毕业3年后平均薪资最高,为13万美元左右,目标实现率也最高(87%)。该项目还在就业成功率以及国际课程经验方面拔得头筹。该学院学生在国际流动性和职业进展方面排名第二。

美《财富》杂志发布2014年度顶级家居十大品牌

References

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