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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 贵州培育石材力争2020年产值突破1000亿 (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

家居 家具 智能 智能家居

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.

manifesto
Imports grew 6.7 per cent year-on-year to $152.2bn after falling 1.4 per cent the previous month, according to China’s General Administration of Customs, defying a median forecast predicting contraction would worsen to 1.9 per cent.
但对于北京来说,若能在特朗普让美国退出TPP后不到一年的时间里达成RCEP协议,将是一场巨大的胜利。
除了跳舞,玛蒂还唱歌和表演,她已经出演了电视剧《美女上错身》(Drop Dead Diva)和《奥斯汀与艾丽》(Austin & Ally)。
游戏平台:Xbox One、Xbox 360、PS4、PS3 、PC
在领英平台上高频出现是找工作的关键。你知道这点,你们经理也知道这点。你的经理兴许还知道你知道这点。所以她会从开始关注周一你的个人简介只是有个大概框架,到周五你增加了工作经历,新人脉,状态更新,推荐信慢慢被顶起,别一夜之间从0涨到500那样太明显了Foss提醒道。
I agreed with Craig and Neil immediately that Ellen is the ideal host for this year’s show. We’re looking forward to an entertaining, engaging and fun show.

Best wishes for the holidays and happiness throughout the New Year.
为实现2020年医疗保健制度覆盖全民的目标,中国将改革药品市场,这将使其成为仅次于美国的第二大药品支出市场。未来5年内,预计中国人均药品支出将增长70%。
9.千万别相信民调
3. Will Guo Jingjing, China's diving queen, get married in 2010?
科森重塑了卡瑞尔的鼻子,把它变成鹰钩鼻。他还把卡瑞尔的发际线往后刮了一点,留出更多额头。

Footnotes

  • 淄博张店环保夜查成常态,陶瓷企业迎检达标
  • “The Fed was much more aggressive than expected,” Mr Koepke says. “Taking markets by surprise was clearly not the way to go.” (This was before the Fed began making regular public statements after its monetary policy meetings.)

指尖陀螺
茱莉亚哈茨
尽管看起来有着大量的目标核对工作,但在5月7日,中国驻贝尔格莱德的大使馆却被从美国空军B-2幽灵轰炸机上发射的五枚卫星制导联合直接攻击弹药击中。三名中国记者——新华社记者邵云环,光明日报记者许杏虎和他的妻子朱颖在袭击中身亡。另外20名中国公民受伤5人伤势严重。
唐纳德·特朗普总统是美国第一位亿万富豪总统,不过,根据上周一公布的《福布斯2017全球富豪榜》,他已经不像过去那么富有了。
鹈鹕一直在费力的吸引并留下自由球员,他们必须在这个夏天留下朱-霍勒迪,考辛斯的家乡在附近的阿拉巴马,而且他和安东尼-戴维斯是密友,同时,多个令人沮丧和伤病困扰的赛季让鹈鹕一直在失败的循环中摇摆。
FRESH OFF THE BOAT (ABC, Feb. 4) A Chinese-American family adjusts to life in mid-'90s Florida in this culture-clash comedy based on a memoir by the restaurateur and food-and-travel-show host Eddie Huang. Hudson Yang plays the 11-year-old hip-hop wannabe Eddie, and Randall Park (Kim Jong-un in “The Interview”) plays his father, proud proprietor of a suburban steakhouse.

推进资产证券化 促进住房租赁市场发展

References

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