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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 2015年广东省企业500强出炉 15家LED企业入榜 (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

企业盈利不应违背政策导向

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.

During last year's LFW, there were 250 anti-fur protesters, The Guardian reported, and a show in February saw an activist storm the stage at a Mary Katrantzou show.
The full list of this year's honorees follows.
1. Wal-Mart Stores
Prices at China's factory gates fell for a 34th consecutive month in December, pushed down by falling energy and commodity prices.
If you don't, you need to trade Boogie Cousins and all those veterans you signed over the past two offseasons.
获奖者:加拿大总理贾斯廷·特鲁多
Common industries for college startups include catering, agriculture, IT, transportation, education and culture. 13.8% of the entrepreneurs were interested in hospitality and catering, while 13.7% chose agriculture, the report said.

US president Donald Trump’s zero-sum, Art-of-the-Deal approach to negotiation will give comfort to old-fashioned incumbents. I am hoping 2018 will provide an opportunity for positive, problem-solving new leaders to emerge. But change could stall if business chiefs, disheartened by the poor quality of political leadership, turn inwards instead.
但他们事先计划投放100000反平壤宣传单。
Beijing is pushing hard to conclude the Regional Comprehensive Economic Partnership by the end of the year. The deal has long been called China’s answer to the Trans-Pacific Partnership and its bid for regional trade hegemony.
调查结果显示,今年大约有9.8%的应届毕业生选择“慢就业”。所谓的“慢就业”是指一些毕业生不着急就业,而是选择旅游、在家陪父母以及继续等待机会自主创业等方式,慢慢考虑人生道路的现象。
祝贺佳节。

Footnotes

  • 大连存量房交易4月起须网签备案
  • 埃德加?赖特的《极盗车神》是本年度、十年内、甚至是本世纪最激动人心的飞车电影了。

年龄:46
spont自发+aneous表形容词,表示“…有;…特征的”→自发的
Overseas tourists continued to shun Beijing through 2013.
Mr Baweja agrees with this conclusion, noting that both South Korea and India, another net commodity importer, are exporters of refined oil products, the dollar value of which should rise this year.
源于:last(adj 最后的)
发脾气大奖

高安产区观察:仿古砖、全抛釉3年内价格下跌近四成

References

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