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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 红星美凯龙2大电商矛盾激化 传星易家已解散 (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

一系列减税降费政策出台 劳动者得到实惠

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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献上节日的问候与祝福,愿你拥有一个充满生机和欢乐的新年。
While people in first-tier cities are under more pressure, smaller cities may not be the ideal place to live either, according to the 2016 Annual Report on Social Mentality of China by the Chinese Academy of Social Sciences.
Lady Gaga ranks fourth with $59 million, followed by Beyoncé at $54.5 million. The former played 66 shows during our scoring period, also cashing in on deals with Versace and MAC, as well as her own Fame fragrance. The latter’s On The Run tour with husband Jay Z grossed over $100 million for 19 North American dates, giving music’s first couple a nightly average comparable to that of the Rolling Stones.

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In an emailed statement, FIFA said that during group stage matches, it sold a total of 143,364 of the cheapest tickets, which amounted to roughly 3,000 such tickets available per match.
近日,新一期福布斯世界富豪排行榜揭晓,比尔·盖茨在近22年内第17次问鼎榜首。
In 2013, the total number of applicants who qualified for the national service exam reached a record 1.52 million. In 2014, the total number decreased for the first time in four years to 1.41 million, the People's Daily website said.
国家整体的幸福感

Footnotes

  • 家居电商模式路漫漫 “网购家具”消费体验参差不齐
  • adj. 民主的,大众的,平等的

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n. 外表,外貌,出现,出场,露面
The Thai capital has bounced to the top of an annual list of the world's most popular travel destinations after spending several years in the wilderness (of second place).
“学会让经济指标和人民主观的幸福感同步发展是很重要的,因为我们应该不仅仅是追求更强的经济能力,而应追求提高各个领域生活质量。”报告总结道。
Gitanjali表示,她想要进一步改善改设备,这样它最终就能进入市场了。

资本“转战”:从炒房价到炒房租

References

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