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Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 杭州进一步加强房地产中介监管 (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

依托城市群发展加快县域经济转型升级步伐

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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We will strengthen the prevention and control of water and soil pollution.
The ranking of 95 schools, up from 90 last year, includes nine institutions, from seven countries, that were ranked for the first time. Frankfurt School of Finance and Management in 41st place is the year’s highest new entrant. The German school has one of the most gender-balanced programmes, with women accounting for 49 per cent of students.
Chicago-based rival AT Kearney is also preparing for a change at the top, with a vote to replace Johan Aurik, who has already served the maximum two terms as managing partner, due to take place in the first quarter of 2018. His replacement will be expected to focus on how to pull AT Kearney out of the ranks of mid-sized players.
久而久之,这种民族融合给球队带了不同寻常的和谐。队中的年轻球员,尤其是切尔西的阿扎尔和卢卡库以及曼联的贾努扎伊,成了许多竞争对手羡慕的对象。
许多经济学家认为,欧洲央行(ECB)不会在2016年加大其1.46万亿欧元资产购买计划的规模,尽管该行行长马里奥德拉吉(Mario Draghi)保证额外的货币政策刺激仍是选项。
岁数最小的富豪是来自挪威的企业继承人亚历山大·安德森,她今年只有19岁。亚历山大20岁的姐姐是岁数第二小的上榜富豪。

cred相信+it表名词,通常是抽象名词→相信
1=somewhat false
Written instructions apparently issued by China’s tourism administration, shown to the FT by one Beijing travel agent, order agencies to cancel group tours to South Korea booked for after March 15 and add that companies not in compliance could be fined or have their licences revoked. The tourism administration was not immediately available for comment.
Also featured in the 2013 top 10 were Singapore, Zurich, Paris, the Venezuelan capital of Caracas and Geneva.
Eleven James:

Footnotes

  • 2015年涂料行业大事盘点 出台多项法规政策
  • 以下四个因素应该会对2013年的就业复苏起到推动作用:[qh]

n. 诱惑,引诱
McDonough School of Business at Georgetown University in Washington DC returns to the custom ranking in 15th place after dropping out last year because of a low survey response rate from clients. Only three schools enter the custom ranking for the first time, including London’s Cass Business School in 60th place.
《不安感》
她是头号权势女性:过去10年里,德国总理默克尔八度上榜——其中七次都荣登榜首。
4、《美国队长3:内战》
她说,“在未来12到24个月,除非这些瓶颈得到解决,否则西得克萨斯中质油价格会跌至每桶50美元,这将促使产油国减产。”

24省市公布2019年交通投资计划 地方交建火热开工 投资额超2万亿

References

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