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Editorials

Covid-19: breaking the chain of household transmission

BMJ 2020; 370 doi: 落实物联网概念 打造智能化生活 (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

家居建材消费投诉升温

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.

节目18 杂技《冰与火》,赵丽 张权
Rather than strangling the doctor (difficult, due to his injury) Jalava took the corny line as inspiration. He decided to go ahead and actually build a prosthetic finger that contains two gigabytes of digital storage. He can now jack his finger into a computer just by peeling back the nail to expose the USB plug. He can also remove the entire finger at any time and hand it to a friend to use.
200912/93010.shtml
6.Gal Gadot
80年来,普华永道(PwC)一直负责奥斯卡奖的计票工作并确保将正确的信封交给颁奖嘉宾。这家会计师事务所很快向两部影片、颁奖嘉宾和观众作出了道歉,因为它交给比蒂和唐纳薇的颁奖通告不是关于这个奖项的。
Tracey and Viv Williams, a British couple, dressed as the green cartoon ogres from Shrek at their wedding held recently. Tracy, 33, made a lovely Princess Fion
沃尔玛百货

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But economists generally expect the momentum of the recent past to resume and continue once storm distortions abate. The 45 economists who responded to The Wall Street Journal's latest monthly forecasting survey saw the jobless rate falling to 7.8% by next June and 7.5% by the end of 2013. Some say job growth could accelerate from its slow pace. 'I think businesses are going to have to hire,' said Bob Baur, an economist with Principal Global Investors.[qh]
"Last year, 1.2 million Chinese visited Australia. We anticipate this will grow during the China-Australia Year of Tourism and will continue to grow afterward."
foundation
没戏。这家受到热捧的美国电动车制造商曾经承诺在2018年生产40万辆新款Model 3s。该公司最新的产量目标暗示20万-30万辆。但是电池生产中出现的严重问题意味着一开始就慢了,而且特斯拉的记录不佳。对尚未证明自己离了华尔街不断输入的资金也能活的特斯拉而言,2018年可能会是不成功便成仁的一年。

Footnotes

  • 首付十几万元 “买”30年长租公寓 你敢不敢?
  • 尽管詹姆斯和费德勒在工资和薪水上要少一些(相比于C罗和梅西),但是这两人去年的代言费是最高的,其中17次大满贯得主费德勒去年代言收入达到了4100万英镑。

在成为德国最大贸易伙伴之前,中国是德国在亚洲的最大贸易市场。在过去两年里,德国一直是中国在欧洲最大的贸易伙伴。
char茶,ity状态-请喝茶的状态-施舍-仁慈
奥巴马取得胜利,也以为着在接下来四年的发展道路:关于国家开支、税收、医疗健康、政府的角色,还有应对中国发展和伊朗核问题等的外交措施。
'Winning the Skytrax World's Best Airport Award for the fifth consecutive year is immense encouragement to our 50,000-strong airport community at Changi Airport, every one of whom is passionate about delivering the most memorable airport experience to our passengers', said Lee Seow Hiang, CEO of Changi Airport Group, in a statement.
Age: 53
年龄:46

58安居客张波:销售金额未来将呈现缓慢下滑态势

References

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